A large congenital and solitary intrahepatic arterioportal fistula in an old woman

Arterioportal fistula(APF)is a rare cause of portal hypertension and may lead to death.APF can be congenital,post-traumatic,iatrogenic(transhepatic intervention or biopsy)or related to ruptured hepatic artery aneurysms.Congenital APF is a rare condition even in children.In this case report,we describe a 73-year-old woman diagnosed as APF by ultrasonography,computed tomography,and hepatic artery selective arteriography.The fistula was embolized twice but failed,and she still suffered from alimentary tract hemorrhage.Then,selective arteriography of the hepatic artery was performed again and venae coronaria ventriculi and short gastric vein were embolized.During the 2-year follow-up,the patient remained asymptomatic.We therefore argue that embolization of venae coronaria ventriculi and short gastric vein may be an effective treatment modality for intrahepatic APF with severe upper gastrointestinal bleeding.

ENDOVASCULAR EMBOLIZATION TREATMENT OF CEREBRAL ARTERIOVENOUS MALFORMATIONS（REPORT OF 54 CASES）

For further reaseach on endovascular embolization treatment of AVMs, 54 patients with AVMs treated with embolization were observed. It was found that embolization was an effective procedure for the treatment of AVMs. Combined treatment of AVMs with presurgical embolization and direct surgery could reduce the comphcations resulting from large and high flow AVMs with lone surgical removal.

EFFECTS OF INTRAVENOUS FENTANYL ON SPONTANEOUS RENAL SYMPATHETIC NERVE ACTIVITY IN NORMAL AND VAGOTOMIZED RABBITS

Objective To investigate the roles of sympathetic and vagus nerves in hypotension and bradycardia induced by fentanyl. Methods Fourteen rabbits were divided into 2 groups: normal and vagotomized rabbits. Rabbits were anesthetized, paralyzed, and artificial ventilated. Right renal sympathetic nerve was exposed and prepared for recording electrical activity. Fentanyl was injected intravenously in incremental doses of 1, 4, 15, 30, and 50 μg/kg at 10 minutes intervals. Results Fentanyl significantly reduced the spontaneous activity of renal sympathetic nerve, mean arterial pressure, and heart rate above a total dose of 20 μg/kg in both normal and vagotomized rabbits. However, normal rabbits spontaneous sympathetic nerve activity and mean arterial pressure were more depressed than vagotomized rabbits at total doses of 50 and 100 μg/kg. There were no significant difference in the reduction of heart rate between normal and vagotomized rabbits. Conclusion Fentanyl induction of bradycardia and hypotension in rabbits is mainly due to depression of sympathetic nerve activity.

Advances and progress of endarterectomy in the treatment of carotid stenosis

Carotid stenosis, one of the risk factors that tend to result in cerebral ischernia, infarction as well as ischemic manifestations. CEA （carotid endarterectomy）, was initially designed delicately to excise of the thickened, atheromatous tunica intima from the focal stenosis segment, which therefore has been acknowledged as an efficacious way in the management of the prophylaxis of cerebral ischemia. Deruing 1990＇s, carotid endarterectomy （CEA） has matured to a widely performed, standard intervention with well defined successive steps. In the recent years, appearance of angloplasty, stenting, and distal protection procedures provides competitive alternatives to classical endarterectomy. However, long-term benefits of carotid angioplasty should be confirmed by larger, randomized, comparative clinical trials.

老年颈内动脉血管内膜粥样硬化超声诊断分析

目的探讨颈内动脉粥样硬化的超声诊断价值。方法收集我院2013-2017年进行颈动脉超声检查并诊断为颈内动脉粥样硬化的老年患者167例，回顾性分析其超声检查资料。结果颈内动脉共计208处挟窄，包括轻度狭窄51处（24．52％）、中度狭窄101处（48．56％）、重度狭窄35处（16．83％）、闭塞21处（10．10％）。血管内膜增厚共计295处，包括：Ⅰ型增厚114处（38．64％）、Ⅱ型增厚101处（34．24％）、Ⅲ型增厚80处（27．12％）。斑块共计320处，包括：硬斑块144处（45．00％）、软斑块93处（29．06％）、混合斑块83处（25．94％）。结论超声诊断颈内动脉粥样硬1h具有较好的应用价值，可作为常规筛查手段推广应用。

Vascular reconstruction of segmental intestinal grafts using autologous internal iliac vessels

Background The aim of this study was to assess whether the autologous internal iliac artery and vein could be used as an interpositional graft for vascular reconstruction in segmental intestinal allografts and autografts.Methods Thirty-four intestinal transplants(19 living-related allografts and 15 autografts)were conducted in our programs between January 2011 and January 2019.Patient characteristics,type of vascular reconstruction,and post-operative complications were reviewed.Results There were 20 males and 14 females with a median age of 35 years.Of 34 grafts,22(64.7%)(11 allografts and 11 autografts)were revascularized using the autologous internal iliac artery and vein for reconstruction.Vascular reconstruction on the back table took 2166min to complete.Both total operative time and cold ischemia time tended to be longer in the vascular-reconstruction group than in the direct-anastomosis group(5306226 vs 4406116 and 159649 vs 125666 min,respectively),but these differences were not significant.The incidence of vascular thrombosis tended to be higher in the direct-anastomosis group than in the vascular-reconstruction group(16.7%vs 0%,P=0.118).At a median follow-up of 36.9 months,no stenosis or pseudoaneurysms developed.In 19 allografts,acute rejection occurred in 4(21.1%)and chronic rejection occurred in 1(5.2%).Conclusions Our results indicate that the use of an autologous internal iliac interposition graft greatly facilitates intestinal graft implantation and minimizes the risk of vascular complications.

Auricular point sticking for relieving pain in arteriovenous fistula puncture

Objective:To observe the clinical efficacy of auricular point sticking at different points to relieve the pain in arteriovenous fistula puncture.Methods:A total of 42 patients with arteriovenous fistula were randomized into a Shenmen(TF4)group and an Elbow(SF3)group by the random number table method,with 21 cases in each group.After enrolled into different groups,before the dialysis,patients were given auricular point sticking with Wang Bu Liu Xing(Semen Vaccariae)seeds at Shenmen(TF4)and Elbow(SF3),respectively.Patients were asked to press the seeds themselves for 2 min each time,four times a day,and an additional 5-15 min before the arteriovenous fistula puncture.Intensive pressing was offered duri ng the pun cture,15・20 presses for each time,and the plasters were cha nged every 2-3 d.The nu merical rati ng scale(NRS)was used to score the pain level one week before and after auricular point sticking.The NRS score was then compared and analyzed.Results:The intra-group comparison showed that the changes of NRS score in both groups were statistically sigrdficant after auricular point sticking(both P<0.05).After the treatment,there was no sigrdficant differenee in NRS score between the two groups(P>0.05).Conclusion:Auricular point sticking at Shenmen(TF4)or Elbow(SF3)can effectively relieve the pain of arteriovenous fistula puncture,and these two points have equivale nt an algesic effect.

“Petal effect”-inspired superhydrophobic and highly adhesive coating on magnesium with enhanced corrosion resistance and biocompatibility

With properties of complete degradation and favorable mechanical behavior, Mg and its alloys are regarded as the next generation medical metal materials. However, fast degradation and poor surface biocompatibility hinder their clinical applications. Inspired by the ＂petal effect＂, we successfully constructed a superhydrophobic and highly adhesive coating on pure Mg via a simple hydrothermal treatment in a solution containing sodium oleate. The superhydrophobicity of the fabricated coating results from its flake-like micro-nanostructure and the low-surface-energy oleate group. Water droplet on the superhydrophobic coating cannot roll off even when the sample is turned upside down, owing to the sealed air-pockets and the van der Waals’ attraction at the solidliquid interface, indicating a highly adhesive force. The chemical and mechanical stability of the superhydrophobic coating were measured. Potentiodynamic polarization and electrochemical impedance spectroscopy measurements suggest enhanced corrosion resistance of the as-prepared sample.Furthermore, cell cytotoxicity, migration and adhesion data of human umbilical vein endothelial cells（HUVECs） reveal an improved cytocompatibility of the modified surface. Finally,hemolysis assay and platelet adhesion assay suggest an improved hemocompatibility. It is believed that the facile and low-cost method can expand the new application of superhydrophobic surface with highly adhesive on Mg in biomedical fields.