Treatment of Concomitant Intra-abdominal Malignancy and Abdominal Aortic Aneurysm / 中国医学科学院学报

Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.

Femoral-popliteal Arteriosclerosis Obliterans:Review of Evidence-based Studies on Drug-eluting Endovascular Treatment / 中国医学科学院学报

Atherosclerosis-related diseases have increasingly become health concerns with the increased living conditions and aging.Globally,about 200 million people have suffered from arteriosclerosis obliterans(ASO),which can even be life-threatening in some cases.The past seven decades have witnessed the rapid advances in the treatment of ASO,which has developed from surgery to endovascular interventions including plain balloon angioplasty,bare metal stent placement,drug-coated balloon,and drug-eluting stent.However,the roles of these new techniques for femoral-popliteal lesions,especially their real-world clinical outcomes and indications,remain unclear.This article reviews the latest evidences on the use of drug-eluting devices in treating femoral-popliteal arteriosclerosis obliterans.

Interval-spaced Sessions of Partial Splenic Artery Embolization in Juvenile Patients with Hypersplenism / 中国医学科学院学报

Objective To determine whether interval-spaced sessions of partial splenic artery embolization(PSE) is a safe and effective alternative treatment for hypersplenism in juvenile patients. Methods Eight patients(3 males and 5 females) were included in this retrospective study.All patients were diagnosed as hypersplenism and underwent PSE in 2-3 sessions separated by 1-2 month intervals.Immediate,short,and long term follow-up were done.The effectiveness of the treatment was evaluated.Results No major postoperative complication was noted.No patient developed septic shock,splenic abscess,or spleen rupture.Postoperative pain and fever were common and manageable;only two patients developed loculated pleural effusions,which were well alleviated after conservative treatment.All patients showed significant increase in thrombocytes and white blood cells count after the first session of embolization.The cell counts became remarkable after the last session and remained at normal levels during the follow-up period.Conclusions PSE using 2-3 interval-spaced sessions can effectively decrease spleen size and reverse hypersplenism in juvenile patients.Also,it may reduce the postoperative complications commonly seen in traditional PSE.

Effect of Adequate Anticoagulantion Therapy on the Outcome of Spontaneous Isolated Dissection of Superior Mesenteric Artery / 中国医学科学院学报

Objective To investigate the optimal treatment strategy of spontaneous isolated dissection of superior mesenteric artery (SIDSMA) and the effect of anticoagulation therapy on the prognosis of SIDSMA. Methods The clinical data of 29 patients presented with acute or subacute mesenteric ischemia (a history of less than 14 days) due to SIDSMA admitted to the Department of Vascular Surgery of Peking Union Medical College Hospital from January 1st 2003 to December 31th 2016 were retrospectively analyzed. Results In this study,28 cases were male and the remaining one was female,with an average age of (49.1±7.6) years. The emergency endovascular treatment were performed on 4 cases with severe mesenteric intestinal ischemia,and the symptoms were relieved postoperatively. The remaining 25 cases were treated with conservative treatment. Among 13 cases who were received adequate anticoagulantion therapy,symptoms were relieved or disappeared in 9 cases (69.2%),whereas conservative treatment was ineffective in 4 cases (30.8%),for whom surgical intervention were performed. Among 12 cases who received conservative treatment without sufficient anticoagulation,the abdominal pain was relieved in only 2 cases (16.7%) and the remaining 10 cases (83.3%) were converted to surgical intervention. The success rate of conservative treatment for patients with adequate anticoagulant therapy was significantly higher than that of patients who had not received adequate anticoagulant therapy (P=0.015). Conclusions Adequate anticoagulation therapy has good therapeutic effect in most SIDSMA cases with acute or subacute mesenteric ischemia. For patients with severe mesenteric ischemia or those fail to respond to initial conservative treatment,endovascular treatment may be a more reasonable option.

Outcomes of Chimney and/or Periscope Techniques in the Endovascular Management of Complex Aortic Pathologies / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The chimney/periscope technique has been used to address complex aortic pathologies. This study aimed to report the outcomes and experiences of chimney and/or periscope grafts (CPGs) used in the endovascular management of complex aortic pathologies.</p><p><b>METHODS</b>Twenty-two patients with complex aortic pathologies were retrospectively studied from January 2013 to August 2016 in two vascular centers of teaching hospitals. All patients were diagnosed using computed tomography angiography (CTA). The patients were followed up at postoperative 1, 3, 6, and 12 months and yearly thereafter with X-ray, ultrasound, and/or CTA.</p><p><b>RESULTS</b>Twenty-two cases (17 males; mean age 60.7 ± 16.3 years) with complex aortic pathologies were analyzed. Nineteen patients underwent CPGs only, and the other three cases underwent the simultaneous implantation of chimney/periscope and fenestrated/scallop grafts. Twenty-six arteries were managed with forty CPGs during the procedures. Complete angiographies revealed two Type I endoleaks, one Type III endoleak, and one Type IV endoleak. Other intraoperative complications included brachial thrombosis, external iliac artery rupture, and left renal stenosis. The 30-day mortality was 0. The mean follow-up was 26.1 ± 10.1 months with a range of 2-39 months. During the follow-up, two Type I endoleaks and one Type IV endoleak were observed. One right renal stent occlusion occurred in the 5th month and turned patent after reintervention. Three patients died during the follow-up, one due to an aneurysm rupture as a Type I endoleak, and two due to myocardial infarction. The instant technical success was 96%. The primary and secondary patencies were 92% and 96%, respectively. The overall survival rates were 95%, 84%, and 84% at 12, 24, and 36 months, respectively. Stent migration was not observed in any patient.</p><p><b>CONCLUSIONS</b>Chimney/periscope techniques could be used to tackle complex aortic pathologies, but the indications must be strictly controlled, and additional experiences are required.</p>

Impact of the Action Time of Inducers on Differentiation of 3T3-L1 Cells / 中国医学科学院学报

Objective To explore the effect of the action time of inducers on the differentiation of 3T3-L1 cells to adipocytes. Methods According to the "Cocktail" method,3T3-L1 cells were divided into three groups according to the action time of inducers,with the action time being 2,3 or 4 days,respectively. Cell morphology was observed using inverted microscope and adipose content were detected by Oil red "O" staining and detection of triglyceride. The cell viability was identified by trypan blue staining method. Results The proportion of samples (n=12) with differentiation rate above 80% in group A was 66% (12/18),while the differentiation rate of all the samples (n=18)in group B and group C were above 80%. For the Oil red "O",the OD value at 510 nm in group C was 2.59±0.17,which was significantly higher than that in group A (2.12±0.47;F=6.62,P=0.0001)and group B (2.20±0.17;F=5.15,P=0.0001),while no significant difference was found between group A and group B (F=1.14,P=0.74). As for the triglyceride,the value in group C was (1351.04±119.01)ng/ml,which was significantly higher than that in group A[ (1077.88±272.75)ng/ml;F=6.73,P=0.001] and group B [(1089.38±115.39)ng/ml;F=5.78,P=0.001],while no difference was found between group A and group B (F=0.27,P=0.64). The cell viability in group A,B,and C was (98.3±1.2)%,(98.5±1.8)%,and (98.9±2.1)%,respectively,showing no significant difference (F=0.18,P=0.83). Conclusions The modified procedure for the differentiation of 3T3-L1 cells to adipocytes can increase the differentiation rate and thus may be applied for establishing adipocyte models. The recommended action time is three days.

Endovascular Repair for Acute Type B Aortic Dissection / 中国医学科学院学报

Objective To report experience and result of endovascular repair for acute type B aortic dissection (ATBD). Methods Totally 125 ATBD patients receiving endovascular repair with stent-graft were enrolled in this study. Demographic data,operation details,perioperative findings,and follow-up results were retrospectively analyzed. Results All the 125 patients were successfully implanted with 135 stent-grafts. Thirteen cases were covered left subclavian artery,16 cases underwent left subclavian artery revascularization,and 10 cases underwent visceral artery revascularization. No perioperative mortality occurred. Meanwhile,the perioerative major adverse events included renal infarction (n=1),renal artery bleeding (n=2),stroke (n=2),myocardial infarction (n=1),and renal dysfunction (n=2;one of them suffered from permanent dialysis),and incision complication (n=5). The mean cost during hospital stay was (112 657±58 921) Yuan;more specifically,the cost for complicated dissection cases was significantly higher than uncomplicated cases [(171 623±93 635)Yuan vs. (92 531±48 721) Yuan,P<0.001]. All the patients received regular follow-up for 3-120 months [mean (23.5±11.2) months],except that 14 cases (11.2%) lost to follow-up. During the follow-up,three deaths were reported,among whom one died due to rupture of distal dissection one year after primary operation. No re-intervention case was noted. Conclusions Endovascular repair for ATBD is safe and feasible. Emergency repair for complicated ATBD cases can get satisfactory results,although the medical cost is higher than uncomplicated cases.

Prospective Randomized Study of Sarpogrelate Versus Clopidogrel-based Dual Antiplatelet Therapies in Patients Undergoing Femoropopliteal Arterial Endovascular Interventions: Preliminary Results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sarpogrelate is a selective 5-hydroxytryptamine (5-HT) receptor subtype 2A antagonist which blocks 5-HT induced platelet aggregation and proliferation of vascular smooth muscle cells. We compared the efficacy of sarpogrelate-based dual antiplatelet therapies for the prevention of restenosis and target lesion revascularization (TLR) rates comparing with that of clopidogrel after percutaneous endovascular interventions (EVIs) of femoropopliteal (FP) arterial lesions.</p><p><b>METHODS</b>This prospective, multicenter, randomized clinical trial recruited a total of 120 patients with successful EVI of FP lesions at seven centers across China between January 2011 and June 2012. Patients were randomized to receive either sarpogrelate (100 mg trice daily for 6 months, n = 63) or clopidogrel (75 mg once daily for 6 months, n = 57). All patients also received oral aspirin (100 mg once daily for 12 months). Clinical follow-up was conducted up to 12 months postprocedure.</p><p><b>RESULTS</b>There was no significant difference between the two groups in basic demographic data. The restenosis rate was higher in the clopidogrel group (22.80%) than in sarpogrelate group (17.50%), but there was no significant difference between these two groups (P = 0.465). The TLR rate, ipsilateral amputation rate, mortality in all-cause and bleeding rate were also similar in the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Aspirin plus sarpogrelate is a comparable antithrombotic regimen to aspirin plus clopidogrel after EVI of FP arterial lesions. Dual antiplatelet therapies might play an important role in preventing restenosis after successful EVI of FP lesions.</p>

Prediction of Cerebral Hyperperfusion Syndrome with Velocity Blood Pressure Index / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cerebral hyperperfusion syndrome is an important complication of carotid endarterectomy (CEA). An >100% increase in middle cerebral artery velocity (MCAV) after CEA is used to predict the cerebral hyperperfusion syndrome (CHS) development, but the accuracy is limited. The increase in blood pressure (BP) after surgery is a risk factor of CHS, but no study uses it to predict CHS. This study was to create a more precise parameter for prediction of CHS by combined the increase of MCAV and BP after CEA.</p><p><b>METHODS</b>Systolic MCAV measured by transcranial Doppler and systematic BP were recorded preoperatively; 30 min postoperatively. The new parameter velocity BP index (VBI) was calculated from the postoperative increase ratios of MCAV and BP. The prediction powers of VBI and the increase ratio of MCAV (velocity ratio [VR]) were compared for predicting CHS occurrence.</p><p><b>RESULTS</b>Totally, 6/185 cases suffered CHS. The best-fit cut-off point of 2.0 for VBI was identified, which had 83.3% sensitivity, 98.3% specificity, 62.5% positive predictive value and 99.4% negative predictive value for CHS development. This result is significantly better than VR (33.3%, 97.2%, 28.6% and 97.8%). The area under the curve (AUC) of receiver operating characteristic: AUC(VBI) = 0.981, 95% confidence interval [CI] 0.949-0.995; AUC(VR) = 0.935, 95% CI 0.890-0.966, P = 0.02.</p><p><b>CONCLUSIONS</b>The new parameter VBI can more accurately predict patients at risk of CHS after CEA. This observation needs to be validated by larger studies.</p>

Logistic Regression Analysis of Depression in Arteriosclerosis Obliterans Patients and Its Risk Factors / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the depression in arteriosclerosis obliterans (ASO) patients and its risk factors.</p><p><b>METHODS</b>The self-rating depression scale (SDS) was applied in 228 ASO patients hospitalized in the vascular surgery department of Peking Union Medical College Hospital from March 2010 to October 2011. The risk factors of depression were analyzed by using univariate and multivariate Logistic regression analysis.</p><p><b>RESULTS</b>Of these 228 ASO patients, 133 (58.3%) were found to be depressive. Univariate and multivariate analysis showed that female (OR=0.15,95% CI:0.05-0.45), hypertension (OR=4.63,95% CI:1.90-11.29), coronary heart disease (OR=3.62,95%CI:1.43-9.18), as well as Fontaine 2a (OR=20.76,95% CI:3.21-134.28), 2b (OR=26.34,95% CI:4.20-164.97), 3(OR=192.28,95% CI:25.97-1423.51), and 4(OR=291.41,95% CI:28.67-2962.21) were the risk factors of depression in ASO patients.</p><p><b>CONCLUSIONS</b>ASO patients can easily develop depression. Female, hypertension, coronary heart disease, and Fontaine 2a, 2b,3,and 4 are the risk factors of depression in ASO patients.</p>

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular aneurysm repair (EVAR) is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography (CTA), which is routine for follow-up, has side effects (e.g., radiation) and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound (CEUS) have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak.</p><p><b>METHODS</b>Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging (CDFI) and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDFI was conducted using Fisher's exact test and clinical outcomes of all patients were followed up.</p><p><b>RESULTS</b>Sixteen patients were enrolled, and 12 (75%) had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFI-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically different (P = 0.008). Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type III endoleak had open surgery when endovascular repair failed.</p><p><b>CONCLUSIONS</b>CEUS is a new, safe, and effective means for detection of endoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.</p>

Using a surgeon-modified iliac branch device to preserve the internal iliac artery during endovascular aneurysm repair: single-center experiences and early results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>To evaluate the feasibility of a new surgeon-modified iliac branch device (IBD) technique to maintain pelvic perfusion in the management of common iliac artery (CIA) aneurysm during endovascular aneurysm repair (EVAR).</p><p><b>METHODS</b>From January 2011 to December 2013, a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm. A stent-graft limb was initially deployed in vitro, anastomosed with vascular graft, creating a modified IBD reloaded into a larger sheath, with or without a guidewire preloaded into the side branch. The reloaded IBD was then placed in the iliac artery, with a covered stent bridging internal iliac artery and the branch. Finally, a bifurcated stent-graft was deployed, and a limb device was used to connect the main body and IBD.</p><p><b>RESULTS</b>Technical successes were obtained in all patients. The mean follow-up length was 24 months (range: 6-38 months). All grafts remained patent without any sign of endoleaks. There were no aneurysm ruptures, deaths, or other complications related to pelvic flow.</p><p><b>CONCLUSIONS</b>Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.</p>

Open construction of experimental abdominal aortic aneurysm swine models with Dacron patch for evaluating endovascular aneurysm repair techniques / 中国医学科学院学报

<p><b>OBJECTIVE</b>To construct an experimental abdominal aortic aneurysm (AAA) swine model with Dacron patch for evaluating endovascular aneurysm repair (EVAR) technique.</p><p><b>METHODS</b>The experimental pigs were generally anesthetized for the open procedure of an aneurysm model creation with Dacron and subsequent arteriography and EVAR with stent graft. Repeat arteriography was performed after 3-month follow-up.</p><p><b>RESULTS</b>AAA models were successfully constructed in all 10 experimental pigs. The average aneurysm diameter was (26.3±3.1)mm, increasing by (15.7±3.1)mm comparing to the primary aorta diameter (10.5±0.4)mm. The aorta diameter before and after the experiment showed significant difference (P<0.001). All the animals were survived after the procedure. One swine died 24 hours after the subsequent EVAR because the covering of both renal arteries by the stent graft. The rest 9 animals survived well after the whole operation and 3-month follow-up. The surviving rates at 1 month and 3 months after the operation were both 90%. One type 2 endoleak (10%) was observed after the EVAR, which disappeared at 3-month follow-up.</p><p><b>CONCLUSIONS</b>Open construction of experimental AAA swine models with Dacron patch is safe and feasible. The model can be used in the developing new EVAR techniques and implant training.</p>

Clinical analysis of two carotid endarterectomy procedures in treating carotid artery stenosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the effectiveness and costs of the eversion carotid endarterectomy (eCEA) and the carotid endarterectomy with patch angioplasty (pCEA) in treating carotid artery stenosis.</p><p><b>METHODS</b>Patients with carotid artery stenosis who underwent the carotid endarterectomy in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were enrolled in this study. According to the two different surgical procedures, the patients were divided into eCEA group and pCEA group.</p><p><b>RESULTS</b>The two groups were not significantly different in terms of gender ,age ,risk factors, stenosis degree of carotid artery, and the ratio of bilateral lesions (all P>0.05).The ratio of shunt and antibiotics application, operative time, hospitalization cost, and length of hospital stay in the eCEA group were significantly lower than those in pCEA group (P<0.05).The therapeutic effectiveness, complications, surgery-related death, restenosis, and ipsilateral stroke were not significantly different between these two groups (P>0.05).</p><p><b>CONCLUSION</b>Both surgical procedures are safe and effective in treating the carotid artery stenosis;however, eCEA has lower cost when compared with pCEA and therefore can be used as the first choice.</p>

Establishment and functional identification of a stable cell line overexpression heme oxygenase-1 / 中国医学科学院学报

<p><b>OBJECTIVE</b>To establish a stable cell line overexpression heme oxygenase-1 (HO-1) mediated by a modified lentivirus system and identify its function.</p><p><b>METHODS</b>The HO-1 gene was amplified by polymerase chain reaction and cloned into the modified pLentiLox3.7 expression vectors. The recombinant plasmids were transfected into HEK293T cells and the HO-1 was detected by Western blot. The recombinant plasmids were transfected into HEK293T cells to produce the viruses, with the helping plasmids including plp1, plp2, and VSVG. HEK293T cells were infected by the viruses and the cells that can express HO-1 were identified by Western blot. The reactive oxygen species were detected in the HO-1-overexpression HEK293T cells and the normal cells after the adding of hydrogen peroxide. The same experiment was performed with human umbilical vein endothelial cells.</p><p><b>RESULTS</b>The stable cell line that can overexpress HO-1 was established, which was verified by Western blot. The reactive oxygen species in the HO-1-overexpression HEK293T cells and human umbilical vein endothelial cells decreased obviously after exposure to hydrogen peroxide.</p><p><b>CONCLUSIONS</b>The lentivirus-carrying HO-1 was successfully packaged and the stable cell line overexpression HO-1 was established. HO-1 can play a protective role in the course of oxidative damage.</p>

Research advances in endotension after endovascular abdominal aneurysm repair / 中国医学科学院学报

When more abdominal aortic aneurysms are repaired by endovascular approaches, the post-operative endotension without endoleak increase along with the extended follow-up. An early detection of such endotension and a proper differentiation from endoleaks are particularly important for the treatment decision-making. This article reviews the mechanism, diagnosis, and management of endotension.

Comparison of endovascular aortic repair and open surgical repair for ruptured abdominal aortic aneurysm / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the clinical efficacies of endovascular aortic repair(EVAR)and open surgical repair(OSR)for ruptured abdominal aortic aneurysm(rAAA).</p><p><b>METHODS</b>The clinical data of 28 rAAA patients undergoing emergent treatment between February 2002 and February 2013 in PUMC Hospital were retrospectively reviewed. Among them 13 cases were treated by EVAR and 15 cases by OSR.</p><p><b>RESULTS</b>Before the surgery,the general conditions,comorbidities,and hemodynamics were not significantly different between these two groups(all P>0.05),although the EVAR group had significantly higher mean age than OSR group(P=0.041). In the perioperative period,the EVAR group showed significantly lower 30-day mortality(P=0.044),less blood loss(P=0.005),less blood transfusion(P=0.003),less infusion quantity(P=0.000),shorter length of procedure(P=0.001),and shorter hospital stay(P=0.020). Also,the EVAR group had no severe perioperative complications and showed superior 1-year follow up survival(P<0.05).</p><p><b>CONCLUSIONS</b>EVAR is an effective treatment for rAAA and can improve the clinical outcomes. EVAR may be adopted as the first-line treatment for rAAA,especially for the aged.</p>

Advances in the biochemical markers of complications associated with carotid endarterectomy / 中国医学科学院学报

Carotid endarterectomy(CEA)has been proved to be an effective surgery to treat the cerebral ischemia caused by carotid atherosclerotic stenosis. However,there is still no effective mean for the early diagnosis of the CEA-related severe complications such as stroke and death. Many studies have explored the potential biomarkers for stroke alert,although there is still a long way to go for their actual application in clinical settings. The carotid atherosclerotic stenosis,the perioperative complications of CEA,and the stroke share similar pathogenic mechanisms,and some biomarkers such as S100B,matrix metalloproteinase 9,asymmetric dimethylarginine,and neuron-specific enolase have been studied in the clinical trails of CEA. This article summarizes recent advances in this field.

Expressions of p-c-jun and cyclinD1 between vascular smooth muscle cells and endothelial cells exposured to cigarette smoke extract / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the cell viabilities of vascular smooth muscle cells and vascular endothelial cells stimulated by cigarette smoke extract(CSE) .</p><p><b>METHODS</b>The CSE was prepared by smoke-bubbled phosphate buffered saline(PBS) generation.After culturing cells with different concentrations of CSE, we used the cell counting kit-8 to determine the cell viability.The expression levels of c-jun and cyclinD1 were analyzed through Western blot.The c-jun plasmid was transfected to detect the change of cyclinD1 expression.</p><p><b>RESULTS</b>The smooth muscle cell viability increased when the CSE concentration ranged 0.625%-10%, whereas the endothelial cells viability decreased when exposed to the CSE concentration. After exposure to CSE for 48 hours, there was no difference in c-jun expression between toxin group and PBS group;however, the expression of p-c-jun in the smooth muscle cells significantly increased in the toxin groups than in the PBS group(P<0.05) and the expression of p-c-jun in the vascular endothelial cells significantly decreased(P<0.05) . The level of cyclinD1 significantly increased after exposed to CSE, and its expression level also increased in respond to the c-jun overexpression.</p><p><b>CONCLUSION</b>CSE can enhance the proliferation of vascular smooth muscle cells and decrease in the activity of endothelial cells proliferation, which may be explained by the phosphorylation of c-jun and the expression of cyclinD1.</p>

New method to predict cerebral hyperperfusion syndrome after carotid endarterectomy by transcranial Doppler / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the diagnostic value for predicting cerebral hyperperfusion syndrome (CHS) by adding a transcranial Doppler (TCD) measurement at the end of the carotid endarterectomy (CEA) at the operating room.</p><p><b>METHODS</b>Patients who underwent CEA between August 2009 and December 2011 of the prospective clinical trial in whom both intra- and post-operative TCD monitoring were performed were included. The middle cerebral artery velocities pre-clamping, post-declamping and post-operatively were measured by TCD. The intra-operative velocity increase ratio (VR1) was compared to the postoperative velocity increase ratio(VR2) in relation to CHS by calculating the sensitivity,specificity, positive predictive value, negative predictive value. The receiver operating characteristic curve (ROC) were also performed. The area under the curve (AUC) of ROC of VR1 and VR2 were compared.All the data were analyzed using SPSS 20.0 software.</p><p><b>RESULTS</b>VR1 > 100% was identified in 6 patients, while VR2 > 100% was identified in 18 patients, respectively. Ten patients were diagnosed with CHS. The AUC of VR2 (0.728) was higher than AUC of VR1 (0.636). The best fit cutoff point of VR2 was 100%. The sensitivity, specificity, positive predictive value, negative predictive value were 70%, 83%, 39%, 95%, respectively, which demonstrates a better predictive power than VR1.</p><p><b>CONCLUSION</b>Besides the commonly used intra-operative TCD monitoring, additional TCD measurement at the end of the carotid endarterectomy at the operating room is more useful to more accurately predict CHS.</p>