Objective To evaluate the effect of extracorporeal membranous oxygenation (ECMO) on the small bowel preservation in a porcine model of controlled donors after cardiac death (CDCD).Method The domestic crossbred donor pigs were anesthetized and ventilated with 100％ oxyger.An intravenous cannula was placed through iliac arteries and jugular vein,and connected to ECMO system.The ECMO was performed to infuse abdominal organs when cardiac death was declared.Pathology,electron microscope,energy metabolism and cell apoptosis level of intestinal mucosa were evaluated before operation,in cardiac death and at the end of extracorporeal support,respectively.Result The normothermic extracorporeal support could quickly restore graft blood supply and oxygenation.One-h extracorporeal support could improve the energy status in intestine of donation after cardiac death (DCD).The histologic damage and apoptosis of 1-h extracorporeal support had no significant difference with those before operation and in cardiac death (P＞0.05).With the extension of extracorporeal support,the intestinal mucosa damage degree was gradually increased,and the content of adenosine triphosphate in intestinal mucosa reduced gradually.Conclusion The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the viability of small bowel.However,the integrity of intestinal mucosa is destroyed gradually as extracorporeal supporting time over,which may be initiated by the activation of intestinal epithelial apoptosis.

Objective To investigat the changes of hemodynamics and arterial blood gas during the establishment of ECMO model and provide an ideal platform for the study of the mechanism of DCD protection using ECMO, a porcine model of controlled donors of cardiac death (CDCD) with extracorporeal support was established in the paper. Methods Eight domestic crossbred pigs were anes-thetized, atracurium (1mg/kg) and heparin (150~200 U/kg) was administered and the ventilator was discontinued while the animal was under deep anesthesia to kill the animal.Meanwhile, blood was drained from the left jugular vein catheter into the ECMO circuit and re-turned into the left femoral artery to establish the porcine model of CDCD with extracorporeal support . The average blood press and arterial blood gas were ministered at normal, cardiac arrest and ECMO supporting 1 h, 3 h and 5 h. Results The model of CDCD with extra-corporeal support was established successfully.Two animals restored the beating of the heart and the high doses of potassium chloride were given untill cardiac arrest during extracorporeal support.Blood gases throughout the apneic time showed a severe hypoxemia and acidosis, pH and PaO2 reduced to 7.09 ±0.24 and 5.3 ±0.93mmHg respective-ly, which can be improved during extracorporeal support.MAP and PaO2 were maintained over 300mmHg and 65mmHg respectively. Conclusion A new porcine model of controlled donors of cardiacdeath with extracorporeal support has been successfully established and showed to be feasible for related pathophysiological research work.

Objective To explore the applicative value of contrast enhanced ultrasound (CEUS) through rectumin the T-staging of rectal cancer.Methods 24 cases with rectal cancer were examined preoperatively by endorectal ultrasound (ERUS) and CEUS during May 2012 to November 2013 in our hospital.The characteristics of contrast enhanced ultrasound imaging in early and late phase of the rectal cancers were studied,and the imaging distribution and enhancement mode were observed.The preoperative staging diagnosis was conducted by consulting T staging criteria.The diagnostic results were compared with the postoperative pathologic diagnosis.Results The contrast enhanced time in rectal cancer began at 14-35s.The early tumor showed uneven nodular,ribbon or ring in high enhancement.At the advanced late,angiographic tumor showed homogeneous enhancement and continued to be observed during the whole time.Normal rectal wall ultrasonography showed spotty low enhancement or no enhancement.The overall accuracy of ERUS in T-staging was 66.7％ (16/24) and the overall accuracy of CEUS was 83.3％ (20/24) respectively.There was a significant difference in the overall accuracy between ERUS and CEUS (P＝0.018).The sensitivity,accuracy and positive predictive value of CEUS were 100.0％ (2/2),100.0％ (2/2),100.0％ (2/2) inT1 stage,83.3％ (10/12),83.3％ (10/12),100.0％ (10/10) in T2 stage,100.0％ (8/8),88.9％ (8/9),88.9％(8/9) in T3 stage,and 100.0％ (2/2),100.0％(2/2),100.0％ (2/2) in T4 stage,respectively.Conclusions As compared toroutine transrectal ultrasound,transrectal contrast enhanced ultrasound imaging on rectal cancer shows the typical sonographic characteristic imaging on microvascular focus size and borders,on characteristic infiltration zone.Therefore,contrast enhanced ultrasound improves the diagnostic accuracy of preoperative T-staging in rectal cancer surgery.

Objective To evaluate the values of clinical application of color Doppler ultrasound in the diagnosis and treatment of iatrogenic femoral artery pseudoaneurysm (IFAP) in the elderly following percutaneous transluminal coronary angioplasty(PTCA). Methods A tota.of 35 patients aged(73.8±1.3) years with IFAP after PTCA were examined by color Doppler ultrasound.All cases were treated by compression simply for blocking blood flow with probe guided by ultrasound,and the failed cases were injected Reptilase into the lumen of pesudoaneurysm. Results 35 patients were diagnosed as IFAP by color Doppler ultrasound and the coincidence rate with clinical diagnosis was 100％ (35/35).Among all patients,31 cases were cured by simply compression guided by ultrasound and 3 cases were cured hy the injected reptilase into lumen,the cure rate was 97.15％(34/35).One cases was cured by surgery after failure to treat by the two above methods.34 cases (97.2％)were verified into occlusio by ultrasound after 24-48 h of treatment. Recurrence and other serious complications were not found during follow-up of 3-6 months. Conclusions Color Doppler ultrasound can be used for the preferred method in accurate diagnosis and effective cure of IFAP following PTCA in the elderly.

Objective To evaluate the value of color Doppler flow imaging (CDFI) in the diagnosis of elderly femoral arterial pseudo aneurysm and treating with ultrasound-guided compression after percutaneous transluminal coronary angioplasty (PTCA). Methods Twenty-six elderly patients who were found a mass and/or vascular murmur in the puncture region were examined by CDFI, and the results of CDFI were proven by clinic and MRI. All pseudo aneurysms were repaired by CDFI guidance to compress simply and/or injecting directly batroxobin into the pseudo aneurysm lumen combined with compression.Results Pseudo aneurysms were diagnosed definitely by CDFI in 26 cases,and the accuracy rate was 100%. Twenty-two cases were repaired with CDFI guidance to compress simply and percutaneously injection of batroxobin into the pseudo aneurysm lumen combined with compression occurred in 3 cases. One case was cured by surgery after failing to be repaired with CDFI guidance. Conclusions CDFI has an important diagnosis value of pseudo aneurysm after PTCA. The method of CDFI guidance compression and batroxobin injection for repairing pseudo aneurysm is simple, safe and effective.

Objective To compare the diagnosis value of three-dimensional power Doppler imaging(3D-PDI)and color Doppler flow imaging(CDFI)on carotid artery stenosis.Methods Forty-nine patients with carotid artery atherosclerosis plaque or stenosis diagnosed by CDFl were enrolled in the study.The degree and ratio of carotid artery stenosis were measured by 3D-PDI in free-hand mode,and measured by DSA in one week,the results were compared with CDFI.Results 3D-PDI of normal carotid artery with atheromatous plaque showed the stereo image,quantity character and exact position of plaque,volume of vessel lumen and spatial distribution of blood flow directly.There was no statistical difference in diameter stenosis rate between 3D-PDI and CDFI[(52.0±0.9)% vs(51.7±0.8)%,P＞0.05],and the area stenosis rate measured by CDFI was significantly lower than that by 3D-PDI[(58.0±0.2)% vs(52.0±0.5)%,P＜0.01].In the diagnosis of stenosis classification,the rates of light,mild and severe stenosis were significantly different between CDFI and 3D-PDI(P＜0.05)and not significantly between 3D-PDI and DSA methods(X2=0.0538,P＞0.05).The detection rates of atherosclerotic plaques numbers in carotid crotch were significantly different between 313-PDI and CDFI(P＜0.05).Conclusions 3D-PDI can offer more valuable information for the diagnosis and trentment of carotid artery stenosis,it is more accurate than CDFI and similar to DSA.

Objective To evaluate the short-term clinical effect of 125Ⅰ seeds interstitial braehytherapy for recurrent malignant tumor after radiotherapy. Methods 21 patients with recurrent gynecologic tumors after radiotherapy received 125Ⅰ seeds interstitial braehytherapy through TPS, ultrasound. 125Ⅰ seeds radiotherapy per grain was for 20.72-29.60 MBq. The distribution of seeds was checked by X-my after treatment. The clinical therapeutic efficacy was observed by chest CT, ultrasound. Results The overall effective rate was 100 %, CR 85.71%(18/21), PR 14.29 %(3/21). Conclusion 125Ⅰ seeds interstitial brachytherapy is minimally invasive, convenient, safe, utility and feasible in clinical practice. The radioactive protection is easy. It is a new and high technology of malignant tumor treatment. Colligation treatment method is increased by this technique. But this technology cannot replace routine method.

Objective To evaluate the endothelial function in diabetic patients by high resolution sonography. Methods The intima-media thicknesses (IMT) of the bilateral carotid artery, femoral artery and the iliac artery of 22 elderly patients and 142 non-elderly patients with diabetes mellitus (DM) and 20 elderly and 20 non-elderly healthy persons were measured. The changes of the diameter of brachial artery were determined by measuring the diameter of brachial artery during reactive hyperemia and after sublingual nitroglycerin. Results The increased percentage of the brachial artery diameter under reactive hyperemia was significantly lower in elderly patients with DM (10. 03?6. 39)% than that in the elderly healthy control (15. 87?4. 79)% (P 0. 05). The IMT in elderly patients with early-stage DM incrassated significantly(P

Objective An ideal small bowel transplantation model is the prerequisite and guarantee of small bowel transplan-tation-related researches.The aim of this study is to establish a pig model of orthotopic segmental small bowel transplantation by modifi-cation of blood vessel reconstruction and surgical techniques. Methods Twenty healthy pigs were equally assigned as donors and re-cipients.The superior mesenteric vessels were freed and the distal ileum harvested as grafts.After irrigation and preservation, the small bowel was transplanted by end-to-end anastomosis of the superior mesenteric arteries and veins, and then the small bowel was re-constructed simultaneously to restore intestinal continuity, with the proximal part of the graft brought out as a stoma for the purpose of graft monitoring. Results Transplantation was successfully performed in 9 of the 10 cases, with a success rate of 90%.The donor operations averaged 100 min, recipient operations 172 min, warm ischemia 1.3 min, cold ischemia 96 min, and vascular anastomosis 27.6 min.No postoperative anastomosis fistula occurred in any of the cases. Conclusion The pig model of orthotopic segmental small bowel transplantation is ideal for small bowel transplantation-related researches.

Objective To evaluate the clinical efficiency of humanized anti-CD52 monoclonal antibody (Campath-1H) and anti-CD25 monoclonal antibody (Zenapax) induction therapy in intestinal transplantation patients.Method The data of 6 patients receiving Campath-1H and 5 patients receving Zenapax induction therapy in intestinal transplantation between 2007 and 2012 were analyzed retrospectively.The counts of peripheral blood lymphocytes and monocytes,incidence of rejection and infention,and liver and kidney toxicity of recipients were recorded before and 3 months after transplantation.Results Of 6 intestinal transplantation patients receiving Campath-1H induction therapy,1 died of acute heart failure on the postoperative day 3,and the rest 5 patients had a powerful depletion of lymphocytes and monocytes in 8 weeks,followed by gradual increases after 8 weeks.The percentage of peripheral blood CD3 + T cells,CD4 + T cells,and CD8 + T cells was dropped to 5％ before administration,and remained at a steady low level in the first 8 weeks after induction.Of 5 patients receiving Zenapax induction therapy,1 died of Aspergillus infection on the postoperative day 25,and the rest 4 patients had an obeivous increase of lymphocytes and monocytes on the postoperative day 1.Counts of lymphocytes and monocytes kept steady at normal levels from the 1st to 12th week.One case of mild rejection was found in Campath-1H group.One case of mild,one moderate and one severe rejection were detected in Zenapax group.All rejections were successfully cured by prompt anti-rejection therapy.There were no significant difference in serum creatimine,urea nitrogen,alanine aminotransferase or total bilirubin after 3 months in comparison to preoperation.Conclusion Both Campath-1H induction therapy and Zenapax induction therapy successfully induce immune tolerance in patients with intestinal transplantation.Campath-1H seems to offer better immunosuppression against Zenapax during the first 3 months posttransplantation.