Objective To estimate the application value of dual-source CT on preoperational evaluating new type of three branches aortic arch covered stent graft implantation on DeBakey type I aortic dissection.Methods 20 cases with DeBakey type I aortic dissec-tion prepared to performe three branches aortic arch covered stent graft implantation were reviewed,and their CT findings were ana-lyzed in order to evaluate the guiding value for operation.Results The location and size of entries were determined and the diameter of aortic arch and three branchesas well as the intervals of three branches were also measured by dual-source CT.Furthermore, blood-supply for main vessel and complications related with covered stent were further analyzed prior to operation.The surgical pro-tocols were designed according to preoperational CT findings.Among all cases,13 cases were fit for new type of three branches aor-tic arch covered stent graft implantation.While the rest cases (N=7)were adopted other operations due to non-fitted indications. Conclusion Dual-source CT is of significance for preoperational evaluating new type of three branches aortic arch covered stent graft implantation on DeBakey type I aortic dissection.

Background and purpose:Early evaluating the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) in patients with hepatic cancer is still a diffcult clinical problem. The purpose of this study was to evaluate the ability of the apparent diffusion coeffcient (ADC) to help predict early disease progression after TACE.Methods:Institutional review board approval was obtained, and all patients signed informed consent. Magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) (b=50, 500, 1 000 mm2/s) were performed before and 1 month after initiating TACE for 23 patients with hepatic cancer (14 were male, 9 were female; mean age: 53.3 years;range: 21-85 years). Contrast-enhanced MRI was performed 3 months after initiating TACE. Patients were classiifed as either progressing or non-progressing according to RECIST 1.1. The preoperative ADC values of tumor and the ADC values of tumor 1 month after TACE were analyzed by pairedt-test in both progressing and non-progressing group. Unpairedt-test was used to compare ADC parameters between progressing and non-progressing group. In all the 23 hepatic cancer patients, receiver operating characteristic (ROC) curve analysis was performed to determine a threshold ADC ratio (ADC%) to differentiate progressing from non-progressing patients.Results:Thirteen progressing and 9 non-progressing patients were evaluated. Increase in ADCs of tumor was observed in non-progressing patients at 1 month after TACE compared with preoperative ADCs. There was a signiifcant difference between the 2 groups (P=0.01). In progressing group, preoperative ADCs of tumor were similar to those at 1 month after TACE (P=0.221). There was no significant difference in preoperative ADCs of tumor and ADC% between the progressing and non-progressing groups. In patients with hepatic cancer, 1 month ADC ratio in non-progressing patients were signiifcantly higher than those of progressing patients (P=0.029). Using ROC to evaluate the ability of ADC% could predict early disease pro-gression after TACE. Using -6.455% as the threshold, the area under the ROC curve was 0.867 (95%CI: 0.643-1.000). The sensitivity was 100%, and the speciifcity was 66.7%.Conclusion:One month after TACE, the increases in ADCs of tumor were observed only in the non-progressing group; and the ADC ratio seems to be a promising tool for helping predict the early disease progression after TACE in patients with hepatic cancer.

Objective: To explore the effect of autophagy on process of high phosphate salt induced vascular smooth muscle cell (VSMC) calciifcation in experimental rats. Methods: Rats’ model of VSMC calciifcation was induced by phosphate incubation. VSMC were divided into 3 groups:①Control group,②Calciifcation group which included 3 subgroups as 4-day subgroup, the cells were cultured by 3.2 mmol/L phosphate for 4 days, 6-day subgroup and 8-day subgroup,③Calciifcation+ 3-MA (autophagy inhibitor) group, in which the 8-day cells were cultured with 5mmol/L 3-MA. Calcium nodule formation and calcium deposition in VSMC were measured by Alizarin red staining and o-cresolphthaleincomplexone method, protein expressions of Runx2, α-SMA and LC3 II were examined by Western blot analysis, autophagosome formation in VSMC was measured by transmission electron microscope and the localization and expression of Runx2 and LC3 II in VSMC were observed by immunolfuorescent microscope. Results: Compared with Control group, the cells at 8-day subgroup showed more calcium nodules, higher calcium deposition, increased protein expressions of Runx2, LC3 II, more autophagosome and decreased α-SMA expression, allP<0.05. Compared with 8-day subgroup, the cells in Calcification+3-MA group presented increased calcium deposition, decreased lfuorescence distribution of LC3 II and more cells with positive Runx2 protein expression, all P<0.05. Conclusion: Autophagy has the protective effect on process of phosphate induced VSMC calciifcation in experimental rats.

Objective To summarize the experiences and protocol of extracorporeal membrane oxygenation (ECMO) technique in donors with brain death and unexpected cardiac arrest.Method We described here the organ donation of one case of brain death complicated with hemodynamic instability and cardiac arrest,and the corresponding recovery of the receptor liver.A 50-year old female developed brain death due to brain aneurysmal hemorrhage.He was given two kinds of high-dose vasopressor,but hemodynarnic instability was not improved.After ECMO support,the hemodynamics turned to stable,but unexpected cardiac arrest happened.The total operating time of ECMO was 5 h,including 4 h after cardiac arrest.The liver was transplanted into a 65-year old female with hepatocellular carcinoma (diagnosed by Hangzhou Criteria) by classic orthotopic liver transplantation with end-to-end anastomosis.Result One liver and two kidneys were obtained successfully,and all the receptors recovered uneventfully.The post-operative ALT and AST levels reached the peak at 169 U/L and 365 U/L respectively,and returned to normal two weeks later.Conclusion ECMO can be used to support brain death complicated with hemodynamic instability and unexpected cardiac arrest.It can save precious time for organ donation,and preserve the function of liver and kidney as well.

The mainly antigenic sites for the adenovirus neutraliation are present on Loop1 and Loop2 of hexon.Majority research were focus in the human adenovirus.Little was known on infectious canine hepatitis virus (ICHV), which was also called canine adenovirus typeⅠ.Here,ICHV (the isolated strain) DNA was isolated and purified from the cultured MDCK cells.The Loop1 and Loop2 fragments were amplified by polymerase chain reaction(PCR) method,and then was connected by ligase T4.The target fragment was then connected with vector pET28a.The nucleotide sequence ecoding Loop1 and Loop2 was determined.The nucleotide sequence identity of Loop1 region between the isolated strain and CLL, RI261 and Toronto A26/61 strains is 100%, 100% and 83.8%, and the nucleotide sequence identity of Loop2 region between the isolated strain and CLL, RI261 and Toronto A26/61 strains is 88.1% , 88.1% and 99.3%, and amino acid identity is 93.6%, 93.6% and 98.6%.The recombinant Loop protein was expressed in E.coli and was approximately 36kDa in size,and then was purified. Then BALB/c mice were injected subcutaneously in the back and armpit with the recombinant Loop protein.The anti-ICHV antibody titers of immunized serum was tested by indirect ELISA and the titers were up to 1:320.Western blot demonstrated that immunized sera could specifically combine with ICHV. The research laid a foundation for creating new genetic engineering products of infectious canine hepatitis virus.

Objective To elucidate the interaction between osteoblast of bone marrow microenvironment and leukemia cells,and to investigate the role of osteoblast in the leukemia cells survival and apoptosis and the influence of leukemia cells on the osteoblast.Methods Leukemia cells from AML1-ETO9a-Rac1 mouse leukemia model and osteoblast cells were used.The ratio of GFP+ leukemia cells that co-cultured with or without osteoblast was detected by FACS.In addition,the apoptosis level of leukemia cells was detected by flow cytometry by PI and Annexin Ⅴ labeling.Activation level of PARP was determined by Western-blot.Real-time PCR (RT-PCR) was utilized to detect the mRNA level of TPO,N-cadherin,OPN and Ang1 in osteoblast which was separated from leukemic mice.Results The ratio of GFP+ cells in AE9a-Rac1 leukemia cells co-cultured with osteoblast cell was significantly higher than that of AE9a-Rac1 leukemia cells cultured alone.The apoptotic level of AE9a-Rac 1 leukemia cells cultured alone was significant higher than that of AE9a-Rac 1 leukemia cells in co-culture system.Western blot showed that activated level of PARP in AE9a-Rac1 leukemia cells co-cultured with osteoblast was lower than that cultured alone.RT-PCR result showed that TPO and N-cadherin mRNA levels in primary osteoblast separated from leukemic mice were higher than that from normal mice.Ang1 and OPN mRNA levels of osteoblast from leukemia mice were lower.Conclusion Osteoblast cell can support the survival and inhibit the apoptosis of leukemia cells.Leukemia cells can influence the functions of osteoblast by microenvironment associated cytokines production.

This paper, on top of its introduction of the concept of medical ethics counseling, analyzed the necessity of establishing a medical ethics consultation system in China.By reviewing the development of the medical ethics counseling system in other countries, the authors, in view of China′s medical practice, put forward specific recommendations on establishing a medical ethics counseling system in China.Issues on the construction of organ donation ethics counseling system in China were also discussed in focus.

Objective To prospectively evaluate the effects of heart rate and heart-rate variability on dual-source computed tomographic coronary image quality in patients with high heart rates,and to determine retrospectively the accuracy of dualsource computed tomographic diagnosis of coronary artery stenosis in the same patients.Methods The image quality and diagnostic accuracy were compared between the normal group of 40 patients whose heart rates exceeded 70 beats/min and the control group of 40 patients whose heart rates were 70 beats/min or slower.Results No statistically significant differences between the groups were found in diagnostic-image quality scores of total segments or of any coronary artery,nor were any significant differences found between the groups in the accurate diagnosis of angiographically significant stenosis.Calcification was the chief factor that affected diagnostic accuracy.In high -heart -rate patients,heart -rate variability was significantly related to the diagnostic image quality of all segments(P=0.001) and of the left circumflex coronary artery(P=0.016).Heart-rate variability more than 5 beats/min most strongly contributed to an inability to evaluate segments in both groups.When heart rates rose,the optimal reconstruction window shifted from diastole to systole.Conclusion The image quality of dual -source computed tomographic coronary angiography at high heart rates enables sufficient diagnosis of stenosis,although variability of heart rates significantly deteriorates image quality.

Objective To investigate the CT findings and guidance significance of multi-slice computed tomography(MSCT) in aortic intramural hematoma(IMH).Methods The clinical data and MSCT findings of 35 cases of aortic intramural hematomas diagnosed by MSCT with continuous volume scanning were analyzed.Results The direct signs of IMH were crescent or circular thickening of aortic wall without intimal flap and true and false lumens in all 35 patients.The indirect signs were penetrating ulcer(18 cases),calcification ingression(7 cases),atherosclerosis(16 cases)and single or bilateral pleural effusion(21 cases).The complicated signs were aneurysms(5 cases) and typical type B aortic dissection(3 case).Conclusion MSCT is a fast and noninvasive examinational technique,by which the direct,indirect and complicated signs of aortic IMH can be clearly revealed.All these signs have important guidance values for clinical diagnosis and management.

Objective To explore the relationship between serum cccDNA and liver damage in the patients with chronic HBV infection.Methods Serum cccDNA,ALT of 156 patients with chronic HBV infection were measured,and pathology of liver tissue in 85 patients was detected.Results The positive rate of Serum cccDNA and ALT had no significant difference(P＞0.05).Between pathology light,medium and severe group,S0_(～1) and S_(2～4) group,G_(0～1) and G_(2～4) group the serum cccDNA mean was significantly different(P＜0.01).The positive rate of serum cccDNA was significantly different between the group of NAASC and ASC,CH,LC,HCC,and the group of ALT ≤40u/Land 40～80,80～400,≥400u/L(P＜0.01).Conclusion Serum cccDNA and liver inflammation,fibrosis and ALT had no relevance,serum cccDNA with at a low level may be non-active,but should be excluded from serious liver diseases.