Objective To investigate into the indications and related anatomic foundation of transjugular intrahepatic portosystemic shunt(TIPS) creation by direct transcaval approach in patients with portal hypertension cirrhosis suffering unusual anatomy between the hepatic veins and portal bifurcation; and to evaluate the security, feasibility and clinical significance. Methods Direct transcaval approach TIPS were performed in 65 patients including active variceal bleeding (n=52), intractable ascites (n=12), and as a bridge to liver transplantation (n=1). Results Technical and functional success were achieved in all patients. The success rate was 100% without related complications including the technique and primary patency rate is obvious higher than classical TIPS. Conclusion In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is secure and feasible. The results suggest that the direct transcaval approach offering favorable primary patency because the shunt has a straight line in construction.

Purpose:To assess the security and efficacy of mechanical recanalization and stenting of lilac arteries with complete occlusions without preceding thrombolytic therapy. Materials and methods:During a 3-year period,Eighteen consecutive patients underwent mechanical reeanalization and stenting for complete occlusion of the iliac artery.The method involved recanalizition with a guide wire and a catheter advanced as a while unit through the occluded segment(snowplow technique).Results The occluded segments were successfully traversed and dilated and 32 stents were placed in 18 patients.The mean ankle-brachial index (BAI)increased from 0.39?0.33 before the procedure to 0.86?0.13 after the procedure(P

Objective To investigate the correlation between serum S100B, IL-6 and intracranial pressure in patients with severe craniocerebral injury.Methods 81 cases of patients with severe brain injury in our hospital from August 2012 to April 2016 were selected,intracranial pressure was monitored immediately after admission to calculate the average daily ICP level ,and venous blood were collected after craniocerebral injury 6,12,24,48, 72 hours.Detection of serum S100B protein and IL-6 levels,and the correlation analysis with the level of intracranial pressure.Results Patients with severe craniocerebral injury S100B levels increased gradually after injury, reached the peak at 24 hours, then decreased gradually; while patients with IL-6 and intracranial pressure after injury gradually increased, the difference was statistically significant in different time points among the S100B,IL-6 and intracranial pressure levels (P<0.05).Conclusion The changes of intracranial pressure after severe craniocerebral injury were proportional to the levels of serum S100B and IL-6,S100B and IL-6 can reflect the changes of intracranial pressure,intracranial pressure changes predicted by S100B plasma concentration in 48 hours were more sensitive than those in the same concentration of IL-6.

Objective To design a new lumbosacral anterior plate by statistical analysis for the numerical value of the anatomic structure in Chinese.Methods The numerical value of lumbosacral angle and height of lumbosacral vertebrae,and discus intervertebralis were measured in 350 orthotropia and lateral view X-ray pictures of lumbosacral vertebrae of adult normal individuals.According to the acquired amplitude of lumbosacral vertebrae in Chinese,we designed the modified lumbosacral anterior plate,and then tested the plate in 4 different states of working condition on 8 fresh spinal columns to assay biomechanical data,and the results were compared with those of lumbosacral anterior secure plate(PACH).Results The amplitude of lumbosacral angle were 125 to 135,the heights of anterior border L5 and S1 vertebrae were(27.06?2.30) and(22.3?2.8)mm,the height of L5S1 discus intervertebralis was(8.2?0.3)mm.The flex bias and the compression rigidity had significant deviation for the vertebral column fixed the modified plate [flexation(4.706?0.012)mm,extension(4.549?0.298)mm,lateral bending(5.412?0.384)mm,average value of rigidity in 400 N(105.8?7.6)N/mm] and PACH[flexation(5.241?0.113) mm,extension(5.662?0.246)mm,lateral bending(6.767?0.017)mm,and average value of rigidity(87.4?4.2)N/mm] respectively,with statistical significance among them(P

Objective:It has been proposed that blood pressure variability(BPV) is positively related to end-organ damage(EOD) in hypertension.The present work was designed to observe the effects of long-term treatment with nitrendipine and hydralazine on BPV and EOD in spontaneously hypertensive rats(SHR),to examine the hypothesis that lowering BPV with an antihypertensive drug is an important factor in organ protection.Design and methods:Drugs were mixed in rat chow.After 4 months of drug administration,blood pressure was recorded continuously in conscious freely moving rats for 24 h.The heart,kidneys,and brain were then isolated and examined.Results:It was found that nitrendipine significantly decreased blood pressure and BPV,and significantly decreased EOD score in SHR.Hydralazine decreased blood pressure,but did not lower BPV.No effect on EOD was found in hydralazine-treated rats.In control rat(n=38),EOD score was weakly related to systolic blood pressure(r=0.331,P<0.05) and closely related to long-term systolic BPV(r=0.551,P<0.01).In nitrendipine-treated rats,EOD score was closely related to long-term systolic BPV(r=0.602,P<0.01),but not to blood pressure level(r=0.174,P>0.05).Conclusion:BPV plays an important role in the organ-protecting effects of nitrendipine.

Objective To study the pathogenesis of upper gastrointestinal rehaemorrhagia after the transjugular intrahepatic portasystemic shunt (TIPS) and its influencing factor.Methods Fifty postoperative patients with TIPS were selected.The patients were followed-up,and the effect of the various factors in the role of upper gastrointestinal rehaemorrhagia after TIPS was analyzed.Results The portal vein pressure of 50 patients with TIPS decreased from preoperative (39.8 ±9.2) cmH2O (1 cmH2O =0.098 kPa) to postoperative (25.2 ± 5.8) cmH2O,and there was statistical difference (P ＜ 0.05).Fourteen patients appeared upper gastrointestinal rehaemorrhagia after TIPS,which accounted for total of 28％ (14/50) and included 3 cases of postoperative vomiting blood within 3 days.Acute stomach mucosa lesions bleeding was considered,and bleeding was controlled within a short-term medical treatment (1 patient after more than a year in recurrent upper gastrointestinal rehaemorrhagia).Twelve cases of patients appeared upper gastrointestinal rehaemorrhagia within 2 years after TIPS,and the causes of rehaemorrhagia in 6 cases were esophageal variceal rehaemorrhagia,gastric and duodenal ulcer in 3 cases,erosive gastritis in 2 cases,coagulation abnormalities in 1 case.Esophageal variceal rehaemorrhagia rate was 12％ (6/50).Conclusions The main reasons of upper gastrointestinal rehaemorrhagia after TIPS are variceal rehaemorrhagia and non variceal rehaemorrhagia,both of which are important causes of rehaemorrhagia after TIPS.Variceal rehaemorrhagia after TIPS occurs more than 3 months,and non variceal rehaemorrhagia occurs within 3months,so it is very important to protect gastric mucosa with proton pump inhibitor in postoperative patients.

Objective To investigate the influence of the stent position in transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) on the long-term effect.Methods The clinical data of 527 patients with upper gastrointestinal bleeding duo to portal hypertension,who were treated with TILPS during the the period from January 2012 to December 2014,were retrospectively analyzed.According to whether the stent was placed into the left branch of portal vein,the patients were divided into the study group (stent in the left branch of portal vein,n=318) and the control group (stent in the main portal vein,n=209).The success rate of surgery,the shunt channel flow dynamics,the stent patency rate,the incidence of hepatic encephalopathy,the rate of re-bleeding,etc.were compared between the two groups.Results The success rate of shunting operation was 100％ in both groups.One year after the treatment,the blood velocity and flow parameters in the shunt channel of the study group were significantly higher than those of the control group (P＜0.05).During the the follow-up period lasting for one year,the incidences of shunt channel dysfunction in the study group and in the control group were 1.26％ (4/318) and 5.74％ (12/209) respectively (P=0.003),the incidences of hepatic encephalopathy in the study group and in the control group were 0.31％ (1/318) and 4.31％ (9/209) respectively (P=0.001),and the incidences of re-bleeding in the study group and in the control group were 0.94％ (3/318) and 2.87％ (6/209) respectively (P=0.095).Conclusion During the performance of TIPS,the puncture of the left branch of portal vein and placement of the stent in the left branch of portal vein can reduce both the incidence of shunt channel dysfunction and the incidence of hepatic encephalopathy.

Objective To study the influence of parental generation coal-burning-borne fluorosis on tooth development of their offspring.Methods High fluoride air model was established on the basis of burning coal habit of the epidemic areas.Fluoride feed was made of coal drying corn from the epidemic areas.Totally 48 SD rats were randomly divided into 4 groups with male to female ratio of 1:1 by random number table method.Rats in high,middle and low fluoride groups were put in the high fluoride air room and feed food with 40,25 and 10 mg/kg fluorine,and the control group was put in normal air room and feed normal food.After 8 weeks,rats were mating and parturition.Tooth eruption time of offspring rat was observed;and dental fluorosis incidence,the tooth length and fluorine content were observed at 21 d.Results In high and middle fluoride groups [(6.83 ± 0.94),(6.25 ± 1.06) d],tooth eruption time of offspring rat was later than that of control group [(5.34 ± 0.89) d,all P ＜ 0.01].At 21 d,dental fluorosis was observed in the lower incisors of the high and middle fluorine groups;compared with control group [(5.21 ± 0.19) mm,(223.00 ± 14.08) μg/kg],the tooth length was decreased [(4.83 ± 0.22),(4.96 ± 0.25) mm,P ＜ 0.01or ＜ 0.05],and tooth fluoride content was increased [(362.64 ± 20.35),(289.79 ± 19.18) μg/kg,all P ＜ 0.01].Dental fluorosis incidence of offspring rats was positively correlated with the fluorine dose (r =0.704,P ＜ 0.01).Conclusion Parental generation rats’ intaking excessive fluoride can affect offspring rats tooth development and dental fluorosis,which is related to the fluorine dose.

Objective To establish a fluorosis model induced by coal burning and in ameloblasts of rat offsprings.Methods High fluoride air model was established based on the burning coal habit of the epidemic areas.Fluoride feed was made of corn dried by coal burning.Thirty-six SD rats were divided into 3 groups by random number table method according to body weight in a male and female ratio of 2 ∶ 1∶ in the high fluoride air room and rats were feed food with fluorine at 40 mg/kg (high fluoride group),25 mg/kg (low fluoride group);in the normal air room and rats were feed food with fluorine at 0 mg/kg (the control group),12 rats in each group.Mating litter in a ratio of 2 ∶ 1 at the end of 8 weeks.The offsprings were killed on postnatal day 3 and 7 to make mandible sections.Specimens were prepared for light microscope examination to observe the morphological changes of ameloblasts in the tooth germ.Results At the end of 0,2,4,6 and 8 weeks,serum fluoride of the high fluoride group were (0.031 ± 0.003),(0.060 ± 0.006),(0.085 ± 0.006),(0.110 ± 0.007) and (0.134 ± 0.008) mg/L;serum fluoride of the low fluoride group were (0.031 ± 0.003),(0.046 ± 0.005),(0.077 ± 0.006),(0.091 ± 0.007) and (0.104 ± 0.007) mg/L;serum fluoride of the control group were (0.030± 0.003),(0.037 ± 0.002),(0.044 ± 0.002),(0.046 ± 0.003) and (0.049 ± 0.003) mg/L.At the end of 2,4,6 and 8 weeks,serum fluoride of high fluoride group and low fluoride group were significantly higher than that of control group (all P ＜ 0.05).At 7 d,offspring rats in high fluoride group,adamantoblasts were in distortions and vacuole changes,but offspring rats in low fluoride group and the control group had no abnormality.Conclusion By providing rat with high fluoride air and food,we could establish a fluorosis model induced by coal burning in ameloblasts of rat offsprings.