ABSTRACT
Objective To investigate the assessment value of multimodal CT examination for collateral circulation after cerebral ischemia. Methods Within 3 days of admission,39 patients with ischemic stroke received multimodal CT examinations,including CT scan,CT perfusion (CTP)imaging,and CT angiography (CTA). The postprocessing software of the German SIEMENS 64-slice spiral CT system was used to evaluate the state of brain tissue perfusion and the conditions of head blood vessels of the subjects. The cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP) and the score of the modified Rankin scale (mRS)in the 90 d after discharge were compared between the patients with good collateral circulation and poor collateral circulation. Results Among 39 patients, multimodal CT examination revealed that 2 patients were negative,one of them was followed up by head MR and was clinically proven as transient ischemic attack,and the other was lacunar infarction. Thirty-seven patients were positive. Multimodal CT examination found 24 patients had offending vessels occlusion and/or stenosis on the lesion sides,the collateral circulation formation in 11 of them was observed on the lesion sides;another 13 patients had poor collateral circulation on the lesion sides. The comparison of lesion sides and contralateral sides,the patients with good collateral circulation showed the CBF decreased (t= -5. 92),the MTT and TTP prolonged (t=4. 27 and 3. 17 respectively). There were significant differences (all P<0. 01). The CBV and CBF in patients with poor collateral circulation were decreased significantly (t= -14.27 and-14.82 respectively),MTT and TTP prolonged (t=7. 26 and 7. 54 respectively). There were significant differences (all P <0. 01). There were significant differences in CBF,CBV,and TTP on the lesion sides between the two groups of patients (t=3. 24,4. 11,and -2. 34,respectively;all P<0. 05). The 90 d mRS scores for patients with good collateral circulation and poor collateral circulation were 1. 3 ± 0.6 and 4. 0 ± 0. 9 respectively. There was significant difference (t = -8. 29,P <0. 01). The patients of having collateral circulation formation had good prognosis. Conclusion Multimodal CT examination has certain clinical significance for evaluation of cerebral perfusion state,understanding the establishment or patency of cerebral collateral circulation,and determining the clinical prognosis.
ABSTRACT
Objective To investigate the thermostability of aristolochic acid Ⅰand the effect of the compatibility on aristolochic acid Ⅰ in Caulis Aristolochiae Manshuriensis decoction and to explore the detoxification mechanism of compatibility for aristolochic acid Ⅰ.Methods Analyzing the contents of aristolochic acid Ⅰ by HPLC in the single decoction of Caulis Aristolochiae Manshuriensis,the concoction of Caulis Aristolochiae Manshuriensis with Cortex Moutan,the residues of decocted Caulis Aristolochiae Manshuriensis and the residues of concocted Caulis Aristolochiae Manshuriensis with Cortex Moutan,respectively.Results Aristolochic acid Ⅰ decreased after heating in pure water,a new peak was found in HPLC spectra and supposed to be the derivate of aristolochic acid Ⅰ,which was also found in the decoction of Caulis Aristolochiae Manshuriensis.The content of aristolochic acid Ⅰ in the concoction of Cortex Moutan with Caulis Aristolochiae Manshuriensis is lower than that in the single Caulis Aristolochiae Manshuriensis decoction.Furthermore,the quantity of aristolochic acid Ⅰ in the residues of Caulis Aristolochiae Manshuriensis after concoction is lower than that in the residues of single Caulis Aristolochiae Manshuriensis decoction.Conclusion Aristolochic acid Ⅰ is unstable in decoction and a part of it was changed into another compound.The stripping of aristolochic acid Ⅰfrom Caulis Aristolochiae Manshuriensis is not inhibited when Cortex Moutan concocted with Caulis Aristolochiae Manshuriensis.It is the chemical reaction of aristolochic acid Ⅰ,which could decrease the toxicity in the decoction or concoction of Caulis Aristolochiae Manshuriensis.