Mitochondria-localizing triphenylphosphine-8-hydroxyquinoline Ru complexes induce ferroptosis and their antitumor evaluation.

Ruthenium complexes are one of the most promising anticancer drugs and ferroptosis is a novel form of regulated cell death, the study on the effect of Ru complexes on ferroptosis is helpful to find more effective antitumor drugs. Here, the synthesis and characterization of two Ru complexes containing 8-hydroxylquinoline and triphenylphosphine as ligands, [Ru(L1) (PPh3)2Cl2] (Ru-1), [Ru(L2) (PPh3)2Cl2] (Ru-2), were reported. Complexes Ru-1 âˆ¼ Ru-2 showed good anticancer activity in Hep-G2 cells. Researches indicated that complexes Ru-1 âˆ¼ Ru-2 could be enriched and appear as red fluorescence in the mitochondria, arouse dysfunction of mitochondria, induce the accumulation of reactive oxygen species (ROS) and lipid peroxidation (LPO), while the morphology of nuclei and cell apoptosis had no significant change. Further experiments proved that GPX4 and Ferritin were down-regulated, which eventually triggered ferroptosis in Hep-G2 cells. Remarkably, Ru-1 showed high inhibitory activity against xenograft tumor growth in vivo (TGIR = 49%). This study shows that the complex Ru-1 could act as a novel drug candidate by triggering cell ferroptosis.

A three-dimensional printing navigational template combined with mixed reality technique for localizing pulmonary nodules.

OBJECTIVES: Localizing non-palpable pulmonary nodules is challenging for thoracic surgeons. Here, we investigated the accuracy of three-dimensional (3D) printing technology combined with mixed reality (MR) for localizing ground glass opacity-dominant pulmonary nodules. METHODS: In this single-arm study, we prospectively enrolled patients with small pulmonary nodules (<2 cm) that required accurate localization. A 3D-printing physical navigational template was designed based on the reconstruction of computed tomography images, and a 3D model was generated through the MR glasses. We set the deviation distance as the primary end point for efficacy evaluation. Clinicopathological and surgical data were obtained for further analysis. RESULTS: Sixteen patients with 17 non-palpable pulmonary nodules were enrolled in this study. Sixteen nodules were localized successfully (16/17; 94.1%) using this novel approach with a median deviation of 9 mm. The mean time required for localization was 25 ± 5.2 min. For the nodules in the upper/middle and lower lobes, the median deviation was 6 mm (range, 0-12.0) and 16 mm (range, 15.0-20.0), respectively. The deviation difference between the groups was significant (Z = -2.957, P = 0.003). The pathological evaluation of resection margins was negative. CONCLUSIONS: The 3D printing navigational template combined with MR can be a feasible approach for localizing pulmonary nodules.

Three-dimensional printed navigational template for localizing small pulmonary nodules: A case-controlled study.

BACKGROUND: Localization of small pulmonary nodules is an inevitable challenge for the thoracic surgeon. This study aimed to investigate the accuracy of three-dimensional (3D) printing technology for localizing small pulmonary nodules, especially ground-glass nodules (GGNs). METHODS: This study enrolled patients with peripheral small pulmonary nodules (≤ 2 cm) who required preoperative localization. In the comparison period, patients underwent both computed tomography-guided (CT-G) and 3D-printing template guided (3D-G) localization to compare the accuracies of the two methods. In the testing period, the 3D-printing technique was implemented alone. The 3D-printing physical navigational template was designed based on data from perioperative CT images. Clinical data, imaging data, surgical data, and evaluation index were collected for further analysis. The learning curve of the 3D-printing localization technique was assessed using cumulative sum (CUSUM) analysis and multiple linear regression analysis. RESULTS: In the comparison period (n = 14), the success rates of CT-G and 3D-G were 100% and 92.9% (P = 0.31), respectively; in the testing period (n = 23), the success rate of 3D-G was 95.6%. The localization times of CT-G, 3D-G (comparison), and 3D-G (testing) were 23.6 ± 5.3, 19.3 ± 6.8, and 9.8 ± 4.6 minutes, respectively. The CUSUM learning curve was modeled using the equation: Y = 0.48X2 - 0.013X - 0.454 (R2 = 0.89). The learning curve was composed of two phases, phase 1 (the initial 20 patients) and phase 2 (the remaining 17 patients). CONCLUSIONS: 3D printing localization has adequate accuracy and is a feasible and accessible strategy for use in localizing small pulmonary nodules, especially in right upper lobe. The use of this technique could facilitate lung nodule localization prior to surgery.

The evaluation of coronary artery-to-pulmonary artery fistula in adulthood on 256-slice CT coronary angiography: Comparison with coronary catheter angiography and transthoracic echocardiography.

OBJECTIVE: To review the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on CT coronary angiography (CTCA) and evaluate its diagnostic performance compared with coronary catheter angiography (CCA) and transthoracic echocardiography (TTE). MATERIALS AND METHODS: We retrospectively reviewed with a diagnosis of CPAF from among 19855 consecutive CCTA performed with 256-slice MDCT scanner for suspected coronary artery disease. CT images were evaluated for - origin, number, size and course (tubular/worm-like dilation/significant aneurysm formation/wall attachment sign) of fistula vessels, drainage site, drainage site imaging features (pierced sign, isodensity sign, smoke sign, jet sign), and main pulmonary artery (MPA) enlargement. 25 patients of CPAF also underwent CCA and 47 patients underwent TTE. RESULTS: There were 72 patients with CPAF (0.36%) in our study, of which 44 were men and 28 were women, with mean age of 55.8 ±â€¯13.2 years (range 22-85 years). CPAF originated from conus artery, left anterior descending artery (LAD), combined conus artery and LAD in 55, 67, 50 cases, respectively. Tubular dilation, worm-like dilation and aneurysm was seen in 14, 58 and 35 cases, respectively. Wall attachment sign was noted in 69 cases. All the cases demonstrated only a single drainage site, with left lateral wall, left anterolateral, anterior, right lateral and right anterolateral walls of MPA in 44, 21, 5, 1 and 1 cases, respectively. The mean diameter of the fistula drainage site was 2.6 ±â€¯1.3 mm. Pierced sign, jet sign, smoke sign, isodensity sign was seen in 72, 46, 41 and 24 cases, respectively. MPA enlargement was seen in 20 patients. CCA showed CPAF in only 20 cases among 25 patients; while TTE showed CPAF in only 9 patients among 47 patients. CONCLUSION: CTCA is competent in detecting and characterizing CPAF with an excellent diagnostic performance as the first imaging modality of choice, which is valuable for giving a distinct and intuitive explanation to patients and physicians and making an objective and exact assessment for further management.

Highly Efficient Synthesis of Fructooligosaccharides by Extracellular Fructooligosaccharide-Producing Enzymes and Immobilized Cells of Aspergillus aculeatus M105 and Purification and Biochemical Characterization of a Fructosyltransferase from the Fungus.

In this work, Aspergillus aculeatus M105 was obtained to produce high extracellular fructooligosaccharide-producing enzyme activity. The maximum yields of fructooligosaccharides produced by its extracellular enzymes and immobilized cells were 67.54 and 65.47% (w/w), respectively. A fructosyltransferase (FTase), AaFT32A, was purified from M105. The optimal pH and temperature of AaFT32A were pH 5.0-6.0 and 65 °C, respectively. The Km, Vmax, and kcat values for the transfructosylating activity of AaFT32A were 2267 mM, 1347 µmol/min/mg protein, and 1550.2 s(-1), respectively, and those values for the hydrolytic activity of AaFT32A were 6.10 mM, 32.44 µmol/min/mg protein, and 37.3 s(-1), respectively. The sequence of AaFT32A deduced from the cloned gene shared 99.4% identity with a FTase from Aspergillus japonicus CB05 and a fructofuranosidase from Aspergillus niger and 96.5% identity with a FTase (Aspacl_37092) from A. aculeatus ATCC 16872. The fungal strain and its FTase may have potential applications in the prebiotics industry.

Echocardiographic Findings of an Anomalous Origin of the Left Coronary Artery in Children and Adolescents: Real or Fake?

An anomalous origin of the left coronary artery (LCA) is a relatively uncommon congenital heart defect that can lead to myocardial ischemia and sudden cardiac death. An LCA arising from the pulmonary artery and an LCA arising from the opposite sinus of Valsalva are the common types of anomalous origins of the LCA. Echocardiographic assessment of the coronary arteries is an important component of the routine cardiovascular evaluation, but echocardiographic "pseudo images" of LCA origination can be present in some patients. Detection of an anomalous origin of the LCA remains a challenge to sonographers.

Image quality evaluation of iterative model reconstruction on low tube voltage (80 kVp) coronary CT angiography in an animal study.

BACKGROUND: Iterative model reconstruction (IMR) is a newer generation iterative reconstruction method, but its value on coronary computed tomography (CT) angiography requires investigation. PURPOSE: To evaluate coronary image quality using IMR at a low-tube voltage of 80 kVp on coronary CT angiography in miniature pigs. MATERIAL AND METHODS: Five healthy miniature pigs underwent prospective electrocardiogram-gated coronary 256-slice CT angiography at 120 kVp and 80 kVp tube voltages, respectively. Filtered back projection (FBP) was used to reconstruct the 120 kVp standard-dose (SD) image sets (SD-FBP group), while iDose(4) and IMR were used to reconstruct the 80 kVp low-dose (LD) image sets (LD-iDose(4) and LD-IMR groups). Objective and subjective image qualities were compared among three groups. RESULTS: There were no significant differences in mean CT values of the ascending aorta, left main coronary artery, and right coronary artery between the LD-IMR and LD-iDose(4) groups (P > 0.05), but the values were significantly lower in the SD-FBP group than in those two groups (P < 0.05). The image noise in the LD-IMR group (21.5 ± 3.9 HU) was significantly lower than in the LD-iDose(4) (63.7 ± 9.8 HU) and SD-FBP (50.6 ± 4.6 HU) groups (P < 0.05). The signal-to-noise and contrast-to-noise ratios were significantly higher in the LD-IMR group than in the LD-iDose(4) and SD-FBP groups, respectively (P < 0.05). Subjective scoring of image noise, streak artifacts, and overall image quality indicated that the LD-IMR group was consistently superior to the LD-iDose(4) and SD-FBP groups (P < 0.05). CONCLUSION: IMR can significantly improve image quality at a low-tube voltage (80 kVp) with a 66% radiation dose reduction on coronary 256-slice CT angiography in miniature pigs.

Individualized reduction of radiation dose with a chest circumference-adapted technique and iterative reconstructions in 256-slice retrospective and prospective ECG-triggered computed tomography coronary angiography.

PURPOSE: To assess the impact of chest circumference (CC)-adjusted tube current and iterative reconstructions (iDose) on individualized radiation dose reduction and image quality (IQ) in ECG-triggered computed tomography coronary angiography (CTCA). MATERIALS AND METHODS: A total of 102 patients underwent retrospectively ECG-triggered CTCA utilizing CC-adapted tube current [mAs=1000×(0.051×CC-23.765)/900] and filtered back projection (FBP) reconstruction (group A). On the basis of the CC-adjusted tube current technique, 54 patients (group B) underwent retrospective ECG-triggered CTCA with a 20% mAs reduction compared with group A and 90 patients (group C) underwent prospective ECG-triggered CTCA with an 80% mAs reduction compared with group A; both groups B and C were reconstructed with FBP and iDose. Subjective IQ was assessed, and image noise, signal-to-noise, and contrast-to-noise ratios (SNR and CNR) were quantified. RESULTS: Patients in group A had the highest radiation dose, followed by group B and group C. iDose provided decreased image noise and increased SNR and CNR, as did subjective IQ. The image noise was higher and SNR and CNR in group B were obviously lower than those in group A with FBP, but in group B, iDose4 increased the mean objective IQ. There was no difference between group B with iDose and group A with FBP, as was the case with subjective IQ. CONCLUSION: The combination of a CC-adapted technique, prospective triggering, and partial iterative reconstruction techniques reduces the radiation dose significantly, without significant degradation of IQ.

Potentially optimal body size to adjust tube current for individualized radiation dose control in retrospective ECG-triggered 256-slice CT coronary angiography.

INTRODUCTION: We aimed to determine a potentially optimal body size index for adjusting the tube current in retrospective ECG-triggered helical 256-slice CT coronary angiography (CTCA) for individualized radiation dose control. METHODS: Consecutive patients (n=102) with suspected coronary artery disease underwent retrospective ECG-triggered CTCA with a 256-slice CT scanner. Body mass index (BMI), nipple level (NL) bust and six anthropometric body size indexes, including thoracic anteroposterior diameter at NL, chest circumference (CC) at NL, left main (LM) and right coronary artery (RCA) origin level, chest area (CAr) and chest attenuation (CAt) at RCA origin level were measured, and their correlation with image noise in the aorta was evaluated using linear regression. Pearson correlation analysis was performed respectively to determine the body size index that correlated best with the other body size indexes. An equation was derived to use the best correlated body size index for adjusting tube current. RESULTS: Linear regression demonstrated that CCRCA had the best correlation with image noise. Pearson correlation analysis showed that CCNL, CCLM and CArRCA had the closest linear relationship with CCRCA. The equations connecting CCRCA and tube current for males and females were XmA = 662 × (0.055 × CCRCA - 28.594) / 302 and XmA = 662 × (0.049 × CCRCA - 21.584) / 302, respectively, for a fixed image noise value of 30 HU. CONCLUSIONS: Tube current selection is different for males and females, particularly in patients with a small chest circumference. CCRCA is an ideal body index for appropriately adjusting tube current in CTCA for individualized radiation dose control.

Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection.

BACKGROUND: The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure. METHODS: The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software. RESULTS: Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P = 0.213). The aortic rupture patients are more likely to have ascending aortic diameters = 4 cm (62.5% vs. 9.0%, P = 0.032), involvement the aortic arch concavity (62% vs. 27%, P = 0.041) and have had multiple stents placed (P = 0.039). CONCLUSIONS: Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter = 4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.

Individualized radiation dose control in 256-slice CT coronary angiography (CTCA) in retrospective ECG-triggered helical scans: using a measure of body size to adjust tube current selection.

PURPOSE: To reduce radiation dose for retrospective ECG-triggered helical 256-slice CTCA by determining an optimal body size index to prospectively adjust tube current. METHODS: 102 consecutive patients with suspected CAD underwent retrospective ECG-triggered CTCA using 256-slice CT scanner. Six body size indexes including BMI, nipple level (NL) bust, thoracic anteroposterior diameter at NL, chest circumference (CC) at NL, left main and right coronary artery (RCA) origin level were measured and their correlation with noise was evaluated using linear regression. An equation was developed to use this index to adjust tube current. Additional 102 consecutive patients were scanned with the index-based mAs adjustment. A t-test for independent samples was used to compare radiation dose levels with and without the index-based mAs selection method. RESULTS: Linear regression indicated that CC RCA had the best correlation with noise (R2=0.603). Effective radiation dose was reduced from 16.6±0.9 to 9.8±2.7 mSv (p<0.01), i.e. 40.9% lower dose with the CC RCA-adapted tube current method. The image quality scores indicated no significant difference with and without the size-based mAs selection method. CONCLUSION: An accessible measure of body size, such as CC RCA, can be used to adapt tube current for individualized radiation dose control.

Assessment of aortopulmonary collateral flow and pulmonary vascular growth using a 3.0 T magnetic resonance imaging system in patients who underwent bidirectional Glenn shunting.

OBJECTIVES: To explore the feasibility of evaluating the aortopulmonary collateral flow (APCF) and pulmonary vascular growth of patients who underwent bidirectional Glenn shunting (BGS) using phase-contrast magnetic resonance imaging (PC-MRI) and contrast-enhanced magnetic resonance imaging (CE-MRI). METHODS: Blood flow measurements of the great vessels of the body were recorded in 22 post-BGS patients using 3.0 T PC-MRI. Right and left pulmonary blood flow (Q(P)), stroke volume (SV) of the ascending aorta (Q(S)), blood flow of descending aorta (Q(d)) and venous return of the superior and inferior venae cavae (Q(V)) per minute were calculated using the Report Card software. APCF was equal to the difference between Q(S) and Q(V). The parameters for pulmonary vascular growth were assessed using CE-MRI. The relationship between pulmonary vascular growth and APCF was evaluated using correlation analysis. A comparative analysis was conducted between the MRI results and the results of five cases who underwent cardiac catheterization and 10 cases who underwent angiography. RESULTS: Estimated APCF ranged from 0.23 to 1.63 l/(min/m(2)), accounting for 5-44% of Q(S). Morphologic abnormalities such as pulmonary stenosis, dilatation and thrombosis were clearly visualized through CE-MRI. Significant differences in individual pulmonary artery growth were observed. A significant negative correlation was found between APCF and the pulmonary artery index (PAI; r = -0.461, P = 0.031) when the McGoon rate was 2.04 ± 0.59 and the PAI was 253.27 ± 85.86 mm(2)/m(2). Good consistency or relativity was found between cardiac catheterization, angiography and MRI. CONCLUSIONS: Assessing the APCF and parameters for pulmonary vascular growth in patients who underwent BGS is feasible using 3.0 T PC-MRI integrated with CE-MRI, which may play an important role in clinical and therapeutic decision-making and prognostic evaluation.

Evaluation of image quality and radiation dose at prospective ECG-triggered axial 256-slice multi-detector CT in infants with congenital heart disease.

BACKGROUND: There are a limited number of reports on the technical and clinical feasibility of prospective electrocardiogram (ECG)-gated multi-detector computed tomography (MDCT) in infants with congenital heart disease (CHD). OBJECTIVE: To evaluate image quality and radiation dose at weight-based low-dose prospectively gated 256-slice MDCT angiography in infants with CHD. MATERIALS AND METHODS: From November 2009 to February 2010, 64 consecutive infants with CHD referred for pre-operative or post-operative CT were included. All were scanned on a 256-slice MDCT system utilizing a low-dose protocol (80 kVp and 60-120 mAs depending on weight: 60 mAs for ≤ 3 kg, 80 mAs for 3.1-6 kg, 100 mAs for 6.1-10 kg, 120 mAs for 10.1-15 kg). RESULTS: No serious adverse events were recorded. A total of 174 cardiac deformities, confirmed by surgery or heart catheterization, were studied. The sensitivity of MDCT for cardiac deformities was 97.1%; specificity, 99.4%; accuracy, 95.9%. The mean heart rate during scan was 136.7 ± 14.9/min (range, 91-160) with a corresponding heart rate variability of 2.8 ± 2.2/min (range, 0-8). Mean scan length was 115.3 ± 11.7 mm (range, 93.6-143.3). Mean volume CT dose index, mean dose-length product and effective dose were 2.1 ± 0.4 mGy (range, 1.5-2.8), 24.7 ± 5.9 mGy·cm (range, 14.7-35.8) and 1.6 ± 0.3 mSv (range, 1.1-2.5), respectively. Diagnostic-quality images were achieved in all cases. Satisfactory diagnostic quality for visualization of all/proximal/distal coronary artery segments was achieved in 88.4/98.8/80.0% of the scans. CONCLUSION: Low-dose prospectively gated axial 256-slice CT angiography is a valuable tool in the routine clinical evaluation of infants with CHD, providing a comprehensive three-dimensional evaluation of the cardiac anatomy, including the coronary arteries.

[Intravascular ultrasound-guided interventional therapy for borderline lesions in patients with acute coronary syndrome].

OBJECTIVE: To assess the efficacy and safety of intravascular ultrasound (IVUS)-guided interventional therapy for borderline lesions in patients with acute coronary syndrome (ASC). METHODS: Thirty-one ASC patients with borderline lesions (coronary artery stenosis between 40%-70% confirmed by coronary arteriography [CAG]) and a minimal lumen area (MLA) of the infarction related artery(IRA) < or =4.0 mm(2) shown by IVUS underwent percutaneous coronary intervention (PCI). Another 31 PCI cases without IVUS were also enrolled as the control group. The minimal luminal diameter, cross section luminal area, total cross section, plaque area and area stenosis rate were measured before and after stent deployment at a conventional or higher pressure in the IVUS group. All the patients were followed up for 10-12 months and clinically evaluated 1, 3, 6 month and 12 months after the procedure to collect the data of angina recurrence, myocardial infarction and revascularization. RESULTS: All the 31 cases were successfully stented with satisfied CAG results (with residual stenosis <0, TIMI flow grade III) and without dissection or any related complications. Among the 32 stents, 28 showed insufficient adherence or underexpansion (stent malapposition) to require 18-20 atm dilation or another high pressure balloon to attain the adequate IVUS results. CAG and IVUS were repeated in 22 patients (70.97%) of the IVUS group during the 10 to 12 months of follow up. No stent restenosis occurred with the in-stent diameter late loss >50%, nor was in-stent thrombus found by IVUS. Endomembrane proliferation was found but without any significant difference. Minimal stent lumen area were not significantly different from the immediate results after PCI (10.12-/+1.15 mm(2) vs 8.98-/+2.12 mm(2), P>0.05). The 31 patients in the control group were successfully stented with satisactory CAG results, but 3 suffered angina at 3-6 months who showed stent restenosis and insufficient stent adherence. CONCLUSION: IVUS can more effectively guide the interventional therapy for ACS borderline lesions and assess the immediate efficacy of therapy than CAG. Post-dilation with higher pressure (16-20 atm) guided by IVUS can further improve the procedural results. IVUS-guided PCI for ACS borderline lesions ensures high immediate and long-term success rate.

[Detection and its clinical value of myocardial bridging with 64-slice spiral CT coronary angiography].

UNLABELLED: To evaluate the detection rate of myocardial bridging by 64-slice spiral CT coronary angiography. METHODS: The data of 3011 patients with suspected coronary artery disease undergoing 64-slice spiral CT coronary angiography were collected and analyzed retrospectively. RESULTS: A total of 174 cases (5.8%) with myocardial bridging were detected by 64-slice spiral CT coronary angiography, among which 168 (96.6%) had single foci of involvement and 6 (3.4%) had were multiple foci. Involvement of the left anterior descending coronary artery (LAD) was detected in 167 out of the 174 cases (96.0%). The length of the myocardial bridge varied between 5 and 120 mm (mean of 30.5 mm), and the depth of the tunneled artery ranged between 1.3 and 2.8 mm (mean 2.3 mm). Seventy-nine of the cases (45.4%) had uncomplicated myocardial bridging and 95 (54.6%) had myocardial bridging complicated by coronary atherosclerosis. CONCLUSION: Multi-slice spiral CT coronary angiography is a reliable and noninvasive modality for diagnosis of myocardial bridging to allow direct measurement of the length and depth of the myocardial bridge and detection of concurrent coronary and cardiac lesions.

[Endovascular repair for patients with DeBakey III aortic dissection].

OBJECTIVE: To investigate the clinical therapeutic effects of endovascular repair for patients with DeBakey III aortic dissection. METHODS: From December 2002 to June 2007, endovascular TALENT stent-graft exclusion was performed in 75 (65 males, mean age 54.4 +/- 12.6 years) patients with DeBakey III aortic dissection (1 young woman due to Ehlers-Danlos syndrome, 2 young men due to primary aldosteronism and trauma respectively). All patients were diagnosed by contrast enhanced computed tomography (CT) or MRI. Stent-grafts were deployed via femoral artery to exclude the tear of dissection. Aortic angiography was performed immediately after procedure. RESULTS: Eighty-one stent-grafts were installed in 75 patients successfully without operation related dissection. Endoleakage immediately after stent-graft deploying was evidenced in 25 patients and disappeared after stent placements (n = 6) or balloon dilation (n = 19). Two patients died from aortic rupture within 2 days after procedure. Iliac artery was torn in a female patient with Ehlers-Danlos syndrome, this patient developed hemorrhagic shock after stent-graft placement and recovered after anti-shock treatments and iliac artery replacement with synthetic artery. During the follow-up of 1 - 24 months, 2 patients (including the woman with Ehlers-Danlos syndrome) suddenly died half a year after procedure. The remaining patients were alive and well. Repeat CT during follow up showed that reduced lumen size and thrombosis in the false lumen. There was no aortic rupture, endoleak and stent migration during the follow-up period except descending aortic dissection distal of the stent-graft in 1 patient 1 year after procedure and the patient were successfully treated surgically without complication. CONCLUSIONS: Endovascular repair is a safe and effective treatment for patients with DeBakey III aortic dissection, suitable for old patients with high risk of surgery. Ehlers-Danlos syndrome should be considered in young DeBakey III aortic dissection patients without hypertension. Further studies are warranted on endovascular repair therapy for artery complication of Ehlers-Danlos syndrome.

[Diagnostic value of 64-slice spiral CT coronary angiography for restenosis after bypass surgery].

OBJECTIVE: To assess the accuracy of 64-slice spiral CT in diagnosis of restenosis of coronary artery bypass grafts (CABG) and native coronary arteries in patients after bypass surgery. METHODS: Fifty-eight patients receiving bypass surgery with totally 140 CABG (43 arterial and 97 venous grafts) were examined using 64-slice spiral CT. CABG and all native coronary arteries with a diameter of >1.5 mm were evaluated for the presence of significant stenoses (>50% diameter reduction) in comparison with the results by coronary angiography as the golden standard. RESULTS: Of the 140 CABG examined, 38 were occluded and 104 remained patent, all of which were accurately identified by 64-slice spiral CT. The sensitivity of CT for restenosis detection in the patent graft was 100% (18/18) with a specificity of 95.2% (80/84). In the segmental evaluation of the native coronary arteries, the sensitivity of the CT in identifying significant stenosis in the evaluable segments (90%) was 84% (87/103) with a specificity of 74% (384/518). The accuracy of CT in detecting the presence of at least 1 stenosis in the CABG, distal runoff vessels or nongrafted arteries was 91% (53/58). CONCLUSION: CT allows noninvasive angiographic evaluation of both the native coronary arteries and bypass grafts after bypass surgery.