ABSTRACT
Objective:To summarize the safety and efficacy of aortic banding in the treatment of refractory endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).Methods:The clinical and follow-up data of 10 patients with refractory endoleaks EVAR undergoing aortic banding at Peking University People's Hospital from Jun 2019 to Aprl 2022 were retrospectively analyzed.Results:The aortic banding was indicated for type Ⅰ endoleak in 6 patients, type Ⅱ endoleak in 3 patients and internal tension in 1 patient with persistent aneurysm enlargement or rupture. The surgical procedure was based on laparotomy. The proximal aortic neck was exposed and re-fixation with artificial strip to prevent bleeding. The surgical procedures was successful in all the 10 cases without residual endoleak or re-bleeding. The post-operative contrast-enhanced ultrasonography revealed neither new-onset endoleak nor occlusion of stent-grafts. Perioperative complications included one case of delayed wound healing and one case of incomplete ileus. No perioperative deaths occurred. Midterm follow-up was achieved in 10 patients with a mean follow-up time of 13 months. No recurrence of endoleak was found. One patient underwent endovascular repair for independent thoracic aortic aneurysm 6 months after surgery. There were no other aorta-related secondary surgeries or aortic-related deaths.Conclusion:Aortic banding for refractory endoleaks after EVAR is minimally invasive and reliable. It can effectively eliminate the refractory endoleaks, and reduce the risks of aortic-related secondary surgery or death.
ABSTRACT
Objective:To compare the effects of desflurane and sevoflurane anesthesia on the sleep quality of sleep-deprived mice.Methods:Thirty-two clean-grade healthy male C57BL/6 mice, aged 10 weeks, weighing 20-25 g, were divided into 4 groups ( n=8 each) by the random number table method: control group (C group), sleep deprivation group (SD group), sleep deprivation+ sevoflurane group (SD+ SEV group), and sleep deprivation+ desflurane group (SD+ DES group). In the four groups, EEG-EMG electrodes were implanted for recording EEG and EMG, and sleep deprivation model was developed by the gentle stimulation method with a brush for 12 h (6: 00-18: 00) after 7 days of adaptation. The 6 h after sleep deprivation was divided into 2 time periods: T 1 period (18: 00-20: 00) and T 2 period (20: 00-24: 00). T 1 period In SD group, mice were allowed ad libitum recovery sleep after sleep deprivation. C group and SD group were exposed to 60% oxygen 1.5 L/min. In SD+ DES group and SD+ SEV group, mice were exposed to 6% desflurane and 2.5% sevoflurane, respectively, for 2 h in 60% oxygen 1.5 L/min following sleep deprivation. T 2 period Four groups were allowed ad libitum recovery sleep with the EEG-EMG signal recording. The percentages and number of wakefulness time, rapid eye movement time and non-rapid eye movement time during each time period were calculated using Lunion Data software. Results:Compared with C group, the percentage of non-rapid eye movement time and the percentage of rapid eye movement time were significantly decreased, and the percentage of wakefulness time was increased during 12 h sleep deprivation in SD group, SD+ SEV group and SD+ DES group ( P<0.05). Compared with T 1 period, the percentage of non-rapid eye movement time was significantly increased, and the percentage of wakefulness time and percentage of rapid eye movement time were decreased in T 2 period in SD group ( P<0.05). Compared with SD group, the percentage of non-rapid eye movement time and percentage of rapid eye movement time were significantly decreased, and the percentage of wakefulness time was increased in T 2 period in SD+ SEV group and SD+ DES group ( P<0.05). There was no significant difference in the percentage of non-rapid eye movement, rapid eye movement and wakefulness time in T 2 period between SD+ SEV group and SD+ DES group ( P>0.05). Compared with SD+ SEV group, the number of non-rapid eye movement in T 2 period was significantly reduced in SD+ DES group ( P<0.05). Conclusions:The effect of desflurane anesthesia in improving sleep quality is better than sevoflurane anesthesia in sleep-deprived mice.
ABSTRACT
Objective:To evaluate the diagnosis and surgical treatment of abdominal aortic vascular endograft infections.Methods:Clinical data of 13 patients of abdominal aortic vascular endograft infections undergoing surgical treatment at Department of Vascular Surgery, Peking University People's Hospital from Jan 2015 to Jan 2021 was retrospectively analyzed.Results:All 13 patients underwent infected graft resection under axillobifemoral bypass. Three patients died perioperatively and 10 recovered. Eight patients were followed-up,with bypass graft being occluded and another one with bypass graft infections exposure.Conclusions:Abdominal aortic vascular endograft infections are catastrophic diseases with high surgical difficulty and risk. Extra-anatomic reconstruction with graft removal is a safe and effective treatment for the eradication of infection.
ABSTRACT
Objective:To evaluate the role of sonic hedgehog (Shh)/glioma-associated oncogene homolog 1 (Gli1) signaling pathway in sleep deprivation-induced cognitive impairment in young mice.Methods:Forty-eight SPF healthy male C57BL/6 mice, aged 4 weeks, weighing 14-16 g, were divided into 3 groups ( n=16 each) by the random number table method: control group (C group), sleep deprivation group (SD group) and Shh agonist SAG group (SD+ SAG group). Multi-platform water environment method was used to prepare the sleep deprivation model in mice, and the sleep deprivation was 20 h a day for 10 consecutive days.In SD+ SAG group, SAG 10 mg/kg was intraperitoneally injected at 5 min before each sleep deprivation, while the equal volume of normal saline was intraperitoneally injected in group C and group SD.The mice underwent novel object recognition and Y-maze tests at 24 h after development of the model.Mice were sacrificed after the behavioral testing, and the hippocampi were isolated for determination of the density of dendritic spines in hippocampal CA1 region (by Golgi staining), expression of Gli1 and brain-derived neurotrophic factor (BDNF) in hippocampal tissues (by Western blot), and expression of Gli1 and BDNF mRNA in hippocampal tissues (by quantitative real-time polymerase chain reaction). Results:Compared with group C, the preference index in novel object recognition and Y-maze tests and density of dendritic spines in CA1 region were significantly decreased, and the expression of Gli1 and BDNF protein and mRNA in hippocampus was down-regulated in group SD ( P<0.05). Compared with group SD, the preference index in novel object recognition and Y-maze tests and density of dendritic spines in CA1 region were significantly increased, and the expression of Gli1 and BDNF protein and mRNA in hippocampus was up-regulated in group SD+ SAG ( P<0.05). Conclusions:Inhibition of Shh/Gli1 signaling pathway and reduction of plasticity of dendritic spines of hippocampal neurons are involved in sleep deprivation-induced cognitive impairment in young mice.
ABSTRACT
Objective:To explore the outcomes of standard endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with complex neck anatomical features.Methods:Clinical data of AAA patients received standard EVAR from Jan 2004 to Dec 2018 were retrospectively collected. Based on pre-operative computed tomography angiography (CTA) data, patients were divided into complex neck group and non-complex neck group to compare the results between them.Results:There were 88 patients (66.2%) in complex neck group and 45 patients (33.8%) in non-complex group. There was no significant difference in peri-operative characters (blood loss, contrast volume used, hospital stay time, technical success rate) and follow-up results (late re-intervention, late endoleak, aneurysm enlargement, survival rate),all P>0.05.Multivariant logistic regression analysis revealed neck diameter larger than 31 mm was related with late re-intervention ( OR=24.975, P=0.02). Conclusion:Standard EVAR for AAA with complex neck characters does not cause higher perioperative complications and less favorable long term survival rate.
ABSTRACT
Objective:To evaluate the effect of nicotinamide mononucleotide (NMN) on neurogenesis decline in sleep-deprived infancy rats.Methods:Seventy-eight clean-grade healthy male Sprague-Dawley rats, aged 7 days, weighing 10-15 g, were divided into 3 groups ( n=26 each) using a random number table method: control group (group Con), sleep deprivation group (group SD) and sleep deprivation plus NMN group (group SD+ NMN). Sleep deprivation model was established by gentle stimulation method with a brush (10 h per day) for 14 consecutive days.NMN 500 mg/kg was intraperitoneally injected in group SD+ NMN, while the equal volume of aqua pura was given instead in Con and SD groups.5′-bromo-2′-deoxyuridine (BrdU) 100 mg/kg was intraperitoneally injected immediately after the end of sleep deprivation to label the new-born cells.At 24 h after completion of sleep deprivation, the stem cell pluripotency transcription factor (SOX2) and doublecortin (DCX) positive cells in the hippocampal DG region were counted using immunofluorescence and immunohistochemical methods, and positron emission tomography-computed tomography was used to observe the metabolism of 18F-fluorodeoxyglucose in the hippocampus.At 4 weeks after completion of sleep deprivation, the number of neuronal nuclei antigen (NeuN)/BrdU and glial fibrillary acid protein (GFAP)/BrdU positive cells in hippocampal DG region was recorded using immunofluorescence, and novel object recognition test was performed to evaluate the cognitive function. Results:Compared with group Con, the number of SOX2 and DCX positive cells was significantly reduced, the standard uptake value of glucose in the hippocampus was decreased, the number of NeuN/BrdU and GFAP/BrdU positive cells was reduced, and discrimination index in novel object recognition test was decreased in group SD ( P<0.05). Compared with group SD, the number of SOX2, DCX NeuN/BrdU and GFAP/BrdU positive cells was increased, the standard uptake value of glucose in the hippocampus was increased, and discrimination index in novel object recognition test was increased in group SD+ NMN ( P<0.05). Conclusion:Nicotinamide mononucleotide can promote neurogenesis, thus improving cognitive function, and the mechanism is related to increasing the metabolism of hippocampal glucose in sleep-deprived infancy rats.
ABSTRACT
Objective:To evaluate the prognostic accuracy of the sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria in predicting the mortality in patients with infection or suspected infection by using network Meta-analysis.Methods:Five databases including Wanfang Data, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), PubMed, Web of Science were searched from February 23, 2016 to September 5, 2020 to identify the relevant literatures comparing the prognostic accuracy of two or more scores for mortality in patients with infection or suspected infection. The literatures screening, data extraction and the quality assessment of the included studies were all conducted independently by two reviewers. Stata 14.0 software was used to test the heterogeneity between the original studies of pairwise comparison of each of the three scoring systems. Ring inconsistency test was used to judge the consistency between direct comparison and indirect comparison. Then network Meta-analysis was performed and the results were ranked. The predictive ability of the three scoring systems was evaluated by surface under cumulative ranking curve (SUCRA). A "comparison-correction" funnel plot was drawn to assess whether there was publication bias in the included studies.Results:A total of 38 studies were enrolled, the overall quality was high. Network meta-analysis showed that SOFA had a great prognostic performance in predicting mortality for patients with infection or suspected infection, which was followed by qSOFA [mean difference ( MD) = 0.07, 95% confidence interval (95% CI) was 0.05-0.09] and SIRS scores ( MD = 0.16, 95% CI was 0.14-0.18), and the qSOFA score was better than SIRS score ( MD = 0.09, 95% CI was 0.07-0.11). In the order of predicting the death risk of patients with infection or suspected infection, SOFA score had higher predictive value, followed by qSOFA score, and SIRS score was the lowest, with SUCRA values of 1.0, 0.5 and 0, respectively. Funnel plot showed that all the studies were distributed on both sides of the midline, but the distribution was not symmetrical, suggesting that there was a high possibility of publication bias and small sample effect. Conclusions:SOFA score had the best prognostic performance in predicting mortality of patients with infection or suspected infection as compared with qSOFA score and SIRS score. However, the funnel plot showed that included literatures may exist small sample effects or publication bias. So the final results should be validated by more prospective studies with multicenters and large samples.
ABSTRACT
Objective:To investigate the safety and efficacy of simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) for patients with concomitant severe carotid and coronary artery disease.Methods:The clinical data of 19 patients with concomitant severe carotid artery stenosis and coronary artery disease undergoing simultaneous CEA and CABG at Peking University People′s Hospital from Jan 2011 to Dec 2019 were retrospectively analyzed.Results:The mean ages was 69 years old.The operation adopted the strategy of CEA first and then CABG. Conventional CEA with carotid arterial shunting was performed. The primary composite end points were perioperative cardiovascular and neurological adverse event rates, as well as the late follow-up outcomes. The technical success rate was 100%. There were no adverse cardiovascular events during the perioperative period. Ischemic stroke occurred in 2 patients. No early death was observed. Seventeen cases were successfully followed up for 1-103 months. One patient developed cerebral infarction after 8 months, one developed acute myocardial infarction 43 months after surgery. No cases suffered from carotid artery restenosis. The 5-year overall survival rate was 91%.Conclusions:Simultaneous CEA and CABG treatment for patients with concomitant carotid and coronary artery disease is safe with few perioperative cardiovascular events and no deaths.
ABSTRACT
Surgical treatment for bone and soft tumors of pelvis and sacrum presents a big challenge, because of the complex anatomy of sacropelvic region, large tumor volume at presentation, rich blood supply to the tumor and visceral involvemen, et al. Therefore, surgical excision and reconstruction are technically difficult for sacropelvic tumors. Extensive intraoperative haemorrhage could be life-threatening, and this issue remains a major concern. How to effectively control bleeding during surgery is critical for successful operation and patient's favorable prognosis. Some previous attempts, such as interventional selective internal iliac artery embolization or manual ligation through an additional anterior approach, were tested to be ineffective. Inspired by the success of resuscitative endovascular balloon occlusion of the aorta (REBOA) which resemble an endovascular tourniquet for traumatic hemorrhagic shock, some researchers have applied this techinique to control surgical bleeding during pelvic or sacral tumor resection.The authors have performed REBOA for more than 1 500 sacropelvic tumr surgeries since 2003 in Peking University People's Hospital. The patient age, the diameter of femoral artery and aorta, atherosclerosis, as well as tumor location, volume and expansion and blood suppy, have to be thoroughly evaluated prior to REBOA administration. Admittedly, the application of REBOA do reduce intraoperative bleeding, shorten the operation duration, improve the safety of surgery, yet some complications were observed including local hematoma at the puncture site, acute arterial thrombosis, femoral artery pseudoaneurysm or occlusio, et al. The purpose of this study is to review the literature on REBOA administration in pelvic and sacral tumors excision, with the focus on its indications, performing procedure, the safety and efficacy, and complications. Moreover, in order to popularize the clinical application of aortic balloon occlusion in the future, we summarize our experience of abdominal aortic balloon occlusion over 10 years.
ABSTRACT
Objective:To investigate the perioperative situation and recent effect of pelvic exenteration for patients with locally recurrent cervical cancer.Methods:A total of 17 patients with locally recurrent cervical cancer who underwent pelvic exenteration in Peking University People's Hospital from October 2015 to May 2018 were retrospectively analyzed for their clinical and pathological characteristics, surgical conditions, hospitalization costs, postoperative complications, and survival situation.Results:(1) The median age of 17 patients with locally recurrent cervical cancer was 51 years (range 27-64 years). Pathological type: 13 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, and 2 cases of adenosquamous carcinoma. Thirteen patients received radiotherapy during the initial treatment and 4 patients did not receive radiotherapy. (2) Pelvic exenteration was performed in 17 patients with locally recurrent cervical cancer, of which 9 cases were performed with total pelvic exenteration (operation range including radical cystectomy, partial urethrectomy rectectomy and partial vaginalectomy), and 8 cases with anterior pelvic exenteration operation (operation range including: radical cystectomy, part of urethrectomy and part of vaginalectomy). Of the 17 patients successfully completed the operation. The median operation time was 450 minutes (range 240-760 minutes), the median intraoperative blood loss was 2 200 ml (range 200- 8 400 ml), the median postoperative hospital stay was 17 days (range 9-55 days), the median hospital cost was 83 857 yuan (range 41 588-296 354 yuan). (3) Of the 17 patients underwent pelvic exenteration, 16 of them had early complications, the most common one was fever (14 cases). Fourteen of them had late complications, and the most common one was a urinary system infection (12 cases). (4) The median overall survival time was 26.0 months (range 3-44 months), the median progression-free survival (PFS) time was 9.0 months (range 2-44 months). Among them, 13 patients received radiation therapy during the initial treatment, the median PFS time was 9.0 months (range 2-30 months); 4 patients did not receive radiation therapy in the initial treatment, the median PFS time was 10.5 months (range 2-44 months).Eleven patients received adjuvant therapy after pelvic exenteration, the median PFS time was 12.0 months (range 2-44 months); 6 patients did not receive adjuvant therapy, the median PFS time was 5.0 months (range 2-9 months).Conclusions:Pelvic exenteration has a wide range of operations, many postoperative complications, and high hospitalization costs. Adjuvant treatment after pelvic exenteration could improve the PFS time for some patients. Its clinical value and health economic value need to be further explored.
ABSTRACT
Objective:To investigate the c-Jun N-terminal kinase (JNK), CCAAT/enhancer-binding protein homologous protein (CHOP) pathway apoptosis and the changes of cytokine levels in immune-related organs and tissues of sepsis mice at different time points.Methods:Twenty-seven male BALB/c mice were divided into normal group, sepsis 6 hours group and sepsis 12 hours group by the block randomization method, with 9 mice in each group. The sepsis model was made by cecal ligation and puncture (CLP). Blood sample was collected from each group at the corresponding time point, and the serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL-1β, IL-10) were measured by enzyme linked immunosorbent assay (ELISA). The spleen, thymus and appendix tissues were taken from the mice to detect the expressions of phosphorylation-JNK (p-JNK), JNK1, CHOP and cleaved caspase-3 protein by Western Blot.Results:The level of cytokines, p-JNK/JNK1 ratio, CHOP and caspase-3 in spleen tissues, and the CHOP, caspase-3 in thymus and appendix tissue in the sepsis 6 hours group were significantly higher than those in the normal group [serum TNF-α (ng/L): 24.29±3.09 vs. 2.93±2.09, serum IL-1β (ng/L): 5.00±3.19 vs. 3.54±1.53, serum IL-10 (ng/L): 1 963.93±270.20 vs. 275.09±45.21, spleen p-JNK/JNK1 ratio: 0.257±0.126 vs. 0.154±0.068, spleen CHOP/β-actin: 0.201±0.131 vs. 0.142±0.068, spleen caspase-3/β-actin: 0.215±0.126 vs. 0.098±0.088, thymus CHOP/β-actin: 0.122±0.071 vs. 0.089±0.067, thymus caspase-3/β-actin: 0.258±0.145 vs. 0.108±0.045, appendix CHOP/β-actin: 0.361±0.134 vs. 0.215±0.112, appendix caspase-3/β-actin: 0.439±0.211 vs. 0.321±0.145, all P < 0.05]. However, there were no significant difference in the p-JNK/JNK1 ratio in thymus and appendix (thymus p-JNK/JNK1 ratio: 1.221±0.776 vs. 1.168±0.475, appendix p-JNK/JNK1 ratio: 2.014±1.227 vs. 1.828±0.915, both P > 0.05). Cytokine levels and the p-JNK/JNK1 ratio, CHOP, caspase-3 in spleen, thymus, and appendix in the sepsis 12 hours group were further increased when compared with those in the sepsis 6 hours group, except for a significant decrease in IL-10 level [serum IL-10 (ng/L): 1 698.98±210.52 vs. 1 963.93±270.20, serum TNF-α (ng/L): 41.66±6.57 vs. 24.29±3.09, serum IL-1β (ng/L): 10.37±4.14 vs. 5.00±3.19, spleen p-JNK/JNK1 ratio: 0.399±0.135 vs. 0.257±0.126, spleen CHOP/β-actin: 0.298±0.145 vs. 0.201±0.131, spleen caspase-3/β-actin: 0.353±0.145 vs. 0.215±0.126, thymus p-JNK/JNK1 ratio: 1.667±0.891 vs. 1.221±0.776, thymus CHOP/β-actin: 0.207±0.133 vs. 0.122±0.071, thymus caspase-3/β-actin: 0.416±0.179 vs. 0.258±0.145, appendix p-JNK/JNK1 ratio: 2.425±1.361 vs. 2.014±1.227, appendix CHOP/β-actin: 0.456±0.189 vs. 0.361±0.134, appendix caspase-3/β-actin: 0.635±0.289 vs. 0.439±0.211, all P < 0.05]. Conclusions:The endoplasmic reticulum pathway JNK and CHOP pathways are involved in immune-related cell apoptosis and cytokine expression in mice with sepsis. Apoptosis is more obvious at 12 hours than at 6 hours, and the inflammatory response is stronger.
ABSTRACT
Objective Todiscuss the causes and treatment of intimo-intimal intussusception in endovascular repair of aortic dissecting aneurysms.Methods This retrospective study included 7 patients with intimo-intimal intussusception who underwent endovascular repair of aortic dissecting aneurysms from January 2017 to June 2018.There were 5 males and 2 females aged 34 to 64 years (mean 47.1 years),with a clinical course from 8 hours to 3 months.Six cases presented with acute chest pain and 1 had abdominal pain.Preoperative CTA was performed in all patients to confirm the diagnosis.Six patients received thoracic endovascular aortic repair (TEVAR) and 1 receivedfenestration.Results The endovascular repairs were successful without converting to open surgery in all patients.Pathological classifications were 1 type Ⅰ,5 type Ⅱ and 1 type Ⅲ.Four patients received another aortic stent at distal segment to cover the intimo-intimal intussusception and 1 patient at proximal site.One patients received another bare stent in the superior mesenteric artery,and 1 case received abdominal aortic stent implantation.Balloon was used in 2 cases to dilate the stenosis of aortic stents.The death occurred in 1 case at 3 days after surgery for metadata object description schema,and 1 patient needed continuous renal dialysis after discharge.The postoperative conditions (from 7 to 21 days) of other patients were normal without paraplegia,bowel necrosis,lower limb ischemia or arterial rupture.Conclusions The results indicate that the intimo-intimal intussusception in endovascular aortic dissecting aneurysms repair is rare and it is a severe complication.Re-endovascular aortic repair is a safe and reliable surgical approachbased on the type in early phase.
ABSTRACT
Objective To evaluate the mid-and long-term results of chimney-endovascular aneurysm repair (Ch-EVAR) on efficacy and durability.Methods Data of abdominal aortic aneurysm (AAA) patients receiving Ch-EVAR were retrospectively collected and analyzed.Results From Jan 2011 to Dec 2016,21 patients received Ch-EVAR in our institution including 18 males and 3 females with the average age 74.0 ±6.31 years.One patient died and 20 patients were followed up for an mean period of 53.2 months.During EVAR procedures 14 patients received left renal artery chimney stents,6 patients had right renal artery chimney stents and one did bilateral renal artery chimney stents.Technical success was achieved in all patients (100％).Differences between preoperative and one-week postoperative value of serum creatinine (P =0.639) and estimated glomerular filtration rate (eGFR) (P =0.804) showed no statistical difference.The differences of maximum sac diameter between preoperiation (60.1 ± 13.1 mm) and follow-up (59.2 ± 13.5 mm) was not significant (P =0.826).Six patients died during follow-up and none was aortic events related.All chimney stents were patent.One patient developed late type Ⅱ endoleak and refused reintervention regardless of aneurysm expansion.Conclusion For short hostile neck AAA patients with considerable surgical risk Ch-EVAR may be an effective and durable alternative.
ABSTRACT
Objective To investigate the effect of left subclavian artery (LSA) coverage on ischemic stroke complications in thoracic aortic cavity repair (TEVAR).Methods The clinical data of 69 patients undergoing TEVAR with LSA coverage from Jun 2013 to Jan 2018 were retrospectively analyzed.Results There were 56 males and 13 females,average age of S1.1(32-76).Perioperative mortality was 4.3％ (3/69) and stroke related mortality was 1.4％ (1/69).There were 2 cases (2/66,3.0％) of symptomatic stroke in perioperative period and 5 cases (5/66,7.6％) of cryptogenic stroke,inclucling 2 cases of anterior circulation ischemia (2/66,3.0％),3 cases of posterior circulation ischemia (3/66,4.5％),and 2 cases of multiple ischemia (2/66,3.0％).48 cases (72.7％) of vertebral blood steal were grade Ⅰ,15 cases (22.7％) were Ⅱ and 3 cases (4.5％) were Ⅲ.No new stroke related deaths happened in 6 months,there were 3 cases of symptomatic stroke (3/66,4.5％) and 13 cases of cryptogenic stroke (13/66,19.7％).There were 3 cases of anterior circulation ischemia (3/66,4.4％),8 cases of posterior circulation ischemia (8/66,12.1％) and 5 cases of multiple ischemia (5/66,7.6％)respectively.Conclusion The compensation mechanism of LSA itself reduces the serious ischemic stroke risk caused by LSA coverage.
ABSTRACT
Objective To summarize the clinical experience on acute type B aortic intramural hematoma,and to investigate the relation between focal enhancement characteristics on CT angiography (CTA) and the outcome of acute type B aortic intramural hematoma.Methods From Sep 2009 to Mar 2017,a total of 29 patients with acute type B aortic intramural hematoma treated in our department were retrospectively reviewed.After type B aortic intramural hematoma diagnosis by CTA,patients were prescribed anti-hypertension medicine with targeted systolic blood pressure of less than 120 mmHg.Then patients underwent a schemed CT angiography review within 2 weeks if no complications occurred.Surgical indications included recurrent pain,enlarged extent of hematoma and appearance of penetrated ulcer/dissection/aneurysm,and hematoma around the aorta or rupture.Results In the initial CT imagines,lesions of intimal defect were found in 22 patients,intramural blood pool in 16 patients,and ulcer-like projection in 16 patients.15 patients underwent thoracic endovascular aortic repair,with success rate of 100％,no mortality.The median duration of follow-up was 28 months.There was no aortic related complications nor death.Among the 14 patients treated by medicine 1 patient had formation of dissection and 1 patient with new-onset penetrating ulcer lesion and formation of thoracic aortic aneurysm.These two received thoracic endovascular aortic repair successfully.The proportion of deterioration of intramural hematoma in patients with ulcer-like projection lesions in initial CT imagines was higher than that in patients without ulcer-like projection lesions (7％ vs.33％,P =0.047).The proportion of deterioration of intramural hematoma in patients with intimal defect and intramural blood pool lesions in initial CT imagines was 68％ and 69％,respectively.Conclusions Strict anti-hypertension medical treatment with timely surgical repair was effective for acute type B intramural hematoma of the aorta.Intramural hematoma with ulcer-like projection lesions are prone to deterioration.
ABSTRACT
Objective To analyze the long-term curative effect of radical surgery for Budd-Chiari syndrome and the postoperative recurrence risk factors.Method Clinical data of 83 patients treated with radical surgery for Budd-Chiari syndrome through exposure of the entire inferior vena cava of the hepatic segment at Peking University People's Hospital between Jul 2001 and Dec 2010 was studied.Survival rate,patency rate of the inferior vena cava and hepatic vein,and risk factors were analyzed.Results There were 5 perioperative deaths with a mortality rate of 6％.Child-Pugh C liver function (P =0.001) was independently related to the perioperative death.The mean follow-up time was 84 ± 35 (60-173)months.There were 8 patients (10.3％) lost to follow-up.10 patients (12.8％) died during follow-up.Child-Pugh C liver function (P =0.003) was independently related to the follow-up death.24 cases (40％) suffered from recurrence with inferior vena cava restenosis in 12 cases (20％),that of hepatic vein in 2 cases (3.3％),and 10 cases (16.7％)with both inferior vena cava and hepatic vein restenosis.Membranous lesion of inferior vena cava (P =0.004) and inadequate anticoagulation time (P =0.004) were independently related to the recrudescence.Conclusions Long term recurrence of Budd-Chiari syndrome after radical surgery through exposure of the entire inferior vena cava of the hepatic segment is related to membranous lesion of inferior vena cava and inadequate anticoagulation time.
ABSTRACT
Objective To evaluate thoracic endovascular repair (TEAVR) techniques for the treatment of Stanford type A aortic dissection.Methods From Jan 2010 to Dec 2016,68 cases (male 51,female 17,age 58 ± 9 years) of Stanford type A aortic dissection were treated by endovascular stent grafting.Results Aortic stents were delivered and deployed successfully in all target arteries.48 important aortic arch arteries were reconstructed (brachiocephalic trunk 6,left carotid commond artery 18,left subclavian artery 24).30-day mortality rate was 5.9％ (4/68).Endoleak developed in 13 cases and new stroke in 2 cases.Average follow-up time was 6-112 months.One death occurred after 6-months postoperatively for multiple organ failure.2 cases were new endoleak and 1 case was left upper limb ischemia.Up to the most recent review or death,the false lumen remained thrombosed in all cases.Conclusions Optimized endovascular stent-graft treatment is effective method to treat Stanford type A aortic dissection.
ABSTRACT
To test the therapeutic effect of recombinant fusion polypeptide hEGF-AWRK6 (EK) on burn infection of model mice. EK6 was expressed and purified with Escherichia coli expression system, and the Ⅱ degree burns and Pseudomonas aeruginosa infection model mouse were established. Experiment group was treated with EK (30 mg/L), and the control group was treated with PBS, gentamicin (30 mg/L), burn ointment (10 mg/L). The wound healing rate and colony count were calculated. Wound and surrounding skin were taken for HE staining and collagen western-blot analysis, and the wound pathological changes were observed after 10 days of drug delivery. The results showed that fusion peptide EK was successfully expressed and purified with significant antibacterial activities against Pseudomonas aeruginosa. Compared to the control group, the colony count (CFU) of the wound surface in EK mouse had a remarkable decrease (P<0.01) and healing rate had a significant increase in group EK6 (P<0.01). Pathological analysis result showed that compared to the control group, wound dermal cells in group EK arranged regularly, had more hair growth and a faster epithelization. These results indicated that the fusion peptide EK would be a good candidate for the drug development for the treatment of burning wounds.
ABSTRACT
Objective To present our initial experience with modified branched stent gratis in endovacular repair of common iliac artery aneurysms.Methods In 5 patients,3 were aortobiiliac aneurysms and 2 were single common iliac aneurysms,receiving endovascular repair by a novel modified branched stent graft to keep at least one internal iliac artery patency.Results All cases were successfully completed with patent external and internal iliac artery on the target side.There were no inhospital mortality nor major complications after graft stenting.During a follow-up period of 27.6 months (21 to 33 months),there have been no stenting related endoleak and branch occlusion.Conclusions Modified branched stent graft is safe and efficient,providing an effective way to protect internal iliac artery in endovascular treatment of common iliac aneurysms.
ABSTRACT
Objective To analyze the clinical characteristics of patients with acute myocardial infarction (AMI) in Zepu county of Xinjiang Uygur Autonomous Region.Methods From February 2013 to January 2017,153 AMI patients hospitalized in emergency ICU of People''s Hospital of Zepu County of Xinjiang Uygur Autonomous Region were collected.The population characteristics,clinical manifestations,laboratory examinations,prognosis and complications were retrospectively analyzed and summarized.ResultsThe average age of AMI patients was 57.1 years old,included 133 cases (86.9％) ST-segment elevation myocardial infarction (STEMI),non ST elevation myocardial infarction (NSTEMI) patients were 20 cases (13.1％),most patients with chest pain (92.8％) and chest congestion(85.6％) symptoms.Anterior wall STEMI patients were 45 cases (33.8％),inferior wall infarction were 27 cases (20.3％),anteroseptal infarction were 15 cases (11.3％).73 patients were treated with thrombolysis,the recanalization rate was 93.2％.The cardiogenic shock complication occurred in 12 cases (7.8％) during hospitalization,12 cases (7.8％) were concurrent with Killip level 3 or higher heart failure,10 cases (6.5％) were concurrent with ventricular fibrillation.The onset age between Han nationality and Uygur nationality patients was significantly different (t=6.82),the onset age of Uygur nationality was younger than the Han nationality.There were no statistically significant differences between the two groups in sex,blood sugar level,cholesterol level,triglyceride level,high density lipoprotein level,low density lipoprotein level (χ2=0.02,P＞0.05;t=0.86,0.65,1.14,0.23,0.27,all P＞0.05).Conclusion The population features,clinical manifestations,disease courses and therapeutic effects of the AMI patients in Zepu county of Xinjiang Uygur Autonomous Region have certain characteristics,understanding these characteristics is beneficial for treating the disease.