Objective To study the efficacy of hypo responsiveness of allogenic T cells induced by curcumin (Cur)-treated dendritic cells (DCs) and influence on survival time of renal allografts in rats.Methods DCs were generated from Wistar rat bone marrow and treated with Cur. The costimulatory molecules (CDl1c, CD80, CD86 and major histocompability complex Ⅱ ) were determined by using flow cytometry,and the production of IL-12 in DCs culture supernatant was examined by using ELISA.The probability of Cur treated DCs to stimulate the proliferation of Lewis rat T cells was detected by using mixed leukocyte reaction (MLR),and the antigen specific T cell hypo responsiveness was analyzed by using secondary MLR. Allograft renal transplantation animal models were established by using Wistar rats as donors,and Lewis rats as recipients.At 7th day before allograft renal transplantation,Cur-treated DCs from donors were injected into recipients through tail vein, meanwhile the non-treated control group and immature DCs control group (immature DCs from donors were injected into recipients through tail vein) were set up.The allograft survival time and allograft pathology after transplantation were assayed.Reaction of T cells from the recipients to mature DCs of donors was analyzed at 14th day.Results Cur restrained the expression of DCs phcnotypc and production of IL-12 (P＜0.05). Cur treated DCs displayed poor ability to stimulate T cells proliferation,and potential to induce antigen specific T cell hypo-responsiveness.The survival time of the renal allograft in Cur-treatcd CDs group [(31.5 ± 6.9) days] was significantly longer (P＜0.05) than in control group [(8.6± 2.1) days] and immature DCs control group [(22.4± 7.4) days],and the pathological lesions in the renal allografts in Cur treated CDs group were milder than in the control group and immature DCs control group.T cells from the recipients injected with Cur-treated DCs showed significant hypo-responsiveness to mature DCs from donors (P＜0.05),but higher proliferation ability to the stimulation of third party independent antigen.Conclusion Cur can suppress the maturation and function of DCs,and induce immune suppression of allogeneic T cells,while infusion of Cur-treated immature DCs can prolong the survival of renal allograft remarkably.

Objective To investigate the efficiency of transjugular intrahepatic portosystemic shunt (TIPS) with Fluency stent in improving the hepatic and renal function and survival rate in patients with decompensated cirrhosis.Methods The decompensated cirrhosis patients who were treated in our hospital from May 2008 to September 2011 were retrospectively analyzed.One group of patients (n =48) undergoing TIPS was randomly selected as treatment group,while another group of patients (n =48) treated by medicine and therapeutic endoscope was randomly chosen as control group.Clinical data and fellow-up data were retrospectively reviewed.There was no significant deviation in baseline characteristics (age,gender composition,etiology,renal function,hepatic function et al) among all the patients before the operations; The laboratory results of hepatic and renal function in 2 groups before and after operation (1 week,20 days,3 months,6 months,1 year,2 years,3 years) were recorded and compared with independent samples t-test or Wilcoxon rank sum test.The survival rates of two groups in 3 years were analyzed using Kaplan-Meier survival curve and compared with Chi-square test.Results Three years after the operation,there were significant differences between the treatment group and the control group in AST(70.8 vs.108.7 U/L,Z =-2.958,P ＜ 0.05) and TBIL (51.2 vs.76.2 μmol/L,Z =-2.004,P ＜ 0.05).The Cr value of the 3rd year after the treatment were (9928.2 ± 2363.8) in the the control group and (7742.1 ± 2845.6) μmol/L in the treatment group(t =-2.074,P ＜ 0.05).BUN of the 1st,2nd and 3rd years after the treatment were (2.0 ± 1.1),(2.3 ± 1.5),(2.5 ± 1.3) mmol/L in the treatment group,while it was (2.6 ± 1.1),(3.8 ±1.2),(5.4 ± 1.1)mmol/L in the control group.There was significant difference between the 2 groups (t =-2.222,-3.940 and-6.110,P ＜ 0.05).Comparing the survival rate in the 2 groups with Kaplan-Meier survival curve,the 3 year survival rate in the treatment group was 46.2％,while in the control group it was only 30.0％ (x2 =6.341,P ＜ 0.05).Conclusions Compared with medicine therapy and therapeutic endoscopy,TIPS with Fluency stent may improve the hepatic function,renal function and survival rate in liver cirrhosis patients.It is a safe and effective therapy choice for patients with decompensated cirrhosis.

Objective To evaluate the effect ofcytochrome P450 isoenzyme subfamily 2C19 (CYP2C19)gene polymorphism on the clopidogrel antiplatelet therapy in cirrhosis patients after receiving transjugular intrahepatic portosystemic shunt (TIPS).Methods The clinical data of 171 cirrhosis patients,who were treated with TIPS during the period from January 2013 to December 2014,were retrospectively analyzed.During operation both the portal vein and the elbow vein blood samples were collected and sent for CYP2C19 gene testing.After TIPS,clinical follow-up checkup was made once every 3 months.The gene detection results and clinical follow-up findings were comparatively analyzed.Results A total of 110 patients,who had not received blood transfusion before TIPS and who had regularly taken clopidogrel antiplatelet therapy after TIPS were enrolled in the study.The mean time to take clopidogrel was 192.4 days (31-517 days),and the gene detection results of portal vein and elbow vein were quite consistent.CYP2C19 genotype of *1/*1 was found in 49 patients (44.5％),CYP2C19 genotype of *1/*2 in 27 patients (24.6％),CYP2C19 genotype of *1/*3 in 18patients (16.4％),CYP2C19 genotype of *2/*2 in 11 patients (10.0％),CYP2C19 genotype of *2/*3 in 3patients (2.7％),and CYP2C 19 genotype of *3/*3 in 2 patients (1.8％).Following-up examinations showed that the incidence of shunt dysfunction in patients carrying slow metabolic gene was 87.5％ (14/16),which was significantly higher than that in patients carrying moderate metabolic gene (20.0％,9/45;x2=22.9,P=0.006)as well as in patients carrying fast metabolic gene (8.2％,4/49;x2=37.91,P=O.O00 1).Multivariate analysis of Cox regression model indicated that CYP2C19 slow metabolic gene variation was an important predictive factor for shunt dysfunction (95％CI:1.80-9.03,P=O.O00 7).Conclusion CYP2C19 slow metabolic gene variation,including genotype of *2/*2,*2/*3 and *3/*3,is an important factor that can influence the efficacy of clopidogrel treatment after TIPS.Preoperative CYP2C19 gene detection results can provide useful information,which is very helpful in making an effective and reliable anti-platelet treatment plan for patients after TIPS.

Objective To investigate the manifestations of MR imaging and histopathology of early postoperative normal brain, and to define the correlation between MRI and histopathology. Methods Thirty six New Zealand rabbits weighing 2.0 to 3.0 kg were divided into 10 groups according to the different postoperative days: 1 to 10 day. Six animals were in groups 3, 5, 7, 10, and 2 were in the other groups. A partial resection of the parietooccipital region was performed under the usual aseptic conditions after the animals were anesthetized intravenously with 3% pentobarbital (30 mg/kg). MR imaging procedures consisted of pre and postcontrast scanning were carried out on postoperative 1 to 10 day respectively. Brain tissue samples were obtained to be prepared for examinations immediately after MR scanning. Histopathological study was made under microscope and electron microscope. The findings of MRI were compared with pathology findings. Results (1) Surgical margin contrast enhancement on MR images could be seen 24 hours after surgery. (2) The degree of contrast enhancement increased gradually before 5 days postoperatively, and no remarkable changes were present from 5 to 10 days. (3) The disruption of blood brain barrier(BBB) is the main cause of contrast enhancement during the postoperative 3 days. After that period, mechanism responsible for contrast enhancement is the formation of neovascularity and broken BBB, an increase in the number of neovascularity play a predominant role in the contrast enhancement in normal postoperative brain tissue. Conclusion The characteristics of enhanced MRI present at the surgical margin followed a typical time course during the early postoperative period. The role of neovascularity and BBB disruption in the formation of contrast enhancement at surgical margin vary with time. Knowledge of the characteristics on postoperative MR images of the normal brain can help in differentiating benign changes from malignant gliomas residual.

Objective To evaluate the curative effect,safety,and medium-term effect of intracranial artery stenosis stent (ICASS) for the treatment of the symptomatic intracranial artery stenosis.Methods ICASS was performed in 21 cases with the symptomatic intracranial artery stenosis.The stenting success rate,the improvement rate of stenosis post-stenting and the incidence of complications were observed.The change of the scores of the Modified Rankin Scale (MRS)and National Institutes of Health Stroke Scale (NIHSS)between pre-and post-stenting (1 month,3 months,6 months,12 months and 2 years)and the occurrence of ischemic cerebrovascular events after stenting were compared and analyzed respectively.Results Except one case failed because of intracranial hemorrhage during the operation,other 20 patients were treated with endovascular stent plasty successfully,the total technical achievement ratio was 95.2%.The aver-age stenosis ratio decreased from (73.4±7.9)% to (13.7±9.2)%.The complications incidence was 4.8% within the peroperative. 9 patients were reviewed with DSA in 6 months,the average ratio of stenosis was (29.5 ±12.2)%,no patient was found with the restenosis.Compared with pre-stenting,the score of MRS and NIHSS at the follow-up duration of 3 months,6 months,12 months and 2 years post-stenting of patients were significant improved (all P < 0.05 ).During the follow-up period,2 patients were found with new transient ischemia attack (TIA),1 patient had non-targeted vascular CI without other target vascular therapy-related com-plications.Univariate analysis indicated that patients with elderly (≥ 75 years old),or hypertension,or diabetes,or dyslipidemia,or in the set of events to endovascular treatment for longer than 1 month,or with more than two independent risk factors for patients with underlying diseases treatment,or without systemic therapy,whom would be much more easily to reoccur the cerebrovascular events in post-operation(all P <0.05 ).Conclusion ICASS should be an effective and safe therapeutic method to the symptomatic intracra-nial arterial stenosis.The medium-term efficacy is significant.Serious complications might still be emerge with endovascular stent plasty,so close attention must be paid with.

Objective To investigate the clinical characteristics of hemodialysis (HD) patients complicated with arteriosclerosis obliterans (ASO) of lower extremity,and to discuss the factors that influence the curative prognosis of percutaneous transluminal angioplasty (PTA).Methods The clinical data of 211 patients with ASO of lower extremity receiving HD or not receiving HD,who were admitted to authors' hospital during the period from January 2008 to October 2015,were retrospectively analyzed.PTA was successfully accomplished in all patients.Results The median follow-up time was 2.24 years.Theamputation-free survival of HD group was significantly lower than that of non-HD group (P＜0.000 1),and the postoperative artery patency rate of HD group was also obviously lower than that of non-HD group (P＜0.000 4).The factors influencing the survival rate without amputation of the two groups were different.The independent influence factor in HD group was diabetes mellitus,while in non-HD group the independent influence factors were Fontaine stage and hyperlipidemia.The infection mortality of HD group was 55.5％ (10/18),which was higher than 22.2％(6/26) of non-HD group,the difference was statistically significant (P＜0.05).Conclusion In treating ASO of lower extremity,the curative effect of PTA is poorer in HD patients than in non-HD patients,and the presence of diabetes mellitus may be an independent factor influencing prognosis.

Objective To compare the technical success ,complication rates and comfort of the radiologic placement of central venous ports(CVP) via the internal jugular vein ,subclavian vein via subclavian region ,subclavian vein via supraclavicular region un‐der DSA guidance .Methods We retrospectively reviewed 188 CVP patients implanted at hospitals between December 2012 and De‐cember 2013 .The patients were divided into three groups according to the different catheter implantation sites ,internal jugular vein (group A) ,subclavian vein via subclavian region (group B) and subclavian vein via supraclavicular region (group C) .Intraoperative pain score ,technical success rates ,peri‐procedural ,as well as early and late complication rates were recorded based on the image fol‐low‐up and patient medical records .Results The technical success rate was 100 .0% without any lethal complications .The CVP re‐lated infections were occurred in each group with 1 patient ,but there was no statistics significant different(P>0 .05) .Subclavian vein thrombosis were occurred 2(2 .1% ,2/96) in group B ,which was recanalized after thrombolytic therapy ,and 1(1 .7% ,1/60) in group C ,which was completely occluded .The higher rate of catheter migration and kinking of catheter were occurred in group A and group C .The rate was statistically significant difference among the three groups (P<0 .01) .The late complication rates were statistically higher in group A and C compared with group B (P<0 .05) .The punch‐off was just occurred in group B (n=2) .There were no significant differences about catheter fracture ,port rotation and wound dehiscence among the three groups(P>0 .05) .Con‐clusion In DSA radiologic placement of a CVP via the subclavian vein via subclavian region is safe and efficient with more comfort‐able and lower complication rates ,which could be chosen priority .

Objective To observe the feasibility and security of the embolization with medical adhesive on renal artery in rab‐bits by animal experiments ,and explore the effectiveness of different concentration of embolic agents on the process and the effect of embolization for vascular ,and provide guidance for clinical application of medical adhesive .Methods A mixture of different ratios of lipiodol and medical adhesive were used to embolize the renal artery in 18 rabbits ,the usage and effects of embolization were ob‐served .Results Embolic agents were seen under the fluoroscopy ,easy to control and inject transcatheter ,also repeated injected by one micro‐catheter safety and effectively .Angiography review showed a reliable embolization ,no vascular recanalization and no spill‐over of contrast agent .Optical microscope ,after HE staining in postoperative pathological examination ,showed irregular shaped embolic agents or branch like refractive index of transparent material in the embolized artery .In 5∶1 group and 4∶1 group ,arteri‐ole and small artery were mainly embolized ,there was no significant difference between the two groups(P>0 .05);Whereas medium sized artery was mainly embolized in 3∶1 group ,compared with the 5∶1 group and 4∶1 group ,the differences was statistically significant(P<0 .05) .After operation ,renal function was transient damage ,leukocyte was transient increasing ,one week later ,both of renal function and leukocyte were recovered ,and there was no significantly renal function anomaly .Conclusion It is feasible ,safe and effective for medical adhesive to embolize rabbits renal artery ,the different concentration of the embolic agents can embolize the different branches of rabbit renal artery .

Objective To assess the validity and safety of arterial embolization with medical adhesive in treating peripheral artery pseudoaneurysms(PSA).Methods 25 cases of peripheral artery PSA embolized with Fuaile medical adhesive(FMA) were analyzed retrospectively.25 patients included 28 PSA.Super-selective transcatheter arterial embolization was performed in 19 patients (22 PSA) using 3F microcatheter and 6 PSA in 6 patients were embolized through puncturing directly.All the lesions were treated with mixtures of FMA and iodized oil (1：1) during the radiography.The clinical efficacy and complications were recorded.Results The success rate of embolization was 100% during the operation (28/28), and the average volume of FMA used was 1.8 mL(0.5-5.5 mL).One patient with PSA(d>2 cm) still have hematuria 2 days after the operation.The hematuria disappeared after embolization with micro-coil following re-angiography.Bleed stopped after the second embolization with FMA in one patient with brachial artery PSA.No one developed complications associated with therapy and occurred rebleeding in the follow-up period time (3 months).Conclusion The mixtures of FMA and iodized oil can be a useful alternative embolic agent for the treatment of peripheral artery pseudoaneurysm with high success rate, short operation time and definite clinical effect.

Objective To discuss the prognostic value of aspartate aminotransferase (AST) to neutrophils ratio index (ANRI) in patients with hepatocellular carcinoma (HCC) after receiving transarterial chemoembolization (TACE).Methods The clinical data of 107 HCC patients,who were admitted to authors' hospital to receive treatment during the period from January 2008 to June 2011,were retrospectively analyzed.TACE was successfully performed in all patients.Based on the 5-year overall survival rate,ROC curve was drawn and the cutoff value was determined.Preoperative ANRI,AST-lymphocytes ratio index (ALRI),AST-platelet count ratio index (APRI),neutrophil-lymphocytes ratio index (NLR),platelet count-lymphocytes ratio index (PLR) and other clinical pathological parameters were calculated.Univariate analysis,multivariate Logisitc regression analysis and Kaplan-Meier survival analysis were used to assess the value of the above indexes in prejudging the disease-free survival (DFS) and overall survival (OS).Results ANRI bore a close relationship to the presence of HBsAg,AST,presence of cirrhosis,tumor size,portal vein tumor thrombus (PVTT) and recurrence of tumor (P＜0.05).Univariate analysis showed that ANRI,ALRI,APRI,NLR and PLR were significantly correlated with DFS and OS in HCC patients after receiving TACE (P＜0.05).Logisitc regression analysis revealed that ANRI was independent factor influencing DFS and OS (P＜0.05).Kaplan-Meier survival analysis indicated that the prognosis after TACE was poor in patients whose preoperative ANRI ＞7.8.Conclusion Preoperative ANRI level is an independent and effective predictor for judging the prognosis of HCC patients.A high preoperative ANRI level usually suggests a poor prognosis after TACE.