A hippocampal anti-hypertensive mechanism induced by twirling reinforcing-reducing manipulation in rats

Objective:To investigate a hippocampal anti-hypertensive mechanism induced by twirling reinforcingreducing manipulation(TRRM)using proteomics in rats.Methods:Forty-two male spontaneously hypertensive rats were randomly divided into 3 groups,and 14 Wistar-Kyoto rats were served as control group.In the twirling reinforcing(TRF)group,needles were directly inserted into the Taichong(LR 3)point,then thumbs were moved heavily forward and lightly backward for 3 min,while needles remained inserted for 17 min.In the twirling reduction(TRD)group,the same treatment was applied as in the TRF group except that the thumb moved lightly forward and heavily backward.In the model and control groups,only the corresponding grasping and fixation were applied.All interventions were conducted for 14 days.The blood pressure(BP)of all rats was measured one day before intervention and every other day after.Then hematoxylin-eosin(H&E)staining,label-free and parallel reaction monitoring proteomic techniques were used to assess hippocampal samples from each group.Results:Systolic BPs showed a significant decrease in the TRF and TRD groups compared with the model group(P<.01).In the model group,H&E staining showed obvious pathological changes in the hippocampus,while in the TRF and TRD groups,the hippocampal morphology was only slightly altered.Labelfree proteomic analysis revealed 1163 differential protein expressions between groups.Gene Ontology enrichment analysis confirmed that the differentially expressed proteins were enriched in different biological processes,cellular components,and molecular functions.Kyoto Encyclopedia of Genes and Genomes enrichment analysis showed that TRRM proteins were expressed in the serotonergic synapse pathway,renin-angiotensin system,the mitogen-activated protein kinase signaling pathway,and the peroxisome pathway,which were all also related to BP regulation.Conclusion:TRRM can significantly lower the BP of SHRs.The mode of action may be through the activation of various protein pathways in the hippocampus that are related to BP regulation.

Percutaneous Coronary Intervention in Acute Coronary Syndromes at the Mother-Child University Hospital Luxembourg in Bamako

Introduction: Acute coronary syndromes (ACS) are a diagnostic and therapeutic emergency. Objective: Studying the feasibility, difficulties and results of coronary angioplasty in acute coronary syndromes at the Luxembourg Mother-Child University Hospital in Bamako. Patients and Methods: Cross-sectional, descriptive study with prospective recruitment over 18 months from September 2020 to February 2022. All patients aged at least 18 years old admitted for SCA and having undergone PCI during the study period were included. Result: We collected 249 patients for SCA, of whom 160 underwent angioplasty, either an angioplasty/SCA ratio of 0.64. The average age of the patients was 59.54 ± 11.62 with extremes of 32 and 92 years. The age group of 45 to 65 years was the most representative. The predominance was male, sex ratio of 2.4. The main cardiovascular risk factors were high blood pressure (58.23%) and diabetes (45.78%). Persistent ST-segment elevation on the electrocardiogram was present in 71.48%. The treatment time was more than 12 hours after the first medical contact in 95.5%. The approach was radial in 96.5% of cases. Coronarography was pathological in 91.16% of our patients. The lesions were tri-truncular in 34.13% with the anterior inter ventricular as culprit artery in 72% of cases. The majority of patients (64%) had undergone angioplasty with implantation of an active stent. Angioplasty was performed successfully in 98% and per procedural mortality was 1.87%. Only 6.45% of ACS with ST elevation benefited from primary angioplasty. Conclusion: Percutaneous coronary intervention is performed routinely in our center with satisfactory results. Difficulties exist, related to the diagnostic delay of ACS and the high cost of angioplasty.

Practice of Upper Gastrointestinal Endoscopy at the Mother-Child Hospital in Bamako/MALI: About 465 Cases

Introduction: Upper gastrointestinal (GI) endoscopy is an examination that involves exploring the upper part of the digestive tract using an endoscope. Our study was aimed to evaluate the practice of Upper GI endoscopy at the mother-child hospital in Mali. Patients and Methods: This was a descriptive retrospective study on reports of Upper GI endoscopy results in the digestive endoscopy unit at the mother-child hospital in Bamako from January to December 2018. Results: Endoscopy was performed in 465 patients including 231 males and 234 females. The sex ratio was 0.98. Patients were aged 46.69 years old on average with the extremes of 8 and 90 years old. Epigastralgia was the main referral in 50.5%. Endoscopy was normal in 24.7%. The main diagnostics were duodenogastric reflux in 32.5% and gastritis in 14.4%. Conclusion: The practice of Upper GI endoscopy at the mother-child hospital in Mali has allowed the exploration of the upper digestive tract to contribute to the diagnosis of esogastroduodenal lesions.

Factors Associated with Mother-to-Child Transmission of HIV at the Maternity Unit of the Castors Urban Health Center in Bangui

Introduction: In spite of significant progress towards eliminating mother-to-child transmission (MCT) of HIV by 2025, trends in vertical mother-to-child transmission are still worrying in sub-Saharan African countries. This study aims to take stock of the factors associated with HIV MCT at the level of peripheral health training. Patients and Methods: This was a descriptive and analytical retrospective study, over a five-year period from January 1st, 2017 to December 31st, 2021. The study population was represented by HIV-positive women and their cared infants in the Parent-Child Transmission Prevention Unit (PCTP) of the Castors Urban Health Center (CUHC). Results: 288 medical records were selected out of a total of 347 HIV-positive mothers followed. HIV seroprevalence in the population of women who received PreNatal Consultation (PNC) during the study period was 8.2%. The HIV MCT rate was 3.7%. HIV+ mothers followed were mostly young (average age of 28), not living in a couple (96.9%), poorly educated (58.7%) and not engaged in income-generating activity (58.4%). They had all received triple therapy and the period of initiation of antiretroviral (ARV) therapy was in the majority of cases during the first trimester. Factors associated with MCT were: primiparity (OR = 18.4 [5.55 - 61.05];Khi2 = 32.61;p < 0.001), late discovery of infection during large or after childbirth (OR = 0.03 [0.007 - 0.10];Khi2 = 55.22;p < 0.001), WHO Clinical Stage 2 and 3 (OR = 0.007 [0.001 - 0.03];Khi2 = 108.73;p < 0.001), CD4 count 200/mm3 (OR = 14.12 [4.03 - 57.20];Khi2 = 21.68;p < 0.001), viral load > 1000 copies/mm3 (OR = 8.85 [2.33 - 43.20];Khi2 = 10.46;p = 0.001), prolonged labor (OR = 12.33 [3.45 - 57.25];Khi2 = 18.47;p < 0.001), premature rupture of membranes (OR = 24.03 [6.97 - 96.01];Khi2 = 40.60;p 2 = 5.96;p = 0.014), and artificial or mixed breastfeeding (OR = 0.01 [0.002 - 0.043];Khi2 = 97.65;p Conclusion: Taking into account the risk factors for PCTP is essential if we want to achieve the goal of “Zero New Infections in Children by the year 2025”.

Microbiology laboratory and the management of motherchild varicella-zoster virus infection

Varicella-zoster virus, which is responsible for varicella(chickenpox) and herpes zoster(shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella(particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times:(1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection;(2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear(atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation;(3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and(4) when the baby is born and it is necessary to confirm a diagnosis of varicella(and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.

Effect of complex reinforcing-reducing manipulation on lower limb motion and balance disorder in patients with subacute combined degeneration of the spinal cord

Objective：To observe the effect of complex reinforcing [Shao Shan Huo （Mountain-burning Fire）] and reducing [Tou Tian Liang （Heaven-penetrating Cooling）] manipulations on motion and balance of the lower limbs in patients with subacute combined degeneration of the spinal cord （SCD）. Methods：A total of 100 SCD cases were randomly allocated into an observation group and a control group by their visit sequence, 50 cases in each group. On the basis of Western medical treatment, cases in the observation group were also treated with acupuncture therapy plus complex reinforcing-reducing manipulation; whereas cases in the control group were only treated with the same Western medical treatment as those in the observation group. Before and 2 months after treatment, kinematic parameters including muscle force, muscle tone and range of motion of the hip and knee joints were measured. In addition, balancing parameters including the path length of center of pressure （COP）, peripheral area, COP path length per unit area and rectangular area were also measured before and after treatment. Results：After treatment, there were statistical intra-group differences in COP path length, peripheral area, COP path length per unit area, left-right offset, rectangular area, coefficient of stability and coefficient of weight distribution （P〈0.01）. There were statistical inter-group differences in muscle force, muscle tone and range of motion of hip and knee joints （P〈0.01）. The total effective rate was 83.3% in the observation group, versus 60.0% in the control group, showing a statistical difference （P〈0.05）. Conclusion：Complex reinforcing-reducing manipulations can improve the lower limb motion and balance in SCD patients.

Review on Sons and Lovers

This essay centralizes on the analysis of the writing skills,the theme and my personal insights of Sons and Lovers,as well as my interpretation of the mother-son relationship in terms of feminism.Overall,hope it will provide a specific perspective of this renowned novel and arouse the readers'attention to interpret the novel themselves.

Effect of complex reinforcing-reducing manipulations on hip and knee flexion and extension angles after surgery of gluteus maximus contracture

Objective： To observe the effect of complex reinforcing-reducing manipulations of acupuncture on flexion and extension angles of hip and knee in patients after surgical treatment of gluteus maximus contracture. 〈br〉 Methods： A total of 66 cases following surgery of gluteus maximus contracture were randomly allocated into an observation group and a control group by the random digits table, 33 in each group. In addition to basic treatment, cases in the observation group were treated with reducing manipulation [Tou T ian Liang （Heaven-penetrating Cooling）] on Zhibian （BL 54）, Huantiao （GB 30） and Juliao （GB 29） on the affected side and reinforcing manipulation [Shao Shan Huo （Mountain-burning Fire）] on Biguan （ST 31）, Futu （ST 32）, Zusanli （ST 36）, Fenglong （ST 40）, Xuehai （SP 10）, Diji （SP 8） and Yanglingquan （GB 34）. Patients in the control group only received the same basic treatment as the observation group. The treatment was done once a day, 30 d for a course and a 1-week interval between two courses. Then the flexion and extension angles of hip and knee were evaluated using the Lokomat full automatic robot gait evaluation system after 3 courses of treatment. 〈br〉 Results：There were intra-group statistical differences in hip flexion angle on foot followed （HFA-FF）, the maximum of hip flexion angle （MAX-HFA）, the maximum of hip extension angle （MAX-HEA）, knee flexion angle on foot followed （KFA-FF）, the maximum of knee flexion angle on stance phase （MAX-KFA-TP） and the maximum of knee flexion angle on swing phase （MAX-KFA-WP） in the observation group and in HFA-FF, MAX-HEA and KFA-FF in the control group （P＆lt;0.05）. There were between-group statistical differences in HFA-FF, MAX-HFA, MAX-HEA, KFA-FF and MAX-KFA-TP （P＆lt;0.05）. 〈br〉 Conclusion： The complex reinforcing-reducing manipulations of acupuncture can effectively improve the hip/knee functions following surgery of gluteus maximus contracture.

Predictors of Exclusive Breastfeeding Duration among Mothers Attending Immunization Clinic in a Tertiary Health Facility in Enugu, Nigeria

Background: Breastfeeding is cost effective means towards the realization of some key United Nations Sustainable Development Goals by the year 2030 particularly in resource limited settings. The objectives of the study were to evaluate the predictors of exclusive breastfeeding duration among mother and child pairs utilizing a tertiary immunization clinic facility. Methods: This was a cross-sectional descriptive study. Respondents were mother-and-child pairs who were recruited consecutively. Relevant maternal and child characteristics were collected using a semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences version 20.0 (p Results: Four hundred and twenty seven mother-child pairs were studied. Majority of the mothers have at least secondary education, 383 (80.7%). 407 (95.3%) of the mothers fully understood the actual meaning of EBF. 189 (42.7%) reported practicing EBF in their index child for six months. Maternal perception of insufficient milk production, 52/99 (52.5%) was the most common reason for practicing EBF for Maternal education and occupation and gender of the child were significantly associated with completion of EBF for 6 months among respondents. Conclusion: EBF duration in the current study is low and is significantly associated with maternal education, maternal occupation and gender of the child. Improving girl child education, complementing baby friendly hospital initiative with baby friendly community initiative should be adopted to improve EBF duration in our setting.

Application of a rapid exchange extension catheter technique in type

BACKGROUND In transradial intervention procedures,poor back-up support and noncoaxial alignment of the guide catheter(GC)may result in failure of the balloon or stent to reach the targeted lesion.Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications.A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.AIM To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.METHODS A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study.The clinical characteristics,indications for use of the rapid exchange extension catheter,and procedural details and results were reviewed and analyzed.All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.RESULTS The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity(37.8%),followed by heavy calcification(28.9%),long lesions(20.0%),proximal stent(6.7%),in-stent restenosis(5.2%),and coronary origin anomalies(1.5%).The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter:Multiple predilatation technique(57%),buddy wire technique(33.4%),balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extensioncatheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheterservice time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success(balloon or stent successful crossing of the target lesion with this technique) was94.8%.CONCLUSIONThe rapid exchange extension catheter technique showed acceptable safety andefficacy in the transradial coronary interventions of type B2/C nonocclusivecoronary lesions. We recommend this technique to assist in complex lesionintervention via radial access.

Research on laws of effect of different acupuncture-moxibustion therapies based on data mining

Different acupuncture-moxibustion therapies can produce different clinical effects, that is, the effect has specificity, which is significantly important in obtaining acupuncture-moxibustion efficacy. In this study, the clinical application laws of fire needle, acupoint injection, catgut embedment, acupoint application, moxibustion therapy and filiform needle acupuncture were summarized in the aspects of category of disease, efficacy and related prescriptions （such as medication and acupoint selection） based on the result of data mining, and the general applicable categories of disease of acupuncture-moxibustion treatment methods were further screened, so as to guide the clinical application and give play to the best efficacy.

Correlation of Gut Microbiome Between ASD Children and Mothers and Potential Biomarkers for Risk Assessment

Variation of maternal gut microbiota may increase the risk of autism spectrum disorders(ASDs) in offspring. Animal studies have indicated that maternal gut microbiota is related to neurodevelopmental abnormalities in mouse offspring, while it is unclear whether there is a correlation between gut microbiota of ASD children and their mothers. We examined the relationships between gut microbiome profiles of ASD children and those of their mothers, and evaluated the clinical discriminatory power of discovered bacterial biomarkers. Gut microbiome was profiled and evaluated by 16S ribosomal RNA gene sequencing in stool samples of 59 mother–child pairs of ASD children and 30 matched mother–child pairs of healthy children. Significant differences were observed in the gut microbiome composition between ASD and healthy children in our Chinese cohort. Several unique bacterial biomarkers, such as Alcaligenaceae and Acinetobacter, were identified. Mothers of ASD children had more Proteobacteria, Alphaproteobacteria, Moraxellaceae, and Acinetobacter than mothers of healthy children. There was a clear correlation between gut microbiome profiles of children and their mothers; however, children with ASD still had unique bacterial biomarkers, such as Alcaligenaceae, Enterobacteriaceae, and Clostridium. Candidate biomarkers discovered in this study had remarkable discriminatory power. The identified patterns of mother–child gut microbiome profiles may be important for assessing risks during the early stage and planning of personalized treatment and prevention of ASD via microbiota modulation.

Different manual manipulations and electrical parameters exert different therapeutic effects of acupuncture

Acupuncture is an important component part of Traditional Chinese Medicine(TCM). The therapeutic effects may be influenced by a variety of factors.Stimulation quantity is one of the factors for achieving good therapeutic effects in acupuncture practice. With the development of science and technology, besides the influence of manual manipulations, the parameters adopted for electroacupuncture have become the benchmark of stimulation quantity. This study, by referring to the related literatures, is designed to explore the influence of manual manipulations and electrical parameters on therapeutic effects of acupuncture. The results from the present study show that different manualmanipulations and electrical parameters may exert different therapeutic effects of acupuncture, which are closely related to the characteristics of diseases.Different manual manipulations and electrical parameters should be adopted according to syndrome differentiation of TCM. This is very important in acupuncture treatment.

Determination of Temperature-time Curve of Two Mild Moxibustion Methods:Reinforcing and Reducing

Objective： To observe the specificity of reinforcing and reducing methods of mild moxibustion and explore its clinical significance. Methods： Thirty healthy students were selected and given reinforcing of mild moxibustion on the left Neiguan （PC 6） and reducing on the right Neiguan （PC 6） respectively. Temperature of the acupoint skin surface and the temperature-time curve were recorded by a digital thermometer. Results： In application of mild moxibustion on Neiguan （PC 6）, there was a statistical difference in the temperature-increase section between reinforcing and reducing methods （P〈0.01）. The temperature-increasing section of the temperature-time curve in the reducing method was obviously steeper than that in the reinforcing method. In the period of 0.5-3 min during moxibustion, the temperature of Neiguan （PC 6） was remarkably higher in the reducing than in the reinforcing （P〈0.01）. In the application of the reducing, the time for the temperature of Neiguan （PC 6） to increase to 40~C was remarkably advanced （P〈0.05） and the rate of burning pain in the subjects was remarkably higher in the reducing method than in the reinforcing method （P〈0.001）. Conclusion： In comparison with the reinforcing method, the acupoint temperature increased more quickly in the application of reducing method and can produce obvious hot stimulation in a short period of time. In the application of the reinforcing method, the acupoint temperature increased mildly and could enhance the tolerance of the organism to the high temperature.

Observation on lower-reinforcing and upper- reducing acupuncture method for hyperplasia of mammary gland and its influence on estradiol and progesterone

Objective： To observe the clinical effect of lower-reinforcing and upper-reducing acupuncture method for hyperplasia of mammary gland （HMG） and its influence on estradiol （E2） and progesterone （P）. Methods： A randomized, single-blinded and controlled trial was conducted. A total of 124 cases conforming to the inclusion criteria were randomized by random number table into a treatment group and a control group, with 62 cases in each group. Patients in both groups received acupuncture therapy at the same acupoints, while patients in the treatment group received lower-reinforcing and upper-reducing method, and patients in the control group received even reinforcing-reducing manipulation. The treatment started around 10 d before menstruation and was conducted every other day. Patients received 5 treatments in each menstruation cycle for consecutive 3 cycles. The levels of E2, P and E2/P and clinical efficacy were measured before and after treatment. Results： After treatment, the breast lump size, pain intensity and concomitant symptoms score in both groups were substantially lower than those before treatment, showing statistical significances （all P〈0.01）, and the improvement in the treatment group was higher than that in the control group, and the between-group comparisons showed statistical significances （all P〈0.01）. After treatment, the overall effective rate was 91.9% in the treatment group, higher than 72.6% in the control group, and the between-group comparison showed a statistical significance （P〈0.01）. After treatment, levels of E2, P and E2/P value showed no statistical significance when compared with those before treatment in the two groups （all P〉0.05）. Conclusion： Lower-reinforcing and upper-reducing acupuncture method can effectively alleviate clinical symptoms and signs in HMG patients, and produce a better effect than even reinforcing-reducing manipulation. The majority of HMG patients＇ E2, P level and E2/P value were not beyond the normal ranges; therefore, acupuncture showed no substantial influence on E2 and P levels and E2/P value.

Relative specificity of acupuncture reinforcing and reducing methods

OBJECTIVE:To probe the effects of acupuncture reinforcing and reducing methods on the human body.METHODS:Studied acupuncture reinforcing and reducing actions in the ancient literature,based on modern clinical and experimental studies,in combination with experience of acupuncture teaching and clinical treatment.RESULTS:The key to the generation of reinforcing and reducing actions is not the acupuncture reinforcing and reducing methods themselves,but instead the functional state of the patient during the acupuncture.When reinforcing and reducing methods act on the human body,a reinforcing-reducing effect is produced through regulation of Qi,indicating that the production of the reinforcing-reducing effect requires a certain condition.Specifically,acupuncture does not produce the reinforcing-reducing effect under all conditions,but can produce a reinforcing effect in patients with deficiency syndrome and a reducing effect in patients with excess syndrome.CONCLUSION:Reinforcing and reducing methods each have therapeutic effects on both deficiency syndrome and excess syndrome,but a reinforcing method should be selected first for deficiency syndrome and a reducing method should be selected first for excess syndrome.

Therapeutic Efficacy Observation on ‘Setting Fire on the Mountain’ Manipulation by Lu Shou-yan for Cervical Radiculopathy

Objective: To observe the clinical effect of ‘setting fire on the mountain' manipulation by Lu Shou-yan for cervical radiculopathy as well as the infrared thermographic changes of the cervical area before and after treatment. Methods: A total of 120 eligible cases with cervical radiculopathy were randomly allocated into an observation group and a control group, 60 in each group. Cases in the observation group were treated with Lu Shou-yan's ‘setting fire on the mountain' manipulation, whereas cases in the control group were treated with even reinforcing-reducing manipulation. After two courses of treatment, the infrared thermographic changes and overall therapeutic efficacies in the two groups were compared. Results: The recovery rate and total effective rate in the observation group were 68.3% and 98.3% respectively, versus 28.3% and 81.7% in the control group, showing statistical differences in recovery rate and total effective rate(both P < 0.01). There was between-group statistical significance in comparing the infrared thermography after treatment(P<0.01). Conclusion: ‘Setting fire on the mountain' manipulation by Lu Shou-yan is better than even reinforcing-reducing manipulation for cervical radiculopathy.

Introduction to LU Shou-yan's Acupuncture Theory

LU considers that correct manipulations are essential to the therapeutic effect. Reinforcing and reducing manipulations are especially important for zang-fu problems. He summarized the typical reinforcing-reducing manipulations： mountain-fire burning and heaven-penetrating cooling method as follows.

Introduction to Prof. HUANG Xian-ming's Needling Techniques

In his over seventy-year practice of Chinese medicine, Prof. HUANG Xian-ming inherited plentiful academic experience from his father, Mr. HUANG Hong-fang and has a thorough understanding of the needling techniques described in Nei Jing （ Inner Canon ） and has developed his own school in the clinical treatment. Prof. HUANG believes that the manipulating skills of the needling techniques are the key to the therapeutic effects, and the needling techniques include the tonifying, reducing, warming, clarifying, ascending, descending, diminishing and opening skills. Among them, the tonifying technique is able to support the anti-pathogenic ability and get rid of deficiency, often used for diseases and patterns induced by insufficiency of qi and blood and low immunity. The reducing technique is used to reduce excessive symptoms and dissipate the pathogens, often used for pathogenic patterns of hyperactive pathogenic heat, qi stagnation and blood stasis, and muscular spasm and swelling.

Application advances of catheter modification in difficult coronary artery Intervention

Background Judkins catheter is widely used in recent years, for clinical angiography and intervention of most normal coronary arteries, but still incapable to deal with the problems caused by difficult coronary artery （DCA）. DCA may influence the procedure of diagnosis and intervention of ischemic heart disease （IHD）. To cope with different subtypes of DCA, catheters like Amplatz, EBU, Leya, etc. were born at that moment, but these stan- dard catheters are used just in special cases and have so many sequences that a local hospital may not be able to keep all of them available routinely at any time. To overcome this problem, some centers perform angiography and intervention using modified catheters based on their own condition and have obtained some experiences. Catheter modification techniques used in these years are reviewed, and are stated respectively based on dealing with different subtypes of DCA to provide practical guidance for clinical diagnosis and intervention for IHD patients having DCA.