Effect of Elevated Basal LH on IVF-ET Outcomes in Patients with Polycystic Ovary Syndrome / 中山大学学报(医学科学版)

ObjectiveTo compare the outcomes in controlled ovarian stimulation （COH） and fresh embryo transfer between women with and those without a high basal luteinizing hormone （bLH） level in polycystic ovary syndrome （PCOS）. MethodsThe clinical data of PCOS patients at the Reproductive Medicine Center of the Sixth Hospital of Sun Yat-sen University from January 2015 to December 2021 were retrospectively analyzed. They were divided into the high group （LH≥10 U/L） and normal group （LH<10 U/L） according to the bLH levels. The results of COH and pregnancy outcomes after fresh transfer were compared， including gonadotropin （Gn） initiation dose， Gn duration， total Gn dose， number of oocytes obtained， two pronuclei （2PN） rate， available embryos rate， high-quality embryos rate， blastocyst formation rate， human chorionic gonadotrophin （HCG） positive rate， clinical pregnancy rate （CPR）， spontaneous abortion rate （SAR）， ongoing pregnancy rate （OPR） and live birth rate （LBR）. The differences in hormonal trends during COH were also analyzed. ResultsThere were no statistically significant differences in age， body mass index， anti-Mullerian hormone， and type of infertility between the two groups. Compared with the normal group， the Gn initiation dose and Gn duration were not statistically significant （P>0.05）， while the total Gn dose was significantly lower （P<0.001） in the high group. The number of oocytes retrieved， 2PN rate， available embryos rate， high-quality embryos rate， and blastocyst formation rate were comparable between the two groups （all P>0.05）. After fresh embryo transfer， they had similar pregnancy outcomes in the HCG positive rate， CPR， SAR， OPR and LBR （all P > 0.05）. ConclusionsIn patients with PCOS， high bLH levels do not affect COH or pregnancy outcomes in fresh transfer cycles. Further studies are needed to determine whether LH levels need to be lowered prior to COH and whether frozen-all strategy is required in patients with elevated bLH levels.

Construction and identification of a HEK293 cell line with stable TrxR1 overexpression / 南方医科大学学报

OBJECTIVE@#To construct a HEK293 cell line stably overexpressing TrxR1 as a cell model for functional study of TrxR1 and screening of TrxR1-targeting drugs.@*METHODS@#TrxR1 gene was amplified by PCR and ligated with the lentivirus expression vector pLVX-Puro, which was transformed into Escherichia coli and identified by Sanger dideoxy sequencing. HEK293 cells were infected with the recombinant lentivirus vector (pLVX-Puro-TXNRD1) and screened with Puromycin for cell clones with stable TrxR1 overexpression (HEK293-TrxR1-OE cells). HEK293-TrxR1-OE cells, along with HEK293 cells infected with pLVX-Puro vector (HEK293-NC) and normal HEK293 cells, were tested for mRNA and protein expression levels of TrxR1 using RT-qPCR and Western blotting. TrxR1 enzyme activity in the cells was evaluated with insulin endpoint assay and TRFS-green probe imaging. The sensitivity of the cells to auranofin, a specific TrxR1 inhibitor, was determined with CCK8 assay.@*RESULTS@#TrxR1 gene was successfully inserted into the lentiviral vector pLVX-Puro as confirmed by DNA sequencing. The enzyme activity and mRNA and protein expression levels of TrxR1 were significantly higher in HEK293-TrxR1-OE cells than in HEK293 and HEK293-NC cells (P < 0.005). The inhibitory effects of auranofin on proliferation and cellular TrxR1 enzyme activity were significantly attenuated in HEK293-TrxR1-OE cells as compared with HEK293 and HEK293-NC cells (P < 0.005).@*CONCLUSION@#We successfully obtained a HEK293 cell line with stable TrxR1 overexpression, which shows resistance to auranofin and can be used for screening TrxR1 targeting drugs.

Recent advances in novel anticancer agents targeting β-catenin/TCF4 interaction for molecular cancer therapeutics / 药学学报

Wnt/β-catenin signaling pathway plays an important role in the proliferation, growth, invasion, and metastasis of human cancers. Moreover, β-catenin/T-cell factor 4 (TCF4) interaction regulates the transcription of the key oncogenes in Wnt/β-catenin signaling pathway. Therefore, β-catenin/TCF4 interaction would be a promising therapeutic target for the development of highly selective anticancer agents. At present, most ongoing small-molecule inhibitors targeting β-catenin/TCF4 interaction, including PKF222-815, iCRT3/5/14, LF3, and sanguinarine, have been developed in preclinical studies for human cancer therapeutics. In this review, we summarized the research advances of up-to date inhibitors targeting β-catenin/TCF4 interaction, including the molecular structure and cellular functions of β-catenin in canonical Wnt signaling pathway. This review holds a hopeful avenue for the development of novel and highly selective Wnt inhibitors targeting β-catenin/TCF4 interaction for future anticancer strategy.

Prediction of anti-liver fibrosis effect of Piperis Longi Fructus based on network pharmacology / 中国中药杂志

Network pharmacology and liver fibrosis(LF) model in vitro were used to analyze the underly mechanism of anti-liver fibrosis effect that induced by Piperis Longi Fructus and its major active compounds. TCMSP and TCMIP were used to search for the chemical constituents of Piperis Longi Fructus, as well as the oral bioavailability(OB), drug-likeness(DL), intercellular permeability of intestinal epithelial cells(Caco-2) and Drug-likeness grading were set as limiting conditions. The related target genes of Piperis Longi Fructus were queried by TCMSP database, while related targets of LF were screened by GeneCards databases. Interaction network was constructed using Cytoscape 3.7.1. These above data were imported into STRING database for PPI network analysis. Enrichment of gene ontology(GO) and pathway analysis(KEGG) within Bioconductor database were utilized to note functions of related targets of Piperis Longi Fructus. Finally, the core targets and pathways were preliminarily verified by in vitro experiments. The effects of piperlongumine(PL), the major active component of Piperis Longi Fructus, on proliferation of rat liver stellate cells(HSC-T6) and expression of α smooth muscle actin(α-SMA) and collagen Ⅰ were investigated. The major factors TNF-α of tumor necrosis factor(TNF) pathway and NF-κB p65, IL-6 protein expressions of LF process were examined. A total of 12 active compounds such as PL were obtained by analyzing the bioavailability and drug-like properties, which inferred to 48 targets. The functional enrichment analysis of GO obtained 1 240 GO items, mainly involving in process of biology and molecular function. A total of 99 signaling pathways were enriched in the KEGG pathway enrichment analysis, including TNF signaling pathway, cGMP-PKG signaling pathway, calcium signaling pathways. CCK-8 assay showed that PL inhibited proliferation of HSC-T6 induced by transforming growth factor-β1(TGF-β1). Western blot analysis found that treated with PL suppressed the protein expressions of α-SMA, collagen Ⅰ, TNF-α and p65 in HSC-T6. Enzyme linked immunosorbent assay(ELISA) showed that PL inhibited the expressions of TNF-α and IL-6 in the cluture supertant of HSC-T6 cells. In conclusion, PL could play an anti-liver fibrosis role by regulating TNF/NF-κB signaling pathway. This study provided the mechanism basis of anti-LF effects induced by Piperis Longi Fructus and its major active compounds, which might help for the further study of the mechanism and key targets of Piperis Longi Fructus.

Development of a fluorescence polarization-based high-throughput screening assay to identify antagonists targeting β-catenin/TCF4 interaction / 药学学报

To develop a fluorescence polarization (FP)-based high-throughput screening (HTS) assay to identify novel small-molecule antagonists targeting β-catenin/TCF4 (T-cell factor 4) interaction, recombinant human β-catenin was expressed in Escherichia coli Rosetta (DE3) cells and purified by HisTrapTM column. The bioactivity of purified β-catenin was further analyzed by enzyme-linked immunosorbent assay (ELISA). According to FP principle, the β-catenin/TCF4 binding model was performed, and fluorescence isothiocyanate (FITC) labeled TCF4 peptide (FITC-TCF4) served as the molecular probe of adaptor for binding to β-catenin. The FITC-TCF4 and β-catenin working concentration were optimized, and the binding conditions (complex stability and dimethylsulfoxide (DMSO) tolerance) have been investigated yet for further hits screening. The results showed that recombinant human β-catenin was successfully expressed and purified β-catenin exhibited favorable bioactivity in ELISA binding assay. Subsequently, the FP-based HTS assay was performed using 20 nmol·L-1 FITC-TCF4 and 100 nmol·L-1 β-catenin. Under these optimized conditions, a high Z´factor of 0.88 was achieved in a 384-well format and this FP-based HTS assay was very stable with regard to DMSO. Through screening of a natural-based product library (NBPL) using the established FP-based HTS assay, three hits (sanguinarine, chelerythrine, and compound S720) were identified as potential β-catenin/TCF4 interaction antagonists. Taken together, we have successfully developed a simple, robust and reliable FP-based HTS assay for screening of novel antagonists targeting β-catenin/TCF4 interaction.

Construction and screening of fibroblast-like synoviocytes in human rheumatoid arthritis stably overexpressing lncRNA HOTAIR / 医学研究生学报

Objective　The HOTAIR gene is closely related to pannus formation in rheumatoid arthritis (RA). This study aimed to construct and screen fibroblast-like synoviocytes in human RA (HFLS-RA) stably overexpressing lncRNA HOTAIR, and to pave the way for further study of the role of lncRNA HOTAIR in the pathogenesis of RA.　Methods　LncRNA HOTAIR was cloned and linked to the PMT406 vector digested by BamHI-HF-HF and XhoI. The constructed plasmids were sequenced, identified and then transfected into 293T cells to pack lentivirus. The HFLS-RA cells were infected with the recombinant and empty vector lentiviruses, and purinomycin was employed to screen the lncRNA HOTAIR-overexpressed and control cell lines. The total RNA was extracted from the blank, negatively transfected and overexpressed cells by Trizol, and the cDNA obtained by reverse transcription was amplified by qPCR, followed by determination of the expression of lncRNA HOTAIR.　Results　The relative expression of lncRNA HOTAIR was significantly higher in the overexpression group than in the blank control and negative transfection groups (30.329 ± 3.860 vs 1.001 ± 0.048 and 0.892 ± 0.247, P 0.05).　Conclusion　The HFLS-RA cell line stably overexpressing lncRNA HOTAIR was successfully constructed, which has provided some experimental evidence for further investigation of the role of lncRNA HOTAIR in the pathogenesis of RA.

Therapeutic observation of Gao's nape acupuncture plus swallowing training for pharyngeal deglutition disorder after stroke / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of Gao's nape acupuncture plus swallowing training in treating pharyngeal deglutition disorder after stroke.Methods:One hundred patients with post-stroke pharyngeal deglutition disorder were randomized into a treatment group and a control group,with 50 cases in each group.The two groups both received routine neurological intervention.In addition,the treatment group was given Gao's nape acupuncture plus swallowing training,while the control group was intervened by swallowing training alone.After eight-week treatment,the two groups were observed in terms of the changes in repetitive saliva swallowing test (RSST),modified water swallowing test (MWST),standardized swallowing assessment (SSA) and swallowing-related quality of life (SWAL-QOL).The clinical efficacies of the two groups were also compared.Results:After treatment,the RSST grading,and scores of MWST,SSA and SWAL-QOL changed significantly in both groups (P＜0.05 or P＜0.01).The RSST grading,and scores of MWST,SSA and SWAL-QOL in the treatment group were significantly different from those in the control group after treatment (P＜0.05 or P＜0.01).The total effective rate and markedly effective rate were respectively 100.0％ and 72.3％ in the treatment group,versus 97.9％ and 34.0％ in the control group.There was a significant difference in the markedly effective rate between the two groups (P＜0.01).The difference in the clinical efficacy between the two groups was statistically significant (P＜0.01).Conclusion:Gao's nape acupuncture plus swallowing training is an effective approach for post-stroke pharyngeal deglutition disorder.Its therapeutic efficacy is more significant than that of swallowing training alone.

Clinical Observation of Nape Acupuncture plus Rehabilitation Training in Treating Pseudobulbar Palsy After Cerebral Stroke / 上海针灸杂志

Objective To observe the clinical efficacy of nape acupuncture plus basic treatment and rehabilitation in treating pseudobulbar palsy after cerebral stroke and the relation between the efficacy and age of onset. Method A hundred patients were randomized into an observation group and a control group, 50 cases each. The control group was intervened by basic treatment and swallowing rehabilitation training, and the observation group was intervened by nape acupuncture in addition to the treatment given to the control group, once a day, five sessions a week, for 8 weeks in total. The Repetitive Saliva Swallowing Test (RSST), Water Swallowing Test (WST) and Standardized Swallowing Assessment (SSA) were observed in the two groups before and after the treatment; the relation between the age of onset and the efficacy of the integrated treatment method was also observed. Result The scores of RSST, SSA and WST were significantly improved after the treatment in both groups (P<0.01), and the improvements in the observation group were more significant than those in the control group (P<0.01). The therapeutic efficacy of nape acupuncture plus basic treatment and swallowing rehabilitation training was associated with the age of onset (P<0.05). Conclusion Nape acupuncture plus basic treatment and swallowing training can effectively improve dysphagia in pseudobulbar palsy after cerebral stroke. This method produces the most significant efficacy for patients aged 51-60, better than that for those aged over 60 and equivalent to the efficacy for patients aged 41-50.

Reverse effect of curcumin on CDDP-induced drug-resistance via Keap1/p62-Nrf2 signaling in A549/CDDP cell

Objective To assess the effect of curcumin on CDDP-induced drug resistance and explore the underlying molecular mechanism through Nrf2 system and autophagy pathway. Methods A drug-resistant cell model was established by exposing A549/CDDP cell to 2 μg/mL CDDP. A549/CDDP cell was treated with 20 μg/mL CDDP and 10 μM curcumin. The cell viability and apoptosis level, the signals of Keap1/P62-Nrf2 and autophagy pathway were analyzed. Results CDDP induction promoted drug-resistant phenotype in A549/CDDP cell and activated autophagy as well as Nrf2 signals in A549/CDDP cell. Meanwhile, curcumin combination attenuated autophagy and Nrf2 activation induced by CDDP, and reversed the drug-resistant phenotype. Notably, curcumin combination augmented Keap1 transcription. Furthermore, Keap1 ablation with short hairpin RNAs hampered the efficacy of curcumin, suggesting Keap1 played a crucial role on reversal effect of curcumin. Conclusions The present findings demonstrate that CDDP promotes abnormal activation of Nrf2 pathway and autophagy, leading to drug resistance of A549/CDDP cell. Curcumin attenuates this process and combat drug-resistance through its potent activation on Keap1 transcription, which is essential for interplay between oxidative stress induced Nrf2 activation and autophagy/apoptosis switch.

Reverse effect of curcumin on CDDP-induced drug-resistance via Keap1/p62-Nrf2 signaling in A549/CDDP cell

OBJECTIVE@#To assess the effect of curcumin on CDDP-induced drug resistance and explore the underlying molecular mechanism through Nrf2 system and autophagy pathway.@*METHODS@#A drug-resistant cell model was established by exposing A549/CDDP cell to 2 μg/mL CDDP. A549/CDDP cell was treated with 20 μg/mL CDDP and 10 μM curcumin. The cell viability and apoptosis level, the signals of Keap1/P62-Nrf2 and autophagy pathway were analyzed.@*RESULTS@#CDDP induction promoted drug-resistant phenotype in A549/CDDP cell and activated autophagy as well as Nrf2 signals in A549/CDDP cell. Meanwhile, curcumin combination attenuated autophagy and Nrf2 activation induced by CDDP, and reversed the drug-resistant phenotype. Notably, curcumin combination augmented Keap1 transcription. Furthermore, Keap1 ablation with short hairpin RNAs hampered the efficacy of curcumin, suggesting Keap1 played a crucial role on reversal effect of curcumin.@*CONCLUSIONS@#The present findings demonstrate that CDDP promotes abnormal activation of Nrf2 pathway and autophagy, leading to drug resistance of A549/CDDP cell. Curcumin attenuates this process and combat drug-resistance through its potent activation on Keap1 transcription, which is essential for interplay between oxidative stress induced Nrf2 activation and autophagy/apoptosis switch.

Role of axl in preeclamptic EPCs functions / 华中科技大学学报（医学）（英德文版）

Axl encodes the tyrosine-protein kinase receptor, participating in the proliferation and migration of many cells. This study examined the role of Axl in functions of endothelial progenitor cells (EPCs). Axl was detected by RT-PCR and Western blotting in both placentas and EPCs from normal pregnancy and preeclampsia patients. The Axl inhibitor, BMS777-607, was used to inhibit the Axl signalling pathway in EPCs. Cell proliferation, differentiation, migration and adhesion were measured by CCK-8 assay, cell differentiation assay, Transwell assay, and cell adhesion assay, respectively. Results showed the expression levels of Axl mRNA and protein were significantly higher in both placentas and EPCs from preeclampsia patients than from normal pregnancy (P<0.05). After treatment with BMS777-607, proliferation, differentiation, migration and adhesion capability of EPCs were all significantly decreased. Our study suggests Axl may play a role in the function of EPCs, thereby involving in the pathogenesis of preeclampsia.

Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA). The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.</p><p><b>METHODS</b>Between March 2011 and May 2012, nine male patients (mean age, (79.6 ± 8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution. All patients were treated in the hybrid operating room under general anesthesia. Follow-up computed tomography angiography (CTA) was routinely performed before discharge, at 3, 6, and 12 months and annually thereafter.</p><p><b>RESULTS</b>Procedural success was achieved in all cases. Total sixteen small fenestrations, two large fenestrations and eight scallops were used. Intra-operative complications occurred in four patients, which included one proximal type I endoleak, two type II endoleaks, and one renal artery dissection. The mean hospital stay was (8.9 ± 1.4) days, mean blood loss was (360.5 ± 46.8) ml, and mean iodinated contrast volume was (230.6 ± 58.3) ml. The mean follow-up time was (7.6 ± 4.2) months. The visceral graft patency was 100% until now. One patient had an increase of serum creatinine of more than 30%, but did not require dialysis. No patients died, no stent fractured, and migration were diagnosed during the follow-up.</p><p><b>CONCLUSIONS</b>The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory. However, long-term fenestrated graft durability and branch vessel patency remain to be determined.</p>

Elastic fiber regeneration in vitro and in vivo for treatment of experimental abdominal aortic aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The pathological characteristics of abdominal aortic aneurysm (AAA) involved the regression of extracellular matrix (ECM) in aortic walls, especially elastic structure in medial layer. As the major structural protein of aorta, elastin contributes to the extensibility and elastic recoil of the vessels. We hypothesized that overexpression of elastin in vessel walls might regenerate the elastic structure of ECM, restore the elastic structure of the aneurysmal wall, and eventually lead to a reduction of aortic diameters (ADs) in an experimental model of AAA.</p><p><b>METHODS</b>Tropoelastin (TE) of Sprague Dawley (SD) rat was synthesized by reverse transcription polymerase chain reaction and used to construct adneviral vectors containing elastin precursor protein (AdTE-GFP). Cultured vascular smooth muscle cells (VSMCs) from aortas of male SD rats were transfected with AdTE-GFP, AdGFP, adenoviral vector (AdNull), and phosphate buffered saline (PBS). Immunofluorescence staining was performed to determine the expression of elastin in transfected cells. The expression of elastic fibers in ECM of VSMCs transfected with AdTE-GFP were detected by fluorescence microscopy and transmission electron microscopy (TEM) at 1, 3, and 5 days following gene transfer. The AAA vessel walls were infused with AdTE-GFP or an empty AdNull, or PBS directly into the aneurysmal lumen. ADs of the aneurysms were compared in infused aortas. Formation of new elastic fibers in vivo was assessed by hematoxylin and eosin, and elastic von-Giesson staining. Recombinant elastin-GFP in vivo was identified by immunohistochemical staining.</p><p><b>RESULTS</b>Elastic fibers were increased both in ECM of VSMC and in vessel walls after gene transfer. Histological studies revealed that the AdTE-GFP-transduced aortas had elastic fiber regeneration in the aneurysmal walls. The AdTE-GFP-transduced aortas showed a decreased AD (23.04% ± 14.49%, P < 0.01) in AAA vessel walls.</p><p><b>CONCLUSIONS</b>Elastic fibers have been successfully overexpressed both in vitro and in a rat model of AAA by a technique of gene transfer. The overexpression of elastic fibers within the aneurysmal tissue appeared to reverse the aneurysm dilatation in this model.</p>

Hybrid procedures for thoracoabdominal aortic aneurysms and dissections / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm (TAAA) have recently been proposed as a less invasive alternative to conventional TAAA surgery. This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients.</p><p><b>METHODS</b>Between September 1998 and May 2012, 32 high-risk TAAA patients (five females, median age 61.5 years) underwent hybrid procedures at a single institution. Simultaneous approach and staged approach were performed on the basis of patients' conditions. Follow-up computed tomography angiography (CTA) was routinely performed before discharge and at 6, 12 months and annually thereafter.</p><p><b>RESULTS</b>Procedural success was achieved in all cases. The median hospital stay was (21.5 ± 2.3) days, and the median procedure time was (420 ± 31) minutes. Blood loss averaged (2100 ± 261) ml. A total of 124 visceral artery bypasses was performed. Two patients (6.3%) died within 30 days. One patient exhibited complete paraplegia (3.1%). The visceral graft patency was 96.1% at 3 years. All-cause survival rates were 93.8%, 87.5%, 81.3% and 53.1% at 1, 2, 3 and 5 years, respectively. No patient died due to aortic events. The freedom rates from aortic events were 96.9%, 93.6%, 87.5%, 68.8% at 1, 2, 3 and 5 years, respectively.</p><p><b>CONCLUSIONS</b>The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging. However, the procedure is still a significant physiological insult to patients. Until branched and fenestrated endovascular repair become more common, hybrid procedure will continue to have a role in high-risk patients.</p>

Early and midterm results of covered Cheatham-Platinum stent for treatment of aortic coarctation: a report of 9 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early and midterm results of covered Cheatham-Platinum (CP) stent for treatment of aortic coarctation (CoA) in adolescents and adults.</p><p><b>METHODS</b>From January 2007 to June 2011, 9 consecutive cases of CoA underwent covered CP stent implantation. There were 4 male and 5 female patients, aging from 13 to 44 years with a mean of (24 ± 11) years. The covered CP stent and balloon-in-balloon catheter were selected according to digital subtraction angiography measurements. The covered CP stents were expanded to appropriate diameter by inflation of the inner balloon and outer balloon successively. The systolic pressure gradient across the stenosis and narrowest degree of the stenotic vessels were compared before and after the procedure.</p><p><b>RESULTS</b>After the procedure, the systolic pressure gradient across the stenosis decreased from (66 ± 21) mmHg to (9 ± 4) mmHg (1 mmHg = 0.133 kPa, t = 9.13, P = 0.000) and the narrowest degree of CoA decreased from 79% ± 12% to 17 ± 4% (t = 16.65, P = 0.000). During a mean follow-up of (33 ± 22) months (ranging 4 to 54 months), no intrastent restenosis were found and systolic pressure gradient from upper to low extremity was not more than 15 mmHg in each case.</p><p><b>CONCLUSIONS</b>Covered CP stent implantation is safe and effective for treatment of CoA in adolescents and adults. The early and midterm results are encouraging, but long term results require further follow-up and observation.</p>

Recanalization of superficial femoral artery occlusions with Outback LTD catheter / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate immediate- and median-term outcomes from subintimal recanalization of superficial femoral arteries (SFA) chronic total occlusions (CTO) with the Outback LTD catheter.</p><p><b>METHODS</b>From January 2010 to May 2011, 35 legs in 30 patients with CTO of the SFA and proximal popliteal artery were treated by Outback LTD catheter. There were 20 male and 10 female patients. The mean age of the patients was 68 years. Clinical presentation was severe intermittent claudication (Rutherford category 3, 10/35, 28.6%), rest pain (Rutherford category 4, 13/35, 37.1%), and minor ulceration (Rutherford category 5, 12/35, 34.3%). In all cases, the true lumen could not be entered by using standard antegrade catheter and guide wire techniques. Technical success, complications, procedure times, clinical outcomes and cumulative patency rates in follow-up were evaluated.</p><p><b>RESULTS</b>Median lesion length was (210 ± 15) mm. Recanalization of the arterial occlusion was successful in 34 of 35 treated lesions (97.1%). None of the 30 patients showed any procedure-related complications during or after treatment. The mean follow-up was (7.2 ± 0.3) months. Cumulative primary patency rates after 3, 6, and 12 months were 90.9%, 84.8% and 50.6%. Three minor toe amputations and one major below-the-knee amputation were observed in patients with critical limb ischemia.</p><p><b>CONCLUSIONS</b>The Outback LTD catheter is a safe and effective device to recanalize challenging superficial femoral arteries CTO. The technique could reduce radiation exposure time and raise the technique success rate.</p>

Endovascular aneurysm repair in high-surgical-risk abdominal aortic aneurysm patients: initial and long-term results / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk abdominal aortic aneurysm (AAA) patients.</p><p><b>METHODS</b>From July 1997 to July 2011, 120 consecutive high-surgical-risk patients with AAA who were treated electively using a bifurcated aortic endograft were entered in a registry. There were 96 male and 24 female patients, aged from 52 to 95 years with a mean of 74 years. Follow-up protocol consisted of computed tomography angiograms or ultrasound performed at 3, 6, 9, 12 months, and annually thereafter. The main goal was evaluation of the operative mortality and the long-term survival of these patients. Secondary goals were determination of the frequency of secondary operations, the outcome of the aneurysm sac, and primary and secondary patency rates after aortic endograft placement.</p><p><b>RESULTS</b>Mean aneurysm diameter was (57 ± 8) mm. Thirty-seven patients were operated under local anesthesia and eighty-three under general anesthesia. Five type I endoleaks, twenty-five type II endoleaks and one type III endoleak occurred during the perioperative period. The technical success rate was 95%. Operative mortality was 2.5%. The survival rates at 1-, 3- and 5-year were 92%, 75% and 43% respectively. The mean follow up was (36 ± 3) months. Primary and secondary patency rates at 3 year were respectively 97% and 100%. Secondary intervention rate was 10% (12/120) at 5 year. The reasons included endoleaks for 7 patients, stent-grafts fracture for 2 patients, stent-grafts migration for 2 patients and stent-graft thrombosis for 1 patients.</p><p><b>CONCLUSIONS</b>Initial and long-term results with endograft repair of AAA in high-surgical-risk patients were satisfactory. These results appear to justify endovascular repair for this patient population.</p>

The dilatation of the proximal neck after endovascular repair of abdominal aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVES</b>To review the dilatation of the proximal neck in abdominal aortic aneurysm (AAA) after endovascular repair (EVR), and to analyze the factors contributed to these changes.</p><p><b>METHODS</b>From January 1997 to January 2007, a total of 45 patients treated by EVR met the inclusion criteria. There were 44 male and 1 female patients, with an average age of (69 ± 17) years. The patients were all asymptomatic abdominal aortic aneurysm, combined hypertension in 37 cases, coronary heart disease in 40 cases. All the patients had the complete preoperative enhanced CT information, and accepted more than 6 months of regular enhanced CT follow-up (1, 3, 6, 12 months after surgery and annually thereafter). The proximal aneurysm neck diameter increase was determined by CT, increase over 2 mm as having change, less than 2 mm as no change.</p><p><b>RESULTS</b>The average follow-up interval was (34 ± 25) months (ranging from 9 to 100 months). The mean preoperative proximal neck diameter was (21.5 ± 2.3) mm, and (22.4 ± 2.4) mm one month after operation and (24.0 ± 2.8) mm at the latest follow-up. The increase of proximal neck diameter was detected in 71.1%. The oversizing percentage was 19% ± 6%. The incidence of proximal neck over-sizing stent-graft in diameter was 6.7%. The incidence of no dilation at proximal neck diameter was 97.4%, 68.6%, 39.3% and 3.3% at 16, 24, 36 and 96 months postoperatively respectively. The stent-graft migration was detected in 22.2% patients, and the migration distance was (7.0 ± 1.3) mm (ranging from 0 to 9.5 mm). There were no case which the migration oversized 10 mm or need to reintervention.</p><p><b>CONCLUSIONS</b>The more oversizing percentage, the more dilatation in the proximal neck. The stent-graft migration and the dilatation of the proximal neck might have effect on each other.</p>

Surgical treatment of peripheral arterial aneurysms: a report of 35 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment strategies of peripheral arterial aneurysms.</p><p><b>METHODS</b>Thirty-five cases were reviewed from July 1998 to December 2007, and 28 cases were male, 7 cases were female. Eleven cases were popliteal artery aneurysms, 15 cases were femoral artery aneurysms, 4 cases were extracranial carotid aneurysms and 5 cases were subclavian artery aneurysms. All cases had either open procedures or endovascular procedures.</p><p><b>RESULTS</b>Surgical open procedures were performed on 24 cases, and endovascular procedures were performed on 11 cases. The perioperative complication rate were 16.7% (4/24) and 0% for open and endovascular groups respectively. The average follow-up time was 41 months (7 months to 8 years). The accumulative five year patency were 61% and 48% for surgical grafts and stent grafts respectively. Two cases died of diseases and one had stroke during follow-up.</p><p><b>CONCLUSIONS</b>Surgical open repair is still standard procedure for most peripheral arterial aneurysms and endovascular repair may have its own advantage for high risk patients.</p>

CT-research about how to design the diameter and length of the modular branched stent-graft / 中华外科杂志

<p><b>OBJECTIVE</b>To study the anatomical characteristics about ascending aortic and aortic arch in Chinese population by CT.</p><p><b>METHODS</b>From September 2006 to September 2007, 388 patients free of current known aortic pathology undergone thoracic aorta CTA. The diameter of ascending aorta, aortic arch, and branch vessels of aortic arch were measured respectively by AW4.2 work station. The data base about all the measurements was set up. The CHISS statistical software was used to analysis data.</p><p><b>RESULTS</b>The aortic diameter above coronary artery (CA), the level at origin of and brachiocephalic trunk (BCT), the halfway of the ascending aorta, the level at origin of left common carotid artery (LCCA), the level at origin of left subclavian artery (LSA) and the level at distal of origin of LSA respectively were (34 +/- 5) mm, (34 +/- 5) mm, (33 +/- 4) mm, (30 +/- 4) mm, (28 +/- 3) mm and (26 +/- 3) mm. The diameters of two level between the origin of BCT and right subclavian artery (RSA) were (13.1 +/- 1.9) mm and (12.8 +/- 2.3) mm. Diameters of two level at LCCA were (8.7 +/- 1.5) mm and (7.9 +/- 1.0) mm. The diameters of two level between the origin of LSA and left vertebral artery were (10.7 +/- 1.7) mm and (9.3 +/- 1.3) mm. The aortic lumina length between the origin of CA and BCT was (5.3 +/- 1.2) cm, the aortic lumina length between the origin of BCT and LCCA was (1.3 +/- 0.4) cm, the lumen length between origin of BCT and RSA was (4.1 +/- 0.8) cm, the lumen length between origin of LSA and left vertebral artery was (3.8 +/- 0.8) cm. The distance between the wall of BCT and LCCA was (0.4 +/- 0.2) cm, the distance between the wall of LCCA and LSA was (0.7 +/- 0.6) cm.</p><p><b>CONCLUSIONS</b>Modular branched stent-graft system is fit for most part of the Chinese. The size fit for human could be got on this basic.</p>