Objective:To analyze the imaging characteristics of Stanford B aortic dissection in aortic CT angiography, in order to explore the possible related factors of aortic dissection combined with renal malperfusion and to analyze the morphological changes in each involved vessel after TEVAR.Methods:From January 2018 to December 2019, totally 148 patients of Stanford B aortic dissection underwent TEVAR in our hospital. The preoperative aortic CTA was analyzed, and all cases complicated with renal malperfusion were determined according to the clinical manifestation, laboratory examination and imaging results. The differences of morphological features between the patients with and without renal malperfusion and the possible correlative factors were analyzed.The different ischemic types of the involved renal arteries were analyzed, and the morphological changes of the involved vessels before and after the operation of TEVAR were compared.Results:The logistic regression analysis showed that the concave configuration of the tear at the renal artery level was the independent risk factor for renal malperfusion (right kidney OR=5.319, P=0.032; left kidney OR=12.879, P=0.007). The diameter of renal artery was the independent protective factor for renal malperfusion (right kidney OR=0.464, P=0.018; left kidney OR=0.685, P=0.016). Compared with preoperative CTA, the diameter of the involved renal artery was significantly enlarged after TEVAR, no matter which type of ischemia. Most of the dynamic ischemia (15/16) was improved after TEVAR; while static and mixed ischemia only partially improved after TEVAR (static 22/36, mixed 11/19) . Conclusion:The concave configuration of the renal artery level, and the diameter of renal artery are associated with renal malperfusion.The malperfusion can be improved in most cases of dynamic ischemia type vessels, while only can be partially improved in static and mixed types vessles.

Objective To discuss the discovery of stent graft mis-deployed into false lumen during aortic dissection treatment and re-deployment.Methods Retrospective analysis of the data of deployment of the stent-graft into the false lumen in the initial treatment of aortic dissection between January 2013 to December 2017.Of the five cases,there were three males and two females,range from 28 to 52 year old.Two patients,suffered from acute Stanford type A aortic dissection,with aortic surgical replacement and circulatory elephant trunk technique,displayed the visceral ischemia and internal environment disorder postoperatively.An emergency CT angiography showed that the deployed stent-graft was in the false lumen.Another two cases with sub-acute Stanford type B aortic dissection underwent TEVAR.The stent-grafts were put in the false lumen intra-operatively,one patient with pregnancy-induced hypertension suffered from acute Stanford type B aortic dissection.An emergency endovascular repair was set under general anesthesia to deal with this problem.New stent-graft was utilized to correct the blood flow into true lumen via flap fenestration or secondary intimal tear.Results The successful rate of this operation was 100％.Time of surgery spanned from 45 minutes to 120 minutes,and blood loss was estimated to be from 50 ml to 100 ml.Five stent grafts were placed with 160 mm length and 6 mm taper and one was 120 mm length and 10 mm taper.Patients were observed in ICU for three days and discharged from hospital after seven days.No complications such as paraplegia,visceral ischemia,etc occurred.Postoperative aortic CTA one month later showed no complications,such as endoleak,etc.The stents were in ideal position,with fluent blood flow of aorta and major visceral artery.Conclusions Deployment of the stent-graft in the false lumen is a rare and critical complication in the treatment of aortic dissection.In addition to clinical manifestations and laboratory tests,aortic CTA could identify this complication quickly and accurately.Endovascular repair was recommended as primary treatment of choice,which could re-direct the blood flow into true lumen via flap fenestration or secondary intimal tear technology quickly and effectively.

Objective: To investigate the feasibility and efficacy of transcatheter closure of anastomotic leakage after aortic surgery using Amplatzer Vascular Plug Ⅲ (AVP Ⅲ). Methods: A retrospective analysis was performed in 5 patients with anastomotic leakage after aortic surgery, who underwent transcatheter closure in our hospital from January to June 2017 using AVP Ⅲ. Surgeries were performed in 3 cases of Standford type A dissection, 1 case of ascending aortic aneurysm and 1 case of persistent truncus.There were 3 males,and age was (43.8±13.1) years old. Anastomotic leakages located at the ascending aorta in 4 patients, and the other one located between the aortic arch and the stent-graft.Three of them had aorta-right atrium fistula and patients suffered from progressive heart failure. False aneurysm between aorta and pulmonary artery was formed in 1 patient, and patent aortic false lumenwas found in the other patient. All the AVP Ⅲ were deployed based on a femoral arteriosus loop. Patients were followed up after transcatheter closure to observe the clinical results. Results: Six AVP Ⅲ were successfully implanted in the 5 patients. Trivial residual shunt was seen in 1 patient after closure. The patients were followed up 6 (1, 6) months. The cardiac function improved from NYHA class Ⅱ-Ⅳ to class Ⅰ-Ⅱ after the procedure in 3 congestive heart failure patients.The right atrium systolic pressure was significantly reduced after the procedure((8.7±1.8) mmHg (1 mmHg=0.133 kPa) vs. (24.3±2.3) mmHg, P=0.03). The diameter of the false aneurysm reduced in 1 patient after the procedure. Complete thrombosis formation of the thoracic false lumen was observed in 1 patient. Conclusion Transcatheter closure of anastomotic leakage after aortic surgery using AVP Ⅲ is feasible and effective according to our primary experience.

Objective To explore the correlation of the timing of enteral nutrition (EN) and the prognosis of the patients with septic shock.Methods From December 2016 to August 2017,fifty-five patients with septic shock who received treatment in the ICU of Tongji University School of Medicine were selected in the study and randomly divided into two groups,28 cases in the early enteral nutrition (EEN) group and 27 cases in the delayed enteral nutrition (DEN) group.All the patients was treated with EN before and after 48 h at admission respectively.After 1 week of treatment,the nutrition indicators,clinical efficacy,complications and prognosis of the two groups were compared.Results The levels of ALB,PA and HB in EEN group after treatment were significantly increased,compared with those before treatment,and were superior to those in DEN group ((38.4±4.5) g/L vs.(34.6±3.8) g/L,(207.8±41.4) mg/Lvs.(180.6±47.6) mg/L,(119.2 ±18.3) g/Lvs.(110.7±14.2) g/L;t =3.39,2.26,1.99,P＜0.05).Compared with DEN group,the length of ICU stay,CRRT time,mechanical ventilation time of EEN group were significantly shortened ((6.4± 1.7) d vs.(9.8±2.4)d,(4.7±1.2) d vs.(7.9±2.5)d,(3.6±1.2)d vs.(6.4±1.8) d;t=6.16,6.32,7.09,P＜0.05).After treatment,the SOFA score,APACHE Ⅱ score and qSOFA score were significantly improved in both groups,and the improvement in EEN group was significantly better than that in DEN group((3.8±0.9)points vs.(5.1 ± 1.2) points,(12.2 ± 2.4) points vs.(15.1 ± 3.7) points,(87.4 ± 14.7) points vs.(77.4 ± 13.2) points),(t=4.53,3.46,4.31,P＜0.05).Conclusion The implementation of EEN in patients with septic shock can improve the nutritional status of the patients,alleviate the severity of the disease,reduce the incidence of complications and improve the prognosis.

Objective: To investigate the effect of emergency thoracic endovascular aortic repair (TEVAR) in patients with acute traumatic thoracic aortic injury. Method: From January 2014 to December 2016, a total of 35 patients with acute traumatic thoracic aortic injuries were treated with emergency TEVAR in our hospital, their clinical data were analyzed retrospectively in this study. Results: The patients were 42 (34, 55) years old,and there were 31 males.All cases were diagnosed by emergency aorta computed tomography angiography (CTA),and 5 cases were diagnosed as aortic transaction, 13 cases were diagnosed as aortic pseudoaneurysm, 7 cases were diagnosed as aortic dissection, and 10 cases were diagnosed as aortic intramural hematoma combined hemothorax.The concomitant injuries included cerebral contusion (3 cases, 8.6%), pulmonary contusion with rib fracture (31 cases, 88.5%), long bone fracture (7 cases, 22.5%), contusion of viscera or internal organs (3 cases, 8.6%).Emergency TEVAR were performed with vascular suture system preset under local anesthesia after diagnosis,and combined injury was treated in related departments.CTA was repeated after 1, 3 and 6 months and yearly thereafter. One patient died before transferring to catheter room,and 34 (97.1%) patients underwent TEVAR procedure successfully.Time from door to operating room was (88.6±26.6) minutes,and the procedure time was (52.0±9.4) minutes. A total of 69 Perclose Proglide vascular suture system were used,and 2 cases underwent surgical suture because of hematoma and pseudoaneurysm formation in femoral arteries.The involved length of thoracic aorta was (44.5±7.4)mm. A total of 46 stent-grafts were implanted, the length of stent-graft was (164.3±15.2)mm,and the proximal oversize rate was (22.3±8.6)%. The follow-up time was 24 (12,24) months, and there were no procedure related complication such as endoleak and paraplegia. Complete aortic remodeling was observed in 14 cases. Fully thrombolization at stent segments were observed in 7 cases. Fully thrombalization of pseudoaneurysms were observed in 13 cases. One patient complained mild left upper limb weakness due to left subclavian artery occlusion. Conclusion Emergency TEVAR is safe and effective procedure for the treatment of patients with acute traumatic thoracic aortic injury.

Objective To evaluate the efficacy of the retroperitoneal laparoscopic pyelolithotomy (RLP) and the percutaneous nephrolithotomy (PCNL) in treating renal pelvic stone.Methods The data of 89 patients diagnosed as renal pelvic stone were retrospectively reviewed from January 2009 to July 2016,of whom 43 patients underwent RLP and 46 underwent PCNL.Statistical analysis was performed regarding operation time,blood loss,mean hospital stay,complication rate,and stone-free rate.Results The operation time in RLP group and PCNL group was (117.5 ± 16.7) min and (118.3 ± 16.6) min,respectively,and there was no significant difference (P =0.547).For the two groups,the mean hospital stay was (4.5 ± 0.5) d and (6.1 ± 0.9) d,the mean hemoglobin decrease was (4.5 ± 1.2) g/L and (18.1 ± 3.4) g/L,the post-operative blood transfusion rate was 2.3％ and 14.0％,the post-operative septic shock rate was 0 and 9.3％,respectively,with significant difference between the two groups (P ＜ 0.05).The stone-free rate in both groups was 97.7％ and 95.3％ with no significant difference (P =0.557).Conclusions RLP has the advantages of quick recovery,less blood loss and lower complication rate than PCNL.It could be a minimally invasive option for the treatment of renal pelvic stone.

Objective To analyze the safety and efficacy of endovascular aortic repair (EVAR) for abdominal aortic aneurysm(AAA) with hostile aortic proximal landing anatomy. Methods The clinical and imaging data of 147 AAA patients [135 males, (68.7 ± 8.9) years old, range 43-85 years old] with hostile aortic proximal landing anatomy treated by EVAR from January 2012 to December 2014 in our center were retrospectively analyzed. The range of maximum aneurysm diameter was 45-100 mm; the length range of proximal aneurysm neck was 7-32 mm;the width range of proximal aneurysm neck was 15-30 mm, and the infrarenal angulation was 10°-90° . In addition, there were atherosclerotic changes in the proximal neck in 43 cases. Follow-up protocol consisted of evaluation of clinical symptoms and cTA at 3, 6 and 12 months and annually thereafter. Results The technical success rate was 100%. Different procedures were adopted among patients, with 113 cases of EVAR, 3 cases of fenestrated EVAR and 24 cases of chimney EVAR. The intra-operative type Ia endoleak was observed in 32 cases, in which 25 of them were successfully treated by balloon angioplasty and the other 9 patients were treated with Cuff extension. During the mean follow-up period of 18 months (6-42 months), the accumulative survival rate was 98.0%(144/147),the patency rate of stents was 99.3%(146/147), and the thrombosis rate of aneurysm was 97.3%(143/147). Two patients died because of aneurysm rupture, and another case died of unknown reason. Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac stent in 1 case, and type Ⅲ endoleak in another case. No other complications such as misplace of stent grafts, no bilateral limb ischemia and stent infection were observed during follow-up. Conclusions EVAR is a safe and effective option to treat AAA with hostile aortic proximal landing anatomy. Choosing the most suitable stent-graft, the combination of various interventional techniques and close postoperative follow-up are the key points for successful treatment.

Objective To compare the safety,efficacy and complications of laparoscopic pyelolithotomy (LPL) and percutaneous nephrolithotomy (PCNL) for treatment of renal pelvic stones larger than 2.5 cm.Methods From 2011 to 2016,32 patients underwent LPL and another 32 patients received PCNL for renal pelvic stones larger than 2.5 cm.The baseline characteristics of the patients,stone size,mean operative time,estimated blood loss,postoperative hospital stay,stone-free rate,postoperative analgesia,blood transfusion,and the intraoperative,early postoperative and long-term complications were compared between the two groups.Results The baseline characteristics and stone size were comparable between the two groups.The mean operative time of LPL and PCNL was 117±23.12 and 118.16±25.45 min,respectively (P＞0.05).The two groups showed significant differences in the mean estimated blood loss (63±11.25 vs 122±27.78 mL,P＜0.01) and blood transfusion rate (0 vs 6.2％,P＜0.01) but not in postoperative hospital stay (4.5±1.34 vs 4.8±2.2 days,P＞0.05),stone-free rate (93.1％ vs 87.5％,P＞0.05) or the postoperative analgesia time (1.7± 0.5 and 1.9 ± 0.6 days,P＞0.05).The incidence of intraoperative complications were significant lower in LPL group than in PCNL group (6.2％ vs 25.0％,P＜0.01),but the incidences of early postoperative complications (25.0％ vs 34.4％,P＞0.05) and long-term postoperative complications (9.4％ vs 12.5％,P＞0.05) were sinilar between them.Conclusion PCNL is the standard treatment for pelvic stones larger than 2.5 cm,but for urologists experienced with laparoscopic technique,LPL provides a feasible and safe option for management of such cases.

Objective To compare the safety,efficacy and complications of laparoscopic pyelolithotomy (LPL) and percutaneous nephrolithotomy (PCNL) for treatment of renal pelvic stones larger than 2.5 cm.Methods From 2011 to 2016,32 patients underwent LPL and another 32 patients received PCNL for renal pelvic stones larger than 2.5 cm.The baseline characteristics of the patients,stone size,mean operative time,estimated blood loss,postoperative hospital stay,stone-free rate,postoperative analgesia,blood transfusion,and the intraoperative,early postoperative and long-term complications were compared between the two groups.Results The baseline characteristics and stone size were comparable between the two groups.The mean operative time of LPL and PCNL was 117±23.12 and 118.16±25.45 min,respectively (P＞0.05).The two groups showed significant differences in the mean estimated blood loss (63±11.25 vs 122±27.78 mL,P＜0.01) and blood transfusion rate (0 vs 6.2％,P＜0.01) but not in postoperative hospital stay (4.5±1.34 vs 4.8±2.2 days,P＞0.05),stone-free rate (93.1％ vs 87.5％,P＞0.05) or the postoperative analgesia time (1.7± 0.5 and 1.9 ± 0.6 days,P＞0.05).The incidence of intraoperative complications were significant lower in LPL group than in PCNL group (6.2％ vs 25.0％,P＜0.01),but the incidences of early postoperative complications (25.0％ vs 34.4％,P＞0.05) and long-term postoperative complications (9.4％ vs 12.5％,P＞0.05) were sinilar between them.Conclusion PCNL is the standard treatment for pelvic stones larger than 2.5 cm,but for urologists experienced with laparoscopic technique,LPL provides a feasible and safe option for management of such cases.

OBJECTIVETo screen methylations of CpG islands in prostate cancer using restriction landmark genomic scanning (RLGS).

METHODSThe DNA was extracted from homogeneous cells captured by laser capture microdissection in 20 prostate cancer and 18 benign prostatic hyperplasia (BPH) tissues for scanning the CpG islands using RLGS. The methylation status of each CpG island was compared between the cancer and BPH samples to screen the genes involved in prostate cancer development. The screened genes were uploaded to DAVID database for GO analysis, and the genes with the most significant methylation were analyzed by pyrosequencing.

RESULTS AND CONCLUSIONAmong all the tested CpG islands, 10245 (37.2%) in prostate cancer and 8658 (30.3%) in BPH samples were found to be abnormally methylated, and >60% of the methylated CpG islands were in the promoter region. Compared with BPH samples, the prostate cancer samples showed differential methyation in 735 CpG islands, including 458 hepermethyated and 256 hypomethelated ones. Seven genes (DPYS, P16, APC, GSTP1, TMEM122, RARB, and ARHGAP20) in prostate cancer were identified to have distinct methylations. Bioinformatics analysis suggested that these genes were associated with several biomolecular and biological processes, and among them DPYS gene was involved in 13 GO anotated biologic functions, development of 50 diseases and 47 protein interactions. Pyrosequencing of 7 sites of the CPG island in DPYS gene showed a methylation frequency of 32.7%, suggesting the importance of DPYS gene in the carcinogenesis and progression of prostate cancer.

CpG Islands ; DNA Methylation ; DNA, Neoplasm ; genetics ; Genomics ; Humans ; Male ; Polymerase Chain Reaction ; Prostatic Hyperplasia ; genetics ; Prostatic Neoplasms ; diagnosis ; genetics