Objective To evaluate the efficacy of endovascular aortouniiliac repair (EVAR) combined with cross-femoral bypass grafting (CFBG) for the treatment of abdominal aortic aneurysm (AAA). Methods From May 1997 to February 2007, 8 patients with AAA, in whom bifurcated stent-graft could not be used because of complex iliac anatomy, were treated with EVAR using AUI stent-graft combined with CFBG. The endoleak, ischemic syndromes,patency of the bypasses, and blood supply of the lower limbs were observed after the operation. Results There were no perioperative mortalities in this series. One patient died of myocardial infarction 15 months after the operation. Three patients developed primary endoleak, and was cure spontaneously 1, 3, and 6 months postoperation. The 8 patients were followed up for a mean of 24 months (3-72 months), during which the patency rate of cross-femoral bypass was 100%. One year after the operation, 1 patient developed mild anastomotic stoma stenosis without ischemia of the lower limbs, but no limb ischemia. Conclusion In patients with complex iliac anatomy unfavorable for bifurcated endografting, EVAR using AUI combined with CFBG is safe and effective.

Objective To investigate the causes of high rate of false positives in the detection of syphilis in elderly patients.Methods We used RPR,TP -ELISA and TPPA to detect the antibody of syphilis in 1 200 patients, and the samples were divided into the elderly group (60 or higher)and the control group (<60 years old),confirmed by TPPA,then counted the positive rate and false positive rate,and the results were analyzed.Results The positive rate (8.00%)and false positive rate (4.50%)of the elderly group were significantly higher than the control group (3.83%,1.87%,χ2 =9.36,9.47,all P <0.05).The false positive rate significantly rised with the increase of age of the elderly group.Conclusion The reason of false positive may be associated with the physical condition of the patients,and we should consider it with the clinical manifestations when diagnosed.

Objective To investigate the effects of chondroitinase ABC injection on motor and acetylcholinestarase (AchE) expressed inthe motor end-plate of gastrocnemius in adult rats with spinal cord injury. Methods The spinal cords in T10 of 40 male Wistar rats (10 weeksold) were exposed and the right sites were semi-transected. The left sites were considered as the control (group A), the transected sites wereas the injured group (group B) and chondroitinase ABC-treated group (group C). The rats were assessed with Basso, Beattie & Bresnahan(BBB) score for ethological test, and sacrificed 3 d, 7 d, 14 d and 28 d after operation. The AchE expressed in gastrocnemius was detectedwith zymochemistry staining. Results BBB score in group C was significant higher than that in group B 14~28 d after operation, while theAchE activity in group B and C was lower than that in group A (P<0.05), and lower in group B than in group C (P<0.05). Conclusion ChondroitinaseABC injection can enhance AchE activity and promote the locomotor recovery after spinal cord injury in adult rats.

Objective To identify risk factors for anastomotic leakage,and study the influence of high ligation of the inferior mesenteric artery on anastomotic leakage after rectal cancer resection.Methods The chi-test and the student t test were used for statistics.Clinical data were analyzed for 291 patients who underwent rectal cancer resection between August 2008 and November 2011.Results Anastomotic leakage occurred in 27 (9.3％) patients.Anastomotic leakage significantly increased in patients with tumours located within 10 cm from the anal verge,in male patients,and intraoperative blood loss.The use of high ligation of inferior mesenteric artery,which was associated with lower tumor location and surgical modality,was not a risk factor for anastomotic leakage,though it was associated with tumor stage and postoperative urinary retention.Conclusions Anastomotic leakage after rectal cancer resection is related to the tumor level,male gender,and perioperative bleeding,use of a high tie was not associated with an increased rate of symptomatic anastomotic leakage.

Objective To investigate the activation of nuclear factor-κB(NF-κB),which was stimulated by angiotensin-Ⅱ(AngⅡ)through classical pathway in human pulmonary microvascular endothehal cells(HPMEC).Method The experiment was divided into two groups:in Ang Ⅱ group,HPMECS were incubated with 10-6mol/L AngⅡ for 0,0.5,1,2 and 4 hours,respectively;in losartan group,HPMEC was pretreated with 10-6mol/L losartan(inhibitor of AngⅡ type 1 receptor)for 1 hour,and then stimulated with 10-6mol/L AngⅡ for 2 hours,and the nucleax protein and the cell plasma protein were prepared by lysis and centrifugation.Electrophoretic mobility shift assay(EMSA)was used to detect the NF-κB DNA binding activity.The inhibitor of κBa(IκBα)was detected by Western blotting.The data were expressed as(x±s)and analyzed with one way analysis of variance.A P value less than 0.05 indicated significant difference.Results Compared with the activity of NF-κB at 0 h (100.0±25.1)after AngⅡstimalation,the activity increased significantly at 0.5 hour(144.5±16.1,P＜0.05),and reached peak value at 2 hours(270.1±27.2,P＜0.05).The concentration of IκBα at 0 hours was 44.4%±2.1%,decreased markedly at 0.5 hours(38.9%±3.6%,P＜0.05),and to the lowest level at 2hours(32.6%±2.3%,P＜0.05).The activity of NF-κB(115.4±10.7)and the concentration of IκBα(43.6%±3.7%)in losartan group had ilo significant difference with AngⅡ group at 0 h(P＞0.05).The activity of NF-κB and the concentration of IκBα in losartan group had significant difference with AngⅡ group at 2hours.Conclusions NF-κB can be activated through classical pathway,which stimulated by AngⅡ in HPMEC.

ObjectiveTo investigate the effects of methylprednisolone （MP） on the proliferation and expression of glial fibrillary acidic protein (GFAP) in astrocytes after spinal cord injury in rats. MethodsThe spinal cords in T8～T10 in 48 male Wistar rats (10 weeks old) were exposed and the right site were semi-transected. 24 rats were administrated MP through tail vein as experiment group, and the other rats were injected equal volumes of normal saline as the control group. They were assessed with Basso, Beattie, and Bresnahan (BBB) score for ethological test every 4 d, and were sacrificed, perfused 3 d, 7 d, 14 d and 28 d after operation. The spinal cords were removed and postfixed, The expression of GFAP was observed with immunohistochemical staining and gray values determination. The GFAP positive cells were also counted. ResultsThere was no significant difference in BBB score between these groups until 21 d after operation; but the MP group rats showed significantly better functional recovery than the control group 25 d after operation. The number of positive astrocytes was less in the MP group than in the control group 3 and 7 d after operation, but there was no significant difference 14 d after operation. The GFAP expression in glial scar was significantly lower in the MP group than in the control in the first 21 d after operation, but no significant difference 28 d after operation. ConclusionThe large dose methylprednisolone administration can decrease the number of active AS, attenuate the formation of glial scars, and improve the functional recovery of the hind limbs after acute spinal cord injury.

Objective To probe into the reasons for and results of remedial surgical therapy in thoracic aortic dissection patients after first endovascalar repair.Methods From July 2000 to December 2012,12 cases received second interventional surgery.The average time from second therapy to first surgery was ( 14 ± 11 ) months.Main reasons for second endovascular therapy were sustained type Ⅰ endoleak at proximal landing zone and type A dissection caused by retrograde tear.Therapies included hybrid operations in 8 cases and absnlute endovascular therapy in 4 cases.Results The 30 day mortality after the second intervention was 5.6％ ( 1/12),total mortality rate was 16.7％ (2/12).In 7 cases with endoleak,small endoleak remained after remedial therapy (57.1％ ) in 4 cases.Among 4 cases with secondary type A aortic dissection,successful staged hybrid operation with mid-sternal thoracotomy was adopted in 3 cases,one died of pulmonary emtbolism during follow-up period,1 case with Bebcet disease still had proximal type Ⅰ endoleak after second hybrid operation,and died from tear of aorta.Conclusions Endoleak and secondary type A aortic dissection are the main cause necessitating second intervention after primary endovascular therapy for thoracic aortic dissection.Hybrid operation remains the best choice to treat postoperative complications after endovascular therapy for thoracic aortic dissection.

Objective To determine the influence of hostile neck anatomy on type Ⅰ a endoleak development after endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysmal disease.Methods From July 2008 to July 2011,195 consecutive patients with non-ruptured abdominal aortic aneurysms (AAA) were treated with EVAR.There were 150 males and 45 females,aging from 52 to 95 years with a mean of 69 years.Forty-three patients were with hostile neck anatomy ( HNA ).High-resolution computed tomography was abtained in all patients,with detailed measurement of proximal neck parameters.Univariate and multivariate analyses were used to compare Ⅰ a endoleak and HNA.Follow-up protocol consisted of computed tomography (CT) angiograms or ultrasound at 3,6,and 12 months,and annually thereafter.Results Twenty-three patients had intraoperative type Ⅰ a endoleaks.The adjunctive measures,such as repeated balloon angioplasty,cuff extension,Palmaz stent placement and chimney technique were used for treating type Ⅰ a endoleak.Small endoleak remained in only one patient.The technical success rate was 98.5％ (192/195).The association between type Ⅰ a endoleak development and magnitude of the infrarenal angle was statistically significant.The mean follow-up time was ( 18 ± 3 )months.The survival rates at 1- and 3-year were 97.4％ and 89.2％ respectively.Conclusions The proximal neck angle is related to intraoperative type Ⅰ a endoleak occurrence,but other factors often thought to be indicative of adverse neck anatomy are not significant predictors.Most type Ⅰ a endoleaks in this study were uccessfully eliminated intraoperatively with a satisfactory mid to long term results.

Objective To evaluate early results of Endurant stent-graft in the treatment of abdominal aortic aneurysms (AAAs).Methods From July 2010 to June 2011,68 patients (57 men,11 women; mean age 74.3 years) were treated with Endurant stent-graft at our center.26 cases had hostile proximal neck in the anatomy.According to ASA classification,15 cases were class Ⅱ ; 32 cases were class Ⅲ and 21 cases were class Ⅳ.Results Intraoperative immediate technical success was achieved in all cases.At completion angiography,a type Ⅱ endoleak was detected in 18 (26％) of the 68 patients.The mean operation time was (96 ± 29) min,the mean blood loss was (99 ± 68 ) ml,and the mean contrast usage was (122 ± 65) ml.No intraoperative conversion to open surgery,stent migration,types Ⅰ/Ⅲ endoleak,other major complications,or death was encountered.49 patients (72％) had a postimplantation syndrome with fever,leukocytosis,and increase of C-reactive protein levels,which completely resolved within two weeks.The mean follow-up time was (8 ± 5) months.Conclusions Endurant stent-graft seems to be safe and effective in endovascular aneurysm repair,even in patients with hostile aortoiliac anatomy.

Objective To compare selective coverage and chimney technology of the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR).Methods Eighty-one cases were retrospectively reviewed from January 2005 to January 2013 with two different management of the LSA during TEVAR:selective coverage (SC) vs chimney (C).Technical success rates,operating time,endoleaks,and perioperative cerebrovascular accidents,spinal cord ischemia (SCI),left arm ischemic symptoms and mortality were analyzed.The survival rate was also evaluated.Statistical analysis was performed using the x2 test,t-test and Kaplan-Meier survival curve.Results There were 37 patients in group SC and 34 in group C.Operating time was (61 ± 22) min for SC,and (101 ± 20) min for C (P =0.000) ; left arm ischemic symptoms occurred in 23.4％ in group SC,and 2.9％ in group C (P =0.011).Technical success rates were 100％ and SCI were 0 for both SC and C.Endoleaks,perioperative cerebrovascular accidents,and mortality were similar between the two groups.Conclusions During TEVAR,selective coverage of the left subclavian artery is safe,effective; meanwhile,chimney technology is safe,effective for patients whose left subclavian arteries need revascularization.