Hepatitis C virus (HCV)is an important human pathogen that causes chronic viral hepatitis worldwide.HCV infection,often persistent and asymptomatic,could lead to liver fibrosis/cirrhosis and hepatocellular carcinoma.The interferon/ribavirin therapy has been widely used for treating chronic hepatitis C,but it is not always effective and has strong side effects.The development of small-molecule di-rect antiviral agents (DAA)has greatly improved the curing efficiency of chronic hepatitis C therapeutics and will likely replace the interfer-on-based therapy in the future.However,these developments do not necessarily suggest that the problems of chronic hepatitis C have been completely solved.The HCV research is still facing many challenges in this new DAA era.

Objective To investigate the effect of endovascular treatment to initial and long-term outcomes of postpartum deep venous thrombosis (DVT) . Methods The clinical data, venography and 3-yaer follow up data of 30 female patients with acute or subacute deep vein thrombosis in the postpartum period who received endovascular therapy consisting of catheter-directed thrombolysis with angioplasty (stenting for some patients with iliac vein compression syndrome (IVCS)) were retrospectively evaluated. Clot removal was graded as grade Ⅲ(>95%), grade Ⅱ(50% to 95%), and grade Ⅰ(<50%). Grade Ⅱ, Ⅲconsidered effective. Data from onset time, vaginal delivery or by elective, patients ages, IVCS or not and stenting or not were included in this analysis. And the χ2 test and survival analysis was used for statistical analysis of initial and long-term patency respectively. Results In 30 cases, the initial result included 14 cases(46.7%) of gradeⅢ, 12 cases(40.0%) of gradeⅡand 4 cases(13.3%) of gradeⅠ. Patients' onset time, vaginal delivery or by elective, patients ages and IVCS or not have no significant statistical difference to initial patency(χ2=0.88, 1.28, 1.15, 3.08,P>0.05).For 18 patients with IVCS, there was significant statistical difference between patients implanting stents(initial patency was 100.0%(7/7) and whom not
implanting stents(initial patency was 63.6%,7/11) (χ2=5.14, P<0.05). 1, 3, 6 months and 1, 2, 3 years follow-up showed: The primary patency of postoperative 1, 3, 6 months respectively were 86.7%, 70%(21/30),66.7%(20/30), and postoperative 1, 2, 3 years were all 66.7%. There was significant statistical difference between patients with IVCS implanting stents and whom not implanting stents (χ2=6.562, P<0.05), patients with IVCS not implanting stents and whom without IVCS (χ2=3.377, P<0.05). There was no significant statistical difference among patients with IVCS implanting stents and whom without IVCS(χ2=1.932, P>0.05). Conclusions Endovascular therapy consisting of catheter-directed thrombolysis with angioplasty could be considered as a primary therapeutic procedure in patients with acute or subacute postpartum DVT. Stenting for treatment of iliac compression which contributed to postpartum DVT is very valuable to ensuring higher long-term patency rate.

Objective To explore the clinical features, diagnosis and interventional management of acute deep venous thrombosis of lower extremity (LEDVT)combined with type Ⅱ heparin-induced thrombocytopenia (HITⅡ) and to improve the knowledge of this disease. Methods A retrospective review and analysis of the clinical data of the patients with acute LEDVT combined with HIT Ⅱ enrolled from January 2010 to June 2014. All of them underwent anticoagulation with low molecular weight heparin (LMWH) and the comprehensive interventional therapy at the beginning of treatment.When HIT Ⅱ was
identified, all forms of heparin and LMWH were avoided . Alternative anticoagulation was commenced with argatrobam. Adjustments in interventional therapy were taken while the short-term low-dose glucocorticoid treatment were used.The clinical manifestations, changes of PLT, 4Ts score (Warkentin 4T scoring system, 4Ts) , HIT antibody assay (ELISA) and response to therapy of the patients were analyzed and the treatment effect was observed . The efficacy of interventional therapy was evaluated according to the improvement clinical symptoms and venography. Results The incidence of acute LEDVT combined with HIT Ⅱ was 1.9%(8/416). There were 4 males and 4 females with a median age of 24 years in this study. The median time between their initiation exposure to heparin and onset of thrombocytopenia was 5 days (range,3 to 8 days). The median platelet counts prior to HIT Ⅱ was 218 × 109/L( range,122 × 109/L to 254 × 109/L ). Platelet counts decreased to the lowest level range from 20 × 109/L to 51 × 109/L(median 32 × 109/L). After alternative anticoagulation, the interval period which PLT recovered to the basic level was range from 3 to 7 days (median 3.5 days) . According to the score of 4Ts , there were 2 cases score 6 and 6 cases score 8. HIT antibody assay (ELISA) was detected in 6 patients which the results were positive. During heparin anticoagulation treatment, the LEDVT condition of all patients continued to deteriorate. Vein thrombosis extended in 7 patients. Among them, 5 patients occurred new thrombosis in the inferior vena cava and(or) at the vessel of catheter insertion. Another 2 patients complicated with pulmonary embolism. After underwent anticoagulation with argatrobam , with the increased of PLT the treatment efficacy of thrombolysis therapy was ameliorated. At the endpoint of interventional therapy, the curative effect evaluation was excellent in 3 cases, good in 3 cases and medium in 2 cases respectively. All patients were followed up for 12 to 20 months (median 15.5 months) with no evidence of recurrence .Conclusions The study showed that acute LEDVT combined with HITⅡdisplayed the following features:(1)an absolute drop in platelet count below the normal range (PLT ≤100 × 109/L) or as a relative decrease of 30% to 50% from baseline counts. (2) refractory venous thrombosis,during the interventional treatment of acute LEDVT, platelets counts should be monitored regularly in patients who receiving heparin anticoagulation. For patients with strongly suspected HIT Ⅱ, withdrawal of all forms of heparin and early introduction of alternative anticoagulant therapy can improve the effect of interventional therapy.

Objective To discuss the clinical application of mechanical thrombectomy with AngioJet system for acute lower limb arterial ischemia (ALI).Methods A total of 12 ALI patients,who underwent percutaneous mechanical thrombectomy with AngioJet systemn during the period from January 2015 to November 2016,were enrolled in this study.The clinical data were retrospectively analyzed.The blood flow classification score after thrombolysis in myocardial infarction (TIMI) was used to evaluate the blood perfusion condition,and Cooley standard of efficacy score was used to assess the clinical curative effect.Results The technical success rate of mechanical thrombectomy with AngioJet system was 91.7％ (11/12).The average restored perfusion time was (1.5±0.6) hours.The clinical success rate and limb salvage rate were 83.3％ (10/ 12) and 91.7％ (11/12),respectively.The TIMI flow scores were improved from preoperative grade 0 (n=8) and Ⅰ (n=4) to postoperative grade 0 (n=1),Ⅰ (n=3) and Ⅱ (n=8).In 11 patients (91.7％) the symptoms of lower limb arterial ischemia were strikingly improved after mechanical thrombectomy.In one patient,the postoperative TIMI flow score remained 0 as preoperative state and the symptoms of lower limb arterial ischemia were not improved although catheter directed thrombolysis therapy was employed for 24 hours,and above-knee surgical amputation had to be carried out.Cooley efficacy score showed that complete cure was seen in 4 patients (33.3％),good response in 6 patients (50.0％),general improvement in one patient (8.3％) and pool response in one patient (8.3％).No severe bleeding complications occurred.Conclusion Percutaneous mechanical thrombectomy with AngioJet can rapidly recover the blood perfusion in patients with ALI,thus,further deterioration of the disease can be prevented and the limb salvage rate can be improved.Therefore,this technique has good clinical application value.

Objective: To investigate the safety and effectiveness of the Celect inferior vena cava filter (IVCF) in the treatment of deep venous thrombosis (DVT). Methods: CT follow-up examinations were performed in 72 patients who underwent Celect inferior vena cava filter placement between August 2015 and September 2017. Forty-five patients (62.5%) presented with DVT alone, 27(37.5%) with DVT and pulmonary embolism (PE). With filters in place, each patient was followed up with CT at least once, to visualize new pulmonary embolism, inferior vena cava occlusion, filter tilting, fracture of struts, migration and penetration of struts through the inferior vena cava. Caval penetration was graded on a five-point scale. Results: All Celect filters were successfully deployed. The interval between the filter placement and the CT was 5.0 to 695.0 days, mean (42.4±84.6)days. No new pulmonary embolism, cava occlusion, filter fracture and migration were found. Forty-two (58.3%) filters tilted, including tilt>15 degrees in 8 (11.1%) and tilt ≤15 degrees in 34 (47.2%). Caval penetration with 0 grade was observed in 47 (65.3%) and beyond grade 1 was observed in 25 (34.7%), including grade Ⅰ in 12 (16.7%), grade Ⅱ in eight (11.1%), grade Ⅲ in four (5.6%) and grade Ⅳ in one (1.4%). No patient presented with symptoms associated with caval penetration. Filter retrieval was attempted in 54(75.0%) patients,the indwell time was 5.0 to 111.0 days, mean(32.0±23.9) days. There were 52 (96.3%) filters successfully removed, including four filters tilted lead retrieval hook embedded the caval wall, which used the adjunctive retrieval techniques. Filter retrieval failure in two (3.7%) cases, including one case retrieval hook embedded the caval wall and the other with retrieval hook penetration. Conclusions Celect inferior vena cava filter can effectively prevent PE, but had a tendency to tilt and to penetrate caval wall, which affected the filter retrieval, and had the potential risk of serious complications such as abdominal aortic pseudoaneurysm. The filter should be removed as soon as the risk of PE is manageable. We advocate CT follow-up for patients with long-term inferior vena cava filter placement.

Objective To assess the safety and efficacy of catheter-directed thrombolysis combined with percutaneous transluminal angioplasty (PTA) in treating acute thrombo-embolism of artificial arteriovenous fistula.Methods The clinical data of 64 patients with acute thrombo-embolism of artificial arteriovenous fistula (84 events in total),who were admitted to single medical center during the period from January 2012 to September 2016,were retrospectively analyzed.The diagnosis of acute thrombo-embolism of artificial arteriovenous fistula was confirmed by angiography via femoral approach in all patients.Mechanical thrombectomy of the thrombotic occlusion segment by using common guide wire was carried out first,which was followed by bolus injection of urokinase (125,000-375,000 units);if the thrombus was not completely dissolved the catheter would be retained and the urokinase would be continuously infused with a micro-pump until the thrombus was completely dissolved.Conventional balloon dilatation would be employed when the stenosis of artificial arteriovenous fistula lumen was ＞50％ or the stenosis impeded the performance of dialysis.Kaplan-Meier survival curve was used to estimate the primary and secondary cumulative patency rates after the first intervention.Results Of the 84 interventional procedures,technical success was achieved in 69 procedures (82.1％).A total of 14 conventional balloon dilatation procedures had to be conducted as the fistula was seriously narrowed,and up to 12 procedures (85.7％) were succeeded.The overall clinical success rate was 78.5％ (66/84).During the therapeutic course,bleeding event occurred in 7 procedures (8.3％),including major bleeding (n=3) and minor bleeding (n=4).After the treatment,the 3-,6-,12-,24-month primary and secondary patency rates were 76.1％,63.6％,40.8％,12.5％ and 81.3％,70.8％,47.0％,32.5％respectively.Conclusion For the treatment of acute thrombo-embolism of artificial arteriovenous fistula,catheter-directed thrombolysis is safe and effective,it can assist conventional balloon dilatation therapy to obtain satisfactory therapeutic result for internal fistula stenosis.

Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase(UK)in catheter-directed thrombolysis(CDT)for the treatment of subacute iliofemoral deep venous thrombosis(DVT). Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study.The patients were divided into three groups for comparison:rt-PA-CDT group(n=43), UK-CDT group(n=39)and anticoagulation group(n=34). The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test(accorded to normal distribution)was used to analyze the thrombolysis duration.The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups(P>0.05). The thrombolysis duration, total dosages and thrombolytic rate (≥50)were(5.8±1.3)d,(49.7±16.1)mg,86.0% for rt-PA-CDT group,and(6.3±1.5)d,(440±99)×104 U, 66.7% for UK-CDT group.The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group(t=-1.868, P>0.05). The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group(χ2=4.315, P<0.05). The time of obtaining grade Ⅲthrombosis rate was shorter for rt-PA-CDT group(4.7±0.9)d compared with UK-CDT group(6.0±1.2 d) (t=-2.343,P<0.05).The clinical efficacy rates of the rt-PA-CDT group[88.4%(38/43)]and UK-CDT group [76.9%(30/39)]were significantly higher than that of anticoagulation group[26.5%(9/34)](P<0.05).There was no statistical difference between the rt-PA-CDT group and UK-CDT group(χ2=1.893, P>0.05). No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3%(7/43), 17.9%(7/39)and 8.8%(3/34), respectively, and there were no significant differences among the three groups(χ2=1.396, P>0.05). Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment.Thrombolytic rate of rt-PA is superior to UK.

OBJECTIVE： To study the inhibitory effect of modified Maimendong decoction combined with cisplatin on Lewis lung cancer transplantation model mice， and to explore its potential mechanism. METHODS： Lewis lung cancer transplantation mice model was induced via subaxillary inoculation of Lewis lung cancer cells. 60 mice were randomly divided into model group （normal saline， once a day， i.g.）， cisplatin group （6 mg/kg， once a week， i.p.）， modified Maimendong decoction group （20 g/kg. once a day， i.g.） and combination group （cisplatin 6 mg/kg， once a week， i.p.+modified Maimengdong decoction， once a day， i.g.）， with 15 mice in each group. All mice were treated for consecutive 2 weeks. After medication， tumor weight and thymus index were detected； HE staining was used to observe the pathological change of tumor tissue. TUNEL was used to detect apoptotic index of tumor tissue. The protein expressions of Bcl-2 and Bax were detected by Western blot assay. RESULTS： Compared with model group， tumor weight and protein expression of Bcl-2 were decreased significantly in modified Maimengdong decoction， cisplatin group and combination group （P＜0.05）， and thymus index， tumor apoptotic index and the protein expression of Bax were increased significantly （P＜0.05）. Tumor weight and protein expression of Bcl-2 in combination group were significantly lower than modified Maimengdong decoction group and cisplatin group （P＜0.05）； thymus index， tumor apoptotic index and the protein expression of Bax were significantly higher than addition and subtraction of modified Maimengdong decoction group and cisplatin group （P＜0.05）. HE staining showed that the density of tumor cells was decreased to certain degree in modified Maimengdong decoction group， cisplatin group and combination group； the area of necrosis area in the combination group was significantly larger than in modified Maimendong decoction group and cisplatin group. CONCLUSIONS： Modified Maimendong decoction can inhibit the growth of Lewis lung cancer transplanted tumor in mice by down-regulating the protein expression of Bcl-2 and up-regulating the protein expression of Bax.

Adult ; Antibodies, Viral/isolation & purification* ; COVID-19/virology* ; Feces/chemistry* ; Female ; Humans ; Intestines/virology* ; Male ; RNA, Ribosomal, 16S/genetics* ; RNA, Viral/isolation & purification* ; SARS-CoV-2/pathogenicity*