The covered stents has been increasingly used in the prevention and treatment of the restenosis of the transjugular intrahepatic portosystemic shunt (TIPS), outcoming with obvious achievement, Viatorr stent-graft has been proved to be more efficient for the improvement of shunt patency. The purpose of the article is to review the formation, the character, the application and efficacy of the covered stents used in TIPS. With the improvement of covered stents, TIPS will regain its lost popularity in the treatment of portal hypertension.

Waste plastics in the environment is called"gray pollution"as a result of difficult degradation and when dis-posed by incineration,secondary pollutants are released.In this paper the formation mechanism and path of some persistent or-ganic pollutants in the process of waste plastic incineration disposal and their potential hazards to the ecological system,even to human beings are briefly reviewed,and valuable references and suggestions are given.Some of effective measures which should be taken to inhibit the formation of these toxic organic compounds during waste disposal and reduce their negative effect on mankind.

ObjectiveTo observe the short term efficacy and safety of cryoplasty in treatment of lower extremity arterial occlusive disease. MethodsTwenty five patients (27 limbs) scheduled for lower extremity artery balloon angioplasty were randomized to cryoplasty [ group CRYO, 10 patients with 8 male,age ( 76 ± 8 ) years]or conventional balloon angioplasty [ group COBA, 15 patients with 13 male, age ( 68 ±4) years], In CRYO group, the average lesion length and stenosis were (6.7 ±0.9) cm and, (91±6)％, respectively. The average ankle-brachial index (ABI) was 0. 46 ±0. 07 before treatment. According to Fontaine clinical stages, 7 patients (7/10) in this group were staged Ⅱ and the other 3 (3/10) were staged Ⅲ. According to Trans Atlantic Inter Society Consensus (TASC), 8 patients (8/10) were classified as TASC type A and the other 2 (2/10) were TASC type B. In COBA group, the average lesion length and stenosis were (6. 5 ± 0. 7 ) cm and ( 89 ± 7 ) ％, respectively. The average ABI was 0. 48 ± 0. 08 before treatment.According to Fontaine clinical stages, 13 patients (13/15) were stagedⅡand the other 2(2/15) were staged Ⅲ. And, according to TACS, 13 patients (13/15) were classified as TASC type A and the other 2 (2/15) were TASC type B. The clinical symptoms and signs had no significant difference between the two groups ( P ＞ 0. 05 ).Clinical status was evaluated according to Rutherford classification.The clinical efficacy on the 2nd and 30 th day after the operation was compared using analysis of variance with repeated measurements. ResultsTechnical success was achieved in all patients both in CRYO group (10/10) and in COBA group (15/15). None patient in CRYO group occurred postoperative complication.One patient in COBA group ( 1/15 ) occurred vessel wall dissection. In CRYO group, clinical status were remarkably improved in 8 patients (8/10) and moderately improved in 2 patients (2/10) ; while, in COBA group, they were remarkably improved in 13 patients ( 13/15 ) and moderately improved in 2 patients ( 2/15 ). The average ABI was 0. 84 ± 0. 04 in group CRYO and 0. 84 ± O. 05 in group COBA ( P ＝ 0. 20).The average stenosis was (29 ± 4) ％ in group CRYO and (32 ± 4) ％ in group COBA ( P ＝ 0. 55 ). No significant difference was detected between the two groups.Both the average ABI and stenosis presented statistically significant difference between pre-operation and post-operation in both groups ( P ＜ 0. 01,respectively).Conclusions Cryoplasty is safe for the treatment of lower extremity arterial occlusive disease, which showed a good short-term result in this research.

Objective To evaluate the role of CT imaging in staging of hypopharyngeal and laryngeal carcinoma.Methods 85 patients with hypopharyngeal or laryngeal carcinoma proved by operation were examined contrast-enhanced CT scan.The CT images were analysed by two experienced radiologists who were unknown pathologic results,in combination with the clinical data,the TNM staging of tumors were evaluated,then the results were compared with that of pathology,and Wilcoxon rank sum test was used for statistical analysis.P value less than 0.05 was considered statistically significant.Results The accuracy of the staging of lesions was 70.1% based on clinical data alone,while the clinical informations in combination with CT,the accuracy reached 87.1%,that was of significant statistically(P=0.001).Conclusion CT imaging is useful in staging of hypopharyngeal and laryngeal carcinoma,especially when it is combined with clinical data.

Aim To investigate the signaling mecha-nisms in endothelial monocyte-activating polypeptide-Ⅱ( EMAP-Ⅱ)-induced increase in blood-tumor barri-er ( BTB ) permeability. Methods Relatively pure cerebral microvessel fragments were obtained from the cortex of 3-5 days old Wistar rats by using careful dis-section, enzyme digestion, and dextran centrifugation. Then, these fragments were seeded on dishes and cul-tured primarily. In vitro BTB models were constructed by co-cultivation of rat brain microvascular endothelial cells ( BMECs) with C6 glioma cells. Confluent mono-layers of co-cultured BMECs were divided randomly in-to 5 groups ( each n=6 ): control, EMAP-Ⅱ, H7 +EMAP-Ⅱ, C3 exoenzyme + EMAP-Ⅱ, and C3 ex-oenzyme + H7 + EMAP-Ⅱ groups. Transendothelial electric resistance values and horseradish peroxidase flux were measured to evaluate changes in the BTB permeability . The expression levels of tight junction-re-lated protein occludin and ZO-1 in BMECs were meas-ured by Western blot. Immunofluorescence was used to identify the expression and distribution of occludin and ZO-1 in BMECs. Also, Western blot were used to de-tect the expression levels of myosin light chain ( MLC) and phosphomyosin light chain ( pMLC ) in BMECs. Results Compared with control group, the BTB per-meability of EMAP-Ⅱ group was increased significant-ly. The expression levels of occludin and ZO-1 in BMECs were significantly decreased, accompanied with marked increase in the expression level of pMLC. These above-mentioned effects of EMAP-Ⅱ were sig-nificantly inhibited by pretreatment with H7 ( an inhib-itor of PKC ) or/and C3 exoenzyme ( an inhibitor of RhoA ) . Conclusion Signaling molecules PKC and RhoA play important roles in EMAP-Ⅱ-induced in-crease in BTB permeability; signaling pathways PKC-pMLC and RhoA-pMLC are involved in this process.

Objective To evaluate the safety and efficacy of mechanical thrombectomy in treating in-stent restenosis of lower extremity arteriosclerosis obliterans. Methods From May 2015 to Sep 2016, the clinical data of 9 cases of lower extremity arteriosclerosis obliterans who were with in-stent restenosis(3 were stent graft)were retrospectively collected, and of which 7 were males and 2 were females with a mean age of (75.4 ± 6.3)years old. All the cases were treated by mechanical thrombectomy of Rotarex catheter. All the patients were diagnosed via low-extremity artery CTA, and treated by means of the Rotarex catheter, combined with angioplasty and stent if necessary. All patients received antiplatelet therapy. Doppler ultrasonography was taken during the followed-up. Results All the 9 cases were successed in technology, without complications in hospital. All patients received Rotarex mechanical thrombectomy. Six of which used balloon and 1 stent implanted. The ABI increased from 0.29 ± 0.07 to 0.88 ± 0.07 after treatment, the difference was statistically significant(t=28.875,P<0.05). All the patients were followed up for 3—18 (median time, 11.5)months. No death and symptoms recurrence appeared during the follow-up. Conclusions Mechanical thrombectomy using Rotarex catheter is a safe and effective treatment for in-stent restenosis in lower extremity arterial diseases.

Objective To explore the security and the short term efficacy of VIABAHN stents in the treatment of branching area lesions in lower extremity arterial diseases. Methods The data of 16 patients (11 male and 5 female, aged 59.0 to 81.0 with median of 71.6) with lower extremity arterial occlusive disease from November 2014 to June 2015 were analyzed retrospectively. All lesions were located around the branching area of the lower extremity artery (3 cases in the internal iliac artery orifice, 6 cases in the deep femoral artery orifice and 7 cases in the vascular net around the knee). The short?term effects on these patients in the follow-up period, such as the success rate of surgical technique, the improvement of symptoms and the incidence of complications were summarized. Results Revascularization was technically successful in all 16 patients, and ischemic symptoms relieved significantly after the operation. The ABI were 0.36±0.12 before and 0.89±0.10 after the operation. The patients were followed up for 3 to 9 months (median 5.5 months). All the patients were achieved limb salvage and no complication occurred. Conclusions VIABAHN stent is safe and effective for the treatment of lower extremity arterial occlusive disease. The branches around the lesion can be covered with VIABAHN stents.

Objective To investigate the clinical value of CT lymphangiography (CTL) combined with direct lymphangiography (DLG) in primary intestinal lymphangiectasia (PIL). Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings (12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions), abdominal lymph nodes (6 cases), lymphangiectasia and abnormal distributions (14 cases), fistulas (lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases), lymphangiomatosis (3 cases), and thoracic duct outlet dysfunction and reflux (14 cases).The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.

Objective To investigate the safety and clinical value of using ExoSeal vascular closure device (VCD) in interventional management via antegrade femoral access.Methods Clinical and imaging data of 303 patients (316 affected limbs) who were received interventional procedure via antegrade femoral access closure were retrospectively analyzed.ExoSeal VCD (VCD group,n=127) and manual compression (MC group,n =176) were performed to make femoral artery puncture point hemostasis.The time of hemostasis,actual immobilization time,technical success rate and vascular related complications were recorded and compared between the two groups.Results In VCD group and MC group,the time of hemostasis were (3.68 ± 2.40) min and (18.32 ± 4.54) min,the actual immobilization time were (3.45±5.30) h and (10.44±14.68) h,the technical success rates were 98.52％ (133/135) and 93.92％ (170/181),and the complication rates were 2.22％ (3/135) and 8.84％ (16/181),respectively.There were statistically significant differences between two groups (all P＜0.05).In VCD group,there were 2 cases of subcutaneous hematomas,and 1 case of retroperitoneal hematoma.In MC group,there were 15 cases of subcutaneous hematomas and 1 case of acute thrombosis in the puncture side limb.Conclusion Regarding hemostasis of puncture site in interventional management via antegrade femoral access,the use of ExoSeal VCD is safe and effective.