To explore the clinical value and evaluate the diagnostic accuracy of sub-mSv low-dose prospective ECG-triggering cardiac CT (CCT) in young infants with complex congenital heart disease (CHD). A total of 102 consecutive infant patients (53 boys and 49 girls with mean age of 2.9 ± 2.4 m and weight less than 5 kg) with complex CHD were prospectively enrolled. Scans were performed on a 64-slice high definition CT scanner with low dose prospective ECG-triggering mode and reconstructed with 80 % adaptive statistical iterative reconstruction algorithm. All studies were performed during free breathing with sedation. The subjective image quality was evaluated by 5-point grading scale and interobserver variability was calculated. The objective image noise (standard deviation, SD) and contrast to noise ratio (CNR) was calculated. The effective radiation dose from the prospective ECG-triggering mode was recorded and compared with the virtual conventional retrospective ECG-gating mode. The detection rate for the origin of coronary artery was calculated. All patients also underwent echocardiography before CCT examination. 81 patients had surgery and their preoperative CCT and echocardiography findings were compared with the surgical results and sensitivity, specificity, positive and negative predictive values and accuracy were calculated for separate cardiovascular anomalies. Heart rates were 70-161 beats per minute (bpm) with mean value of 129.19 ± 14.52 bpm. The effective dose of 0.53 ± 0.15 mSv in the prospective ECG-triggering cardiac CT was lower than the calculated value in a conventional retrospective ECG-gating mode (2.00 ± 0.35 mSv) (p < 0.001). The mean CNR and SD were 28.19 ± 13.00 and 15.75 ± 3.61HU, respectively. The image quality scores were 4.31 ± 0.36 and 4.29 ± 0.41 from reviewer 1 and 2 respectively with an excellent agreement between them (Kappa = 0.85). The detection rate for the origins of the left and right coronary arteries was 96 and 90 %, respectively. The detection rates of the origins of left coronary artery and right coronary artery in all cases were 96 % (78/81) and 90 % (73/81), respectively. Twenty cases of conotruncal anomalies and ALCAPA were validated surgically and the accuracy of cardiac CT diagnosis was 95 % (19/20). The overall deformity based sensitivity, specificity, positive predictive value and negative predictive value were 94.0.1, 99.9, 98.6, 99.5 % respectively, by CCT, and 88.2, 99.9, 97.8, 99.0 %, respectively, by echocardiography. Prospective ECG-triggering CCT with sub-mSv effective dose provides excellent imaging quality and high diagnostic accuracy for young infants with complex CHD.

The liquorice plant has long been used in both Eastern and Western cultures. Glycyrrhizin is the major triterpenoid saponin in liquorice root, and glycyrrhetinic acid (GA) is its predominant metabolite and a pharmacologically active form of glycyrrhizin. We have assessed the ability of GA to inhibit the enzyme cytochrome P450 3A (CYP3A). A Lineweaver-Burk plot showed that GA was a mixed inhibitor of CYP3A, with an IC₅₀ of 7.25 µmol/l, a K_m of 4.3 µmol/l and a K_i of 6.4 µmol/l by non-linear regression analysis. CYP3A activity was also affected by intragastric administration of GA, which resulted in increases in area under the plasma concentration-time curve (AUC)_0–t and in apparent elimination half-time (t_1/2) and significant decreases in body clearance, as well as in the formation of 1-hydroxy-midazolam after intragastric or intravenous administration of midazolam (p < 0.05). An increase in C_max after intragastric administration (p < 0.05) was also observed. These results suggest the likelihood of an interaction between GA and CYP3A-metabolised drugs in humans and indicate that liquorice root should be used with caution when taken concomitantly with other drugs that interact with CYP3A.

Direct and indirect GHGs, SOC stock changes, net GHG balance, and GHGI. The annual direct GHGs (N 2 O + CH 4) emissions in the FN600 treatment were 1.88 Mg CO 2-eq ha −1 yr −1 , which was 26.2% higher than in DN600 (P < 0.05) and 44.1% higher than in DN420 (P < 0.05) (Fig. 2c,f). In contrast, the annual indirect GHGs emissions were 29.6% higher in DN600 than in FN600 (12.1 Mg CO 2-eq ha −1 yr −1), mainly because of the higher electricity consumption and polyethylene required for irrigation facilities in DN600 (Table 2). Because DN420 received 30% less N fertilizer than did DN600, its indirect GHGs emissions were 6.4% lower than those of DN600. Direct + indirect GHGs emissions were 23% and 9% higher in DN600 (17.1 Mg CO 2-eq ha −1 yr −1) than in FN600 and DN420, respectively. These results show that, in the life-cycle of wheat and maize production, indirect GHGs are main contributors to overall climate effects. After the 2-year experiment, the SOC content (0-30 cm) in DN420 and DN600 had increased by 0.52 and 0.41 g kg −1 , respectively, significantly more than in FN600 (0.22 g kg −1 , p < 0.05) (Table 2). That is, the increase in SOC stock (0-30 cm) for FN600 in the 2-year experimental period was 0.46 Mg C ha −1 yr −1 , significantly lower than that in DN420 (1.08 Mg C ha −1 yr −1) and DN600 (0.86 Mg C ha −1 yr −1). The annual net GHG balance values were greater than zero for all management systems, indicating that all systems were net GHGs sources (Table 2). Over the 2-year period, the total net GHG balance was 13.0% higher in DN600 (13.9 Mg CO 2-eq ha −1 yr −1) than in FN600. However, the total net GHG balance of DN420 was 15.8% and 4.9% lower than those of DN600 and FN600, respectively. The net GHG balance per unit grain yield is usually defined as GHGI. The GHGI and yield in DN600 (891 kg CO 2-eq Mg −1 grain) were 12.1% and 1.3% higher, respectively, than those in FN600. The GHGI and yield in DN420 were 15.7% lower and 3.2% higher, respectively, than those in DN600.