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BACKGROUND: Experiments have demonstrated that autologous vascular endothelial cells if transplanted onto artificial vascular cavosurface, can enhance the patency rate of vasotransplantation. Whether seeding of prostheses interposition grafts with bone marrow-derived endothelial cells is effective for in vivo endothelialization of artificial vessels remains unclear.OBJECTIVE: To observe the effect of endothelialization of vascular prosthesis by seeding prostheses interposition grafts with bone marrow-derived endothelial cells in animals.DESIGN: A controlled animal experimental study.SETTING: Shanghai Sixth People's Hospital.MATERIALS: This study was carried out in the Shanghai Sixth People's Hospital between September 2000 and October 2001. Twenty hybrid dogs from Shanghai, of either gender, aged 1.0 to 2.0 years old, weighing (18.7±2.3) kg, were involved in this study.METHODS: Bone marrow-derived mononuclear cells were isolated from the dogs. The endothelialization of ePTFE prostheses interposition grafts (4 mm×4 cm and 8 mm×5 cm)was carried out. Common carotid artery transplantation:Ten laboratory dogs were involved. Common carotid artery of 4 cm was resected from each dog. ePTFE prostheses interposition grafts of 4 mm×4 cm was transplanted into the bilateral common carotid artery, and prostheses interposition grafts were performed endothelialization, namely experimental group. Those prostheses interposition grafts, which were not performed endothelialization, were named as control group. Five dogs were used in each group. Patency rate and blood flow rate of transplanted vessels were detected with a color ultrasonograph 2 weeks and 2 months after operation.Inferior caval vein transplantation: Six of the rest 10 dogs were used for experiments. Under the anesthesia, 8-10 cm inferior caval vein was dissociated from each dog. Its two ends were blocked, and about 5 cm inferior caval vein was resected. ePTFE endothelialized vascular prosthesis with 8 mm in diameter and 5 cm in length was anastomosed end to end with 5-0 Prolene. The other 4 dogs were used for control experiment. ePTFE vascular prosthesis with the same specification was used as prostheses interposition graft. Vascular patency rate was determined 2 months after operation.At the same time, coverage rate and intimal thickness of transplanted vascular endothelial cells and vascular intimal thickness were determined.MAIN OUTCOME MEASURES: ①The patency rate and blood flow rate of transplanted vessels at different time points. ②Coverage rate of transplanted vascular endothelial cells and vascular intimal thickness.RESULTS:① At 2 weeks and 2 months after common carotid artery transplantation, the patency rate of experimentalside was 100%(5/5)and 60%(3/5), respectively, and that of control side was 40%(2/5)and 0%(0/5), respectively. At postoperative 2 months, the mean blood flow rate in the experimental group was obviously smaller than that in the control group (P ＜ 0.05). At 2 months after inferior caval vein transplantation, the patency rate of experimental group and control group was 83%(5/6)and 50%(2/4), respectively. ②At 2 weeks after common carotid artery transplantation and inferior caval vein transplantation, the coverage rate of vascular endothelial cells in the experimental group was significantly larger than that in the control group, separately (P ＜ 0.05). At 2 months after each transplantation, the vascular intimal thickness in the experimental group was significantly smaller than that in the control group (P ＜ 0.05).CONCLUSION: Seeding of ePTFE prostheses interposition grafts with bone marrow-derived endothelial cells can rapidly accomplish in vivo endothelialization and inhibit intimal hyperplasy; Circulating endothelial cells, as the potential source of endothelial cells, have certain clinical application values.
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Objectives: To explore the role of liver in the process of severe acute pancreatitis. Methods:Comparing the survival time, the endotoxin level of plasma and ascites , the IL-6 level of serum and ascites, the platelet granule membrane protein-140 (GMP-140) level of plasma and the histology change of lung between control group, portocaval shunting group(PC), acute necrotic pancreatitis (ANP) group and acute necrotic pancreatitis immediately after portocaval shunt(PC+ANP) group of rats. Measuring the serum IL-6 of control group, portocaval shunt control group (injecting normal saline through caval vein, PCJ), ascites injecting group (AJ) and ascites injecting portocaval shunt group (PC+AJ). Results: The survival time of PC+ANP group was much shorter than those of the other groups, and its plasma endotoxin , serum IL-6 and plasma GMP-140 levels were higher than those of the other groups (P
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ObjectiveTo explore the relationship between anastomotic leakage of patients undergoing colonic surgery and the collagen metabolism of colonic wall.Method We measured the overall collagen content of colonic tissue by biochemistry and detected the collagen I, III, MMP-1,MMP-13 by immunohistochemistry in 16 patients with anastomotic leakage compared with 16 control cases. Resultthe overall collagen content and collagen I,III of colonic wall in the leakage group were lower than those in the control group (t=3.417,t=2.841, t=2.261,P
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Objective To evaluate the long term effectiveness of splenectomy in the treatment of ideopathic thrombocytopenic purpura (ITP) and probe into the specific management pre and post operatively. Method We analyzed 202 splenectomized ITP patients from January 1974 to June 2001 retrospectively and divided them into the effective and non effective groups according the postoperative improvement of their clinical symptoms. Results Post operative complications developed in 18 cases (8 9%), 189 cases achieved long term follow up. Good result was achieved in 159 cases including excellent in 96 and fair in 63, surgery was ineffective in 30 cases. Six cases(3 2%) died of surgery related complications during the long term follow up. In the first week after operation platelet counts reached 100?10 9/L in 118 cases, among them 110 cases(69 2%) fell into effective group and 8 cases(26 7%) fell into ineffective group( ? 2= 19 45, P
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ObjectiveTo analyze the postoperative complications and mortality in patients with portal hypertension and its prevention.MethodsFrom December 1988 to December 1998, we have surgically treated portal hypertension in 302 cases.ResultsForty-two(13.9%) patients had complications. Some complications were related to the operative method and the expertise, others were related to the disease and patients′ condition. The main relative factors of complications were: age over 50,liver function grade C, emergency operation, and moderate or severe esophageal varices. 64 patients died at follow-up of surgical complications, rebleeding, encephalopathy and systemic failure. ConclusionThe standard operative maneuver, perioperative intensive therapy and avoidance of emergency operation were important in reducing the complications. More attention should be paid to patients with old age, poor liver function and repeated bleeding. Postoperative patients should be regularly followed-up. Every measures should be undertaken to improve the patients′ general condition in order to lower bleeding, encephalopathy and mortality.