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 .

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 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 .

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.

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 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.

Objective Complicated aneurysms located in the cisternal segment of the internal carotid artery(ICA-CSA)present unique therapeutic difficulties.This study is to discuss the feasibility of the Willis stent-graft in treating complicated ICA-CSA by comparing its effect with that of coiling therapy.Methods Willis covered stents were employed in 19 complicated ICA-CSAs(group A),while coils were used in 17 complicated ICA-CSAs(group B).Follow-up angiography was performed to investigate aneurysm recurrence,endoleak and parent artery(PA)stenosis.Kaplan-Meier curves were constructed to compare the recurrencefree and PA stenosis-free rate in both groups.Results Total exclusion was immediately achieved in 13 ICACSAs and minor endoleaks presented in 5 cases in group A.Total or near-total occlusion was achieved in 7 ICA-CSAs.subtotal occlusion in 8 and partial occlusion in 2 cases in group B after coiling.Acute thrombosis occurred in 1 patient in either group and re-hemorrhage happened in 1 patient after coiling.Follow-up angiography in group A revealed that 16 ICA-CSAs were completely isolated,with two parent arteries showing mild in-stent stenosis.Eighteen months after the procedure,Kaplan-Meier analysis showed that the recurrence-free rate was 93.3%and 50%,while the stenosis-free rate of parent artery was 87.5%and 100% in group A and in Group B,respectively.In group A and group B the clinical neurological symptoms were fully recovered in 9 and 9,obviously improved in 3 and 5,unchanged in 2 and 2,and aggravated in one and 0 patients,respectively.Conclusion The implantation of Willis stent-graft is a feasible endovascular therapy for complicated ICA-CSAs.When the parent artery is very tortuous or when the risk that a main collateral branch may be wrongly covered and occluded is present,the implantation of Willis covered stent can not be taken as the treatment of first choice.

Objective To evaluate the efficacy and mid-term follow-up results of endovascular treatment with Willis covered stent for traumatic pseudoaneurysms located in the internal carotid artery (ICA).Methods ICA angiogmphy was performed in 38 patients with traumatic brain and neck injury.Of the 38 patients.13 delayed traumatic pseudoaneurysms were found.All the pseudoaneurysms were treated with Willis covered stents.Follow-up angiography was performed at 1,3,6 and 12 months after the procedure,and the results were categorized as complete or incomplete occlusion.Clinical manifestations were graded as full recovery,improvement,unchanged and aggravation.Results Willis covered stent placement was technically successful in all traumatic pseudoaneurysms.No procedure-related complications occurred.The initial angiographic results showed a complete occlusion in 9 patients,and an incomplete occlusion in 4.The angiographic follow-up within 3-12 months exhibited a complete occlusion in 12 patients and the parent arteries remained patency in all patients.The clinical follow-up observation demonstrated that full recovery wag obtained in 11 patients,clinical improvement in one,and unchanged condition in one.No morbidity or mortality occurred.Conclusion Willis covered stent implantation iS a feasible and practical treatment for traumatic pseudoaneurysms located in the ICA.This technique can well preserve the parent artery with excellent therapeutic results.

Objective To investigate the technique of transarterial embolization of dural carotidcavernous fistulas(DCCFs)with low concentration(14%-25%)of n-butyl-cyanoacrylate(NBCA)and determine its value.Methods Eight patients with DCCFs were treated by transarterial embolization with low concentration of NBCA using a wedged microcatheter.Of the 8 patients,5 had unsuccessful transvenous embolization and 3 could not be treated with transvenous embolization.Results Transarterial embolization with low concentration of NBCA using a wedged microcatheter resulted in complete obliteration of the affected cavernous sinus and related shunts in 5 patients,no residual arteriovenous shunt was demonstrated on postembolization angiography.On clinical and angiographic follow-up 6-12 months later,complete resolution of clinical symptoms was observed in all 5 patients and there were no recurrent or residual DCCFs found.Partial obliteration of the involved cavernous sinus and the related shunt was achieved in the remaining 3 patients on immediate post-procedure angiography,but the volume of shunt diminished significantly.On clinical and angiographic follow-up 3 months later,in 2 patients,clinical symptoms were improved and the arteriovenous shunts were diminished;in the third patient,clinical symptom resolved and the shunt was obliterated.There were no major complications except for the transient worsening of ocular symptoms due to Ⅵ cranial nerve palsy in 1 patient.Conclusions Transarterial embolization of DCCFs with low concentration of NBCA using a wedged microcatheter was a safe and effective treatment method.It is an optimal alternative for the patients with DCCFs in which transvenous route was unsuccessful,or impossible.