2014年 · 第94卷第29期

CT is widely used in clinical practice, playing an increasingly important role in early, accurate diagnosis and efficacy evaluation of diseases, and promoting the development of medical cause. At the same time, due to the expansion of its indications and the increase of its use frequency, it has gradually become the main source of iatrogenic ionizing radiation^[1]。 The possibility of carcinogenesis caused by CT radiation has become the focus of attention and may become a social and public health problem. In addition, the expansion of CT application range, accompanied by the sharp increase of iodine contrast agent injection, has become the third leading cause of hospital-acquired nephropathy. Studies have shown that nephropathy caused by iodine contrast agent is related to the amount of contrast agent used^[2]。 Nowadays, with the continuous development of CT technology and broad application prospect, how to reduce the radiation dose and contrast agent dosage of CT as much as possible on the premise of ensuring image quality has become the common research direction of medical workers and various manufacturers.

With the development of CT technology, its use frequency is also steadily increasing. Therefore, increasing attention is paid to the assessment of X-ray radiation risk. Major manufacturers have also done a lot of research and development work on this, from a series of processes such as radiation generation, radiation path, detector acquisition and iterative reconstruction technology have done targeted research, so that various low-dose technologies are constantly appearing^[1]。

In recent years, the problem of radiation dose has attracted more and more attention^[1]In daily life, background radiation in nature accounts for about 50% of the average radiation, and medical imaging accounts for 50% of the average annual radiation exposure. Among them, CT radiation accounts for the main part, about 24%, which has a certain relationship with the imaging principle of CT and its more and more widespread clinical application^[2]。 Brenner and Hall in 2007^[3]According to the review report, the radiation dose of CT scan is 30~90 mSv, which will increase the risk of tumors. 1.5% ~2.0% of tumors in the United States may be caused by CT examination every year, and about 62 million people undergo CT examination every year in the United States. The radiation damage caused by it cannot be ignored, so reducing radiation dose has become a hot issue in the clinical application of CT. Enhanced scanning is an important scanning method in CT examination. Combined with ordinary scanning, it can be more conducive to finding lesions or more clearly show the scope and nature of lesions, and provide valuable information for qualitative diagnosis of lesions and tumor staging. However, the accompanying allergic reactions, thyroid toxicity, cardiovascular reactions, contrast nephropathy (CIN), etc. also seriously threaten the health of patients^[4]。

In recent years, more and more attention has been paid to the harm of CT radiation and contrast agent nephropathy (CIN). Low-dose CT angiography (CTA), especially "double-low" scanning technology, has gradually become a hot spot in recent years. The so-called double low refers to the combination of low radiation dose (mainly low kVp and low keV techniques) and low iodine concentration contrast agent. Double low scanning combined with iterative reconstruction technique can ensure that the image quality meets the diagnosis premise, and reduce the radiation dose and iodine intake of patients during CT examination.

CT utilizes an X-ray source for imaging, so the subject inevitably receives X-ray radiation during CT examination. In recent years, the number and frequency of CT examination every year in China has increased obviously. The ensuing challenge is that the human body receives a significant increase in the dose of X-ray radiation. For example, the radiation dose for coronary CT angiography has reached (17.96 ± 1.71) mSv^[1]。 The radiation dose of abdominal phase 3 dynamic enhanced CT scan was also close to 15 mSv^[2]。 In 2011, Li et al.^[3]It is reported that 7% of patients have a 1% increased risk of cancer due to CT scans. Patient care for CT examination is reflected in the premise of obtaining excellent image quality, lower radiation dose and lower iodine intake (iodine load).

According to Hennekens'"Schizophrenia Increases the Risk of Cardiovascular Disease" published in the American Heart Journal in 2005 and Osborn DP' s "British Research Database Statistics on the Relative Risk of Cardiovascular Disease and Cancer Mortality with Severe Mental Disease" published in the General Psychiatry Literature in 2007, the research shows that the risk of coronary heart disease in mental patients is 2 to 5 times that of the general population, and the mortality rate is 2 to 3 times that of the general population. However, the relationship between antipsychotics and the risk of acute myocardial infarction (AMI) remains unclear because of methodological flaws in many early analyses, such as residual confounding, limited statistical efficacy and external authenticity. Recently, Dr. Lin Shuaiting and his team from Kaixuan Hospital in Kaohsiung, Taiwan, studied 56 910 patients with schizophrenia, affective disorders or dementia who visited the emergency department or were hospitalized for the first time for AMI from 1999 to 2009. The relationship between antipsychotic therapy and AMI risk in patients with mental disorders was explored, and its findings were published on May 16, 2014 inCirculationOn.

In the past, there have been many reports on the relationship between the increase of progesterone on the day of human chorionic gonadotropin (hCG) injection and the implantation rate of embryo in vitro fertilization (IVF)^[1,2,3,4]In 2013, a meta-analysis including 60,000 cycles showed that elevated serum progesterone on the day of hCG injection could lead to a decrease in IVF embryo implantation rates^[5]。 At present, it is speculated that the possible reason is that the increase of progesterone on the day of hCG injection affects the normal growth of intima, impairs the receptivity of intima, and further leads to the decrease of embryo implantation rate^[1,4]。 However, the exact effect of hCG daily high progesterone injection on the endometrium during implantation remains unclear. Although previous scholars have studied the changes of intimal tissue morphology during IVF stimulation cycle^[6,7]However, no research has been reported on the correlation between serum progesterone concentration and intimal histomorphology score results on the day of hCG injection during IVF stimulation cycle. This study focused on the relationship between progesterone level and endometrial tissue morphology during implantation during IVF stimulation cycle.

hypothalamic psychosyndrome refers to intracranial lesions, such as craniopharyngioma, which lead to impaired hypothalamic function, clinical manifestations such as overeating, short-term memory decrease, attention disorder, motivation disorder, eating disorder, depression, aggressive behavior, irritation, and difficulty in controlling emotions, which seriously affect the quality of life of patients and hinder patients from returning to society to study and work. It is more common in children. There are many domestic studies on the changes of endocrine function after craniopharyngioma surgery in children, but less attention is paid to the cognitive and mental changes. Four cases of postoperative hypothalamic psychiatric syndrome in patients with craniopharyngioma were summarized in the Neurosurgery Clinic of Yuquan Hospital of Tsinghua University and Haidian Hospital of Beijing from January to December 2012, and the reports are as follows.

Pain is a common non-motor symptom in Parkinson's disease (PD), and related studies have gradually increased in recent years. The incidence of pain in patients with Parkinson's disease ranges from 40% to 85%^[1]All of them were higher than the control group of the same age. Different literature^[1,2,3,4,5]All showed that compared with the pain-free group of the same age, the onset of Parkinson's disease was earlier and the course of disease was longer, and the UPDRS Ⅲ score, H-Y stage, HRSD, HAMA score and levodopa dose were higher than those of the pain-free group. The difference was statistically significant. However, compared with a large number of epidemiological data, domestic reports on clinical diagnosis and treatment are scattered. In order to increase clinicians' understanding of pain in Parkinson's disease, this article focuses on three aspects: clinical manifestations, diagnosis and treatment.

Hemangiopericytoma (HPC), also known as hemangiopericytoma, is a grade II ~ III tumor defined by the World Health Organization (WHO), which rarely occurs in the ventricle. We collected 2 cases of ventricular HPC confirmed by clinical operation and pathology in the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2010 to February 2013, and reported as follows.