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Objective To study the effects of aneurysmal neck angle on stent displacement after endovascular repair of abdominal aortic aneurysm (AAA). Methods The CT images of 28 patients were selected to establish preoperative AAA model, postoperative AAA model and covered stent model respectively, and the models were divided into non-severe angulation group ( n = 14) and severe angulation group ( n = 14) according to the preoperative angle of tumor neck. The geometric shape of each model was measured, and the changes of AAA geometric parameters and postoperative stent displacements before and after surgery were analyzed. The displacement force of the model during the first follow-up was calculated by hemodynamic simulation. Results Significant differences were found in tumor length, maximum diameter, displacement force, tumor neck length and tumor volume between two groups of patients (P 0. 05). For the incidence of internal leakage, there were 2 cases in non-severe angulation group and 4 cases in severe angulation group (P>0. 05).Conclusions Severe neck angulation can lead to a significant increase in support displacement force and decrease in proximal anchorage zone, and thus increase the possibility of support displacement. It is suggested that doctors should strengthen postoperative follow-up for patients with severe neck angulation and be vigilant of the occurrence of long-term internal leakage in clinic.
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Concomitant occurrence of coronary arterial disease (CAD) with abdominal aortic aneurysm (AAA) is not rare. Combined performance of open surgery (OS) of AAA repair and coronary arterial bypass grafting (CABG) has been reported to be effective as the way to avoid the risk of rupture of the aneurysm and acute coronary syndrome (ACS), while it's highly invasive. We successfully performed a combination performance of endovascular aneurysm repair (EVAR) and off-pump CABG (OPCAB) with the support of an intra-aortic balloon pump (IABP) in 2 cases with AAA and unstable angina pectoris (UAP). It was suggested that this strategy is a reasonable clinical option for the patient with UAP complicated with large AAA.
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Objective To research the effect of cavity under Bolus to anisotropic analytical algorithm (AAA) on calculation precision of dose in shallow tissue based on Monte Carlo method;Methods A 30 cm × 30 cm × 30 cm water phantom with the upper surface was constructed which was located at the source-axis distance (SAD) of the medical linear accelerator and the center as well as coincided with the central axis of the radiation field in Eclipse treatment panning system. Above the water phantom, a water film of 1 cm thick with or without different cavities was constructed or. AAA was used to calculate the dose distribution on the central axis and the x-axis of different depth of the water model with different cavities respectively. The accelerator model, the same water phantom and the water film were constructed and the dose distributions of the same positions were calculated with Geant4. Based on the Geant4 calculation result, the calculation precision of AAA with different cavity were compared;Results For cavities with area of 2 cm × 2 cm, if the thickness is smaller than 0.5 cm, the AAA calculation error is about 2%. with the cavity thickness increase, the AAA would overestimate the dose in the shallow area under the cavity. With the cavity area increase, the area where AAA overestimate the shallow dose gradually moved out until near the edge of the radiation field, and the calculation error on the central area gradually reduced until there is basically no error. Conclusions The shallow dose would be increased according to the cavity size when planning with AAA; If there are cavities with large volume, it is better to reposition.
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Background: The AAA (Anterior epitympanic, Attic, and Antrum) space is the space between the mastoid and middle ear which functions to balance the pressure in both organs (buffer). Pathological tissue in the AAA cavity due to chronic infection would disrupt the buffer function and could change the morphology of the mucosa in the tympanic membrane and middle ear. Obstruction in the AAA space measured subjectively by observing the smoothness of the flow using saline solution has been shown to be associated with a plaque in the tympanic membrane (myringosclerosis) in Chronic Otitis Media (COM) patients. This study aims to determine the relationship between AAA space obstructions with myringosclerosis using CT-Scan for an objective result.Methods: Retrospective study with case-control approach used in this study. Case criterias are Chronic Suppurative Otitis Media (CSOM) patients with myringosclerosis, both men and women and age 15-50 years, while the control group are benign CSOM patients without myringosclerosis. Data were analyzed with the chi-square test to prove the association between the AAA space status and length of symptom onset with myringosclerosis.Results: During January 2017-December 2019 there were 33 respondents, 19 cases and 14 controls, 21 men and 12 women with an average age of 35 years (cases) and 23.5 years (control). The length of symptom onset more than 5 years (p <0.05, OR 6.94 with CI 0.5-1.5) and AAA space obstruction (p <0.05 OR 34.25 with CI 0.8-1.8) has been shown to be associated with myringosclerosis in people with benign CSOM.Conclusions: AAA space obstruction and symptom onset more than 5 years significantly associated with myringosclerosis.
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The hepatic endoplasmic reticulum (ER)-anchored cytochromes P450 (P450s) are mixed-function oxidases engaged in the biotransformation of physiologically relevant endobiotics as well as of myriad xenobiotics of therapeutic and environmental relevance. P450 ER-content and hence function is regulated by their coordinated hemoprotein syntheses and proteolytic turnover. Such P450 proteolytic turnover occurs through a process known as ER-associated degradation (ERAD) that involves ubiquitin-dependent proteasomal degradation (UPD) and/or autophagic-lysosomal degradation (ALD). Herein, on the basis of available literature reports and our own recent findings of as well as experimental studies, we discuss the therapeutic and pathophysiological implications of altered P450 ERAD and its plausible clinical relevance. We specifically (i) describe the P450 ERAD-machinery and how it may be repurposed for the generation of antigenic P450 peptides involved in P450 autoantibody pathogenesis in drug-induced acute hypersensitivity reactions and liver injury, or viral hepatitis; (ii) discuss the relevance of accelerated or disrupted P450-ERAD to the pharmacological and/or toxicological effects of clinically relevant P450 drug substrates; and (iii) detail the pathophysiological consequences of disrupted P450 ERAD, contributing to non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) under certain synergistic cellular conditions.
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A 92 year-old-female with melena was admitted to our hospital. She underwent Y-graft replacement of the abdominal aorta at the age of 65. Gastroduodenal fiberscopic examination and computed tomography (CT) confirmed the diagnosis of aortoduodenal fistula. The fistula in the proximal anastomotic site was occluded with a suture ligature and omentopexy was performed. On the 15th post-operative day she developed high-grade fever. CT revealed a pseudoaneurysm formation at the proximal anastomosis site. She underwent emergency endovascular aneurysmal repair (EVAR). Her postoperative course was uneventful. She is doing well without symptoms of recurrent infection.
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Objective To investigate the expressions of ATPase family AAA domain-containing protein 2 (ATAD2) and β-catenin,and to analyze their correlations with clinicopathological features and prognostic significance in patients with hepatocellular carcinoma (HCC).Methods The HCC tissues of 40 patients were tested by real-time PCR to study the expressions of ATAD2 and β-catenin.Real-time PCR and Western blot were performed to detect the proteins and mRNA levels of ATAD2,APC,β-catenin and wnt signaling pathway downstream.The HCC tissues of 80 patients and 20 peritumoral tissues were tested by immunohistochemistry (IHC).The cumulative survival-rate was analyzed by the Kaplan-Meier method,and univariate and multivariate were analyzed by the Cox proportional hazards model.Results ISH:The positive rates of ATAD2 and β-catenin were 65.0％ and 55.0％,respectively.These rates were significantly higher than those in the peritumoral tissues (30.0％ and 25.0％,respectively).The ATAD2 expression was related to tumor size (P ＜ 0.05),metastasis (P ＜ 0.05),serum AFP level (P ＜ 0.05) and TNM stag ing (P ＜ 0.05).The β-catenin expression was only significantly related to metastasis (P ＜ 0.05).Correlation analysis showed that the ATAD2 expression was positively related to the β-catenin expression (Pearson =0.578,P ＜ 0.01,R2 =0.3607,Spearman =0.495).This positive relationship was also found in the remaining 4 cell lines except the SK-hep1.Depleting ATAD2 up-regulated APC and down-regulated β-catenin protein and mRNA expression.Univariate and multivariate analyses showed that ATAD2 and β-catenin expressions,tumor size,metastasis,serum AFP,and TNM staging were poor prognostic factors for HCC,and ATAD2 and β-catenin expressions,metastasis,serum.AFP were independent prognostic factors.Patients whose ATAD2 and β-catenin were both positive had worse survival than those with only one positive expression or both negative expressions (P ＜ 0.05).Depleting ATAD2 down-regulated survivin,cyclinD1,c-myc,MMP7,Vimentin in wnt signaling pathway and EMT related proteins.Conclusions ATAD2 and β-catenin expressions were positively related in patients with HCC.Abnormal expressions between ATAD2 and β-catenin might participate in the wnt signaling pathway.
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Objective To investigate the expression of androgen receptor(AR),ATAD2 in hepatocellular carcinoma(HCC) and the correlations with clinicopathological features,and the role of DHT/AR and ATAD2 in proliferation of HCC cells.Methods The samples of 75 patients with HCC in the First Affiliated Hospital of China Medical University from February 2012 to December 2012 were collected.LM3 and Huh7 cells were divided into control group,DHT group,DHT + CDX (bicalutamide) group and CDX group;and also divided into Ri-ATAD2 group (adding interference fragments) and Ri-C group (adding control vector sequence).Immunohistochemistry was used to detect the expression of AR and ATAD2,and to analyze the correlations between clinical features and survival of patients.Real-time PCR and Western Blot were used to detect the expression of AR and ATAD2,and CCK-8 was used to detect cell proliferation.Results HCC patient samples were grouped according to AR and ATAD2 expression.Compared with low AR expression group (n =31),the ratio of tumor ＜5 cm in high expression group (n =44) was higher,and the ratio of TNM stage Ⅰ + Ⅱ was lower.Compared with low ATAD2 expression group (n=35),the ratio of metastasis and tumor differentiation grade Ⅲ + Ⅳ was higher in high expression group (n=40),and the difference was statistically significant (P ＜ 0.05).The overall survival rate of patients with high expression of ATAD2 was lower than other patients,and the differences were statistically significant (P＜0.05).Multivariate Cox regression analysis showed that ATAD2 expression (HR=1.935,95％ CI:1.066～3.515) and metastasis (HR=2.212,95％ CI:1.059～4.619) were independent predictors of poor prognosis.Compared with LO2 cells,the mRNA and protein level of AR and ATAD2 in LM3 and Huh7 cells were significantly higher,and the differences were statistically significant (P＜0.05).And the proliferation rate of HCC cells increased significantly after 48 and 72 hours compared with the control group,and the differences were statistically significant (P＜0.05).After adding CDX,the proliferation of LM3 and Huh7 induced by DHT was inhibited.DHT enhanced the expression of ATAD2,while CDX inhibited the expression of ATAD2.The expression of ATAD2 protein decreased when LM3 and Huh7 cells were interfered.Compared with Ri-C group,the proliferation of HCC cells in Ri-ATAD2 group decreased significantly after the DHT treatment 48 and 72 hours,and the difference was statistically significant (P＜0.05).Conclusions DHT/AR promoted the proliferation of HCC cells by inducing ATAD2 expression.Modulating ATAD2 expression may be the potential mechanism of DHT/AR in HCC proliferation.
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Concurrent thoracic and abdominal aortic aneurysm is uncommon. It remains a formidable surgical challenge to vascular surgeons, as decision to treat in staged or simultaneous setting still debatable. We present, here, a case of a 62-year-old-man with asymptomatic concurrent thoracic and abdominal aortic aneurysms, which was successfully treated with two-stage hybrid endovascular repair. The aim of this case report is to discuss the treatment options available, possible associated complications and measures to prevent them.
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Aneurisma de la Aorta Abdominal , Aneurisma de la Aorta TorácicaRESUMEN
Objective:To establish a quantitative method for the determination of lysine hydrochloride in pediatric compound lysine granules. Methods:The quantitative determination was performed on an amino acids analyzer. The cationic resin column(150 mm × 4. 6 mm,7 μm)was used. The mobile phase was citrate buffer solution (pH 3. 45) and citrate buffer solution (pH 10. 85) with gradient elution at a flow rate of 0. 45 ml·min-1 . The detection wavelengths were set at 570 nm and 440 nm. Results:The linear range of lysine hydrochloride was 2. 692-21. 536 μg·ml-1(r=0. 999 5), and the average sample recovery was 98. 85% with RSD of 0. 63% (n=9). Conclusion:The method is sensitive, simple and reproducible. It can be used for the quality control of pediatric compound lysine gran-ules.
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Abdominal aortic aneurysm (AAA) is an inflammatory vascular disorder with high mortality. Accumulating evidence shows that toll-like receptor 2 (TLR2) plays a critical role in the regulation of wound-repairing process after tissue injury. We wondered if TLR2 signaling contributed to the pathogenesis of AAA and that targeting TLR2 would attenuate AAA development and progression. In this study, enhanced expression of TLR2 and its ligands were observed in human AAA tissue. Neutralization of TLR2 protected against AAA development and caused established AAA to regress in mouse models of AAA. In addition, TLR2-deficient mice also failed to develop AAA. The prophylactic and therapeutic effects of blocking TLR2 were accompanied by a significant resolution of inflammation and vascular remodeling, as indicated by the decreased expression or activity of MMP-2/9, α-SMA, inflammatory cytokines, and transcription factors NF-κB, AP-1 and STAT1/3 in AAA tissue. Mechanistically, blocking TLR2 decreased the expression and interaction of TLR2 and several endogenous ligands, which diminished chronic inflammation and vascular remodeling in the vascular tissue of AAA. Our studies indicate that the interactions between TLR2 and its endogenous ligands contribute to the pathogenesis of AAA and that targeting TLR2 offers great potential toward the development of therapeutic agents against AAA.
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Clinically, abdominal aortic aneurysm (AAA) may continue to expand or even rupture after endovascular aneurysm repair (EVAR) due to endoleak or endotension. The existence of endoleak and endotension can significantly affect the mechanical/hemodynamic environment in AAAs, thus changing the strain and stresses on aneurysm wall, further influencing the transportation of low density lipoprotein (LDL), oxygen and nitric oxide (NO) in AAAs and aneurysm wall, which might eventually alter the biochemical environment and physiological property of aneurysm wall. This review focused on biomechanical mechanism of AAA enlargement after EVAR and its recent research progress, which indicated that reduction of the aneurysm wall strength due to deterioration of biomechanical environment (such as increase of tensile stress on aneurysm wall) and abnormity of biochemical environment (such as increase of LDL deposition, change of oxygen concentration) might be the source leading to AAA enlargement after EVAR. Based on previous studies, the authors propose that comprehensive investigations on AAA enlargement after EVAR from the perspective of biomechanics and mechanobiology have great research values and clinical significance, which will help clarify the mechanism of AAA enlargement after EVAR, as well as optimize the strategies of aneurysm repair surgery and designs of interventional medical devices.
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A 80-year-old woman was referred to our hospital for coagulation abnormality and huge abdominal aortic aneurysm (AAA). She had persistent hemorrhage from the surgical wound after the operation for her cubital tunnel syndrome 5 days before. Enhanced computed tomography image revealed AAA with a maximum diameter of 91 mm. Laboratory data were compatible with disseminated intravascular coagulation (DIC). Due to the marked hemorrhagic status, we thought the open repair of AAA was an extremely risky procedure. We initiated the medical treatment with gabexate mesilate. However, the hemorrhage continued after 2 weeks of medical therapy. We performed endovascular aneurysm repair (EVAR). DIC improved after the procedure. Postoperative enhanced computed tomography image showed regression of the aneurysm with no endoleak. EVAR might be an acceptable procedure for AAA with DIC.
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A 71-year-old man who had undergone repair of a ruptured abdominal aortic aneurysm with a tube graft 3 months ago was transferred from another hospital with an Aortoenteric Fistula (AEF) for surgical treatment. Computed tomographic (CT) angiography revealed pseudoaneurysm formation at the proximal anastomotic site. Waiting for the elective operation, he developed massive hematemesis with shock. Endovascular stent-graft repair was emergently performed because of high risk for conventional open surgery. Gastrointestinal bleeding was successfully controlled. The psuedoaneurysm disappeared, which was confirmed by postoperative CT angiography. At 1-year follow-up, he has shown no clinical and radiographic evidence of recurrent infection or bleeding. For the case with shock, Endovascular repair could be a bridge to open surgery because it is fast and minimally invasive. Endovascular repair of AEF is technically feasible and may be the definitive treatment in selected patients without signs of infection and gastrointestinal bleeding.
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Objective To develop an automatic segmentation and mesh generation technique for abdominal aortic aneurysm (AAA) and to build a 2D numerical analysis model that can be used for finite element analysis (FEA). Methods A method that totally based on morphology processing was developed to segment all the components of the AAA. For each closed curve that obtained, its signed distance function was then calculated. According to the set relationships between each curve, the final signed distance function was calculated. Under the control of this function and an equilibrium relationship, iterated Delaunay algorithms were used until the equilibrium relationship was satisfied or the set conditions were reached. Then the program ended and the finite element model was generated. Results Automatic segmentation of the lumen as well as semiautomatic segmentation of the wall and calcification were achieved. Different parts of the AAA were meshed, and the type and density of the mesh could be controlled. Two finite element models were established for stress analysis: one was the coupling mesh of the thrombus and the wall, and the other was the coupling mesh of the thrombus, the wall and the calcifications. Conclusions An automatic segmentation and mesh generation algorithm with high accuracy has been developed, without any complicated computation or initial curve. The mesh generation algorithm tends to produce high quality meshes and the generation is easy to be controlled by only two parameters. The generated mesh has been verified to be useful in FEA simulation.
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Objective To compare the differences in the hemodynamic parameters of abdominal aortic aneurysm (AAA) between fluid-structure interaction model (FSIM) and fluid-only model (FM), so as to discuss their application in the research of AAA. MethodsAn idealized AAA model was created based on patient-specific AAA data. In FM, the flow, pressure and wall shear stress (WSS) were computed using finite volume method. In FSIM, an Arbitrary Lagrangian-Eulerian algorithm was used to solve the flow in a continuously deforming geometry. The hemodynamic parameters of both models were obtained for discussion. Results Under the same inlet velocity, there were only two symmetrical vortexes in the AAA dilation area for FSIM. In contrast, four recirculation areas existed in FM; two were main vortexes and the other two were secondary flow, which were located between the main recirculation area and the arterial wall. Six local pressure concentrations occurred in the distal end of AAA and the recirculation area for FM. However, there were only two local pressure concentrations in FSIM. The vortex center of the recirculation area in FSIM was much more close to the distal end of AAA and the area was much larger because of AAA expansion. Four extreme values of WSS existed at the proximal of AAA, the point of boundary layer separation, the point of flow reattachment and the distal end of AAA, respectively, in both FM and FSIM. The maximum wall stress and the largest wall deformation were both located at the proximal and distal end of AAA. Conclusions The number and center of the recirculation area for both models are different, while the change of vortex is closely associated with the AAA growth. The largest WSS of FSIM is 36% smaller than that of FM. Both the maximum wall stress and largest wall displacement shall increase with the outlet pressure increasing. FSIM needs to be considered for studying the relationship between AAA growth and shear stress.
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The pencil beam convolution (PBC) algorithms in radiation treatment planning system have been widely used to calculate the radiation dose. A new photon dose calculation algorithm, referred to as the anisotropic analytical algorithm (AAA), was released for use by the Varian medical system. The aim of this paper was to investigate the difference in dose calculation between the AAA and PBC algorithm using the intensity modulated radiation therapy (IMRT) plan for lung cancer cases that were inhomogeneous in the low density. We quantitatively analyzed the differences in dose using the eclipse planning system (Varian Medical System, Palo Alto, CA) and I'mRT matirxx (IBA, Schwarzenbruck, Germany) equipment to compare the gamma evaluation. 11 patients with lung cancer at various sites were used in this study. We also used the TLD-100 (LiF) to measure the differences in dose between the calculated dose and measured dose in the Alderson Rando phantom. The maximum, mean, minimum dose for the normal tissue did not change significantly. But the volume of the PTV covered by the 95% isodose curve was decreased by 6% in the lung due to the difference in the algorithms. The difference dose between the calculated dose by the PBC algorithms and AAA algorithms and the measured dose with TLD-100 (LiF) in the Alderson Rando phantom was -4.6% and -2.7% respectively. Based on the results of this study, the treatment plan calculated using the AAA algorithms is more accurate in lung sites with a low density when compared to the treatment plan calculated using the PBC algorithms.
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Humanos , Pulmón , Neoplasias PulmonaresRESUMEN
Hypolipidaemic and antioxidant effects of ethanol extract of mature green fruits of Musa AAA (Chenkadali) was evaluated in alloxan induced diabetic rats. The effect of extract at two doses, 500 mg/kg body weight and 1000 mg/kg body weight was analysed and compared with a standard drug, glibenclamide. Rats administered with alloxan showed significantly increased levels of serum triacylglycerol, total cholesterol and alanine amino transferase (ALT) activity. Lipid peroxides increased significantly while reduced glutathione (GSH) decreased considerably in liver and pancreas. Oral administration of the ethanol extract of fruits of Musa AAA (Chenkadali) significantly decreased the levels of serum triacylglycerol, cholesterol and ALT activity. Significant decrease was also observed in the level of lipid peroxides while GSH content increased substantially in liver and pancreas. The effect was dose independent and rats treated with 500 mg/kg body weight showed comparable levels of serum triacylglycerol, cholesterol, ALT activity and liver lipid peroxides to that of normal control and glibenclamide treated groups. Although, there was no significant difference, treatment with 500 mg/kg body weight of the extract showed a higher content of GSH and lower level of lipid peroxides in pancreas compared with glibenclamide. Histopathological examination of pancreas and liver revealed regeneration of islet cells and hepatocytes respectively, which correlate with the biochemical findings. The present study shows that ethanol extract of mature green fruits of Musa AAA (Chenkadali) has antioxidant and hypolipidaemic properties and may be used for treating diabetes mellitus.
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Endovascular repair of descending thoracic aortic aneurysm is an attractive approach. Candidates for endovascular repair should have an inner aortic diameter of 23-37 mm adjacent to the aneurysm without signifi cant thrombus or calcifi cation in these so called landing zones. They should have at least 2 cm of normal aorta both proximal and distal to the aneurysm to ensure adequate fi xationof the divece. Endografting of the descending thoracic aorta requires preoperative measurements of the diameter of the proximal and distal necks of the aneurysm, tratment length, and proximal and distal angulation. This information can be obtained from CT-ic angiography using three dimensional reconstruction.
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El tratamiento endovascular de los aneurismas de aorta abdominal es una alternativa a la cirugía abierta para pacientes de alto riesgo. Consiste en la exclusión del saco aneurismático mediante la interposición de una endoprótesis colocada por vía femoral. El tratamiento endovascular no puede ser utilizado en todos los pacientes. Una limitación frecuente la constituye el nacimiento de una arteria visceral desde el saco aneurismático. Para contrarrestar esta limitación recientemente se han desarrollado endoprótesis fenestradas que presentan orificios que se corresponden con el nacimiento de las arterias involucradas en el aneurisma evitando su oclusión, permitiendo de esta manera el tratamiento endovascular. En esta comunicación se presenta un caso de tratamiento endovascular de un aneurisma de aorta abdominal mediante la colocación de una endoprótesis fenestrada en un paciente cuya arteria renal izquierda nacía directamente del saco aneurismático.
Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.