ObjectiveTo evaluate the clinical efficacy of Zuogui Pill （左归丸，ZGP） decoction on neurological function， motor function， and activities of daily living in patients with ischemic stroke （IS） of liver-kidney yin deficiency syndrome， and to assess its potential mechanisms from the perspectives of cerebral perfusion and corticospinal tract （CST） remodeling. MethodsA total of 108 patients with IS of liver-kidney yin deficiency syndrome and onset time ≤14 days were enrolled and randomly divided into a control group and a treatment group， with 54 cases in each group. The control group received conventional western medicine， while the treatment group received ZGP decoction （one dose per day） in addition to the conventional treatment. Both groups were treated for 90 days. The National Institutes of Health Stroke Scale （NIHSS）， modified Rankin Scale （mRS）， modified Barthel Index （MBI）， Fugl-Meyer Assessment （FMA）， and Chinese medicine syndrome score （CMS） were evaluated before treatment and after （90±3） days of treatment. Three-dimensional arterial spin labeling （3D-ASL） and diffusion tensor imaging （DTI） were performed to obtain ipsilesional cerebral blood flow （CBF） in the unaffected and affected hemispheres， relative CBF （rCBF）， and fractional anisotropy （FA） of the CST. Nodal analysis of FA values along the CST was also conducted. Correlation analysis was used to assess the relationships between post-treatment cerebral perfusion parameters （CBF and rCBF）， and FA values with clinical neurological function scores. ResultsAfter treatment， both groups showed significantly decreased NIHSS， mRS and CMS scores， together with significantly increased FMA and MBI scores （P＜0.01）. Intergroup comparison showed that NIHSS， mRS， and CMS scores in the treatment group were significantly lower than those in the control group ， while MBI and FMA scores were significantly higher （P＜0.01）. The 3D-ASL results revealed that CBF and rCBF values in the affected hemisphere significantly increased in both groups after treatment， and the treatment group had significantly higher values （P＜0.01）. DTI showed that the FA value of the CST on the affected side in the treatment group was significantly higher than that in the control group after treatment （P＜0.05）. Nodal analysis along the CST further demonstrated that the continuity of FA values at lesion-related nodes 45~99 in the treatment group was significantly better than that in the control group （P＜0.01）， with significant increases at nodes 65~71 and 76~81 compared with baseline （P＜0.05 or P＜0.01）， whereas the control group showed a decreasing trend at nodes 80~93 （P＜0.05）. Correlation analysis indicated that CBF and rCBF values in the affected hemisphere were negatively correlated with NIHSS and mRS scores and positively correlated with MBI score （P＜0.05）. FA value of the CST on the affected side， both before and after treatment， were negatively correlated with NIHSS score and positively correlated with FMA score （P＜0.05 or P＜0.01）. ConclusionZGP decoction can effectively improve neurological function， motor function， and activities of daily living in IS patients with liver-kidney yin deficiency syndrome， and its mechanism may be related to enhanced cerebral perfusion in the affected hemisphere and corticospinal tract structural remodeling.

Objective:To analyze the efficacy of laparoscopic partial splenectomy and devascularization (LPSPD), open partial splenectomy and devascularization (OPSPD), laparoscopic total splenectomy and devascularization (LTSPD), and open total splenectomy and devascularization (OTSPD) in the treatment of portal hypertension.Methods:Clinical data of 128 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Qinghai University and the General Surgery Department of the Fifth Medical Center of the Chinese PLA General Hospital from May 2018 to May 2022 were retrospectively analyzed, including 69 males and 59 females, aged 51.0±10.9 years. According to different surgical methods, patients were divided into four groups, namely the LPSPD group ( n=30), the OPSPD group ( n=32), the LTSPD group ( n=31), and the OTSPD group ( n=35). Operation time, postoperative hospitalization time, postoperative complications such as newly occurred PVT, etc of the four groups of patients were compared. Results:The operation times of the LPSPD, OPSPD, LTSPD and OTSPD group were 240.0 (180.0, 399.0), 209.5 (169.0, 259.0), 207.0 (175.3, 297.5) and 200.0 (162.0, 264.0) minutes, respectively. The postoperative hospital stays were 8.0 (7.0, 12.0), 10.0 (8.3, 11.8), 11.0 (9.0, 13.0) and 13.0 (11.0, 15.0) days, respectively. The incidences of newly occurred PVT after surgery were 3.3% (1/30), 3.1% (1/32), 19.4% (6/31), and 20.0% (7/35), respectively. The above indicators were compared among the four groups respectively, and the differences were statistically significant (all P<0.05). The postoperative hospital stay of the LPSPD group was shorter than that of the LTSPD group [8.0 (7.0, 12.0) vs 11.0 (9.0, 13.0), d, Z=-3.93], and the postoperative hospital stay of the OPSPD group was also shorter than that of the OTSPD group [10.0 (8.3, 11.8) vs 13.0 (11.0, 15.0), d, Z=-3.56; all P<0.001]. The incidence of newly occurred PVT after surgery in the partial splenectomy group (LPSPD and OPSPD) was 3.2% (2/62), which was lower than that in the total splenectomy group [LTSPD and OTSPD, 19.7% (13/66), χ2=8.38, P=0.004]. Conclusion:Compared to total splenectomy, partial splenectomy might be favorable for the shortened postoperative hospital stay and lower incidence of newly occurred portal vein thrombosis.

Objective:To analyze the efficacy of laparoscopic partial splenectomy and devascularization (LPSPD), open partial splenectomy and devascularization (OPSPD), laparoscopic total splenectomy and devascularization (LTSPD), and open total splenectomy and devascularization (OTSPD) in the treatment of portal hypertension.Methods:Clinical data of 128 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Qinghai University and the General Surgery Department of the Fifth Medical Center of the Chinese PLA General Hospital from May 2018 to May 2022 were retrospectively analyzed, including 69 males and 59 females, aged 51.0±10.9 years. According to different surgical methods, patients were divided into four groups, namely the LPSPD group ( n=30), the OPSPD group ( n=32), the LTSPD group ( n=31), and the OTSPD group ( n=35). Operation time, postoperative hospitalization time, postoperative complications such as newly occurred PVT, etc of the four groups of patients were compared. Results:The operation times of the LPSPD, OPSPD, LTSPD and OTSPD group were 240.0 (180.0, 399.0), 209.5 (169.0, 259.0), 207.0 (175.3, 297.5) and 200.0 (162.0, 264.0) minutes, respectively. The postoperative hospital stays were 8.0 (7.0, 12.0), 10.0 (8.3, 11.8), 11.0 (9.0, 13.0) and 13.0 (11.0, 15.0) days, respectively. The incidences of newly occurred PVT after surgery were 3.3% (1/30), 3.1% (1/32), 19.4% (6/31), and 20.0% (7/35), respectively. The above indicators were compared among the four groups respectively, and the differences were statistically significant (all P<0.05). The postoperative hospital stay of the LPSPD group was shorter than that of the LTSPD group [8.0 (7.0, 12.0) vs 11.0 (9.0, 13.0), d, Z=-3.93], and the postoperative hospital stay of the OPSPD group was also shorter than that of the OTSPD group [10.0 (8.3, 11.8) vs 13.0 (11.0, 15.0), d, Z=-3.56; all P<0.001]. The incidence of newly occurred PVT after surgery in the partial splenectomy group (LPSPD and OPSPD) was 3.2% (2/62), which was lower than that in the total splenectomy group [LTSPD and OTSPD, 19.7% (13/66), χ2=8.38, P=0.004]. Conclusion:Compared to total splenectomy, partial splenectomy might be favorable for the shortened postoperative hospital stay and lower incidence of newly occurred portal vein thrombosis.

Objective:To investigate the impact on image quality of a new deep learning image reconstruction (DLIR) algorithm in dynamic CT myocardial perfusion imaging (CTP) and to explore whether the algorithm affects the quantification of myocardial blood flow (MBF) in swine.Methods:Dynamic CTP imaging was performed in five anesthetized domestic swine [body weight (58.6±1.9) kg], at both rest and stress state. The tube voltages were fixed at 100 kV, and the low-dose and high-dose scanning tube currents were set as 150 mA and 300 mA, respectively. The low-dose (LD) scan data were reconstructed with filtered back projection (FBP) and three different DLIR strengths (low, medium, and high). High-dose (HD) scan data were reconstructed with filtered back projection (FBP) only. Subjective (5-point scale) image quality was evaluated, and objective evaluations included image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) was performed. Linear regression was used to test the linear trend between DLIR algorithm strength and image quality. Data sets normality was determined by the Shapiro-Wilk test. Comparisons between groups were performed using Student′s t test for normally distributed data or the Wilcoxon rank-sum test for non-normally distributed data. Results:The mean effective radiation dose was 7.2 and 3.8 mSv for the HD protocol and the LD protocol, respectively, with statistically significant difference found between two protocols ( t=282.50, P<0.001). The image noise of the images obtained at LD protocol gradually decreased and the image SNR and CNR gradually increased with DLIR algorithm strength increased ( F=60.10,35.87,41.41; P for trend were all<0.001). As for DLIR-high strength (LD) and FBP (HD) images, the image noise values were (31.7±3.1) and (38.2±1.2) HU; SNR were 16.6±2.0 and 13.8±0.8; CNR were 14.5±1.7, 11.6±0.9, respectively, with significant differences found between two groups ( t=5.70, 4.15, 5.68; all P<0.05). The subjective scores of DLIR-high strength (LD) and FBP (HD) images were significantly different (4.8±0.4 and 4.2±0.6, Z=2.12, P<0.05). No significant differences were found between the MBF calculated from FBP (LD) and from DLIR-high strength (LD), with the values as (81.3±17.3) ml·100 ml -1·min -1 vs. (79.9±18.3)ml·100 ml -1·min -1 at rest state; and (99.4±24.9)ml·100 ml -1·min -1 vs. (100.7±27.3) ml·100 ml -1·min -1 at stress state ( t=1.10, 0.89; P>0.05). Conclusion:DLIR-high strength can improve image quality of myocardial CTP in swine, and can reduce radiation dose without influencing the MBF calculation.

OBJECTIVE: To explore the clinical and genetic characteristics of a Chinese pedigree affected with hereditary dentinogenesis imperfecta (DGI) type II. METHODS: Clinical data of the pedigree members were collected. Genomic DNA was extracted from peripheral blood samples and subjected to whole exome sequencing. RESULTS: Clinical characteristics of the affected family members have included amber teeth along with significant attrition, constricted roots and dentine hypertrophy leading to pulpal obliteration, which were suggestive of DGI type II. All of the affected members were found to have harbored a novel heterozygous c.2837delA (p.Asp946Valfs*368) variant of the DSPP gene which was predicted to be likely pathogenic. CONCLUSION The c.2837delA variant of the DSPP gene probably underlay the disease in this pedigree. Above finding has expanded the variant spectrum of DSPP gene and provided a basis for molecular diagnosis and genetic counseling for this pedigree.
Dentinogenesis Imperfecta/genetics* ; Extracellular Matrix Proteins/genetics* ; Humans ; Mutation ; Pedigree ; Phosphoproteins/genetics* ; Sialoglycoproteins/genetics*

Objective:To evaluate the feasibility of making individualized scanning and contrast injection protocol based on body mass index (BMI) and body weight during dynamic myocardial computed perfusion (CTP) imaging in order to get high-quality images while drastically reducing radiation dose.Methods:A total of 128 patients with coronary heart disease diagnosed by coronary CTA (CCTA) performed CTP from June, 2019 to March, 2020 were prospectively enrolled. Patients were divided into six groups: group 1, BMI<24 kg/m 2, ≤60 kg, 70 kV; group 2,BMI<24 kg/m 2, 61≤kg≤70, 70 kV; group 3, BMI 24-28 kg/m 2, 61≤kg≤70, 80 kV; group 4, BMI 24-28 kg/m 2, 71≤kg≤80, 80 kV; group 5, BMI 24-28 kg/m 2,>80 kg, 80 kV;group 6, BMI>28 kg/m 2,>80 kg, 100 kV. 200 mA was fixed for all patients. Contrast agent with iodine containing 370 mg/ml was used in all patients. The iodine delivery rates (IDR) for each group was 0.8, 1.0, 1.2, 1.4, 1.6, 2.0 g/s, respectively. The attenuation and noise of left ventricle (LV) and septal myocardial were measured to calculate signal to noise ratio (SNR) and contrast to noise ratio (CNR) of the images in each group. The Shapiro-Wilk test was conducted to assess the normality of quantitative data. Quantitative variables were compared using one-way ANOVA if normally distributed. Results:The LV attenuation of the six groups were (506±85), (513±77), (510±81), (456±74), (477±111), (462±43) HU, respectively. There was no significant difference among them ( F=2.249, P=0.054). SNR values of LV were 23±8, 20±5, 21±5, 19±4, 19±7, 19±4, and CNR values were 19±7, 17±4, 17±4, 16±4, 15±6, 15±4, respectively. There were no significant differences among them ( F=1.674, 1.736, all P>0.05). Under a single CTP scan, the radiation dose of 70, 80 and 100 kV groups were 1.6, 2.3 and 4.3 mSv, respectively. The does of the 70 kV group and 80 kV group were significantly lower than that of the 100 kV group, and the dose of the 70 kV group was also significantly lower than that of the 80 kV group (all P<0.001). Conclusions:The application of individualized scanning and contrast agent injection protocol based on IDR is feasible in myocardial CTP with successful image quality, and the radiation dose decreases significantly.

Objective To explore comprehensive nursing measures to the high-risk patients with cerebral apoplexy in nursing outpatient and evaluate the effect.Methods Convenience sampling method was used to select 75 high-risk cerebral apoplexy patients in the nursing outpatient from April 201 4 to December 201 4,patients were carried out comprehensive nursing measures including measuring blood pressure,body weight,and abdominal circumference,instructing to take medication correctly and establish a healthy physical exercise and diet style.Results After 6 months of intervention,systolic blood pressure and diastolic blood pressure of the subjects decreased from (1 48.40 ±1 3.86)mmHg to (1 33.1 ±1 2.49)mmHg and (84.75 ± 8.50)mmHg to (79.75 ±7.40)mmHg respectively(P <0.05).Before and after intervention,the reasonable exercise rate rose from 41 .3% to 72.9%,smoking rate decreased from 53.3% to 21 .4%,compliance with medication rose from 52.0% to 85.7%,salty diet rate decreased from 56.0% to 37.1 %,oiled diet rate decreased from 69.3% to 1 5.7%,compliance with fruit intake rose from 38.7% to 90.0%,compliance with milk drink rose from 30.7% to 75.7%(P <0.05).Conclusions Outpatient comprehensive stoke intervention measures to patients with high-risk for cerebral apoplexy can reduce the risk factors to stoke,improve lifestyle and provide basis for stoke high-risk population.

Objective To investigate the status of work fatigue of the disabled and the healthy so that we get to know their employment quality and compressive strength, and then provide the theory basis for the national policy formulation and vocational rehabilitation. Methods We randomly investigated 280 employees (220 disabled, 60 healthy people) in 3 companies from 3 provinces with Fatigue Impact Scale (FIS). Results There was no statistically significant difference between disabled and healthy people about work fatigue, and also that of 3 domains including psycho-social, cognitive and physical activity. After comparison of 40 items on FIS，the disabled had higher fatigue than that of the healthy in 4 items which belonged to psycho-social domain (P<0.05). Conclusion Disabled people are no less than healthy people in compression capability and working capability. They should believe in themselves, and their family and the employees should have more confidence about their work capability than before. Government should provide some support with them on job retention.