The treatment of Stanford type B aortic dissection with unhealthy or short anchoring zone using physician-modified fenestration TEVAR / 中华普通外科杂志

Objective:To evaluate the efficacy and safety of physician-modified fenestration TEVAR for treating type B aortic dissection with unhealthy or short anchoring zone.Methods:Clinical data of patients with type B aortic dissection who received TEVAR for left subclavian artery fenesration from May 2016 to Dec 2018 were analyzed prospectively.Results:The technical success rate was 93.2%. One case was converted into chimney stenting. One case suffered type Ⅰendoleak. One case had type Ⅲ endoleak. There were no deaths or neurological complications during the perioperative period, and the mean hospital stay was 9.2 (5-26) days. The median follow-up time was 30 (12-42) months. One case developed type Ⅰ endoleak during follow-up. No retrograde dissection occurred and all LSA stents remained patent.Conclusion:Physician-modified fenestration TEVAR is safe and effective for the treatment of type B aortic dissection with unhealthy or short anchoring zone.

Simultaneous Determination of 6 Medicinal Components in Mango Zhike Tablets by Quantitative Analysis of Multi-components by Single Marker Method / 中国药房

OBJECTIVE：To establish a method for simultaneous determination of gallic acid ，protocatechuic acid ，mangiferin， homomangiferin，hyperoside and isoquercetin in Mangguo zhike tablets. METHODS ：HPLC was adopted. The determination was performed on Phenomenex Gemini C 18 column with mobile phase consisted of 0.1％ phosphoric acid water solution-acetonitrile （gradient elution ）at the flow rate of 1.0 mL/min. The detection wavelength was set at 258 nm. The column temperature was set at 30 ℃，and sample size was 5 μL. Gallic acid was used as the internal substance，and the correction factors of gallic acid ， protocatechuic acid ，mangiferin，homomangiferin，hyperoside and isoquercetin were calculated ；the results of quantitative analysis of multi-components by single marker method （QAMS） were compared with those of external standard method （ESM）. RESULTS：The linear range of gallic acid ，protocatechuic acid ，mangiferin，homomangiferin，hyperoside and isoquercetin were 45.75-183 0 μg/mL（r＝0.999 9），2.525-101.0 μg/mL（r＝0.999 9），65.33-261 3 μg/mL（r＝0.999 6），9.058-362.3 μg/mL（r＝ 0.999 9），3.885-155.4 μg/mL（r＝0.999 9），1.870-74.8 μg/mL（r＝0.999 9），respectively. The limits of quantification were 0.571， 0.643，1.053，0.854，0.830，1.500 μg/mL，respectively. The limits of detection were 0.171，0.193，0.316，0.256，0.249，0.450 μg/mL， respectively. RSDs of precision ，stability and reproducibility tests were all lower than 3％ . The average recoveries were 98.8％-101.9％（RSD＝1.3％ ，n＝6），94.3％-101.5％（RSD＝3.3％，n＝6），97.9％-100.5％（RSD＝0.9％，n＝6），98.2％- 101.6％ （RSD＝1.2％，n＝6），102.3％-106.1％（RSD＝1.3％，n＝6）， 96.6％ -99.3％（RSD＝1.0％ ，n＝6），respectively. RCFs of 73） protocate-chuic acid ， mangiferin， homomangiferin，hyperoside and isoquercetin were 0.568 3，0.500 3，0.687 6， 0.939 1 and 0.826 3，using gallic acid as internal substance . The content ranges of protocatechuic acid and other 4 com- ponents measured by QAMS were 0.197-0.440，3.262-11.250， 0.201-1.196，0.168-0.381，0.115-0.293 mg/tablet，respectively. The content ranges measured by ESM were 0.198-0.441，3.239-11.570，0.206-1.194，0.171-0.380，0.119-0.298 mg/tablet， respectively. By comparing the content determination results by QAMS and ESM ，the relative errors were －3.80％-0.74％，and there was no statistical significance （P＞0.05）. CONCLUSIONS ：The established QAMS method is accurate ，reliable and repeatable，and can be used for content determination of 6 medicinal components in Mangguo zhike tablets.

Endovascular treatment for primary infected aortic aneurysms: single center 8-year experience / 中华普通外科杂志

To assess the efficacy and outcome of endovascular aortic repair (EVAR for the treatment of primary infected aortic aneurysms (PIAAs).Methods The clinical data of 15 consecutive patients presenting with PIAA from Apr 2010 to Apr 2018 were retrospectively reviewed.Results 10 were male out of 15 patients ranging from 55 to 80 years old.The aneurysms were located in thoracoabdominal aorta in 1 case,abdominal aorta in 10 cases and left common iliac artery in 4 cases.Positive microbial cultures were reported in 13 patients,including Salmonella species in 12 and Streptococcus in 1.Eleven patients received preoperative antibiotics therapy before elective EVAR for more than 1 week.Four patients underwent emergency EVAR due to ruptured aneurysms.Postoperative antibiotic therapy was given for at least six months.There was no death within 30 days.Mean follow-up time was 44.6 months.Infection relapsed in 6 patients during follow-up.Infection-related death occurred in 3 cases.3 of them were healed.Conclusions EVAR combined with aggressive antibiotic strategy is feasible for the treatment of PIAAs,particularly in high-risk surgical patients or in the acute setting of rupture.

Short-term results of left subclavian artery reconstruction with branched thoracic endovascular aortic repair in the treatment of complex aortic arch lesions / 中华普通外科杂志

Objective@#To evaluate the short-term efficacy of branched TEVAR in the treatment of complex aortic arch lesions.@*Methods@#The clinical data of 18 patients with aortic lesions requiring reconstruction of the left subclavian artery who were treated with branch TEVAR technology in Tianjin Medical University General Hospital from Apr 2016 to Dec 2018 were analyzed retrospectively.@*Results@#There were 16 cases using Castor external branch stent implantation and 2 cases of self-made internal branch stent. The success rate of device release was 100%, the success rate of operation was 100%, and there were no intraoperative deaths. Postoperative complications occurred in 2 cases: one proximal stent tear dissection required open surgery, one died of massive myocardial infarction.Seventeen patients were followed up for 1-8 months. CTA examination in 16 patients 30 days after surgery, found 1 patient with type Ⅲ endoleak. CTA examination done in 8 patients 6 months after surgery found distal occlusion of left subclavian artery stent in 1 patient necess itating distal stent implantation.@*Conclusion@#The branch TEVAR technique is effective method to reconstruct the arch branched artery.

Short-term results of left subclavian artery reconstruction with branched thoracic endovascular aortic repair in the treatment of complex aortic arch lesions / 中华普通外科杂志

Objective To evaluate the short-term efficacy of branched TEVAR in the treatment of complex aortic arch lesions.Methods The clinical data of 18 patients with aortic lesions requiring reconstruction of the left subclavian artery who were treated with branch TEVAR technology in Tianjin Medical University General Hospital from Apr 2016 to Dec 2018 were analyzed retrospectively.Results There were 16 cases using Castor external branch stent implantation and 2 cases of self-made internal branch stent.The success rate of device release was 100％,the success rate of operation was 100％,and there were no intraoperative deaths.Postoperative complications occurred in 2 cases:one proximal stent tear dissection required open surgery,one died of massive myocardial infarction.Seventeen patients were followed up for 1-8 months.CTA examination in 16 patients 30 days after surgery,found 1 patient with type Ⅲ endoleak.CTA examination done in 8 patients 6 months after surgery found distal occlusion of left subclavian artery stent in 1 patient necessitating distal stent implantation.Conclusion The branch TEVAR technique is effective method to reconstruct the arch branched artery.

Fenestrated EVAR using physician-modified stent-grafts for thoraco-abdominal aortic lesions / 中华普通外科杂志

Objective To evaluate fenestrated endovascular aortic repair (FEVAR) using physician-modified stent-grafts (PMSGs) for thoraco-abdominal aortic lesions.Methods Seven cases of thoraco-abdominal aortic lesions (1 type Ⅲ thoraco-abdominal aortic aneurysm,1 type Ⅳ thoraco-abdominal aortic aneurysm,4 chronic thoraco-abdominal aortic dissection and 1 type Ⅰ endoleak after EVAR due to abdominal aortic aneurysm) were treated with FEVAR from Nov 2016 to Nov 2017.Results FEVAR was performed successfully in all cases.Type Ⅱ and Ⅲ endoleak occurred in 4 cases.One died of acute myocardial infarction 2 days postoperatively.Renal dysfunction deterioration occurred in one case of chronic dissection and improved after the medical treatment.Renal subcapsular hematoma was found in 2 cases postoperatively,and resolved after conservative therapy.Mean follow-up period was 7.2 months,target vessel patency was identified in 5 of the 6 cases.Conclusions FEVAR using PMSGs is a viable alternative to treat thoraco-abdominal aortic lesions.

On table fenestrated stent graft in zone 0 and zone 1 for aortic arch diseases / 中华普通外科杂志

Objective To evaluate fenestrated thoracic endovascular aortic repair (f-TEVAR) using fenestrated stent graft on table in zone 0 and zone 1 for aortic arch diseases.Methods 13 patients undergoing f-TEVAR by using physician modified fenestrated stent grafts (PMSGs) on table in zone 0 and zone 1 for aortic arch diseases between Nov 2015 and Mar 2018 were retrospectively reviewed.Results The median age was 59 years(range,33-81 years).PMSGs were deployed from Z0 in 5 patients and Z1 in remaining 8 patients.All but 3 patients underwent elective procedure.The technical success rate was 92.3％.Overall mortality was 7.7％ (1/13).There were no perioperative neurologic complications and paraplegia.One patient suffering from acute left leg ischemia and renal failure recovered after openembolectomy and dialysis.Median length of stay was 9.0 days (range,4-35 days).12 patients were survival at a median follow-up of 11.5 months (range,1.0-19.0 months).Retrograde dissection occurred in one patient and resolved after open repair.During follow up,all target vessels remained patent,with no fenestration-related type Ⅰ or Ⅲ endoleaks.Conclusions f-TEVAR using modified fenestrated stent grafts on table in Z0 and Z1 is feasible for the treatment of aortic arch diseases.

Optimization of Extraction Process for the Total Alkaloids of Longzuan Tongbi Fang by Central Composite Design and Response Surface Method / 中国药师

Objective:To optimize the extraction process for the total alkaloids of Longzuan Tongbi Fang by central composite design and response surface method.Methods:The independent variables were the ethanol contention,solvent consumption and extraction time,and the dependent variable was the weighted overall desirability of the content of total alkaloids and kukoline.The extraction process for the total alkaloids of Longzuan Tongbi Fang was optimized by central composite design and response surface method.Results:The optimum extraction conditions were as follows:9-fold amount of solvent was used,refluxed for 130 min,extracted twice,and the ethanol concentration was 75%.Conclusion:The central composite design and response surface method used for the extraction optimization for the total alkaloids of Longzuan Tongbi Fang is very simple and highly predictive.

Protective Effect of the Extract of Euonymus Hederaceuson on H2O2-induced Oxidative Damage of Vascular Endothelial Cells / 中国药师

Objective: To observe the protective effects of the alcohol extract, ethyl acetate extract and 1-butanol extract of Euonymus hederaceuson on H2O2-induced oxidative damage of vascular endothelial cells ECV-304.Methods: ECV-304 cells were cultured in vitro and H2O2-induced oxidative damage in ECV-304 cells was used as the model.After the treatment with ethanol extract, ethyl acetate extract or 1-butanol extract of Euonymus hederaceus (the final concentration of 400, 200, 100, 50 and 25 μg·ml-1) for 24h, the cell viability was detected by MTT assay.Hoechst staining was used to observe the cell apoptosis, and then the supernatant was collected, and the contents of SOD, NOS and NO were used to determine the effects of the extracts on the oxidative stress of vascular endothelial cells.Results: The ethanol extract, ethyl acetate extract and 1-butanol extract of Euonymus hederaceus within the concentration range of 25-400 μg·ml-1 showed no cytotoxicity on ECV-304 cells, and the ethyl acetate extract at the concentration of 400μg·ml-1 had certain proliferation effect on the cells (P<0.05).The ethyl acetate extract at the concentration of 50-400 μg·ml-1 and the 1-butanol extract at the concentration of 100-400 μg·ml-1of Euonymus hederaceus could increase the survival rate of ECV-304 cells with oxidative injury significantly, and the OD value showed significant difference when compared with that of the model group (P<0.05 or P<0.01).The ethanol extract, ethyl acetate extract and 1-butanol extract of Euonymus hederaceus could significantly improve the SOD and NO levels in ECV-304 cells with oxidative damage (P<0.05 or P<0.01), and had no notable influence on NOS level.The ethanol extract, ethyl acetate extract and 1-butanol extract of Euonymus hederaceus could inhibit the cell apoptosis with oxidative damage and improve the nuclear morphology, and the apoptosis exhibited significant difference when compared with that of the model group (P<0.01).Conclusion: The extracts of Euonymus hederaceus have protective effects on vascular endothelial cells with oxidative damage induced by H2O2.

Diagnosis and management of Stanford B aortic dissection / 国际外科学杂志

Type B aortic dissection is a life-threatening aortic disease.With the development of clinical classification and diagnostic method,the mortality of type B aortic dissection has been greatly decreased.In respect of treatment,endovascular repair due to minimally invasive advantages become the first choice for the treatment of complicated type B aortic dissection.For non-complicated type B aortic dissection,endovascular repair also gradually replace drug treatment,and showed good efficacy.Open surgery is only available for patients who ate not suitable for endovascular repair or repair failure or patients with connective tissue disease.