Objective To assess the clinical value of dual-energy intracranial CT angiography (CTA).Methods Forty-one patients suspected of intracranial vascular diseases underwent dual-energy intracranial CT angiography, and 41 patients who underwent conventional subtraction CT were enrolled as the control group.Image quality of intracranial and skull base vessels and radiation dose between dual-energy CTA and conventional subtraction CTA were compared using two independent sample nonparametrie test and independent-samples t test, respectively.Prevalence and size of lesions detected by dual-energy CTA and digital subtraction CTA were compared using paired-samples t test and Spearman correlative analysis. Results The percentage of image quality scored 5 was 70.7% (29/41) for dual-energy CTA and 75.6% (31/41) for conventional subtraction CTA.There was no significant difference between the two groups(Z= -0.455, P=0.650).Image quality of vessels at the skull base in conventional subtraction CTA was superior to that in dual-energy CTA, especially for the petrosal and syphon segment (Z=-4.087, P= 0.000).Radiation exposure of dual energy CTA and conventional CTA were (396.54±17.43) and (1090.95±114.29) mGy · cm respectively.Radiation exposure was decreased by 64% (t=-38.52, P=0.000) by dual energy CTA compared with conventional subtraction CTA.Out of the 41 patients,19 patients were diagnosed as intracranial aneurysm, 2 patients as arteriovenous malformation (AVM), 3 patients with Moya-moya's disease, and the remaining 17 patients with negative results.Nine patients with intracranial aneurysm, 2 patients with AVM, 3 patients with Moya-moya's disease, and 2 patients with negative findings underwent DSA or operation, with concordant findings from both techniques.Diameter of aneurysm neck, long axis and minor axis by dual-energy CTA was (2.90±1.61), (5.23±1.68) and (3.83±1.69) nun, respectively; Diameter of aneurysm neck, long axis and minor axis by DSA was (2.95±1.71), (5.10±1.60) ,(3.83±1.65) nan,respectively.There was no significant difference for the diameters of aneurysm between dual energy CTA and DSA ((t=-0.734,1.936,0.12.5 respectively, P=0.482,0.085,0.903 respectively), and good correlation was found between diameter measurements using the two techniques(r=0.964,0.976,0.973, respectively, all P=0.000) Conclusions Compared with conventional subtraction CTA, dual energy CTA has good image quality for intracranial vessels; however, image quality of the skull base vessels is worse, especially for the petrosal and syphon segment.Dual energy CTA has decreased radiation dose and a high diagnostic accuracy, being a practical imaging madality for diagnosis of intracranial vascular lesions.

Objective To explore the clinical value of dual-energy CT lung perfusion imaging and perfusion scintigraphy in acute pulmonary embolism (PE) rabbit models. Methods Acute PE models were established in 20 rabbits with femoral vein injection of sponge as embolus materials, and 4 rabbits were injected saline as control group. Two hours after embolization, dual-energy CT and perfusion scintigraphy imaging were performed respectively. Taking the pathologicall findings as the reference standards, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both imaging methods were compared. CT values and enhancement degree (overlay value) of the embolic areas and normal pulmonary parenchyma were measured in DEPI image after embolization. Results Normal lung was color-coded as homogeneously yellowish red, perfusion scintigraphy displayed rarefaction or absence. The sensitivity, specificity, PPV, NPV of DEPI was 100%, 97.50%, 95.24%, 100%, and of perfusion scintigraphy was 67.50%, 81.25%, 64.29%, 83.33%, respectively. Increased CT values and overlay values of embolism areas in DEPI images were lower than those of normal pulmonary parenchyma (P<0.05). Conclusion DEPI has higher sensitivity and specificity than perfusion scintigraphy for detection of pulmonary emboli in an acute PE rabbit models.

AIM: To clone and express mouse canstatin (m canstatin)cDNA and provide a basis for the further research on its anti-angiogenic activity and potential application for cancer therapy. METHODS: Total RNA was extracted from mouse liver tissue by Trizol Reagent, and mouse canstatin cDNA was amplified by RT- PCR, then cloned into vector pMD18-T for sequencing. pET30a(+)-m canstatin recombinant plasmid was constructed and expressed in E.coli BL21 with induction of IPTG. RESULTS: Mouse canstatin cDNA is 684 bp coding 227 amino acids. The sequences of both cDNA and amino acid share high homology with human canstatin, with cDNA identity at 89% and amino acids identity at 96% to human canstatin. In the present study, pET30a(+)-m canstatin recombinant plasmid was expressed in E.coli BL21. CONCLUSION: Mouse canstatin cDNA has been cloned for the first time. Constructed pET30a(+)-m canstatin recombinant plasmid is highly expressed in E.coli BL21.

Objective To summarize the treatment experiences in patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods The clinical data of 9 patients with acute renal injury after orthotopic heart transplantation in our hospital from January 2009 to July 2016 were retrospectively analyzed. Three patients were required the high-dose diuretics (furosemide, >80 mg/d) and six patients were received continuous renal replacement therapy (CRRT). The levels of serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) were compared before and after heart transplantation and after the treatment of AKI. The quality of life was observed in patients in perioperative period. Results After the treatment of diuretics or CRRT, patients showed renal function recovery with significant decreased Cr levels and increased eGFR compared with the postoperation. The patients with diuretic therapy revealed a better eGFR recovery than those with CRRT. Conclusion CSA-AKI should be based on the severity of disease, and comprehensive treatment should be taken to reduce renal damage.

Objective To identify Anaplasma species circulating among livestock and rodents from Xitianmu Mountain area in Zhejiang province , Southeastern China and to analyze variations regarding to their 16S rRNA gene.Methods Samples of spleen, liver and blood were collected to extract DNAs .The 16S rRNA gene fragments of Anaplasma species were amplified by using a nested PCR and then sequenced .Ho-mology analysis was conducted by using BLAST program .The multiple sequence alignment and phylogenetic analyses comparing with the sequences of other Anaplasma species in GenBank were conducted by using MEGA 5.0 software.Results The 16S rRNA gene fragments of Anaplasma were detected in 1 cattle, 8 goats, 5 Rattus confucianus, 1 Apodemus agrarius, 1 Berylmys bowersi and 1 squirrel out of 129 animals. The natural infection rate of Anaplasma was 13.2% in animals from Xitianmu Mountain area in Zhejiang . The alignment and phylogenetic analyses indicated that there were at least four Anaplasma species prevalent in livestock and rodents from Xitianmu Mountain area , including Anaplasma phagocytophilum, Anaplasma marginale, Anaplasma centrale and Anaplasma bovis.Moreover, there was a variant that obviously differed from Anaplasmma bovis and other Anaplasma sp.in GenBank.Conclusion The Anaplasma infection was detected among livestock and rodents from Xitianmu Mountain area in Zhejiang province .A newly discovered variant in rodents was likely to be a novel species .More close attention should be paid to Anaplasma infec-tion among human in Xitianmu Mountain area .

Objective To evaluate the diagnostic accuracy of digital subtraction bone removal CT angiography (DS-BR-CTA) and dual energy bone removal CTA (DE-CTA) compared with conventional and rotational DSA. Methods A total of 264 patients underwent 3D-DSA were enrolled, 190 of them underwent also DS-BR-CTA, while 74 underwent DE-CTA as well. Aneurysms detected with DS-BR-CTA and DE-CTA were analyzed compared with 3D-DSA on per-patient and per-aneurysm basis. The sensitivity, specificity, positive predictive value and negative predictive value of two methods for diagnosis of aneurysm were calculated. Results Taking DSA as the standard, the sensitivity and specificity of DS-BR-CTA to detect intracranial aneurysms was 96.90％ and 98.36％ on per-patient basis, while 97.37％ and 99.97％ on per-aneurysm basis, and the sensitivity and specificity for the detection of aneurysm ≤3 mm was 88.89% and 98.36%. The sensitivity and specificity of DS-BR-CTA to detect intracranial aneurysms was 98.25% and 100% on per-patient basis, 95.52% and 100% on per-aneurysm basis, and the sensitivity and specificity for the detection of aneurysm ≤3 mm was 90.91% and 100%. Conclusion DE-CTA has a comparable diagnostic accuracy with DS-BR-CTA to diagnose intracranial aneurysms, and can be used in the routine workflow for detection of intracranial aneurysms.

Objective To explore the mechanism of Tangshenkang in the prevention and treatment of diabetic nephropathy. Methods HK-2 cells were cultured in vitro and divided into control group, high glucose group (30 mmol/L D-glucose), control group (30 mmol/L D-glucose+10% animal serum), and Tangshenkang drug-containing serum therapy groups (30 mmol/L D-glucose+5%low concentration Tangshenkang, 30 mmol/L D-glucose+10%middle concentration Tangshenkang, 30 mmol/L D-glucose+20% high concentration Tangshenkang). After 24 h and 48 h treatment, MMP-9 and TIMP-1 in cell cultural supernatant were observed by ELISA. Results MMP-9 of HK-2 cultured with high glucose was much decreased and TIMP-1 increased significantly than the control group, with statistical significance (P<0.05). TIMP-1 significantly decreased and MMP-9 increased in HK-2 cultured with high glucose plus Tangshenkang compared with those only induced by high glucose, with statistical significance (P<0.05). Conclusion Tangshenkang could regulate the secretion of fibrosis cell factor of HK-2 cell induced by high glucose, which may be one of the mechanisms in its treatment of diabetic nephropathy.

Objective To investigate the risk factors of postoperative atrial fibrillation (POAF) in patients with on-pump coronary artery bypass grafting (ONCAB). Methods The clinical data of 200 patients with ONCAB were retrospectively analyzed. The patients were divided into POAF group (n=52) and non POAF group (n=148) according to the occurrence of POAF after operation. The perioperative data including age and gender of all patients were collected and analyzed. The index of opinion of statistical results was classified by two categories Logistic regression analysis, and the related risk factors of POAF were analyzed. The receiver operating characteristic (ROC) curves of the age, red blood cell (RBC), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were analyzed in two groups. Results The incidence rate of POAF was 26%, mostly occurred in the postoperative period from 1 d to 3 d. Compared with non POAF group, the age, the proportion of patients with age≥62.5 years or older, the proportion of patients with LAD≥35 mm, left ventricular end-diastolic diameter and perioperative transfusion of RBC were increased in POAF group, and data of mechanical ventilation time, ICU stay time and hospitalization time were prolonged, but the LVEF level decrease ( P<0.05). Among them, the elderly (≥62.5 years), increased LAD (≥35 mm), the higher perioperative transmission amount of RBC were the independent risk factors of POAF after ONCAB, and the higher LVEF was a protective factor for ONCAB. The optimal thresholds for age, RBC, LAD and LVEF were 62.5 years, 1U, 35.5 mm, and 0.34. Conclusion The occurrence of POAF after ONCAB is related with age (≥62.5 years old),LAD≥35 mm and perioperative transfusion of RBC, which can be used as clinically to predict the occurrence of POAF.

Objective To summarize the experience of surgical treatment in patients with uremia and severe coronary artery disease, and reduce the perioperative risk thereof. Methods Sixteen chronic renal failure patients who were received haemodialysis and underwent coronary artery bypass grafting (CABG) during the period of February 2009 to December 2016 in Tianjin First Central Hospital were assessed in this retrospective study. Of the 16 patients, 8 patients and 6 patients were treated with off pump and on pump CABG respectively, one patient was treated with CABG and resection of ventricular aneurysm, and one patient was treated with CABG and tricuspid valve replacements. The renal function changes in preoperative and postoperative periods, 2-day and 1-week after surgery were observed. Echocardiography was used to evaluate cardiac function. The improvement of angina was recorded. Results Fourteen patients were successfully withdrawn from ventilator therapy within 24 h after surgery. The tracheal intubation was removed 65-hour after surgery in one patient. One patient died of multiple organ failure on the seventh day after surgery. The average length of ICU staying and in-hospital stay were (125.5 ± 21.6) h and (28.6 ± 7.4) days respectively. The serum creatinine (sCr) and blood urea nitrogen (BUN) were higher in two days after surgery than those before the operation (P < 0.05). Fifteen patients which followed up (the final follow-up date was February 2017) showing cardiac functionⅠ-Ⅱ, ejection fraction (EF)>0.40, and no angina occurred. Conclusion CABG is relatively safe for patients with end-stage renal disease and severe coronary artery disease. CABG can significantly eliminate angina symptoms with satisfactory clinical effect.

The incidence of dextrocardia is lower. The dextrocardia is often associated with congenital anatomical abnormalities. The patient with normal cardiac structure of dextrocardia and severe coronary heart disease that needs coronary artery bypasss is rarer. This article summarizes the perioperative management and surgical experience of dextrocardia with bypass surgery via a clinical case.