Objective To sum up our preliminary experience on radical surgery for the treatment of Budd Chiari syndrome under genuine direct vision. Method A total of 13 cases were enrolled in this study with age ranging from 17 to 48 years, and history from 3 months to 5 years. There was inferior vena cava (IVC) membranous obstruction in 3 cases, right hepatic venous membrane (HV) in 1 case, IVC membrane with distal thrombosis in 6 cases, long segment of thrombosis of IVC in 2 cases, IVC tumor thrombus extending to right atrium in 1 case of retroperitoneal tumor. Result All lesions were successfully resected. Extracorporeal circulation was used in one case, cell saver was used in 2 cases. No blood transfusion was needed except for one case receiving bank blood transfusion of 2000 ml, and the other one of 400 ml. One patient died of renal failure during perioperative period. Disappearance of the symptoms and sigh after operation was found in all the other cases. Conclusion This new radical surgery gives access to the lesions under clear direct vision facilitating the correction.

Objective To explore the clinical value of intra-arterial thrombolytic therapy for hepatic artery thrombosis after liver transplantation. Methods Routine color doppler imaging (CDI) was used to detect hepatic artery thrombosis (HAT) after liver transplantation in 160 cases. Suspected patients were further confirmed by immediate angiography. Four cases of HAT were diagnosed and treated by intra-arterial thrombolysis. Two cases received repeatable transcatheter hepatic arterial thrombolysis with a low dose of urokinase. Results Hepatic artery recanalization was achieved in 3 cases. Among the 3 cases, multiple HAT occurred in 1 case, intra-arterial thrombolysis was successfully completed in the end. Two cases had intra-abdominal hemorrhage, which was cured by conservative treatment. One case received retransplantation because of interventional thrombolysis failure and intra-abdominal hemorrhage. Conclusion Intra-arterial thrombolytic therapy may be a promising method in the treatment of HAT. Transcatheter hepatic arterial thrombolysis shows a significant result.

Objective To evaluate abdominal aortic balloon occlusion during pelvic tumors surgery and mamagement of related vascular complications. Methods We retrospectively analyze the clinical data of 265 pelvic tumor cases from December 2005 to April 2010.Before pelvic tumor operation,we place a sheath by Seldinger maneuvre in common femoral artery and send a balloon catheter in the abdominal aorta below the level of renal artery.The balloon catheter occluded the blood flow below the level of renal artery totally during the time of removing the tumors.After the procedure,we pull the balloon catheter out and normally retain the sheath for 6 hours. Results The procedure was successful in all cases and the average time of abdominal aorta blockade was (66 ± 4) min.There was no abdominal aortic rupture and acute renal dysfunction.Emergency angiography was performed on the operative region to diagnose the cause of massive bleeding after the open surgery in 6 cases.Among them,3 cases underwent embolization of internal iliac artery to stop bleeding and 1 case underwent embolization of lumber artery.Small covered stent was deployed in the common iliac artery to stop bleeding in 2 cases.Thrombosis of femoral artery at the puncture site occurred in 6 cases and bilateral thrombosis developed in 1 case. Blood flow was restowed to the femoral artery by open thrombectomy.Pseudoaneurysm formation around the puncture point occured in 2 cases and they underwent open surgical repair,then recovered well. Conclusions Balloon catheter occlusion of abdominal aorta is an effective method to control the hemorrhage in the pelvic tumors' operation.

Objective To investigate the clinical features of spontaneous isolated superior mesenteric artery dissection (SISMAD), and to discuss its interventional therapy. Methods The clinical data of 10 patients with SISMAD, who were admitted to authors' hospital to receive interventional treatment during the period from January 2006 to June 2014, were retrospectively analyzed. All the 10 patients were males, aged 44-66 years with a mean of (53±8) years. Clinically, all patients presented with acute-onset abdominal pain or pain around umbilicus, as the effect of conservative treatment was poor, implantation of self-expandable bare stent was carried out. Results Successful implantation of self-expandable bare stent was accomplished in all 10 patients;only one stent was used in 7 patients and 2 stents were used in 3 patients. The blood in the true lumen of superior mesenteric artery (SMA) restored and the residual stenosis extent was less than 15%. The technical success rate was 100%. The abdominal pain was relieved in 8 patients on the operative day after treatment, and in 2 patients the abdominal pain was relieved in 2 days after treatment. All the patients were followed up for 7-71 months (mean of 36 months) and the follow-up rate was 100%. After the treatment patients had no symptoms of abdominal discomfort. Contrast-enhanced CT scan performed at 6, 12 and 24 months after the treatment showed that SMA and stent was patent and no aneurysmal dilatation was observed. Conclusion For the treatment of SISMAD endovascular implantation of self-expandable bare stent is clinically safe and feasible, and its long-term effect is satisfactory.

There are several special advantages of the application of standardized patients ( SPs) in the assessments of clinical skills examination of medical practitioners .However , this application in China is restricted by some limit factors, such as the shortage of SP trainers and SPs , the huge funds needed and the imbalance of regional develop-ment.The suggestion to overcome those limitation and to promote SPs be applied to the clinical skills examination of medical practitioners are as follow: the preparatory of regional university union of SPs , the introduction of social capital to participate in and the adoption of the mode of scale operation .

Objective:To compare total percutaneous access using preclose technique with femoral ar-tery cut-down in endovascular aneurysm repair (EVAR)and assess the safety and feasibility of preclose technique.Methods:In the study,81 cases undergoing EVAR from Dec.2011 to Nov.2014 in Peking University People’s Hospital were retrospectively reviewed.Preoperative CT angiography (CTA)showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases.The maximum diameter of aneurysm >4.5 cm met the indications for surgical treatment.The conditions of bi-lateral femoral artery and iliac artery CTA showed were good,and there was no moderate or severe steno-sis,nor was there any severe calcification in anterior wall of femoral artery.Not only were the cases fit for percutaneous endovascular aortic aneurysm repair (PEVAR),but also feasible with open endovascular aneurysm repair (OEVAR).According to the intention of the patients about the surgical incision,the ca-ses were divided into group PEVAR and group OEVAR.The data of the general situation,operation time,blood loss,technical success rate,length of hospital stay after procedure and wound complications were analyzed statistically.Results:In the study,44 cases (78 incisions)were enrolled in group PEVAR and 37 cases (65 incisions)in group OEVAR.There was no significant difference between the two groups in age,gender,body mass index (BMI),accompanying diseases,average number of stents and outer diameter of stent delivery system.Average operation time of group PEVAR was less than that of group OEVAR [(119.1 ±102.0)min vs.(163.6 ±61.9)min,P =0.025].The blood loss in group PEVAR was less than that in group OEVAR [(64.7 ±97.0)mL vs.(98.6 ±88.3)mL],but there was no significant difference (P =0.106).There was no difference in the technical success rate (94.9% vs. 95.4%,P =1.000).The average length of hospital stay after procedure was significantly shorter in group PEVAR [(7.8 ±2.8)d vs.(12.3 ±7.2)d,P <0.001].There were 2 cases with subcutaneous hematoma of wound in group PEVAR and 7 cases of wound complications that occurred in group OEVAR including 3 cases with lymphatic leakage,3 cases with lower limb ischemia and 1 case with subcutaneous hematoma.The analysis showed that PEVAR could reduce the wound complications (2.6%vs.10.8%), but there was no significant difference between the two groups (P =0.079).Conclusion:Using preclose technique in EVAR is safe and effective.It can shorten the operation time and length of hospital stay after procedure.

Objective To develop a curriculum system for social communication disorders rehabilitation in children with autism based on humanoid robot. Methods The curriculum was developed through the robot programming and the structure hierarchy of the curriculum. It was applied in three children with autism. Results and Conclusion The curriculum has been developed. All the children concentrated in the class, with few emotive disorders.

Objective To investigate the effect of Emodin on intracellular calcium concentration ([Ca~(2+)]i) and apoptosis of hepatic cells after simulated cold ischemia-reperfusion. Methods Glucose-oxygen deprivation, low temperature, subsequent reoxygenation and rewarming were used to induce ischemia-reperfusion injury model in cultured hepatic cells which were divided into 4 groups: control group and Emodin-treated group(100, 10 and apoptosis rate were determined by flow cytometry (FCM) respectively; the content of lactate dehydrogenase (LDH) in supernatant was tested. Results Intracellular calcium fluorescence intensity in Emodin-treated groups of high, medium and low density was 24.12±0.51, 26.35±1.34 and 39.12±1.94, respectively, which were significantly lower than 105.29±1.01 in control group(P<0.01). Apoptosis rate in Emodin-treated groups of high, (179.67±18.57)u/L in Emodin-treated groups of medium and high density respectively, which were significantly lower than (351.33±34.16)u/L in control group(P<0.01). Conclusion Emodin could reduce [Ca~(2+)]i and inhibit apoptosis of hepatic cells after simulated cold ischemia-reperfusion, thus protecting hepatic cells effectively.

Objective To investigate surgical treatment of carotid body tumors (CBT). Methods Fifty-four cases of carotid body tumor were treated by surgery from 1994. There were 39 males and 15 females with a gender ratio of 2.6: 1. The ages ranged from 22 to 53 years averaging at 31 years. All lesions were benign and unilateral. Simple resection of CBT was performed in 12 cases. Resection of CBT with external carotid artery in 5 cases. Resection of CBT with carotid reconstruction in 6 cases ( using great saphenous vein in 4 cases, using vascular graft in 2 cases). Resection of CBT under carotid artery shunt was performed in 32 cases ( including carotid reconstruction in 3 cases). Resection of CBT with breaking mandible was necessary in 2 cases because of too high tumor position. Results Complete resection of CBT without recurrence and metastasis was achieved in all 54 cases. No complication of cerebral ischemia was encountered in all cases. Nerve injury was found in 7 cases ( including injury of sympathetic nerve and superior laryngeal nerve in 2 cases respectively, injury of recurrent laryngeal nerve in 3 cases). Conclusion Carotid shunt is helpful in resection of complicated CBT, carotid reconstruction is required for cases with resection of internal carotid artery. Breaking mandible is helpful in exposing high located tumors.

Objective To evaluate the management of wrong coverage of the left common carotid artery ( CCA ) during interventional treatment of type Ⅲ aortic dissection by stented graft. Methods Coverage of the left CCA occurred in four cases during endovascular repair of type Ⅲ aortic dissection using stented graft. All four cases were male. The ages ranged from 37 to 45 years old with the average of 41. The first case was due to moving proximally of the first stented graft during delivery of one more cuff because of endoleak. Recanalization of the left CCA and subclavian artery ( SA) was acquired through sliding distally of the stented graft with the help of an aortic balloon. Coverage of the left CCA and SA in the second case was due to jumping-forward of stented graft during deploying, we dragged the stented graft distally through the pigtail catheter introduced from the left brachial artery with the help of a trap device. Then, the covered left CCA and SA were recanalized. The 2/3 left CCA was covered because of mislocation of the left CCA for the 3rd case. We recanalized the covered left CCA using chimney technique with the exposure of the left CCA. For the 4th case, half the innominate artery, the left CCA and SA were covered because the performer mistake the stented graft without naked stent as one with proximal naked stent. A bypass of assending aorta to bi-carotid arteries and the left axillary artery was performed using vascular graft one month after the endovascular repair. Result The proximal intimal entry was sealed successfully in all four cases. No endoleak, cerebral infarction and ischemia of the left upper limb occurred. Conclusion In cases of wrong coverage of carotid artery during endovascular repair of type Ⅲ aortic dissection, the CCA must be recanalized as soon as possible through surgical or interventional treatment in order to avoiding cerebral ischemia.