Abstract:The technique of fenestrated endovascular repair (F-EVAR) is once again a technique evolution in endovascular repair, which allows the endovascular reconstruction of branches of the aorta, and the minimally invasive endovascular therapy for the short-neck and juxtarenal abdominal aortic aneurysm (J-AAA) that previously may not be achieved by conventional approaches. In this paper, the author presents the technical background, current status and limitations of this technique, and deems that F-EVAR can be regarded as a classic in the development of aortic endovascular surgery from both conceptual and technical levels, but its limitations should be understood for proper selection of its indications.

Abstract:

For abdominal aortic aneurysm (AAA), open and endovascular repair are two currently available treatment methods. How to select an appropriate procedure so as to ensure a quick and safe recovery of the patients is now the focus of attention. In this paper, the scenarios that include the indications, preoperative assessment, complications, mortality and survival as well as cost-effectiveness of the two methods are compared, and the importance in rational choice of procedure is discussed. It is pointed out that there should be continual improvement in endovascular techniques while not abandoning the traditional open surgery, and the most suitable procedure for the patients should be based on the surgeon's skills and prevailing conditions, rigorously following the surgical indications and objective evaluation with the purpose of achieving the greatest benefit for the patients.

Abstract:

Ruptured abdominal aortic aneurysm (rAAA) is characterized by a rapid onset, severe progression and high mortality and so far, open repair is still the predominant procedure for rAAA. In this paper, the author discusses the prevention and management of perioperative complications in open repair for rAAA, from three aspects: diagnosis, intraoperative considerations and postoperative management. It is pointed out that equal attention must be paid to both prevention and treatment of the complications of rAAA. The emphasis of prevention is placed on improving diagnosis, reducing blood loss, decreasing the time to aortic occlusion and maintaining hemodynamic stability; the essential strategy for treatment is based on early detection, ascertaining the causes and eliminating predisposing factors, and relieving symptoms.

Abstract:

Objective: To evaluate the clinical efficacy of endovascular repair for aortic dissection during third trimester of pregnancy and early postpartum. Methods: The clinical records of 4 patients with pregnancy-related type B aortic dissection who underwent endovascular stent-graft repair were retrospectively analyzed. Of the 4 patients, aortic dissection in 2 cases occurred at 37 weeks of pregnancy, in one case occurred at 2 hours after delivery, and in one case occurred during the early postpartum period; 3 cases were diagnosed with Marfan syndrome (MFS), and the cause in one case was unknown. All patients underwent thoracic endovascular aortic stent-graft repair, and the assistant procedures included balloon dilation of aortic coarctation and insertion of chimney stent-graft into the left common carotid artery. The patients were followed by regular CT angiography monitoring at 1 month, 3 and 6 months after operation. Results: No maternal or child death occurred during the perinatal and follow-up period. One fetus was delivered via vaginal delivery and the other 3 fetuses were delivered by caesarean section. The aortic stent-grafts were successfully implanted in all of the 4 patients, with complete coverage of the primary tear in all cases and intentional coverage of the left subclavian artery in 3 cases, and there were no cases of type I endoleak or stent migration. In one patient with the primary tear located at the opening of the left subclavian artery, the landing zone was extended to the aortic arch and a chimney stent-graft was synchronously inserted into the left common carotid artery, and type II endoleak devolped after operation, which disappeared within the 11-month period of follow-up. The average follow-up time was 17.5 months, during which time, all the newborns survived, and one of them had neonatal jaundice that disappeared 12 d after delivery. Conclusion: Endovascular stent-graft repair has demonstrable short- and mid-term efficacy in treatment of type B aortic dissection during late trimester of pregnancy and early postpartum period. However, the timing and indications for repair should be determined with integrated consideration of the period of pregnancy and the clinical status of the patients.

Abstract:

Objective: To investigate the prevention and treatment of endoleak by summarizing our experience of endovascular aneurysm repair. Methods: The clinical data of 43 patients with infrarenal abdominal aortic aneurysm undergoing endovascular repair (EVAR) from January 2007 to December 2012 in Qilu Hospital and Laiwu-Steel Company Hospital were analyzed retrospectively. The causes, prevention and treatment of endoleak were analyzed. Results: Pimary endoleak after intervention occurred in 11 patients, of whom, 8 cases were type I, 1 case was type II, and 2 cases were type III; 9 cases underwent bifurcated stent-graft implantation and 2 cases underwent tubular stent-graft implantation. The one type II endoleak was not treated because the leak was small; after first-stage balloon dilatation or stent-graft implantation 2 cases of type I endoleaks still existed, but all the other type I and III endoleaks were resolved. Thirty-nine patients were followed up. During the period of 4 to 50 months of follow-up, 2 delayed type Ib and 2 delayed type II endoleaks were found, but the aneurysms did not enlarge during the following 1- to 2-year follow-up period. The residual primary endoleak in 3 cases spontaneously disappeared, but type Ia endoleak recurred in 1 case 6 months after operation, which caused the aneurysm recurrence and rupture and a second endovascular repair. Conclusion: The occurrence of endoleak is related to anatomic condition, stent defects and surgical skill. Prevention and treatment of endoleaks require a good grasp of surgical indications, reasonable choice of stent, and mature operating experience.

Abstract:

Objective: To assess the efficacy and short- and mid-term results of endovascular surgery and hybrid surgical procedures in treatment of complex aortic pathology. Methods: The clinical data of 53 patients with complex aortic diseases admitted from April 2003 to December 2012 were retrospectively analyzed. Of the patients, 39 cases were male and 14 cases were female, and their ages ranged from 31 to 82, with an average age of 55 years; 35 had aortic dissection, 2 cases had aortic arch aneurysm, and 16 cases had abdominal aortic aneurysm; 5 cases were complicated with iliac artery aneurysms. Different endovascular techniques, and/or hybrid procedures were performed in these patients. Results: The technical success rate was 100% for the entire group of patients. Type I endoleak occurred in 8 patients immediately after stent-graft placement, which in 2 cases disappeared after a proximal Cuff placement, and in the remaining cases required no special treatment. Follow-up was conducted for 1 month to 72 months, with an average of 20.2 months, and no stent-graft migration or organ ischemia was noted. In the follow-up patients, no type I endoleak occurred but type II endoleak was found in 2 cases, which resolved without treatment; no patient had paraplegia, but one elderly patient with abdominal aortic aneurysm died one month after operation due to asphyxia resulting from viscous sputum. Conclusion: Endovascular surgery and hybrid procedures have demonstrable short- and mid-term efficacy in treatment of complex aortic diseases. Their long term efficacy, however, needs further evaluation.

Abstract:

Objective: To investigate the imaging characteristics, causes and treatment of Stanford type B acute aortic dissection with proximal false lumen thrombosis. Methods: A retrospective analysis of clinical and follow-up data was performed in 6 patients, who were admitted between January 2010 and October 2012 in the department of vascular and endovascular surgery of the first affiliated hospital of Zhengzhou university, and diagnosed as Stanford type B acute aortic dissection with thrombus formation in the proximal false lumen that was confirmed by CT angiography over 64 slices. Results: All the 6 patients were discharged from hospital after 2- to 4-week conservative medical treatment. Dynamic CTA review, during the follow-up period of 6 months to 2 years, showed that the thrombi in the false lumen were gradually formed and gradually absorbed in a proximal to distal order. Conclusion: Stanford B acute aortic dissection with proximal false lumen thrombosis is in hemodynamically stable status and requires no performance of endovascular aortic repair (EVER). Conservative medical treatment is the first appropriate option for this condition under the premise of close follow-up with imaging assessment.

Abstract:

Objective: To compare the perioperative efficacy of endovascular and open repair for AAA by means of systematic review. Methods: The literature of randomized controlled trials (RCTs) comparing endovascular and open repair for AAA was collected by searching the national and international databases. Meta-analysis was performed by using Revman 5.1 software. Results: Seven randomized controlled trials with 8 reports were included, which involved a total of 2?807 patients, of whom 1 433 cases underwent endovascular repair (endovascular group) and 1 374 cases underwent open surgery (open surgery group). Results of Meta-analyses showed that in endovascular group compared with open surgery group, the operative time and volume of intraoperative blood transfusion was reduced (SMD=–0.87, 95% CI=–1.43––0.31, P=0.002; SMD=–0.83, 95% CI=–0.94––0.72, P<0.00001), the length of postoperative stay in ICU and hospital was shortened (MD=–38.11, 95% CI=–48.61––27.61, P<0.00001; MD=–5.11, 95% CI=–6.26––3.95, P<0.00001), and number of 30-day postoperative death was decreased (OR=0.30, 95% CI=0.16–0.55, P=0.0001). Conclusion: Endovascular repair has the perioperative advantages of minimal trauma, reduced blood loss and quick postoperative recovery versus open surgery, but its long term results still need further observation.

Abstract:

Objective: To investigate the role of osteoprotegerin (OPG) expression in occurrence and development of the abdominal aortic aneurysm (AAA). Methods: Twenty AAA tissue and 6 normal human abdominal aortic tissue samples were collected, and animal AAA model was created in rabbits using a patch technique (18 AAA rabbits were sacrificed to obtain tissue sample at 7, 21 and 35 d after model creation, respectively, with 6 rabbits undergoing sham operation as control). The OPG protein expressions in human AAA and normal human abdominal aortic tissues were detected by immunohistochemical staining, the protein and mRNA expressions of OPG and matrix metalloproteinase 9 (MMP-9) in the above human tissues and AAA tissues from animal models were measured by Western blot and RT-PCR method respectively, and the apoptosis of the vascular smooth muscle cells (VSMCs) in the tunica media of the AAA tissues from animal models was also determined by terminal transferase dUTP nick end labeling (TUNEL) assay. Results: The results of immunohistochemistry showed that OPG expression in human AAA tissue was increased compared with healthy abdominal aortic tissue, which became more evident with the increasing diameter of the aneurysm and was most evident in the ruptured AAA. Results of Western blot and RT-PCR demonstrated that the protein and mRNA expressions of both OPG and MMP-9 in the tissues from either the AAA biopsies or animal models were significantly higher than those in their controls (P<0.05), and the increases were progressive with the increasing diameter of the aneurysm and time duration after model creation. TUNEL assay showed that the apoptosis of VSMCs in model group was significantly increased versus control group with a growing trend towards prolonged period of model creation. Conclusion: OPG expression level is closely connected to the occurrence and development of AAA, and the mechanism may be associated with its stimulating MMP-9 activity and inducing apoptosis of VSMCs.

Abstract:

Objective: To establish a rat model of abdominal aortic aneurysm (AAA) that has high success rate and consistent with the pathological features of human AAA. Methods: Twenty SD rats were randomized into model group and control group. Rats in model group underwent pressurized infusion of porcine pancreatic elastase into a segment of the infrarenal aorta via catheterization of the left common iliac artery (a series of improvements were made during operation), while rats in control group were infused with normal saline in the same fashion. The size of the infused abdominal aortic segments of the two groups was measured by color ultrasound before and at 7 and 14 d after operation, and samples of the infused abdominal aortic segments were also obtained at 14 d after operation for elastic fiber staining. Results: The ultrasonic examination showed that the size of the infused abdominal aortic segments in control group had no obvious change at 7 and 14 d after operation, but was greatly increased in model group, and the success rate of model construction was 100%. On 14 d after operation, the cross-sectional area was (5.17±0.61)- and (1.03±0.09)-fold of that before operation in model group and control group, respectively, and the difference between the two groups had statistical significance (P<0.001). The results of elastic fiber staining showed that the elastic tissues in the media of the infused artery were severely damaged, and relative content of arterial elastic fibers in model group was significantly lower than that in control group (P<0.001). Conclusion: Through improved procedures, a rat model with high success rate and typical pathological characteristics of AAA has been well established, which may provide an ideal experimental model for basic research of AAA.

Abstract:

Objective: To investigate the relations of the c-met expression level in hepatocellular carcinoma (HCC) tissue with the postoperative recurrence and survival of HCC patients. Methods: The expression levels of c-met protein in the tissue samples from preoperative liver needle biopsy and surgical excision specimens of 64 HCC patients undergoing hemihepatectomy (surgical treatment group), as well as in the samples from preoperative liver needle biopsy of 30 HCC patients who received transcatheter arterial chemoembolization (TAE) (TAE group) were detected by Western blot analysis. The c-met expressions between the patients relapsing within and beyond one year in surgical treatment group were compared. Based on the mean c-met expression value obtained from the results in preoperative liver needle biopsy of all patients, the patients in both surgical treatment group and TAE group were stratified into low c-met (≤ mean value) and high c-met (> mean value) subgroups, and then, the one-year recurrence rate, time to recurrence and incidence of cancer embolus between the subgroups of surgical treatment group were compared, and the post-treatment survival among the 4 subgroups in surgical treatment group and TAE group were also compared. Results: In surgical treatment group, the measured values of c-met expression between the specimens obtained by preoperative needle biopsy and surgical resections were consistent, and the c-met expression level in patients who relapsed within one year was higher than those who relapsed beyond one year, and further, the recurrence rate and incidence of cancer embolus was higher, and time to recurrence was shorter in high c-met subgroup than those in low c-met subgroup, and all differences had statistical significance (all P<0.05). The postoperative survival in low c-met subgroup of surgical treatment group was better than that in its higher c-met subgroup and low or high c-met subgroup in TAE group (all P<0.05), but no statistical difference was seen among the latter three subgroups (all P>0.05). Conclusion: The c-met expression level is closely related to postoperative recurrence and survival of HCC patients, and those with low c-met expression may have a better outcome. Thus, it suggests that c-met detection can be used as postoperative prognostic indicator for HCC, and preoperative needle biopsy is a feasible approach for obtaining the specimen.

Abstract:

Objective: To investigate the regulatory effect of miR-193b on urokinase-type plasminogen activator (uPA), which was selected according to target gene predictions, in stomach cancer cells and the mechanism. Methods: Gastric cancer BGC823 cells were transiently transfected with the miR-193b sense sequence (sense sequence transfection group), miR-193b antisense sequence (antisense sequence transfection group) and scrambled sequence (negative transfection group) respectively, with the untransfected BGC823 cells as a blank control. In each group of cells, the expression levels of miR-193b were detected by real-time PCR, and the mRNA and protein expressions were determined by RT-PCR and Western blot analysis, respectively. Results: Compared with blank control group, the miR-193b expression in negative transfection group had no obvious change (P>0.05), while it was significantly increased in sense sequence transfection group and significantly decreased in antisense sequence transfection group (both P<0.05); the uPA mRNA expression levels in all transfection groups had no obvious change; the uPA protein expression in negative transfection group showed no apparent change, but it was reduced in sense sequence transfection group and increased in antisense sequence transfection group. Conclusion: uPA may be the target gene of miR-193b; miR-193b may negatively regulate its expression through inhibition of its post-transcriptional translation, and thereby enhance the invasiveness of gastric cancer cells.

Abstract:

Objective: To investigate the significance of CYP2C19 gene polymorphism determination in optimizing antiplatelet therapy for patients with arteriosclerosis obliterans (ASO) of the lower extremities. Methods: Eighty ASO patients scheduled for lower extremity bypass surgery or procedures of interventional balloon dilation plus stent placement were enrolled and randomly designated to either study group or control group, and genotyping for the polymorphic alleles of CYP2C19*2 and CYP2C19*3 was performed in all patients. Patients in control group were treated with aspirin plus clopidogrel regimen, while in study group, patients with extensive metabolizer phenotypes received aspirin plus clopidogrel regimen and those with poor metabolizer phenotypes were given aspirin plus clopidogrel and sarpogrelate regimen according to the results of genotyping. The occurrence of clopidrogrel resistance in the two groups of patients was observed and compared. Results: The incidence of clopidrogrel resistance in the entire group was 38.75% (31/80), and the occurrence of clopidrogrel resistance showed no association with age, sex, or concomitant diseases of the patients, or with other drug administration (all P>0.05). The incidence of clopidrogrel resistance in extensive metabolizers was 33.33% in study group and 37.93% in control group respectively, which showed no statistical difference (P=0.469); whereas, the incidence of clopidrogrel resistance in poor metabolizers was 23.07% in study group and 72.73% in control group respectively, where the difference reached statistical significance (P=0.017). Conclusion: Among patients with lower-extremity ASO requiring long-term clopidogrel therapy, sarpogrelate addition can effectively reduce the incidence of clopidogrel resistance for those with poor metabolizer phenotypes classified by CYP2C19 genotyping assay.

Abstract:

Objective: To compare the clinical efficacies of integrated interventional therapy and systemic thrombolytic treatment for mixed type of acute lower extremity deep venous thrombosis (DVT). Methods: The clinical data of 458 patients with acute mixed type of lower extremity DVT admitted over 12 years were retrospectively analyzed. One-hundred and twenty-two patients (group A) underwent the integrated interventional therapy that comprised thrombus aspiration and thrombolysis, 53 cases who were complicated with iliac vein compression or obstruction received the auxiliary procedures of percutaneous transluminal angioplasty (PTA) and stent placement, and the other 107 patients (group B) received systemic thrombolytic therapy with urokinase and heparin. Results: The average length of hospital stay for patients in group A was (6.2±2.2) d and in group B was (6.2±2.2) d; the cure rate and effective rate reviewed 2 weeks later in group A was 40.98% and 14.02%, and in group B was 96.72% and 77.57%, respectively, and all differences between the two groups had statistical significance (all P<0.05). During 12–85 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; the incidence of edema, skin pigmentation, and ulceration was 23.15%, 9.26% and 0 in group A, and 50.51%, 80.81% and 9.09% in group B; the rates of vein patency and normal venous valve function were 81.48% and 57.41% in group A, and 65.66% and 15.15% in group B, respectively, and all the differences between the two groups had statistical significance (all P<0.05). Conclusion: Integrated interventional therapy has better short- and mid-term efficacy than systemic thrombolytic therapy for acute mixed type of lower extremity DVT, especially in the aspect of venous valves protection.

Abstract:

Objective: To compare the efficacy of endovenous microwave ablation (EMA) and conventional stripping operation for primary lower limb varicosities. Methods: The clinical data of 170 patients with primary lower limb varicosities were retrospectively analyzed. Of the patients, 110 cases underwent high ligation of the great saphenous vein plus EMA treatment (EMA group), while, the other 60 cases were subjected to the conventional procedure (conventional group). The clinical variables that included operative time, intraoperative blood loss, time to ambulation, length of postoperative hospital stay, complications and clinical efficacy between the two groups were compared. Results: Compared with conventional group, the operative time, intraoperative blood loss, time to ambulation, length of postoperative hospital stay, and incidence of postoperative complications (skin burns, subcutaneous extravasation of blood, poor wound healing and localized paresthesia) in EMA group were reduced, and all differences had statistical significance (all P<0.05). There was no statistical difference with regard to the incidence of postoperative deep venous thrombosis and clinical efficacy (local recurrence, and pigmentation) between the two groups (all P>0.05). Conclusion: High ligation plus EMA for primary lower limb varicosities effectively combines the advantages of both conventional operation and microwave therapy. It is minimally invasive, safe, and effective.

Abstract:

Objective: To observe the short- and mid-term efficacy of different durations of anticoagulant therapy for isolated calf muscle vein thrombosis (ICMVT). Methods: The clinical data of 154 ICMVT patients admitted over the past 4 years were analyzed. Results: Of the 154 patients, the mean age was (52.02±11.23) years, and 69 cases were male and 85 cases were female, with a total of 168 limbs. The diagnosis for all patients was confirmed by duplex ultrasound (DUS). The duration of anticoagulant therapy was 1 month for 52 patients, 3 months for 48 patients, and 6 months for 54 patients, respectively, and compression stockings were used simultaneously in all patients. Results of the followed-up DUS examination at 6 months after treatment showed that the therapeutic effects among the 3 groups had no statistical difference (P>0.05). In the entire group of patients, no pulmonary embolism was noted, hemorrhagic events occurred in 5 cases, and deep venous thrombosis (DVT) developed in 2 cases; DVT or recurrence was found in 14 cases during the period of 6 to 18 months after discontinuance of anticoagulant therapy. Conclusion: The short- and mid-term efficacies of different duration of anticoagulant therapy for ICMVT patients are similar, and their long-term efficacies, however, require further determination.

Abstract:

Objective: To investigate the quality of life after non-surgical treatment of patients with lower extremity deep vein thrombosis (DVT) during a short period of observation. Methods: Fifty eligible lower extremity DVT patients were enrolled. Using SF-36 Health Survey Scale, the scores for 8 subscales of health dimensions that included physical functioning (PF), general health (GH), physical role (RP), emotional role (RE), social functioning (SF), bodily pain (BP), vitality (VT), and mental health (MH), were determined and compared in these patients before and at different time points (1 month, 2, 3, and more than 4 months) after treatment. Results: The base-line data of the patients were evenly distributed and comparable at different stages, average follow-up time was (3.82±1.84) months, and the overall Cronbach’s α coefficient for the scale was 0.8652. Of the patients, the scores for the 8 dimensions were all statistically different before and after standard treatment (all P<0.001), in which the scores at different stages after treatment were significantly higher than those measured before treatment, and were gradually increased with time prolongation. Except for the scores for PF dimension that were statistically different between the stages of 1 month and more than 4 months after treatment (P=0.01), all scores for the 8 dimensions showed no statistical difference (all P>0.05). Conclusion: In a short period after non-surgical treatment of lower extremity DVT patients, their quality of life can be markedly improved and then reach a plateau, and can even restore to a healthy condition. So, the inflection point in quality of life of these patients may be at any time beyond the first 4 months after treatment.

Abstract:

Objective: To investigate the method and efficacy of surgical treatment of femoral artery pseudoaneurysms secondary to injection of illicit drugs. Methods: Clinical data of 45 patients with femoral artery pseudoaneurysm caused by injection of addictive drugs were retrospectively analyzed. Of the patients, 27 cases underwent vascular reconstruction that included 20 cases of ePTFE prostheses transplantation, 4 cases of autogenous great saphenous vein transplantation, and 3 cases of endovascular covered stent exclusion, and another 18 cases were only subjected to triple ligation of the femoral artery. Results: Limb salvage was achieved in all patients. Among the patients undergoing simple vessel ligation, 3 cases developed intermittent claudication at 6 months, 2 and 3 years after surgery, and 2 cases presented limb amyotrophy and weakness at 1 year and 2 years after surgery, respectively. Among the patients undergoing vascular reconstruction, prosthetic infection occurred in 1 case and postoperative hemorrhage occurred in 4 cases shortly after surgery. Conclusion: Procedures of pseudoaneurysm resection plus extra-anatomic prosthetic bypass should be performed when the patients’ general condition permits, and triple ligation of the femoral artery is a feasible approach for patients with poor general conditions and unable to tolerate operation, or with severe local infection, but the long-term complications such as amyotrophy should be considered. Endovascular covered stent exclusion is applicable to those with no evidence of infection and/or rupture.

Abstract:

Objective: To investigate the value of temporary intravascular shunt (TIVS) in management of vascular injuries. Methods: The clinical data of patients who had vascular injuries undergoing TIVS from June 2006 to June 2013 were reviewed. Results: The entire group comprised 5 patients with total of 9 injured limb vessels (injuries in 3 cases were caused by trauma and in 2 cases occurred during tumor resection surgery). In the 5 patients, a total of 8 TIVS tubes were inserted into the injured vessels (5 arteries and 3 veins) for rapid revascularization of the limb, and then wound debridement and fracture management procedures were performed. The shunt time was 2 to 3 h, and all patients underwent autologous saphenous vein grafting for vessel reconstruction after the TIVS tubes were removed. No death occurred in the whole group; one case had ischemic contracture and one case developed venous thrombosis after operation. Conclusion: TIVS allows rapid revascularization of the injured limb, and shortens its ischemic time that provides opportunities for the management of other associated injuries.

Abstract:

Objective: To investigate the influence of FOLFOX (oxaliplatin, leucovorin and 5-fluorouracil) regimen plus radiotherapy on the efficacy of surgical treatment of locally advanced colorectal cancer and postoperative recurrence. Methods: The clinical data of 64 patients with locally advanced colorectal cancer treated over the past 3 years were retrospectively analyzed. Of the patients, 30 cases underwent surgical treatment alone (control group), and 34 cases were subjected to preoperative radiotherapy and FOLFOX chemotherapy (observational group). The tumor resection rate, anal preservation rate, postoperative complications, and tumor recurrence between the two groups were compared, and the relationship between the preoperative CEA concentration in patients and their postoperative recurrence were also analyzed. Results: Thirteen patients in control group and 28 patients in observational group had complete tumor excision, and 4 cases in control group and 11 cases in observational group underwent low colorectal anastomosis, respectively, and the differences reached statistical significance (P=0.001 and P=0.034). The incidence of postoperative complications and 3-year cumulative recurrence rate between the two groups showed no statistical difference (P=0.54 and P=0.76), but the 1- and 2-year recurrence rate in observational group were significantly lower than those in control group (P=0.001 and P=0.025). The postoperative CEA level was significantly lower than that before surgery in patients undergoing tumor resection (P<0.01), and there was a negative correlation between preoperative CEA level and time to tumor recurrence (r2=0.26, P=0.0013). Conclusion: Preoperative neoadjuvant therapy can improve tumor resection and anal perseveration rate, and reduce the 2-year recurrence rate in patients with locally advanced colorectal cancer, and not increase the surgical complications; those with high preoperative CEA level are more likely to have an early recurrence.

Abstract:

Objective: To investigate the alteration of circulating DNA level in colorectal cancer patients before and after surgery and its clinical significance. Methods: The circulating DNA levels in 42 patients with colorectal cancer were detected before and on 3, 14 and 30 d after surgery, and the circulating DNA levels in 14 healthy subjects undergoing health maintenance examination during the same period were determined as control. Results: The preoperative circulating DNA level in colorectal cancer patients was significantly higher than that in healthy subjects [(92.25±46.88) ng/mL vs. (22.14±16.16) ng/mL] (P<0.01), and the preoperative circulating DNA level in colorectal cancer patients showed no significant difference between or among the groups stratified by age, sex and tumor location (P=0.293, P=0.244 and P=0.135). In colorectal cancer patients, the circulating DNA level on postoperative day (POD) 3 reached (114.95±62.41) ng/mL, which was significantly higher than that before surgery (P<0.01), but on POD 14 and 30 it was (38.50±37.71) ng/mL and (31.69±41.48) ng/mL respectively, and both were significantly lower than that before surgery (both P<0.01). Conclusion: The circulating DNA level is elevated in colorectal cancer patients, and it is further increased transiently in early postoperative stage and then markedly decreased. It may probably be used as an indicator for postoperative tumor status and efficacy evaluation in these patients.

Abstract:

Vascular remodeling is an important process in the occurrence and development of aortic dilatation disease, in which the immune cell-mediated immunological inflammatory response plays a crucial role. Here, the authors address the mechanisms of the participation of mast cells (MCs) in the pathogenesis of aortic vascular remodeling, chiefly involving their participation in the aortic wall inflammation, influence on the synthesis and degradation of extracellular matrix, and activation of renin angiotensin system (RAS), as well as their relation to angiogenesis. Finally, we put forth the possible direction for future research in this field.

Abstract:angioplasty has satisfactory short-term efficacy in treatment of LASO, but the mid- and long-term restenosis rate is still high. Given that the inflammatory reaction is involved in the entire process of arteriosclerosis, it is important to study the effect of inflammation on the postoperative condition of LASO and the predictive effect of inflammatory factors on risk of restenosis, as well as how to reduce restenosis after endovascular treatment via the control of the inflammatory response. This paper presents the research progression in this field.