Objective To evaluate the efficacy of endovascular stent-graft placement for the treatment of Debakey Ⅲ type aortic dissection. Methods From June 2001 to July 2006, 31 patients with Debakey Ⅲ type aortic dissection were diagnosed by contrast-enhanced CT scan. Vascular access was obtained through the right or left femoral artery after arteriotomy and stent-graft was deployed into the true lumen to occlude the primary entry tear. Immediate aortography was performed after the procedure and the follow-up data of CT scan were evaluated. Results Stent-graft deployment was successfully performed in all the patients. Immediate aortography after the procedure showed no leakage in 27 patients and minor leakage in 4. After the operation, one patient showed paraplegia, and one developed left arm ischemia. No stent movement or organ ischemia was found at the early postoperative stage in the other patients. Six months after the operation, in all the 31 patients, contrast-enhanced CT scan showed the disappearance of the false lumen and thrombosis at the level of the stent; and the minor leakage of was improved in the 4 patients. Four years after the operation, one patient developed severe internal leakage at the approximal end of the stent, and was treated by thoracotomy. Conclusions Endovascular stent-graft placement is effective for the treatment of Debakey Ⅲ type aortic dissection. However, further studies are needed to evaluate its long-term outcomes.

Acute massive pulmonary thromboembolism after pneumonectomy usually results in death if not diagnosed early and treated aggressively.It was a case of acute embolism in the main pulmonary ar-tery with thrombus following right pulmonary wedge resection.Diagnosis was made clinically and with computerized tomography before emergency surgery.Thromboembolectomy was successfully performed on cardiopulmonary bypass and the patient was subsequently discharged home after uneventful recovery.Al-though the patient had no previous history of thrombosis,he took high dose of warfarin for anticoagulating postoperatively,which suggested that the patient with pulmonary embolism attack may be associated with the hypercoagulable state of his own.

Objective To evaluate the value of ultrasound-measured changes in diaphragmatic excursion (DE) in predicting successful weaning from mechanical ventilation during the spontaneous breathing trial (SBT).Methods Sixty-three patients of both sexes,who were mechanically ventilated for more than 24 h and screened for ascertained readiness to wean,aged 45-64 yr,were enrolled in the study.Bilateral DE was measured using ultrasound at 0,10 and 30 min of SBT.The patients who successfully completed 30 min of SBT were extubated.The patients were divided into either success group or failure group according to whether or not weaning was successful.Receiver operating characteristic (ROC) curves were used to evaluate the value of bilateral △DE30-10 in predicting successful weaning.Results There were 48 cases in success group and 15 cases in failure group.Bilateral △DE30-10 was significantly higher in failure group than in success group (P＜0.05).The area under the ROC curves of the right △DE30-10 in predicting successful weaning was 0.958,＜0.175 cm was used to predict successful weaning,and the sensitivity and specificity were 93.3％ and 87.5％,respectively.The area under the ROC curves of the left △DE30-10 in predicting successful weaning was 0.903,＜0.275 cm was used to predict successful weaning,and the sensitivity and specificity were 80.0％ and 89.6％,respectively.Conclusion The fight △DE30-10 measured using ultrasound can serve as an assistant index in predicting successful weaning from mechanical ventilation during SBT.

Objective To research the performance of micro infiltration type lung adenocarcinoma (MIA) in the low -dose CT (LDCT).Methods The clinical data of 34 patients with lung adenocarcinoma who found by LDCT screening and diagnosed as micro infiltration were retrospectively analyzed, LDCT performance of lesions was observed.Results In 34 patients,32 cases of single grinding glass tubers,2 cases of multiple ground glass nodules (2 and above),a total of 36 nodules.With pure glass grinding nodule in 11 (30.5%),mixed grinding glass nodules 25 (69.5%).Lesions was 0.7 -2.4cm in diameter,the diameter was about 1.0 -2.0cm,a total of 27(75.0%),an average of (1.7 ±0.3) cm.5(13.8%) of left upper lobe,left lung lobe 9(25.0%),6(16.6%) of the upper lobe, right lung middle in 8(22.2%),characterized by lower lobe in 8(22.2%).Radiographic signs included air -20 cases (55.6%),fine bronchiectasis sign clear edge in 22(61.1%),Ye Zheng a total of 29(80.6%),including deep lobe 9(25.0%),shallow lobes 20(55.6%),burr 17(47.2%),pleural indentation 20(55.6%).Bronchus truncation 6(16.7%),vascular cluster 9(25.0%).Conclusion Found in LDCT screening between 1.0 -2.0cm in diameter of grinding glass nodules,especially the grinding glass nodules,quantitative classification is higher at the same time, lesion boundaries clear,or points Ye Zheng,burr,air -with fine bronchiectasis and pleural indentation,micro infiltra-tion is characteristic and highly suggestive of lung adenocarcinoma.

Objective To investigate the effect of L-carnitine on pathological changes of myocardium and the underlying mechanism in chronic renal failure rats (CRF). Methods A total of 55 male SD rats were randomly divided into sham group (n=10),model group (n=15),low dose (300 mg/kg),medium dose (600 mg/kg) and high dose (900 mg/kg) L-carnitine group(n=10,each).5/6 subtotal nephrectomy was performed in these rats without sham group.One week after the operation,normal saline or corresponding dose L-carnitine were intragastrically administrated to sham and model group or L-carnitine groups for 17 weeks.Transthoracic echocardiography,mean arterial pressure (MAP),heart rate (HR) and heart weight/body weight were assessed.Moreover,24h urine protein,renal function,SOD,MDA,IL-6,ATP,ADP were measured at the end of the study.Additionally,pathological changes in myocardium were detected by light microscope and transmission electron microscope. Results (1) ATP (μmol/g·wt)in L-carnitine groups (2.35±0.24,3.59±0.28,3.78±0.25) was significantly higher than that in model group (1.61±0.12) (all P＜0.01).(2) Thickness of posterior wall of left ventricle (mm) in high dose L-carnitine group was thinner than that in model group (3.74±0.23 vs 4.18±0.48,P＜0.05). (3) The ratios of heart weight to body weight in both medium dose and high dose L-carnitine groups (3.92±0.27,3.65±0.2) were significantly lower compared to model group (3.99±0.27) (all P＜0.01). (4) Under light microscopy,disarrangement and hypertrophy of cardiac myocytes,increased myocardial fibrosis were observed in model group, while these changes and the pathological scores were significantly improved in both medium dose and high dose L-carnitine groups (7.14±1.07,6.13±0.99),as compared with model group (9.88±1.13) (all P＜0.01).Under electron microscopy,typical changes in cardiac hypertrophy were observed,including dissolution of myocardial fibers,increasing and swelling of mitochondria,membrane rupture as well as matrix increase in model group,while these changes were ameliorated by L-carnitine in a dose-dependent manner. (5) Seventeen weeks after the treatment,both IL-6 and MDA were decreased in all L-carnitine-treated groups than those in model group [IL-6 (ng/L):261.86±13.18,240.12±18.7,233.34±36.88 vs 596.64±81.41; MDA (nmol/L):15.23±2.01,12.41±0.6.10.97±1.9 vs 21.84±2.71).Whereas,SOD (U/ml) were increased in L-carnitine-treated groups (51.2±6.11,58.51±5.52,60.63±6.94) than that in model group(32.01 ±5.69 )(all P＜0.05).(6) No significant differences of systolic,diastolic blood pressure or MAP were found among groups. Conclusion L-carnitine can improve energy metabolism,micro-inflammation and oxidative stress in myocardium of CRF rats,which may be associated with the amelioration of cardiac hypertrophy and fibrosis.

Objective To investigate the effects of parathyroid hormone(PTH)on microinflammatory and nutritional status in maintenance hemodialysis(MHD)patients.Methods Ninety-eight MHD patients were selected,who hod undergone hemodialysis for at least three months before the study and were in a stable clinical status without signs of infection or disease activity.The serum level of intact PTH was measured by electrochemiluminescence immunoassay(ECLIA),while the serum levels of interleukin(IL)-1β,IL-6,IL-8 and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA).The levels of C-reactive protein(CRP),albumin(Alb),pre-albumin(PA),hemoglobin(Hb)and lipids were measured.Body measurement and modified quantitative subjective global assessment(MQSGA)was done simultaneously.Correlation analysis between serum PTH level and the parameters for inflammation and nutrition Was performed.Results The serum levels of intact PTH in MHD patients[(353.46±102.41)ng/L]were significantly higher than those in the control people[(57.45±5.76)ng/L,P<0.01],and the serum levels of IL-1β,IL-6,IL-8,TNF-α and CRP were significantly higher in MHD patients than those in the control people(P<0.01 or <0.05).Relative body weight(RBW),triceps skin fold thickness(TSF),mid-arm circumference(MAC)and mid-arm muscle circumference(MAMC)in MHD patients decreased significantly(P<0.05 or <0.01),while the score of MQSGA increased markedly(P<0.01).The levels of intact PTH showed significantly positive correlations with the levels of CRP,IL-1β, IL-6,TNF-α, lipoprotein(a) [Lp(a)] , serum phosphorus and ages of MHD(P<0.05 or <0.01 ).The levels of intact PTH showed significantly negative correlations with RBW, MAC, MAMC, Alb, Hb and total cholesterol(TC) in MHD patients (P<0.01 or <0.05) . And there was also significantly positive correlation between PTH and MQSGA in MHD patients (P<0.05). Conclusion PTH is probably involved in the presence and the progression of malnutrition-inflammation-atherosclerosis syndrome in MHD patients.

AIM:To observe the effect of altitude hypoxia on ?-aminobutyric (GABA) content and prepro-somatostatin mRNA (PPS-mRNA) in the rat hypothalamus. METHODS: Using altitude hypoxia model,in situ hybridization and amino acid analyzer, the number of PPS-mRNA and GABA content in rat hypothalamus was determined. RESULTS:After altitude hypoxia, the contents of GABA in hypothalamus and the number of PPS-mRNA neurons in periventricular nucleus (PeVN), paraventricular nucleus (PaVN) and arcuate nucleus (ArcN) increased significiantly. Bicuculline, a GABA receptor antagonits, could enhance PPS-mRNA expression evoked by altitude hypoxia, but had no effect on GABA content. CONCLUSION: Altitude hypoxia can induce neurotransmitter imbalance of hypothalamus.

AIM: To observe the effect of altitude hypoxia on glutamate, aspartate and nitric oxide synthase (NOS) in the rat hypothalamus. METHODS: Using altitude hypoxia model, amino acid analysis system and the NADPH-d histochemistry, we determined the content of glutamate, aspartate and the number of NADPH-d neurons in the rat hypothalamus. RESULTS: After altitude hypoxia, the contents of glutamate, aspartate in the hypothalamus of rats were increased significantly, densely and deeply stained NADPH-d neurons were seen in hypothalamic paraventricular nucleus (PVN)and supraoptic nucleus(SON). If rat were pretreated with the NMDA receptor blockers Ketamine (ip,40 mg/Kg)or AP-V(i.c.v, 10 ?g) , the number of NADPH-d neurons in the rat hypothalamic PVN and SON was markedly less than that in corresponding altitude hypoxia group. CONCLUSION: NMDA receptor may take part in the expression of hypothalamic NOS induced by altitude hypoxia.

Objective To investigate the expression and clinical significance of myeloid cell leukemia-1 (MCL-1) and F-box and WD repeat domain-containing 7 (FBW7) in breast cancer polyploid induced by spindle poisons. Methods (1) Nocodazole spindle poison was used to treat breast cancer cell MDA-MB-231. The morphological changes of cells were ob?served under microscope, and cells were harvested in 0, 6, 12, 24, 48 and 72 h. The cell cycle and DNA-ploidy changes were examined by flow cytometry. The expressions of FBW7 and MCL-1 proteins were detected by Western blot assay. (2) A multikinase inhibitor (Sorafenib) with Nocodazole or Taxol was used to treat MDA-MB-231 cells. MCL-1 protein expression was detected by Western blot assay after 48 h treatment. The cell cycle and DNA-ploidy changes were examined by flow cy?tometry after 48 h treatment. MTT method was used to observe cell proliferation after 48 and 72 h treatment. Results (1)Af?ter treatment by Nocodazole, polyploid characteristics of large cell size and nucleus were appeared. The percentages of octa?ploid were (0.8±0.2)%, (8.5±2.3)%, (7.8±2.0)%, (9.9±0.9)%, (28.2±0.8)%and (35.1±4.9)%after 0, 6, 12, 24, 48 and 72 h treatment, showing the increasing trend in turn (P<0.001). The number of polyploidy (tetraploid and octaploid) cells was as high as (97.6±0.7)%after 48 h treatment. The expression level of FBW7 protein was decreased significantly but the expres?sion of MCL-1 protein was increased significantly after 48 h treatment. (2) After 48 h treatment, the expression level of MCL-1 protein, polyploidy percentage and cell proliferation decreased significantly in Nocodazole+Sorafenib group and Taxol+Sorafenib group compared with those of Nocodazole group and Taxol group (P<0.05). Conclusion The lower expression of FBW7 protein and over-expression of MCL-1 protein are correlated with the formation of breast cancer polyploidy. Sorafenib can reduce polyploid tumor cells by inhibiting MCL-1 protein expression.

Objective To investigate the effects of trimetazidine on the oxidative stress in maintenance he-modialysis (MHD) patients. Methods Eighty-six MHD patients and 30 healthy volunteers were recruited in the study. The activity of glutathione peroxidase (GSHPx) was measured by colorimetry and superoxide dismutase (SOD) in serum was measured by hydroxylamine method. The levels of serum malondialdehyde (MDA) were meas-ured by thiobarbituric acid reaction. Serum advanced oxidation protein products (AOPP) levels were measured by enzyme-linked immunosorbent assay (ELISA). All MHD patients were randomly divided into two groups, treatment group (n = 46) and control group (n = 40), who had undergone hemodialysis for at least three months before the study and were in a stable clinic status without signs of infection or disease activity. In the treatment group,20 mg of trimetazidine was taken orally three times each day for twenty-four weeks, when the parameters for oxidative stress were studied. The levels of GSHPx. SOD, MDA and AOPP in serum were measured before and after the treat-ment. Results At the initiation of the investigation, the serum levels of GSHPx [(584.37±215.70) μmol/L, (580.87±309.12) μmol/L vs (769.06±302.46) μmol/L] and SOD [(347.87±82.09) kU/L, (348.16±75.33) kU/L vs (428.34±15.23)kU/L] in the M HD patients were significantly lower than those in the normal eontrol group (P < 0.01), whereas the content of MDA [(4.94±1.32) nmol/L, (4.97±1.61) nmol/L vs (3.56±0.46)nmol/L] and AOPP [(120.95±59.24) μg/L,(121.76±69.12) μg/L vs (47.69±20.15) μg/L] in MHD patients was higher than those in the control group( P < 0.05 and P <0.01, respectively). After treatment for twelve weeks, the scores of GSHPx and SOD were significantly increased in the treatment group compared to that before treatment (P <0.01). However, the contents of the MDA and AOPP decreased. There were significant differences in the levels of GSHPx, SOD,MDA and AOPP between the two groups of MHD patients after the treatment with trim-etazidine. Conclusions Trimetazidine in maintenance hemodialysis patients appears to be associated with an im-provement of oxidative stress.