The recent shift of the concept of cardiovascular disease as a chronic progressive condition,potentially involving multiple districts,has driven attention to the optimal management of patients with concomitant coronar...The recent shift of the concept of cardiovascular disease as a chronic progressive condition,potentially involving multiple districts,has driven attention to the optimal management of patients with concomitant coronary and peripheral artery disease,representing a subset of patients with an increased risk of events and impaired survival.Recent pharmacological achievements in terms of antithrombotic therapy and lipid-lowering drugs allow multiple therapeutical combinations,thus requiring optimizing the treatment in a tailored fashion according to patients’risk profiles.Nevertheless,data dedicated to this specific subset of patients are still modest.We summarize currently available strategies and indications for the management of antithrombotic and lipid-lowering drugs in patients with the poly-vascular disease.展开更多
Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 t...Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.展开更多
As the number of patients suffering from cardiovascular diseases and peripheral vascular diseases rises,the constraints of autologous transplantation remain unavoidable.As a result,artificial vascular grafts must be d...As the number of patients suffering from cardiovascular diseases and peripheral vascular diseases rises,the constraints of autologous transplantation remain unavoidable.As a result,artificial vascular grafts must be developed.Adhesion of proteins,platelets and bacteria on implants can result in stenosis,thrombus formation,and postoperative infection,which can be fatal for an implantation.Polyurethane,as a commonly used biomaterial,has been modified in various ways to deal with the adhesions of proteins,platelets,and bacteria and to stimulate endothelium adhesion.In this review,we briefly summarize the mechanisms behind adhesions,overview the current strategies of surface modifications of polyurethane biomaterials used in vascular grafts,and highlight the challenges that need to be addressed in future studies,aiming to gain a more profound understanding of how to develop artificial polyurethane vascular grafts with an enhanced implantation success rate and reduced side effect.展开更多
Background:Here we analyzed mid-term data of thoracic endovascular aneurysm repair(TEVAR)surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection(STBAD)involvin...Background:Here we analyzed mid-term data of thoracic endovascular aneurysm repair(TEVAR)surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection(STBAD)involving the left subclavian artery(LSA).Methods:Between April 2014 and February 2019,32 patients with STBAD involving a Castor single-branched stent graft were included.We analyzed their outcomes,including technical success rate(TSR),surgical duration(SD),presence of ischemia,perioperative complications,LSA patency,and survival rate(SR),using computed tomography angiography and clinical evaluation during mid-term follow-up.Results:The mean patient age was 54.63±12.37 years(range,36–83 years).The TSR was 96.88%(n=31/32).The mean SD was 87.44±10.89 with a mean contrast volume of 125.31±19.30 mL.No neurological complications or deaths occurred during the study period.The patients had a mean hospital stay of 7.84±3.20 days.At a mean follow-up of 68.78±11.26 months,four non-aortic deaths(12.5%)were observed.The LSA patency rate was 100%(n=28/28).There was only one case of type I endoleak immediately after surgery(3.12%)(type I from LSA).However,none of the patients experienced type II endoleaks,and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry.Finally,all patients exhibited good LSA patency.Conclusion:TEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.展开更多
Infectious diseases are the common enemies of mankind.In the course of historical development,they persistently threaten human health and safety.Even today,despite the developments in medical science,we cannot escape ...Infectious diseases are the common enemies of mankind.In the course of historical development,they persistently threaten human health and safety.Even today,despite the developments in medical science,we cannot escape the fear and suffering caused by infectious diseases.Whether in ancient or modern times,the source of infection,route of transmission,and a susceptible population are the three key conditions for the prevalence and spread of infectious diseases.All factors closely related to these three conditions can affect the prevalence of infectious diseases.China is one of the cradles of world civilization.The ancient people accumulated a great deal of experience and lessons in the long struggle against infectious diseases.In the face of the current threat posed by widespread infectious disease,it is imperative to review and summarize ancient Chinese ideas and health policies on epidemic prevention and control to inspire contemporary efforts in the prevention and control of infectious disease.The combination of prevention-oriented epidemic prevention ideology and traditional medicine provides valuable insights,especially for impoverished and medically underserved regions.展开更多
BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modalit...BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive characteristics.However,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains controversial.METHODS A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022.Based on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were compared.RESULTS Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts.Notably,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST levels either preoperatively or postoperatively(P<0.05).Postoperative scores across all dimensions of life quality surpassed preoperative scores,with the study cohort achieving higher scores(P<0.05).At 22.00%,the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group(42.86%;P<0.05);conversely,no marked difference was obser-ved in the 1-year postoperative survival rate between the two cohorts(P>0.05).CONCLUSION TIPS,which has demonstrated robust efficacy in managing cirrhotic EGVB,remarkably alleviates varicosity and improves hemodynamics in patients.This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.展开更多
There are diverse protocols to manage patients with recurrent disease after primary cytoreductive surgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) for peritoneal carcinomatosis. We describe a case of...There are diverse protocols to manage patients with recurrent disease after primary cytoreductive surgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) for peritoneal carcinomatosis. We describe a case of metachronous liver metastasis after CRS and HIPEC for colorectal cancer, successfully treated with a selective metastectomy and partial graft of the inferior vena cava. A 35-year-old female presented with a large tumour in the cecum and consequent colonic stenosis. After an emergency right colectomy, the patient received adjuvant chemotherapy. One year later she was diagnosed with peritoneal carcinomatosis, and it was decided to carry out a CRS/HIPEC. After 2 years of total remission, an isolated metachronous liver metastasis was detected by magnetic resonance imaging surveillance. The patient underwent a third procedure including a caudate lobe and partial inferior vena cava resection with a prosthetic graft interposition, achieving an R0 situation. The postoperative course was uneventful and the patient was discharged on postoperative day 17 after the liver resection. At 18-mo follow-up after the liver resection the patient remained free of recurrence. In selected patients, the option of re-operation due to recurrent disease should be discussed. Even liver resection of a metachronous metastasis and an extended vascular resection are acceptable after CRS/HIPEC and can be considered as a potential treatment option to remove all macroscopic lesions.展开更多
The effect of topical propranolol gel on the levels of plasma renin,angiotensin Ⅱ(ATⅡ) and vascular endothelial growth factor(VEGF) in superficial infantile hemangiomas(IHs) was investigated. Thirty-three consecutiv...The effect of topical propranolol gel on the levels of plasma renin,angiotensin Ⅱ(ATⅡ) and vascular endothelial growth factor(VEGF) in superficial infantile hemangiomas(IHs) was investigated. Thirty-three consecutive children with superficial IHs were observed pre-treatment,1 and 3 months after application of topical propranolol gel for the levels of plasma renin,AT Ⅱand VEGF in Department of General Surgery of Dongfang Hospital from February 2013 to February 2014. The plasma results of IHs were compared with those of 30 healthy infants of the same age from out-patient department. The clinical efficiency of topical propranolol gel at 1st,and 3rd month after application was 45%,and 82% respectively. The levels of plasma renin,AT and VEGF in patients preⅡ-treatment were higher than those in healthy infants(565.86±49.66 vs. 18.19±3.56,3.20±0.39 vs 0.30±0.03,and 362.16±27.29 vs. 85.63±8.14,P<0.05). The concentrations of VEGF and renin at 1st and 3rd month after treatment were decreased obviously as compared with those pre-treatment(271.51±18.59 vs. 362.16±27.29,and 405.18±42.52 vs. 565.86±49.66 P<0.05; 240.80±19.89 vs. 362.16±27.29,and 325.90±35.78 vs. 565.86±49.66,P<0.05,respectively),but the levels of plasma AT declined slightly Ⅱ(2.96±0.37 vs. 3.20±0.39,and 2.47±0.27 vs. 3.20±0.39,P>0.05). It was indicated that the increased renin,AT Ⅱand VEGF might play a role in the onset or development of IHs. Propranolol gel may suppress the proliferation of IHs by reducing VEGF.展开更多
The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells(HVECs) was investigated.HVECs from one case of hemangioma in proliferative phase were cultured...The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells(HVECs) was investigated.HVECs from one case of hemangioma in proliferative phase were cultured.Both primary culture and sub-culture were conducted in M199 medium.The HVECs of passage 3 were divided into 4 groups based on the concentrations of anti-KDR antibody.Cell count was performed and inhibitory rate of HVECs was measured before and 9 days after interference.The results showed that the number of HVECs in the anti-KDR antibody-treated groups was significantly decreased and the inhibitory rate of HVECs by anti-KDR antibody(50,10 and 2 μg/mL) was 84%,63% and 39% respectively at 9th day after interference,with the difference being significant.In the control group,the number of HVECs was increased significantly.In was concluded that the anti-KDR antibody could suppress the activity of VEGF through blocking the KDR,indicating the potential clinical applications of anti-KDR antibody in the treatment of hemangioma.展开更多
Currently,there are antiplatelet drugs,extracranial-intracranial(EC-IC)vascular bypass,carotid endarterectomy(CEA),endovascular intervention(EI),and other revascularization procedures for symptomatic chronic internal ...Currently,there are antiplatelet drugs,extracranial-intracranial(EC-IC)vascular bypass,carotid endarterectomy(CEA),endovascular intervention(EI),and other revascularization procedures for symptomatic chronic internal carotid artery occlusion(CICAO).In consulting the literature,we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment.We reported the case of a 50-year-old male patient with blurred vision,headache,and weakness in the right upper limb.After the exclusion of other neurological diseases,he was diagnosed with symptomatic CICAO;the occlusion segment was long and the stump was too short.We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting.After 6 months of follow-up,computed tomography angiography(CTA)confirmed that the left internal carotid artery was unobstructed,and the symptoms were relieved.A brief review of the literature is presented in addition to this report.展开更多
Objective:To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor(VEGF),as preparation for genetic transfection that follows.Methods:Rat VEGF was obtained by using RT-PCR amplifi...Objective:To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor(VEGF),as preparation for genetic transfection that follows.Methods:Rat VEGF was obtained by using RT-PCR amplification and then cloned into the shutter plasmid pDC316.Subsequently,this newly constructed plasmid pDC316-VEGF,after identification by nuclease digestion analysis and sequencing analysis,was transfected into human embryonic kidney cells HEK293 by Lipofectamine 2000 mediation,together with adenovirus-packaging plasmid pBHGE3.Based on the homologous recombination of the two plasmids within HEK293 cells,the recombinant adenovirus vector carrying VEGF and VDC316-VEGF was created.VDC316-VEGF was subsequently identified using PCR,purified using repeated plaque passages,proliferated using freezing and melting within HEK293 cells,and titrated using 50% Tissue Culture Infective Dose(TCID50)assay.Results:The newly constructed recombinant adenovirus was confirmed to carry rat VEGF based on PCR results,and its titration value determined based on TCID50 assay was 3 × 109 pfu/ml.Conclusion:The recombinant adenovirus carrying rat VEGF was successfully constructed.The newly constructed adenovirus can produce a sufficiently high titration value within HEK293 cells,providing a reliable tool for genetic transfection in further gene therapy researches.展开更多
BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons.Ex vivo or in situ repair combined with renal artery revascularizat...BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons.Ex vivo or in situ repair combined with renal artery revascularization is the classical procedure for these complicated cases,which are not suitable for endovascular repair.The choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous graft.CASE SUMMARY A 39-year-old female patient presented with left lumbar pain for more than 3 mo.Computed tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal branches.This patient met the criteria for surgical repair due to symptoms of threatened rupture.According to the anatomy and location of multiple RAAs,ex vivo revascularization with saphenous vein graft (SVG) was performed.At the 3-year follow-up,computed tomography angiography demonstrated the aneurysmal degeneration of the Yshaped SVG.The patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG aneurysm.CONCLUSION SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft,especially for solitary kidney patients.展开更多
The vascular graft with 4 mm diameter was prepared by casting one layer of polyurethane (PU) film onto the knitting tubular fabric as the reinforced support. The effects of different PU content and wall thickness on t...The vascular graft with 4 mm diameter was prepared by casting one layer of polyurethane (PU) film onto the knitting tubular fabric as the reinforced support. The effects of different PU content and wall thickness on the longitudinal mechanical properties of vascular graft were investigated. The breaking elongation, breaking force, initial modulus and breaking work were studied. The results showed that the longitudinal mechanical properties of vascular graft were enhanced as the content of polyurethane increased, which resulted from the combination of PU excellent elasticity and fabric preferable strength.展开更多
BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft ...BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.展开更多
Aortic dissection involving a right-sided aortic arch(RAA)is extremely rare with an incidence in adults of 0.04%to 0.1%^([1]).Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening...Aortic dissection involving a right-sided aortic arch(RAA)is extremely rare with an incidence in adults of 0.04%to 0.1%^([1]).Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening condition.For complicated aortic dissection,conventional open surgical repair is considered a standard therapy^([2]).However,in such cases,endovascular repair has emerged as the procedure展开更多
BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major c...BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major concern in percutaneous techniques.Herein,we present a case of successful control of continuous oozing using a vascular closure device(VCD)and the application of Surgicel(Johnson&Johnson,United States)over the access tract.CASE SUMMARY An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm×75 mm.The patient had a medical history of atrial fibrillation and was receiving rivaroxaban(15 mg/d).Routine pEVAR was performed using the preclose technique with ProGlide(Abbott,Santa Clara,CA,United States).Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site.A sheet of Surgicel was applied to the suture thread using a surgical needle.Surgicel was applied to the surface of the artery along the access tract using a pusher,and hemostasis was immediately attained.CONCLUSION This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.展开更多
<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot incr...<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot increase to the expected value for dialysis. From a mechanical perspective, the vascular resistance at the artificially designed anastomosis causes an energy loss that affects blood flow rate growth and leads to early failure. This research studied how to maximize the RCAVF maturity and primary patency by controlling the energy loss rate. We theoretically analyzed and derived a model that evaluates the energy loss rate <em>E</em><sub><em>avf</em></sub> in RCAVF as a function of its blood vessel geometric parameters (GPs) for given flow rates. There was an aggregate of five controllable GPs in RCAVF: radial artery diameter (<em>D</em><sub><em>ra</em></sub>), cephalic vein diameter (<em>D</em><sub><em>cv</em></sub>), blood vessel distance between artery and vein (<em>h</em>), anastomotic diameter (<em>D</em><sub><em>a</em></sub>), and anastomotic angle (<em>θ</em>). Through this analysis, it was found that <em>E</em><sub><em>avf</em></sub> was inversely proportional to <em>D</em><sub><em>ra</em></sub>, <em>D</em><sub><em>cv</em></sub>, <em>D</em><sub><em>a</em></sub>, and <em>θ</em>, whereas proportional to <em>h</em>. Therefore, we recommended surgeons choose the vessels with large diameters, close distance, and increase the diameter and angle of the anastomosis to decrease the early failure of RCAVF. Simultaneously, we could explain the results of many clinical empiricisms with our formula. We found that increasing <em>D</em><sub><em>cv</em></sub> and <em>θ</em> was more significant in reducing <em>E</em><sub><em>avf</em></sub> than increasing <em>D</em><sub><em>ra</em></sub> and <em>D</em><sub><em>a</em></sub>. Based on our model, we could define two critical energy loss rates (<em>CEL</em><sub><em>a</em></sub>, <em>CEL</em><sub><em>b</em></sub>) to help surgeons evaluate the blood vessels and choose the ideal range of <em>θ</em>, and help them design the preoperative RCAVF plan for each patient to increase the maturity and the primary patency of RCAVF.</span>展开更多
Iliocaval venous compression syndrome(ICS)is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra.Chronic compression can lead to venous stenosis and stasis,which manif...Iliocaval venous compression syndrome(ICS)is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra.Chronic compression can lead to venous stenosis and stasis,which manifests as chronic venous disease and treatment resistance.Therefore,early recognition of ICS and prompt treatment are essential.Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies.The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass,which is followed by computed tomography(CT)or magnetic resonance(MR)venography.CT and MRI can identify the anatomical causes for venous compression.In patients with high clinical suspicion for ICS,negative findings on CT and MR venography would still warrant further investigations.Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality.In this review paper,we will discuss the evidence,utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.展开更多
In this paper,a kind of composite microtube,which is made from superfine silk powder and polyurethane,reinforced by polyster and spandex tubular fabrics,was examined.The cross-section of composite microtubes were micr...In this paper,a kind of composite microtube,which is made from superfine silk powder and polyurethane,reinforced by polyster and spandex tubular fabrics,was examined.The cross-section of composite microtubes were microporous,and micropores were uniform distributed,the inner surface was relatively smooth.The results showed that the wall thickness of composite microtubes increased,which led to the strength,the breaking work and the initial modulus incresead;that the spandex content increased brought about the initial modulus and the breaking work decreased,but the breaking extension and the breaking load were firstly increased and then decreased;and all the mechanical properties decreased as the SFSP content increased.展开更多
Activin receptor-like kinase 1(ALK1)is a transmembrane serine/threonine receptor kinase of the transforming growth factor beta(TGFβ)receptor superfamily.ALK1 is specifically expressed in vascular endothelial cells,an...Activin receptor-like kinase 1(ALK1)is a transmembrane serine/threonine receptor kinase of the transforming growth factor beta(TGFβ)receptor superfamily.ALK1 is specifically expressed in vascular endothelial cells,and its dynamic changes are closely related to the proliferation of endothelial cells,the recruitment of pericytes to blood vessels,and functional differentiation during embryonic vascular development.The pathophysiology of many cerebrovascular diseases is today understood as a disorder of endothelial cell function and an imbalance in the proportion of vascular cells.Indeed,mutations in ALK1 and its co-receptor endoglin are major genetic risk factors for vascular arteriovenous malformation.Many studies have shown that ALK1 is closely related to the development of cerebral aneurysms,arteriovenous malformations,and cerebral atherosclerosis.In this review,we describe the various roles of ALK1 in the regulation of angiogenesis and in the maintenance of cerebral vascular homeostasis,and we discuss its relationship to functional dysregulation in cerebrovascular diseases.This review should provide new perspectives for basic research on cerebrovascular diseases and offer more effective targets and strategies for clinical diagnosis,treatment,and prevention.展开更多
文摘The recent shift of the concept of cardiovascular disease as a chronic progressive condition,potentially involving multiple districts,has driven attention to the optimal management of patients with concomitant coronary and peripheral artery disease,representing a subset of patients with an increased risk of events and impaired survival.Recent pharmacological achievements in terms of antithrombotic therapy and lipid-lowering drugs allow multiple therapeutical combinations,thus requiring optimizing the treatment in a tailored fashion according to patients’risk profiles.Nevertheless,data dedicated to this specific subset of patients are still modest.We summarize currently available strategies and indications for the management of antithrombotic and lipid-lowering drugs in patients with the poly-vascular disease.
基金the National Natural Science Foundation of China(No.81900432)the Science Foundation of Union Hospital(No.F016.02004.21003.124).
文摘Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.
基金supported by the National High Level Hospital Clinical Research Funding:2022-PUMCH-A-191.
文摘As the number of patients suffering from cardiovascular diseases and peripheral vascular diseases rises,the constraints of autologous transplantation remain unavoidable.As a result,artificial vascular grafts must be developed.Adhesion of proteins,platelets and bacteria on implants can result in stenosis,thrombus formation,and postoperative infection,which can be fatal for an implantation.Polyurethane,as a commonly used biomaterial,has been modified in various ways to deal with the adhesions of proteins,platelets,and bacteria and to stimulate endothelium adhesion.In this review,we briefly summarize the mechanisms behind adhesions,overview the current strategies of surface modifications of polyurethane biomaterials used in vascular grafts,and highlight the challenges that need to be addressed in future studies,aiming to gain a more profound understanding of how to develop artificial polyurethane vascular grafts with an enhanced implantation success rate and reduced side effect.
文摘Background:Here we analyzed mid-term data of thoracic endovascular aneurysm repair(TEVAR)surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection(STBAD)involving the left subclavian artery(LSA).Methods:Between April 2014 and February 2019,32 patients with STBAD involving a Castor single-branched stent graft were included.We analyzed their outcomes,including technical success rate(TSR),surgical duration(SD),presence of ischemia,perioperative complications,LSA patency,and survival rate(SR),using computed tomography angiography and clinical evaluation during mid-term follow-up.Results:The mean patient age was 54.63±12.37 years(range,36–83 years).The TSR was 96.88%(n=31/32).The mean SD was 87.44±10.89 with a mean contrast volume of 125.31±19.30 mL.No neurological complications or deaths occurred during the study period.The patients had a mean hospital stay of 7.84±3.20 days.At a mean follow-up of 68.78±11.26 months,four non-aortic deaths(12.5%)were observed.The LSA patency rate was 100%(n=28/28).There was only one case of type I endoleak immediately after surgery(3.12%)(type I from LSA).However,none of the patients experienced type II endoleaks,and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry.Finally,all patients exhibited good LSA patency.Conclusion:TEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.
文摘Infectious diseases are the common enemies of mankind.In the course of historical development,they persistently threaten human health and safety.Even today,despite the developments in medical science,we cannot escape the fear and suffering caused by infectious diseases.Whether in ancient or modern times,the source of infection,route of transmission,and a susceptible population are the three key conditions for the prevalence and spread of infectious diseases.All factors closely related to these three conditions can affect the prevalence of infectious diseases.China is one of the cradles of world civilization.The ancient people accumulated a great deal of experience and lessons in the long struggle against infectious diseases.In the face of the current threat posed by widespread infectious disease,it is imperative to review and summarize ancient Chinese ideas and health policies on epidemic prevention and control to inspire contemporary efforts in the prevention and control of infectious disease.The combination of prevention-oriented epidemic prevention ideology and traditional medicine provides valuable insights,especially for impoverished and medically underserved regions.
文摘BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive characteristics.However,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains controversial.METHODS A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022.Based on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were compared.RESULTS Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts.Notably,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST levels either preoperatively or postoperatively(P<0.05).Postoperative scores across all dimensions of life quality surpassed preoperative scores,with the study cohort achieving higher scores(P<0.05).At 22.00%,the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group(42.86%;P<0.05);conversely,no marked difference was obser-ved in the 1-year postoperative survival rate between the two cohorts(P>0.05).CONCLUSION TIPS,which has demonstrated robust efficacy in managing cirrhotic EGVB,remarkably alleviates varicosity and improves hemodynamics in patients.This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis.
文摘There are diverse protocols to manage patients with recurrent disease after primary cytoreductive surgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) for peritoneal carcinomatosis. We describe a case of metachronous liver metastasis after CRS and HIPEC for colorectal cancer, successfully treated with a selective metastectomy and partial graft of the inferior vena cava. A 35-year-old female presented with a large tumour in the cecum and consequent colonic stenosis. After an emergency right colectomy, the patient received adjuvant chemotherapy. One year later she was diagnosed with peritoneal carcinomatosis, and it was decided to carry out a CRS/HIPEC. After 2 years of total remission, an isolated metachronous liver metastasis was detected by magnetic resonance imaging surveillance. The patient underwent a third procedure including a caudate lobe and partial inferior vena cava resection with a prosthetic graft interposition, achieving an R0 situation. The postoperative course was uneventful and the patient was discharged on postoperative day 17 after the liver resection. At 18-mo follow-up after the liver resection the patient remained free of recurrence. In selected patients, the option of re-operation due to recurrent disease should be discussed. Even liver resection of a metachronous metastasis and an extended vascular resection are acceptable after CRS/HIPEC and can be considered as a potential treatment option to remove all macroscopic lesions.
基金supported by Key Project of Social Development in Science and Technology Bureau of Fujian Province,China(No.2011Y0042)
文摘The effect of topical propranolol gel on the levels of plasma renin,angiotensin Ⅱ(ATⅡ) and vascular endothelial growth factor(VEGF) in superficial infantile hemangiomas(IHs) was investigated. Thirty-three consecutive children with superficial IHs were observed pre-treatment,1 and 3 months after application of topical propranolol gel for the levels of plasma renin,AT Ⅱand VEGF in Department of General Surgery of Dongfang Hospital from February 2013 to February 2014. The plasma results of IHs were compared with those of 30 healthy infants of the same age from out-patient department. The clinical efficiency of topical propranolol gel at 1st,and 3rd month after application was 45%,and 82% respectively. The levels of plasma renin,AT and VEGF in patients preⅡ-treatment were higher than those in healthy infants(565.86±49.66 vs. 18.19±3.56,3.20±0.39 vs 0.30±0.03,and 362.16±27.29 vs. 85.63±8.14,P<0.05). The concentrations of VEGF and renin at 1st and 3rd month after treatment were decreased obviously as compared with those pre-treatment(271.51±18.59 vs. 362.16±27.29,and 405.18±42.52 vs. 565.86±49.66 P<0.05; 240.80±19.89 vs. 362.16±27.29,and 325.90±35.78 vs. 565.86±49.66,P<0.05,respectively),but the levels of plasma AT declined slightly Ⅱ(2.96±0.37 vs. 3.20±0.39,and 2.47±0.27 vs. 3.20±0.39,P>0.05). It was indicated that the increased renin,AT Ⅱand VEGF might play a role in the onset or development of IHs. Propranolol gel may suppress the proliferation of IHs by reducing VEGF.
文摘The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells(HVECs) was investigated.HVECs from one case of hemangioma in proliferative phase were cultured.Both primary culture and sub-culture were conducted in M199 medium.The HVECs of passage 3 were divided into 4 groups based on the concentrations of anti-KDR antibody.Cell count was performed and inhibitory rate of HVECs was measured before and 9 days after interference.The results showed that the number of HVECs in the anti-KDR antibody-treated groups was significantly decreased and the inhibitory rate of HVECs by anti-KDR antibody(50,10 and 2 μg/mL) was 84%,63% and 39% respectively at 9th day after interference,with the difference being significant.In the control group,the number of HVECs was increased significantly.In was concluded that the anti-KDR antibody could suppress the activity of VEGF through blocking the KDR,indicating the potential clinical applications of anti-KDR antibody in the treatment of hemangioma.
文摘Currently,there are antiplatelet drugs,extracranial-intracranial(EC-IC)vascular bypass,carotid endarterectomy(CEA),endovascular intervention(EI),and other revascularization procedures for symptomatic chronic internal carotid artery occlusion(CICAO).In consulting the literature,we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment.We reported the case of a 50-year-old male patient with blurred vision,headache,and weakness in the right upper limb.After the exclusion of other neurological diseases,he was diagnosed with symptomatic CICAO;the occlusion segment was long and the stump was too short.We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting.After 6 months of follow-up,computed tomography angiography(CTA)confirmed that the left internal carotid artery was unobstructed,and the symptoms were relieved.A brief review of the literature is presented in addition to this report.
基金Natural Science Foundation of Jiangsu Province(BK2005158)
文摘Objective:To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor(VEGF),as preparation for genetic transfection that follows.Methods:Rat VEGF was obtained by using RT-PCR amplification and then cloned into the shutter plasmid pDC316.Subsequently,this newly constructed plasmid pDC316-VEGF,after identification by nuclease digestion analysis and sequencing analysis,was transfected into human embryonic kidney cells HEK293 by Lipofectamine 2000 mediation,together with adenovirus-packaging plasmid pBHGE3.Based on the homologous recombination of the two plasmids within HEK293 cells,the recombinant adenovirus vector carrying VEGF and VDC316-VEGF was created.VDC316-VEGF was subsequently identified using PCR,purified using repeated plaque passages,proliferated using freezing and melting within HEK293 cells,and titrated using 50% Tissue Culture Infective Dose(TCID50)assay.Results:The newly constructed recombinant adenovirus was confirmed to carry rat VEGF based on PCR results,and its titration value determined based on TCID50 assay was 3 × 109 pfu/ml.Conclusion:The recombinant adenovirus carrying rat VEGF was successfully constructed.The newly constructed adenovirus can produce a sufficiently high titration value within HEK293 cells,providing a reliable tool for genetic transfection in further gene therapy researches.
文摘BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons.Ex vivo or in situ repair combined with renal artery revascularization is the classical procedure for these complicated cases,which are not suitable for endovascular repair.The choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous graft.CASE SUMMARY A 39-year-old female patient presented with left lumbar pain for more than 3 mo.Computed tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal branches.This patient met the criteria for surgical repair due to symptoms of threatened rupture.According to the anatomy and location of multiple RAAs,ex vivo revascularization with saphenous vein graft (SVG) was performed.At the 3-year follow-up,computed tomography angiography demonstrated the aneurysmal degeneration of the Yshaped SVG.The patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG aneurysm.CONCLUSION SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft,especially for solitary kidney patients.
基金Supported by Education Depart ment of Hubei Province,China (No. Z200717001)
文摘The vascular graft with 4 mm diameter was prepared by casting one layer of polyurethane (PU) film onto the knitting tubular fabric as the reinforced support. The effects of different PU content and wall thickness on the longitudinal mechanical properties of vascular graft were investigated. The breaking elongation, breaking force, initial modulus and breaking work were studied. The results showed that the longitudinal mechanical properties of vascular graft were enhanced as the content of polyurethane increased, which resulted from the combination of PU excellent elasticity and fabric preferable strength.
基金Supported by National Natural Science Foundation of China,No.81600375
文摘BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.
文摘Aortic dissection involving a right-sided aortic arch(RAA)is extremely rare with an incidence in adults of 0.04%to 0.1%^([1]).Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening condition.For complicated aortic dissection,conventional open surgical repair is considered a standard therapy^([2]).However,in such cases,endovascular repair has emerged as the procedure
文摘BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major concern in percutaneous techniques.Herein,we present a case of successful control of continuous oozing using a vascular closure device(VCD)and the application of Surgicel(Johnson&Johnson,United States)over the access tract.CASE SUMMARY An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm×75 mm.The patient had a medical history of atrial fibrillation and was receiving rivaroxaban(15 mg/d).Routine pEVAR was performed using the preclose technique with ProGlide(Abbott,Santa Clara,CA,United States).Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site.A sheet of Surgicel was applied to the suture thread using a surgical needle.Surgicel was applied to the surface of the artery along the access tract using a pusher,and hemostasis was immediately attained.CONCLUSION This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.
文摘<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot increase to the expected value for dialysis. From a mechanical perspective, the vascular resistance at the artificially designed anastomosis causes an energy loss that affects blood flow rate growth and leads to early failure. This research studied how to maximize the RCAVF maturity and primary patency by controlling the energy loss rate. We theoretically analyzed and derived a model that evaluates the energy loss rate <em>E</em><sub><em>avf</em></sub> in RCAVF as a function of its blood vessel geometric parameters (GPs) for given flow rates. There was an aggregate of five controllable GPs in RCAVF: radial artery diameter (<em>D</em><sub><em>ra</em></sub>), cephalic vein diameter (<em>D</em><sub><em>cv</em></sub>), blood vessel distance between artery and vein (<em>h</em>), anastomotic diameter (<em>D</em><sub><em>a</em></sub>), and anastomotic angle (<em>θ</em>). Through this analysis, it was found that <em>E</em><sub><em>avf</em></sub> was inversely proportional to <em>D</em><sub><em>ra</em></sub>, <em>D</em><sub><em>cv</em></sub>, <em>D</em><sub><em>a</em></sub>, and <em>θ</em>, whereas proportional to <em>h</em>. Therefore, we recommended surgeons choose the vessels with large diameters, close distance, and increase the diameter and angle of the anastomosis to decrease the early failure of RCAVF. Simultaneously, we could explain the results of many clinical empiricisms with our formula. We found that increasing <em>D</em><sub><em>cv</em></sub> and <em>θ</em> was more significant in reducing <em>E</em><sub><em>avf</em></sub> than increasing <em>D</em><sub><em>ra</em></sub> and <em>D</em><sub><em>a</em></sub>. Based on our model, we could define two critical energy loss rates (<em>CEL</em><sub><em>a</em></sub>, <em>CEL</em><sub><em>b</em></sub>) to help surgeons evaluate the blood vessels and choose the ideal range of <em>θ</em>, and help them design the preoperative RCAVF plan for each patient to increase the maturity and the primary patency of RCAVF.</span>
文摘Iliocaval venous compression syndrome(ICS)is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra.Chronic compression can lead to venous stenosis and stasis,which manifests as chronic venous disease and treatment resistance.Therefore,early recognition of ICS and prompt treatment are essential.Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies.The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass,which is followed by computed tomography(CT)or magnetic resonance(MR)venography.CT and MRI can identify the anatomical causes for venous compression.In patients with high clinical suspicion for ICS,negative findings on CT and MR venography would still warrant further investigations.Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality.In this review paper,we will discuss the evidence,utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.
基金State Natural Sciences Fundgrant number:50873079+1 种基金National Major Foudamental Research Program of Chinagrant number:2009CB526402
文摘In this paper,a kind of composite microtube,which is made from superfine silk powder and polyurethane,reinforced by polyster and spandex tubular fabrics,was examined.The cross-section of composite microtubes were microporous,and micropores were uniform distributed,the inner surface was relatively smooth.The results showed that the wall thickness of composite microtubes increased,which led to the strength,the breaking work and the initial modulus incresead;that the spandex content increased brought about the initial modulus and the breaking work decreased,but the breaking extension and the breaking load were firstly increased and then decreased;and all the mechanical properties decreased as the SFSP content increased.
基金supported by the National Natural Science Foundation of China,No.81801175(to CLT)the Fundamental Research Funds for the Central Universities of China,No.WK9110000044(to CLT)+2 种基金China Scholarship Council,No.201706270155(to CLT)the China Postdoctoral Science Foundation,No.2019M662179(to CLT)the Anhui Province Postdoctoral Science Foundation of China,No.2019B324(to CLT)
文摘Activin receptor-like kinase 1(ALK1)is a transmembrane serine/threonine receptor kinase of the transforming growth factor beta(TGFβ)receptor superfamily.ALK1 is specifically expressed in vascular endothelial cells,and its dynamic changes are closely related to the proliferation of endothelial cells,the recruitment of pericytes to blood vessels,and functional differentiation during embryonic vascular development.The pathophysiology of many cerebrovascular diseases is today understood as a disorder of endothelial cell function and an imbalance in the proportion of vascular cells.Indeed,mutations in ALK1 and its co-receptor endoglin are major genetic risk factors for vascular arteriovenous malformation.Many studies have shown that ALK1 is closely related to the development of cerebral aneurysms,arteriovenous malformations,and cerebral atherosclerosis.In this review,we describe the various roles of ALK1 in the regulation of angiogenesis and in the maintenance of cerebral vascular homeostasis,and we discuss its relationship to functional dysregulation in cerebrovascular diseases.This review should provide new perspectives for basic research on cerebrovascular diseases and offer more effective targets and strategies for clinical diagnosis,treatment,and prevention.
