Abstract:

Objective: To investigate the diagnosis and treatment strategy of spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Methods: The clinical data of 15 patients with SIDSMA undergoing endovascular stent placement from January 2008 to December 2010 were retrospectively analyzed. Results: None of the 15 patients had complication of rupture/hemorrhage of the dissection or bowel infarction. Of the patients, single layer stents were deployed in 12 cases, and overlapping stents were deployed in 3 cases. A total of 18 stents (2 balloon expandable stents and 16 self-expandable stents) were deployed. Fourteen (93.3%) patients had relief of symptoms, one (6.7%) patient’s symptoms remained unchanged, and no death or severe complications such as intestinal infarction, abdominal bleeding, cardiac infarction, cerebrovascular accident, renal failure, gastrointestinal tract hemorrhage or pneumonia occurred after operation or during follow-up. The average length of hospital stay and follow-up was 3 d (2–7 d) and 11 months (6–23 months), respectively. All of the 15 patients underwent CTA examination 6 months later, and the results showed that the stent patency rate was 100% and one (6.7%) patient developed a new dissection distal to the stent. Conclusion: For SIDSMA patients without rupture/hemorrhage or bowel infarction, endovascular stent placement is a feasible, minimally invasive and effective treatment option.

Abstract:Objective: To evaluate the safety and efficacy of bare stent placement for the isolated visceral artery dissection. Methods: Within May 2008 to March 2012, 6 patients with visceral artery dissection underwent endovascular treatment with bare stents. Of the patients, 5 cases were superior mesenteric artery dissection (SMAD) and one case was celiac artery dissection. The intimal tears and dissecting aneurysms were covered and occluded with single or overlapping double bare stent placement, respectively. Results: All of the 6 patients underwent successful operation without any complications. In the patient with celiac artery dissection and one SMAD patient, the false lumen diminished immediately after overlapping double bare stent placement. In the other 4 patients, the true lumens remained patent and false lumens became occluded as revealed by CT or color Doppler examination 3 months after single or overlapping double bare stent placement. Conclusion: Endovascular management with single or overlapping double bare stent placement is a feasible, safe and effective approach for the visceral artery dissection.

Abstract:Objective: To investigate the prognostic impact of coverage of the left subclavian artery (LSA) without prior revascularization during thoracic endovascular aortic repair (TEVAR). Methods: The clinical data of 76 patients with thoracic lesions undergoing TEVAR between June 2007 and January 2012 were retrospectively analyzed. The lesions comprised aortic dissection (56 cases), intramural hematoma (6 cases), thoracic aneurysm(5 cases) and traumatic rupture of the thoracic aorta (9 cases). Of the patients, 32 cases underwent TEVAR with complete LSA coverage, 9 cases with partial LSA coverage and 35 cases without LSA coverage. The clinical outcomes and complications of the patients were analyzed . Results: One patient (1.3%) died of acute stroke during perioperative period. Of the 32 patients with LSA coverage, cerebrovascular accident occurred in 3 cases (9.4%), left upper extremity claudication developed in 4 patients (12.5%) and left subclavian steal syndrome appeared in one case (3.1%). The follow-up ranged from 3 to 40 months, during which one patient died, and type I endoleak occurred in 2 patients and was resolved by a second surgical intervention. Conclusion: Selective primary LSA coverage during TEVAR is practicable.

Abstract:Objective: To compare the incidence of pulmonary embolism (PE) in cancer and non-cancer patients with lower extremity deep vein thrombosis (DVT). Methods: The clinical data of 128 patients with lower extremity DVT admitted in recent years were retrospectively analyzed. The patients were divided into cancer group (16 cases) and non-cancer group (112 cases), and the incidences of symptomatic PE between the two groups during hospitalization and follow-up period were compared, respectively. Results: During hospitalization (7–14 d), the incidence of symptomatic PE in cancer group and non-cancer group was 25.0% and 2.7% respectively, and the difference had statistical significance (P=0.005). During follow-up period (6–60 months), two cases in cancer group and 8 cases in non-cancer group were lost to follow-up, and one case in each group developed PE (8.3% vs. 0.89%) and died, and the difference had no statistical significance (P=0.185). Conclusion: The incidence of PE is increased in cancer patients with lower extremity DVT.

Abstract:Objective: To investigate the alteration and tendency of bodily pain (BP) in patients with lower extremity deep vein thrombosis (DVT) during a short-term observation following standard non-surgical treatment. Methods: The scores of BP dimension in SF-36 scale in 57 patients admitted from March 2009 to October 2011 and fulfilled the inclusion criteria were measured by questionnaire. Measurements were performed before and 1, 2, 3 and ≥4 (4–8) months after treatment, respectively. Information database of the patients was established by EPidata 3.1 software, and then their BP alterations as well as the influence exerted by wearing compression stockings during the short-term period after non-surgical treatment were analyzed using SPSS 12.0 statistical software. Results: Finally, 50 patients were eligible and entered the database. The distributions of age (P=0.997), nationality (P=0.477) and sex (P=0.989) of the patients at different observation time points with different number of enrolled cases were relatively even and comparable. BP dimension scores of the patients were significantly different before and after standard non-surgical treatment (P<0.001), but had no significant differences were found among the different observation time points after treatment in any pairwise comparison (all P>0.05). Whether wearing the compression stockings or not had no obvious influence on the alteration trend of BP dimension scores of the patients after treatment. Conclusion: After the non-surgical treatment, the BP of the DVT patients is improved and transits into a stable phase, on which the wearing of compression stockings seems to exert no impact.

Abstract:

Objective: To compare the clinical efficacies of large-lumen catheter thrombus aspiration and thrombolytic treatment for mixed type of acute lower extremity deep venous thrombosis (DVT). Methods: The clinical and follow-up data of 458 patients with acute mixed type of lower extremity DVT admitted over 11 years were retrospectively analyzed. Of the patients, 327 cases (group A) underwent large-lumen catheter thrombus aspiration, and the other 131 cases (group B) received systemic thrombolytic therapy with urokinase. Results: No severe complication occurred in group A during operation, while in group B, life-threatening bleeding occurred in 2 patients during thrombolytic therapy. The average length of hospital stay for patients in group A was 6.5 d and in group B was 9.5 d (P<0.05), and the cure rate in group A and group B was 94.8% and 37.4%, respectively (P<0.05). During 36–48 months follow-up period, the difference between the diameter of the two legs at 15 cm below knee joint was (0.53±0.42) cm in group A and (1.42±1.35) cm in group B (P<0.05); the incidence of edema, skin pigmentation, and ulceration were 27.83%, 13.15% and 0 in group A, and 55.73%, 83.97% and 9.16% in group B, respectively (all P<0.05); the vein patency rate and rate of normal functioning valves were 90.83% and 73.09% in group A, both of which were significantly higher than those in group B (37.41% and15.27%) (both P<0.05); the overall effective rate in group A and group B was 100% and 71.76%, respectively (P<0.05). Conclusion: Large-lumen catheter thrombus aspiration has better efficacy than thrombolytic therapy for acute mixed type of lower extremity DVT, especially in the aspect of venous valves protection.

Abstract:Objective: To investigate the clinical efficacy of subfascial endoscopic perforator vein surgery (SEPS) in treatment of lower extremity venous ulcers (venous leg ulcers, VLU). Methods: The clinical data of 70 patients (76 affected legs) with chronic venous insufficiency (CVI) of lower limb admitted within three and a half years were retrospectively analyzed. According to CEAP clinical classification, 38 cases (41 affected legs) were classified as stage C4, 18 cases (18 affected legs) as C5 and 14 cases as C6, respectively. Of the patients, 18 C4 cases (18 affected legs) underwent high ligation and short segment stripping of the greater saphenous vein (traditional group), and all of the other cases underwent SEPS procedure combined with high ligation and short segment stripping of the greater saphenous vein (SEPS group). The CEAP clinical scores of the affected legs before and after operation, and ulcer healing time and recurrence of the affected legs were analyzed. Results: In the patients of SEPS group, the varicosities disappeared after surgery, dull ache and heavy sensation of the affected leg were gradually alleviated, and local itching and ulcer wound surface pain were relieved; the pigmentation and induration in the area of healed ulcerations were obviously improved, and dermatitis disappeared in C5 patients; the active ulcers in the gaiter area in C6 patients healed within 10–60 d (average of 47.3 d) after surgery; the postoperative CEAP clinical scores of the affected legs were all lower than those before surgery (all P<0.05), and no recurrence was seen during the follow-up period (average of 15 months). No significant differences were noted in the clinical scores between the C4 patients who underwent SEPS and no SEPS (all P>0.05). Conclusion: SEPS is an effective treatment method for severe low limb CVI with VLU.

Abstract:Objective: To compare the clinical efficacies between encircling constriction of superficial femoral vein and simple superficial vein stripping in treatment of valve incompetence of the lower limb deep veins. Methods: Forty-eight patients with lower limb deep venous valve insufficiency and varicose veins admitted from March 2010 to January 2011 were randomly assigned to observation group (undergoing encircling constriction of superficial femoral vein combined with high ligation and stripping of the great saphenous vein) and control group (receiving high ligation and stripping of the great saphenous vein only). The inner diameter and average blood flow velocity of the common femoral vein and venous reflux time in response to Valsalva maneuver of the patients in the two groups were measured by color Doppler sonography before and after operation. Results: Compared with the data before operation, the function of venous valves and hemodynamic state of the patients in both groups were significantly improved after operation, as evidenced by the reduced inner diameter and accelerated average blood velocity of the common femoral vein and shortened venous reflux time (all P<0.05). However, the changing amplitudes of the above three variables before and after operation in observation group were all significantly greater than those in control group (all P<0.05). Conclusion: Both of the encircling constriction technique and simple superficial vein stripping procedures are effective for treatment of lower limb deep venous valve insufficiency, while the efficacy of encircling constriction technique is superior to that of simple superficial vein stripping.

Abstract:Objective: To investigate the effective methods for treatment of the lower leg vascular ulcers caused by mixed vascular etiologies. Methods: Endovascular therapy combined with minimally invasive surgery were performed in 22 patients with mixed vascular ulcers of the lower leg who were admitted from October 2008 to October 2011. The occluded segments of lower limb arteries of the patients were recanalized by balloon dilatation angioplasty and stents implantation, and their lower limb venous incompetences were treated with high ligation and stripping of the great saphenous vein as well as ligation of the perforator veins near the ulcers via small incision, respectively. Results: The ulcers in all of the patients were healed quickly and completely, and the average time of healing was 28 d. The follow-up period ranged from 6 to 28 months, and no recurrence was noted. Conclusion: Combination of endovascular treatment and minimally invasive surgery is effective for treatment of lower leg mixed vascular ulcers, and is recommend for use.

Abstract:Objective: To investigate the effects of let-7a on the migration and proliferation ability of vascular smooth muscle cells (VSMCs) cultured in vitro. Methods: VSMCs were isolated from the thoracoabdominal aorta of rats and then, were cultured and subcultured. Subsequently, the cultured VSMCs were assigned either to let-7a mimics (experimental group) or its negative control (negative control group) transfection using lentiviral expression vector, or no transfection treatment (blank control group). Transfection efficiency was estimated by expression of green fluorescence protein. In the cells of each group, the let-7a expression was detected by real-time PCR method, and the cell migration ability and proliferation status were determined by scratch test and CCK-8 assay, respectively. Results: Fluorescence microscopic observation revealed that the cell transfection efficiency reached more than 85%. Real-time PCR results showed that the let-7a expression was significantly higher in VSMCs of experimental group than that of either negative control group or blank control group (both P<0.01). The results of cell scratch test and proliferation measurement demonstated that both the migration and proliferative ability of the cells of experimental group were significantly decreased compared with those of negative control group and blank control group (all P<0.01), while all of the above parameters showed no obvious differences between negative control group and blank control group (all P>0.05) Conclusion: Let-7a has inhibitory effect on migration and proliferation of VSMCs cultured in vitro.

Abstract:

Objective: To assess the arterial intimal changes of rats, which were injured with intra-arterial injection of distilled water and fed with high-fat diets, for a further understanding of the pathogenesis of arteriosclerosis obliterans. Methods: After distilled water was injected into the left side of femoropopliteal artery form the non-mechanical, superficial injury, rats were fed with high-fat diets. At 7, 15, 30 and 90 d after the intimal injury, the femoropopliteal artery of the left hind limb was excised. HE and other staining were performed, and the results were observed by light microscope. Results: A large number of endothelial cells exfoliated after 7 d; endothelial cells completely exfoliated after 15 d. Endothelial thickening and lumen stenosis was observed after 30 d and endothelial thickening, partial calcification, thrombus formation and luminal occlusion were noted after 90 d. Conclusion: Injection of distilled water into the femoropopliteal artery of rats, and then fed with high-fat diets can form an arteriosclerosis obliterans model in a relatively short period of time.

Abstract:Objective: To investigate the influence of heat shock protein (HSP70) knock down on the growth of colon cancer cells in nude mice. Methods: Two shRNA plasmid vectors against HSP70 (HSP70 shRNA-1 and HSP70 shRNA-2) were constructed and were transfected into colon cancer HT29 cells respectively, and the empty plasmid transfected (negative control) and untransfected HT29 cells (blank control) served as control. The gene and protein expressions of HSP70 in the cells of each group were determined by RT-PCR and Western blot analysis, respectively. Three groups of xenograft tumor model in nude mice were created by subcutaneous inoculation with HSP70 shRNA-2 transfected, empty plasmid transfected and untransfected HT29 cells respectively, and then the growth of the xenograft tumors was observed. The lumps in the nude mice were stripped off after three weeks and the H&E, immunohistochemical staining and TUNEL assay were performed to determine the morphological condition, proliferating cell nuclear antigen (PCNA) expression and apoptosis in the tumor tissues, respectively. Results: The results of RT-PCR and Western blot showed that the gene and protein expressions of HSP70 in HT29 cells were significantly inhibited by either HSP70 shRNA-1 or HSP70 shRNA-2 transfection, which was more evident in HSP70 shRNA-2 transfected cells. Compared with blank control group, in HSP70 shRNA-2 transfection group, the growth of the xenograft tumor was significantly reduced (P<0.01), marked necrosis in the central area of the tumor was observed, the PCNA expression significantly decreased and apoptosis significantly increased in the tumor tissues (P<0.01), while none of the obvious above changes were noted in empty plasmid transfection group. Conclusion: HSP70 silencing can inhibit the growth and enhance the apoptosis of xenograft tumor of colon cancer HT29 cells in nude mice. HSP70 is probably an effective target for colon cancer.

Abstract:Objective: To investigate the DLC2 protein expression and its correlation with expression of RhoA and prognosis in hepatocellular carcinoma (HCC) patients. Methods: Western blotting and immunohistochemical staining were employed to detect DLC2 protein expression in 128 HCC specimens. The correlation between DLC2 protein expression and clinicopathological characteristics and prognostic value of DLC2 for HCC patients were analyzed. Results: HCC tissues revealed significantly lower level of DLC2 protein than pericarcinomatous liver tissues (PCLT) (P<0.05). There was a significant correlation between underexpression of DLC2 protein and cell differentiation (P<0.05). Meanwhile, underexpression of DLC2 protein was correlated with overexression of RhoA. Furthermore, HCC patients with DLC2-negative expression showed a significantly poorer prognosis than those with DLC2-positve expression. Conclusion: Our data indicates that decreased DLC2 expression in HCC correlates with cell differentiation of HCC and overexpression of RhoA, and underexpression of DLC2 is associated with poor prognosis in HCC patients.

Abstract:Objective: To investigate the relationship between the expression of ribosomal S6 kinase 2 (RSK2) and chemoresistance in hepatocellular carcinoma cells (HCC). Methods: Human HCC HepG2 cells were divided into RSK2 interference group (cells were transfected with PGCsi3.0-RSK2 siRNA plasmid), 5-FU treatment group (cells were treated with 5-FU for 24 h), 5-FU treatment+RSK2 interference group and blank control group. The cell proliferation of each group was determined by MTT assay and the protein expression levels of RSK2, c-Jun, Bcl-2 and LKB1 were detected by Western blot analysis. Results: Compared with blank control group, the RSK2 interference and 5-FU treatment group both significantly inhibited the proliferation of HepG2 cells(both P<0.05). Moreover, the combined effect of RSK2 interference and 5-FU treatment was greater than each alone (both P<0.05). Compared with RSK2 interference group, the protein expression levels of RSK2, c-Jun and Bcl-2 were increased and LKB1 protein level was decreased in cells of 5-FU treatment+RSK2 interference group (all P<0.05). Conclusion: Inhibition of RSK2 expression can enhance the sensitivity of HCC to chemotherapeutic agent 5-FU, and the mechanism may be related to its regulating the expression of c-Jun, Bcl-2 and LKB1.

Abstract:Objective: To analyze Hepatitis B virus (HBV) genotypes and drug resistance mutations among people in Zhangjiakou. Methods: The genotypes and drug resistant mutation of HBV in 98 infected cases of Han nationality in Zhangjiakou were detected by nested quantitative real-time PCR and real-time fluorescent PCR. Results: The main genotypes among the 98 cases in Zhangjiakou were genotype B (29.59%), C (30.61%) and B+C (39.80%). The total mutation rate of YMDD was 58.16% (57/98), among which, YVDD mutation accounted for 61.40% (35/57), and YIDD mutation was 38.60% (22/57). The YMDD mutation rate in genotype B was 21.43% (21/98), C was 33.67% (33/98) and B+C was 44.90% (44/98) respectively, and the difference among them was statistically significant (P<0.05). Conclusion: The main HBV genotypes of Han nationality in Zhangjiakou are genotypes B, C and B+C, and the genotype B+C has the highest YMDD mutation rate after Lamivudine treatment.

Abstract:Objective: To investigate the advantages and disadvantages of three types of autogenous arteriovenous (AV) fistulas for hemodialysis, so as to provide guidance for their clinical application and maintenance. Methods: Sixty-three patients undergoing autogenous AV fistula procedures were divided into snuff-box AV fistula group (20 cases), wrist AV fistula group (25 cases) and elbow AV fistula group (18 cases) according to the type of AV fistula. The incidences of postoperative thrombosis, pseudoaneurysm formation and high-output heart failure, and the average anastomosis diameter and blood flow volume through AV fistula of the three groups were analyzed and compared. Results: In the entire group, postoperative thrombosis developed in 7 patients and their dialysis treatments were continued after removal of the embolus. Of these patients, 5 cases in wrist AV fistula group progressed to fistula failure within one year after operation, and then were switched to perform a contralateral forearm AV or elbow AV. One case each in wrist AV fistula group and elbow AV fistula group developed high-output heart failure which was alleviated by narrowing the anastomotic diameter. Color ultrasound examination one year after operation showed that the AV fistula blood flow of each group was more than 300 mL/min. Comparison among the three groups showed that the incidence of postoperative thrombosis in wrist AV fistula group (5/25) was higher than that in snuff-box AV fistula group (1/20) and elbow AV fistula group (1/18), and the incidence of pseudoaneurysm formation in elbow AV fistula group (7/18) was higher than that in snuff-box AV fistula group (2/20) and wrist AV fistula group (3/25) (all P<0.05), while the incidences of high-output heart failure had no obvious difference among them (P>0.05); the anastomosis diameter and AV blood flow volume in elbow AV fistula group were both higher than those in snuff-box AV fistula group and wrist AV fistula group (all P<0.05). Conclusion: Snuff-box AV fistula should be the first choice for patients with satisfactory vascular access, while elbow AV fistula can be used for those with poor vascular access or with forearm fistula failure.

Abstract:Objective: To compare the safety and efficacy of laparoscopic total colectomy and open resection in treatment of familial adenomatous polyposis (FAP). Methods: The clinical data of 56 patients with FAP admitted from January 2003 to January 2011 were retrospectively analyzed. Patients were divided, according to the procedures, into laparoscopic group (31 cases) and conventional open surgery group (25 cases). The pre-, intra- and postoperative data between the two groups were compared. Results: The general data between the two groups before surgery were comparable (P>0.05). There was no significant difference in intraoperative blood loss between the two groups, and no transfusion was required in any of the groups (both P>0.05). However, laparoscopic procedure took a longer operative time than that in open surgery group (P<0.05). In comparison with open surgery group after operation, the incidence of postoperative complications (0 vs. 24%), number of patients needing analgesics (0 vs. 6), average length of postoperative hospital stay (8 d vs. 14 d), and average daily volume of abdominal drainage (30 mL vs. 100 mL) were all significantly reduced in laparoscopic group (all P<0.05), but there was no difference in time to recovery of gastrointestinal function (P>0.05). At three months after operation, no recurrence was noted in laparoscopic group but it occurred in 3 cases in open surgery group (P<0.05). Conclusion: Laparoscopic total colectomy is safe and effective for treatment of FAP, and it is superior to open surgery in improving patients' quality of life and long term outcomes.

Abstract:Due to the diverse manifestations of aortic dissection and varied specificity and sensitivity of examinations used, its confirmed diagnosis by the existing detection methods is so difficult that the intervention opportunity may be lost. This paper addresses the classification and diagnosis strategy for aortic dissection, so as to provide advices on how to make a prompt diagnosis and develop more specific and sensitive detection, and then give the patients an immediate and effective treatment.

Abstract:Multilayer bare stent can maintain the patency of the branching arteries of the coverage area in endovascular aneurysm exclusion, which solves the problem faced in using a membrane-covered stent. This paper addresses the current status and mechanisms of using multilayer stent for endovascular aneurysm exclusion, as well as the associated problems, so as to provide a basis for its clinical use.

Abstract:From a view of the anatomical relationships between the paraesophageal veins and esophageal veins, the authors have reviewed the related literature and then analyzed the correlations of the paraesophageal veins with the degree of severity and the recurrence of esophageal varices. This paper addresses the related issues, so as to summarize the theoretical basis of the different research findings.

Abstract:In this paper, the authors analyzes the risk factors of the incidence of cerebral infarction following abdominal surgery, which includes the age, surgical trauma and stress, intraoperative hypotension and other factors such as hypercoagulability, and comprehensive treatment and its preventive measures for this condition are also summarized.