Objective To evaluate the therapeutic effects and experience of the tracheal stent implantation for the management of severe tracheal stenosis.Materials Thirteen patients with severe tracheal stenosis of various causes underwent high kilovoltage radiography and computed tomography for evaluating the site,form and extent of the stenosis including 10 at the trachea,1 at the right main bronchus and 2 at left main bronchus.The C2 catheter assisted with ultra-slipping guide wire was inserted into the trachea under fluoroscopy and then a replaced high shoring guide wire was pushed through the stenotic segment and retained the stent. Results All stents were implanted successfully with successful rate 100% together with dyspneic improvements.The mean survival time was 6.2 months for patients with malignant neoplasm.One patient with benign tracheal stenosis has been followed-up for 5 years without restenosis. Conclusions The tracheal stent implantation is an effective means for severe tracheal stenosis.

Objective To investigate the effect of different doses of lidocaine on expression of the high mobility group box 1 protein (HMGB1) in small intestine in septic rats.Methods Fifty adult male Wistar rats weighing 200-250 g were randomly divided into 5 groups ( n =10 each):sham operation group (group S),sepsis group( group Sep ) and different doses of lidocaine group (group L1～3 ).Group S were not applied cecal ligation and puncture (CLP).Sepsis intestinal damage model was performed in group Sep by CLP.Group L1～3 were given intraperitoneally lidocaine in a dose ofS,10 and 20 mg/kg at immediately,1 and 2 h after CLP,respectively.Isometric normal saline was given intraperitoneally in group S and group Sep.The small intestine tissues were taken at 24 and 48 h after CLP.The small intestine morphology was observed with optical microscope.The expression of the HMGB1 mRNA were examined by PCR and the activity of diamine oxidase (DAO) were determined by ELISA.Results Compared with group S,the expression of HMGB1 mRNA was increased and the activity of DAO decreased in group Sep and groups L1～3 at 24 and 48 h after CLP ( P ＜ 0.05 ).Compared with group Sep,the expression of HMGB1 mRNA was decreased and the activity of DAO increased in a dose-dependent manner in groups L1～3 ( P ＜0.05),The injury of pathology of small intestine was slighter in groups L1～3 than in group Sep.Conclusion Lidocaine can reduce samll intestine injury through inhibiting HMGB1 expression in septic rats by a dose-dependent manner.

Objective To retrospectively analyze the effect of interventional embolization for hepatocelluar carcinoma (HCC) associated with arteriovenous shunting (AVS), and to discuss the factors influencing the therapeutic results. Methods The clinical data of 62 cases with HCC associated with AVS , who were treated with interventional chemoembolization , were retrospectively analyzed. Based on the type and extent of AVS identified by angiographic manifestations, appropriate obstruction of the shunt and Lipiodol chemoembolization of HCC were conducted. The curative effect of the shunt embolization was assessed by DSA at one or two months after the treatment. The relevant factors influencing the prognosis of embolization were analyzed by using univariate and multivariate Cox regression analysis methods. Results Of the 62 patients, arterioportal shunting (APS) was detected in 44, hepatic arterio-venous shunting (HAVS) in 11, APS together with HAVS in 4, and hepatic artery-pulmonary artery shunting (HAPAS) in 3. Re-examination with DSA was carried out in 53 patients at 1 - 2 months after the treatment , which showed that the shunting disappeared in 18 cases, obvious reduction of the shunt flow was seen in 19 cases, the lesion remained stable in 9 cases and the disease became worse in 7 cases. Univariate analysis indicated that the kind of embolic material and the presence of tumor thrombus could affect the obstructive result of the shunt , while multivariate Cox regression analysis showed that portal tumoral thrombus was an independent risk factor. The embolization effect of polyvinyl alcohol (PVA) particles and Lipiodol-ethanol mixture, used as the embolic agents, was better than that of gelatin sponge particles. Conclusion To ensure a successful interventional chemoembolization for HCC combined with AVS the procedure should be individualized according to the type and extent of the arteriovenous shunting. The type of embolic materials used for embolization can affect the results to a certain degree.

ObjectiveTo evaluate the technical feasibility of animal model of avascular necrosis of femoral head (ANFH)with transcatheter arterial embolization (TAE).MethodsTwenty experimental pigs were randomly divided into experimental group and control group (each n= 10).Experimental group:A 5F Cobra catheter was inserted into left femoral artery,and the feeding arteries of femoral head were superselectively inserted.The feeding arteries were embolismed through transcatheter arterial injecting the segments of silk measuring about 500μm.Control group:The arterial embolization was not performed,and the other treatment was identical to experimental group.The articulation of hip in all pigs underwent plain X-ray examination,CT and MR scanning 2 weeks and 4 weeks after treatment,respectively.Histological examination was made in 4 weeks to evaluate volume of bone trabecula (TBV) and percentage of bone lacuna (PBL) at unit area under microscope.The data were compared between the two groups.Results In experimental group,CT and MRI showed swolling in hip soft tissue and high T1 in hip joint cavity,while no obvious abnormalities were found in plain X-ray film 2 weeks after feeding arteries were embolized.Four weeks after feeding arteries embolization,plain X-ray film,CT and MR showed typical necrosis of femoral head in the experimental group,while no obvious abnormalities were found in control group.The histology examination revealed there were obvious karyopyknosis and anachromasis in the bone cells.The quantity of bone cells decreased obviously or disappeared.PBL increased and TBV decreased significantly compared with those of control group (P＜0.05).ConclusionThe animal model of ANFH in pigs can be induced by TAE.It can preferably mimic the pathological situation of ANFH.

Objective To evaluate the clinical effect of DSA-guided foam sclerotherapy for lower extremity varicose veins.Methods A total of 41 legs in 26 patients with lower extremity varicose veins were treated with foam sclerosing agent of lauromacrogol un-der DSA guidance.4 cases with venous return disorder (3 in iliac vein and 1 in inferior vena cava)were treated with balloon dilatation first,and then lauromacrogol foam sclerotherapy after 24 hours.For injection method,2 patients were injected sclerosing agent through a catheter inserted in the trunk of great saphenous vein of sick limb with retrograde catheterization,and the others were in-j ected sclerosing agent directly in the varicose veins.Results The sclerotherapy was successfully accomplished in all affected limbs of 26 patients.The average dose of lauromacrogol for each patient was 5.88 mL.No serious complications occurred during and after operation.In 1 to 12-month follow-up,varicose veins disappeared in 24 patients (92.3%),the soreness,fatigue and pigmentations disappeared in all patients,the ulcer healed in all limbs.Conclusion DSA-guided foam sclerotherapy is a micro-invasive,safe and ef-fective treatment for lower extremity varicose veins.

Objective To study the clinical features and prognosis of patients with primary BuddChiari syndrome (BCS) caused by hepatic vein thrombosis.Method 16 patients with primary BCS caused by hepatic vein thrombosis treated in our hospital between June 2010 to December 2012 were used as the study group while 132 patients with primary BCS caused by other causes were used as the control group.A retrospective study was then employed to analyze the clinical data of the two groups of patients during hospitalization and on follow-up.The study was censored in June 2013.The median follow-up was 24 months (range,6 months to 36 months).The difference in quantitative data between the 2 groups were analyzed using the independent-samples t test and the Wilcoxon W rank sum test,and the difference in qualitative data were analyzed using the Chi-square test and the Fisher's exact test.The survival rates and recurrence rates were calculated using the Kaplan-Meier method.Result The study group was significantly lower than the control group in age,duration of symptoms,albumin level,diameter of spleen and survival rate,but it was significantly higher in the proportion of patients with ascites,average hospitalization time,alanine transaminase,aspartate aminotransferase,total bilirubin,carbohydrate antigen-125 and recurrence rate after percutaneous transluminal angioplasty.The differences were significant (P ＜ 0.05).The Rotterdam BCS prognosis grades of the study group were:9 patients grade Ⅱ and 7 patients grade Ⅲ.In the control group,there were 65 patients with grade Ⅰ,51 patients with grade Ⅱ,and 16 patients with grade Ⅲ.The prognosis grade of the study group was significantly higher than the control group (P ＜ 0.05).Conclusion When compared to the patients with BCS due to other causes,patients with BCS caused by hepatic vein thrombosis were more common in the young,most of them were diagnosed in the acute period,they had worse clinical outcomes and had more severe clinical symptoms and liver damage.

Objective To investigated the serum level of carcinoma antigen 125 (CA-125) and its clinical significance in patients with Budd-Chiari syndrome.Methods We reviewed medical records and laboratory tests of patients with BCS first diagnosed in our hospital between August 2011 and April 2013.235 patients were included as experiment group,while 120 healthy adult volunteers were randomly selected as control group.The serum level of CA-125 were detected by electrochemilumescence immunization assay in this single-center retrospective control study.Results The average serum level of CA-125 in experiment group is higher than that of control group [(147.9 ±246.6) kU/L vs (16.0 ±7.2) kU/L,P ＜0.001].In experiment group,the relative coefficient for serum CA-125 with ascites,alanine aminotransferase,aspartate aminotransferase,albumin and Rotterdam BCS scores was 0.79,0.45,0.29,-0.393 and 0.71,respec tively,P ＜0.001.As of October 2013,we found that the 68 BCS patients with serum CA-125 level 5-fold higher than the upper limit of normal (＞ 175 kU/L) presented much lower survival rates and asymptomatic survival rates than the rest 167 BCS patients after intervention therapy:(95.6％ and 79.8％) vs (98.8％ and 92.0％),P ＜ 0.05.Conclusions The serum level of CA-125 in BCS patients have positive correlation with ascites volume,liver injury degree and Rotterdam BCS scores.Serum CA-125 evaluation appears to be a valuable examination option in BCS as CA-125 levels negatively correlate with worse prognosis,thus could be applied as an efficient tool for prognostication.

Objective To investigate the effects of different doses of lidocaine on acute liver injury in septic rats.Methods Fifty male Wistar rats,weighing 200-250 g,aged 8-10 weeks,were randomly divided into 5 groups(n =10 each):sham operation group(group S),sepsis group(group CLP),and different doses of lidocaine groups(groups L1-3).Sepsis was induced by cecal ligation and puncture(CLP)in anesthetized rats.At 0,1 and 2 h after CLP,lidocaine 5,10 and 20 mg/kg(in normal saline 0.5 ml)were injected intraperitoneally in groups L1-3 respectively,while normal saline 0.5 ml was given in groups S and CLP.At 24 h after CLP,blood samples were taken for determination of the plasma alanine aminotran sferase(ALT)concenlralion.The rats were then sacrificed,and the liver was removed for microscopic examination and determination of the hepatic high-mobility group box 1 protein(HMGBI)mRNA expression.Results Compared with group S,the plasma ALT concentration was significandy increased and hepatic HMGBI mRNA expression was up-regulated in groups CLP and L1-3(P ＜ 0.05).Compared with group CLP,HMGBI mRNA expression was down-regulated in groups 14-3,while the plasma ALT concentration was decreased in groups L2 and L3(P ＜ 0.05),The plasma ALT concentration was significantly decreased and HMGBI mRNA expression was down-regulated in groups L2 and L3 com pared with group L1,and in group L3 compared with group L2(P ＜ 0.05).The microscopic examination showed that the pathologic changes were attenuated in groups L1-3,and the changes were least severe in group L3.Concluslon Lidocaine can reduce acute liver injury in septic rats,this effect is dose-related,and inhibition of hepatic HMGBI mRNA expression is involved in the mechanism.

Objective To investigate the effect of lidocaine on the LPS-induced NF-κB activity in rat peritoneal macrophages. Methods The peritoneal macrophages obtained from male Wistar rats were placed in 12-well plates at 2 × 106 cell/ml after being cultured for 3 days. Each well contained 1 ml of cell suspension. The cells were randomized into control group (group C), LPS group and 3 LPS + lidocaine group S (group LL1.2.3)(n = 10 wells each). In group LPS and LL1,2,3, the cells were exposed to LPS 100 ng/ml. In group LL1,2,3 the cells were exposed to lidocaine 2, 20 200 kg/ml respectively in addition to LPS 100 ng/ml. After being incubated for 24 h, the HMGB1 concentration in the supernatant (by ElISA) and HMGB1 mRNA expression (by RT-PCR)and NF-κB activity in the cells were measured. Results LPS signiticantly increased HMGB1 concentration,HMGB1 mRNA expression and NF-κB activity in the supernatant. Lidocaine treatment significantly attenuated the LPS-induced increase in HMGB1 concentration HMGB1 mRNA expression and NF-κB activity in a dose-dependent manner. Conclusion Lidocaine can inhibit NF-κB activity in the rat peritoneal macrophages and in turn inhibit the synthesis and release of HMGB1.

Objective To investigate the role of high mobility group protein box 1 (HMGB1) in pulmonary vascular remodeling in a rat model of acute lung injury (ALI).Methods Thirty healthy pathogen free male Wistar rats weighing 220-250 g were randomly divided into 3 groups (n =10 each) ∶ group control (group C) ;group LPS (group M) and group LPS + HMGB1 antibody (group H).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 7 ml/kg.ALI was induced with LPS 1 mg/kg infused iv over 30 min in groups M and H.In group H HMGB1 antibody 2 mg/kg was injected iv at 12,24 and 36 h after LPS administration respectively.The animals were sacrificed at 72 h after LPS administration.The left lung was removed for microscopic examination,measurement of the thickness of the medial layer (tunica media) of pulmonary arterioles and determination of the expression of PCNA (by immune-histochemistry) and HMGB1 protein (by Western blotting).Results The medial layer of pulmonary arterioles was significantly thicker and the expression of PCNA and HMGB1 higher in group M than in group C.LPS also induced significant inflammatory cell infiltration within the alveoli and damage to the septa.In group H HMGB1 antibody significantly attenuated the above-mentioned LPS-induced changes.Conclusion HMGB1 may play an important role in the LPS-induced pulmonary vascular remodeling.