Objective To explore the value of real-time tissue elastography (RTE) with tissue dispersion quantitative analysis technique for assessment of liver fibrosis stage.Methods 51 rats were injected 6％ thioacetamide to induce liver fibrosis model,and 9 rats were injected saline as control group.In modeling 4 weeks,8 weeks,12 weeks respectively,14 rats in group of liver fibrosis model and 3 rats in control group were randomly selected to RTE.All the rats underwent tissue dispersion quantitative analysis,to obtain 12 quantitative parameters of elasticity,which included average relative strain value (MEAN),standard deviation of relative strain value (SD),area ratio of low-strain region (％ AREA),complexity (COMP),kurtosis (KURT),skewness (SKEW),contrast (CONT),entropy (ENT),inverse difference moment (IDM),angular second moment (ASM),correlation (CORR) and liver elasticity index (LF index).Subsequently,rats were sacrificed and their livers were taken for pathology analysis.Liver fibrosis model group was divided into S0,S1,S2,S3,S4 group.The 12 quantitative parameters of elasticity were compared with each group.Results 49 rats were successfully modeled,and 42 rats were analyzed.Except COMP,KURT,CORR,the other quantitative parameters had statistically differences (P ＜ 0.05).The other 9 parameters were correlated with liver fibrosis stage.Among these parameters,MEAN,％ AREA and LF index had higher related coefficient(r =-0.831,0.882,0.866).The ROC curve was made by MEAN,LF index and ％AREA to estimate the fibrosis stage,when S≥S1,S≥S2,S≥S3,S =S4,the areas under the ROCcurve were 0.884,0.925,0.934,0.962 (MEAN);0.917,0.958,0.984,0.962 (％AREA);0.917,0.948,0.966,0.967 (LF index),respectively.Conclusions As a non-invasive examination,RTE dispersion quantitative analysis technology can be used to quantitatively assess liver fibrosis.

Objective To evaluate the feasibility of the posterior C2 pedicle screw placement (C2 PSP) by MPR techniques of helical CT.Methods Totally 250 patients (500 sides) who underwent head and neck CTA examination were enrolled.The bony parameters and the arterial parameters were measured after MPR.The bony parameters included pedicle diameter (D),isthmus height (T),internal height (H),and the arterial parameters included medial shifting:lateral (L),neutral (N),medial (M);and the degree of riding included below (b),within (w),above (a).The prevalence of narrow pedicles,high-riding vertebral arteries (HRVA) and the subtypes of IAVA in the general population were calculated,and the statistical analysis between narrow pedicles,HRVA,IAVA and C2 vertebral arteries groove (C2 VAG) injury were performed.Results The rate of narrow pedicles and HRVA were 14.40％ (72/500) and 24.60％ (123/500;x2=141.984,P＜0.001).When it came to the simulation of the C2 PSP inserting,the incidence of C2 VAG injuries was 19.40％ (97/500).In narrow pedicle and HRVA patients,the C2 VAG injuries incidence were higher than that of without narrow pedicle and HRVA patients (both P＜0.001).In 58 sides (58/500,11.60 ％),the narrow pedicles and HRVA occurred simultaneously.There were statistical significance differences of narrow pedicles and HRVA and the C2 VAG injuries in different types of IAVA (all P＜0.001),the subtypes of IAVA M-a consisted most common,which account for 55.56％ (40/72),46.34％ (57/123) and 48.45％ (47/97),respectively.Conclusion Most of the C2 VAG injuries happened in narrow pedicles,HRVA or IAVA M-a type patients.MPR can be used to comprehensively evaluate osseous and arterial parameters,which will provide anatomy foundation to the screw placement of C2 pedicles.

Objective:To compare the effect of intracorporeal anastamosis and extracorporeal anastamosis on abdominal infection associated with laparoscopic right hemicolectomy.Methods:The clinical data of 210 patients with colon cancer who underwent laparoscopic right hemicolectomy in Dalian Third Peoples′s Hospital, Liaoning Province from January 2015 to December 2019 were analyzed retrospectively.Among them, 79 patients underwent intracorporeal anastamosis (intracorporeal anastamosis group) and 131 patients underwent extracorporeal anastamosis (extracorporeal anastamosis group). The perioperative indexes and postoperative abdominal infection were compared between the two groups.Results:In intracorporeal anastamosis group, the intraoperative bleeding was (45.2±4.2) mL, the operative time was (161.3±22.4) min, the number of lymph node dissection was (30.8±9.6), the postoperative exhaust time was (3.3±1.2) d, and the postoperative hospital stay was (7.6±0.5) d. In extracorporeal anastamosis group was (42.1±5.0) mL, (167.3±26.7) min, (32.9±8.6), (3.4±1.0) d and (7.5±0.6) d, respectively, there were no significant difference between the two groups (t value were 0.417, 0.207, 0.829, 0.338 and 0.293, respectively; P value were 0.699, 0.845, 0.231, 0.734 and 0.802, respectively). In intracorporeal anastamosis group, the incidence of abdominal infection (with anastomotic fistula)was 13.9%(11/79), the incidence of abdominal infection (without anastomotic fistula)was 10.1%(8/79), and in extracorporeal anastamosis group was 1.5%(2/131)and 0.8%(1/131), the differences were statistically significant (χ 2=12.805, 10.238; P=0.003, 0.008). In intracorporeal anastamosis group, the incidence of respiratory system infection was 1.3%(1/79), the incidence of urinary system infection was 2.5%(2/79), the incidence of surgical incision infection was 1.3%(1/79). In extracorporeal anastamosis group was 3.1%(4/131), 0.8%(1/131) and 3.1%(4/131), respectively.There were no significant difference between the two groups (χ 2 value were 0.662, 0.420 and 0.662, respectively; P value were 0.364, 0.587 and 0.364, respectively). Conclusion:Laparoscopic right hemicolectomy with intracorporeal anastamosis and extracorporeal anastamosis have the same surgical effect, but intracorporeal anastamosis may increase the risk of postoperative abdominal infection.

Objective To explore the mechanism by which total flavones of rhododendron(TFR)protect against cerebral ischemia-reperfusion(I/R)injury by inhibiting the TNF-α/caspase-8/caspase-3 signaling pathway.Methods The middle cerebral artery occlusion(MCAO)method was used to establish the rat I/R model.Rats were randomly divided into Sham surgery,MCAO,and post-I/R intervention with TFR 200 mg/kg(TFR 200 mg/kg)groups.After establishing the MCAO rat model,rats in the TFR 200 mg/kg group were administered TFR(200 mg/kg)solution for 14 consecutive days following I/R injury surgery.Hematoxylin-Eosin(HE)staining was used to observe neurological function scoring,cerebral blood flow assessment,histological examination of brain tis-sue,assay kits were used to detect lactate dehydrogenase(LDH)and neuron-specific enolase(NSE)activities in rat serum.ELISA assay kits was used to measure interleukin-1(IL-1)and interleukin-6(IL-6)levels,and West-ern blot and immunohistochemistry were conducted to detect the expression levels of cleaved caspase-3,caspase-8,and TNF-α proteins in rat brain tissue 14 days post-surgery.Results After cerebral ischemia-reperfusion treat-ment,MCAO resulted in abnormal neurological function in rats,significantly increased neurological function sco-ring index,obvious changes in cerebral tissue histomorphology and cerebral blood flow,significant upregulation of cleaved caspase-3,caspase-8,and TNF-α protein expression levels in brain tissue,and significant elevation of LDH,NSE,IL-1,and IL-6 levels in serum.Rats in the TFR 200 mg/kg group showed significantly reduced neu-rological function scoring,significant improvement in cerebral tissue pathological damage,decreased expression levels of cleaved caspase-3,caspase-8,and TNF-α proteins in brain tissue,as well as decreased levels of LDH,NSE,IL-1,and IL-6 in serum.Conclusion TFR may alleviate cerebral ischemic hypoxic injury by inhibiting the TNF-α/caspase-8/caspase-3 signaling pathway.

Objective:To compare the effect of midcaudal combined approach and the cephalic middle approach in laparoscopic complete mesocolic excision (CME) in the treatment of right colon cancer complicated with incomplete intestinal obstruction.Methods:From January 2014 to January 2019, 90 patients with right colon cancer complicated with incomplete intestinal obstruction admitted to the Third People′s Hospital of Dalian were retrospectively analyzed.All patients underwent laparoscopic right hemicolectomy, CME plus D3 lymph node dissection.According to the choice of different surgical approaches, 44 patients were treated with the midcaudal combined approach (observation group) and the other 46 patients were treated with cephalic middle approach (control group). The intraoperative, postoperative and complications of the two groups were compared statistically.Results:Compared with the control group, the bleeding volume in the observation group was significantly reduced ((105.3±22.6) ml vs.(309.6±28.0) ml, t=13.698), the operation time was significantly shortened ((165.2±17.9) min vs.(219.5±21.5) min, t=8.327), and the differences were statistically significant (all P<0.05). There were no significant differences in the number of lymph nodes dissected ((21.4±7.8)vs.(20.4±6.6), t=0.534), the proportion of lymph nodes dissected≥12(86.4%(38/44)vs.84.8%(39/46), χ 2=0.208), the complications after operation(6.8%(3/44)vs.10.9%(5/46), χ 2=0.318), the length of hospital stay after operation ((11.8±1.6) d vs.(12.5±2.3) d, t=0.986), the difference was statistically significant (all P>0.05). Conclusion:It is safe and feasible to use the middle caudal approach in laparoscopic CME for right colon cancer complicated with incomplete ileus. Compared with the cephalic middle approach, it can reduce thebleeding volume and shorten the operation time.

Objective:To report a single-center experience with the Cordis Incraft endograft with low-profile in abdominal aortic aneurysms (AAAs) with severe infrarenal neck.Methods:All patients underwent EVAR with Incraft stent grafts between September 2019 and September 2022, were prospectively enrolled, and retrospectively analyzed. Anatomical details of the proximal aortic neck were evaluated, divided into the severe infrarenal neck (SIN, 13 cases) and normal infrarenal neck (NIN, 50 cases) groups. Early endpoints were intraoperative unplanned cuff or coil embolism, technical success (TS), 30-day morbidity/mortality, and reinterventions. Follow-up endpoints were occurrence of endoleaks, endograft migration, branch stent/ iliac stent-graft stenosis or occlusion, reintervention. The postoperative endoleak, aneurysm sac shrinkage, patency of iliac stent-graft/branch stent, and freedom from reinterventions between the two groups were compared.Results:A total of sixty-three patients were enrolled in this trial, all of whom were successfully treated. There was no significant difference in patient and lesion characteristics, excluding aneurysm neck length, neck angle and maximum aneurysm sac diameter. Proximal aneurysm neck length was shorter in the SIN group [(9.9±8.3)mm vs. (29.6±12.3)mm, P<0.001] and the neck angle was more tortile in the SIN group [(39.1±30.4)°vs.(25.1±15.4)°, P=0.036], as well maximum sac diameter was larger in the SIN group [(57.5±13.4)mm vs. (45.5±12.4)mm, P=0.016]. Although the results showed no differences between the two groups regarding the oversize rate of the main body stent graft, endoleak in operative and perioperative period, as well the hospital stay, the operative time was significantly longer in the SIN group [(96.36±31.83)min vs. (63.58±26.68)min, P=0.001]. Over the 3 years of follow-up (median time, 18 months), there were significant differences between the two groups regarding the complication occurrence of endoleak, renal stent or iliac stent-graft stenosis/occlusion ( P=0.012), and reintervention ( P=0.044). Conclusion:Data from this trial demonstrated excellent early and mid-term outcomes of EVAR using Incraft stent grafts, including severe infrarenal neck, with acceptable safety and efficacy in the short and middle terms.

Objective:To evaluate the safety and effectiveness of ARAHKEY(arterial closure using an additional hemostatic device that is deeply compatible with an extravascular suturing device) technique during percutaneous transluminal repair of thoracic aortic disease(TEVAR).Methods:From January 2021 to January 2023, a total of 202 patients underwent TEVAR in our center.24 patients were treated with ARAHKEY technology, which involves using an additional 7F Exosel at the femoral artery puncture site to achieve hemostatic effect when two ProGlide embedded sutures cannot achieve hemostatic effect.Results:All patients achieved complete hemostasis.The mean time for compression hemostasis was(5.8±2.6)min.In this study cohort, no complications including recurrent bleeding, infection, and late acquired hematoma were observed.Conclusion:ARAHKEY technology is a safe method that can be considered as the primary choice when using ProGlide during TEAVR without achieving hemostatic effects.

Objective To compare the radiation dose of in vitro pre-fenestration and in situ fenestration thoracic endovascular aortic repair(TEVAR)in treatment of aortic disease.Methods Data of 51 patients with aortic diseases who received in vitro pre-fenestration(group A)and 21 cases who underwent in situ fenestration(group B)TEVAR were retrospectively analyzed.The fluoroscopy duration,total reference air kerma(AK),total dose area product(DAP)and TEVAR time were compared between groups.Results TEVAR was successfully completed in all 72 patients.Fluoroscopy duration([21.42±8.04]min vs.[34.57±9.07]min)and total DAP(44315.0[31157.0,56307.5]μGy·m2 vs.72153.0[45460.0,82354.0]μGy·m2)in group A were both significantly lower than those in group B(both P＜0.05),while total AK(2423[1638,3533]mGy vs.3600[1898,3921]mGy)and TEVAR time([83.41±22.89]min vs.[81.00±22.13]min)in group A were not significant different from those in group B(both P＞0.05).Conclusion Compared with in situ fenestration TEVAR,both the fluoroscopy time and total DAP of in vitro pre-fenestration TEVAR significantly reduced for treating aortic diseases.