Purpose:To assess the security and efficacy of mechanical recanalization and stenting of lilac arteries with complete occlusions without preceding thrombolytic therapy. Materials and methods:During a 3-year period,Eighteen consecutive patients underwent mechanical reeanalization and stenting for complete occlusion of the iliac artery.The method involved recanalizition with a guide wire and a catheter advanced as a while unit through the occluded segment(snowplow technique).Results The occluded segments were successfully traversed and dilated and 32 stents were placed in 18 patients.The mean ankle-brachial index (BAI)increased from 0.39?0.33 before the procedure to 0.86?0.13 after the procedure(P

Objective To investigate into the indications and related anatomic foundation of transjugular intrahepatic portosystemic shunt(TIPS) creation by direct transcaval approach in patients with portal hypertension cirrhosis suffering unusual anatomy between the hepatic veins and portal bifurcation; and to evaluate the security, feasibility and clinical significance. Methods Direct transcaval approach TIPS were performed in 65 patients including active variceal bleeding (n=52), intractable ascites (n=12), and as a bridge to liver transplantation (n=1). Results Technical and functional success were achieved in all patients. The success rate was 100% without related complications including the technique and primary patency rate is obvious higher than classical TIPS. Conclusion In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is secure and feasible. The results suggest that the direct transcaval approach offering favorable primary patency because the shunt has a straight line in construction.

Objective To investigate the correlation between serum S100B, IL-6 and intracranial pressure in patients with severe craniocerebral injury.Methods 81 cases of patients with severe brain injury in our hospital from August 2012 to April 2016 were selected,intracranial pressure was monitored immediately after admission to calculate the average daily ICP level ,and venous blood were collected after craniocerebral injury 6,12,24,48, 72 hours.Detection of serum S100B protein and IL-6 levels,and the correlation analysis with the level of intracranial pressure.Results Patients with severe craniocerebral injury S100B levels increased gradually after injury, reached the peak at 24 hours, then decreased gradually; while patients with IL-6 and intracranial pressure after injury gradually increased, the difference was statistically significant in different time points among the S100B,IL-6 and intracranial pressure levels (P<0.05).Conclusion The changes of intracranial pressure after severe craniocerebral injury were proportional to the levels of serum S100B and IL-6,S100B and IL-6 can reflect the changes of intracranial pressure,intracranial pressure changes predicted by S100B plasma concentration in 48 hours were more sensitive than those in the same concentration of IL-6.

Objective:It has been proposed that blood pressure variability(BPV) is positively related to end-organ damage(EOD) in hypertension.The present work was designed to observe the effects of long-term treatment with nitrendipine and hydralazine on BPV and EOD in spontaneously hypertensive rats(SHR),to examine the hypothesis that lowering BPV with an antihypertensive drug is an important factor in organ protection.Design and methods:Drugs were mixed in rat chow.After 4 months of drug administration,blood pressure was recorded continuously in conscious freely moving rats for 24 h.The heart,kidneys,and brain were then isolated and examined.Results:It was found that nitrendipine significantly decreased blood pressure and BPV,and significantly decreased EOD score in SHR.Hydralazine decreased blood pressure,but did not lower BPV.No effect on EOD was found in hydralazine-treated rats.In control rat(n=38),EOD score was weakly related to systolic blood pressure(r=0.331,P<0.05) and closely related to long-term systolic BPV(r=0.551,P<0.01).In nitrendipine-treated rats,EOD score was closely related to long-term systolic BPV(r=0.602,P<0.01),but not to blood pressure level(r=0.174,P>0.05).Conclusion:BPV plays an important role in the organ-protecting effects of nitrendipine.

Objective To study the pathogenesis of upper gastrointestinal rehaemorrhagia after the transjugular intrahepatic portasystemic shunt (TIPS) and its influencing factor.Methods Fifty postoperative patients with TIPS were selected.The patients were followed-up,and the effect of the various factors in the role of upper gastrointestinal rehaemorrhagia after TIPS was analyzed.Results The portal vein pressure of 50 patients with TIPS decreased from preoperative (39.8 ±9.2) cmH2O (1 cmH2O =0.098 kPa) to postoperative (25.2 ± 5.8) cmH2O,and there was statistical difference (P ＜ 0.05).Fourteen patients appeared upper gastrointestinal rehaemorrhagia after TIPS,which accounted for total of 28％ (14/50) and included 3 cases of postoperative vomiting blood within 3 days.Acute stomach mucosa lesions bleeding was considered,and bleeding was controlled within a short-term medical treatment (1 patient after more than a year in recurrent upper gastrointestinal rehaemorrhagia).Twelve cases of patients appeared upper gastrointestinal rehaemorrhagia within 2 years after TIPS,and the causes of rehaemorrhagia in 6 cases were esophageal variceal rehaemorrhagia,gastric and duodenal ulcer in 3 cases,erosive gastritis in 2 cases,coagulation abnormalities in 1 case.Esophageal variceal rehaemorrhagia rate was 12％ (6/50).Conclusions The main reasons of upper gastrointestinal rehaemorrhagia after TIPS are variceal rehaemorrhagia and non variceal rehaemorrhagia,both of which are important causes of rehaemorrhagia after TIPS.Variceal rehaemorrhagia after TIPS occurs more than 3 months,and non variceal rehaemorrhagia occurs within 3months,so it is very important to protect gastric mucosa with proton pump inhibitor in postoperative patients.

Objective To design a new lumbosacral anterior plate by statistical analysis for the numerical value of the anatomic structure in Chinese.Methods The numerical value of lumbosacral angle and height of lumbosacral vertebrae,and discus intervertebralis were measured in 350 orthotropia and lateral view X-ray pictures of lumbosacral vertebrae of adult normal individuals.According to the acquired amplitude of lumbosacral vertebrae in Chinese,we designed the modified lumbosacral anterior plate,and then tested the plate in 4 different states of working condition on 8 fresh spinal columns to assay biomechanical data,and the results were compared with those of lumbosacral anterior secure plate(PACH).Results The amplitude of lumbosacral angle were 125 to 135,the heights of anterior border L5 and S1 vertebrae were(27.06?2.30) and(22.3?2.8)mm,the height of L5S1 discus intervertebralis was(8.2?0.3)mm.The flex bias and the compression rigidity had significant deviation for the vertebral column fixed the modified plate [flexation(4.706?0.012)mm,extension(4.549?0.298)mm,lateral bending(5.412?0.384)mm,average value of rigidity in 400 N(105.8?7.6)N/mm] and PACH[flexation(5.241?0.113) mm,extension(5.662?0.246)mm,lateral bending(6.767?0.017)mm,and average value of rigidity(87.4?4.2)N/mm] respectively,with statistical significance among them(P

Objective To investigate the influence of the stent position in transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) on the long-term effect.Methods The clinical data of 527 patients with upper gastrointestinal bleeding duo to portal hypertension,who were treated with TILPS during the the period from January 2012 to December 2014,were retrospectively analyzed.According to whether the stent was placed into the left branch of portal vein,the patients were divided into the study group (stent in the left branch of portal vein,n=318) and the control group (stent in the main portal vein,n=209).The success rate of surgery,the shunt channel flow dynamics,the stent patency rate,the incidence of hepatic encephalopathy,the rate of re-bleeding,etc.were compared between the two groups.Results The success rate of shunting operation was 100％ in both groups.One year after the treatment,the blood velocity and flow parameters in the shunt channel of the study group were significantly higher than those of the control group (P＜0.05).During the the follow-up period lasting for one year,the incidences of shunt channel dysfunction in the study group and in the control group were 1.26％ (4/318) and 5.74％ (12/209) respectively (P=0.003),the incidences of hepatic encephalopathy in the study group and in the control group were 0.31％ (1/318) and 4.31％ (9/209) respectively (P=0.001),and the incidences of re-bleeding in the study group and in the control group were 0.94％ (3/318) and 2.87％ (6/209) respectively (P=0.095).Conclusion During the performance of TIPS,the puncture of the left branch of portal vein and placement of the stent in the left branch of portal vein can reduce both the incidence of shunt channel dysfunction and the incidence of hepatic encephalopathy.

Objective To investigate the detection rate of contrast-enhanced ultrasound (CEUS) for iso-echo liver cancers, and to evaluate the application of CEUS in treating iso-echo liver cancers with radiofrequency ablation (RFA). Methods A total of 27 patients with liver cancers (31 lesions in total) were enrolled in this study. Of the 27 patients, hepatocellular carcinoma (HCC) was seen in 11 (11 lesions) and hepatic metastasis in 16 (20 lesions). In all patients the diagnosis was detected by contrast-enhanced CT or contrast-enhanced MRI and was clinically confirmed. Under real-time CEUS guidance, RFA was carried out for all the 31 lesions. The ablated extent was evaluated by CEUS, and CEUS findings were used to guide the further treatment. Results All 31 lesions were detected by CEUS and were treated with RFA. No serious complications occurred after RFA. Both CEUS and CECT performed one month after RFA showed that complete tumor necrosis was seen in all the 31 lesions. After RFA the serum AFP levels in all 11 HCC patients fell to normal range, and the serum CEA, CA-199 as well as CA-153 levels in patients with hepatic metastasis decreased significantly(P<0.01). Conclusion CEUS can markedly increase the detection rate of iso-echo liver cancers. Besides, CEUS plays an important role in guiding the performance of RFA for iso - echo liver lesions.

The human venous valve of the brachial,femoral and long saphenous veins wereexamined with light,transmission and scanning electron microscopy.The observationshows that the venous valve is composed of three functional layers covered withendothelium on both surfaces.A loosely structured layer is located underlying theendothelium.A network mainly containing randomly oriented elastic fibers was foundnear the side towards the lumen.To the side towards the venous wall,there is adense layer composed of eircumferentially and transversly oriented collagen bundles.Some smooth muscle cells extend from the wall of the vein to the base of thevenous valve.The elastic fibers and smooth muscle cells together with the collagenfibers contribute to the mechanical load-bearing performance of the valve and to thepassive closing and openning mechanism.In addition,the smooth muscle cells mightplay an active role in the normal functioning of the valve.The scanning and transmission electron microscopy of venous valve showdifferent arrangement of the endothelium.On the surface of the valve next to the wallof the vein,the endothelial cells are transversely arranged,while on the othersurface over which the current of blood flows,the cells are longitudinally arrangedin the direction of the current.These accord with the role of fluid mechanics.12 normal venous valves were tested by universal testing instrument (Instrontype 1122).The mean value of the maximum tension of the valve is 1 N.Theaverage value of the tensile ultimate strength is 10N/mm~2.