Objective:To study the impact of different scattering correction algorithms in the reconstruction of PET/CT images on image artifacts and the precision of quantitative parameters.Methods:The phantom as described in the National Electrical Manufacturers Association (NEMA) NU2 standard was filled with 18F. The background activity was fixed, and the activity of the solution in the spheres was adjusted to obtain several configurations, including the normal ratio group (4.08∶1) and the extreme ratio group (200∶1). The surface contamination group with the same ratio as the extreme ratio group contained a small radioactive source with different doses of 18F (74, 37, 3.7 and 0.37 MBq) placed at the surface of the phantom. PET/CT images of 30 patients (21 males, 9 females, age: (44.5±10.2) years) from Peking University Cancer Hospital & Institute between July 2012 and December 2021 were retrospectively analyzed, including 10 with normal images ( 18F-FDG) and 20 with abnormal images (10 with dislocation during acquisition, 10 with surface contamination). The images were reconstructed with relative and absolute scattering correction. The phantom was evaluated using the target to background ratio (TBR) and the artifact classification. CV as well as the artifact classification were used to compare the clinical image quality. Mann-Whitney U test and χ2 test were used to analyze data. Results:In the normal ratio group and the extreme ratio group, the TBRs of phantom images reconstructed with relative correction were significantly higher than those with absolute correction (normal ratio group: 3.30(1.94, 4.53) vs 2.72(1.56, 3.56); z=-2.20, P=0.028; extreme ratio group: 105.47(45.62, 162.82) vs 101.36(43.96, 155.57); z=-1.99, P=0.046). In the surface contamination group, with the increase of the activity of the small source, the artifact became more obvious, and the artifact classification score of absolute correction was significantly better than that of relative correction (1.5(1.0, 2.0) vs 2.5(2.0, 3.0); z=-2.00, P=0.046). In the 10 normal 18F-FDG PET/CT patients, the CVliver of the relative correction (9.67%(8.00%, 11.00%)) was significantly lower than that of absolute correction (11.00%(9.00%, 12.00%); z=-2.57, P=0.010), indicating the higher image quality of images with relative correction. In abnormal images, the image quality of absolute correction was significantly higher than that of relative correction with fewer and less severe artifacts (dislocation cases: 9/10 vs 4/10; χ2=5.50, P=0.019; surface contamination cases: 9/10 vs 4/10; χ2=5.50, P=0.019). Conclusions:The relative scattering correction is suitable for normal situations in clinical PET acquisition. However, with dislocation or surface contamination, the absolute scattering correction helps to reduce the artifacts and improve the image quality.

Objective:To investigate the predictive value of neutrophil-lymphocyte ratio (NLR) for Trousseau’s syndrome (TS) in patients with acute multiple cerebral infarctions (AMCI).Methods:The patients with AMCI in Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine from July 2013 to March 2022 were retrospectively enrolled. The demographic and baseline clinical data of patients with TS and those without TS were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of TS-AMCI, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of NLR for TS-AMCI. Results:A total of 59 patients with AMCI were enrolled, including 43 males and 16 females, aged 64.9±14.0 years. There were 16 patients in the TS-AMCI group and 43 in the non-TS-AMCI group. The proportions of patients with diabetes mellitus, hypertension and previous stroke or transient ischemic attack in the TS-AMCI group were significantly lower than those in the non-TS-AMCI group (all P<0.05), while the proportion of patients with ischemic heart disease were significantly higher than that in the non-TS-AMCI group ( P<0.05). The proportion of patients with bilateral infarction in the TS-AMCI group was significantly higher than that in the non-TS-AMCI group ( P<0.001). The D-dimer, NLR, white blood cell count, neutrophil count, monocyte count, percentage of neutrophils, total cholesterol and low-density lipoprotein cholesterol in the TS-AMCI group were significantly higher than those in the non-TS-AMCI group (all P<0.001), while the lymphocyte count, lymphocyte percentage, red blood cell count, hemoglobin and hematocrit were significantly lower than those in the non-TS-AMCI group (all P<0.001). Multivariate logistic regression analysis showed that high NLR was an independent predictor of TS-AMCI (odds ratio [ OR] 2.897, 95% confidence interval [ CI] 1.270-6.527; P=0.011), while high hemoglobin was independently negatively correlated with TS-AMCI ( OR 0.839, 95% CI 0.723-0.975; P=0.022). ROC curve analysis showed that the area under the curve of NLR for predicting TS-AMCI was 0.929 (95% CI 0.831-0.979; P<0.001). When the NLR cutoff value was 4.01, the corresponding Youden index was 0.744. At this time, the sensitivity and specificity were 100% and 74.42% respectively. Conclusion:NLR has high predictive value for TS-AMCI.

Anal fistula is a common disease, surgical treatment is the best option. There are many kinds of surgical treatments for anal fistula, traditional surgical methods, such as fistulotomy and fistulectomy are more thorough in treating internal opening, infection and fistula tract, but the injury to the sphincter is also greater. In recent years, surgery is becoming refined, many scholars pay more and more attention to the protection of anal sphincter, which has derived a series of minimally invasive surgeries, such as Endorectal advancement flap procedure, Ligation of intersphincteric fistula tract, Fistula laser closure procedure, Video-assisted anal fistula treatment, Over-the-scope clip, Endofistular polyurethane-sponge vacuum therapy and biological sphincter preservating procedures. This paper describes the application status and progress of sphincter preserving surgeries by reviewing relevant literature, in order to provide relevant reference for clinical workers, optimize the treatment plan and improve the cure rate.

Objective To investigate the safety and effectiveness of Solitaire FR stent mechanical thrombectomy combined with 5F Navien catheter aspiration technique for the treatment of acute middle cerebral artery occlusion.Methods From February 2016 to May 2016,the case data of 11 consecutive patients with acute middle cerebral artery occlusion treated with Solitaire FR stent mechanical thrombectomy combined with 5F Navien catheter aspiration technique at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively.The age,gender,National Institutes of Health Stroke Scale (NIHSS) score on admission,thrombolysis in cerebral infarction (TICI) grade,operation-related complications,NIHSS score at 24 h after operation,and modified Rankin Scale (mRS) score at day 90 after operation were documented.The relevant data differences before and after treatment were analyzed with the SPSS software.Results Among the 11 patients with acute middle cerebral artery occlusion,7 were men and 4 were women,the age ranged from 44 to 78 years,and the mean age was 66 ± 11 years.The preoperative and postoperative NIHSS scores were 18 ± 3 and 8 ±4 respectively.There was significant difference before and after treatment (t =5.327,P ＜ 0.01).The recanalization of occluded middle cerebral artery achieved successfully.The follow-up at day 90 after operation,the good prognosis of the patients (mRS 0-2) was in 7 cases.No complications associated with severe M1 segment catheter operation occurred.Conclusion The preliminary experience showed,Solitaire FR stent mechanical thrombectomy combined with 5F Navien catheter aspiration technique for the treatment of acute middle cerebral artery occlusion was a safe and effective endovascular mechanical thrombectomy method.

Objective To investigate the safety and effectiveness of intravenous thrombolysis bridging intra-arterial thrombectomy for opening the acute occlusion of intracranial large artery.Methods Theclinical data of 63 patients with acute intracranial large artery occlusion treated with intravenous thrombolysis bridging intra-arterial thrombectomy in Beijing Xuanwu Hospital,Capital Medical University from January to September 2016 were analyzed retrospectively. The initiation time of intravenous thrombolysis was within 4. 5 h after onset. The initiation time of endovascular therapy (femoral artery puncture)was within 6 h after onset. They were divided into either a simple stent mechanical thrombectomy group (n=41)or a stent mechanical thrombectomy combined with catheter suction group (n=22)according to the ways of thrombectomy. There were no significant differences in the gender composition,average age,occlusion site and National Institutes of Health Stroke Scale (NIHSS)score on admission between the two groups of patients (all P <0. 05). The modified Thrombolysis in Cerebral Infarction (mTICI)was used evaluate the effect of vascular patency. The vascular recanalization time,number of thrombectomy,NIHSS scores on admission,at 72 h after procedure and at day 90,and intraoperative and postoperative complications treated with two kinds of intra-arterial treatment under the intravenous thrombolysis bridging were analyzed. Results (1)In the simple stent mechanical thrombectomy group,there were 37 patients with anterior circulation occlusion (90. 2%)and 4 with posterior circulation occlusion (9. 8%). In the stent mechanical thrombectomy combined with catheter suction group, there are 20 patients with anterior circulation occlusion (90. 9%)and 2 with posterior circulation occlusion (9. 1%). There were no significant differences between the two groups of patients (P<0. 05). After treatment, the large vessels achieved good recanaliazation (mTICI grade:Ⅱb-Ⅲ). (2)The mean recanalization time of the simple stent mechanical thrombectomy group was 86 ± 11 min and the mean number of arterial embolectomy was 2. 8 ± 0. 9 times. The complication rate after procedure was 14. 6%(5 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 51. 2%(21/41)at 90 days of follow-up. The mean recanalization time of the stent mechanical thrombectomy combined with catheter suction group was 83 ± 11 min and the mean number of arterial embolectomy was 2. 2 ± 0. 8 times. The compli-cation rate after procedure was 13. 6%(2 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 59. 1%(13/22)at 90 days of follow-up. There were significant differ-ences in the above indices between the two groups(all P<0.05).Conclusion Both intravenous throm-bolysis bridging simple stent mechanical thrombectomy and stent mechanical thrombectomy combined with catheter suction can quickly make the recanalization of intracranial occlusion of large artery,and the stent mechanical thrombectomy combined with catheter suction has a better recanalization rate. However, both techniques need to be further studied in improving the clinical prognosis of patients.

Objective To investigate the level of Irisin in polycystic ovarian syndrome ( PCOS) patients and analyze its potential correlation with 25 (OH) vitamin D3 and other metabolic indicators , with an attempt to explore the role of Irisin in PCOS and thus inform the diagnosis and treatment of this condition .Methods Totally 67 PCOS patients presenting in the reproductive infertility center of the First Hospital of Shanxi Medical University from April 2015 to January 2016 were enrolled as the PCOS group;meanwhile, 72 women of child-bearing age from the health check-up center were included as the control group .We measured the height , body mass, waist circumference, abdominal girth, hip circumference, and blood pressure and calculated their body mass index (BMI) and waist-to-hip ratio (WHR).The serum biochemical indicators including Irisin , 25(OH) vitamin D3, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol ( LDL-C ) , fasting plasma glucose ( FPG ) , fasting insulin ( FINS ) , follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TES) , and Homeostatic Model Assessment of Insulin Resistance ( HOMA-IR ) were measured .Results The body mass [ ( 66.074 ± 12.952) kg vs.(57.671 ±8.806) kg, P =0.000], BMI [ (25.340 ±4.149) kg/m2 vs.(22.201 ± 3.585 ) kg/m2 , P=0.003 ] , waist circumference [ ( 88.829 ±12.212 ) cm vs.( 80.550 ±10.343 ) cm, P=0.007], hip circumference [ (100.805 ±8.614 ) cm vs.(92.007 ±9.325 ) cm, P=0.000], WHR (1.279 ±0.082 vs.0.857 ±0.071, P=0.000), diastolic blood pressure [ (78.548 ±8.936) mmHg vs. (73.071 ±10.614) mmHg, P=0.036], TG [ (2.263 ±1.142) mmol/L vs.(1.330 ±1.329) mmol/L, P=0.019], FPG [ (5.128 ±0.392) mmol/L vs.(4.809 ±0.394) mmol/L, P=0.008], FINS [ (13.319 ± 8.122) mU/L vs.(4.921 ±2.028) mU/L, P=0.000], LH [ (8.153 ±2.271) IU/L vs.(3.811 ±2.607) IU/L, P=0.000], TES [ (63.068 ±25.704) ng/dl vs.(34.811 ±11.827) ng/dl, P=0.000] and, HOMA-IR (2.245 ±0.853 vs.1.021 ±0.153, P=0.000) in PCOS group were higher than those in the normal control group.Serum irisin level in PCOS group was significantly elevated when compared with control group [ (831.542 ± 98.484) ng/ml vs.(612.345 ±86.308) ng/ml, P=0.006], while HDL-C [ (1.278 ±0.345) mmol/L vs. (2.493 ±0.262) mmol/L, P=0.011], and 25 (OH) VD3 concentrations [ (17.181 ±5.078) nmol/L vs. (20.823 ±5.305) nmol/L, P=0.009] were decreased significantly .Linear regression analysis showed that iri-sin was positively associated with body mass (r=0.396, P=0.028), BMI (r=0.712, P=0.000), waist circ-umference (r=0.462, P =0.021), hip circumference (r =0.478, P =0.006), WHR (r =0.686, P =0.002), TG (r=0.397, P=0.036) and HOMA-IR (r=0.467, P=0.019) in the PCOS patients and there was a negative correlation between irisin and 25 (OH) VD3 (r=-0.654, P=0.004).Multiple regression analysis in PCOS group with irisin as dependent variable and other anthropometric and biochemical indicators as independent variables revealed that there was linear regression relationship between serum irisin and BMI (β=0.822, P<0.001), TG (β=0.076, P=0.035), and 25 (OH) VD3 levels (β=-0.242, P=0.027). Conclusions Serum Irisin level is increased in PCOS patients and it is correlated with 25 ( OH) vitamin D3 , BMI, HOMA-IR, and TG.Irisin provides a new method for the diagnosis and treatment of PCOS .

Objective To explore the changes in serum concentrations of irisin,vaspin and reactive oxygen species (ROS) in patients with type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS),and to investigated the correlation of irisin and vaspin with clinical parameters of MS.Methods A total of 260 T2DM patients were enrolled.Age and gender were recorded,anthropometrics,biochemical parameters,and levels of irisin,vaspin and ROS in fasting serum were measured,and homeostatic model assessment of insulin resistance (HOMA-IR) calculated.Wilcoxon rank sum test,correlation analysis,Logistic regression analysis,multiple linear regression analysis and receiver operating characteristic (ROC) curve analysis were performed.Results Compared to T2DM patients without MS,T2DM patients with MS had lower serum level ofirisin [male:112.81 (86.96-191.84) μg/Lvs.156.23 (110.61-225.97) μg/L,female:141.09 (77.52-175.55) μg/L vs.172.15 (95.69-240.37) μg/L,P ＜0.01],higher levels of vaspin and ROS [male:1.13 (0.95-1.38) μg/Lvs.0.36 (0.21-0.82) μg/L,1 540 (1 250-1 860) kU/Lvs.1 020 (920-1 350) kU/L;female:1.52 (1.13-1.80) μg/Lvs.0.51 (0.47-1.08) μg/L,1 650 (1 320-1 940) kU/Lvs.1 120 (980-1 420) kU/L,P ＜0.01].In the T2DM patients,serum irisin level was negatively correlated with vaspin (r =-0.382,P ＜ 0.01) and ROS (r =-0.410,P ＜ 0.01),while vaspin was positively correlated with ROS (r =0.400,P ＜ 0.01).Multiple linear regression analyses showed that irisin was significantly correlated with body mass index (BMI),waist circumference and triglyceride,while vaspin was correlated with gender,BMI,and waist circumference (all P ＜ 0.05).Logistic regression analysis revealed that irisin,vaspin and ROS were all associated with MS (OR =0.77,95 ％ CI 0.608-0.978;OR=1.39,95％ CI 1.252-1.539;OR=1.38,95％ CI1.112-1.718,all P＜0.05).ROC analysis demonstrated that irisin and vaspin had significant area under the curve (AUC =0.931,P ＜0.01;AUC =0.777,P ＜ 0.01) for the prediction of MS.Conclusions Serum irisin level was significantly decreased,while vaspin and ROS were significantly increased in T2DM patients with MS.Irisin and vaspin were associated with clinical presentations of MS,suggesting that irisin and vaspin might be valuable predictors of MS.

Objective Through the detection of the levels of serum betatrophin,anthropometric and biochemical indices,to determine the alteration of betatrophin levels in patients with polycystic ovary syndrome (PCOS) and the relationship between betatrophin levels and metabolic indexes such as 25-hydroxy vitamin D3 [25 (OH) D3].Methods The study group was composed of 24 women with PCOS and 20 age-natched healthy women as controls.Following general physical examination of the subjects,anthropometrie measurements were performed (height,weight,waist circumference,hip circumference).Body mass index (BMI) and waist-hip ratio were calculated;25 (OH) D3,Ca2+,fasting blood glucose,fasting insulin,triglycerides,high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C) were also measured and homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated in all subjects.Serum betatrophin levels were examined with an enzyme-linked immunosorbent assay (ELISA).Using independent sample T test to compare the differences between groups,the linear correlation analysis was performed to study the correlation of betatrophin with anthropometric and biochemical indices,the influencing factors of betatrophin were analyzed by multiple linear regression.Results Circulating betatrophin levels [(0.341±0.034) ng/ml vs.(0.810±0.162) ng/ml,t=4.271,P＜0.001] and HDL-C [(1.014±0.321) mmol/L vs.(1.419±0.287) mmol/L,t=2.218,P＜0.05] significantly decreased in women with PCOS compared with controls,and BMI [(27.691±4.392) kg/m2 vs.(23.310±4.781) kg/m2,t=-2.073,P＜0.05],fasting blood glucose [(5.950±0.411) mmol/L vs.(4.883±0.314) mmol/L,t=-2.142,P＜ 0.05],HOMA-IR [(4.946 ± 0.741) vs.(3.387± 0.397),t=-2.493,P＜0.05],triglycerides [(1.510± 0.848) mmol/L vs.(1.037±0.402) mmol/L,t=-2.223,P＜0.05],LDL-C [(3.431±0.479) mmol/L vs.(2.396±0.435) mmol/L,t=-2.433,P＜0.05] were obviously increased.Moreover,there was a postive correlation between betatrophin and HOMA-IR (r=0.425,P＜0.05) as well as 25(OH)D3 (r=0.577,P＜0.05) and Ca2+ (r=0.448,P＜0.05),while the betatrophin was negatively related to BMI (r=-0.451,P＜0.05),triglycerides (r=-0.454,P＜0.05),LDL-C (r=-0.551,P＜0.05).Circulating betatrophin levels were higher when 25 (OH) D3 levels were beyond 35 nmol/L in PCOS patients [(0.539±0.092) ng/ml vs.(0.199±0.031) ng/ml,t=3.072,P＜0.001],and the multiple linear regression analysis showed that the main factors affecting the levels of betatrophin were BMI (OR=-0.260),HOMA-IR (OR=0.218),25(OH)D3 (OR=0.238),and glycerol (OR=-0.162).Conclusion It is speculated that betatrophin may be a valuable predictive factor of PCOS because betatrophin is closely associated with insulin resistance,lipid metabolism disorders and the lack of 25-hydroxy vitamin D3 in PCOS patients.

Objective ToexploretheapplicationofVasoCT,astentimagingtechnique,instent-assisted coilaneurysmembolization.Methods Twentyconsecutivepatientswith23intracranialaneurysmswere treated with stent-assisted aneurysm embolization in the General Hospital of Armed Police Forces from December 2013 to November 2014 were enrolled. The patients performed VasoCT scan immediately after procedure. Then all the available images were used for stent-optimized reconstruction respectively. Under the XpertCT mode,the available images were observed with both volume imaging and maximum intensity projection. The available images were analyzed and they were divided into very clear,less clear,and not clearaccordingtothestentdevelopingclarity.Results Ofthe22aneurysmstreatedwithstent-assisted embolization,16 were occluded completely,6 were occluded partially. All the stents were expanded completely and were released to the expected locations;11 aneurysm stents developed clearly,9 developed less clearly,and 2didnotdevelopclearly.Conclusion VasoCTcanbeusedinthestent-assistedaneurysmembolization.It can clearly reveal the microscopic structure of the stents,location,relationship with the artery wall,and relationship between stents and coils. The clarity of stent development is associated with the diameters of the packed coils,and the stents are also affected by the metal artifacts projecting direction and the dense degree of the packing coils.

Objective Indocyanine green (ICG) video angiography is widely used in aneurysm surgery.This study is to evaluate and analyze the effect of intraoperatively aneurysms clipping by quantitative analysis of ICG video angiography.Methods Twenty patients with cerebral aneurysms (six with anterior communicating artery aneurysms,five with communicating artery aneurysms and nine with middle cerebral artery aneurysms),admitted to our hospital from September 2012 to September 2013,were chosen in our study; they all underwent aneurysms clipping involving ICG.Same areas of interest (AOIs,aneurysm area,parent artery area and branch artery area) of images intercepted from angiogram videos before and after clipping of aneurysms were analyzed by Image-pro plus.Results Dramatic differences in time to peak of blood flow of aneurysm areas were observed before and after clipping of aneurysms ([10.975±1.208] s vs.[47.950±2.350] s,t=57.299,P=0.000).There were no dramatic differences in times to peak of blood flow of parent and branch vessels before aneurysms clipping and after aneurysms clipping ([10.600±1.619] svs.[10.350±1.452] s,t=0.641,P=0.529;[10.400±1.153] s vs.[10.425±1.311] s,t=-0.079,P=0.938).Conclusion Quantitative analysis is a good method to evaluate the effect of aneurysm clipping surgery according to the blood flow,which might improve the success rate.