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Objective To investigate the effect of autologous peripheral blood stem cell transplanta-tion combined with CD34 + cells and oral sarpogrelate hydrochloride for the treatment of vascular reconstruc-tion and blood supply on the thromboangiitis obliterans. Methods Thromboangiitis obliterans ( TAO) of 262 patients with 262 lower limbs were divided into stem cells CD34 + cells transplantation combined with sarpogrelate hydrochloride group ( group A) with 100 lower limbs, CD34 + stem cell transplantation group ( group B) with 91 lower limbs, and sarpogrelate hydrochloride oral group ( group C) with 71 lower limbs. The degree of lower limb local blood flow variability were calculated at the three levels of skin, blood vessels and blood by preoperative and postoperative use of multi-function monitoring instrument, Doppler detector, transcutaneous oxygen pressure monitor, and digital subtraction angiography ( DSA) , respectively. Results⑴ The degree of shank, foot cyanosis, cool skin, and pain was relieved significantly in groups A and B than in group C for 1 month after the treatment (P<0. 05). ⑵Intermittent claudication distance, the skin temperature of the lower leg and foot to patients in the groups A and B than in group C, with a significant difference (F=7. 01, F=7. 04, P<0. 05) for 3 months after the treatment. ⑶ Among the patients with amputation, 10 cases were in group A, 16 cases in group B, and 31 cases in group C for 6 months after the treatment. ⑷ Transcutaneous oxygen pressure was increased from ( 30. 43 ± 4. 31 ) mmHg to ( 37. 21 ± 9. 01)mmHg (F=5. 69, P<0. 05), ankle brachial index from (0. 32 ±0. 23) to (0. 91 ± 0. 16) (F=6. 71, P<0. 05), the volume of blood flow index from the photoelectric (0. 22 ± 0. 04) to (0. 83 ± 0. 13 (F=5. 69, P<0. 05), oxygen saturation from (42. 41 ±9. 61)％ to (79. 61 ±20. 34)％ (F=5. 74, P<0. 05), and DSA score (0. 23 ± 0. 03) increased to (1. 35 ± 0. 23) (F=7. 14, P<0. 05), which was sig-nificantly higher than group B and group C ( F=7. 01, F=7. 04, F=7. 12, F=7. 08, F=7. 15, P<0. 05) for one year after treatment. Conclusions Treatment of peripheral blood stem cells CD34 + cell transplantation combined with oral sarpogrelate hydrochloride can significantly improve the vascular regener-ation and its blood supply in TAO lower extremity limb.
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Objective To explore the expression of(hyopxia inducible factor-α,HIF-1α)and gax genes on the intimal hyperplasia for venous autografts in rat.Methods Sixteen Wistar rats were randomLy divided into 2 groups,a control group and an experimental group,8 rats in each group.A rat model of venous autografts was established by transplanting the right external jugulars vein into right common carotid artery in 16rats.The transplanted vein in the experimental group was immersed in solution with recombinant adeno-associated virus(rAAV)and HIF-1α by incubation for 45 minutes at 0℃-4℃ before anastomosis and coated using glue gel in which rAAV-gax added just after anastomosis,the control ones were immersed only in the physiological solution in which rAAV solution without HIF-1α gene added,nothing to be coated except for glue gel only.The vein grafts were taken at 14 days after operation,RT-PCR technique,Western blotting and electric microscopy were used to detect the expression of HIF-1α mRNA and protein,gax mRNA and protein,phenotypic switch of VSMC.Results The expression of HIF-1α mRNA,the experimental group(93.1±22.9)bP,the con trol group(42.7±15.9)bP,P<0.01;the exprossion of gax mRNA,the experimental group(106.9±38.7)bP,the contrd group(50.7±25.8)bP,P<0.01;the exprossion of HIF-1α protein,the experimental group(10.86±2.76)kD,the control group(4.52±1.90)kD,P<0.01;the expression of gax protein,the experimental group(13.65±3.35)kD,the control group(5.40±2.26)kD,P<0.01;VSMC proliferation,the experinental group(21.3±5.4)%,the control group(41.2±8.6)%,P<0.05.Conclusion The present study demonstrated that HIF-1α and gax genes transfection could inhibit proliferation of VSMC and their phenotypic conversion from contractile phenotype to synthetic phenotype in venous autografts.
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Objective To investigate the efficiency of autologous transplantation of peripheral blood stem cell for treatment of patients with chronic lower limb ischemia. Methods Forty-six patients with chronic lower limb ischemia were treated by autologous peripheral blood stem cell transplantation. Results Fortytwo patients had pain relief on legs, and cold and cool feelings in lower limbs disappeared. Thirty-five patients had pain relief on feet, and 29 of them had disappearance of cold and cool feelings. Due to necrosis in middle and lower part of leg, 4 patients took extremity amputation after 4 weeks of the transplantation. In the 42 patients who kept their legs 3 months after transplantation, the distance of anginacruris extended from (87. 45 ±41.22) m to (348.52 ± 147.24) m, skin temperature increased from(28.52 ±0.51 ) ℃ to(33.56±0.62) ℃ ,and ankle-brachial index (ABI) increased from(0.48 ±0.06)to(0.75 ±0.07). There were statistical differences, and the scores of the distance of anginacruris, skin temperature, and ABI after transplantation were better than before. six months after transplantation autobiography of lower extremity was used, and neonatal lateral vessels of different degrees were found in 37 patients. Conclusion Autologous transplantation of peripheral blood stem cell is a simple, safe, and effective method, especially in treating patients with lower limb ischemia in which no arterial reconstruction is feasible.
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Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis(DVT).Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment,20 in which were treated by therapy with anticoagulation and thrombolysis,and therapy with pressure gradient,and the other 26 patients by operation and thrombolysis therapy,and therapy with pressure gradient.Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy.Results Inferior vena cava filters were placed successfully in all patients,38 cases were implanted permanence inferior vena cava filter,8 cases were implanted temporary inferior vena cava filter.Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment.None of pulmonary embolism was occurred.Follow up 2-24 months(average 13 months) for 36 cases with permanence inferior vena cava filter,there was no complication of the filter and pulmonary embolism occurred.Conclusions The method of inserting inferior vena cava filter is simple and safe,which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
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Objective To assess the curative effect of percutem transilluminated with negative pressured on the potaried technique on the treatment of venous ulcer in lower extremity.Methods The clinical date of 300 cases involving 300 legs with venous ulcer in lower extremity,who underwent the percutum transilluminated negative pressured potaried technique using TRIVEXTM Ⅱ potaried system or the percutum transfixion surgical treatment from October 2005 to June 2009,were analyzed.Three hundred cases were randomly divided into potaried group and transfixion group.In potaried group,there were 190 cases involving 190 legs treated with TRIVEXTM Ⅱ potaried system.In transfixion group,110 cases involving 110 legs treated with percutum transfixion.The clinical indexes of skin infection rate and skin necrosis rate,shrinkage rate of wound area and skin depigmentation rate,ulcer healing rate and ulcer recurrence rate were calculated to assess the clinical curative effect on day 5,day 20,day 120 and day 360 after operation respectively.Results The rates of skin infection and skin necrosis were significantly decreased in potaried group compared with transfixion group on day 5 after operation (P0.05).Ulcer recurrence rate was remarkably lower in potaried group than that in transfixion group on day 360 (P
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Objective To explore the clinical effects of 125 I seeds interstitial brachytherapy in treatment of the cancer of pancreas.Methods 12 patients with pancreatic cancer underwent performed using 125 I intraoperative permanent implantation to tumor bed and regional lymph nodes.Postoperative 3～7 days WBC count and immuoassay were detected after one week,film X-ray was taken to observe the distribution of 125 I seeds.Result 12 patients average survived 9.66-month,and one survive 25-months.No patient present severes complications .Conclusions 125 I seeds interstitialbrachytherapy for the malignant tumor of pancreas is simple,safe and effective,and it is one of ideal methods to treat cancer.