Objective To investigate the effect of protamine(PS)coated polylactic acid(PLA)nanocapsule on the immune response of murine bone marrow-derived dendritic cells(BMDCs).Methods PLA nanocapsules were prepared by W1/O/W2 method.Protamine was used to modify the surface of PLA nanocapsule that encapsulated ovalbumin(OVA),a model anti-gen.The prepared OVA/PLA/PS nanocapsules were used to stimulate BMDCs.Flow cytometry was used to analyze the ex-pression of surface molecules CD80,CD83,CD86,MHCⅠ,and MHC Ⅱ,and the uptake of nanocapsule.The levels of IL-12 p70 secreted by BMDCs were detected by ELISA.Results OVA/PLA/PS nanocapsules could significantly up-regulate the expres-sion of CD80,CD83,MHCⅠ,and MHC Ⅱ in BMDCs,and increase the secretion of IL-12 p70 by BMDCs.Furthermore,OVA/PLA/PS nanocapsules could enhance the uptake efficiency of OVA by BMDCs.Conclusion OVA/PLA/PS nanocapsule can en-hance the immune response of BMDCs,and may become a good drug delivery carrier.

Objective Postictal language testing can provide useful diagnostic information for seizure lateralization.However no such a study based on non-English language was done previously.We investigated the latency of language recovery in Chinese patients with temporal lobe epilepsy (TLE).Methods Complex partial seizures in patients with TLE were extracted from our video-electroencephalogram (EEG) database.For all patients,consciousness testing started as soon as seizures were detected.When they were alert and cooperative,they were asked to read out a sentence “昨晚他们听到老在电台里讲话”which was printed on a card.When the patients were able to read the sentence correctly,the language function was considered recovered.Results Totally 65 complex partial seizures from 22 cases of TLE (11 left and 11 right) were included.Patients were cooperative to language testing in 54 seizures (83％).The latency for consciousness recovery (CRL) and latency for consciousness language recovery (LRL) were not associated with seizure duration,but the seizure lateralization.The CRL (median,161 s) and LRL (281 s) in the left TLE were statistically significantly longer than that in the right TLE (30 s,54 s respectively).Using 150 s recovery time as bound language recovery ratio was 87％ (27/31) in right TLE and 13％ (3/23) in left TLE.Conclusion Postictal language testing based on ideographic Chinese words helps to establish seizure lateralization in patients with TLE.

Objective To summarize the methods and results of surgical treatment of coarctation of the aorta associated with aortic dissection.Methods Analyzed the clinical data of 10 patients with aortic coarctation associated type B aortic dissection who underwent one-stage surgical repair between 2011 and 2013 in Anzhen Hospital.There were 7 males and 3 females with the age ranged from 23 to 56 years,average at 41.2 years.All patients were diagnosed by UCG and CTA.There are three key points to determine the operation method,diameter of the aortic arch and descending aorta,and the extent of dissection.Descending thoracic aortic replacement with short stented elephant trunk was performed in 3 patients,thoracic and abdominal aortic replacement in 1 patient,ascending-abdominal aorta bypass with arch or descending aortic ligature in 3 patients.Results One hospital death occurred(10％).There was no severe surgical complication.No death or reoperation occurred during follow up period.Conclusion Aortic coarctation associated type B aortic dissection is a rare and complex disease.Surgical treatment is an effective and safe method for the disease.

Objective Study the early and midterm results of a technique-total aortic arch replacement without using extracorporeal circulation or aortic bypass for the treatment of aortic aneurismal disease involving the transverse aortic arch and proximal descending aorta. Methods Between April and November 2004, 7 consecutive patients with true (n = 3) or false (n =4) aortic aneurysm underwent this procedure. The mean follow-up was 6. 6 years. The median age at operation was 57years ( range 23 to 75 years). Normothermia general anesthesia and median sternotomy combined with left anterior thoracotomy were administered. A partially occluding clamp was placed on ascending aorta and a longitude aortic incision was made. Anastomosis of a branched graft to ascending aorta in an end-to-side fashion was commenced. The descending aorta distal to the aneurysm was occluded and transected, and anastomosed to the distal end of the branched graft in an end-to-end fashion. Finally,the arch vessels were divided and anastomosed to the branches of the graft and the aneurysm excised. Results The average cross-clamp time of descending aorta, left common carotid artery, and innominate artery was (13.6 ±5.6)min, (5.7 ±0.8)min, and (7.8±2.5) min respectively. The mean intubation time was (12.3 ±4.1) hours. There were no adverse outcomes or neurologic complications in this series. All patients survived and recovered completely. The mean follow-up time was (79.7 ±2.1) months. All patients lead a normal life. There was no late death. CT follow-up study 6 years after surgery reveals no abnormal image. Conclusion Total aortic arch replacement without cardiopulmonary and aortic bypass is a feasible and effective method for the aortic aneurismal disease involving the transverse aortic arch and proximal descending aorta in selected patients.

Adult acquired aortic disease such as aortic dissection,aortic aneurysm,is common,and the treatment is complicated.Furthermore,the specific molecular etiology of this kind of disease is unknown.MicroRNA,which is a short peptide molecule,to some extent,participated in almost every aspect of biological functions.This paper aims to review the role of microRNA in molecular etiology of adult acquired aortic disease.

ObjectiveTo evaluate the value of endoscopy in the diagnosis of biliary tract roundworm disease.Methods32 cases of biliary tract roundworm diseases were diagnosed and treated with fibre (electron) stomach duodenum endoscopy and fibre biliary tract endoscopy under the direct-view.Results32 cases were all clearly diagnosed and the worms were taken out with direct-view endoscopy or direct cholangiography with no complications.ConclusionEndoscopy is effective and accurate for the biliary tract roundworm disease and has the advantage of rapidly dispelling the sufferings of the patients.

Objective To investigate the clinical effect of modified anterior approach to manage fracture of the ulnar coronoid process via the space of brachial artery and vein with median nerve.Methods From June 2012 to January 2013,11 patients with ulnar coronoid fracture were fixed via the modified anterior approach.The operation time,intraoperative blood loss and postoperative complications were recorded.Flexion and rotation range of motion about the injured and normal elbow were observed during postoperative follow-up period.Function of elbow joint was evaluated by mayo elbow performance index (MEPI).Results There was approximate 8 cm in length and 5 cm in width between the brachial vessels and median nerve.Operated angle from radial to ulnar side was fifty degrees and from proximal to distal end was sixty degrees.All the patients were available for follow-up.The fracture healed,that is the elbow flexion restored [(130.7 ±5.0) °] was 96.6％ of the unaffected elbow,elbow extension restored [(7.6 ± 8.1) °] was 84.0％ of the unaffected elbow,pronation restored [(86.9 ± 3.8) °] was 98.2％ of the unaffected side,and supination restored [(85.6 ± 6.0) °] was 96.7％ of the unaffected side.MEPI of the elbow joint was over 75 points.Conclusion Modified anterior approach is relatively safe and simple in operation and results in satisfactory function recovery of the elbow joint,providing a new surgical approach for treatment of coronoid process fracture.

Objective To evaluate the risk factors of Sun' s procedure for acute Stanford A type aortic dissection involving aortic arch.Methods Between February 2009 to February 2012,data from 233 patients who underwent Sun' s procedure for acute Stanford type A aortic dissection involving aortic arch were collected retrospectively.All the risk factors related to mortality were analyzed by univariate statistical analysis.Significant univariate variables were entered into multiple logistic analysis.Results Total 23 patients died in the hospital and the mortality was 9.87 ％.Univariate analysis showed that age,limb ischemia,and cardiopulmonary bypass longer than 268 minutes were risk factors for mortality.After these factors were entered into multiple logistic regression analysis,multiple logistic regression showed that age(P =0.017,OR =1.062),cardiopulmonary by pass time longer than 268 minutes(P =0.001,OR =6.150) were final independent risk factors for mortality.ConclusionAge and cardiopulmonary bypass time longer than 268 minutes were final independent risk factors for mortality.Longer cardiopulmonary bypass time should be avoided.

Objective EuroSCORE is a widely used objective risk scoring model.The aim of this study was to evaluate the validation of EuroSCORE Ⅱ in predicting mid-term survival after total aortic arch replacement with stented elephant trunk implantation(sun' s procedure) for Stanford Type A aortic dissection.Methods Total 90 patients entered the study randomly.All the patients underwent aortic surgery using total aortic arch replacement with stented elephant trunk implantation (Sun's procedure).The patients were divided into three groups based on the predicting mortality by EuroSCORE Ⅱ.Ggroup 1:0 ＜:P ≤ 5 ％,Group 2:5 ％ ＜ P ≤ 10％,Group 3:P ＞ 10％.Kaplan-Meier method was used to evaluate the long term survival of three groups.Receiver operating characteristic curve was used to test discrimination of the EuroSCORE.Calibration was assessed with a Hosmer-Lemeshow goodness-offit statistic.Results 87 patients were followed umil October,2013.The mean follow-up time was(33.32 ± 11.11) months.Total 5 patients died during the follow-up time.Three patients died in group 1,2 patients died in group 2 and 1 in group 3.There was no statistical difference for the mid-term survival rate between 3 groups (P =0.054).Conclusion Although EuroSCORE Ⅱ is the newest risk model for cardiac surgery,it is not accurate when it is applied for predicting mid-term survival after aortic surgery.A new risk evaluating system specially designed for aortic surgery should be developed in the future.

Objective To investigate the pathogenesis,diagnosis,treatment and prognosis of aort-oesophageal fistula(AEF).Methods Retropective analysis was performed on 6 patients presenting with AEF between January 2002 and December 2014,and relative literature was reviewed on its pathogenesis,di-agnosis,prognosis and treatment.Results Five men and 1 woman with a mean age of 49 (range,27-71 years)were recruited to the study.One case of AEF was caused by esophageal foreign body,2 cases were caused by aneurysm while the other 3 patients presented AEF after aortic surgery.All 6 patients showed he-matemesis,among whom 3 presented sentinel hemorrhage,1 presented exsanguination after sentinel hemor-rhage,2 presented sudden exsanguination.Among 4 patients with sentinel hemorrhage,2 accompanied with chest pain,1 with dysphagia and 1 with fever.Two patients had a history of hypertension.Diagnostic rate was nearly 100% by gastroscopy or CT/CTA.Four patients died from hemorrhagic shock and 2 patients re-covered from surgery.Conclusion AEF should be seriously considered for patients with a history of hyper-tension,aortic disease or esophageal foreign body presenting sentinel hemorrhage,chest pain,dysphagia,fa-tal exsanguination followed by symptom-free interval.Prompt examinations and aggressive surgery are of great significance for survival.