Clinical outcomes of severe calcified lesions after carotid artery stenting / 中华普通外科杂志

Objective:To evaluate the safety and efficacy of carotid artery stenting (CAS) in the treatment of non-circumferential severe calcification using the distal embolic protection device.Methods:Clinical data of patients with severe calcification lesions in cervical carotid artery treated by CAS from Jan 2018 to Dec 2020 at our center was analyzed retrospectively.Results:226 consecutively admitted patients of cervical carotid artery stenosis and non-circumferential severe calcification (CR>270°) underwent CAS using the distal embolic protection device. The technical success rate was 90.26%. No death or myocardial infarction occurred during the perioperative period. Two patients had ipsilateral hemiparesis ischemic stroke during post-dilatation. The incidence of perioperative bradycardia/hypotension was 25.34%. Patients were followed up for 6-36 months, with median follow-up period of 17.3 months. The incidence of mild or moderate in-stent restenosis (<70%) was 16.59%, and the incidence of severe in-stent restenosis or occlusion (>70%) was 3.22%.Conclusions:For carotid artery stenosis with non-circumferential severe calcification in high risk for CEA patients, carotid artery stenting is safe and effective with the aggressive pre-dilation strategies, strict stent selections and implantation standards. The incidence of perioperative death, myocardial infarction or ipsilateral hemiparesis ischemic stroke was low. The patency rate of the carotid stent in the calcification lesion is satisfactory during the mid-term follow-up.

Comparing plain old balloon and drug-coated balloon supported bare metal stents in the treatment of femoral-popliteal TASC D lesions / 中华普通外科杂志

Objective:To compare the efficacy between drug-coated balloon (DCB) combined with bare metal stenting (BMS) and plain old balloon angioplasty (POBA) with BMS placement in the treatment of femoral-popliteal TASC D lesions.Methods:According to the Trans-Atlantic Inter-Society Consensus (TASC) D grade femoral-popliteal lesions as the standard, we enrolled 115 cases (120 limbs) receiving DCB combined with BMS (group DCB, 37 limbs in 36 cases) and POBA combined with BMS (group POBA, 83 limbs in 79 cases) from Jan 2017 to Mar 2020 to observe patency rate, freedom from clinical-drived target lesion reintervention rate (FCD-TLR) and complications.Results:The mean follow-up time was 18.1 months and the average occlusion length was (29.1±6.5)mm. In group DCB vs group POBA, the primary patency rates at 3-month, 9-month, 1-year and 2-year were 89.2% vs. 86.7%, 86.4% vs. 76.9%, 66.8% vs. 70.9% and 63.1% vs. 56.9%, respectively ( P=0.73); FCD-TLRs were 100.0% vs. 95.1%, 94.3% vs. 82.3% , 78.5% vs. 80.6% and 74.1% vs. 68.9% ( P=0.69), respectively. Conclusion:The benefit of DCB combined with BMS over POBA combined with BMS in improving the early primary patency rate and reducing FCD-TLR was not definite.

Correlation of programmed death ligand 1 and interleukin-10 expressions with the prognosis in uterine cervical cancer tissues / 肿瘤研究与临床

Objective:To investigate the correlation of the expressions of programmed death ligand 1 (PD-L1) and interleukin-10 (IL-10) with the prognosis in uterine cervical cancer tissues.Methods:A total of 82 patients with uterine cervical cancer hospitalized at Nantong Maternal and Child Health Hospital from January 2015 to December 2019 were retrospectively analyzed, and the clinicopathological data of all patients were collected and sorted out. Immunohistochemical method was used to detect the positive expression of PD-L1 protein in cancer tissues, and Western blot was used to detect the expression level of IL-10 protein in cancer tissues. The survival of all patients for 24-month follow-up was recorded and 82 patients were divided into the survival group and the death group. The clinicopathological characteristics and the expressions of PD-L1 and IL-10 in both groups were compared. Multivariate Cox proportional risk model was used to analyze the factors affecting the survival of patients with uterine cervical cancer. The value of PD-L1 and IL-10 expressions predicting the survival in uterine cervical cancer was evaluated by using receiver operating characteristic (ROC) curve. The best cut-off value of IL-10 relative expression in cancer tissues obtained from ROC curve analysis predicting 24-month survival of patients was used to group; ≥ the best cut-off value was treated as IL-10 high expression group, and < the best cut-off value was treated as IL-10 low expression group. Kaplan-Meier method was used to compare the survival of PD-L1 positive and negative groups, IL-10 high and low expression groups.Results:There was no loss of follow-up in 82 patients during 24-month follow-up, of which 11 cases (13.4%) died and 71 cases (86.6%) survived. The proportion of patients with Federation International of Gynecology and Obstetrics (FIGO) staging Ⅲ-Ⅳ, poor differentiation, tumor long diameter > 4 cm and lymph node metastasis in the death group was higher than that of those in the survival group (all P < 0.05). PD-L1 was positive in 9 of 11 patients in the death group and 11 of 71 patients in the survival group ( P < 0.001). The relative expression level of IL-10 protein in the death group was higher than that in the survival group (1.18±0.32 vs. 0.89±0.21, P < 0.001). Multivariate Cox regression analysis showed that FIGO staging, tissue differentiation degree, tumor long diameter, whether lymph node had metastasis or not, whether PD-L1 was positive and the relative expression level of IL-10 protein were independent factors affecting patients' 24-month survival (all P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of PD-L1 and IL-10 single and the combination of both predicting 24-month survival in cancer tissues was 0.748 (95% CI 0.664-0.894), 0.710 (95% CI 0.655-0.884) and 0.839 (95% CI 0.742-0.951), respectively. There were 20 cases in PD-L1-positive group and 62 cases in PD-L1-negative group. The best cut-off value of relative expression level of IL-10 protein was 7.12. There were 19 cases in IL-10 high expression group and 63 cases in IL-10 low expression group. The overall survival of patients in PD-L1-positive group was worse than that in PD-L1-negative group (24-month overall survival rate: 55.0% vs. 96.8%, P = 0.001). The overall survival of patients in IL-10 high expression group was worse than that in IL-10 low expression group (24-month overall survival rate: 57.9% vs. 95.2%, P = 0.001). Conclusions:The prognosis of patients with positive PD-L1 and IL-10 high expressions in uterine cervical cancer tissues is poor. The combined detection of PD-L1 and IL-10 has a high predictive effect on the prognosis.

Early mortality risk prediction models for patients with sepsis-induced cardiorenal syndrome based on machine learning / 中华肾脏病杂志

Objective:To explore the method of constructing an early mortality risk prediction model for patients with sepsis-induced cardiorenal syndrome by machine learning algorithm, so as to provide a basis for early clinical identification of high-risk patients and accurate treatment.Methods:Patients with sepsis-induced cardiorenal syndrome from January 1, 2015 to May 31, 2019 in Tongji Hospital, Tongji University were enrolled. Basic characteristics, laboratory indexes, hospitality treatment and other relevant baseline data were collected. Thirty-day mortality was defined as the primary end-point event after the enrolled patients were diagnosed. Python software was applied to establish different machine learning models, and the area under the receiver -operating characteristic curve ( AUC) was used to evaluate the predictive value of models. Disease-related risk factors were selected according to the most optimal model. Importantly, visualized decision tree and semi-naive Bayesian (sNB) models were established to further explore the interrelationship between these risk factors. Results:A total of 340 patients were included, of whom 114 patients (33.5%) died within 30 days after diagnosis. The AUC of support vector machine (SVM), random forest (RF), gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), and light gradient boosting machine (LGBM) prediction models were 0.652, 0.868, 0.870, 0.754, and 0.852, respectively. The AUC of GBDT model had the most efficiency to predict end-point events, and the prediction AUC value was better. According to the feature ranking of GBDT model, the relevant influencing factors were selected, including total sequential organ failure assessment (SOFA) score, neural SOFA score, vasoactive drug application, cardiac troponin I (cTNI), age, myoglobin, circulation system SOFA score, chronic kidney disease, heart rate and baseline serum creatinine. Visualized decision tree model had 4 layers, 15 nodes and 8 terminal nodes as evidenced by total SOFA score, myoglobin, baseline serum creatinine and age. The total SOFA score, change rate of myoglobin, serum creatinine and age were included into the visualized decision model. The AUC value of the model for predicting end-point event was 0.690. sNB model revealed complex correlation between the risk factors, in which neural SOFA score was related to total SOFA score, vasoactive drug application was related to total SOFA score, and cTNI was related to baseline serum creatinine. Conclusions:A risk prediction model for patients with sepsis-induced cardiorenal syndrome is established and the model showes that high SOFA score remains the primary risk factor for patients with sepsis-induced cardiorenal syndrome based machine learning. Visualized decision tree and sNB models help clinicians to further identify the dependence and logic relationship among these risk factors clearly and provide a novel method to predict mortality risk for patients with sepsis-induced cardiorenal syndrome.

Early and intermediate outcomes of second-grade false-lumen endovascular occlusive repair for aortic dissection / 中华普通外科杂志

Objective:To summarize the early and intermediate outcomes of second-grade false-lumen endovascular occlusive repair (FLEVOR) for aortic dissection.Methods:The clinical data of 12 patients undergoing second-grade FLEVOR after proximal repair of aortic dissection at our center from Aug 2016 to Aug 2019 was retrospectively analyzed.Results:The mean age was (51.3±14.9) years old. Four patients received open repair due to Stanford type A aortic dissection previously, the other 8 patients underwent thoracic endovascular aortic repair for Stanford type B aortic dissection. The time to the proximal repair varied from 3 months to 16 years. The technical success rate was 100%. Visceral ischemia, early spinal cord ischemia and in-hospital death did not occur perioperatively. The mean follow-up time was 16.7 months. Persistent false lumen perfusion was found in 3 patients, complete thrombosis of false lumen was achieved in the other 8 patients. The maximum diameter of abdominal aorta decreased in 8 (72.7%) patients.Conclusions:FLEVOR could block the blood flow from the false lumen and induce the thrombosis of false lumen, which promotes the aortic remodeling. Meanwhile, FLEVOR could protect the blood supply of spinal cord and viscera, and reduce the risk of type Ⅱ endoleaks.

Short term result of COOK-ZFEN custom-made endovascular stent graft system for the treatment of short-neck abdominal aortic aneurysm / 中华普通外科杂志

Objective:To evaluate the safety and efficacy of a Zenith fenestrated aortic stent-graft (ZFEN) system in the treatment of short-necked aneurysms.Methods:The clinical data of 5 patients receiving F-EVAR in Zhongshan Hospital, Fudan University from Mar 2018 to Sep 2019 according to the standards of short-necked abdominal aortic aneurysm and COOK ZFEN custom stent were retrospectively analyzed.Results:Patients' average age was (69±11) years old. The time of stent customization was 4-6 weeks. The average maximum diameter of AAA was (60.8±14.0) mm. The average proximal neck diameter was (26.0±2.6) mm and the average length anchoring zone was (6.4±2.2) mm. The rate of technical success was 100%. There was no intraoperative loss of visceral vessels and stent displacement. The meane follow-up time was 6.8 months. The perioperative mortality was 0, and there were no other major complications. There were 3 patients with simple type Ⅱ endoleak and 1 patient with type Ⅲ endoleak. The endoleaks disappeared in 4 patients during follow-up of 3-12 months. 1 patient suffered with type Ⅱ and type Ⅲ endoleak, and the visceral vessels and branching stents were patent in all patients.Conclusion:The short term result of COOK ZFEN stent-graft system was safe and feasible for the treatment of short-necked AAA.

Treatment for arteriosclerosis obliterans complicated with acute thrombosis of lower extremity / 中华普通外科杂志

Objective:To discuss the clinical treatment for arteriosclerosis obliterans combined with acute thrombosis (ASOCAT) of lower extremities.Methods:The treatment methods and results of 30 patients with ASOCAT admitted to our center from Jan 2009 to May 2019 were retrospectively analyzed.Results:The course of acute thrombosis in 30 patients was (9.5±5.2) days, and the average course of ASO was (2.1±1.4) years. Among 30 patients, 13 patients had aortoiliac occlusion (type Ⅰ), and 17 patients had femoropopliteal lesion (type Ⅱ). Twenty-eight patients underwent endovascular treatment, 1 had hybrid operation, and 1 was given aorto-bilateral femoral bypass. One patient died perioperatively. 24 patients were followed up for (16.3±16.1) months. One died during follow-up.Two patients underwent above-knee amputation within 6 months. Two patients had distal superficial femoral artery reocclusion within 12 months. The restenosis/reocclusion rates within 12 months of type Ⅰ and Ⅱ patients were 12.5% and 21.4%, respectively. The 6/12-month amputation-free survival rates for type Ⅰ and type Ⅱ were 87.5%/87.5% and 92.8%/85.7%, respectively.Conclusion:Reasonable and active use of open surgery, endovascular treatment or hybrid operation could achieve acceptable outcomes in patients with ASOCAT.

Long-term follow up outcomes of surgical resection of Shamblin Ⅱ/Ⅲ carotid body tumor: a single center analysis / 中华普通外科杂志

Objective:To evaluate the correlation between tumor size and surgical outcomes of Shamblin Ⅱ/Ⅲ carotid body tumor (CBT) and the prognosis.Methods:From Apr 2011 to Dec 2017, 88 patients with Shamblin Ⅱ and Ⅲ CBTs undergoing tumor resection were retrospectively analyzed. The long-term prognosis of surgical resection was also evaluated.Results:One patient died of multi-organ failure postoperatively, two patients abandoned surgery. The perioperative mortality was 1%. 85 patients having 87 lesions successfully resected were analyzed. There were 13 Shamblin Ⅱ and 74 Shamblin Ⅲ CBTs resection. Two patients had bilateral CBTs resection. The median of tumor size, procedural blood loss, procedural time, and length of hospital stay was 3.0 (1.2-5.5) cm, 200 (0-2 500) ml, 162 (85-430) min, and 10 (6-28) d, respectively. Seventy-two patients had carotid vascular intervention during the procedure, and thirty-three patients had neurological complications after the procedure. Correlation analysis showed that the tumor size had positive relationship with blood loss (Spearman R=0.35, P<0.01) and procedural time (Spearman R= 0.54, P<0.01). Tumor size was positively associated with the risk of cranial neurological complication ( OR=1.72, 95% CI 1.08-2.73, P=0.02) and carotid vascular intervention ( OR=2.69, 95% CI 1.27-5.69, P=0.01). There were four patients who were diagnosed with malignant CBT due to the metastasis. Three suffered CBT recurrence after 1, 5, and 7 years during the follow up. Conclusions:Shamblin Ⅱ or Ⅲ CBTs should be intervened as early as possible to facilitate the surgical resection, as well as to reduce the risk of carotid vascular and neurological complications.

Comparison of intravascular ultrasound and venography in the intraoperative evaluation of iliac vein compression syndrome / 中华普通外科杂志

Objective@#To compare intravascular ultrasound (IVUS) with venography in the intraoperative evaluation of iliac vein compression syndrome (IVCS).@*Methods@#From Sep 2017 to Mar 2018, consecutive patients with suspicious iliac vein compression, underwent both venography and IVUS. The results were compared between IVUS and venography.@*Results@#40 patients with 48 limbs were enrolled. Venography underestimated both the diameter and area stenosis compared with IVUS (39.63%±15.48% vs. 64.97%±16.42%, P<0.001; 51.83%±18.23% vs. 59.19%±14.17%, P=0.021, respectively). The eccentricity detected by venography was lower than IVUS (0.69±0.17 vs. 0.93±0.17, P<0.001). Taking IVUS as gold standard, the sensitivity and the specificity of venography for detecting a ≥50% stenosis was 18.92% and 81.82%, and the intertechnique agreement was extremely low between venography and IVUS (κ=0.004).@*Conclusion@#Compared with IVUS, venography underestimated the degree of stenosis in IVCS. The sensitivity of venography in detecting a significant stenosis was very low.

Comparison of intravascular ultrasound and venography in the intraoperative evaluation of iliac vein compression syndrome / 中华普通外科杂志

Objective To compare intravascular ultrasound (IVUS) with venography in the intraoperative evaluation of iliac vein compression syndrome (IVCS).Methods From Sep 2017 to Mar 2018,consecutive patients with suspicious iliac vein compression,underwent both venography and IVUS.The results were compared between IVUS and venography.Results 40 patients with 48 limbs were enrolled.Venography underestimated both the diameter and area stenosis compared with IVUS (39.63％ ± 15.48％ vs.64.97％ ±16.42％,P＜0.001;51.83％ ±18.23％ vs.59.19％ ±14.17％,P=0.021,respectively).The eccentricity detected by venography was lower than IVUS (0.69 ±0.17 vs.0.93 ±0.17,P ＜0.001).Taking IVUS as gold standard,the sensitivity and the specificity of venography for detecting a ≥50％ stenosis was 18.92％ and 81.82％,and the intertechnique agreement was extremely low between venography and IVUS (κ =0.004).Conclusion Compared with IVUS,venography underestimated the degree of stenosis in IVCS.The sensitivity of venography in detecting a significant stenosis was very low.

A review of effects of disrupted primary caregiver infant relationship on brain development and psychopathology / 中国心理卫生杂志

The disrupted caregiver infant relationships are not unpopular (infant abuse and non-traumatic caregiver-infant relationship).Animal and human studies have demonstrated this disruptive relationship exerts the fundamental and enduring impacts on stress system, limbic system and relevant cortex.Individual carrying such biological susceptibility might develop psychopathology under stresses at later life.The assessment needs to get involved the measures with more objectivity,real time and moment-to-moment components.The study on caregiverinfant relationship also should focus on the historical and cultural aspects of China.

Early result of in-situ fenestration with self-designed puncture system to preserve left subclavian artery in TEVAR / 中华普通外科杂志

Objective To evaluate a self-designed in-situ fenestration system to preserve left subclavian artery during thoracic endovascular aortic repair (TEVAR).Methods From June 2016 to May 2017,aortic dilatation disease patients with insufficient proximal landing zone were treated by the selfdesigned in situ fenestration system to preserve the left subclavian artery during TEVAR.The patients were regularly followed-up with CTA.Results Totally 12 patients with an average age of 65 ± 11 years were enrolled.Among them,6 patients had thoracic aortic aneurysm and the other 6 suffered from aortic dissection.The mean operating time was 145 ± 36 minutes.The perioperative procedure success rate was 100％.One patient had intraoperative type Ⅰ endoleak,1 patient had type Ⅱ endoleak.One patient had suffered from stroke and 1 patient had mild paraplegia post-operatively.All patients were followed-up for a mean time of 6.5 ± 3.0 months.The type Ⅰ endoleak in 1 patient disappeared,type Ⅱ endoleak remained in one.There was no death during perioperative and in follow up period.Conclusions This self-designed in-situ fenestration system effectively and quickly restores the blood flow of the left subclavian artery during TEVAR.

Closed-cell stents for cervical internal carotid artery pseudo-occlusion and its effects on vessel remodeling / 中华普通外科杂志

Objective To evaluate the closed-cell stents in the treatment of carotid pseudo-occlusion.Methods From Jan 2014 to Dec 2017,clinical data of 34 patients undergoing carotid artery recanalization with closed-cell stents for pseudo-occlusion were analyzed retrospectively.Results The technical success rate was 97.1％ (33/34) and the intracranial blood supply improved in 91.2％ patients (31/34).The 30-day perioperative ipsilateral symptomatic ischemic stroke rate was 2.9％ (1/34).All the patients were discharged with no peri-operative hyperperfusion syndrome,myocardial infarction.The average follow-up time was 15.2 ±7.6 months.The incidence of carotid artery restenosis was 17.6％.There was no stroke-related mortality.Ultrasound or CTA found luminal dilatation of the distal internal carotid artery.The diameter increased from (2.5 ±0.5) mm to (4.1 ±0.6) mm after intervention (P ＜0.001).Conclusion Closed-cell stents for carotid artery pseudo-occlusion is safe and effective,decreasing cerebral stroke and carotid occlusion.

Transplantation of peripheral purified CD34+ cells in treatment of thromboangiitis obliterans / 中华普通外科杂志

Objective To evaluate the safety and efficacy of transplantation of purified CD34 + cells (PCCs) in treatment of critical limb ischemia (CLI) caused by thromboangiitis obliterans (TAO).Methods From May 2009 to June 2015,34 TAO-induced-CLI cases underwent PCCs transplantation.None of these patients were eligible for surgical or endovascular revascularization.G-CSF was subcutaneously injected for 5 days before peripheral CD34 + cells were isolated,purified and intramuscularly injected in the limbs.Patients were regularly follow-up.Results Technical success was achieved in all cases.The mean number of transplanted cells was (7.5 ± 2.4) × 105/kg.The follow-up was accomplished in 32 cases,ranging from 6 to 79 months (mean 45 ±24 months),and two patients were lost.Wong-Baker FACES pain rating scale score significantly decreased from 8.0 ±2.0(4-10)to 2.2 ±3.1 (P ＜0.05) at 1 month.The Peak pain-free walking time improved from (4.0 ± 2.0) min to (13.5 ± 5.3) min (P ＜ 0.05) at 3 months and (19.0 ± 3.1) min (P ＜ 0.05) at 6 months.The ankle-brachial index increased from 0.42 ± 0.20 to 0.50 ± 0.10 (P ＜ 0.05) at 3 months and 0.52 ± 0.11 (P ＜ 0.05) at 6 months,respectively.Transcutaneous partial oxygen pressure rose from (25 ± 11) mmHg to (48 ± 11) mmHg(P ＜ 0.05) at 3 months and (58 ± 10) mmHg (P ＜ 0.001) at 6 months,respectively.Ulcers healed in 21 out of 22 patients at (5 ± 4) months.The overall amputation-free survival rate was 94.1％ at 6 months and 91.2％ at 48 months.No major adverse events were observed perioperatively or postoperatively.Conclusions Transplantation of PCCs could yield safe,satisfactory and durable treatment outcomes in patients with TAO-induced-CLI.

Surgical treatment for atheromatous pseudo-occlusion of the internal carotid artery:a single center experience / 复旦学报（医学版）

Objective To investigate the efficacy and safety of surgical treatment for internal carotid artery atheromatous pseudo-occlusion (APO).Methods Clinical data of patients with carotid artery stenosis treated by carotid endarterectomy from Dec.,2011 to Jun.,2016 in Zhongshan Hospital Affiliated to Fudan University were analyzed retrospectively.Carotid endarterectomy were performed in 32 patients with pseudo-occlusion of the internal carotid artery (APO group).And 124 patients with traditional severe stenosis (70％-99％) served as control group.Perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosisrate and mortality in follow-up were compared between the two groups.Results Perioperative major complications:one patient (3.1 ％) developed myocardial infarction in the APO group,no ischemic stroke,cerebral hemorrhage and death cases;2 (1.4％) ischemic stroke cases,6 (4.2％) myocardial infarction cases and 1 (0.7％)death case was found in control group.Perioperative minor complications:1 (3.1％) incision bleeding case,2 (6.3％) pulmonary infection cases,2 (6.3％) cerebral hyperperfusion syndrome cases were found in APO group;3 (2.1％) incision bleeding cases,2 (1.4％) incision infection cases,4 (2.8％)pulmonary infection cases,2 (1.4％) cranial nerve injury cases,2 (1.4％) cerebral hyperperfusion syndrome cases were found in control group.Patients were followed up for 6-60 months,with mean follow-up period of (35.3 ± 17.5) months.During follow-up,1 (3.1％) ipsilateral ischemic stroke recurrence case,4 (12.5％) restenosis cases,and 3 (9.4％) death cases were found in the APO group.And 8 (5.6％) ipsilateral ischemic stroke recurrence cases,9 (6.3％) restenosis cases,8 (5.6％)death cases were found in control group.There were no significant differences in perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosis rate and mortality between the two groups.Conclusions Surgical treatment for atheromatous pseudo-occlusion of the internal carotid artery is safe and effective.Perioperative and follow-up results are satisfactory.

Endovascular aortic repair of abdominal aortic aneurysm of short neck with Endurant stent graft / 中华外科杂志

Objective@#To evaluate the safety and effectiveness of the Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length <10 mm.@*Methods@#This study was a retrospective analysis. From January 2010 to May 2015, 22 consecutive abdominal aortic aneurysm patients with proximal neck length <10 mm were treated with endovascular aortic repair by Endurant stent graft in Department of Vascular Surgery, Zhongshan Hospital, Fudan University. There were 19 (86.3%) male cases, aging from 57 to 84 years. All patients underwent preoperative CT angiography and the anatomic parameters of abdominal aortic aneurysm were measured. All patients performed standard endovascular aortic repair first and if there was obvious proximal typeⅠ endoleak, the CUFF or the chimney technology were applied to observed the perioperative technical and the clinical success rate. During follow-up, the incidence of adverse events and the reintervention rate were observed.@*Results@#These 22 cases had proximal neck length 5 to 9 mm with the average of (7.2±1.4) mm. Immediate endoleak occurred in 5 patients with 4 cases of proximal typeⅠ endoleak, 3 cases were implanted proximal CUFF, 1 case implanted CUFF and left renal artery chimney. One case died perioperatively, the clinical success rate was 95.4%, the technical success rate was 77.3%. During the follow-up of 6 to 54 months, there was 1 case with delayed proximal type-1 endoleak, during operation the patient had no endoleak, but disappeared 6 months later without further intervention. So the incidence of adverse event was 4.5% and reintervention rate was 0.@*Conclusion@#The Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length < 10 mm is safe and effective.

Endovascular treatment of popliteal artery aneurysm in a clinical analysis of 9 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of endovascular repair of popliteal artery aneurysm (PAA) and to summarize the clinical experience and lessons.</p><p><b>METHODS</b>A clinical data of 9 PAA cases (males 8, females 1, age range 55-84) undergoing endovascular repair from October 2006 to December 2014 at Zhongshan Hospital Fudan University were retrospectively analyzed. CT angiography was made in all of the 9 cases preoperatively, and 10 PAA were included in the analysis. Of the 9 cases, 6 cases were symptomatic. The mean diameter of PAA was 3.9 cm (range, 2.1-8.2).</p><p><b>RESULTS</b>The technique successful rate of endovascular repair was 10/10. The preoperative complications were 2/10, including one case suffered hematoma in the arterial puncture site and 1 case with distal artery embolization. The mean follow-up was 33 months (range, 3-87). During the follow-up, 2 cases received the secondary intervention and drug thrombolysis because of the stent distal thrombosis. The stent-graft primary patency at 1 year was 78.8% (95% CI: 48%-91%). One case suffered stent fracture, and one case died of brainstem hemorrhage 15 months post endovascular repair of PAA.</p><p><b>CONCLUSIONS</b>Endovascular treatment of PAA is safe and effective in perioperative and midterm follow-up. However, individual endovascular strategy and postoperative complications in the long-term follow-up should be payed more attention.</p>

Clinical analysis of hybrid treatment for extensive aortic disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of extensive aortic diseases (EAD) after hybrid repair with supra-arch branches or visceral arterial debranching and endovascular repair.</p><p><b>METHODS</b>A total of 24 EAD patients (19 male and 5 female) underwent hybrid repair in Department of Vascular Surgery, Zhongshan Hospital, Fudan University between March 2005 and April 2015. The clinical data was analyzed retrospectively. The mean age was (49±12) years (from 29 to 69 years). The high-risk candidates for open surgery were enrolled in the study. The patients, including 14 cases with thoracic aortic aneurysms and 10 cases with aortic dissection, were treated by one or two stages. Post-operative follow-up with CT angiography was performed at 3, 6 and 12 months and then annually thereafter.</p><p><b>RESULTS</b>A total of 74 branches, including 63 with visceral arteries and 11 with supra-arch arteries, were recanalized. Nine patients were treated in two-stage hybrid procedure and fifteen were repaired by one stage. The perioperative mortality was 12.5% (3/24), whereas the aneurysm-related mortality was 8.3% (2/24). The 30-day patency of the grafts was 95.9% (71/74). There was no endoleak, paralysis, and intestinal ischemia at 30 days post-hybrid procedures. Four cases (16.6%) suffered acute renal dysfunction. During the follow-up (3 to 123 months), there were two deaths and one endoleak (type Ia and III) which emerged at 4 months post-procedure. The 1-year and 3-year survival rates were 81.7% and 73.5%, respectively.</p><p><b>CONCLUSIONS</b>Hybrid treatment is safe and effective for complex EAD patients in the midterm follow-up. It is especially suitable for the high-risk patients with comorbidities, re-intervention, or little tolerance to open surgery repair.</p>

Serum protein biomarkers of postmenopausal osteoporosis based on TMT labeling and LC-MS/MS technology / 中华骨科杂志

Objective To screen the serum protein molecular markers of postmenopausal osteoporosis by the proteomicsanalysis using Tandem Mass Tag (TMT) combined with liquid chromatography-tandem mass spectrometry (LC-ESI-MS/MS).Methods 20 serum protein samples were recruited (10 cases of postmenopausal patients with osteoporosis and 10 cases of postmenopausal women without osteoporosis)and the high abundance ratios protein was removed,differentiation protein was extracted and labeled with TMT reagent.Then,mass spectrometric detection,data analysis of differentially expressed proteins,and analysis of biological information were carried out.Results 87 significantly differentially expressed proteins were screened from the differentiated protein expression profile by LC-ESI-MS/MS combined with TMT labeling.While 50 proteins were up-regulated,and 37 proteins were down-regulated.Differentially expressed proteins were analyzed by GO annotation,these proteins are mainly involved in 15 kinds of biological processes,7 kinds of cellular component,6 kinds of molecular function.RAB7A,TSP1,GAS6,SPP24 were screenedas candidate proteins which were related to mechanism of bone remodeling of osteoporosis.By STRING 10.0 protein interaction network analysis tools,RAB7A,TSP1,GAS6 were located in the center of the interaction network.SPP24 was located at edge of the network,but it is directly related to the protein BMP-2 of bone remodeling.RAB7A,TSP1,GAS6,SPP24 may be associated with the pathogenesis of postmenopausal osteoporosis.Conclusion These results provide that the proteomics analysis by using TMT coupled with LC-ES1-MS/MS was a feasible method for screening the molecular biomarkers.It suggests that RAB7A,TSP1,GAS6 and SPP24 may be useful biomarkers which can be used both in diagnosis and treatment of postmenopausal osteoporosis.

Prospectively longitudinal study of the relationship between infancy abuse and antisocial personality disorder / 中华行为医学与脑科学杂志

ObjectiveTo investigate the relationship of antisocial personality disorder(ASPD) and infancy abuse.MethodsWith prospectively longitudinal research design,76 samples at infancy were initially recruited.Infancy abuse was measured by Child Protective Service records and reconfirmed by one hour family interview.56 remained samples at young adulthood were measured for antisocial personality disorder,depression,and substance abuse by utilizing Structured Clinical Interview-Ⅰ/Ⅱ (SCID-Ⅰ/Ⅱ) of DSM-Ⅳ.Longitudinal data was analyzed by multiple imputation and hierarchal regression.Results 33.9％ samples met at least one item of ASPD,38.0％ were diagnosed with substance abuse and 32.4％ with depression.Gender was correlated with ASPD symptoms (F=1.40,P =0.001 ).Infancy abuse significantly predicted ASPD (β =0.28,P=0.03 ).Further analysis demonstrated that infancy abuse was associated with ASPD with controlling substance abuse and depression (β =0.19,P =0.04 ).ConclusionInfancy abuse,with fundamental long-term effects on personality,is a risk factor for the etiology of antisocial personality disorder.The underlying mechanism might involve biological alternations.It is necessary to establish national early-life abuse monitoring and prevention system.