A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).</p><p><b>METHODS</b>A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods.</p><p><b>RESULTS</b>A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR = 1.81, P = 0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR = 1.53, P = 0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P = 0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P < 0.001) and a shorter total postoperative stay (WMD 6.27 days, P < 0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR = 0.48, P < 0.001 and OR = 0.28, P = 0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70, P < 0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR = 1.13, P = 0.381) and re-intervention rate (OR = 2.19, P = 0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR = 0.33, P = 0.039) at late follow-up period.</p><p><b>CONCLUSIONS</b>On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.</p>

Evaluation of efficacy of the anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment.</p><p><b>METHODS</b>There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference.</p><p><b>RESULTS</b>Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94.4% vs.69.5%, P < 0.01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85.9% vs. 75.3%, P > 0.05). A mean follow-up period was (43 ± 18) months. There was no significant difference in incidence of complication and recurrence between two groups.</p><p><b>CONCLUSIONS</b>The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.</p>

Endovascular repair of a tuberculous aneurysm of descending thoracic aorta / 中华医学杂志(英文版)

Tuberculous aortic aneurysm (TBAA) is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial, endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication. The outcome was favorable.

The expression of sonic hedgehog in rat vein grafts / 中华外科杂志

<p><b>OBJECTIVE</b>To study the expression of cell cycle related factor sonic hedgehog (SHH) in autogenous vein graft and its relation with neointima formation.</p><p><b>METHODS</b>Autogenous vein graft model were established in 24 male Wistar rats of 8 weeks old and 140 g weight, by transplanting the left jugular vein to intra renal abdominal aorta with microsurgical technique. Graft veins were harvested at 14 d and 28 d after transplantation. The immunohistochemistry and Western blot were used to detect the SHH and PCNA expression in the vein graft. At the same time SHH mRNA was measured by quantitative real-time PCR. The opposite normal veins served as control.</p><p><b>RESULTS</b>Histological staining showed that the percent of SHH+ cells was only (2.0 +/- 0.5)% in the normal vein, but was much more in the vein graft after surgery, as (39.4 +/- 0.4)% and (63.0 +/- 0.3)% respectively (P < 0.01). The expression of SHH and PCNA were both elevated in the vein graft. There was a positive correlation between them which indicated by Western blot (r = 0.808, P < 0.01). The SHH mRNA content also increased in vein graft to 9.5 and 23.8 folds of that in control.</p><p><b>CONCLUSION</b>SHH is upregulated in autogenous vein grafts and may correlated with the proliferation of vascular smooth muscle cells.</p>

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>

Inflammatory abdominal aortic aneurysm: clinical features and long term outcome in comparison with atherosclerotic abdominal aortic aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inflammatory abdominal aortic aneurysms (IAAAs) are rare but distinct clinical entities of atherosclerotic abdominal aortic aneurysms (aAAAs). In this study we report a 20-year single institution experience for IAAA and analyze their clinical features and long term outcome in comparison with aAAA.</p><p><b>METHODS</b>Between 1988 and 2008, 412 cases of abdominal aortic aneurysms (AAAs) underwent elective surgical operations, 11 (2.7%) of whom were diagnosed as IAAAs and 389 (94.4%) were diagnosed as aAAAs. The former group was matched in a case control fashion to a group of 33 patients with aAAAs having similar characteristics of age, gender, and preoperative risk factors. All available clinical, pathologic, and postoperative variables were retrospectively reviewed, and the two groups were compared.</p><p><b>RESULTS</b>The two groups did not differ significantly in clinical characteristics and preoperative risk factors, although patients with IAAAs were significantly more symptomatic (100% vs. 42.4%, P = 0.001) and had larger aneurysms on admission ((7.4 +/- 0.7) cm vs. (6.3 +/- 0.9) cm, P = 0.006). In IAAAs, the preoperative erythrocyte sedimentation rate was found to be significantly elevated compared to aAAA group ((44.5 +/- 9.1) mm/h vs. (11.4 +/- 5.4) mm/h, P < 0.05). Surgical morbidity and mortality rates did not differ between the two groups. The operation time for patients with IAAAs was significantly longer than that for patients with aAAAs ((308 +/- 36) minutes vs. (224 +/- 46) minutes, P < 0.05), but the cross-clamp time was similar in both groups ((41.5 +/- 6.2) minutes vs. (41.8 +/- 6.2) minutes, P = 0.92). A five-year survival rate analysis showed no significant difference between the two groups (P = 0.711).</p><p><b>CONCLUSIONS</b>Despite having more symptoms, larger size and longer operation time, patients with IAAA can now be treated with approaches that cause low morbidity and mortality, similar to patients with aAAA. Long term outcome of IAAA patients is of no difference from aAAA patients.</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>

Experience in the management of acute superior mesenteric artery ischemia / 中华外科杂志

<p><b>OBJECTIVE</b>To study the management of acute superior mesenteric artery (SMA) ischemia and to improve its prognosis.</p><p><b>METHOD</b>The clinical data of 37 patients treated from January 1996 to August 2007 was retrospectively reviewed.</p><p><b>RESULTS</b>Of the cases, 19 (51.4%) patients were diagnosed with acute SMA embolism, 15 (40.5%) with acute SMA thrombosis, 2 (5.4%) with spontaneous isolated dissection of SMA and 1 (2.7%) with SMA aneurysm. Nineteen (51.4%) patients were misdiagnosed in emergency. Eighteen (48.6%) patients died in the hospital, and most of them died of severe infection and multiple organ failure. Three cases of the survived 19 patients experienced severe complications (2 with short gut syndrome, 1 with cerebral hemorrhage). Nine cases were followed-up for a mean period of 15 months, and 5 died during that term.</p><p><b>CONCLUSIONS</b>Acute SMA ischemia has multiple etiological factors. Early intervention can improve the prognosis.</p>

Effect on hyperplasia of VSMCS in rat by the plasmid containing the short hairpin RNA of AT1R / 中国应用生理学杂志

<p><b>AIM</b>RNA interference is a new technology that inhibit effectively of the expression the specific genes. The present study was designed to investigate whether the plasmid containing the short hairpin RNA (shRNA) of angiotensin II type 1 receptor (AT1R) can inhibit the hyperplasia of VSMCs in rat.</p><p><b>METHODS</b>The plasmids containing the shRNA of AT1R were constructed, and transfected vascular smooth muscle cell (VSMC) to detect the effect on the AT1R expression by RT-PCR and Western blot, and detect the hyperplasia of VSMCs by trypan blues training and MTT.</p><p><b>RESULTS</b>The plasmids was certified to be in the right rank, and there was significant difference (P < 0.01) in the expression of AT1R mRNA and protein between the plasmid transfected group and the control group. There was significant difference (P < 0.01) in the hyperplasia of VSMCs between the plasmid transfected adding Ang II group and the control group.</p><p><b>CONCLUSION</b>The plasmids containing the shRNA of AT1R have the effect of RNAi, and inhibit the hyperplasia of VSMCs induced by Ang II in rat.</p>

Effect of ischemic pretreatment on expression of heat shock protein 70 and injury of spinal cord in canine / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate effect of ischemic pretreatment on expression of heat shock protein 70 (HSP70) and injury of spinal cord in canine.</p><p><b>METHODS</b>Fourty-one canine were divided into three groups: the sham-operative group, the pretreatment group and the control group. In the pretreatment group aorta was obstructed for 6 min, and then was opened for 6 min, this procedure was repeated twice, finally aorta was obstructed for 35 min. In the control group aorta was obstructed for 35 min. Nervous function were assessed and HSP70 expression were detected in tissue of spinal cord.</p><p><b>RESULTS</b>In the pretreatment group, HSP70 expressed in cytoplasm and nucleus at 6, 24 hour after reperfusion, and intensity of HSP70 expression was stronger than that in the control group; The score of nervous function in the pretreatment group was higher than that in the control group. On 7 day after reperfusion the score of nervous function in pretreatment group had no obvious variation, and HSP70 expression was still observed.</p><p><b>CONCLUSIONS</b>Ischemic pretreatment can improve ischemic tolerance of spinal cord; HSP70 expression in cytoplasm and nucleus may play a role in ischemic tolerance.</p>

Inhibition of hyperplasia of vascular smooth muscle cells in rat by the plasmid containing the short hairpin RNA of angiotensin II type 1 receptor / 中华外科杂志

<p><b>OBJECTIVE</b>RNA interference is a new technology that inhibit effectively the expression the specific genes. The current study was designed to investigate whether the plasmid containing the short hairpin RNA (shRNA) of angiotensin II type 1 receptor (AT(1)R) can inhibit the hyperplasia of vascular smooth muscle cells in rat.</p><p><b>METHODS</b>The plasmids containing the shRNA of AT(1)R were constructed, and transfected vascular smooth muscle cell (VSMC) to detect the effect on the AT(1)R expression by RT-PCR and Western blot, observe the shape of VSMCs by the inverted phase contrast microscope, and detect the hyperplasia of VSMCs by trypan blues staining and MTT.</p><p><b>RESULTS</b>The plasmids was certified to be in the right rank. After transfecting cells, there was significant difference (P < 0.01) in the expression of AT(1)R mRNA between the plasmid transfected group (pAT(1)R-shRNA(1) 1.37 +/- 0.15; pAT(1)R-shRNA(2) 1.45 +/- 0.12) and the control group (2.09 +/- 0.26), and there was significant difference (P < 0.01) in the expression of AT(1)R protein between the gene transfected group (pAT(1)R-shRNA1 1.12 +/- 0.04; pAT(1)R-shRNA2 1.20 +/- 0.07) and the control group (3.17 +/- 0.21). It is shown that pAT(1)R-shRNA can decrease the expression of AT(1)R mRNA and protein. There was significant difference (P < 0.01) in the Cell number between the plasmid transfected adding AngII group (pAT(1)R-shRNA1 5.48 +/- 0.44; pAT(1)R-shRNA2 5.55 +/- 0.45) and the AngII control group (8.13 +/- 0.41); there was significant difference (P < 0.01) in the Ratio of light density by MTT between the plasmid transfected adding AngII group (pAT(1)R-shRNA1 0.365 +/- 0.024; pAT(1)R-shRNA2 0.307 +/- 0.025) and the control group (0.485 +/- 0.011); It is shown that that pAT(1)R-shRNA can inhibit the hyperplasia of VSMCs, and matching the result of morphology observation.</p><p><b>CONCLUSIONS</b>The plasmids containing the shRNA of AT(1)R can inhibit the expression of AT(1)R mRNA and protein in VSMCs, and inhibit the hyperplasia of VSMCs induced by AngII in rat.</p>

Batroxobin reduces intracellular calcium concentration and inhibits proliferation of vascular smooth muscle cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Batroxobin (BX), a serine protease used in defibrinogenation and thrombolysis, also has an effect on c-fos gene and growth factor. This study attempted to determine the effects of BX on the proliferation of vascular smooth muscle cells (VSMCs) and calcium metabolism.</p><p><b>METHODS</b>VSMCs were treated with BX at concentrations of 0.1, 0.3, or 1.0 mmol/L and cell numbers were determined at 0, 24, 48, and 72 hours. Intracellular calcium concentration ([Ca2+]i) was measured using direct fluorescence methods.</p><p><b>RESULTS</b>BX was found to suppress proliferation of VSMCs in a dose-dependent fashion with inhibition rates of 18% and 31% by 48 and 72 hours, respectively. In addition, BX decreases basal [Ca2+]i significantly. The basal level in untreated cells was 162.7 +/- 33.8 nmol/L, and decreased to 131.5 +/- 27.7 nmol/L, 128.3 +/- 28.5 nmol/L, and 125.6 +/- 34.3 nmol/L with the three concentrations of BX, respectively. Noradrenaline (NE)-induced [Ca2+]i stimulation was also attenuated by BX (0.1 mmol/L BX, 20% +/- 8% inhibition; 0.3 mmol/L BX, 54% +/- 11% inhibition; 1.0 mmol/L BX, 62% +/- 15% inhibition). The ability of NE to stimulate [Ca2+]i was attenuated in cultures in Ca(2+)-free medium, as was the ability of BX to blunt NE-induced stimulation.</p><p><b>CONCLUSION</b>These findings demonstrate that BX can effectively inhibit proliferation of VSMCs, probably by blocking the release and uptake of Ca2+, thus influencing [Ca2+]i.</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>