Endovascular repair has gained worldwide popularity for the treatment of aortic dissection and aortic aneurysm.The non-tapered stents are selected usually.The aortic diameters vary in different level.High incidence of distal stent-induced complications is closely related to the aortic taper angle.According to several published studies,the aortic taper angle could be evaluated by establishing geometric model.Applications of tapered stents can significantly reducing the incidence of distal stent-induced comnplications.This review summaries the latest researches in the studies of the progress and the application of the aortic taper angle and the tapered stents,providing a reference for endovascular stent-graft selecting in the treatment of aortic dissection and aortic aneurysm.

Described in the paper is the reform made at public hospitals in Zhejiang province,with analysis of its problems and causes. Based on such,the authors proposed the following actions:to accelerate the reform of public hospitals centering on health promotion, and encourage such hospitals to shoulder the health care responsibility on behalf of the government; to proceed with hierarchical medical system and contract-based service focusing on capacity building of general practitioners; to attract private capital into building the healthcare system; and to motivate non-governmental organizations to cater to diversified healthcare needs of the people.

Objective To characterize the changes in the dimensions during systolic and diastolic periods in the aorta with ECG-gated multi-detector CTA scans.Methods The CT angiograms of 115 patients (78 males,mean age 55.2 ± 9.4 years;37 females,mean age 60.1 ± 8.5 years) both in systolic and diastolic periods were obtained on a 64-slice ECG-gated multi-detector CT scanner.The diameters were measured at four anatomic levels of the aorta.(Level A:1 mm proximal to the innominate artery;Level B:1 mm distal to the left common carotid artery;Level C:1 mm distal to the left subclavian artery;Level D:10cm distal to the left subclavian artery).On each level,the maximal and the minimal diameters were measured both in systolic and diastolic periods.Results The paired sample t test results showed a significant difference between the systolic and diastolic diameters in all individual subjects on every level (P ＜0.001).The mean maximum diameter changes were 1.95％ (range-2.0％ to 7.0％),2.12％ (range-3.0％ to 6.0％),1.88％(range-1.0％ to 8.0％)and2.47％(range-3.0％ to 10.0％)at level A,B,C and D,respectively.The mean minimum diameter changes were 1.43％ (range-3.0％ to 5.0％),2.67％ (range-2.0％ to 11.0％),1.75％ (range-14.0％ to 9.0％)and 2.99％ (range -2.0％ to 11.0％) at level A,B,C and D,respectively.Conclusions The differences of the aortic diameters between systolic and diastolic periods are significant.The pulsatility of aorta in Chinese population may be different from published Western literature.

ABSTRCT Purpose To explore the evolution of HER2 nega-tive subgroups(IHC Null,Ultra-low and 1+)in breast cancer with hormone receptor(HR)positive before and after neoadju-vant therapy,and the relationship with clinical pathological fea-tures.Methods There were 255 patients who did not achieve pathological complete response(pCR)consecutively after neoad-juvant therapy.Immunohistochemistry was used to detect the ex-pression of ER,PR,HER2 and Ki67 and to evaluate the evolu-tion of HER2-negative subgroups after neoadjuvant therapy and its relationship with clinicopathological characteristics.Results Among the 255 patients included in this study,HER2 expression was 0 and 1+in 116 cases(45.5％)and 139 cases(54.7％)respectively before neoadjuvant therapy,and then HER2 0 was further divided into Null group(61 cases,23.9％)and Ultra-low group(55 cases,21.6％).After neoadjuvant therapy,HER2 expression was 0 and 1+in 117 cases(45.9％)and 138 cases(54.1％)respectively,and then HER2 0 was further di-vided into Null group(64 cases,25.1％)and Ultra-low group(53 cases,20.8％).HER2 status changed in 121 patients(47.5％)after neoadjuvant therapy.The highest conversion rate was from HER2 Ultra-low before neoadjuvant therapy to 1+after neoadjuvant therapy,with a conversion rate of 11.76％(30/255),followed by HER2 1+to the Ultra-low,with a conversion rate of 10.98％(28/255).After the neoadjuvant therapy,44 of 55 cases had transformation in the HER2 Ultra-low group,with the conversion rate of as high as 80％.Chi-square test showed that HER2 expression before neoadjuvant therapy was correlated with the maximum tumor diameter(≤2 cm,＞2cm)after neo-adjuvant therapy(x2=6.106,P=0.047);the tumor of HER21+before neoadjuvant therapy was mostly 2 cm or less in the di-ameter.The HER2 status after neoadjuvant therapy was correla-ted with the tumor thrombus(x2=6.975,P=0.029).Patients with HER2 Ultra-low after treatment were more likely to have vascular invasion.Conclusion In HR positive breast cancer,when the HER2 0 cases are divided into Ultra-low and Null sub-groups,the HER2 conversion rate increases significantly after neoadjuvant therapy,in which the Ultra-low conversion rate is the highest,indicating that the HER2 Ultra-low cases are highly unstable after neoadjuvant therapy.It is important to detect HER2 expression in residual lesions after neoadjuvant therapy and to identify the Ultra-low HER2 expression subgroup.

Objective To study the changes in the diameter of the ascending aorta at different levels.Methods A total of 287 patients were enrolled in this study from November 2016 to January 2017 at the Chinese People's Liberation Army General Hospital in Beijing.Each patient had undergone enhanced computerized tomography scanning,and the systolic and diastolic images were reconstructed for each patient.Ten times distance accounts for percentage was calculated per 10％ unit of ascending aorta.The maximal diameters of each level were measured by 3 mensio Vascular 8.1 software with curved planar reformation.Generalized additive mixed model with smoothing function and threshold saturation effect analysis with generalized estimating equations were used to analysis the changing regularity of ascending aortic diameters and its consistency using stratified analysis.Furthermore,stratified analyses were conducted aauording to sex,age,BMI,smoking status and history of chronic diseases.Results A nonlinear relationship between the maximal diameters and distance was observed.With the increase of distance,the maximal diameters of ascending aorta presented an inverted U shape.In the first half,the ascending aortic maximal diameter increased 1.16 mm while the distance increased ten percent of the ascending aortic length (P ＜ 0.001).In the second half,the ascending aortic maximal diameter reduced 0.47 mm while the distance increased ten percent of the ascending aortic length (P ＜ 0.001).The results showed that the changing regularity of ascending aortic diameter has no significant difference between systolic and diastolic periods.Conclusions With the increase of distance,the maximal diameters of ascending aorta increase and then decrease.The regularity of ascending aortic diameter between systole and diastole is consistent.In each subgroup,the regularity of ascending aortic diameter is not completely consistent,but the difference has not clinical significance.

Objective To evaluate midterm outcomes of thoracic endovascular aortic repair (TEVAR) with in situ fenestration (ISF) to revascularize the aortic arch vessels.Methods From Feb 2012 to Dec 2014,10 patients underwent TEVAR with aortic arch vessels revascularized via ISF.There were 6 patients of thoracic aortic aneurysms (TAA) and 4 of type B aortic dissection (TBAD).Patients were followed for all-cause mortality,endoleak of post-TEVAR,integrity and patency of aortic endograft and branch vessels.Results Totally 11 branch vessels [10 left subclavian arteries (LSA),1 left common carotid artery (LCA)] via ISF were revascularized in 10 patients.Patients were followed-up for 24-55 mouths,mean of 42.80 months.1 TAA patient died in 2 years post-TEVAR unrelated to the operation.All fenestrations remained patent,and there were no endoleaks and no occlusion,compression,or fracture of stents.There were no postoperative strokes and left upper limbs ischemia.1 patient had distal aortic endograft pseudoaneurysms formation in 2 years post-TEVAR and underwent reTEVAR treatment.Conclusion Aortic arch vessels revascularization via ISF in TEVAR is safe and feasible.Midterm outcomes is satisfactory.

Genetically engineered intestinal microbes could be powerful tools to detect and treat intestine inflammation due to their non-invasive character, low costs, and convenience. Intestinal inflammation is usually detected along with an increasing concentration of thiosulfate and tetrathionate molecules in the intestines. ThsSR and TtrSR are two-component biosensors to detect the presence of thiosulfate and tetrathionate molecules, respectively. In real-life intestinal inflammation detection, sophisticated instruments are needed if using fluorescent proteins as reporters. However, chromoproteins and other colored small molecules, which can be seen by the unaided eye, could extend the use of ThsSR and TtrSR biosensors to detect intestine inflammation. The feasibility of ThsSR and TtrSR systems was tested by monitoring the fluorescence intensity of sfGFP in response to the concentration of thiosulfate and tetrathionate, followed by the incorporation of the two systems into Escherichia coli Top10 and E. coli Nissle 1917. The potential for the real-life application of the two systems was further corroborated by substituting sfGFP with a series of chromoproteins and a protoviolaceinic acid synthesis cassette as reporter genes. The results indicated that signal expression of the new systems had a positive correlation with the concentration of tetrathionate and thiosulfate molecules. Thus, the modified ThsSR and TtrSR system may potentially be applied in the human body for the detection of intestinal inflammation.
Escherichia coli ; Humans ; Inflammatory Bowel Diseases ; Intestines ; Thiosulfates