Endovascular Stent Graft Repair of Aortic Dissection Type B Extending to the Aortic Arch

Objective

To analyse our experience with endovascular stent graft repair of descending aorta dissections that require supraaortic branch vessel revascularisation.

Design

Retrospective study.

Methods

From 2001 to 2009, 22 consecutive patients with the above dissections were retrospectively analysed. Inclusion requirement: aortic landing zone proximal to the left subclavian artery of less than 15 mm. Hybrid, scalloped or fenestrated endovascular stent grafts were selected based on dissection characteristics. Annual follow-up visits (median 27.1 months) included computed tomography angiography. End points include progressive pathology, complications and survival rates.

Results

Surgery was successful in all except for one operative complication. Two patients died within 30 days after surgery, one to cerebral infarction and the other to myocardial infarction. No postoperative complications occurred in the remaining patients. Thrombosis formed in the aortic false lumen of the graft exclusion segment in all patients. The maximum diameter of this segment decreased in 18 patients and was stable in two. In 19 patients, blood flow remained in the false lumen distal to the exclusion area not covered by stent. Patency was seen at mid- and long-term follow-up, without proximal endoleak, graft displacement or deaths.

Conclusion

Endovascular stent graft methods show promise in endovascular stent graft repair of proximal descending aortic dissections involving the distal arch.     

腹腔镜联合胸腔镜同时处理结直肠癌合并肺转移14例

目的 探讨腹腔镜联合胸腔镜（双镜）同时处理结直肠癌同时伴肺转移的可行性和安全性。方法 回顾性分析2001年1月2011年8月期间14例腹腔镜联合胸腔镜同时手术处理结直肠癌同时伴肺转移病人的临床资料。结果14例手术均达到R0根治术,平均手术时间为4.1h （3.2~5.3h）,平均术中出血量120ml （50~300ml）,平均住院时间12d（9~17d）,术后1例发生肺部感染,术后无死亡发生。结论 结直肠癌同时合并肺转移,若经评估能达到R0切除,胸腔镜联合腹腔镜（双镜）手术同时处理转移灶和原发灶是安全可行的。     

ORF3a deletion in field strains of porcine‐transmissible gastroenteritis virus in China: A hint of association with porcine respiratory coronavirus

Porcine‐transmissible gastroenteritis virus (TGEV) is a pathogenic coronavirus responsible for high diarrhoea‐associated morbidity and mortality in suckling piglets. We analysed the TGEV ORF3 gene using nested polymerase chain reaction and identified an ORF3a deletion in three field strains of TGEV collected from piglets in China in 2015. Eight TGEV ORF3 sequences were obtained in this study. Phylogenetic tree analysis of ORF3 showed that the eight TGEV ORF3 genes all belonged to the Miller cluster. CH‐LNCT and CH‐MZL were closely correlated with Miller M6, while CH‐SH was correlated with Miller M60. These results thus indicate that the existence of Miller, as well as the Purdue cluster, in Chinese field strains of TGEV. Furthermore, we found the first evidence for a large deletion in ORF3 resulting in the loss of ORF3a, previously reported in porcine respiratory coronavirus, in three field strains (CH‐LNCT, CH‐MZL, and CH‐SH) of TGEV. The results of the present study thus provide important information regarding the underlying evolution mechanisms of coronaviruses.     

Sotrastaurin, a protein kinase C inhibitor, ameliorates ischemia and reperfusion injury in rat orthotopic liver transplantation

Sotraustaurin (STN), a small molecule, targeted protein kinase C (PKC) inhibitor that prevents T-lymphocyte activation via a calcineurin-independent pathway, is currently being tested in Phase II renal and liver transplantation clinical trials. We have documented the key role of activated T cells in the inflammation cascade leading to liver ischemia/reperfusion injury (IRI). This study explores putative cytoprotective functions of STN in a clinically relevant rat model of hepatic cold ischemia followed by orthotopic liver transplantation (OLT). Livers from Sprague-Dawley rats were stored for 30 h at 4°C in UW solution, and then transplanted to syngeneic recipients. STN treatment of liver donors/recipients or recipients only prolonged OLT survival to >90% (vs. 40% in controls), decreased hepatocellular damage and improved histological features of IRI. STN treatment decreased activation of T cells, and diminished macrophage/neutrophil accumulation in OLTs. These beneficial effects were accompanied by diminished apoptosis, NF-κB/ERK signaling, depressed proapoptotic cleaved caspase-3, yet upregulated antiapoptotic Bcl-2/Bcl-xl and hepatic cell proliferation. In vitro, STN decreased PKCθ/IκBα activation and IL-2/IFN-γ production in ConA-stimulated spleen T cells, and diminished TNF-α/IL-1β in macrophage-T cell cocultures. This study documents positive effects of STN on liver IRI in OLT rat model that may translate as an additional benefit of STN in clinical liver transplantation.     

Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery

Acute kidney injury (AKI) occurs commonly after pediatric cardiac surgery and associates with poor outcomes. Biomarkers may help the prediction or early identification of AKI, potentially increasing opportunities for therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 311 children undergoing surgery for congenital cardiac lesions to evaluate whether early postoperative measures of urine IL-18, urine neutrophil gelatinase-associated lipocalin (NGAL), or plasma NGAL could identify which patients would develop AKI and other adverse outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. Severe AKI, defined by dialysis or doubling in serum creatinine during hospital stay, occurred in 53 participants at a median of 2 days after surgery. The first postoperative urine IL-18 and urine NGAL levels strongly associated with severe AKI. After multivariable adjustment, the highest quintiles of urine IL-18 and urine NGAL associated with 6.9- and 4.1-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine NGAL levels associated with longer hospital stay, longer intensive care unit stay, and duration of mechanical ventilation. The accuracy of urine IL-18 and urine NGAL for diagnosis of severe AKI was moderate, with areas under the curve of 0.72 and 0.71, respectively. The addition of these urine biomarkers improved risk prediction over clinical models alone as measured by net reclassification improvement and integrated discrimination improvement. In conclusion, urine IL-18 and urine NGAL, but not plasma NGAL, associate with subsequent AKI and poor outcomes among children undergoing cardiac surgery.     

Retrieval Analysis of Femoral Zirconium Components in Total Knee Arthroplasty : Preliminary Results

Safety of oxidized zirconium (OxZr) in total knee arthroplasty (TKA) has been supported by biomechanical, clinical, and radiologic data. Retrieved OxZr femoral components and corresponding polyethylene (PE) inserts were examined to rule out patterns leading to early failure. Sixteen retrieved TKA with an OxZr femoral component were included. The PE inlays were analyzed applying an established scoring system for wear and surface damage. Femoral components were screened for scratching, pitting, delamination, and striations. The prostheses were in situ for 16.4 ± 11.9 months. The average wear and damage score for the tibial PE inserts was 36.0 ± 12.7. The average score in the visual analysis of the OxZr femoral components was 1.3 ± 1.3. The data presented in this study did not show major wear of the PE in TKA using OxZr components. In this cohort, there were no failures directly related to this implant.     

Denosumab and changes in bone turnover markers during androgen deprivation therapy for prostate cancer

Androgen deprivation therapy (ADT) for prostate cancer increases fracture risk, decreases bone mineral density, and increases bone turnover markers (BTMs) including serum type 1 C‐telopeptide (sCTX), tartrate‐resistant alkaline phosphatase 5b (TRAP‐5b), and procollagen‐1 N‐terminal telopeptide (P1NP). In a prespecified exploratory analysis of a phase 3, multicenter, double‐blind study, we evaluated the effects of denosumab (60 mg subcutaneously every 6 months for 3 years) versus placebo (1468 patients, 734 in each group) on BTM values. BTMs were measured at baseline, month 1, and predose at months 6, 12, 24, and 36 in the overall population. BTMs at month 1 are also reported for subgroups based on age (< 70 years versus ≥ 70 years), prior duration of ADT (≤ 6 months versus >6 months), and baseline BTM (≤ median versus > median BTM values). Treatment with denosumab provided a rapid and sustained decrease of BTM values compared with placebo. The median change in sCTX levels at month 1 was ?90% in the denosumab group and ?3% in the placebo group (p < 0.0001). The median change in TRAP‐5b levels at month 1 was ?55% in the denosumab group and ?3% in the placebo group (p < 0.0001). The maximal median change in P1NP was ?64% in the denosumab group and ?11% in the placebo group, (p < 0.0001). Significantly greater decreases in BTM for denosumab were also seen in subgroup analyses based on age, prior ADT treatment, and baseline BTM values. Suppression of bone turnover markers was consistent with marked increases in bone mineral density reported previously. © 2011 American Society for Bone and Mineral Research     

Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast-enhanced CT

OBJECTIVE: Tuberculosis in the abdominal lymph nodes may be difficult to distinguish from lymphomas. This study evaluated specific CT imaging criteria for differentiating these entities. MATERIALS AND METHODS: We retrospectively reviewed the anatomic distribution and CT enhancement patterns of disease in 69 patients, 26 (38%) with tuberculosis and 43 (62%) with untreated lymphomas involving abdominal lymph nodes. Of the patients with tuberculosis, five (19%) had disseminated disease and 21 (81%) had nondisseminated disease. Of the patients with lymphomas, 16 (37%) had Hodgkin's disease and 27 (63%) had non-Hodgkin's lymphoma. RESULTS: Disseminated and nondisseminated tuberculosis involved predominantly lesser omental, mesenteric, anterior pararenal, and upper paraaortic lymph nodes. Lower paraaortic lymph nodes were involved more often in Hodgkin's disease (15 patients [94%]), non-Hodgkin's lymphoma (24 patients [89%]), and disseminated tuberculosis (five patients [100%]) than in nondisseminated tuberculosis (one patient [5%]). Mesenteric lymph nodes were involved more often in disseminated tuberculosis (four patients [80%]) and nondisseminated tuberculosis (11 patients [52%]) than in Hodgkin's disease (one patient [6%]) (p < .01). Anatomic distribution was not different between disseminated tuberculosis and non-Hodgkin's lymphoma. Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a multilocular appearance, whereas lymphomatous adenopathy characteristically showed homogeneous attenuation (14 patients [87.5%] with Hodgkin's disease and 19 patients [70%] with non-Hodgkin's lymphoma [p < .01]). CONCLUSION: Our findings indicate that the anatomic distribution and specific enhancement patterns of lymphadenopathy seen on contrast-enhanced CT can be useful in differentiating between tuberculosis and untreated lymphomas of the abdominal lymph nodes.     

快中子诱导人鼻咽癌细胞系凋亡的研究

目的　研究中子不同剂量照射人鼻咽癌（ＣＮＥ２） 细胞凋亡发生特点及与Ｘ射线所致凋亡的差异。探讨凋亡在中子治疗肿瘤中的作用及临床意义。方法　采用琼脂糖凝胶电泳及ＤＮＡ特异性荧光染色方法（Ｈｏｅｃｈｓｔ３３３４２） 检测照射后不同时间人鼻咽癌（ＣＮＥ２）细胞。结果　发现中子可诱导人鼻咽癌细胞发生凋亡,这种凋亡发生存在着一定的时间剂量相关性。在相同剂量照射下,同一时间点上,中子照射所致的凋亡反应强于Ｘ 射线所致的凋亡。结论　快中子照射离体细胞可引起较强的凋亡反应。中子杀伤肿瘤的机理可能也是主要通过凋亡途径来实现的。