Objective To evaluate thoracic endovascular repair (TEAVR) techniques for the treatment of Stanford type A aortic dissection involving ascending aorta.Methods From Jan 2010 to Aug 2015,seven type A aortic dissection patients with the primary entry tear next to the orifice of left subclavian artery were treated with endovascular repair.Results Stents (6 COOK Corp,1 YouYan Corp.) were deployed through femoral artery in 6 patients and through peritoneal right common iliac artery in 1 case.Entries were through incised carotid artery in 2 cases and punctured from carotid artery by PER-CLOSE designer (Abbott Corp.) in 5 cases.One died of Type 1 endoleak.6 patients were followed up from 1 to 28 months.One suffered from severe MODS complications and died after 6 months.During the follow-up period,all the stents were patent and there was no migration.The true lumen increased significantly and the false lumen shrank gradually.Conclusions Endovascular aortic repair is a safe and effective method for Stanford Type A aortic dissection involving ascending aorta in selected cases.

Intravenous leiomyomatosis is characterized by a proliferation of benign smooth muscular tissue growing into uterine with malignant appearance.On extremely rare occasions,the tumor may grow out of the pelvis and extend into the inferior vena cava and the right atrium.We report a case of intravenous leiomyomatosis extending into the right atrium.A 41-year-old woman complained of 20 days of intermittent abdominal pain and lower limbs swell.Medical history of the patient revealed a previous hysterctomy operation 3 years ago due to uterine leomyoma.Echocardiography showed a homogenous mass extending from the inferior vena cava to the right atrium,without evidence of adherence to the right atrial wall,the left ventricular ejection fraction was only 60%.Computer tomography showed that a large mass arising from the left internal iliac vein and extending into the right chambers.Pelvic vascular ultrasound revealed the thrombotic material in the inferior vena cava and the left common iliac vein,and confirmed the presence of a complex mass in the left annex region.Based on the findings,the initial diagnosis was intracardiac and intravenous tumor.An operation was performed through a sternotomy and laparotomy to remove the whole tumor from the left common iliac vein to the right atrium,ligate left internal iliac vein meanwile.No hormonal therapy was administrated after the operation.Immunohistochemical studies revealed that the tumor cells were fusiform shape,there was no karyokinesis and necrosis,and the tumor cells were positive for smooth muscle antigen and desmin,as well as estrogen receptor and progesterone receptor.Six months postoperation follow-up revealed no signs of recurrence.The differential diagnosis of the disease compared with primary cardiovascular sarcomas and thrombus was difficult.The final diagnosis relied on immunohistochemical analysis,however,the short-term result of operation was acceptable.

Primary rat hepatocytes were cultured using different in vitro models and the enzyme leakage, albumin secretion, and cytochrome P450 1A (CYP 1A) activity were observed. The results showed that the level of LDH was decreased over time in culture. However, on day 5, LDH showed a significant increase in monolayer culture (MC) while after day 8 no LDH was detectable in sandwich culture (SC). The levels of AST and ALT did not change significantly over the investigated time. The CYP 1A activity was gradually decreased in a time-dependent manner in MC and SC. The decline of CYP 1A was faster in MC than in SC. This effect was partially reversed by using cytochrome P450 (CYP450) inducer such as Omeprazol and 3-methylcholanthrene (3-MC) and the CYP 1A induction was always higher in MC than in SC. In bioreactor basic CYP 1A activity was preserved over 2 weeks and the highest albumin production was observed in bioreactor followed by SC and MC. Taken together, it was indicated each investigated model had its advantages and disadvantages. It was also underlined that various in vitro models may address different questions.
Albumins/*secretion ; Bioreactors ; Cell Culture Techniques/*methods ; Cell Separation ; Cytochrome P-450 CYP1A1/metabolism ; Hepatocytes/*cytology ; Hepatocytes/metabolism ; L-Lactate Dehydrogenase/metabolism ; Mitochondria, Liver/enzymology ; Mitochondrial Proteins/metabolism ; Rats, Sprague-Dawley ; Time Factors

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.

Objective To study the local irritation of repeated intrathecal injection of Ziconotide Acetate,and to provide reference for irritancy evaluation ofintrathecal injection.Methods Sixteen New Zealand rabbits were assigned into two groupsat random:Control group and Ziconotide Acetate group,eight animals each group.Totally 50 μL saline or Ziconotide Acetate (100 μg/mL) were administrated by repeated lumbar intrathecal injection once daily for 7 d.Animal behavior was observed every day,and four animals in each group were sacrificed 2 d later after the last injection,the lumbar spinal cord was removed for histopathological examination and irritancy evaluation.The remaining animals were sacrificed for initancy evaluation 14 d later after the last injection.Results Only one animal died after anesthesia on day three in saline group,while no obvious adverse reactions were observed in other rabbits during the entire study,and no intrathecal irritant reactions of histopathological examination were found in both groups.The reversible minor mechanical damage was observed at the injection point,2 d after the last administration.Conclusion For 7 d repeated lumbar intrathecal injection in rabbits,no intrathecal irritant reactions observed in Ziconotide group,and the New Zealand rabbit could be used as a local irritation evaluation model.

Objective To investigate the clinical features,diagnosis and treatment of primary leiomyosarcoma of the inferior vena cflva(IVC).Methods We retrospectively analyzed the clinical data of 7 IVC leiomyosarcoma cases between June 2006 and April 2009,including clinical presentations,surgical procedures.pathological diagnosis and prognosis. Results Tumors were resected completely in 3 cases,among them.prosthetic grafts were used for IVC reconstruction in 2 eases.One patient underwent partialresection to recover the blood flow of the hepatic vein.Three cases underwent laparotomy and biopsy only.The diagnosis of IVC leiomyosarcoma was confirmed by pathology in all of 7 cases.Estrogen receptors and progesterone receptors were positive in 3 patients and negative in 4 patients.There was no perioperative mortality.Three cages who received tumor radical resection have been on warfarin for 6 months after operation and are doing well during a follow up for 8,32,and 33 months respectively with no tumor recunence and nor thrombosis formation.The cage undergoing tumor partial resection died of organdisfunction in 2 months.The three cases undergoing laparotomy only died of organ disfunction in 7 months.Conclusions The only effective way of treating primary leiomyosarcoma of the inferior vena cava is total resection with necessary reconstruction of the IVC.

Objective To study effects of different degree of hypothyroidism in severe preeclampsia (S-PE) pregnant women on renal function and the correlation between them.Methods 46 S-PE patients with subclinical hypothyroidism (SCH) registered for treatment in the Shengjing Hospital of China Medical University from May 2011 to March 2013 were selected into SCH group,and 23 S-PE with overt hypothyroidism (OH) were selected into OH group,and 109 S-PE with normal thyroid stimulating hormone (TSH) levels were selected into simple group.Thyroid hormone and kidney function tests were analyzed in pregnant women with S-PE.We made an analysis of the relative risk of the detection rate of abnormal renal function and also the relationship between the levels of thyroid hormone and serum uric acid,serum urea and creatinine in patients with S-PE.Results (1) In SCH group serum TSH was (6.1±3.2) mU/L,free triiodothyronine (FT3) was (4.0±0.6) pmol/L,free thyroxine (FT4) was (11.8± 1.5) pmol/L; in OH group serum TSH was (5.2± 1.3) mU/L,FT3 was (3.7±0.6) pmol/L,FT4 was (9.3±0.5) pmol/L; in simple S-PE group serum TSH was (1.9±0.8) mU/L,FT3 was (4.0±0.8) pmol/L and FT4 was (11.9±1.9) pmol/L.TSH in SCH group was significantly higher than that in simple S-PE group (P＞0.01),the difference of in SCH and OH group were not statistically significant (P＞0.05).The difference of FT3 in three groups were not statistically significant (P＜0.05) ;FT4 in OH group was significantly lower than thoes in SCH and simple groups (P＜0.05).(2)Serum uric acid,creatinine and urea levels in OH group was (436± 114),(75± 15) μmol/L and (6±3)mmol/L,in simple S-PE group they were (378± 114),(65 ±22) μmol/L and (5±3) mmol/L.In comparison,the differences was statistically significant(P＜0.05).The differences were not statistically significant in SCH and OH groups (P＞0.05).(3)The abnormal detection rate of uric acid was significantly higher in SCH than that in OH group [46％ (21/46) versus 22％ (5/23),OR=3.0,P＜0.05].The comparison of remaining index has no statistical significance(P＞0.05).(4)In SCH group there was a significant inverse correlation of serum FT3 with serum urea levels,serum creatinine and serum uric acid (r=-0.32,-0.58,-0.35,P＜0.05).There was not a correlation of serum TSH,FT4 with indicators of renal function (P＞0.05).In OH group there was a negative correlation between FT3 and serum creatinine concentrations (r=-0.40,P＜0.05).In OH group there was not a correlation of FT3 with serum uric acid and urea (P＞0.05).There was a positive correlation between TSH and serum creatinine in simple S-PE group (r=0.20,P=0.04).There was not a correlation between TSH and serum urea(r=0.04,P=0.65),and serum uric acid (r=0.12,P=0.20).Conclusions There was effect of different hypothyrosis state in pre-eclampsia patients on renal function.Serum uric acid,urea and creatinine concentrations in S-PE pregnant women with OH were significantly higher than those in simple S-PE group with normal TSH.There was a negative correlation between FT3 and serum creatinine in S-PE.Hence the thyroid function should be regularly monitored in S-PE patients to find damage of renal function and management hypothyrosis.

Aim To investigate the immunomodulatory effects of sea cucumber fucoidan ( SC-FUC) on macro-phage and the signaling pathways. Methods Cell via-bilities in response to different concentrations of SC-FUC were analyzed by MTT, phagocytosis ability was detected by neutral red,and nitric oxide ( NO) produc-tion was examined by Griess reaction kit. The mRNA expression levels of IL-6 , IL-10 , Toll-like receptors (TLRs) and related signal molecules MyD88, TRIF, NF-κB were assayed by real-time PCR. All the experi-ments were based on murine RAW264. 7 cell line. Re-sults SC-FUC could promote RAW264 . 7 cell prolif-eration, phagocytosis as evidenced by uptake of neutral red and release of NO. The effects were significant at the early stage (6 h and 12 h) . SC-FUC could up-reg-ulate the expression of IL-6 , IL-10 , TLR4 , TLR5 , TLR9. Moreover, mRNA expressions of TLRs signaling molecules were increased, as well as MyD88, TRIF, NF-κB. Conclusions SC-FUC could activate macro-phage, and then promote the immune function by pro-moting production or expression of NO, IL-6, IL-10. It is speculated to be relevant to activated cell surface re-ceptors in macrophage, including TLR4, TLR5, TLR9, and NF-κB signaling pathways.

Aim To establish a cell model targeting on GLP-1 R,and evaluate its function by the cAMP assay,for screening the new class of GLP-1 analogues as anti-diabetic candidates. Methods An eukaryotic expression vector pEGFP-GLP-1 R was constructed and transfected into HEK293A cells.After selecting with G41 8,a cell line stably expressing GLP-1 R-GFP was estab-lished.The expression and the cellular distribution of GLP-1 R-GFP fusion protein were investigated by Western blot and fluo-rescence microscopy.Then,the activity of GLP-1 analogue Lira-glutide was evaluated by monitoring the content of cAMP via HTRF using this cell model.Results GLP-1 R-GFP-293A cell line was successfully established.GLP-1 R-GFP fusion proteins were mainly distributed in the cell membrane.The dose-respon-sive relationship experiments revealed that cAMP could be effec-tively stimulated by Liraglutide using this cell model.Conclu-sion This cell model could be used to detect the bioactivity of GLP-1 analogues in vitro,which lays a foundation for the screen-ing of GLP-1 analogues and small GLP-1 R agonists.

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.