Quantification of Adventitial Vasa Vasorum Vascularization in Double-injury Restenotic Arteries / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Accumulating evidence indicates a potential role of adventitial vasa vasorum (VV) dysfunction in the pathophysiology of restenosis. However, characterization of VV vascularization in restenotic arteries with primary lesions is still missing. In this study, we quantitatively evaluated the response of adventitial VV to vascular injury resulting from balloon angioplasty in diseased arteries.</p><p><b>METHODS</b>Primary atherosclerotic-like lesions were induced by the placement of an absorbable thread surrounding the carotid artery of New Zealand rabbits. Four weeks following double-injury induced that was induced by secondary balloon dilation, three-dimensional patterns of adventitial VV were reconstructed; the number, density, and endothelial surface of VV were quantified using micro-computed tomography. Histology and immunohistochemistry were performed in order to examine the development of intimal hyperplasia.</p><p><b>RESULTS</b>Results from our study suggest that double injured arteries have a greater number of VV, increased luminal surface, and an elevation in the intima/media ratio (I/M), along with an accumulation of macrophages and smooth muscle cells in the intima, as compared to sham or single injury arteries. I/M and the number of VV were positively correlated (R2 = 0.82, P < 0.001).</p><p><b>CONCLUSIONS</b>Extensive adventitial VV neovascularization occurs in injured arteries after balloon angioplasty, which is associated with intimal hyperplasia. Quantitative assessment of adventitial VV response may provide insight into the basic biological process of postangioplasty restenosis.</p>

The effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS).</p><p><b>METHOD</b>A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies: anticoagulant group (41 limbs), thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS.</p><p><b>RESULTS</b>The average time of follow-up were (41 ± 19) months in anticoagulant group, (52 ± 11) months in thrombolysis group, and (26 ± 10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58.5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS (P < 0.05). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0.5 ± 1.0) cm and (0.7 ± 1.0) cm, which were more obvious compared to other two groups (P < 0.05). Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS.</p><p><b>CONCLUSIONS</b>The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheter-directed thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.</p>

The analysis of the follow-up results for the crural artery bypass / 中华外科杂志

<p><b>OBJECTIVE</b>To review the follow-up results of the crural artery bypass.</p><p><b>METHODS</b>Sixty-five limbs in 64 patients with long stenosis or occlusion in femoral artery and popliteal artery were performed 65 times femoral-crural artery bypass surgery or femoral-popliteal-crural bypass surgery during April 2001 to July 2007. The ankle-brachial index before bypass surgery was 0.35 +/- 0.20 in anterior tibial artery and 0.38 +/- 0.21 in posterior tibial artery. Critical limb ischemia was 93.8%.</p><p><b>RESULTS</b>The ankle-brachial index after bypass surgery was 0.84 +/- 0.26 in anterior tibial artery and 0.83 +/- 0.22 in posterior tibial artery. The perioperative mortality rate was 1.6%, the perioperative amputation rate was 1.5%. Fifty-four patients 54 limbs were followed up. The average follow-up time was (24.1 +/- 16.6) months. The follow-up limb salvage rate was 85.2%. The follow-up mortality rate was 25.9%. Critical limb ischemia decreased as 13.0%. The follow-up ankle-brachial index was difference with before and after bypass surgery as 0.66 +/- 0.26 in anterior tibial artery and 0.64 +/- 0.25 in posterior tibial artery. It was no difference in cumulative limb salvage rate, cumulative primary and secondary patency rate by comparing autogenous vein with composite vascular as graft and comparing femoral-crural artery bypass surgery with femoral-popliteal-crural bypass surgery as surgical method.</p><p><b>CONCLUSIONS</b>When the patients are failed in endovascular intervention or have long stenosis or occlusion in femoral artery and popliteal artery to face to amputation, the crural artery bypass is a feasible method. It's helpful to improve the secondary patency rate and limb salvage rate by enhancing the follow-up after operation and early intervention.</p>

Study on small diameter artificial vascular graft with eNOS gene transfected endothelial cells in canine / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the patency efficacy of small diameter artificial vascular graft with eNOS gene transfected endothelial cells in canine.</p><p><b>METHODS</b>By using the two steps high pressure injection, eNOS gene transfected endothelial cells were planted on artificial vascular graft with a diameter of 3 mm. The artificial vascular grafts were transplanted into canine femoral artery, and the patency of the artery was observed through digital subtracted angiography (DSA) and electron telescope 1, 4, 12 and 24 weeks after the operation.</p><p><b>RESULTS</b>The adherence rate of eNOS gene transfected endothelial cells to artificial vascular grafts was up to 90%. For 10 days, the cells extended and formed a continuous intima. One week after the operation, 3/9 grafts were obstructed in the group of simple artificial vascular grafts; 4 weeks after, all of grafts (9/9) were obstructed in the group of simple artificial vascular grafts and almost half grafts (5/10, 4/9) in un-transfected groups were obstructed; 12 weeks after, all of the grafts were obstructed in the group of simple artificial vascular grafts and in un-transfected groups (9/9, 9/10); 24 weeks after, all of the grafts were obstructed in the groups of un-transfected artificial vascular grafts, while nearly all of grafts (8/10) were open in eNOS groups. Electron microscope scanning showed that endothelial cells of artificial vascular grafts in eNOS transfected groups arranged closely and formed a continuous intima; only few red blood cells, leucocytes, platelets deposited at the surface of endothelial cells in the artificial vascular grafts.</p><p><b>CONCLUSIONS</b>The patency efficacy of eNOS gene transfected endothelial cells planting on artificial vascular graft is satisfactory. It could provide an experimental basis for further clinical application of the artificial vascular grafts.</p>

Immune function of erythrocytes in patients with chronic venous insufficiency of the lower extremities / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The influence of inflammatory processes has been one of the hot topics in discussions of the etiology of chronic venous insufficiency (CVI). Erythrocytes are very important in controlling inflammatory immunity and innate immune reactions. The purpose of this study was to analyze the correlation between the development of CVI and the change of CD35, Fy6 on erythrocytes, and interleukin-8 (IL-8) levels.</p><p><b>METHODS</b>A group of 43 patients with CVI were studied in parallel with 8 healthy individuals serving as control subjects. Control subjects were those with normal findings on lower extremity duplex examinations. We used an erythrocyte flow cytometer to examine the expression of both CD35 and Fy6 on red blood cells, and an enzyme-linked immunosorbent assay analysis method to measure plasma IL-8 levels. We also analyzed the change of IL-8 levels under the influence of erythrocytes using a modified method of the hemaimmune reaction.</p><p><b>RESULTS</b>Compared with normal control subjects, CD35 expression increased significantly among patients with CVI classified as C4 without lipodermatosclerosis, but tended to decrease and reach the lowest level among patients classified as C5-C6. Fy6 expression increased significantly among patients in the early stages of CVI, but tended to decrease remarkably among patients classified as C5-C6. The inflammatory response intensified at the C5-C6 classification, where high levels of IL-8 coexisted with a low expression of Fy6. The increase in IL-8 in the CVI group was higher than in the control group in association with the complete blood cells, regardless of the presence of erythrocytes, when inactive tumour cells were added, whereas the level of IL-8 in the CVI group was significantly lower than in the control group.</p><p><b>CONCLUSIONS</b>Abnormalities of erythrocyte innate immunity represents a fundamental derangement in CVI. These inadequate inflammatory responses may lead to local tissue and microvascular damage of the lower extremity.</p>

Reoperations for occluded arterial bypasses in the lower limbs / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We reviewed the outcomes of reoperations for 29 patients (30 limbs) who had undergone occluded arterial bypass in the lower limbs from May 1996 to September 2005.</p><p><b>METHODS</b>The 30 lower limbs of the 29 patients with arteriosclerotic obstruction received 44 reoperations, including thrombectomy alone (group T, 27) and inflow or outflow reconstruction plus thrombectomy (group C, 17). Among the 17 operations in group C, 17.6% (3/17) were inflow reconstructions involving the axillary-femoral (1), aorta-iliac (1) and aorta-femoral (1) arteries, and 76.4% (13/17) outflow reconstructions involving the femoral-popliteal bypass-tibial (8), femoral-tibial (1), femoral-popliteal bypass-popliteal arteries below the knee (2), and the femoral-popliteal bypass-tibial-peroneal trunk (2). One patient (1 limb) underwent both inflow and outflow reconstructions with an iliac arterial stent and a graft-popliteal anastomosis patch. Polytetrafluoroethylene (PTFE) grafts were used in the inflow or outflow reconstructions above the knee. Autovenous grafts or autovenously combined PTFE grafts were used in the outflow reconstructions below the knee.</p><p><b>RESULTS</b>The percentages of Fontaine stage III and IV before primary operation and reoperation were 60% (18/30) and 86.7% (26/30), respectively (P < 0.05). Four patients died of heart attack (2), stroke (1) and multiple organ failure (1) after reoperations. Among them, only 1 patient underwent occluded bypass, and others, patent bypass. Five patients after patent bypass are still alive. The accumulative patent rate was 28.6% (8/28). The average duration of patency in groups T and C was (4.16 +/- 5.68) (0.13 - 24) months and (7.14 +/- 6.37) (0.26 - 21) months, respectively (P > 0.05). Among 42 reoperations, 19 failed within 1 month in groups T (16) and C (3) (P < 0.01). Nine patients had limb amputated (10/28 limbs, 35.71%) because of graft infection (2 limbs), pseudo aneurysm at anastomosis (1 limb), and gangrene caused by failed grafts (7 limbs). The amputation was performed on 6 limbs within 1 month and on 4 limbs 1 month after reoperation (P > 0.05). The rate of limb salvage was 64.29% (18/28).</p><p><b>CONCLUSIONS</b>The percentages of Fontaine stage III and IV before reoperation may be much higher than those before primary operation. Thrombectomy plus inflow/outflow reconstruction creates patency better than thrombectomy alone for re-occluded bypass.</p>

Clinical classification and evaluation systems for chronic venous insufficiency of lower extremities / 上海第二医科大学学报

The evaluation systems for chronic venous insufficiency of lower extremities play a very important role in standardizing the diagnosis and evaluating the curative effect in patients with the disease. This paper gives an introduction to the CEAP classification system, VSS evaluation system and chronic venous insufficiency questionnaire.

Dynamic changes of plasma NPY before and after vascular intracavitary therapy in patients with lower extremity ASO / 上海第二医科大学学报

Objective To dynamically observe the concentrations of plasma neuropeptide Y(NPY)in the patients with lower extremity arteriosclerosis obliterans(ASO)before and after vascular interventional therapy.Methods The levels of plasma NPY were detected by radioimmunoassay in 13 patients with lower extremity ASO(ASO group)before vascular intracavitary therapy and immediately,1 d,3 d and 5 d after vascular intracavitary therapy.Meanwhile,15 healthy subjects were served as control group.Besides,the ankle-brachial indexes(ABI)and clinical staging of ASO group were also obtained and compared before and 3 d after vascular intracavitary therapy.Results Compared with control group,the level of NPY in ASO group was much higher before vascular intracavitary therapy[(250.67?88.27)pg/mL vs(168.40?64.64)pg/mL,P

Amplification of All Immunoglobulin V Genes of Human Atherosclerosis by Polymerase Chain Reaction / 上海第二医科大学学报

Objective To amplify all immunoglobulin V genes of human atherosclerosis by PCR and to sequence the products of PCR cloned into T-vector. Methods Peripheral blood samples of 50 patients with atherosclerosis were collected,from which lymphocytes were segregated by density gradient centrifugation and total RNA was extracted by TRIzol reagent.V genes of VL(including VK and V?) and VH were amplified by RT-PCR,and the products were digested by restriction enzyme and then cloned into T-vector.Two clones were picked randomly to sequence.(Results)Total RNA were extracted purely with integrity,and all V genes of VL and VH were amplified by PCR successfully.The sequences were highly homologous to human immunoglobulin genes. Conclusion All immunoglobulin V genes of human artherosclerosis were amplified successfully,which lays a foundation for the construction and (selection) of phage library.

Transfection and Expression of eNOS Gene on Canine Endothelial Cells / 上海第二医科大学学报

Objective To study endothelial nitric oxide synthase (eNOS) gene transfecting endothelial cells (ECs). Methods eNOS gene was transfected into the steady ECs system by cationic liposomal transduction and check the transfection effect by RT-PCR and immunohistochemistry assay. To test the concentrations of NOS, nitric oxide (NO) and von willebrand factor (vWF) in culture media by colorimetry and ELISA, respectively,and transfected EC function was observed. Results The effect of transfection was satisfactory with RT-PCR products electrophoresis, sequence and immunohistochemistry. The concentrations of NOS and NO in transfected EC culture media increased with time (P

Primary experimental study on the construction of tissue engineering blood vessel / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the primary experimental methods to construct tissue engineering blood vessel.</p><p><b>METHODS</b>Using the collagen-chitosan to prefabricate the scaffolds with 3-dimensional structure, the proliferated human endothelial cells (ECs), smooth muscle cells (SMCs) and fibroblasts act as the seed cells. The cells were seeded to scaffolds in two-step method, and engineering tissue were matured by static culture or bioreactor culture. Extracellular matrix contents and the platelet aggregation were examined in engineering tissue, tissue engineering blood vessels were taken as patches to repair the man-made defaults on the rats aorta.</p><p><b>RESULTS</b>The proliferated human ECs, SMCs and fibroblast can hold activity and act as seed cells. The prefabricated scaffolds, with excellently cell and tissue biocompatibility, can facilitated cells adherence and upgrowth, the cells quantities and extracellular matrix contents in engineered tissue are time dependent increase (P < 0.05). Platelet aggregation tests confirm the tissue engineering blood vessel have some anti-coagulability. Using the engineering tissue patch to repair the default, 6 aortas in 8 animal were patency till 10 days post-operation.</p><p><b>CONCLUSIONS</b>The seeding cells can be seeded on the 3-dimensional collagen-chitosan scaffolds and matured, the tissue engineering blood vessel can be constructed primarily.</p>

The evaluation for the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI).</p><p><b>METHODS</b>Ninety-seven limbs in 97 patients who were proved to be PDVI by ascending venography were divided into Group A (79 limbs) and Group B (18 limbs). Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins. And they were also treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins at the same time. Patients of Group B were simply treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins. Ascending venography and CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation.</p><p><b>RESULTS</b>The difference between preoperative and postoperative scores of Group A and Group B were both remarkable (Group A, P < 0.01; Group B, P < 0.05). The difference of scores, which equated to preoperative scores minus postoperative score, between Group A and Group B were also prominent (P < 0.01). Post-operation ascending venography was performed on 67 limbs in Group A. The effective rate of the operation is 83.58% (28 + 28/67), obviously effective rate is 41.79% (28/67). Same exam was performed on 12 limbs in Group B and the effective rate of the operation is 33.33%. The difference between two groups' effective rate is significant (P < 0.05).</p><p><b>CONCLUSIONS</b>Clinical scoring of Group A decreased much more than Group B; The effective rate of Group A in ascending venography is also much higher than Group B. Encircling constriction of superficial femoral vein is useful to relief the symptom and recover the shape and function of the valve of superficial femoral veins. Those who are diagnosed to be PDVI by means of pre-operation ascending venography and Valsalva test should accept the operation of the encircling constriction of superficial femoral vein.</p>

Endothelial nitric oxide synthase gene transfected endothelial cells inhibit smooth muscle cell proliferation and platelet aggregation early in vitro / 中华外科杂志

<p><b>OBJECTIVE</b>To test the function of endothelial cells transfected eNOS gene.</p><p><b>METHODS</b>To test the function of eNOS-overexpressing endothelial cells inhibiting smooth muscle cell proliferation and platelet aggregation in vitro by colorimetry, MTT and (3)H-TdR permeate, respectively, in four different endothelial cells groups.</p><p><b>RESULTS</b>The platelet aggregation is significantly decreasing between the groups of EC and eNOS at the different time (P < 0.05), is 42.2 and 32.6 separately at the time of 120 h. The SMC proliferation is significantly decreasing between the groups of EC and eNOS at the different time (P < 0.05). It is 0.28 and 0.22 by MTT test, 4691 and 3995 by (3)H-TdR permeate separately at the time of 120 h.</p><p><b>CONCLUSIONS</b>eNOS-overexpressing endothelial cells inhibited significantly smooth muscle cells proliferation and platelet aggregation in vitro; which shows powerful effect 48 hours post transfection and lasts up to 120 hours at the least; and were held back by L-NAME.</p>