Endovascular repair of spontaneous extracranial internal carotid artery dissection: observation of mid-term clinical effect in 6 patients / 介入放射学杂志

Objective To preliminary evaluate the mid-term clinical effect of endovascular repair in treating spontaneous extracranial internal carotid artery (ICA) dissection,and to observe the patency of stent.Methods The clinical data and imaging materials of 6 patients with spontaneous extracranial ICA dissection,who were treated with endovascular repair during the period from March 2012 to December 2012,were retrospectively analyzed.The U.S.National Institute of Heahh Stroke Scale (NIHSS) scores were determined before and after endovascular repair,and the postoperative stent patency condition was assessed,the results were analyzed.Results A total of 6 patients,including 4 males and 2 females with a median age of 50 years old (40.75-54.75 years old),received endovascular repair therapy.The median interval from the onset of disease to accept endovascular treatment was 10 days (one week-3 months).After the implantation of stent,the blood flow in the true lumen returned to normal immediately,although part of the false lumen was still filled with contrast agent.Embolism of retinal artery occurred in one patient during the operation,no death occurred.The median follow-up time was 54.4 months (49.7-57.9 months).The NIHSS score determined at the last follow-up visit was not significantly different from the preoperative one (P=0.102).Imaging reexamination revealed that the false lumen at the ICA stent segment disappeared in all 6 patients,and no obvious in-stent stenotic changes were observed.Conclusion Endovascular therapy of selected symptomatic extracranial carotid artery dissection with bare stents can effectively prevent the recurrence of clinical symptoms and promote ICA remodeling with excellent mid-term patency.

Polymorphism of methylenetetrahydrofolate reductase gene is associated with response to fluorouracil-based chemotherapy in Chinese patients with gastric cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The importance of polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene for the prediction of the response to fluorouracil-based adjuvant chemotherapy in gastric cancer patients remains unclear. The aim of this study is to assess the predictive value of several polymorphisms of the MTHFR gene for clinical outcomes of gastric cancer patients treated with fluorouracil-based adjuvant chemotherapy in Chinese population.</p><p><b>METHODS</b>Three hundred and sixty-two Chinese patients with gastric cancer were treated with fluorouracil-based adjuvant chemotherapy. DNA samples were isolated from peripheral blood collected before treatment. The three single nucleotide polymorphisms (SNPs) (rs1801131, rs1801133, rs2274976) genotypes of the MTHFR gene were determined by matrixassisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).</p><p><b>RESULTS</b>The average response rate for chemotherapy was 46.7%. Homozygous genotypes rs2274976G/G (χ(2) = 22.7, P < 0.01) and rs1801131A/A (χ(2) = 14.3, P = 0.008) were over-represented in responsive patients. Carriers of the rs2274976A allele genotypes (G/A and A/A) and of the rs1801131C allele genotypes (A/C and C/C) were prevalent in nonresponsive patients. In the haplotype association analysis, there was a significant difference in global haplotype distribution between the groups (χ(2) = 20.69, P = 0.000 124).</p><p><b>CONCLUSIONS</b>These results suggest that polymorphisms of the MTHFR gene may be used as predictors of the response to fluorouracil-based chemotherapy for gastric cancer patients in Chinese population. Well-designed, comprehensive, and prospective studies on determining these polymorphisms of MTHFR gene as clinical markers for predicting the response to fluorouracil-based therapy in gastric cancer patients is warranted.</p>

Establishment and observation of animal model with benign proliferative stenosis after esophageal stent implantation / 中华消化内镜杂志

Objective To establish and observe the canine model with esophageal stent implantation for further study of the benign stenosis caused by proliferation.Methods According to orthogonal design,different combinations of two stents and six polytetrafluoroethylene (PTFE) patches were confirmed.Stent was designed as cylinder with mushroom shape on both ends.Beagle dogs (weight 10-12 kg) were adopted and cervical segment of esophagus were dissected.After PTFE patch was encircled around the esophagus,stent was delivered under fluoroscopy.The main body of the stent was located in accordance with the patch.Eating condition and position of the stent were followed on week 1,2,4,6 and 8.Gross specimen was harvested at the end point,and the degree of tissue hyperplasia was evaluated.Each animal model was given a mark according to the eating condition and tissue hyperplasia.Results Eight combinations of stent and patch were provided with orthogonal design.Three models failed for the following reasons:unable to eat in one dog,stent disgorged out in another,and the third died from esophageal necrosis between stent and patch.Four models had obvious tissue hyperplasia on the segment of stent,and weight loss or stent dislocation were observed in each model.One model developed appropriate tissue hyperplasia with normal diet,and stent dislocation was not found during the follow-up.Significant difference was confirmed among 8 models (F =14.7000,P =0.031).Conclusion Animal model with appropriate tissue hyperplasia could be established with following elements:beagle dogs weight from 10 kg to 12 kg; stent 50 mm in length,20 mm in diameter,with top mushroom 10 mm in length,30 mm in diameter,and end mushroom 10 mm in length,25 mm in diameter; PTFE patch 60 mm in length,15 mm in width.