Objective To evaluate the effects and methods of interventional therapy of the atherosclerotic renal artery stenosis(ARAS).Methods 28 cases of ARAS were implanted with stents by guiding catheter or guidewire exchanging, 31 stents were implanted (Palmaz stent in 22, Wallstent in 4, and Symphony stent in 5). Follow up was undertaken for 6 months to 1 year, together with recording the blood pressure, creatinine, the effective number of antihypertensive medication and comparing with those before the procedure. Results Stents were implanted successfully in all cases. Complication of renal arterial embolism happened in 2 cases with recanalization by guidewire exchanging. Restenosis happened in 4 cases.Conclusion Stent implantation for renal artery stenosis by guiding catheter is an ideal method or probably the chief interventional therapy to preserve the renal function.

Objective To conduct the endoscopic sinus surgery on chronic nasosinusitis by the image guided navigation system (IGNS) and to analyze the curative effect and complication compared with traditional methods .Methods 81 cases of chronic nasosi-nusitis were randomly selected and performed endoscopic sinus surgery by using IGNS ,and compared with the other 111 cases of chronic nasosinusitis by using traditional nasal endoscopic surgery in the aspects of curative effect ,complications ,etc .Results TypeⅠ and type Ⅱ nasosinusitis had no significant difference in the effective rate between the navigation group and non-navigation group;type Ⅲ nasosinusitis had significant difference in the effective rate between navigation group and non-navigation group .The total incidence rate of complications had significant difference between the navigation group and non-navigation group(P<0 .05);the incidence rate of complications in type Ⅰ and type Ⅱ nasosinusitis had no significant difference between the navigation group and the non-navigation group(P>0 .05);the incidence rate of complications in type Ⅲ nasosinusitis had significant difference be-tween the navigation group and the non-navigation group with statistical significance (P< 0 .05);the effective rates of Haller gas room and Onodi gas rooms showed no significant difference between the navigation group and the non-navigation group (P>0 .05);the total effective raates of anatomical deformity of the frontal recess or the sinus area had significant difference between the naviga-tion group and the non-navigation group(P<0 .05);the total effective rates of agger nasi cell had significant difference between the navigation group and the non-navigation group (P<0 .05) ,the total effective rates of non-agger nasi cell had no significant differ-ence between the navigation group and the non-navigation group (P>0 .05) .Conclusion For the patients with type Ⅲ chronic na-sosinusitis ,chronic frontal sinusitis ,conduct endoscopic sinus surgery by using IGNS is a reasonable choice ,can increase the opera-tive effect and accuracy ,and reduce the occurrence of complications .

Objective To evaluate the clinical effect of image guided navigation system (IGNS) and traditional methods for nasal inverted papilloma and sinus osteoma .Methods 73 cases of nasal inverted papilloma and sinus osteoma patients were divided into the navigation group and the non-navigation group ,the navigation group was given image guidance endoscopic sinus surgery ,the non-navigation group was given traditional endoscopic sinus surgery .operative time ,the anesthesia time ,amount of bleeding ,compli-cations and postoperative effects of the two groups were analyzed .Results The anesthesia time of the two groups had no significant difference(P>0 .05) ,the operative time ,blood loss had significant difference(P< 0 .05) .Ⅰ ,Ⅱ level recurrence rate of the two grups in nasal inverted papilloma had no significant difference(P>0 .05) ,while in stage Ⅲ ,Ⅳ ,the difference of recurrence rate had significant difference(P<0 .05) .In sinus osteoma ,1 case of recurrence in the non-navigation group ,the navigation group had no re-currence .In nasal inverted papilloma ,the complications of the two grouos had significant difference (P<0 .05) ,there was no signifi-cantly difference in stage Ⅰ ,Ⅱ(P>0 .05) ,while had significant different in stage Ⅲ ,Ⅳ(P<0 .05) .In the sinus osteoma ,the com-plications of the two grouos had significant difference(P<0 .05) .Conclusion For sinus osteoma and Ⅲ ,Ⅳ level of nasal inverted papilloma ,IGNS could work well with endoscopic system ,improve operation accuracy and reduce complications .IGNS is of a useful tool for endoscopy sinus surgery and would make a great important development in future .

ObjectiveTo study the role of laparoscopic splenectomy (LS) using the anterior approach with sequential layered dissection. MethodsFrom December 2007 to July 2009, we performed 27 LS using the anterior approach with sequential layered dissection. The clinical data were retrospectively analyzed. ResultsThe range of splenic length was 8-20 cm. Accessory spleen was found in 6 patients (22.2%). The mean operative time was 125 mins. The mean intraoperative blood loss was 90 ml, and the mean postoperative stay was 5.5 days. ConclusionsLaparoscopic splenectomy using the anterior approach with sequential layered dissection could be carried out smoothly and rapidly. It reduced accidental injuries and shortened the operative time.

Objective To evaluate the safety and efficacy of intra-arterial thrombolysis in patients with acute cerebral ischemic stroke.Methods Twenty-one patients with acute internal carotid circulation infraction(internal carotid 3,MCA 12,ACA 5,lenticulostriate in 1) were treated with intra-arterial thrombolysis of recombinant tissue plasminogen activator(rt-PA) which was performed within 2-6 hours of symptom onset.Recanalization was observed during the operation.Intracerebral hemorrhage(ICH) was monitored immediately and 24 h after the treatment by CT or MRI scanning.Chinese stroke scale was used to evaluate the recovery of neurological functions pre-operatively and 30 d after the treatment.Results All the 21 patients were 100% success in receiving intra-arterial thrombolysis technique and revealed 16 having the degree of recanalization of 2 to 3 grade as regards to TMI,16 patients' degree of recanalization reached 2 to 3 grade according to TMI;5 patients showed 1 to 2 grade.Symptomatic ICH was observed in 3 patients,with two dead.Arterial dissection was found in one patient.Thirty days after the operation,17 patients' cerebral function reduced over 50 percent;2 less than 50 percent;and 2 died.The patients achieved 2 to 3 grade of recanalization were obviously getting better than those achieving 0 to 1 grade.Conclusions It is adapt to have intra-arterial thrombolysis with six hours from onset;but still have the danger of severe ICH.The treatment should be started as early as possible.

Objective To prospectively evaluate 3D time-of-flight magnetic resonance angiography (3DTOF MRA) and high resolution contrast enhanced volume scan magnetic resonance angiography (CEMRA) with sensitivity encoding in diagnosing craniocervical artery stenosis. Methods Forty-six patients suspected with craniocervical artery diseases underwent MRI, 3DTOF MRA of the head and also CEMRA of the neck. The images of MRA were reconstructed with MIP and VR. The degree of arterial stenosis demonstrated on MRA was compared with that showed on digital subtraction angiography(DSA), and the data were analyzed with Spearman rank correlation coefficient (Rs). Results Excellent correlation in determining the degree of craniocervical artery stenosis existed between MRA and DSA (Rs = 0.97). With DSA as a golden standard, the sensitivity, specificity and accuracy of MRA in detecting over 50% arterial stenosis were 100%, 99.4% and 99.4% respectively. Conclusion 3DTOF MRA and CEMRA with sensitivity encoding at 3.0T are reliable and effective examinations for evaluating craniocervical artery disease. These techniques can be used as the necessary exams before DSA and can even substitute for the conventional DSA in some instances.

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.

Objective To investigate the alterations of invariant nature killer T( iNKT) cells in peripheral blood samples from patients with rheumatoid arthritis ( RA) and to clarify the correlation between the percentage of iNKT cells and the ratio of IFN-γ/IL-4 in order to further understand the significance of iNKT cells in the development of RA.Methods Peripheral blood mononuclear cells ( PBMCs) were isola-ted from 70 patients with RA and 40 healthy subjects.Among them, thirty patients in the stage of inactive RA were involved in a follow-up study.Fluorescence activated cell sorting ( FACS) was used to detect the percentage of iNKT cells.PBMCs were cultured in vitro for analysis of cytokine production.The dynamic changes of iNKT cells in percentages were analyzed by FACS.MILLIPLEX MAP Human Cytokine/Chemo-kine kit was used to measure the secretion of IFN-γand IL-4 in serum samples and culture media of PBMCs. The expression of IFN-γand IL-4 in iNKT cells at mRNA level were analyzed by RT-PCR.Results Com-pared with the healthy subjects, the patients with active RA showed the delayed proliferation of iNKT cells and the decreased percentages and proliferation rates of iNKT cells (P<0.05).The percentages and prolif-eration rates of iNKT cells in patients with active RA were significantly lower than those in patients with inac-tive RA (P<0.05).No statistical significant differences with iNKT cells were found between healthy sub-jects and patients with inactive RA (P>0.05).The ratios of IFN-γ/IL-4 in serum samples and culture media of PBMCs were increased in patients with active RA as compared with those in patients with inactive RA and healthy subjects (P<0.05).No statistical significant differences with the ratios of IFN-γ/IL-4 were observed between healthy subjects and patients with inactive RA (P>0.05).Compared with healthy subjects and patients with inactive RA, patients with active RA showed increased transcriptional level of IFN-γand decreased transcriptional level of IL-4.No significant differences with the expression of IFN-γand IL-4 in iNKT cells at mRNA level were observed between healthy subjects and patients with inactive RA.The per-centage of iNKT cells was negatively related to the IFN-γ/IL-4 ratio in patients with RA (P<0.05).Con-clusion Decreased percentage and impaired function of iNKT cells were detected in patients with RA. iNKT cells were closely related to the development and disease activity of RA.

First-aid stations were divided randomly into 4 groups.Advanced airway for sudden cardiac arrest patients with laryngeal mask airway (LMA) was established in groups A and C while trachea cannula was inserted on spot of emergency medical service (EMS) or in ambulance in groups B and D.According to the results,the success rate of insertion and cardiopulmonary resuscitation (CPR) of groups A and C were higher than the other two groups (P ＜ 0.05).However,the required time was shorter (P ＜ 0.05).Due to a difficult catheterization environment,LMA is more effective and convenient than trachea cannula in EMS.

Objective The aim of this study was to analyze risk factors which may affect prognosis of patients with hepatits B virus (HBV)-related liver failure,and to construct a model for prognostic evaluation and further assess its predictive ability.Methods In this retrospective cohort study,569 hospitalized patients who were diagnosed with HBV-related liver failure from January 2007 to December 2010 were enrolled.All the patients were followed up and survival analysis was performed using the Kaplan-Meier method.Univariate and multivariate COX proportional hazards regression analyses were applied to variables such as age,sex,complications,biochemical markers,coagulation markers,and HBV DNA levels to construct a model for prognostic evaluation,and 79 independent cases of HBV-related liver failure were used to confirm the model's predictive ability.Accuracy of the constructed model and model for end-stage liver disease (MELD) was evaluated by receiver operating characteristic (ROC) curves.Results The median survival time for all the patients was 59 days.The survival rates at 1,3,6 months were 58.9％,46.2％ and 45.5％,respectively;and survival rates at 1 and 3 years were 44.9％ and 44.5％,respectively.Hepatic encephalopathy,pulmonary infection,upper gastrointestinal bleeding (UGIB),albumin (Alb),aspartate aminotransferase (AST),creatinine (Cr),international normalized ratio (INR) were determined to be independent risk factors (all P＜0.01) which may affect survival of patients with HBV related liver failure.Accordingly,the prognostic index (PI) of the constructed model for prognostic evaluation 4.98 × assignment of hepatic encephalopathy + 4.57 × assignment of pulmonary infection + 4.41 ×assignment of UGIB-9.69 ×lm[Alb (g/L)]+2.46 ×ln[AST (U/L)]+5.18×ln[Cr (mmol/L)]+3.35×ln (INR) 15.36.The area under receiver operating characteristic curve was 0.838 for the constructed model assessing 90-d survival of the patients,and was 0.751 for model for end-stage liver disease,with no significant difference between the two models (Z=1.085,P =0.278).Conclusions Prognosis of patients with HBV-related liver failure can be accurately predicted by the constructed prognostic assessment model,which is consisted of hepatic encephalopathy,pulmonary infection,UGIB,Alb,AST,Cr,and INR as independent risk factors,and is able to predict the 90 d survival.