Analysis of blood components of Yougui Yin in normal rats and rats with kidney deficiency caused by adenine based on UPLC-MS technology / 中国中药杂志

Based on the serum medicinal method, this study aims to investigate the migrating components of Yougui Yin in the blood after intragastric administration, and to provide reference for the basic research of its pharmacodynamics. The kidney deficiency rat model was replicated by adenine method. Normal rats and model rats were administered orally for a single gavage of Yougui Yin. The components in blood were rapidly analyzed and identified by ultra-high performance liquid chromatography/quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS) and multiple reaction monitoring(MRM), and the migrating components in blood of Yougui Yin were explored by multivariate statistical analysis. The results showed that there were 42 characteristic peaks in the plasma of normal rats by UPLC-Q-TOF-MS technology and 13 chemical components were identified, including 6 alkaloids, 2 flavonoids, 2 triterpenoid saponins, 1 iridoid, 1 phenylpropanoid and 1 monoterpenoid. There were 22 characteristic peaks in the plasma of kidney-deficiency rats, and 12 chemical components were identified, including 2 iridoids, 6 alkaloids, 2 flavonoids, 1 monoterpenoid and 1 triterpenoid saponin. Verbascoside, isoacteoside, acteoside, pinoresinoldiglucoside, loganin and morroniside were identified by MRM both in the plasma of normal rats and kidney-deficiency rats. Compared with 85 monomer components in Yougui Yin, 17 common prototype components were found by UPLC-MS in the plasma of normal rats and kidney deficiency rats, including verbascoside, isoacteoside, acteoside, rehmapicrogenin derived from Rehmanniae Radix Praeparata, pinoresinol diglucoside and geniposidic acid from Eucommiea Cortex, loganin and morroniside derived from Corni Fructus, mesaconine, benzoylmesaconine, benzoylaconitine, benzoylhypacoitine, mesaconitine, aconitine derived from Aconiti Lateralis Radix Praeparata, liquiritin, isoliquiritin and glycyrrhizic acid derived from Glycyrrhizae Radix et Rhizoma. Thirty-one metabolites of medicinal ingredients not found in the plasma of adenine-induced kidney deficiency rats were also detected in the plasma of normal rats. Twelve metabolites of medicinal materials not found in the plasma of normal rats were detected in the plasma of kidney deficiency rats. The results of the study provide reference for explaining the material basis and mechanism of Yougui Yin in the treatment of kidney deficiency.

Treatment of thoraco-abdominal aortic disease with fenestrated stent-graft or branch stent-graft technique guided by 3D printing / 中华普通外科杂志

Objective To summarize the experience and effect of applying 3D printing to repair thoraco-abdominal aortic disease with fenestrated stent-graft or branch stent-graft technique.Methods From Oct 2017 to Sep 2018,22 patients with thoracic and abdominal aortic diseases,including aortic arterial dissection (9 patients) and aortic aneurysm (13 patients) were admitted.There were 19 males and 3 females,with mean age of (60 ± 13) years.Before the surgery 3D printing model guide plate was made according to CT,and then the pre-fenestrated stent-graft technique,branch stent-graft technique and other techniques were adopted in the surgery to perform endovascular repair.Resuits All of the operations were completed in one stage without open surgery.The average operation time was (5.67 ± l.23) hours without renal insufficiency and paraplegia,1 branch artery was lost during operation (1.4％) and 1 patient died (4.5％).Conclusion The application of 3D printing in the treatment of thoraco-abdominal aortic disease involving branches is more accurate than traditional measurement and localization.It had a safe and reliable short-term result.

Isolation, culture and characterization of endothelial progenitor cells from the human peripheral blood / 中国组织工程研究

BACKGROUND:Endothelial progenitor cel s, known as the precursor cel s of mature endothelial cel s, have the function of neovascularization and neoendothelialization. Therefore, endothelial progenitor cel s have potential applicability in many fields. Endothelial progenitor cel s can be isolated and cultured from different resources with different methods, but the biological properties and identification of endothelial progenitor cel s stil have controversies. OBJECTIVE:To explore the methods of isolation and culture of endothelial progenitor cel s from the human peripheral blood and to identify the biological features of endothelial progenitor cel s. METHODS:Mononuclear cel s were isolated from the human peripheral blood using density gradient centrifugation, and the cel s were resuspended in endothelial basal medium-2 supplemented with the EGM-2-MV-SingleQuots. Then, the cel s were inoculated in human fibronectin-coated culture flasks and cultured in EBM-2MV medium. The morphology of endothelial progenitor cel s was observed. The proliferation potential and surface markers of endothelial progenitor cel s were characterized careful y. Furthermore, the functional properties such as nitric oxide release and tube formation on Matrigel were also evaluated. RESULTS AND CONCLUSION:While adherent cel s maintained, spindle-shaped cel s formed a cel cluster after 6-7 days. Then, adherent cel s developed to endothelial progenitor cel s with a cobblestone appearance after 2-3 weeks. The endothelial progenitor cel s were confluent with an outgrowth appearance. Endothelial progenitor cel s had a higher proliferation potential compared with human aortic endothelial cel s under the same culture condition. Endothelial progenitor cel s expressed CD31, CD34, CD144 and KDR, displaying an obvious endothelial phenotype. Endothelial progenitor cel s were also found to uptake DiL-acLDL and exhibit lectin binding capability. Furthermore, endothelial progenitor cel s were able to form capil ary tubes on Matrigel and had the ability to release nitric oxide. Therefore, endothelial progenitor cel s can be obtained from the human peripheral blood by density gradient centrifugation and adherent culture. A combining method for the identification of endothelial progenitor cel s should be recommended.

Combined iliac artery stenting and open femoral endarterectomy in the treatment of multi-level iliac and common femoral occlusive disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of hybrid procedure for the treatment of multi-level iliac and common femoral occlusive disease.</p><p><b>METHODS</b>From January 2008 to June 2011, 36 lower limbs with sever iliac and common femoral occlusive diseases were treated by iliac artery stenting combined with open femoral endarterectomy. The mean age of the whole study population was 65 years (range 49 to 87 years) with a male predominance (26 males, 72.2%). The early clinical results were determined by ankle brachial index and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analysis were used to assess the influence of various risk factors on primary patency.</p><p><b>RESULTS</b>All lower limbs underwent successful hybrid surgical and endovascular therapy. Clinical improvement was seen in 94.4% of patients. The mean duration of follow-up was 24.2 months, overall, the primary patency rates, primary assisted patency rates and second patency rates were 72.2%, 83.3% and 94.4% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P = 0.041, 0.012). Cox regression analysis did not reveal any independent predictor of primary patency.</p><p><b>CONCLUSION</b>Hybrid procedures provided an effective treatment management of multilevel iliac-femoral arterial occlusive disease.</p>

Progress in the study of carbonic anhydrase inhibitors as potential anticancer drugs / 药学学报

Carbonic anhydrase IX (CA IX) is a tumor associated protein which is able to be a potent anticancer target, since it is highly expressed in a multitude of carcinomas, while it is present in a limited number of normal tissues. This review focuses on its role in tumor physiology, the most recent three dimensional structure features of this enzyme which has recently been elucidated. In addition, we present recent advances in the development of small inhibitors able to target CA IX for therapeutic applications.

Treatment of thoracoabdominal aortic diseases through hybrid operation / 中华外科杂志

<p><b>OBJECTIVES</b>To review the experience with the hybrid operations for patients with thoracoabdominal aortic diseases, as well as to evaluate and discuss the outcomes.</p><p><b>METHODS</b>Between June 2008 and September 2011, 11 patients (9 male and 2 female, mean age 52 years) were treated by hybrid operation. Hybrid operation includes debranching of the visceral arteries, followed by endovascular repair of the diseases (include aneurysmal disease, aortic dissection, or Takayasu's arteritis).</p><p><b>RESULTS</b>All the operations were successful. The mean operating time was 8.5 hours for patients done in one stage and 8.1 hours for the first stage of patient related in two stages. The endovascular stage took on average 2.0 hours. Overall mortality rate was 1/11 and morbidity was 4/11. No aneurysm-related death occurred. Two patients developed endoleak. Permanent paraplegia and renal failure rate was 0. Mean follow-up was 13.5 months.</p><p><b>CONCLUSION</b>Hybrid operation is a mini invasive and safe method for thoracoabdominal aortic diseases with acceptable morbidity and mortality.</p>

Surgical treatment of carotid body tumour and postoperative complications / 中华普通外科杂志

Objective To discuss the experience in the diagnosis, treatment, complications and follow up of carotid body tumor. Methods All the 25 cases were diagnosised by DSA and CTA. The tumor was resected under carotid adventitial plane in 18 cases, with external carotid artery resection in 4cases, and in 3 cases, internal carotid artery (ICA) and external carotid artery (ECA) were resected simultaneously in which internal carotid artery was reconstructed in two cases including using self vein bypass in one and anastomosis between ICA and ECA in the other. ICA was ligated in the third case. Results No cases died perioperatively. ALL CBTs were treated successfully. Horner syndrome and trachyphonia were relieved after operation. Postoperative trachyphonia, bucking and lingual paralysis developed in 3 cases, and in one case with vagus resection caused dyspnea tracheotomy was performed. The rate of nerves injuries was 12% but no semiplegia and aphasia occurred. Follow up period was from 4 to 90 months (average 44 ±6 months) for 21 cases. The trachyphonia and bucking were improved during follow up but the lingual paralysis persists, and tumor recurred in two cases with one dying. Conclusions CBT treatment should include active surgery, sufficient preoperative preparation and avoiding the postoperative nervous complications.

Hybrid surgical and endovascular therapy in TASC type D atherosclerotic occlusive disease: a retrospective analysis of 48 cases / 中华外科杂志

<p><b>OBJECTIVE</b>to retrospectively analyze 4-year results after hybrid (combined surgical-endovascular) therapy in patients with complex peripheral TASC type D atherosclerotic occlusive disease.</p><p><b>METHODS</b>from January 2006 to December 2009, 48 lower limbs in 46 patients with TASC type D atherosclerotic occlusive disease were treated by hybrid surgical and endovascular therapy. There were 32 male and 16 female, age ranged from 54 to 85 years with an average of 67 years. The early clinical results were determined by ankle brachial index (ABI) and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analyses were used to assess the influence of various risk factors on primary patency.</p><p><b>RESULTS</b>all lower limbs underwent successful hybrid surgical and endovascular therapy. The average ABI before and after hybrid therapy were 0.63 ± 0.18 and 0.24 ± 0.13 (P < 0.05). The average intermittent claudication distance significantly increased from (87 ± 48) m to (247 ± 62) m (P < 0.05). The mean duration of follow-up was 21.7 months (ranging 1 to 46 months). Over all, the primary patency rates, primary assisted patency rates and second patency rates were 79.2%, 83.3% and 95.8% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P < 0.05). Primary patency rates were lower in patients who underwent open surgery with both proximal and distal endoluminal procedures when compared with endovascular reconstruction proximal or distal to the site of open reconstruction (P < 0.05). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency rate (P = 0.013 and P = 0.008, respectively).</p><p><b>CONCLUSIONS</b>Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease.</p>

Transluminal therapy for type B thoracic dissection / 中华普通外科杂志

Objective To investigate the technical details and therapeutic effect in treating StarIdford B aortic dissection by endovaseular aortic repair(EVAR). Methods We retrospectively review 115 type B aortic dissection cases undergoing the procedure of mini-traumatic EVAR from November 1998 to February 2009.There were 71 male patients and 44 female patients with a mean age of55.7 years and follow up period from 7 to 83 months for 75 cases. Results The procedure Was technically successful in 113 cases and 122 stent grafts were placed with hybrid surgery being carried out in 3 cases of carotid artery bypass.Severe perioperative complications included subclavian steal syndrome in 4 eases,pulmonaryinfections in 3 cases.arterial embolism in 2 cases,acute cerebral infarction in 2 cases,kidney tailure in 2 cases.alimentary tract hemorrhage,graft infection,acute intestinal ischemia and type A dissection occurred in one each case respectively.Five cases died perioperatively.Among the 75 cases that were fouowed up,there were 9 eases with type I endoleak and at last 5 cases redid endovaacular repmr.2 cases with secondary type A dissection accepted graft replacement.There were 6 deaths during the follow-up period,4 dying of acute myocardial infarction(2 cases),cerebral hemorrhage(1 case),type A dlssection (1 case)respectively,the causes of other2 deaths were not confirmed. Conclusion EVAR was effective for Standford B aortic dissection as shown by midterm follow up.

Tissue-engineered graft constructed by bone marrow mesenchymal stem cells and vascular acellular matrix / 中国组织工程研究

BACKGROUND: At present, the commercial artificial small vascular grafts (diameter < 6 mm) are still unsatisfactory, due to poor blocompatibility and low long-term patency rate. Therefore, finding a vascular substitute with normal biological function and studying construction and function of tissue-engineered blood vessel have become hot topics recently.OBJECTIVE: To construct a novel tissue-engineered blood vessel by rabbit bone marrow mesenchymal stem cells (MSCs) and vascular acellular matrix, and to investigate the biocompatibility and patency rate of tissue-engineered blood vessels.DESIGN, TIME AND SETTING: An in vitro randomized controlled study at level of cytology and histopathology was performed at the Laboratory of Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2006 to June 2008.MATERIALS: The decellularized vascular acellular matrix was obtained by a detergent-enzymatic procedure. MSCs from rabbits were isolated using density gradient centrifugation method and cultured in culture flasks coated with fibronectin. Subsequently, the expanded MSCs were seeded on the decellularized scaffolds, and then co-cultured in the self-made bioreactor to construct the tissue-engineered blood vessels.METHODS: Sixty rabbits were randomly divided into three groups. A1.0-cm abdominal aorta was sheared, and a tissue-engineered blood vessel was transplanted on the abdominal aorta using 8/0 polypropylene thread. Tissue-engineered blood vessel group: Tissue-engineered blood vessel was considered as the transplanted vessel; vascular acellular matrix group:Xenoma artery treated by vascular acellular matrix was considered as the transplanted vessel; xenoma artery group: Fresh xenoma artery was considered as the transplanted vessel.MAIN OUTCOME MEASURES: Immunocytochemical staining was used to identify the cultured MSCs. After 3 months of transplantation, the grafts were retrieved for digital subtraction angiography, pathological test and scanning electron microscope examination.RESULTS: Rabbits MSCs presented a whirlpool-like appearance at 8 days after culture. The immunocytochemistry results were consistent with the phenotype of MSCs. After high proliferation, MSCs were seeded onto the vascular acellular matrix for 12 days,and seed cells attached to well in the lumen of blood vessels. Three months after implantation, the patency rate was 90% of tissue-engineered blood vessel group and 80% of vascular acellular matrix group, which was superior to xenoma artery group (25%). At three months after transplantation, HE staining and scanning electron microscope demonstrated that internal, middle,and external membrane were clearly observed in the tissue-engineered blood vessel group, and the membrane morphology was similar to normal artery. The endothelial cells were covered completely. However, the endothelial cells were not covered completely in the vascular acellular matrix group, while mural thrombosis, mild proliferation of intima, and inflammatory cell infiltration were observed. The intima was thick and necrotic in the xenoma artery group, while lumens were stenotic and accompanied with a certain degree of thrombus organization.CONCLUSION: This study provides a new strategy to develop a tissue-engineered blood vessel with excellent biocompatibility and high patency rate constructed by rabbit MSCs and vascular acellular matrix.

The treatment of complications of endovascular repair of aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the experience with special consideration for the occurrence and management of complications after thoracic aortic stent-graft treatment (EVAR).</p><p><b>METHODS</b>Retrospectively review the 33 cases with complications following EVAR from July 2002 to March 2008. There were 21 male patients and 12 female patients with a mean age of 46.3 years and mean postoperative period of 12.3 d. There were 5 cases with left carotid artery covered, 5 cases with proximal or distal endoleak, 4 cases with limbs artery injuries, 3 cases with entire stent in false lumen, 3 cases with retrogression dissections, and 2 cases with Stanford A type dissection. In addition, there were 1 case of acute cerebral infarction during the procedure, 1 case of cerebral haemorrhage 2 d after endovascular repair and 1 case of pseudoaneurysm of the left brachial artery. The procedures for the complications included second stent grafts placement in 13 cases, right-left carotid and left carotid-subclavian bypass in 7 cases, iliac-femoral artery repair or graft implantation in 4 cases, abdominal aortic dissection windowing in 2 cases, one artery thrombectomy and one Beutall's procedure.</p><p><b>RESULTS</b>Follow-up consisted of a CTA, MRI and office visit at 1, 6, 12 months and yearly thereafter. All the endoleak and retrogression dissections disappeared after secondary endovascular procedure. The ischemic complication of limbs, central nervous system and intestinal were cured after artery bypass. One case died of cardiac tamponade due to Stanford A aortic dissection and another case died of cerebral hemorrhage.</p><p><b>CONCLUSIONS</b>The complication should be corrected as soon as possible and it might get more success to combine the endovascular approach and open surgery. Meanwhile, enhanced follow-up would help to find correlative complications in time.</p>

Eversion carotid endarterectomy for carotid stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the effect of using eversion carotid endarterectomy (eCEA) for carotid stenosis.</p><p><b>METHODS</b>Twenty four patients with carotid stenosis (stenosis grade 65% approximately 95%), of which 18 were symptomatic and 6 were asymptomatic, were treated by eCEA under regional anesthesia. All patients underwent preoperative cervical duplex and DSA, CT or MRA scanning examination. The eversion technique involved an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque.</p><p><b>RESULTS</b>There was no perioperative mortality and stroke. Transient ischemic attacks (TIA) disappeared, cerebral ischemia symptom improved in our patients. But there were mini chronic symptom of cerebral ischemia in 4 patients with both carotid arterial stenosis.</p><p><b>CONCLUSION</b>Carotid eversion endarterectomy appears to be a universally applicable, safe, and durable operative technique.</p>