Objective To explore the safety,technical feasibility,and catheter-related complications of ultrasound-guided implantation of totally implantable access port (TIAP) in the upper arm.Methods A total of 642 patients,who were admitted to authors' hospital during the period from February 2014 to December 2016 to receive ultrasound-guided implantation of TIAP in the upper arm,were enrolled in this study.The patients included 407 males (63.4％) and 235 females (36.6％),their age ranged from 11 to 89 years old,with a mean age of (58.29±4.33) years old.Under ultrasound guidance,by using Seldinger's technique TIAP was implanted in the upper arm.Results Implantation of TIAP in the upper arm was performed in all 642 patients.The initial success rate of implantation was 99.53％ (639/642),in 3 patients successful implantation was obtained in the second time of implantation as the initial puncturing failed.During the follow-up of 155,302 catheter days,complications occurred in a total of 58 patients (9.0％),including early complications in 9 patients and late complications in 49 patients.The complications included TIAP-related infection (n=28,4.4％),venous thrombosis (n=7,1.1％),sac bleeding (n=3,0.4％),port hub rotation (n=3,0.4％),cracked skin (n=l,0.2％),catheter obstruction (n=2,0.3％),catheter displacement (n=4,0.6％),movement restriction of catheter-side upper limb (n=7,1.1％),venous return obstruction of upper limb (n=2,0.3％) and median nerve injury (n=l,0.2％).No port-related death occurred.Conclusion The ultrasoundguided implantation of TIAP in the upper arm is technically-safe,clinically-effective and minimally-invasive,besides,it carries lower incidence of complications.Therefore,this method is worthy of clinical popularization and application.

Objective To identify the circulating miRNAs which can be used to evaluate the diagnosis and prognosis of sepsis by microarray and quantitative real-time PCR,and to predict target genes of miR-519c-5p by bioinformatics analysis. Methods Three sepsis patients,3 septic shock patients and 3 normal controls were enrolled in this study. Plasma RNA was extracted,and was used for hybridized by miRCURY LNATMmicroRNA Array.The signals were scanned and used to conduct differential expression profilings and cluster analysis.Further-more,we performed qRT-PCR to confirm the expression of miRNAs chosen from microarray screening. We used the miRanda and Targetscan databases to predict target genes of the concerned miRNAs and used KEGG database to analyze the related pathways. Results Fifty-seven and 11 miRNAs were observed significantly upregulated in sepsis and septic shock patients,respectively(fold change≥2.0;P<0.05).qRT-PCR results showed that miR-519c-5p was significantly upregulated in patients with sepsis or patients with septic shock compared with the healthy normal controls(P<0.05).Twenty-nine target genes of miR-519c-5p were predicted by the bioinformatics analysis,and 7 potential target genes participate in the sepsis-related pathways.MiR-519c-5p might be a potential positive regulator for the critical cell cycle control gene of MAP2K4,contributing to the vascular endothelial cells apoptosis via MAPK signaling pathway. Conclusions We demonstrated that the plasma level of miR-519c-5p can be used for the diagnosis of sepsis and miR-519c-5p may be a potential therapeutic target for sepsis.