Analysis of death-related factors of type B aortic dissection treated medically during the acute phase / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection.</p><p><b>METHODS</b>Clinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 +/- 12) years old. Therapy included analgesia, controlled hypotension and beta-receptor blocker, the mortality in acute phase was 33.3% (14/42). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase.</p><p><b>RESULTS</b>In univariate logistic regression analysis, the malperfusion of aortic branches (P = 0.018) and maximum aortic diameter (P = 0.002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches (P = 0.041) and maximum aortic diameter (P = 0.005) were also considered as the significant death-related factors.Risk of death augmented significantly (P = 0.000) when the maximum aortic diameter over 40 mm.</p><p><b>CONCLUSION</b>Malperfusion of aortic branches and the large maximum aortic diameter (> 40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.</p>

Deep venous thrombosis of lower extremities: effects of different treatment on the incidence of pulmonary embolism / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of the different treatments of deep venous thrombosis (DVT) of lower extremities on the incidence of the pulmonary embolism (PE).</p><p><b>METHODS</b>201 patients (97 males and 104 females, mean age 60.4 years ranged from 24 to 83) from August 2002 to June 2008 with DVT were retrospectively reviewed and divided into 3 groups based on different treatment, including anticoagulants plus thrombolytics alone (group 1), thrombectomy plus anticoagulants plus thrombolytics (group 2) and anticoagulants plus thrombolytics after delivery of inferior vena cava (IVC) filter (group 3) respectively. One hundred and seventy-four cases had left lower limb DVT, 24 cases had right lower limb DVT and 3 cases had both sides of lower limb DVT. Different incidence of PE in different period (7-14 d in hospital and follow-up after discharge) were calculated. Effects of the three different treatment methods of DVT on the incidence of PE were studied.</p><p><b>RESULTS</b>For in-patients, the prevalence of symptomatic PE was 2.8% (3/107) in the group of receiving anticoagulants plus thrombolytics alone, but in the other two groups, no symptomatic PE happened. There was no significant difference in incidence of symptomatic PE among the 3 groups (P=0.425). For patients discharged, after 6 to 72-month follow-up (mean 24-month), we found that no PE happened in group 1 and group 2, while in group 3, the incidence of PE was 2.4% (1/42). There was also no significant difference (P=0.656) among 3 groups.</p><p><b>CONCLUSIONS</b>There is no significant difference in relation to the incidence of PE in these 3 groups. Therefore vena cava filter implantation should be restricted to optimal indication.</p>

The expression of mammalian target of rapamycin and its substrates in autogenous vein graft in rats / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of mammalian target of rapamycin (mTOR) and its substrates including p70s6k and 4E-BP1 in autogenous vein graft.</p><p><b>METHODS</b>Autogenous vein graft model was established in 64 Wistar rats by transplanting the right common jugular vein to infrarenal abdominal aorta. Vein graft samples were harvested 6 hours, 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks after surgery. The mRNA expression of mTOR, p70s6k and 4E-BP1 were measured by RT-PCR and in situ hybridization. Western blot and immunohistochemistry methods also were used to detect the protein expression of mTOR, p70s6k and 4E-BP1. Proliferating cell nuclear antigen (PCNA) was also detected at the same time.</p><p><b>RESULTS</b>The mRNA expression of mTOR and p70s6k increased soon after vein graft transplanting, rose quickly and reached the peak 3 days to 2 weeks after surgery, which recovered 6 to 8 weeks after surgery. The expression of 4E-BP1 mRNA decreased soon after surgery and reached the lowest at 1 week, then rose to the peak 4 to 6 weeks after transplantation. Protein expression of mTOR and p70s6k reached the peak 2 to 4 weeks and recovered to normal level 8 weeks after surgery, but the expression of 4E-BP1 decreased to the lowest during 1 to 2 weeks and reached the peak 4 to 6 weeks after transplanting. The positive cells mostly located in vascular smooth muscle cell (VSMC) just like PCNA.</p><p><b>CONCLUSIONS</b>The expression of mTOR and its substrates were activated in vein graft soon after transplantation, which means that mTOR and its substrates might become new targets for the prevention and therapy of stenosis or obliteration after vein graft transplanting.</p>

The expression and significance of hypoxia-inducible factor-1 alpha and related genes in abdominal aorta aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To study the expression of hypoxia-inducible factor (HIF)-1alpha and related genes in abdominal aorta aneurysm (AAA) and explore the underlying pathogenesis.</p><p><b>METHODS</b>Twenty-two AAA specimens were collected and 5 normal abdominal aorta tissue were used as control. Northern blot, western blot and immunohistochemistry were used to evaluated the expression of HIF-1alpha mRNA and protein product. Western blot and immunohistochemistry method were also used to determine the expression of vascular endothelial growth factor (VEGF) and caspase-3. Microvessel density (MVD) was studied by immunohistochemistry stain of CD34.</p><p><b>RESULTS</b>The expression of HIF-1alpha mRNA and protein product were significantly higher in AAA than that in normal abdominal aorta (P < 0.01). The expression of VEGF and caspase-3 were also higher in AAA and both had a significantly positive relationship with HIF-1alpha expression (P < 0.01). Most of the positive cells located in VSMC and adventitia of AAA. The MVD counts were higher in AAA.</p><p><b>CONCLUSION</b>HIF-1alpha may have an important role the development of AAA, which maybe obtained by regulating the expression of VEGF or caspase-3.</p>

The effect of nuclear transcription factor-kappaB decoy oligodeoxynucleotides on the intimal hyperplasia in vein graft / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of nuclear transcription factor-kappaB decoy oligodeoxynucleotides (NFkappaB decoyODNs) on the intimal hyperplasia (IH) in vein graft in rats.</p><p><b>METHODS</b>Autogenous vein graft model for 72 Wistar rats was established, and the interior jugular vein was transplanted to common jugular artery by microsurgical technique. The rats were divided into 6 groups according to different processing methods, including NFkappaB decoyODNs 50 microg and 200 microg, scramble decoyODNs 50 microg and 200 microg, control and lipofectin + pluronic teams. Vein graft samples were harvested in 1 or 2 weeks after surgery and ICAM-1 mRNA were measured by RT-PCR. Western blotting and immunohistochemistry methods were also employed to detect the expression of p65 and ICAM-1. IH was compared at the same time.</p><p><b>RESULTS</b>The intimal hyperplasia was evident in 1 or 2 weeks after vein graft, and ameliorated by 50 microg of NFkappaB decoyODNs with inhibition rate from 22% to 31%, 200 microg of NFkappaB decoyODNs had a higher inhibition rate from 41% to 53%. However, no effect was found in the other teams. The expression of ICAM-1 mRNA was also inhibited significantly by NFkappaB decoyODNs and more obvious in 2 weeks after surgery. Expression of ICAM-1 and p65 decreased greatly in NFkappaB decoyODNs team, which has a inhibition rate from 30% to 57%.</p><p><b>CONCLUSION</b>Transfection of NFkappaB decoyODNs can inhibit the IH after vein graft, which may be accomplished by the inhibition of gene expression of ICAM-1.</p>