0.05, but the duration of pain was different in group A and B, P

OBJECTIVE:To study the effect of alcohol extract of Toddalia asiatica on the inflammation-associated cytokines of model rats with adjuvant arthritis(AA). METHODS:70 SD rats were randomly divided into a normal control group,a model con-trol group,a positive control chemical medicine group(Leflunomide tablets,0.012 g/kg),a positive control TCM group(Tripter-ygium glycosides tablets,0.012 g/kg)and the groups of low,medium and high-dose [1,4,6 g(crude drug)/kg] alcohol extract of T. asiatica,with 10 rats in each group. The rats in all groups except for the normal control group were given complete Freund’s complete adjuvant id for the establishment of AA models. At the same time,the rats in the drug administration groups were given corresponding drugs ig,while those in the normal control group and the model control group were given isometric normal saline ig,twice a day,for 28 consecutive days. The degree of toe swelling,arthritis index and the levels of interleukin(IL)-1β,IL-6, IL-10,tumor necrosis factor α(TNF-α)and prostaglandin E2(PGE2)in serum and synovial membranes of all groups of rats were determined. RESULTS:Compared to the normal control group,the model control group demonstrated higher degree of primary and secondary toe swelling,arthritis index and levels of IL-1β,IL-6,TNF-αand PGE2 in serum and joint synovial membrane,and low-er level of IL-10 therein(P<0.01). Compared to the model control group,all the above-mentioned indexes of the rats in drug ad-ministration groups significantly improved(P<0.05 or P<0.01). CONCLUSIONS:The alcohol extract of T. asiatica. has a preven-tive and therapeutic effect on the model rats with AA by regulating the expression of anti-inflammatory and proinflammatory cyto-kines in serum and synovial membrane.

Objective To describe the technique, efficacy, and safety of percutaneous interventional therapy for anastomotic biliary strictures after orthotopic liver transplantation (OLT).Methods From May 2004 to December 2009, 25 patients with anastomotic biliary strictures afte OLT were enrolled in our study. The modalities of biliary drainage included external drainage in 22patients, and external-internal drainage in 3 patients who underwent re-transplantation. All patients accepted percutaneous interventional therapy in our hospital, including single PTBD in 4 patients,PTBD combined with balloon dilation in 14 patients, balloon dilation and plastic stent implantation in 5 patients, balloon dilation and metallic stent implantation in 2 patients. The drainage catheters were exchanged every 1 to 3 months. Results The success rate of PTBD was 100%. Of the all 25patients, 15 (60 %) patients were cured, and 10 (40 %) patients were improved. The effective rate was 100 %. The drainage catheters failed to pass through the narrow bile duct when initial PTBD in 7 patients, and success was achieved in 3 patients by operation again after biliary drainage for one week.In the other 4 patients, anastomotic bile ducts were occluded, which was confirmed by cholangiography after biliary drainage for 4 to 8 weeks. The rate of biliary tract infection was 24 % (6/25). No serious procedure-related complications occurred in the all 25 patients. Conclusion PTBD combined with balloon dilation and biliary stenting is a effective and safe therapeutic modality for anastomotic biliary strictures after OLT, which can improve the patients' clinical symptoms and elevate patients' quality of life. To avoid bile duct occlusion, the drainage catheters should be passed through the narrow segments of bile duct when initial PTBD.

Objective To evaluate combination multiple interventional therapies for acute lower extremity deep venous thrombosis (DVT).Methods From January 2008 to October 2014,96 patients with acute unilateral proximal or mixed DVT received interventional treatments including 74 DVT cases of the left lower extremity,and 22 patients in the right.Procedures undertaken included catheter-directed thrombolysis (CDT) only (n =7),CDT combined with thrombolysis (n =89),balloon angioplasty (n =32),and stent implantation (n =6).Results The mean circumference difference between the normal and affected thighs dicreased from (6.7 ± 1.8) cm to (0.8 ± 0.3) cm,t =13.48,P ＜ 0.001.That between the normal and affected calves decreased from (5.9 ± 1.6)cm to (0.7 ±0.4)cm,t =12.84,P ＜0.001.After intervention the Porter's score reduced from (9.7 ± 2.4) points to (1.1 ± 0.6) points,t =15.46,P ＜0.001,and the venous patency rate was (90 ± 8)％.Conclusion CDT combined with thrombolysis through dorsal vein,PTA,and stent implantation is a safe and effective therapeutic modality for acute lower extremity DVT.

Objective To investigate the technique,efficacy,and safety of percutaneous interventional treatments for biliary complications (BC) after liver transplantation (LT).Methods The clinical and imaging data of 127 patients with BC after LT,who received percutaneous interventional treatments in the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2015,were analyzed retrospectively.On the basis of the cholangiographic appearance,patients were classified into 5 groups:biliary leakage group (n =11),anastomotic biliary strictures group (n=28),hilar biliary strictures group (n =30),multifocal biliary strictures group (n =51),and bilomas group (n =7).The modality of interventional treatments was percutanous transhepatic biliary drainage (PTBD),PTBD combined with balloon dilation,PTBD combined with balloon dilation and stent implantation.The methods of biliary drainage included external drainage and external-internal drainage.All the patients were followed up after treatment.The curative effect and operation-correlated complications were observed.Results The first successful rate of PTBD was 97.6％ (124/ 127).The total curative rate,improvement rate and inefficacy rate of interventional treatments were 37.8％ (48/127),44.9％ (57/127) and 17.3％ (22/127) respectively.In biliary leakage group,all the patients were cured by percutaneous interventional treatments with the curative rate being 100％.In anastomotic biliary strictures group,the cure and improvement rates were 64.3％ (18/28) and 35.7％ (10/28) respectively.The efficacy rate was 100％ (28/28).In hilar biliary strictures group,the cure,improvement and inefficacy rates were 40％ (12/30),53.3％ (16/30) and 6.7％ (2/30) respectively.The efficacy rate was 93.3％ (28/30).In multifocal biliary strictures group,the cure,improvement and inefficacy rates were 13.7％ (7/51),54.9％ (28/51) and 31.4％ (16/51) respectively.The efficacy rate was 68.6％ (35/51).In bilomas group,3 cases (3/7) obtained improvement and treatment of 4 cases was inefficative.The efficacy was the best for the patients with bilary leakage,and it was the worst for the patient with bilomas (P＜0.001).The main operation-correlated complication was bile tract infection during drainage.The rates of bile tract infection were 32.4％ (34/105) and 81.8％ (18/22) in patients with external drainage and external-internal drainage,respectively.There was statistically significant difference between these two items (P＜ 0.001).Conclusion PTBD combined with balloon dilation and biliary stent implantation is a safe and effective therapeutic modality for BC after LT,which can improve patients' clinical symptoms,improve patients' quality of life.The patients with bilomas should be treated by retransplantation as soon as possible.The biliary external drainage can decrease the rate of biliary tract infection significantly.

Objective To investigate the nursing of traumatic carotid-cavernous fistula(TCCF)by intervention.Methods 18 patients with TCCF by intervention were given nursing measures including psychological preparation,eye care,disease observation and complications care.Results All patients gained successful embolization,and the symptoms of proptosis and vascular murmur in patients were alleviated.One case received spring embolism because of balloon rupture.The symptoms of vascular spasm in two patients were alleviated with timely treatment.Hyperperfusion syndrome was relieved after lowering blood pressure in two patients.Conclusions The intervention embolization is an effective treatment of TCCF.Good nursing could improve the efficacy and reduce the incidence of complications.

Objective To investigate the imaging characteristics of different biliary strictures after liver transplantation and their relationship with causes. Methods Forty-six patients with jaundice and biliary stricture were enrolled in this study.The diagnosis was confirmed by percutaneous transhepatic cholangiography (PTC).All the patients had hepatic arteriography with DSA or CTA and underwent liver biopsy.Their imaging characteristics were analyzed and the related statistic analysis was conducted.Results Anastomosis biliary stricture (ABS) was demonstrated in 21 cases,and non-anastomosis biliary stricture (NBS) with hepatic artery thrombosis (HAT) occurred in 13 cases,and there were 12 cases of NBS without HAT.PTC examination confirmed there were 26 cases of biliary stricture at hepatic hilum,and the incidence of biliary stricture in NBS group was significantly higher than that in ABS group (92％ vs.14.35％,P＜0.05).There were 31 cases of intrahepatic bile duct stricture,and the incidence in NBS group was significantly higher than that in ABS group ( 100％ vs.28.6％,P＜0.05).There were 33 cases of dilatation of intrahepatic bile duct,and the incidence in NBS without HAT group was significantly lower than that in ABS group and NBS with HAT group (16.7％,100％ and 76.9％ respectively) (P＜0.05).There were 21 cases of extrahepatic biliary dilatation,and the incidence in ABS group was significantly higher than that in NBS group (85.7％ vs. 12％,P＜0.05). There were 18 cases of stricture and dilatation in intrahepatic bile duct,and the incidence in NBS with HAT group was significantly higher than that in ABS group and NBS without HAT group (76.9％,28.6％ and 16.7％ respectively,P＜0.05).The results of the liver biopsy were accorded with the diagnosis of biliary stricture,Conclusion The different biliary strictures carry different imaging characteristics,including location of biliary stricture,and location and type of secondary biliary dilatation.

ABSTRACT:Objective To assess the effect of prolonged laparoscopic surgery on peritoneal mesothelial cells and fibrinolysis in humans.Methods We examined prospectively 1 6 consecutive patients who underwent laparoscopic surgery (LAP)and 2 1 patients who underwent conventional open surgery (OP)for high-medium rectal cancer with curative intent.During the procedure,biopsy of the parietal peritoneum was made before operation and at 45 min,90 min,and 120 min after operation.The tissue-type plasminogen activator (tPA)and plasminogen activator inhibitor-1 (PAI-1 )were determined by enzyme-linked immunosorbent assay in peritoneal tissues.The cellular injury was detected by LDH assay.The proliferation was quantified by MTT assay.Results PAI-1 activity in the peritoneal tissue was significantly lower in LAP group than in the OP group.tPA activity decreased after 45min of open surgery,but there was no significant change in the LAP group.With time extension,the LDH activity increased and the proliferation of the mesothelial cells decreased.Conclusion Preservation of a prolonged hypofibrinolytic state by inhibition of PAI-1 up-regulation during LAP may predispose patients to less postoperative peritoneal adhesion. The cellular injury becomes apparent and the proliferation is inhibited during prolonged laparoscopic surgery.

ObjectiveTo investigate imaging features of the liver, portal vein and hepatic vein or transhepatic inferior venacava in patients with severe liver cirrhosisin multidetector row computed tomography ( MDCT), and assess the feasibility, safety and clinical significance of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). MethodsFifty patients with severe liver cirrhosis confirmed by clinical data and imaging examination were enrolled in this study. Simulation of intrahepatic portosystemic shunt by percutaneous transhepatic approch is as follows. The right midaxillary line (the eighth or ninth intercostal space) was selected as puncture point A the right branch of portal vein was puncture point B,transhepatic inferior vena cava was puncture point C, and the distal part of right portal vein was D. A-B-C connection is simulated as percutaneous transhepatic puncture tract, C-B-D connection is simulated as portosystemic shunt tract.After tri-phase contrast-enhanced CT scanning, postprocessing images through multiple planner reconstruction ( MPR ) were obtained. The data were indicated statistically by x ± s. And 95％ confidence interval for mean was calculated.Anatomic relationship among the right portal vein,transhepatic inferior vena cava, hepatic artery and bile duct were analyzed for all patients. ResultsThe length of the needle (A-B-C) is ( 145. 7 ± 14. 8 ) mm. The curvature of the needle ( the angle of A-B line and B-C line) is ( 145.0 ±9.9)°. The length of transhepatic shunt tract (B-C) is (42.7 ±7.2) mm. The length of the shunt tract (C-B-D) is ( 117. 7 ±11.6 ) mm; The angle of the shunt tract ( the angle of B-C line and B-D line) is (1O8.5 ± 5.9)°. In 24/50 patients, transhepatic inferior vena cava locate in the dorsal of the right portal vein, in 26/50 patients they are in the same plane.In all patients, the right branches of hepatic artery and bile duct locate in the ventral of the right portal vein.Conclusion The procedure of PTIPS is feasible and safe. To quantify the length and angle of the needle and the length and angle of the shunt tract provides the anatomic basis for clinical application.

Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy.Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015.These patients were enrolled in this retrospective study.The success rates,efficacy,and complications were evaluated.Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed.Results PTIPS was successfully carried out in 25 patients but failed in 2.No fatal procedural complications were observed.The mean PPG dropped from (22.3 ± 5.7) mmHg to (12.4 ± 3.1) mmHg after successful PTIPS (1 mmHg =0.133 kPa,P ＜0.05).The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0％) deaths from liver failure due to severe cirrhosis,and 1 death (4.0％) from stroke during the follow-up period.Shunt dysfunction happened in 4 (16.0％) patients.The original symptoms reoccurred in 2 patients (8.0％) and the remaining patients were diagnosed by routine CT or US examination.Three patients recovered after shunt revision with stent implantation or balloon angioplasty,while one patient refused any further therapy except oral medication.This patient suffered from the first episode of rebleeding 36 months after PTIPS.Hepatic encephalopathy developed in 2 (8.0％) patients,1 patient recovered after medical treatment,while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent.The remaining patients were asymptomatic with patent shunts.Conclusion PTIPS was a feasible,safe,and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.