Objective To explore the association between cardiorespiratory fitness and total atherosclerotic burden of brain-and heart-arteries in patients with ischemic stroke.Methods This study retrospectively enrolled consecutive patients with ischemic stroke of the large-artery atherosclerosis or small-artery occlusion subtypes accompanied by cervicocephalic atherosclerosis,who were admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University,between May 2023 and December 2024.General and clinical data,including age(＜60years,≥60years),sex,admission blood pressure,body mass index,history of hypertension,diabetes mellitus,hyperlipidemia,ischemic stroke,symptomatic coronary artery disease,smoking,alcohol consumption,and medication use(including antiplatelet drugs,anticoagulants,lipid-lowering drugs,antidiabetic drugs,antihypertensive drugs,and β-blockers),characteristics of ischemic stroke(including the duration of onset,ischemic side[left,right,bilateral],and ischemic location[anterior circulation,posterior circulation,bilateral circulation])were collected from all patients enrolled.On the morning after admission,fasting venous blood samples were collected to measure the levels of triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,fasting blood glucose,glycated hemoglobin,homocysteine,fibrinogen,D-dimer,C-reactive protein,high-sensitivity C-reactive protein,N-terminal pro-B-type natriuretic peptide,creatine kinase-MB,cardiac troponin T,and myoglobin.Transthoracic echocardiography was performed within 7 days after admission to evaluate cardiac function.Left ventricular ejection fraction and cardiac output were recorded,and cardiac index were calculated.Upon admission,neurological impairment,disability,motor function,and balance ability were assessed using the National Institutes of Health stroke scale(NIHSS),modified Rankin scale(mRS),Fugl-Meyer assessment(FMA),and Berg balance scale,respectively.The Saltin-Grimby physical activity level scale was used to evaluate the intensity of habitual physical activity prior to stroke onset.Cardiopulmonary exercise testing was performed within 7 days after admission to assess cardiopulmonary fitness.During the test,peak oxygen uptake(VO2peak),percentage of predicted VO2peak(VO2peak%pred),and metabolic equivalent of task(MET)were recorded.Based on the minimum oxygen uptake required for independent living(15 ml/[kg·min]),VO2peak was classified into low VO2peak(＜15 ml/[kg·min])and high VO2peak(≥15 ml/[kg·min]).With VO2peak%pred＜0.60 as the cutoff,VO2peak%pred was divided into low VO2peak%pred(＜0.60)and high VO2peak%pred(≥0.60).MET were categorized into low MET(＜mean MET)and high MET(≥mean MET)according to the mean value of MET in this study population.Imaging data of cardio-cerebral arteries were obtained by simultaneous CT arteriography within 7 days after admission.Total atherosclerotic burden of brain-and heart-supplying arteries(TAB-BHAs)was used to quantitatively evaluate the overall degree of cardio-cerebral atherosclerosis.And patients were stratified into high TAB-BHAs(≥4 points)and low TAB-BHAs(＜4 points)groups.The differences in general and clinical characteristics,as well as cardiopulmonary fitness indices,were assessed among different groups of TAB-BHAs.Spearman' s correlation was used in the preliminary analysis of the relationship between cardiorespiratory fitness indicators and TAB-BHAs.Multivariate Logistic regression was conducted with VO2peak,low VO2peak%pred,and low METs as independent variables,and high TAB-BHAs as the dependent variable to assess the association between cardiopulmonary fitness and TAB-BHAs.Covariates were selected through regressions stratified by age≥60 years,male,the least absolute shrinkage and selection operator(LASSO),and the variables exhibit statistically significant differences between the low and high TAB-BHAs groups,respectively.Results A total of 104 patients with ischemic stroke were enrolled.Among all patients enrolled,60patients(with ages ranging from 30 to 72years and a mean age of[54±11]years)met the inclusion and exclusion criteria,and were ultimately included.Amid the 60 patients,52 were male and 8 were female.There were 20 patients(33.3%)with low VO2peak,28 patients(46.7%)with low VO2peak%pred,and 31 patients(51.7%)with low MET(MET＜5.0).45 patients were classified into the low TAB-BHAs group and 15 into the high TAB-BHAs group.(1)Compared with the low TAB-BHAs group,patients in the high TAB-BHAs group were significantly older and had a higher proportion of patients aged≥60 years,they also showed significantly higher fibrinogen levels and a history of antihypertensive drug use(all P＜0.05).No significant differences were observed in other general or clinical characteristics between the two groups(all P＞0.05).Regarding cardiopulmonary fitness parameters,patients in the high TAB-BHAs group had lower VO2peak and MET levels,and higher proportions of patients with low VO2peak,low VO2peak%pred,and low MET compared with those in the low TAB-BHAs group(all P＜0.05).(2)Based on the Spearman's correlation analysis,VO2peak(r=-0.298,P=0.021),VO2peak%pred(r=-0.305,P=0.018),MET(r=-0.303,P=0.018)all exhibited negative correlations between and TAB-BHAs.(3)LASSO regression was used to identify the most pertinent variables for high TAB-BHAs,including low VO2peak,low VO2peak%pred,and fibrinogen.Multivariate Logistic regression analysis was then performed with low VO2peak,low VO2peak%pred,and low MET as independent variables and high TAB-BHAs as the dependent variable.The results showed that after adjusting for age≥60 years,male,and fibrinogen,both low VO2peak(adjusted OR,4.420,95%CI 1.052-18.573,P=0.042)and low VO2peak%pred(adjusted OR,7.423,95%CI 1.411-39.046,P=0.018)were independently associated with high TAB-BHAs in ischemic stroke patients.After further adjusting for variables that differed among high and low TAB-BHAs groups(including age≥60 years,male,fibrinogen,and history of using antihypertensive drugs),multivariate Logistic regression showed that low VO2peak%pred remained independently associated with high TAB-BHAs in ischemic stroke patients(adjusted OR,6.347,95%CI 1.170-34.418,P=0.032).Conclusion Poor cardiopulmonary fitness might be associated with high degree of overall cardio-cerebral atherosclerosis,suggesting cardiorespiratory fitness as a potential correlated indicator that could provide clues for improving early screening of patients with heavy cardio-cerebral atherosclerotic burden and for exploring the underlying mechanisms.

Objective To explore the association between cardiorespiratory fitness and total atherosclerotic burden of brain-and heart-arteries in patients with ischemic stroke.Methods This study retrospectively enrolled consecutive patients with ischemic stroke of the large-artery atherosclerosis or small-artery occlusion subtypes accompanied by cervicocephalic atherosclerosis,who were admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University,between May 2023 and December 2024.General and clinical data,including age(＜60years,≥60years),sex,admission blood pressure,body mass index,history of hypertension,diabetes mellitus,hyperlipidemia,ischemic stroke,symptomatic coronary artery disease,smoking,alcohol consumption,and medication use(including antiplatelet drugs,anticoagulants,lipid-lowering drugs,antidiabetic drugs,antihypertensive drugs,and β-blockers),characteristics of ischemic stroke(including the duration of onset,ischemic side[left,right,bilateral],and ischemic location[anterior circulation,posterior circulation,bilateral circulation])were collected from all patients enrolled.On the morning after admission,fasting venous blood samples were collected to measure the levels of triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,fasting blood glucose,glycated hemoglobin,homocysteine,fibrinogen,D-dimer,C-reactive protein,high-sensitivity C-reactive protein,N-terminal pro-B-type natriuretic peptide,creatine kinase-MB,cardiac troponin T,and myoglobin.Transthoracic echocardiography was performed within 7 days after admission to evaluate cardiac function.Left ventricular ejection fraction and cardiac output were recorded,and cardiac index were calculated.Upon admission,neurological impairment,disability,motor function,and balance ability were assessed using the National Institutes of Health stroke scale(NIHSS),modified Rankin scale(mRS),Fugl-Meyer assessment(FMA),and Berg balance scale,respectively.The Saltin-Grimby physical activity level scale was used to evaluate the intensity of habitual physical activity prior to stroke onset.Cardiopulmonary exercise testing was performed within 7 days after admission to assess cardiopulmonary fitness.During the test,peak oxygen uptake(VO2peak),percentage of predicted VO2peak(VO2peak%pred),and metabolic equivalent of task(MET)were recorded.Based on the minimum oxygen uptake required for independent living(15 ml/[kg·min]),VO2peak was classified into low VO2peak(＜15 ml/[kg·min])and high VO2peak(≥15 ml/[kg·min]).With VO2peak%pred＜0.60 as the cutoff,VO2peak%pred was divided into low VO2peak%pred(＜0.60)and high VO2peak%pred(≥0.60).MET were categorized into low MET(＜mean MET)and high MET(≥mean MET)according to the mean value of MET in this study population.Imaging data of cardio-cerebral arteries were obtained by simultaneous CT arteriography within 7 days after admission.Total atherosclerotic burden of brain-and heart-supplying arteries(TAB-BHAs)was used to quantitatively evaluate the overall degree of cardio-cerebral atherosclerosis.And patients were stratified into high TAB-BHAs(≥4 points)and low TAB-BHAs(＜4 points)groups.The differences in general and clinical characteristics,as well as cardiopulmonary fitness indices,were assessed among different groups of TAB-BHAs.Spearman' s correlation was used in the preliminary analysis of the relationship between cardiorespiratory fitness indicators and TAB-BHAs.Multivariate Logistic regression was conducted with VO2peak,low VO2peak%pred,and low METs as independent variables,and high TAB-BHAs as the dependent variable to assess the association between cardiopulmonary fitness and TAB-BHAs.Covariates were selected through regressions stratified by age≥60 years,male,the least absolute shrinkage and selection operator(LASSO),and the variables exhibit statistically significant differences between the low and high TAB-BHAs groups,respectively.Results A total of 104 patients with ischemic stroke were enrolled.Among all patients enrolled,60patients(with ages ranging from 30 to 72years and a mean age of[54±11]years)met the inclusion and exclusion criteria,and were ultimately included.Amid the 60 patients,52 were male and 8 were female.There were 20 patients(33.3%)with low VO2peak,28 patients(46.7%)with low VO2peak%pred,and 31 patients(51.7%)with low MET(MET＜5.0).45 patients were classified into the low TAB-BHAs group and 15 into the high TAB-BHAs group.(1)Compared with the low TAB-BHAs group,patients in the high TAB-BHAs group were significantly older and had a higher proportion of patients aged≥60 years,they also showed significantly higher fibrinogen levels and a history of antihypertensive drug use(all P＜0.05).No significant differences were observed in other general or clinical characteristics between the two groups(all P＞0.05).Regarding cardiopulmonary fitness parameters,patients in the high TAB-BHAs group had lower VO2peak and MET levels,and higher proportions of patients with low VO2peak,low VO2peak%pred,and low MET compared with those in the low TAB-BHAs group(all P＜0.05).(2)Based on the Spearman's correlation analysis,VO2peak(r=-0.298,P=0.021),VO2peak%pred(r=-0.305,P=0.018),MET(r=-0.303,P=0.018)all exhibited negative correlations between and TAB-BHAs.(3)LASSO regression was used to identify the most pertinent variables for high TAB-BHAs,including low VO2peak,low VO2peak%pred,and fibrinogen.Multivariate Logistic regression analysis was then performed with low VO2peak,low VO2peak%pred,and low MET as independent variables and high TAB-BHAs as the dependent variable.The results showed that after adjusting for age≥60 years,male,and fibrinogen,both low VO2peak(adjusted OR,4.420,95%CI 1.052-18.573,P=0.042)and low VO2peak%pred(adjusted OR,7.423,95%CI 1.411-39.046,P=0.018)were independently associated with high TAB-BHAs in ischemic stroke patients.After further adjusting for variables that differed among high and low TAB-BHAs groups(including age≥60 years,male,fibrinogen,and history of using antihypertensive drugs),multivariate Logistic regression showed that low VO2peak%pred remained independently associated with high TAB-BHAs in ischemic stroke patients(adjusted OR,6.347,95%CI 1.170-34.418,P=0.032).Conclusion Poor cardiopulmonary fitness might be associated with high degree of overall cardio-cerebral atherosclerosis,suggesting cardiorespiratory fitness as a potential correlated indicator that could provide clues for improving early screening of patients with heavy cardio-cerebral atherosclerotic burden and for exploring the underlying mechanisms.

Objective To explore imaging predictors in elderly patients with first-ever ischemic stroke combined with asymptomatic coronary artery disease(ACAD).Methods A total of 241 non-cardioembolic ischemic stroke patients within 14 d of symptom onset admitted to the neuro-logical department of our hospital from September 2019 to November 2021 were consecutively en-rolled.Based on the diagnosis,they were divided into an ACAD group(103 cases)and a non-ACAD group(138 cases).All patients underwent routine brain MRI and hybrid coronary and cer-vicocephalic CT angiography.Logistic regression analysis was used to identify factors influencing the presence of ACAD in these patients.Results The ACAD group had significantly larger ratios of males,smoking,silent brain infarcts(SBI,both single and multiple),positive stenosis in in-tracranial arteries,numbers of positive stenotic segments in intracranial and extracranial arteries,and total number of positive stenotic segments in head and neck arteries when compared with the non-ACAD group(P＜0.05,P＜0.01).Multivariate logistic regression analysis revealed that both single and multiple SBI were independent risk factors for ACAD(OR=4.474,95％CI:2.057-9.731,P=0.001;OR=8.071,95％CI:3.945-16.513,P=0.001).Conclusion SBI is an independ-ent predictive factor for ACAD in elderly patients with first-ever ischemic stroke,and it has better predictive value than cerebral white matter hyperintensities and intracranial/extracranial arterial stenosis for ACAD.

A 69-year-old female patient with diabetes mellitus was scheduled to undergo angiography of head because of acute cerebral infarction. When iopromide injection-370 was injected intravenously with a high-pressure syringe before operation, the contrast medium extravasated at the injection site of her right hand, resulting in severe subcutaneous hematoma, tissue necrosis, and infection. The maximum area of extravasation wound extended to 6.0 cm × 7.0 cm. Therapies such as local wet compress with cold 50% magnesium sulfate and dexamethasone, daily debridement and dressing change, and external application of hydrogel, silver containing hydrophilic foam, and hydrocolloid were given. On day 14 after extravasation, the necrotic tissue of the wound gradually fell off and the wound began to heal. Then the wound healed on day 35 after extravasation.

A 69-year-old female patient with diabetes mellitus was scheduled to undergo angiography of head because of acute cerebral infarction. When iopromide injection-370 was injected intravenously with a high-pressure syringe before operation, the contrast medium extravasated at the injection site of her right hand, resulting in severe subcutaneous hematoma, tissue necrosis, and infection. The maximum area of extravasation wound extended to 6.0 cm × 7.0 cm. Therapies such as local wet compress with cold 50% magnesium sulfate and dexamethasone, daily debridement and dressing change, and external application of hydrogel, silver containing hydrophilic foam, and hydrocolloid were given. On day 14 after extravasation, the necrotic tissue of the wound gradually fell off and the wound began to heal. Then the wound healed on day 35 after extravasation.

Objective To investigate the value of third generation dual-source CT in early differential diagnosis of intracranial hemorrhage and iodinated contrast medium after endovascular treatment of acute ischemic stroke (AIS).Methods Totally 78 patients with AIS underwent endovascular treatment were prospectively enrolled.Dual-energy CT (DECT) examination (80 kV/Sn150 kV) of the head was performed after treatment with a third generation dual-source CT scanner.Iodine overlay maps and virtual non-contrast images were post-processed.Taking conventional brain CT images obtained 24 48 h after AIS attack as references,the accuracy,sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of DECT for identifying hemorrhage were computed respectively.Results Totally 31 patients with 53 foci of intracranial hyper-attenuation were finally enrolled.Among 53 foci,26 were correctly diagnosed as hemorrhage by DECT,23 were correctly diagnosed as iodinated contrast medium,while 1 calcification was misdiagnosed as hemorrhage combined with iodinated contrast medium,3 were misdiagnosed as contrast medium which showed delayed hemorrhagic transformation.The sensitivity,specificity and accuracy of DECT was 89.66％ (26/29),95.83％ (23/24) and 92.45％ (49/53),PPV and NPV was 96.30％ (26/27) and 88.46％ (23/26),respectively.Conclusion The third generation dual-source CT is available in early and accurate diagnosis of hemorrhagic transformation after endovascular treatment of AIS,which can help clinicians to adjust the subsequent treatment strategies in time.

Objective To evaluate the value of magnetic resonance black-blood thrombus imaging (BTI) of the stage of disease in intracranial venous and sinus thrombosis(CVT).Methods From June 2015 to October 2016,37 patients with CVT diagnosed with routine imaging examinations in Beijing Xuanwu Hospital,Capital Medical University were enrolled prospectively,and they also underwent BTI examination.The patients were randomly divided into either a acute group (≤14 d,n=23) or a chronic group (>15 d,n=14) according to the time from the onset of symptoms to BTI.Signal to noise ratio(SNR) and contrast to noise ratio(CNR) difference between acute and chronic CVT groups were compared.The magnetic resonance venography (MRV) examination was used as a reference to calculate the accuracy of BTI on per-segment level.Results (1) The SNR and CNR of thrombosis in the acute group and chronic group were 206±97 and 94±41,201±96 and 86±40,respectively.There was significant difference between two groups (t=4.9 and 5.0 respectively;all P<0.01).(2) In 37 patients with CVT,the thrombi in 159 cerebral veins and venous sinus segments were detected with MRV.BTI identified the thrombi accurately in 152 vascular segments,and the thrombi in 352 vascular segments were eliminated.The diagnostic sensitivity and specificity were 95.6% (152/159) and 98.0% (352/359) respectively.Conclusion Achieving direct angiography of cerebral venous thrombosis,BTI technique can accurately differentiate acute or chronic thrombus.It has higher accuracy.

By taking American Penn State University Medical Center as an example, the paper introduced the current American radiology resident education training situation and elaborated the radiology resident rotation system, multiform teaching model and academic research training. Medical education in American sheds light on how to reasonably arrange rotation, mobilize students' subjective initiative and improve scientific research ability, which radiology resident medical education in China can draw lessons from.

Objective To evaluate the value of contrast-enhanced whole-heart coronary magnetic resonance angiography ( CE CMRA ) at 3.0 T in the delineation of cardiac venous anatomy. Methods Contrast-enhanced whole-heart CMRA at 3.0T was performed in 43 consecutive subjects using ECG-triggered, navigator-gated, inversion-recovery prepared, segmented gradient-echo sequence with a 32-channel cardiac coil. The visibility of the coronary veins was graded visually using a 4-point scale.Continuous variable was expressed as (-x)±s. The paired student t test was used to evaluate the differences of the coronary sinus (CS) ostium diameter in anteroposterior and superoinferior directions. Results CMRA examination was successfully completed in 40 subjects with acquisition time of ( 6. 9 ± 1.8 ) min. The cardiac veins were finally evaluated in 38 of 40 (95.0%) subjects. The mean distance of the posterior vein of the left ventricle (PVLV) and the left marginal vein (LMV) to the CS ostium were (3.34 ± 0. 90) and (6. 12 ± 1.02) cm, respectively. The mean visibility scores of CS, posterior interventricular vein (PIV),PVLV, LMV, and anterior interventricular vein (AIV) were 4.0 ± 0.0, 3.4 ± 0. 5, 3.4 ± 0. 5, 3.0 ± 0. 8,and 3. 3 ± 0. 5, respectively. The diameter of the CS ostium in the superoinferior direction ( 1.13 ±0. 26) cm was larger than that in the anteroposterior direction (0. 82 ± 0. 19) cm (t = -4. 31 ,P <0. 05).Conclusion Contrast-enhanced whole-heart CMRA at 3.0 T can clearly depict the cardiac venous anatomy.

Objective To prospectively assess right ventricular dysfunction and the metergasis before and after therapy of thrombolysis with ECG gated multi-detector spiral computed tomography (MSCT)in patients with acute pulmonary embolism. Methods Triple rule-out ECG gated MSCT examination was performed in 96 consecutive patients suspected of PE. 25 patients with central PE were confirmed. 25 agematched subjects without cardiac and pulmonary disease were recruited as control group. Triple rule-out ECG gated MSCT were performed again to assess cardiac function after therapy of thrombolysis. Dimension ratios for the right ventricle (RV) and left ventricle ( LV), main pulmonary artery and aorta were measured.Furthermore, the RV and LV end-diastolic volumes (EDV), end-systolic volume (ESV) and ejection fraction (EF) were also measured. The mean values were compared with analysis of variance (ANOVA) and Newman-Keuls test before and after thrombolysis. Results The mean values of RVEDV, RVESV, RVEF,RV/LV ESV volume ratio, RV/LV dimension ratio and main pulmonary artery/aorta dimension ratio in control group were (150.5±24.1) ml,(71.5 ±18.5) ml, (53.5 ±4.2)%, 1.08 ±0.04, 1.01 ±0.04 and 0. 99 ±0. 02, respectively. While those in PE group were ( 190. 3 ± 16. 2) ml, ( 128. 1 ± 13.2) ml,(32.7 ± 3.6 ) %, 2.00 ± 0.26, 1.30 ± 0. 09 and 1.34 ± 0. 11, respectively. Those after therapy of thrombolysis were ( 159. 2 ± 21.5 ) ml, ( 80. 7 ± 9.4) ml, (49. 2 ± 5.9) %, 1.22 ± 0.25, 1.02 ± 0.02 and 1.02±0.11,respectively. ESV and EDV of RV were larger (q= 6.28, P<0.01; q=7.59, P<0.01),EF value was lower (q = 4. 82, P < 0.01 ) in PE group than those in control group. RV/LV ESV volume ratio, the RV/LV dimension ratio and main pulmonary artery/aorta dimension ratio were larger ( q = 6. 04,P <0. 01; q =4. 43, P <0. 01; q =4. 36, P <0. 01 ) and EDV of LV was lower in PE group than those in control group. However, ESV and EDV of RV and RV/LV ESV volume ratio were lower (q = 5.03, P <0.01;q=6. 11,P<0.01;q=4.74,P<0.01), EF value was larger (q=6.29, P<0.01) and EDV of LV was larger(q =4.01 ,P <0.01 ) after therapy of thrombolysis than before. Conclusion Retrospective triple rule-out ECG-gated MSCT can show pulmonary embolism, measure the function of RV and LV and evaluate curative effect of thrombolysis.