Objective To investigate the clinical significance of soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-1β(IL-1β) in pregnant women with chorioamnionitis. Methods The levels of sICAM-1, IL-1β,CRP and WBC were detected by enzyme linked immunosorbent assay in maternal serum of 56 pregnant women with PPROM and 38 pregnant women with PROM. Every embryolemma was histopathologically confirmed after deliver-y. Results Chorioamnionitis in PPROM was more than that in PROM of full term(P<0.05). The serum levels of sI-CAM-1, IL-1β, CRP and WBC in chorioamnionitis in pregnant women were higher than those in non-chorioamnionitis (P <0.05). The serum levels of sICAM-1 was more sensitive and specific than those of CRP and WBC. The serum levels of IL-1β was more sensitive than those of CRP and WBC, but their specificity was similar. Conclusion The levels of sICAM-1 and IL-1β in maternal serum are good clinical biological markers for predicting chorioamnionitis in pregnant women.

Objective To evaluate the effect of dexmedetomidine on brain injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes, aged 18-64 yr, with body surface area of 1.6-2.0 m2, with left ventricular ejection fraction＞30％, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ), scheduled for elective cardiac surgery with CPB, were equally and randomly divided into control group (group C) and dexmedetomidine group (group D) using a random number table.Before induction of anesthesia, dexmedetomidine was given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery in group D, and the equal volume of normal saline was given in group C.After induction and before skin incision (T0) , at 30 min after beginning of CBP (T1) , at 30 min after the end of CBP (T2) , at the end of surgery (T3) , and at 24 and 72 h after surgery (T4.5) , blood samples from jugular bulb were drawn for determination of serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-10, S-100β protein and neuron-specific enolase (NSE).Results Compared with group C, the serum concentrations of TNF-α and S100β at T1-3 and IL-6 and NSE at T1.4 were significantly decreased, and the serum concentrations of IL-10 at T1-4 were increased in group D (P＜0.05).Conclusion Dexmedetomidine given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery can reduce the brain injury in the patients undergoing cardiac surgery with CPB, and the mechanism is related to inhibited inflammatory responses.

Objective To investigate the effects of autologous blood withdrawal-reinfusion on the perioperative coagulation function in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB ) . Methods Eighty-four ASA physical status Ⅱ-Ⅳ patients ,without impairment of coagulation function ,scheduled for cardiac surgery with CPB ,were equally and randomly divided into 2 groups using a random number table :autologous blood withdrawal-reinfusion group (group ABWR , n= 44 ) and control group (group C , n= 40 ) . Decreased coagulation function was diagnosed based on the following two criteria :laboratory standard of decreased coagulation function and clinical signs .After anesthesia and before the beginning of operation (T1 ) ,at 5 min after heparin was reversed with protamine (T2 ) ,at the end of operation (T3 ) and at 24 h after the end of operation (T4 ) ,venous blood samples were obtained to measure the blood routine and parameters of coagulation function . Blood routine included the red blood cell (RBC ) , hemoglobin (Hb ) , hematocrit (Hct ) , platelet count , and plasma fibrinogen concentration (Fib) .The parameters of coagulation function included thrombelastography (TEG) variables and prothrombin time (PT ) ,activated partial thromboplastin time (APTT ) ,international normalized ratio (INR ) , and activated clotting time (ACT ) . The volume of intraoperative blood loss , amount of mediastinal drainage at 6 and 24 h after operation , consumption of tranexamic acid and heparin during operation , and consumption of fibrinogen after operation ,and requirement for transfusion of allogeneic RBCs ,fresh frozen plasma (FFP) and platelet during operation and within 24 h after operation were recorded .The development of decreased coagulation function during operation and within 24 h after operation .Results Compared with group C , perioperative consumption of allogeneic RBCs were decreased ,reaction time (R) measured by celite-activated TEG was increased at T3 (P<0.05) ,and no significant change was found in the blood routine index ,incidence of decreased coagulation function ,volume of intraoperative blood loss ,amount of mediastinal drainage ,consumption of tranexamic acid and heparin , and postoperative consumption of fibrinogen in group ABWR ( P> 0.05 ) . Conclusion Autologous blood withdrawal-reinfusion provides similar effects on coagulation function with allogeneic blood transfusion ,and does not increase the development of decreased coagulation function in patients undergoing cardiac surgery with CPB .

Objective To evaluate the reproducibility of ADC measurements at 1.5 vs 3.0 T and at 1.5 T of different scanners in liver,spleen and pancreas of healthy volunteers.Methods Abdominal DWI were performed on 33 healthy volunteers by using GE 1.5 T,Siemens 1.5 T and Philips 3.0 T MR scanners.The mean ADC values of liver,spleen,pancreatic head,body,and tail were calculated.The ADC data were analyzed by using paired-sample t tests.Results The mean ADC of liver at GE 1.5 T,Siemens 1.5T and Philips 3.0 T were (1.56 ±0.10) ×10-3,(1.67 ±0.15) ×10-3 and(1.35 ±0.12) ×10-3 mm2/s,spleen were (0.96±0.10) × 10 3,(0.98 ±0.11) ×10-3and(0.81 ±0.14) × 10-3 mm2/s,pancreatic head were (2.09 ± 0.27) × 10-3,(2.20 ± 0.21) × 10-3 and (2.05 ± 0.27) × 10-3 mm2/s,pancreatic body were (2.03 ± 0.27) × 10-3,(2.09 ± 0.30) × 10-3 and (1.76 ± 0.25) × 10-3 mm2/s,pancreatic tail were (1.88 ± 0.28) × 10-3,(1.88 ± 0.27) × 10-3 and (1.56 ± 0.27) × 10-3 mm2/s,respectively.From the aspect of different field strength MR scanners,there were significant differences in mean ADC of liver (t =11.073,P ＜0.01 in GE 1.5 T vs Philips 3.0 T; t =12.795,P ＜0.01 in Siemens 1.5 T vs Philips 3.0 T),spleen (t =4.143,P ＜ 0.01 in GE 1.5 T vs Philips 3.0 T; t =5.376,P ＜ 0.01 in Siemens 1.5 T vs Philips 3.0 T),pancreatic body (t =4.677,P ＜ 0.01 in GE 1.5 T vs Philips 3.0 T; t =5.174,P ＜0.01 in Siemens 1.5 T vs Philips 3.0 T) and tail (t =5.356,P ＜0.01 in GE 1.5 T vs Philips 3.0 T; t =4.648,P ＜0.01 in Siemens 1.5 T vs Philips 3.0 T),but there were no significant differences in mean ADC of pancreatic head (t =0.340,P ＞ 0.05 in GE 1.5 T vs Philips 3.0 T; t =1.349,P ＞ 0.05 in Siemens 1.5 T vs Philips3.0 T).From the aspect of different 1.5 T MR scanners,there were significant differences in mean ADC of liver (t =-4.563,P ＜ 0.01),but there were no significant differences in mean ADC of spleen (t =-0.732,P ＞ 0.05),pancreatic head (t =-0.879,P ＞ 0.05),body (t =-1.020,P ＞0.05) and tail (t =0.054,P ＞ 0.05).Conclusion Between 1.5 T and 3.0 T MR scanners,there were significant differences in mean ADC of liver,spleen,pancreatic body and tail,but there were no significant differences in mean ADC of pancreatic head.At different 1.5 T MR scanners,there were significant differences in mean ADC of liver,but there were no significant differences in mean ADC of spleen,pancreatic head,body and tail.

Objective To evaluate the value of contrast-enhanced ultrasonography (CEUS) in quantitative diagnosis of chronic kidney dysfunction(CKD) by comparing it with color Doppler imaging (CDFI). Methods Tirty-three cases (15 males and 18 females) of clinical confirmed CKD (stage Ⅲ～Ⅴ)were included. Forty-five healthy volunteers were performed as control group. CEUS and CDFI were performed on each patient. After intravenous bolus injection of 1ml SonoVue each side,CEUS of renal cortex blood perfusion was collected successively,and a time-intensity curve(TIC) was created with Philips iU22 system's QLAB software. Resistance index(RI) and peak systolic velocity(PSV) of renal partial arteries were also tested. Results Compared with normal kidney,CKD patients had delayed perfusion and decreased intensity. Changes of area under curve(AUC), derived peak intensity(DPI), slope rate of ascending curve(A)and time to peak(TTP) were statistically significant ( P ＜0. 05). Sensitivities of AUC,DPI,A and TTP in diagnosis of CKD (stage Ⅲ～Ⅴ ) were 91.2% ,84. 9% ,90.9% and 85.3%, their specificities were 95.4%,88.9% ,93.3% and 90.9%, their accuracies were 93.6%, 87. 2%, 92.3% and 88. 5%, respectively. The results of CEUS were better than RI in CDFI (sensitivity 70.4%, specificity 37. 8%, accuracy 52.2%).Conclusions CEUS can precisely display the hemodynamic change in CKD ( stage Ⅲ～Ⅴ ), and is more sensitive than CDFI.

Objective To investigate the clinical effects of liver transplantation including living related liver transplantation for Caroli's disease (CD). Methods Seven consecutive patients with diffused type of Caroli's disease had undergone liver transplantation (LT) from September 1999 to February 2007 in our single center. The clinical characteristics and survival of these patients were retrospectively reviewed. Results All 7 patients were diagnosed as Caroli's disease with diffused type which manifested recurrent cholangitis in clinical symptoms. Among them, 4 were female and 3 male.The mean age was 16 years old (ranging from 10 to 31 years old). Six patients were subjected to conservative therapy and only one patient had previously undergone cholecystectomy and T tube drainage before transplantation. In types of surgery, 4 patients accepted split liver transplantation with right liver lobe, two got whole liver transplantation and only one underwent living related liver transplantation. In two patients venovenous bypass was done during the operation. The mean duration of surgery was 9. 1 h. Post-transplant complications included pulmonary infection (3 cases), acute rejection (2 cases), pleural effusion (2 cases) and biliary leakage in the split section of donor liver (1 case). One patient died within 19 days caused by acute renal failure and multiple organs dysfunction.The rest six patients are alive without any signs of recurrence of protopathy and the longest survival time is 7 years. Conclusion Liver transplantation is a valuable treatment to Caroli's disease with diffused type. Due to the organ shortage, living related liver transplantation may own identical effects on LT.

Objective To investigate the value of spectral CT with iodine parameters in distinguishing moderately-differentiated adnocarcinoma from poorly-differentiated adenocarcinoma.Methods 61 patients with gastric adenocarcinoma underwent preoperative CT scanning that included arterial phase(AP) and venous phase(VP) with gemstone spectral imaging(GSI) mode.All measurements were performed on the GSI viewer.The iodine concentration (IC) and the water concentration (WC) of the primary lesion were measured.Then the normalized iodine concentration (NIC) and contrast enhancement ratio (CER) were calculated.The CT values were measured at 70 keV Mono image.All the values of CER, NIC, IC and WC in the primary lesion were recorded and assessed by independent-samples t test.Receiver operating characteristic (ROC) was used to determine the threshold of IC and NIC for differentiating poorly-differentiated adenocarcinoma and moderately-differentiated adnocarcinoma.Results The IC values between moderate differentiation group and poor differentiation group were 8.73±4.05 vs 11.07±4.80(100 μg/cm3) in AP and 16.89±4.89 vs 21.18±5.96(100 μg/cm3) in VP.The values of NIC between moderately differentiated group and poorly differentiated group were 0.10±0.06 vs 0.13±0.06 in AP and 0.38±0.10 vs 0.49±0.12 in VP respectively.Significant difference of NIC (tVP=3.38, PVP<0.01) and IC (tVP=2.87, PVP=0.01) were only found between poor differentiation group and moderate differentiation group in venous phase.The value of WC and CER (both P>0.05) in double phases revealed no significant difference between the two groups.Conclusion Iodine quantitative parameters of spectral CT can be potentially used to preoperatively evaluate the differentiation degree of gastric adenocarcinoma.Thus, the iodine parameters can reflect the differentiation degree of gastric adenocarcinoma.

Objective we assessed our institutional outcomes of hybrid treatment for aortic arch disease with supra-aortic debranching and endovascular stent graft repair.Methods From March 2016 to November 2016,6 patients underwent Hybrid total aortic arch repair:1 had aortic arch pseudoaneurysm;1 had type Ⅲ aortic dissection;4 had aortic arch aneurysm because of hypotension,of whom 1 with aneurysm prerupture and 1 with Aortic intramural hematoma.Supra-aortic vessels were involved and high-risk for traditional operations in all patients.Bifurcated artificial vessels were used,main vessel was end-to-side anastomosed with ascending aorta.Branching vessel were end-to-end anastomosed with right innominate artery and left subclavian artery,end-to-side anastomosed with left common carotid artery.Then,stent graft was implanted into ascending aorta and aortic arch.All patients were followed postoperatively,with regularly contrast computed tomography angiogram (CTA) and echocardiography(discharge,three months,six months,and yearly).Results Hybrid procedure with supra-aortic debranching and endovascular stent graft repair were completed in all patients,technical success rate was 100％.There were no perioperative obvious morbidity and mortality,follow-up period were 2-9 months.1 patients had stroke during follow-up period,condition improved after treatment.Supra-aortic vessels were patency and there were no endoleak in all patients.There were no recurrent aortic disease during follow-up period.Conclusion Hybrid aortic arch replacement can be performed with good postoperative and early results in high-risk patients for traditional open repair.

Objective To explore the indications for liver transplantation among patients with hepatolithiasis.Methods Data from 1 431 consecutive patients with hepatolithiasis who underwent surgical treatment from January 2000 to December 2006 were retrospectively collected for analysis.Surgical procedures included T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones,hepatectomy,cholangiojejunostomy,and liver transplantation.Results Nine hundred and sixty-one patients who had a stone located in the left or right intrahepatic duct underwent hepatectomy or T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones.The rate of residual stones was 7.5%(72/961).Four hundred and seventy patients who had a stone located in the bilateral intrahepatic ducts underwent surgical procedures other than liver transplantation;the rate of residual stones was 21.7%(102/470).Only 15 patients with hepatolithiasis underwent liver transplantation;they all survived.According to the degree of biliary cirrhosis,recipients were divided into 2 groups: a group with biliary decompensated cirrhosis(n=7),or group with biliary compensated cirrhosis or noncirrhosis group(n=8).There were significant differences in operative times,transfusion volumes and blood losses between 2 groups(P

Objective To determine the consistency of spectral CT parameters in advanced gastric cancer using different region of interests (ROIs) and their relationship with tumor micro-vessel density (MVD).Methods Thirty patients with histologically proven gastric cancer were prospectively enrolled.All the patients were examined using spectral-dual-phase-abdominal CT and treated successfully with radical surgery within 2 weeks after CT scanning.Two observers independently acquired iodine concentration(IC), normalized IC(nIC),and CT value at workstation using three different ROI protocols:10 mm2 circular ROI near tumor border where enhanced obviously,30 mm2 near the tumor center and the freehand outline ROI. The Data of the two observers were tested with interclass correlation coefficient (ICC) and Bland-Altman plot.The mean value of each parameter was documented as the final result.Differences of each group of ROI data were compared using ANOVA test. All the specimen were pathologically examined and MVD was counted. The relationship of each parameter to tumor MVD was analyzed by Pearson correlation. Results All of the IC,nIC and CT values obtained by the 2 observers using three ROI measurements were consistent well,and the ROI-outline had the highest ICC than that of smaller circular ROIs(ICC:0.991 to 0.997).The 95% differences confident interval of nIC-AP and nIC-VP using freehand outline ROI by two observers were-0.003 to 0.002 and -0.001 to 0.012, respectively. The outline-ROI method had better inter-observer accuracy. There were significant differences between the means of the all parameters with three ROI protocols (P<0.05). Values of ROI-10 mm2 were highest, while the values of ROI-outline were lowest (P<0.05).The mean counts of tumor MVD was(29.0±8.4)/high magnification.The nIC in venous phase(VP)had good correlations with intra-tumoral MVD, especially the ROI-outline (r=0.670, P<0.01), within different ROI measurements.Conclusions The different ROI selection in tumor has significant impact on the final CT parameters. Outlined ROI protocol improves inter-observer consistency and nIC-VP obtained by this method can indirectly reflect the condition of tumor angiogenesis.