Thirty two patients with Stanford B thoracic aortic dissections accepted endovascular graft exclusions. Four endoleaks occurred after the stent grafts were deployed. Three were cured with additional endovascular stent graft placement, while one sealed spontaneously. It is concluded that many factors are related to the occurrence of endoleaks. The detecting methods of intraoperative DSA and postoperative spiral CT of the thoracic aorta are effective on revealing endoleaks. It is advocated that additional endovascular procedures should be done immediately after the endoleaks are detected. Low volume of the leakage may seal spontaneously. But the topic of the mamagement and prognosis of delayed endoleaks is to be studied.

To evaluate the significance and methods of preoperative revealing of the tears of thoracic aortic dissections before endovascular graft exclusion, 32 cases were studied. Among them, 26 cases were evaluated with spiral CT only, 5 with CT and MR together, while one with MR only. Compared with intra operative Digital Subtraction Angiography, the detectable rate of CT,MR and DSA for revealing the tears was 90 32%, 66 7%, and 100% respectively.The most frequently appeared locations of the tears were at the section between 3 and 7 o'clock. In the case of multi entrances, the results evaluated with CT were different from those with DSA. It is concluded that accurate evaluation of the tears would be profitable to stent grafts selection and operative decision, and spiral CT images are most effective in preoperative evaluation of the tears.

In order to evaluate digital subtraction angiography(DSA) in the management of Endovascular Graft Exclusion (EVGE) for dissecting thoracic aortic aneurysms,the operation procedures and results in 32 cases of EVGE were retrospectively analysed. The stent grafts were sent to the segment where the tears were located through the incision on the common femoral artery. After the deployment, the tears were sealed. Intraoperatively, 100% of the tears were revealed by DSA, and 4 endoleaks were also detected and managed effectively. The value of DSA in preoperative evaluation, choice of operative procedure, intraoperative monitoring, success ratio evaluation, complication prevention and management was determined. It is concluded that DSA can monitor EVGE on real time and throughout the operation. It can meet the needs of measuring, locating, evaluating thoracic aortic aneurym and deciding its operation,as well as detecting and controlling its complications. Moreover, it provides a large visual field and operating space, and is a high valuable monitoring method for EVGE.

To assess the principles of diagnosis and management of Klippel Trenaunay Syndrome (KTS), ascending venography and PPG were used as the means of diagnosis for KTS. 18 cases received nonoperative therapy with elastic bandages or stockings, and 26 patients were operated on, including stripping of varicose vein, decompression of popliteal vein and segmental transplantation with valve to femoral or popliteal vein. The effective rate in the operative group was 73.1% (19/26),whereas the illness of 18 patients was stable with elastic support. Thirty one of 44 patients have been improved during 1～10 year follow up period . It is important that the indications and styles of operation must be carefully considered according to the clinical manifestations and venogram.

To assess the principles of perioperative management and prevention and treatment of postoperative complications of extracranial carotid artery aneurysm(ECAA),15 patients with ECAA received surgical treatment between 1988 and 2000.Among them,11 patients underwent aneurysmectomy with artery reconstruction,3 had resection of aneurysm and ligation of external carotid artery, and the other patient had aneurysmorrhaphy. No postoperative deaths or severe complications occurred except one patient with Horner's syndrome.Satisfactory results were achieved in 7 out of 8 patients within a 6 month to 7 year follow up period. The results showed that aneurysmectomy with artery reconstruction is a best operative procedure for extracranial carotid artery aneurysm. In order to prevent severe complications,such as brain ischemia and injury of cranial nerves, intensive perioperative management must be emphasized.

This paper is to summarize our experiences in the operation indication and management of perioperative complications in treatment of Stanford B aortic dissection by using endovascular graft exclusion (EVGE). 32 patients underwent the procedure of EVGE . Various sizes of tubular grafts were introduced over the entry tear of aorta via the femoral artery. The procedure was technically successful in all patients. No Severe complication occurred during the perioperative period except one death due to heart infarction. These preliminary results suggest that EVGE is safe and efficient for Stanford B aortic dissection. EVGE is a method of first choice for the patients with this disease.

[ ABSTRACT] AIM:To investigate the change of phosphorylation of tau protein and expression of cyclooxygenase 2 ( COX-2) in colon submucosal neurons of enteric nerve system in inflammatory bowel disease ( IBD) rats induced by tri-nitrobenzene sulfonic acid (TNBS).METHODS:Male rats (n=30) were randomly assigned to 3 groups (n=10 each):control group, IBD group and TNBS group.The IBD rats were induced by TNBS+ethanol enema for 14 d.The control and TNBS rats were given an equal volume of saline and TNBS, respectively.The general situation and the histopathologic change of the rat colon were observed.Immunofluorescence was used to check the change of phosphalated tau protein and COX-2 expression in the submucosal neurons of the colon.The expression of COX-2 and phosphorylated tau231 and tau262 in the rat colon submucosal neurons was observed by double immunofluorescence staining.RESULTS:Compared with con-trol group, the number of neurons in the colon of IBD rats decreased obviously and the expression of phospholated tau231 and tau262 was significantly increased.The number of neurons in the colon of TNBS rats showed no significant difference compared with control rats.The rat neurons in control group and TNBS group did not express COX-2.COX-2 expression was observed in the nucleus and cytoplasm of colonic neurons in IBD rats, which showed significantly different from control and TNBS rats.CONCLUSION:The decreased neurons in the enteric nerve system of IBD rats might be associated with the phosphorylation of tau protein and the expression of inducible COX-2.

Objective To compare the significance of DNA-associated autoantibodies to cell membrane(cmDNA)in systemic lupus erythematosus(SLE)detected with indirect immunofluorescence on human B lymphoma cell line Raji and pmmyelocytic line HL60.Methods Indirect immunofluorescence assay both on cell line Raji and HL60 was used to measure anti-cmDNA antibodies in sera of 306 SLE patients.192 patients with other rheumatic diseases and 50 healthy controls.Results Indirect immunofluorescence assay on cell line Raji was used to measure anti-cmDNA antibodies.72.5% SLE and 10.4% other rheumatic diseases were positive for anti-cmDNA,but negative in 50 blood donors(P<0.01).Indirect immunofluorescence assay on cell line HL60 was used to measure anti-cmDNA antibodies,76.1% SLE and 16.7% other rheumatic diseases were positive for anti-cmDNA,but negative in 50 blood donors(P<0.01).The sensitivity of anti-cmDNA were 72.5%and 76.1%,respectively.The specificity of anti-cmDNA was 91.7% and 86.8%,respectively.There was no significant difference in sensitivity and spocificity(P>0.05).The methods of culture,freeze and resuscitation on the two cells were similar.but cell line Raji was easier to resuscitate than cell line HL60.Observing with fluorescence microscope.we find that cmDNA was expressed on the both cells and the staining was stronger on cellline Raji than HL60.Conclusion Anti-cmDNA antibody has high positivity which is one of the most valuable marker in the diagnosis of SLE.We recommend to measure anti-cmDNA antibodies with indirect immunofluorescence assay on cell line Raji rather than HL60.

ObjectiveTo compare the significance of anti-cmDNA antibody in systemic lupus erythematosus (SLE) patients detected with IIF on human's B lymphoma cell line Raji and promyelocytic line HL60.The diagnostic value of anti-cmDNA antibody in SLE was also explored.MethodsThree hundred and six patients with SLE were included in this study.As control groups,we included 192 patients with other rheumatic diseases and 50 healthy controls.The testing method for anti-cmDNA antibody was set up.The assessment of the significance of anti-cmDNA antibody in SLE detected with IIF on cell line Raji and HL60 was carried out andthe diagnostic value of anti-cmDNA antibody in SLE was investigated.ANA and antidsDNA antibody were measured by IIF at the same time.Anti-Sm was measured by immuno-diffusion andWestern blotting.AnuA was tested by enzyme linked immunosorbent assay.The statistical methods used in this study including McNemar X2 test,Spearman related test and Logistic regression analysis.Results The fluorescence brightness of Raji cell line was stronger than HL60 cell line.There was no statistically significant difference in the sensitivity and specificity of anti-cmDNA antibody in SLE detected with IIF with Raji or HL60 cell lines (P＞0.05).The sensitivity of anti-cmDNA antibody detected with IIF on Raji cell line was higher than anti-dsDNA antibody and anti-Sm antibody(P＜0.01),while the specificity of anti-cmDNA antibody was similar to anti-dsDNA antibody (P＞0.05) and was lower than anti-Sin antibody (P＜0.01).The sensitivity of anti-cmDNA antibody was similar to AnuA(P＞0.05) and the specificity was lower than AnuA (P＜0.01).The sensitivity of ANA was higher than anti-cmDNA antibody (P＜0.01) and the specificity was much lower than anti-cmDNA antibody(P＜0.01).The sensitivities of anti-dsDNA antibody,anti-Sm antibody and AnuA were much higher when combined with anti-dsDNA antibody than any one antibody only (P＜0.05).Anti-cmDNA antibody was correlated with mucosa ulcer in SLE patients(OR=2.343,P=0.029).The ESR of SLE patients was also correlated with anti-cmDNA antibody(OR=l.031,P=0.012).Anti-cmDNA antibody was not correlated with SLEDAI (r=0.070,P=0.600).ConclusionRaji cell line is better than HL60 cell line in detecting anti-cmDNA antibody with IIF.Anti-cmDNA antibody has higher sensitivity and specificity in SLE.Combined detection of anti-cmDNA antibody and other autoantibodies can further improve the diagnostic accuracy of SLE.

Objective To assess the diagnostic value of anti-mutated citrullinated vimentin antibodies (anti-MCV) for rheumatoid arthritis (RA), and compare it with anti-cyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factors (RF). Methods Commercially available enzyme-linked immunosorbent assay (ELISA) kit was used to detect anti-MCV antibodies in a group of 177 RA patients, 46 patients with other rheumatic diseases, and 48 healthy blood donors. At the same time, anti-CCP, RF were detected. T test and χ2 test were selected. Results The average concentration of anti-MCV was (523±376) U/ml in RA, (96± 55) U/ml in patients with other rheumatic diseases, (34±18) U/ml in healthy controls. Different threshold levels (20, 40, 60, 80, 100, 120, 140 U/ml) for positive results were calculated bythe areas under the ROC curve (the areas were 0.521, 0.706, 0.769, 0.791, 0.816, 0.826, 0.822), then the best diagnosis efficacy for RA was determined as more than 120 U/ml. At this level, the sensitivity and the specificity for anti-MCV were 80.1% and 80.9% for RA diagnosis. The positive and negative predictive value were 92% and 67.8%. Comparing with anti-CCP, anti-MCV showed comparable specificity but higher sensitivity. And it's also better than RF apparently. If all 3 antibodies were detected at the same time, or anti-MCV combine with one of them, the sensitivity would increase to 95.7%. In addition, Anti-MCV showed positive in 32 of 67(55.2%) patients with RA whose anti-CCP was negative, meanwhile 31 of 59 (52.5%) patients with RA whose RF was negative. Conclusion RF and anti-CCP are complementary in diagnosing RA. The combination detection of RF and anti-CCP could significantly improve the specificity for the diagnosis of RA.