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Objective To compare the safety and clinical efficacy of transcatheter closure for ruptured aortic sinus aneurysm (RASA) with those of surgical treatment.Methods A total of 31 successive patients with RASA,who were treated in a single center during the period from October 2003 to May 2017,were enrolled in this study.Among them,11 patients received transcatheter closure therapy,their mean age was (36.64±10.87) years old;20 patients received surgical closure,their mean age was (28.90± 10.06) years old.The technical success rate,complications,residual shunt,operation time,hospitalization days,amount of blood transfusion,medical expenses,etc.were compared between the two groups.Results No statistically significant differences in age,sex and preoperative cardiac functional grading established by the Heart Disease Association of New York (NYHA) existed between the two groups (P＞0.05).The technical success rates in transcatheter closure group and surgical closure group were 100％ (11/11) and 95％ (19/20)respectively (P＞0.05).The amounts of blood transfusion in transcatheter closure group and surgical closure group were 0 ml and (427.25±331.36) ml respectively (P＜0.01).The time spent for operation in transcatheter closure group and surgical closure group was (60.00±00.00) min and (205.50±129.35) min respectively (P＜0.05).Days staying in intensive care unit (ICU) in transcatheter closure group and surgical closure group were 0 day and (1.50±0.61) days respectively (P＜0.01).The residual shunt rates in transcatheter closure group and surgical closure group were 9.09％ (1/11) and 10.00％ (2/20) respectively.None perioperative death occurred in both groups.No statistically significant differences in hospitalization days and in medical expenses existed between the two groups (P＞0.05).Conclusion Both transcatheter closure and surgical closure are safe and effective for the treatment of ruptured RASA,although transcatheter closure therapy has more advantageous in aspect of minimally-invasive management,operative time and length of hospital stay.For patients with a RASA which position is suitable for percutaneous interventional management,transcatheter closure therapy should be employed as a preferred therapy.
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Objective To investigate the protective effects and possible mechanism of pigment epithelium derived faetor (PEDF) on myocardial cells H9C2 under hypoxia and serum-free condition.Methods H9C2 cells were culture in vitro and performed the hypoxia and serum-free processing.The cells were divided into the control group (H9C2),hypoxia group (hypoxia + H9C2),PEDF group(hypoxia+H9C2 +PEDF) and mitochondrial fission inhibitor(Mdivi-1) group(hypoxia+h9C2+Mivi-1).The apoptotic rate was detected by TUNNEL staining.The proteins levels of dynamin related peptide1 (Drp1) and cleaved-caspase 3 were measured by Western blot.Electron Microscopy and MitoTracker Red were used to detect the mitochondria morphology,the mitochondrial membrane potential was evaluated by cationic dye JC-1.MitoSOXTM was used to detect mitochondrial reactive oxygen species (ROS).Results Hypoxia induced mitochondrial fission(P＜0.05).The hypoxia group (6 h) and control group had statistical difference(P＜0.05).PEDF reduces mitochondrial fission under hypoxia condition(P＜0.05),which had statistical difference between the PEDF group and hypoxia group (6 h)(P＜0.05).PEDF and Mdivi-1 could decrease cell apoptosis under hypoxia condition(24 h),compared with the hypoxia group,the difference was statistically significant(P＜0.05).Conclusion PEDF decrease cell apoptosis by inhibiting H9C2 cells mitochondrial fission under hypoxia condition.
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Objective To investigate the protective effects and possible mechanism of pigment epithelium derived faetor (PEDF) on myocardial cells H9C2 under hypoxia and serum-free condition.Methods H9C2 cells were culture in vitro and performed the hypoxia and serum-free processing.The cells were divided into the control group (H9C2),hypoxia group (hypoxia + H9C2),PEDF group(hypoxia+H9C2 +PEDF) and mitochondrial fission inhibitor(Mdivi-1) group(hypoxia+h9C2+Mivi-1).The apoptotic rate was detected by TUNNEL staining.The proteins levels of dynamin related peptide1 (Drp1) and cleaved-caspase 3 were measured by Western blot.Electron Microscopy and MitoTracker Red were used to detect the mitochondria morphology,the mitochondrial membrane potential was evaluated by cationic dye JC-1.MitoSOXTM was used to detect mitochondrial reactive oxygen species (ROS).Results Hypoxia induced mitochondrial fission(P＜0.05).The hypoxia group (6 h) and control group had statistical difference(P＜0.05).PEDF reduces mitochondrial fission under hypoxia condition(P＜0.05),which had statistical difference between the PEDF group and hypoxia group (6 h)(P＜0.05).PEDF and Mdivi-1 could decrease cell apoptosis under hypoxia condition(24 h),compared with the hypoxia group,the difference was statistically significant(P＜0.05).Conclusion PEDF decrease cell apoptosis by inhibiting H9C2 cells mitochondrial fission under hypoxia condition.
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<p><b>OBJECTIVE</b>To evaluate the surgical techniques for acute left deep venous thrombosis (LDVT) secondary to left iliac vein compression syndrome (IVCS).</p><p><b>METHODS</b>Thirty-six patients with acute LDVT secondary to IVCS received inferior vena cava filter placement, and in 2 of the cases, stent implantation was canceled for acute episode of obsolete DVT. The remaining 34 patients underwent left femoral venotomy for iliofemoral thrombectomy with Fogarty catheter and distal femoral vein thrombus removal by sequential compression of the legs, followed by implantation of stent-graft (2 cases) or bare-metal stents (32 cases) in the left common iliac veins. With routine anticoagulation and thrombolytic treatments, the patients were regularly examined for postoperative blood flow in the affected limb.</p><p><b>RESULTS</b>In 2 of the cases undergoing bare-metal stent implantation, the residue thrombi were squeezed into the stent by balloon, which was managed subsequently with local thrombolysis. One patient with bare-metal stent implantation received a secondary stenting for posterior stent displacement. Three patients had self-limited bleeding due to decreased serum FBG. Significant improvements were achieved at 3, 6, 30 and 180 days postoperatively in the circumferences of the affected limb (P<0.05) and in the levels of D-dimer (P=0.011), and FBG level showed no significant variations (F=1.163, P=0.345). The total rate of excellent outcomes was 83.3% (26/34) with a total effective rate of 91.2% (31/34) in these cases.</p><p><b>CONCLUSIONS</b>Thrombectomy to revascularize the inflow tract and stent implantation to enlarge stenosed iliac veins are key issues in treatment of acute LDVT secondary to IVCS.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Angioplasty, Balloon , Leg , May-Thurner Syndrome , General Surgery , Thrombectomy , Methods , Vascular Patency , Venous Thrombosis , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the surgical approaches for management of postoperative stenosis of ateriovenous fistula (AVF) in patients with end-stage renal disease (ESRD).</p><p><b>METHODS</b>Of the 415 patients with ESRD receiving radial-cephalic end-to-side anastomosis during the last 3 years, 29 developed postoperative AVF stenosis (of type Ia in 5 cases, type Ib in 17 cases, type II in 3 cases, and type II in 2 cases). A proximal anastomosis was created between the radical artery and cephalic vein for type Ia stenosis. In the 17 cases with type I b stenosis, 5 were managed by interception of suitable segments from the accessory cephalic veins for cephalic vein reconstructions, and 12 by transposition of the accessory cephalic veins. Of 3 cases with type II stenosis, 1 was managed by interception of the accessory cephalic vein for interposing into the cephalic vein, 1 by interception of the distal great saphenous vein for interposing into the cephalic vein, and 1 by transposition of the forearm basilic vein for end-to-side anastomosis with the radial artery. The 2 cases with type III were managed by end-to-side anastomosis between the forearm basilic vein and the radial artery or by conversion to AVF repair on the contralateral forearm.</p><p><b>RESULTS</b>Twenty-eight of the 28 patients finally received surgical repair of AVF stenosis and the surgeries were completed successfully. Thrombosis of the outflow vein occurred 12 h after the repair in 1 case to require emergency embolectomy and anastomosis; restenosis occurred in 2 cases at 9 months postoperatively, for which progressive percutaneous transluminal angioplasty (PTA) was performed. The rate of restenosis was 7.1% (2/28). All the 28 patients undergoing AVF stenosis repair had successful HD for 12 months after the operation.</p><p><b>CONCLUSION</b>Reconstructing the arteriovenous anastomosis, replacing the stenosis segment with an accessory cephalic vein or great saphenous vein graft, or altering the outflow with the forearm basilic vein can be surgical options for repairing postoperative AVF stenosis.</p>
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Aged , Female , Humans , Male , Middle Aged , Anastomosis, Surgical , Arteriovenous Fistula , General Surgery , Arteriovenous Shunt, Surgical , Brachiocephalic Veins , General Surgery , Constriction, Pathologic , General Surgery , Diabetic Nephropathies , General Surgery , Radial Artery , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the surgical technique of skeletonization of the great saphenous vein (GSV) at the saphenofemoral junction (SFJ) in surgical intervention of primary varicosity and evaluate the outcomes one year after the operation.</p><p><b>METHODS</b>A total of 624 cases (774 limbs) of primary varicosity of the GSV were prospectively divided into skeletonization group (265 cases, 325 limbs) and control group (359 cases, 449 limbs). In the skeletonization group, skeletonization of the GSV at the SFJ, its branches and other aberrantly joined superficial veins was performed, and in the control group, routine high ligation of the GSV was performed, after which laser-ablation of the GSV, GSV stripping, Muller's operation, mutilation of the perforators and ulcer-related operations were performed in both groups.</p><p><b>RESULTS</b>Twenty cases in the skeletonization group were found to have superficial veins directly joining into the femoral vein or into the GSV in different tissue layers. In 14 cases in the control group, the superficial veins of the internal femoris or lateral femoris were mistaken for the GSV. No difference was found in the operating time between the two groups (t=0.68, P>0.05), but the skeletonization group had a significantly less bleeding volume (t=1.75, P<0.05). Statistical differences were found between the two groups in intraoperative bleeding rate in the inguinal regions, venous clinical severity scores (2.1∓0.5 vs 4.6∓0.9, t=1.96, P<0.05), and residual varicosity and recurrences (3/325 vs 13/449, V=1.25, P<0.05) at the one year follow-up.</p><p><b>CONCLUSION</b>Skeletonization of the GSV and its branches and other aberrantly joined superficial veins at the SFJ can decrease the postoperative residual varicosity and recurrence due to blood reflux.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Groin , General Surgery , Prospective Studies , Saphenous Vein , Pathology , General Surgery , Treatment Outcome , Varicose Veins , Pathology , General SurgeryABSTRACT
Objective To investigate how to improve teaching achievement of specified trained doctors with vascular skill. Methods Specified trained doctors were divided into groups(two doctors for one group) and expected vascular surgeon was appointed as majored teacher. Teaching revolution was proceeded with self-made vascular training platform,projected questions according with teaching content,cultivation of solidificatism and refined schema of check. Results After revolution,operative skills of specified trained doctors were improved significantly,basal operative procedures during operations were smooth,skill related theory was solid and compounding during operation was initiative. Conclusion Teaching revolutions of vascular skill can improve basal operative skill of specified trained doctors and develop habits of solidificatism.
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AIM: To investigate biological effect of endothelin-1 (ET-1) on differentiation of cardiomyogenic cells (CGCs) induced from rabbit bone mesenchymal stem cell (BMSCs) in vitro. METHODS: The BMSCs from shaft of femur of Japan rabbits were isolated and propagated for cell culture. Cultured BMSCs were randomly divided into six groups: Group Ⅰ: the control group (uninduced group); Group Ⅱ: the ET-1 group, added ET-1 (30 nmol/L) into culture medium; Group Ⅲ: 5-aza group, added 5-aza (10 ?mol/L) into culture medium; Group Ⅳ: 5-aza+ET-1 group, after inducing with 5-aza for 3 weeks, ET-1 was added into culture medium. This group was divided into three parts-Ⅳ 1、Ⅳ 2、Ⅳ 3, and separated to add 10、 30、 50 nmol/L ET-1. During the cell culture, growing and differentiation of BMSCs were observed. After inducing for 4 weeks, the differentiation rate and the diameter of cardiomyogenic cells were calculated; Western-blot was employed to analyze the expressions of GATA-4 protein and phosphorylation level. The expression of ?-MHC mRNA was assessed by RT-PCR. Immunohistochemistry staining of Troponin-I and ultrastructure observation of induced cardiomyogenic cells were also completed simultaneously. RESULTS: The cell diameters of CGCs in group Ⅳ 2 were enlarged significantly (P0.05). In group Ⅲ and Ⅳ 2 , the positive cells of cTroponin I staining were more, the expression of ?-MHC mRNA was significantly increased (P
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OBJECTIVE:To analyze the distribution of the common pathogenic bacteria and drug resistance in urinary tract infection for clinical reference of rational use of antibacterials. METHODS:The medical records of patients hospitalized in urinary surgery in our hospital from Jan. to Oct. in 2008 were retrospectively collected for analyses of the results of mid-stream urine culture and antibiotic resistance,meanwhile,the current utilization of antibacterials in urinary surgery was analyzed. RESULTS:Gram negative bacilli were the major pathogenic bacteria in urinary tract infection(61.82%),of which,escherichia coli represented 58.82%,and the resistant rates of the gram negative bacilli to imipenem,amikacin,cefoperazone/sulbactam and piperacillin/tazobactam were 8.82%,8.82%,11.76% and 11.76%,respectively. CONCLUSION:The antibiotics should be used rationally according to the result of susceptibility test in treating patients with urinary tract infection.
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AIM: To investigate the effect of microwave ablation of liver cancer on the cellular immunity in mice. METHODS: A C57BL/6J mouse model of liver cancer was established by subcutaneous injection of Hepa 1 - 6 cells. The tumors were subjected to microwave ablation under the ablation condition of 45 ℃, 50 ℃, 55 ℃ or 60 ℃ for 180 s. The CD4~+ T cells, CD8~+ T cells and natural killer cells (NK) in peripheral blood were detected by FACS. The cytotoxicity of splenic NK and splenic cytotoxic T lymphocytes (CTL) activated by inactivated Hepa 1-6 cells was assayed by LDH method. RESULTS: The proportions of CD4~+ T cells, CD8~+ T cells and NK cells in peripheral blood in 50 ℃ and 55 ℃ group at 21 d after ablation were significantly increased and that of NK cells in 60 ℃ group was significantly increased. There was no significant difference between those in group 42 d after ablation and control. The cytotoxicities of splenic CTL and NK cells in 50 ℃ and 55 ℃ groups at 21 d or 42 d after ablation were significantly increased, and they were much higher than those in 45 ℃ group at the same time. The cytotoxicities of splenic CTL in 50 ℃ and 55 ℃ groups at 21 d after ablation were much higher than that in 60 ℃ group at the same time. CONCLUSION: Under a certain ablation temperature, microwave ablation of liver cancer promotes the cellular immunity.
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AIM: To investigate the homing effect of immature dendritic cells (iDC) after injection of iDC into the mouse hepatoma treated by microwave ablation and the possibility of stimulating tumor immunity after thermal ablation. METHODS: The model of hepatoma was established with Hepa 1-6 cells injected into the subcutaneous tissue of C57BL/6J mice. The tumors were treated by microwave ablation under different temperatures, and then fluorescent-labeled iDCs (PKH26-DC) were injected into the ablated tumor tissues. The influences of ablation to homing of PKH26-DC, maturation and excitation ability towards T-cell were observed. RESULTS: There were no homing PKH26-DCs and expression of CCR7 in draining lymph nodes in (65?5)℃ and (90?5)℃ ablation groups after intratumoral injection of iDCs. The number of homing PKH26-DCs was 32?8 in (50?5)℃ ablation group vs 21?6 in un-ablated group, and the expression rate of CCR7 was 100% vs 90%. The number of clusters with immunological synapsis was 8-12 in (50?5)℃ ablation group vs 4-6 in un-ablated group under 100-magnification visual field, and the number of lymphocytes in each cluster was 12-25 vs 3-10. CONCLUSION: Thermal ablation of hepatoma under an appropriate temperature level may promote maturing and homing of iDCs and stimulate immunity of lymphocytes.