Open surgery was the main treatment for abdominal aortic diseases in the past .However , with the development of endovascular instruments , endovascular repair technique has become the main option for abdominal aortic diseases .Unibody bifurcated stent-graft and modular bifurcated stent-graft are often used to treat abdominal aortic diseases .Unibody bifurcated stent-graft has its own features in endovascular repair of abdominal aortic diseases .We made a literature summary on application of unibody bifurcated stent-graft in abdominal aortic diseases .

Objectives: To explore the role of liver in the process of severe acute pancreatitis. Methods:Comparing the survival time, the endotoxin level of plasma and ascites , the IL-6 level of serum and ascites, the platelet granule membrane protein-140 (GMP-140) level of plasma and the histology change of lung between control group, portocaval shunting group(PC), acute necrotic pancreatitis (ANP) group and acute necrotic pancreatitis immediately after portocaval shunt(PC+ANP) group of rats. Measuring the serum IL-6 of control group, portocaval shunt control group (injecting normal saline through caval vein, PCJ), ascites injecting group (AJ) and ascites injecting portocaval shunt group (PC+AJ). Results: The survival time of PC+ANP group was much shorter than those of the other groups, and its plasma endotoxin , serum IL-6 and plasma GMP-140 levels were higher than those of the other groups (P

Objective To investigate the value of low-dose coronary artery imaging with flash dual-energy CT.Methods In total of 240 patients suspected with coronary heart disease were performed dual-energy CCTA(DE-CCTA)and were divided into four groups according to the A tube electric current and the methods of reconstruction,including group A(conventional group:180 mAs+FBP)and low-dose groups(including group B,C,D:1 50 mAs,120 mAs,90 mAs +SAFIRE,respectively).The mean of CT value, image noise,SNR,CNR,image quality and radiation dosage were compared among the four groups.Among the patients,52 cases with coronary artery stenosis which were diagnosised by DE-CCTA were also confirmed by CAG,and the consistency of these two methods in the diagnosis of coronary artery stenosis were compared.Results The scores of all image quality were more than 3 points and were statistically significant among the four groups(P <0.05).The mean of CT value is not statistically significant (P >0.05), while the image noise,SNR,CNR and the radiation dosage were statistically significant (P <0.05)among the four groups.The ED of group D was lower 55.62% than group A.DE-CCTA and CAG in the diagnosis of coronary artery stenosis had satisfactory consistency (Kappa=0.84,P<0.05).Conclusion Low-dose coronary artery DE-CCTA not only have none affect of image quality and diagnostic accuracy, but also can significantly reduce the radiation dosage.

Objective To understand the general self-efficacy level of patients with tuberculosis(TB patients) and its influencing factors, provide evidence for improving the general self-efficacy of TB patients.Methods All TB inpatients in a comprehensive pulmonary hospital were conducted face-to-face survey through a general questionnaire and general self-efficacy scale, self-efficacy level of TB patients and its influencing factors were analyzed.Results Mean scale of general self-efficacy of 402 TB patients was (20.4±4.2), of which only 14 cases(3.5%)showed a high level self-efficacy.163(40.5%), 225(56.0%), and 14(3.5%)patients were with low(10~),medium(20~), and high(30~) self-efficacy scale.The general self-efficacy level of TB patients was influenced by the course of disease(P<0.001), residence(P=0.012), whether or not attended the lecture on tuberculosis education(P=0.034), whether or not conducted physical exercise(P=0.053,stepwise multiple linear regression analysis: P=0.017), working status(P=0.027), No.of hospitalization due to TB(P=0.002), family economic situation(P=0.027), and education level(P=0.020).Conclusion TB patients' self-efficacy level is low, and the general self-efficacy level and its influencing factors should be assessed by health care workers during the follow-up for patients, individualized nursing intervention for improving the TB patients' self-efficacy level should be developed.

Endovascular aortic repair (EVAR) has been the main treatment means for abdominal aortic aneurysm.It has become an expert consensus that in the case of abdominal aortic aneurysm that is complicated by iliac aneurysm,the preservation of internal iliac artery is necessary because it can prevent the occurrence of gluteal muscle ischemnia,sigmoid ischemia,male sexual dysfunction and other complications.In recent years,with the continuous updating of the endovascular devices it has become possible to retain the internal iliac artery in the performance of EVAR.At present,the reconstruction of internal iliac artery in EVAR includes a variety of techniques,including intraluminal iliac branched device (IBD) technique,sandwich technique,common iliac artery covered-stent bell-bottom (BBT) technique,external iliac artery-internal iliac artery intraluminal shunt technique (reverse chimney technique),and spring coil embolism technique.This article aims to make a summary of all the above mentioned techniques.

Objective: To explore the relationship between prepregnancy body mass index, weight gain during pregnancy with preschool obesity and body composition in offspring, so as to provide evidence for gestational weight gain and childhood obesity prevention. Methods: A total of 1 333 preschool children were recruited from 3 kindergartens in Tianjin from September to December 2020. Structured questionnaire was used to collect children s lifestyle information. Height, weight and body fat mass of children were assessed, and body fat percentage (FM%), fat mass index (FMI) and non fat mass index (FFMI) were calculated. Maternal medical records were collected and the mothers were grouped according to their prepregnancy weight status and weight gain during pregnancy. χ 2 test, t test, linear regression model and Logistic regression were used to analyze the differences of obesity and body composition among different groups. Results: The prevalence of overweight and obesity in preschoolers was 12.7% and 7.7%. After adjusting maternal age and delivery, gestational age, gender, age and lifestyle of children, the correlation between maternal pre pregnancy BMI,gestational weight gain with obesity and body composition indexes of children in preschool age was statistically significant ( P <0.05). For mothers with normal weight before pregnancy, excessive weight gain during pregnancy increased risk of high FM% and high FMI in offspring ( OR=1.81, 1.68, P <0.05). There was no significant correlation between maternal weight gain during pregnancy with offspring obesity and body composition among mothers with prepregnant overweight or obesity. Conclusion Maternal weight status before pregnancy and weight gain during pregnancy are correlated with obesity and body composition in the preschool age of offspring. It is suggested that mothers should maintain appropriate weight status before and during pregnancy.

Objective:To explore the predictors and reasons for restenosis in patients with Takayasu′s arteritis(TA) involved renal artery after plain old balloon angioplasty(POBA).Methods:The clinical data of 47 TA patients (47) with renal artery admitted to Xuanwu Hospital, Capital Medical University from January 2014 to December 2020 were analyzed, including 12 man and 35 female. The age ranged from 21 to 43 years old, with an average of (28.52±10.78) years old. All patient were diagnosed as TA and underwent POBA. The patients were divided into restenosis group ( n=18) and non-restenosis group ( n=29). The patients were followed up at 1, 3, and 6 months after surgery, and after 6 months, the patients were followed up every 6 months. All patients were followed up from 36 to 108 months.The basic clinical data of the two groups were compared, and the length of stent and residual stenosis were also compared. Measurement data were expressed as ( ± s), and t-test was used for comparison between groups. Counting data were expressed as the number of cases and percentage, and comparison between groups was analyzed using the chi-square test. Multivariate Logistic regression model was used to analyze the independent risk factors of restenosis after balloon dilation, and the OR value and 95% confidence interval were calculated. Logistic regression model was used to analyze the independent risk factors for restenosis after balloon dilation. Results:All patients received POBA and operation was successfully. Restenosis was found in 18 patients, and 29 patients remained normal during the follow-up. The primary patency rate was 61.7%. Multivariate Logistic regression analysis showed that HDL-C and lesion length were the influencing factors of restenosis after POBA in TA of renal artery. The serum HDL-C level was significantly lower and the lesion was significantly longer in restenosis group than in non-restenosis group ( P<0.05). The proportion of residual stenosis>20% was higher in restenosis group than in non-restenosis group ( P>0.05). Conclusion:Serum HDL-C level, lesion length may be may be independent influencing factors of restenosis after plain old balloon angioplasty in TA of the renal artery restenosis.

Objective: To investigate the effect of anastomotic reinforcing sutures on the incidence of anastomotic leakage after laparoscopic radical resection of rectal cancer. Methods: In this study, 300 patients diagnosed with rectal cancer, scheduled to undergo laparoscopic anterior resection at the Department of Gastrointestinal Surgery of Anhui Provincial Hospital, between September 2014 and December 2016, were prospectively enrolled. Patients were randomly assigned to undergo laparoscopic rectal resection with (reinforcing group, n = 150) or without (control group, n = 150) anastomotic reinforcing sutures. The laparoscopic total mesorectal excision was followed for all patients. In the reinforcing group, 4-0 absorbable sutures were used to reinforce the 2-4 needles used for the 2 cross-cutting lines that formed the stapler. Concurrent obstructions; the need for hemorrhagic emergency surgery, preventive ileostomy, Hartmann operation, abdominoperineal resection, or open surgery; and the presence of unresectable cancer were all reasons for excluding patients from the study. Univariate and multivariate analyses were performed on the clinical data collected for the two groups. According to the multivariate analysis results, patients were further divided into high-risk (≥ 2 high risk factors) and low-risk (≤1 high risk factor) groups, and were stratified to analyze the relationship between reinforcing suture use and the incidence of anastomotic leakage. This trial, approved by the Ethics Committee of Anhui Provincial Hospital, was registered as NCT02830633. Results: A total of 291 patients were included in the study, namely 145 in the reinforcing group and 146 in the control group. There were no significant differences between the two groups with respect to their general data or intra-operative conditions (all P > 0.05) . The overall incidence of anastomotic leakage was 7.6% (22/291) ; 3.4% (5/145) in the reinforcing group and 11.6% (17/146) in the control group (χ² = 6.992, P = 0.008) . Multivariate analyses showed that the lack of reinforcing sutures was an independent risk factor for anastomotic leakage (OR = 2.75; 95%CI, 1.72-5.48; P = 0.014) . Other independent risk factors included NRS2002 score ≥ 3 points, tumor diameter ≥ 4 cm, and tumor to anal margin distance < 5 cm. There were 80 patients in the high-risk group and 211 in the low-risk group, based on the aforementioned 3 risk factors. The incidence of anastomotic leakage was 27.1% (13/48) among the control patients in the high-risk group, but only 6.2% (2/32) among high-risk patients receiving reinforcing anastomotic sutures (χ² = 5.470, P = 0.019) . In the low-risk group, the incidence of anastomotic leakage was 2.7% (3/113) among patients receiving reinforcing anastomotic sutures, and 4.1% (4/98) among those not receiving reinforcing sutures. No significant difference was observed (χ² = 0.333, P = 0.564) . Conclusion Anastomotic reinforcing sutures for the prevention of anastomotic leakage after laparoscopic radical resection of rectal cancer is convenient and effective, particularly for patients with multiple risk factors.

Objective: To investigate the effect of endovascular treatment of cerebral infarction with right aortic arch and Kommerell's diverticulum. Methods: Retrospective analysis was done to assess the treatment effect of a case from vascular surgery, Xuanwu Hospital of Capital Medical University. This case was diagnosed as cerebral infarction with right aortic arch and Kommerell's diverticulum. Results: One month after the treatment of cerebral infarction, we successfully used the thoracic aortic stent to isolate the Kommerell's diverticulum. There were no operative complications occurred. The stent had good shape and smooth blood flow was seen in the stent. Conclusions Endovascular treatment to cerebral infarction with right aortic arch and Kommerell's diverticulum is safe and feasible, and the clinical outcome requires further long-term follow-up.

Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.