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OBJECTIVE: To evaluate a modified subtraction coronary computed tomography angiography (CCTA) technique with a two-breathhold approach in terms of image quality and stenosis grading of calcified coronary segments and in the detection of significant coronary stenosis in segments with severe calcification. MATERIALS AND METHODS: The institutional board approved this study, and all subjects provided written consent. A total of 128 patients were recruited into this trial, of which 32 underwent subtraction CCTA scans and invasive coronary angiography (ICA). The average Agatston score was 356 ± 145. In severely calcified coronary segments, the presence of significant (> 50%) stenosis was assessed on both conventional CCTA and subtraction CCTA images, and the results were finally compared with ICA findings as the gold standard. RESULTS: For severely calcified segments, the image quality in conventional CCTA significantly improved from 2.51 ± 0.98 to 3.12 ± 0.94 in subtraction CCTA (p < 0.001). In target segments, specificity (70% vs. 87%; p = 0.005) and positive predictive value (61% vs. 79%, p < 0.01) were improved using subtraction CCTA in comparison with conventional CCTA, with no loss in the negative predictive value. The segment-based diagnostic accuracy for detecting significant stenosis was significantly better in subtraction CCTA than in conventional CCTA (area under the receiver operating characteristic curve, 0.94 vs. 0.85; p = 0.03). CONCLUSION: This modified subtraction CCTA method showed lower misregistration and better image quality in patients with limited breathhold capability. In comparison with conventional CCTA, modified subtraction CCTA would allow stenosis regrading and improve the diagnostic accuracy in coronary segments with severe calcification.
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Humans , Angiography , Constriction, Pathologic , Coronary Angiography , Coronary Stenosis , Methods , ROC Curve , Sensitivity and SpecificityABSTRACT
Objective To investigate the feasibility of subtraction coronary computed tomography angiography (Sub-CCTA) for the diagnosis of coronary heart disease in the segment with severe calcification.Methods A retrospective analysis was performed on 27 patients who underwent clinically indicated digital subtraction angiography (DSA) and CCTA using a 320-detector row CT.Compared with the results of DSA,sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Con-CCTA and Sub-CCTA were calculated.The clinical diagnostic accuracy of the two imaging methods was evaluated using the receiver operating characteristic (ROC) curve.The stenosis of coronary segments was divided into four grades (Ⅰ,Ⅱ,Ⅲ,Ⅳ).Kappa coefficient was used to measure agreement between two imaging methods.Image quality of 4-scale grade scoring method was used and t test was conducted.Results A total of 52 segments with severe calcification were evaluated.The scores of image quality in Con-CCTA and Sub-CCTA were 2.8 ± 0.5 and 3.4 ± 0.7,respectively.There was significant difference between them (t =5.9,P ＜ 0.05).Compared with the result of DSA as the golden standard,the Kappa coefficients were 0.55 and 0.81 respectively in Con-CCTA and Sub-CCTA for the quantitative evaluation of the severe calcified segments.The sensitivity,specificity,positive predictive value and negative predictive value and accuracy of Con-CCTA were 81.0％,63.1％,63.1％,81.1％ and 70.8 ％;and for Sub-CCTA they were 90.5 ％,85.2％,82.1 ％,92.0％ and 87.5 ％ respectively.Compared with Con-CCTA,the area under the ROC curve of Con-CCTA and Sub-CCTA were 0.84 (95％CI:0.70-0.93) and 0.96 (95％ CI:0.86-1.00),respectively,and the difference was statistically significant (P =0.03).Conclusions Sub-CCTA can improve the diagnostic accuracy of coronary artery stenosis in severe calcified segment.Application of subtraction technique in CCTA can reduce or even eliminate the artifacts caused by severe calcified plaque,and has a good clinical application prospect.
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[Objective]To explore and analyze Professor GUO Weifeng's clinical experience in treating posterior circulation ischemic vertigo. [Methods] By learning with the teacher, collection of relevant information and medical records ,to expound Professor GUO Weifeng 's academic thoughts and clinical experience in posterior circulation ischemic vertigo, from aspects of etiology, pathogenesis, and syndrome differentiation and treatment variation, prescription medication, summarizing the characteristics of his prescriptions and ways of treatment as well as exemplifying them. [Results] Professor GUO Weifeng through many years of clinical practice proposes that the basic pathogenesis of this disease is liver with kidney deficiency and hyperactivity of liver-yang. Because of its more associated with obesity and high blood pressure, high blood lipids, diabetes, always mingle phlegm and stasis. The main treatment method is to nourish the Yin of liver-kidney, pacify liver and extinguish wind. Then, transform phlegm and disperse blood stasis. If pathogenic into collateral for a long time,we need using insect drug for treatment. Clinical treatment should be based on positive and evil of the partial ups and downs, the disease of both, flexible adjustment of medication, it is not limited by present method. [Conclusion] Professor GUO Weifeng 's clinical experience in treating posterior circulation ischemic vertigo is effective and worthy of wide application.
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Objective To observe the clinical effects of the homemade medicated and dietary compound granules in treating sub-health insomnia with deficient cultivation of heart-spirit. Methods Sixty qualified patients were randomly divided into treatment group and control group, 30 cases in each group. The treatment group was given homemade medicated and dietary compound granules(mainly composed of Semen Ziziphi Spinosae, Radix Codonopsis, Sclerotiium Poriae Circum Radicem Pini, Radix Polygalae, Flos Rosae Rugosae, Plumula Nelumbinis, Fructus Ziziphi Jugubae, and Arillus Longan). The control group was given Oryzanol powder. The course of treatment lasted for half a month. Before and after treatment, the scores of Pittsburgh Sleep Quality Index(PSQI) and the traditional Chinese medicine(TCM)symptom rating scale were observed, and the clinical efficacy of the two groups were also evaluated. Results After treatment for half a month and after suspension of medicine for half a month , (1) the total effective rate of the treatment group was higher than that of the control group (P 0.05). The total PSQI scores , sleep quality scores , falling asleep time scores, and daytime function disorder scores of the treatment group were lower than those of the control group (P<0.01);(3) the total scores of TCM symptoms as well as the scores of dreaminess and susceptibility to awakening, palpitation and amnesia, lassitude and weakness, poor appetite, pale complexion, vertigo and dizziness, abdominal distension and loose stools were declined in the treatment group (P < 0.05 or P < 0.01 compared with those before treatment). Conclusion Medicated and dietary compound granules are effective on improving sleep quality, shortening time to fall asleep, improving sleep disorder, increasing the efficiency of daytime function, improving patients’ mental state entirely, and maintaining the short-term curative effect.
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Objective To study the therapeutic effects and related mechanism of Tongmai Yizhi granules on vascular dementia in rats. Methods Bilateral carotid artery ligation was used to establish rat model of vascular dementia (VD). The rats were randomly divided into 6 groups: sham operated,the model control,piracetam (0. 375 g·kg-1 ·d-1 ) as positive con-trol,low dose (2. 5 g·kg-1 ·d-1 ),middle dose(5. 0 g·kg-1 ·d-1 ),and high dose (10. 0 g·kg-1 ·d-1 ) of Tongmai Yizhi granules. Each group was intragastrically administered with 10 mL·kg-1 of corresponding medications for 31 days after the VD model was established. The sham group was given with 0. 9% NaCl solution. Y-electric maze was used to test the learning and memory function of rats at the second and fourth weeks. On the day 32,hippocampal tissues were collected for pathological analy-sis by microscope. The activities of SOD and content of MDA in serum and tissue homogenate were tested. Results Compared with model control group,each dose of Tongmai Yizhi granules obviously shortened the incubation period of VD rats in electric maze test,and accuracy of learning and memory was improved (P<0. 05 or P<0. 01). The activity of SOD was decreased,and the content of MDA was increased after treatment with Tongmai Yizhi granules (P < 0. 01). Hippocampal neuronal cells were disar-ranged,and the number of cone cells was decreased significantly in the model control group. In contrast,the necrosis and degener-ation of hippocampal neurons were alleviated in all Tongmai Yizhi treatment groups. Conclusion Tongmai Yizhi granule can apparently improve learning and memory function of VD rats. It can also improve the activity of SOD and reduce the content of MDA in serum and hippocampus,effectively remove free radicals,and alleviate the injury of hippocampal pyramidal cells.
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Objective To observe the effect of Kouchuangping oral liquid (KCP), which can clear away stomach-heat, purge fire, nourish yin, on golden yellow hamster aphtha that induced by PQ. Methods Inject PQ which can cause membrana mucosa ulceration in golden yellow hamster’s cheek pouch, observe the pathomorphological process of ulcerative lesion and antioxidation of three different KCP dosage teams. Result The KCP has the function of anti-inflammation and anti-exudation on ulcerative lesion, which can relieve epithelium necrosis and promote the recovery of ulceration. It also can increase the vigor of SOD in serum and degrade the content of MDA. Conclusion KCP has the functions of antioxidation and eliminate oxydic and metabolic products.
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Professor ZHOU Zhong-ying has rich and particular clinical experience in the application of traditional Chinese medicine.This article tries to introduce some drugs’concerted applications of him : Regulating and lowering qi with bitter and pungent herbs,such as Coptis Root matches Cinnamon Bark,Coptis Root matches Pinellia Tuber,Coptis Root and Scutellaria Root match Magnolia Bark and Atractylodes Rhizome,Coptis Root matches Evodia Fruit,Coptis Root matches Caulis Perillae(Folium Perillae);combined method of warming,heat-clearing,regulating and tonifying is used when damp-heat hurts stomach yin,leading failure of stomach qi to descend and rise and internal cold and heat induces diffi ciency of stomach.Also,this article introduces other paired herbs: Radix Rehmanniae matches Blackend swallowwort root,Blackend swallowwort root mathes Scaly Anteater,Herba Lycopi,Scaly Anteater matches Evonymus alata,Atractylodes Rhizome matches Amoorcorn tree bark,Radix Scrophulariae matches Atractylodes Rhizome,Caulis aristolochiae matches Liquidambaris,fructus.
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Objective To study the action of chromatogram retention index in forecasting the LC50 of chlorinated phenols and chlorinated benzenes for the Guppy.Methods Chromatogram retention time of chlorinated phenols and chlorinated benzenes were determined,and the LC50 for Guppy was from the published data.Results A regression model was established,for chlorinated phenols,it was lg(LC50)=1.599-2.64?10-3I,r=0.970,P