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Objective:To investigate the distribution characteristics of atherosclerosis in patients with obstructive sleep apnea syndromes (OSAS) by ultrasonography and explore the differences of intracranial and extracranial atherosclerosis lesions.Methods:From July 2016 to July 2019, 139 patients with OSAS confirmed by the department of neurology and/or respiratory of Xuanwu Hospital, Capital Medical University were enrolled retrospectively. According to the results of polysomnography (PSG), patients were divided into 3 groups: mild degree (53 cases), moderate degree (35 cases) and severe degree (51 cases). Demographic parameters, distribution and the severity of atherosclerosis both in intracranial and extracranial arteries, and the incidence of ischemic stroke were compared among the three groups.Results:①Among 139 OSAS patients, there were more males (64.7%) than females (35.3%). Of all the risk factors for cerebrovascular diseases, the prevalence of hypertensin was the highest (50.4%), followed by hyperlipidemia (48.9%). The prevalences of hypertension and ischemic stroke, the body mass index (BMI) in severe OSAS group were higher than those in mild group (all P<0.017). ②The total detection rate of extracranial atherosclerosis (83.5%) was significantly higher than that of intracranial atherosclerosis (23.0%)( P<0.01). ③The extracranial atherosclerotic lesion with highest detection rate of was simple plaque formation (51.1%, 71/139 cases), and there was no significant difference in extracranial lesions among the three groups ( P=0.106). However, with the aggravation of OSAS degree, the stenosis degree of extracranial artery increased ( P=0.006), and there was a weak correlation between the severity of OSAS and the degree of extracranial artery stenosis ( r s=0.263, P=0.002). ④The incidence of middle cerebral artery stenosis accounted for 15.8%(22/139 cases) of intracranial arteries involved and there were no significant differences in the rate, degree and distribution of intracranial artery lesions among the three groups (all P>0.05). Conclusions:The detection rate of extracranial arterial lesions in OSAS patients is higher. With the aggravation of OSAS, the degree of atherosclerosis stenosis in extracranial arteries and the incidence of ischemic stroke trend to increase.
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Objective:To evaluate the impact of runoff score on the patency of femoropopliteal artery (FPA) stent in patients with type 2 diabetes mellitus with ultrasonography.Methods:A retrospective review of a database of 127 patients with type 2 diabetes mellitus (127 limbs) undergoing femoropopliteal stents in Xuanwu Hospital from January 2016 to July 2018 was made. Demographic characteristics and possible related risk factors were recorded. The extent of FPA disease and the runoff lesions below the knee (anterior tibial artery, posterior tibial artery, and peroneal artery) were preoperative evaluated and regular followed-up by color Doppler ultrasonography (CDU). Femoropopliteal artery lesions were graded according to the Trans-Atlantic Inter-Society Consensus (TASCII), and the runoff lesions below the knee were scored according to the Society for Vascular Surgery (SVS). The patency and the predictors for in-stent restenosis were assessed using a Kaplan-Meier and Cox proportional hazards model.Results:Follow up period ranged from 1 month to 24 months.The total patency rates at the 3, 6, 12, 24 months were 91.5%, 70.9%, 45.7% and 31.7%, respectively. Post-procedural runoff score according to SVS criteria: 1-3 scores in 45 limbs, 3.5-5 scores in 37 limbs, 5.5-7 scores in 34 limbs, 7.5-10 scores in 11 limbs. The median runoff score was 4.Patients were stratified according to runoff scores (score ≤4 and >4 groups), and the difference of the patency rates between the two groups was statistically significant by Kaplan-Meier analysis and Log-rank test (χ 2=10.825, P=0.001). The runoff score affected patency significantly on COX analysis ( RR=1.155, P=0.006, 95% CI: 1.042-1.281). Conclusions:Compromised runoff negatively affects the patency of FPA stent. High post-procedural runoff score is a main risk factor related to loss of patency. CDU is a reliable method for monitoring patients with femoropopliteal stenting.
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Objective To investigate the diagnostic value of PSV/PSVpop,a new parameter detected by color Doppler ultrasonography,for patients with severe s tenosis (70 ％-99 ％)in superficial femoral artery (SFA).Methods One hundred and eighty-five cases (234 limbs) with SFA stenosis detected by CDU and confirmed by DSA were included in this study.Peak systolic velocity of intra stenotic(PSV),proximal stenotic (PSVpro),and popliteal artery (PSVpop) were measured and recorded respectively.The ratio of PSV/PSVpro,PSV/PSVpop were calculated.Using DSA as the gold standard,the cut off values for the diagnosis of severe stenosis were determined with receiver operating characteristics (ROC) analysis.The efficacy of the above parameters were compared.Results The new parameter PSV/PSVpop≥4 had 96.3％ of sensitivity,91.6％ of specificity,94.4％ of accuracy,95.7％ of positive predictive value,and 91.4％ of negative predictive value and 0.978 of area under the ROC curve(AUC) could define 70％-99％ stenosis of SFA.The AUC of PSV/PSVpop was higher than those of the traditional parameters PSV(0.922) and PSV/ PSVpro(0.920),the difference was statistically significant (P ＜0.01).The AUC of combined parameter PSV/PSVpop + PSV surpassed conventional combined parameter PSV/PSVpro + PSV (0.978 ∶ 0.940,P ＜ 0.05),but had no statistically significant difference with single parameter of PSV/PSVpop (0.978 ∶ 0.978,P ＞ 0.05).Conclusions The diagnostic efficacy of PSV/PSVpop is superior to traditional hemodynamic parameters in the diagnosis of SFA severe stenosis.
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Objective To evaluate the correlation between the types of vertebral artery occlusion and their compensatory hemodynamic changes and posterior circulation ischemia using color Doppler flow imaging combined with transcranial color-coded sonography.Methods From June 2015 to June 2016,A total of 108 patients with vertebral artery occlusion confirmed by vascular sonography,digital subtraction angiography (DSA) or CT angiography (CTA) were enrolled retrospectively.According to the magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) findings,they were divided into posterior circulation infarction (n=78 in infarction group) and non-posterior circulation infarction (n=30 in TIA group).Color Doppler flow imaging and transcranial color Doppler ultrasonography were used to examine the contralateral vertebral artery extracranial diameter, peak systolic velocity(PSV) and end diastolic velocity(EDV) of bilateral extracranial and intracranial vertebral arteries.The differences of the vertebral artery occlusion types,establishment of collateral circulation and hemodynamic changes of the contralateral vertebral artery were compared between the two groups.Results The patients with single vertebral artery occlusion in the infarction group and TIA group were 69 (88.5%) and 26 (86.7%) respectively;those with bilateral vertebral artery occlusion were 9 (11.5%) and 4 (13.3%) respectively.There was no significant difference in the number of vertebral artery occlusion between the two groups (χ2=0.000,P=1.000).The proportion of patients with vertebral artery occlusion in intracranial segment in the infarction group was higher than that in the TIA group (70.5% [55/78] vs.36.7% (11/30);χ2=10.444,P=0.001).The proportion of patients with the establishment of collateral circulation in the infarction group was lower than that in the TIA group (14.1% [11/78] vs.43.3% (13/30);χ2=10.711,P=0.001).The peak systolic velocity (PSV) and the end diastolic velocity (EDV) of contralateral extracranial vertebral artery in patients with single vertebral artery occlusion in the TIA group were higher than those in the infarction group (65±21 cm/s vs.57±15 cm/s,25±8 cm/s vs.20±7 cm/s,t=2.043 and 2.606 respectively,all P<0.05).Conclusion The establishment of collateral circulation and hemodynamic compensation of the contralateral vertebral artery after vertebral artery occlusion were closely associated with the occurrence of posterior circulation ischemia.
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Objective To investigate the evaluation value of anterior communicating artery patency for patients with severe carotid artery stenosis treated by carotid endarterectomy (CEA )with transcranial color Doppler ultrasonography. Methods From June 2014 to June 2015,89 consecutive inpatients with unilateral symptomatic severe carotid stenosis treated with CEA at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They were divided into either a patent group (n=45)or a non-patent group (n=44)according to whether the anterior communicating artery was patent or not (DSA findings). Whether the anterior communicating artery was patent or not diagnosed by the transcranial color Doppler ultrasonography was compared with the consistency of the digital subtraction angiography (DSA)results. The differences of intraoperatively implemented temporary shunt rate and the differences of hemodynamic parameters including peak velocity (PSV),end-diastolic velocity (EDV),and pulsatility index (PI)of the preoperative and postoperative bilateral middle cerebral artery and anterior cerebral artery (ACA)of both groups were analyzed. Results Compared with the results of DSA, the sensitivity and specificity of transcranial color Doppler ultrasonography for preoperative evaluation of the patency of anterior communicating artery were 91. 1%(41/45)and 97. 7%(43/44)respectively,the total accordance rate was 94. 4%(84/89)(Kappa=0. 888,P0.05). There were no significant differences in PSV,EDV and PI of the contralateral ACA in the non-patent group between after procedure and before procedure (all P>0. 05). Conclusions Transcranial color Doppler ultrasonography can accurately and objectively evaluate whether the anterior communicating artery is patent or not in patients with unilateral severe carotid stenosis. It has an important clinical significance for selective shunt in CEA and improving the success rate of CEA.
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AIM: To construct signal peptide-canstatin expression vector pEGFP-C1-SP-Can and express secretable mouse canstatin fusion protein in Eca-109 cells.METHODS: Site-directed mutagenesis was used in amplifying the signal peptide of murine plasminogen to construct the plasmid pEGFP-C1-SP.The cDNA of mouse canstatin,obtained from a cloning vector pMD18T-Can by PCR,was inserted into pEGFP-C1-SP to construct a secretable expression vector pEGFP-C1-SP-Can.Constructed plasmid pEGFP-C1-SP-Can was transiently transfected into Eca-109 cells via lipofectamine,and subsequently its secretable expression in the medium of cultured Eca-109 was observed by Western blotting.RESULTS: DNA sequencing and restriction enzyme analysis attested the validity of the constructed plasmids pEGFP-C1-SP and pEGFP-C1-SP-Can.EGFPcanstatin fusion protein was proved to be secretably expressed in Eca-109 by Western blotting.CONCLUSION: It is concluded that the constructed vector pEGFP-C1-SP-Can is valid and capable of expression in Eca-109,these findings provide a basis for testing the function of mouse canstatin and its application in gene therapy.
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AIM: To clone and express mouse canstatin (m canstatin)cDNA and provide a basis for the further research on its anti-angiogenic activity and potential application for cancer therapy. METHODS: Total RNA was extracted from mouse liver tissue by Trizol Reagent, and mouse canstatin cDNA was amplified by RT- PCR, then cloned into vector pMD18-T for sequencing. pET30a(+)-m canstatin recombinant plasmid was constructed and expressed in E.coli BL21 with induction of IPTG. RESULTS: Mouse canstatin cDNA is 684 bp coding 227 amino acids. The sequences of both cDNA and amino acid share high homology with human canstatin, with cDNA identity at 89% and amino acids identity at 96% to human canstatin. In the present study, pET30a(+)-m canstatin recombinant plasmid was expressed in E.coli BL21. CONCLUSION: Mouse canstatin cDNA has been cloned for the first time. Constructed pET30a(+)-m canstatin recombinant plasmid is highly expressed in E.coli BL21.