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.

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 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 serum cystatin C (CysC) level and explore its relationship with cytokines and atherosclerosis (AS) in maintenance hemodialysis (MHD) patients.Methods A total of 110 stable MHD patients undergoing hemodialysis for at least six months and 60 healthy control people were enrolled in the study.Serum levels of CysC and high-sensitivity Creactive protein (hsCRP) were measured by immunoturbidimetry.The serum levels of total homocysteine (tHcy),IL-1β,IL-6 and TNF-α were determined by ELISA.Prevalence of atherosclerosis was detected by carotid ultrasonography.The relationship of CysC level and cardiac geometry incidence in MHD patients was analyzed by Logistic regression model.Results The serum CysC level was significantly higher in MHD patients as compared with healthy controls [(6.19±0.95) mg/L vs (0.76±0.21) mg/L,P＜0.01],and the serum levels of hsCRP,tHcy,IL-1β,IL-6,TNF-α were significantly higher in MHD patients than those in healthy control group (P＜0.05 or P＜0.01).The serum CysC level was higher in MHD patients with carotid artery atherosclerosis compared to patients without carotid artery atherosclerosis (P＜0.05).CysC was positively correlated with hsCRP,tHcy,IL-1β,IL-6,TNF-α respectively (P＜0.05 or P＜O.01),and was positively correlated with carotid intimal medial thickness (IMT) and AS.Besides,a negative correlation was found between the serum CysC level and the serum albumin level (P＜0.05),while CysC was positively correlated with dialysis duration,systolic pressure and iPTH (P ＜0.05).Conclusion Serum CysC level is significantly higher in MHD patients and is correlated with hsCRP,tHcy,IL-1β,IL-6,TNF-α as well as carotid artery atherosclerosis,which indicates that CysC is an independent risk factor of AS in MHD patients.

ced glutathione in MHD patients appears to be associated with an improvement of oxidative stress.

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.