Analysis of death-related factors of type B aortic dissection treated medically during the acute phase / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection.</p><p><b>METHODS</b>Clinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 +/- 12) years old. Therapy included analgesia, controlled hypotension and beta-receptor blocker, the mortality in acute phase was 33.3% (14/42). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase.</p><p><b>RESULTS</b>In univariate logistic regression analysis, the malperfusion of aortic branches (P = 0.018) and maximum aortic diameter (P = 0.002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches (P = 0.041) and maximum aortic diameter (P = 0.005) were also considered as the significant death-related factors.Risk of death augmented significantly (P = 0.000) when the maximum aortic diameter over 40 mm.</p><p><b>CONCLUSION</b>Malperfusion of aortic branches and the large maximum aortic diameter (> 40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.</p>

Application of pterional approach head positional three-dimensional digital subtraction angiography in intracranial aneurysm surgery / 中国脑血管病杂志

Objective: To investigate the guiding significance of pterional approach head positional three-dimensional digital subtraction angiography (3D-DSA) in intracranial aneurysm clipping. Methods: One hundred fifty patients with aneurysmal subarachnoid hemorrhage were enrolled in the study. Three-dimenlional angiography was performed after detecting the aneurysms with conventional angiography, and then, the images of 3D-DSA were rotated to the head position for the pterional approach. The size of aneurysm, spatial location, aneurysm neck, and the relationship between aneurysm and patent artery revealed by the images were compared to the conditions at surgical exposure through pterional approach. Results: Of the 150 patients, the diameter of aneurysm revealed by 3D-DSA in 140 patients were in accordance with the intraoperative measurements, the coincidence rate was 93.3%; the coincidence rate of the spatial location between the aneurysms and its parent arteries was 100%. A total of 149 aneurysm clips were selected before the surgery according to 3D-DSA. Six clips were replaced during the operation because it was inconsistence with the prediction before the surgery, and the accurate rate was 96.0% (143/149). The related perforating arteries or adjacent vascular branches of aneurysms in 49 patients were identified before the surgery according to 3D-DSA. The major adjacent blood vessels missed by 3D-DSA in 11 patients were detected during the surgery, and the coincidence rate reached 81.7%. These vessels were all completely preserved during intraoperative anatomical separation under the direct vision. Conclusion: Head positional 3-D DSA for simulate pterional approach may accurately provide information of local blood vessels of aneurysm before surgery, and it plays a good guiding role for surgical clipping of aneurysms.

Evaluation by perfusion-weighted magnetic resonance to hemodynamic character and surgical effect of carotid system stenoses or occlusion / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate hemodynamic character and surgical effect of stenoses or occlusion of carotid artery system by perfusion-weighted MRI.</p><p><b>METHODS</b>Twenty-one patients with stenoses or occlusion of carotid artery system underwent surgical treatment. Two patients underwent endarterectomy, extracranial-intracranial arterial bypass to 10 patients, and percutaneous stent angioplasty to 9 patients.</p><p><b>RESULTS</b>Preoperative perfusion-weighted magnetic resonance (MR) revealed normal regional cerebral blood flow in all patients, with delayed time to peak in both middle cerebral artery distribution and border zone. Postoperative perfusion-weighted MR revealed normal time to peak in border zone, but abnormal in middle cerebral artery distribution. Evaluated by perfusion-weighted MR, it showed that surgical method can improve the hemodynamic disorder of this kind of disease. The early curative effect of endarterectomy and percutaneous stent angioplasty is better than extracranial-intracranial arterial bypass.</p><p><b>CONCLUSIONS</b>Perfusion-weighted MR is a good method to evaluate hemodynamic character of stenoses or occlusion of carotid artery system. Surgical method is helpful to this kind of disease, and its curative effect can be evaluated impersonally and accurately by this new technique.</p>

Batroxobin reduces intracellular calcium concentration and inhibits proliferation of vascular smooth muscle cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Batroxobin (BX), a serine protease used in defibrinogenation and thrombolysis, also has an effect on c-fos gene and growth factor. This study attempted to determine the effects of BX on the proliferation of vascular smooth muscle cells (VSMCs) and calcium metabolism.</p><p><b>METHODS</b>VSMCs were treated with BX at concentrations of 0.1, 0.3, or 1.0 mmol/L and cell numbers were determined at 0, 24, 48, and 72 hours. Intracellular calcium concentration ([Ca2+]i) was measured using direct fluorescence methods.</p><p><b>RESULTS</b>BX was found to suppress proliferation of VSMCs in a dose-dependent fashion with inhibition rates of 18% and 31% by 48 and 72 hours, respectively. In addition, BX decreases basal [Ca2+]i significantly. The basal level in untreated cells was 162.7 +/- 33.8 nmol/L, and decreased to 131.5 +/- 27.7 nmol/L, 128.3 +/- 28.5 nmol/L, and 125.6 +/- 34.3 nmol/L with the three concentrations of BX, respectively. Noradrenaline (NE)-induced [Ca2+]i stimulation was also attenuated by BX (0.1 mmol/L BX, 20% +/- 8% inhibition; 0.3 mmol/L BX, 54% +/- 11% inhibition; 1.0 mmol/L BX, 62% +/- 15% inhibition). The ability of NE to stimulate [Ca2+]i was attenuated in cultures in Ca(2+)-free medium, as was the ability of BX to blunt NE-induced stimulation.</p><p><b>CONCLUSION</b>These findings demonstrate that BX can effectively inhibit proliferation of VSMCs, probably by blocking the release and uptake of Ca2+, thus influencing [Ca2+]i.</p>