Trehalose attenuates abdominal aortic aneurysm formation by inducing autophagy in smooth muscle cells.

BACKGROUND: Trehalose is a naturally occurring disaccharide, which has been identified as an autophagy inducer and exhibits protective effect in cardiovascular diseases such as myocardial infraction and atherosclerosis. However, the functional role of trehalose in abdominal aortic aneurysm (AAA) remains undefined. METHODS: To study the effect of trehalose in AAA, trehalose (1 g/kg per day) were given for 14 continuous days in a mouse model of elastase-induced abdominal aortic aneurysm. On day 14, ultrasound was performed to measure aortic diameter before the abdominal aortas were harvested and processed for further analysis. Verhoeff-Van Gieson staining and TUNEL staining were performed on paraffin sections to evaluate vascular histology and apoptosis, immunofluorescence staining and Western-blot were performed to evaluate expression of autophagy markers. RESULTS: Echocardiography and in situ pictures demonstrated that trehalose attenuated infrarenal aorta dilation. Verhoeff-Van Gieson staining showed elastin degradation was improved in trehalose-treated group. Compared with vehicle-treated mice, trehalose treatment restored smooth muscle cell contractile phenotype with increased α-SMA, Calponin and Myh11 expression. Furthermore, trehalose also attenuated cell apoptosis and leukocytes infiltration. Importantly, trehalose induced autophagy with decrease SQSTM1/p62 accumulation, increased lamp2 expression and LC3B conversion. CONCLUSION: Trehalose attenuated AAA progression with decreased inflammation and restored SMC contractile phenotype by inducing autophagy. These results demonstrated the therapeutic potential of trehalose in AAA.

SHOX CNE9/10 Knockout in U2OS Osteosarcoma Cells and Its Effects on Cell Growth and Apoptosis.

BACKGROUND Osteosarcoma is a common malignant tumor of musculoskeletal stromal cells. Osteosarcoma clinical behavior depends mostly on the histologic grade, the site of primary tumor, the response to chemotherapy, and the presence of pulmonary metastases. The aim of this study was to knockout SHOX CNE9/10 in U2OS osteosarcoma cells and to analyze the effects on cell growth and apoptosis. MATERIAL AND METHODS U2OS cells with CNE9 knockout and U2OS cells with CNE10 knockout were established via the CRISPR/Cas9 system. Sanger sequencing was used to detect the success of the knockdown experiment. Western blotting and quantitative polymerase chain reaction were used to detect the expression levels of short stature homeobox-containing gene (SHOX) protein and messenger RNA (mRNA) after knockdown of CNE9 and CNE10. The cell viability and apoptotic rate were detected by the Cell Counting Kit-8 method and by flow cytometry. RESULTS The Sanger sequencing results showed that the knockdown experiment was successful. The levels of SHOX mRNA and protein were significantly reduced after knocking down CNE9 and CNE10. Knockdown of CNE9 and CNE10 significantly increased the growth and inhibited the apoptosis of U2OS osteosarcoma cells. CNE9/CNE10 knockdown U2OS cells were successfully constructed. CONCLUSIONS Knockdown of CNE9 and CNE10 promoted U2OS cell growth and inhibited apoptosis by decreasing SHOX expression. This CNE9/CNE10 knockout U2OS cell model could provide a bridge for the research on SHOX and CNEs in osteosarcoma.

Protective effect of intraoperative re-dose of prophylactic antibiotics on surgical site infection in diabetic patients: a retrospective cohort study.

BACKGROUND: Surgical site infection (SSI) has a high incidence in diabetic surgical patients. Preoperative antibiotic prophylaxis followed by an intraoperative re-dose was a common strategy in diabetic prolonged procedures. However, there were lacking studies on the relative benefits of this strategy on SSI. Our study aimed to clarify the effect of intraoperative re-dose of prophylactic antibiotics on SSI in diabetic patients. METHODS: A total of 1,840 diabetic patients with prolonged surgeries were included and Cefazolin was the only type of antibiotic prophylaxis. We assessed the relationship between intraoperative re-dose of cefazolin and 30-day incidence of SSI using a retrospective cohort study method. RESULTS: There were 361 diabetic cases with preoperative antibiotics only and 1,479 cases with pre- plus intraoperative antibiotics, in which 60 subjects suffered from SSI. Pre- plus intraoperative prophylaxis group had a lower rate of SSI in the overall and subgroup analyses when compared with preoperative only group. Operation location, combined with hypertension, poor blood glucose control, high WBC count and ASA score >2 were significantly associated with an increased risk of SSI for diabetic surgical patients (all P<0.05). Intraoperative re-dose of prophylactic antibiotics was statistically related to a lower incidence rate of SSI than preoperative prophylaxis alone (crude RR =0.47; 95% CI, 0.27-0.82; P<0.01), while the association remained significant even after adjusting the potential confounders (adjusted RR =0.51; 95% CI, 0.29-0.90; P=0.02). CONCLUSIONS: For diabetic patients, intraoperative re-dose of prophylactic antibiotics may be an independent protective factor for the prevention of SSI. A specific perioperative antibiotics injection strategy should be encouraged for diabetic patients with prolonged surgeries to minimize the possibility of SSI.

Serum levels of matrix metalloproteinase 9 and toll-like receptor 4 in acute aortic dissection: a case-control study.

BACKGROUND: Matrix metalloproteinase 9 (MMP9) and Toll-like receptor 4 (TLR4) play important roles in aortic pathophysiology. However, there is lacking research on serum TLR4 levels in acute aortic dissection (AAD) patients, and the performance of serum MMP9 and TLR4 for the diagnosis of AAD is still unknown. This study aimed to evaluate the serum levels of MMP9 and TLR4 in AAD patients, identify their associations with circulating C-reactive protein (CRP) and D-dimer, which are well-known classical biomarkers of AAD, and further explore the potential diagnostic role of MMP9 and TLR4 in AAD. METHODS: Serum levels of MMP9 and TLR4 were measured by enzyme-linked immunosorbent assay (ELISA) in 88 AAD patients and 88 controls. The clinical test related information was collected from patients' electronic medical records. RESULTS: Serum MMP9 and TLR4 levels were significantly higher in AAD patients than those in healthy controls in the general and stratified comparisons. Either serum MMP9 or TLR4 was independently associated with the risk of AAD (all p < 0.001). There was a positive significant association between serum MMP9 and TLR4 (r = 0.518, p < 0.001). Both MMP9 and TLR4 levels were statistically correlated with circulating CRP, but not D-dimer. Based on receiver-operating characteristic (ROC) analysis, the area under the curves (AUCs) of MMP9 and TLR4 alone for the diagnosis of AAD were 0.810 and 0.799 with optimal cut-off points of 379.47 ng/ml and 7.83 ng/ml, respectively. Moreover, a combination of serum MMP9 and TLR4 increased the AUC to 0.89 with a sensitivity of 60.2% and specificity of 94.3%. CONCLUSIONS: Serum MMP9 and TLR4 could be potential biomarkers for identifying AAD, while the combined diagnostic value was higher in safely ruling out AAD.

Application of carbon nanoparticles in lymph node dissection and parathyroid protection during thyroid cancer surgeries: a systematic review and meta-analysis.

PURPOSE: To investigate whether carbon nanoparticles (CNs) are helpful in identifying lymph nodes and metastatic lymph nodes and in parathyroid protection during thyroid cancer surgery. METHODS: English and Chinese literature in PubMed, Cochrane Database of Systematic Reviews, EMBASE, ClinicalTrials.gov, China Biology Medicine Database, China National Knowledge Infrastructure, China Master's and Doctoral Theses Full-Text Database, Wanfang database, and Cqvip database were searched (till March 22, 2016). Randomized controlled trials (RCTs) that compared the use of CNs with a blank control in patients undergoing thyroid cancer surgery were included. Quality assessment and data extraction were performed, and a meta-analysis was conducted using RevMan 5.1 software. The primary outcomes were the number of retrieved central lymph nodes and metastatic lymph nodes, and the rate of accidental parathyroid removal. RESULTS: We obtained 149 relevant studies, and only 47 RCTs with 4,605 patients (CN group: n=2,197; blank control group: n=2,408) met the inclusion criteria. Compared with the control group, the CN group was associated with more retrieved lymph nodes/patient (weighted mean difference [WMD]: 3.39, 95% confidence interval [CI]: 2.73-4.05), more retrieved metastatic lymph nodes (WMD: 0.98, 95% CI: 0.61-1.35), lower rate of accidental parathyroid removal, and lower rates of hypoparathyroidism and hypocalcemia. However, the total metastatic rate of the retrieved lymph nodes did not differ between the groups (odds ratio: 1.13, 95% CI: 0.87-1.47, P=0.35). CONCLUSION: CNs can improve the extent of neck dissection and protect the parathyroid glands during thyroid cancer surgery. And the number of identified metastatic lymph nodes can be simultaneously increased.

Wnt5a and Ror2 expression associate with the disease progress of primary thyroid lymphoma.

Primary thyroid lymphoma (PTL) is a rare malignant thyroid tumor; its pathogenesis is closely related to chronic lymphocytic thyroiditis. The different pathological subtypes and stages of PTL have distinct clinical characteristics and prognosis, but the specific reasons are not clear. Wnt5a is a representative protein of non-canonical Wnt signaling. It plays an important role in many different types of tumors. This study is to explore the changes of Wnt5a and its receptor Ror2 in PTL development process and the clinical significance of their represent. We collected 22 PTL patient tumor specimens and clinical data. We observed the expression of Wnt5a and Ror2 in PTL tumor tissues by immunohistochemistry. Wnt5a was expressed positively in 12 (54.5 %) cases, and Ror2 was expressed positively in 18 (81.8 %) cases. The expression of Wnt5a had a significant difference in different pathological subtypes of PTL (P < 0.05). Wnt5a and Ror2 expression were associated with local invasion and clinical stage, respectively (P < 0.05), and had no significant correlation with age, gender, and tumor size. Although, no significant difference in overall survival was found between positive and negative groups of Wnt5a (P = 0.416) or Ror2 (P = 0.256), respectively. We still consider that Wnt5a and Ror2 play a complex and subtle role in the pathogenesis and progression of PTL and may become potential biomarkers and therapeutic targets of PTL.

Sex difference in the prevalence of metabolic syndrome and cardiovascular-related risk factors in urban adults from 33 communities of China: The CHPSNE study.

Little is known about the epidemiology of metabolic syndrome in urban areas of China. To estimate the prevalence of MetS and identify its cardiovascular-related factors in men and women, a representative sample of 15,477 urban adults aged 18-74 years in Northeast China was selected from 2009 to 2010. The diagnosis of metabolic syndrome was based on criteria set by the National Cholesterol Education Program/Adult Treatment Panel. The overall prevalence of metabolic syndrome was 27.4% (men 27.9% and women 26.8%). Multivariable logistic regression analysis revealed that a higher education level and a higher family income were associated with a higher prevalence of metabolic syndrome in men, but associated with lower prevalence of metabolic syndrome among women. Higher physical activity was associated with a decreased prevalence of metabolic syndrome in men (adjusted odds ratios (aORs) = 0.88, 95% confidence interval (CI): 0.79-0.99), but associated with an increased prevalence of metabolic syndrome in women (aOR = 1.14, 95% CI: 1.00-1.29). Compared with rice as the major staple food, cooked wheaten foods were associated with lower adjusted odds for metabolic syndrome both in men (aOR = 0.72, 95% CI: 0.58-0.90) and in women (aOR = 0.72, 95% CI: 0.56-0.92). In conclusion, metabolic syndrome is highly prevalent in urban areas of China, and there is heterogeneity by sex in the relationships between risk factors and metabolic syndrome prevalence.

A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms.

BACKGROUND: Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR). METHODS: A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. RESULTS: A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR = 1.81, P = 0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR = 1.53, P = 0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P = 0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P < 0.001) and a shorter total postoperative stay (WMD 6.27 days, P < 0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR = 0.48, P < 0.001 and OR = 0.28, P = 0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70, P < 0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR = 1.13, P = 0.381) and re-intervention rate (OR = 2.19, P = 0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR = 0.33, P = 0.039) at late follow-up period. CONCLUSIONS: On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.

[Critical limb ischemia during perioperative period of open surgery for rupture abdominal aortic aneurysm: treatment and prognosis].

OBJECTIVE: To explore the treatment and prognosis of critical limb ischemia during perioperative period of open surgery for ruptured abdominal aortic aneurysm (AAA). METHODS: Retrospective reviews were conducted for the clinical data of unstable ruptured AAA patients with open repair at our hospital from June 2002 to June 2012 to examine the characteristics and treatment regimens for associated critical limb ischemia. RESULTS: A total of 46 unstable AAAs were enrolled. There were 37 males and 9 females with an average age of 69 years. All AAAs were repaired by a bifurcated polytetrafluoroethylene graft via a transperitoneal midline incision. Critical limb ischemia was found in 8 patients during or after the procedure. Treatments included additional graft-distal iliac artery bypass (n = 2), anastomotic stoma stenting (n = 2), Fogarty catheter embolectomy plus local thrombolysis (n = 2), Fogarty catheter embolectomy (n = 1) and venous thrombolysis (n = 1). Lower limb necrosis developed in 5 patients (4 unilateral, 1 bilateral) and all of them died. CONCLUSION: Open repair of ruptured AAA may be associated with a considerate morbidity of critical limb ischemia. Early reconstruction of blood flow improves the prognosis.

[Effects of left renal vein division on postoperative renal function during open repair of abdominal aortic aneurysm].

OBJECTIVE: To explore the effects of left renal vein division (LRVD) on postoperative renal function and examine the overall prognosis in patients undergoing open repair of abdominal aortic aneurysm (AAA). METHODS: Retrospective analyses were conducted for the clinical data of AAA patients with open repair at our hospital from January 2000 to December 2011. They were divided into LRVD (n = 35) and non-LRVD (n = 141) groups. The 30-day mortality, cardio-cerebrovascular complications, pulmonary complications, preoperative and postoperative levels of creatinine and glomerular rate filtration (GFR), aortic cross-clamping time, blood loss volume, intensive care duration and dialysis or continuous renal replacement therapy (CRRT) rate were compared between two groups. RESULTS: A total of 189 AAA repair were performed. And 13 patients with suprarenal clamping were excluded. The LRVD group had a significant higher proportion of ruptured AAA (48.6% vs 27.7%, P < 0.01), higher 3-day postoperative creatinine (P < 0.01), longer intensive duration (P < 0.05) and decreased 3-day postoperative GFR (P < 0.01). No significant difference existed in 30-day mortality, incidence of major complications, creatinine or GFR at discharge (P > 0.05). CONCLUSIONS: LRVD during open surgery of AAA has no effect on the postoperative mortality and renal function.

[Correlation of hemoglobin concentration with the diameter of abdominal aortic aneurysm and long-term patient survival].

OBJECTIVE: To assessed the relationships between hemoglobin concentration from the patients with abdominal aortic aneurysm (AAA) and its diameter as well as patients' long-term survival. METHODS: Between January 2002 to June 2012, 255 AAA patients were reviewed retrospectively. The outcomes were compared between 3 groups of different treatments (excluding 20 cases dead within 30 days). The procedures included open AAA repair (n=76), endovascular (EVAR) (n=62) and non-operated (n=97). The mean follow-up period was 63±42 months. The association of hemoglobin level with AAA diameter was assessed with multiple linear regression. Kaplan-Meier survival curves of anemic and non-anemic patient groups were compared by the log-rank method in 3 groups. Cox's proportional hazard regression mode was used to determine the effects of anemia on vital status after EVAR, open AAA repair or non-operation. RESULTS: A total of 88 (34.5%) of AAA patients had anemia. After adjustment for various risk factors, hemoglobin level was inversely correlated with maximal AAA diameter (ß=-0.152, P=0.017). During a long-term follow-up, the 5-year survival rates were 56%, 51% and 42% in anemic patients versus 94%, 90% and 80% in non-anemic ones. Survival was lower in anemic patients than those without anemia in 3 groups (P=0.005, 0.001, 0.025 by log-rank respectively). In three groups, according to multivariable Cox regression analysis, the hemoglobin levels were independently correlated with long-term mortality respectively after adjusting for various risk factors. The hemoglobin levels were correlated with death (HR: 0.923, 0.963, 0.963; P: 0.001, 0.002, 0.028; 95%CI: 0.8798-0.970, 0.941-0.986, 0.932-0.996). CONCLUSION: Hemoglobin concentration is independently associated with AAA diameter and reduced long-term survival after undergoing EVAR, open AAA repair and non-operation.

[Expression of HIF-1a in acute limb ischemia of rats].

OBJECTIVE: To explore the expression of hypoxia-inducible factor 1 alpha (HIF-1a) in rat lower limb skeletal muscle with acute ischemia. METHODS: Acute lower limb ischemia was established in 25 male or female SD rats of 200-250 g by ligating left iliac artery with microsurgical techniques. Gastrocnemius of lower limb was harvest at the time points of sham (0h), 4, 8, 12 and 24 h respectively. Immunohistochemistry, Western blot and real-time polymerase chain reaction (PCR) were used to detect the expression of HIF-1a in lower limb gastrocnemius. RESULTS: There was a low expression of HIF-1a in normal gastrocnemius, but it was highly expressed in lower limb ischemia. With the elongation of ischemia time, its expression increased (P < 0.05), peaked at 4 h and 8 h (P < 0.05) and then declined gradually. CONCLUSION: With a characteristic trend during acute limb ischemia, HIF-1a may play an important role in the adaptive response to acute limb ischemia.

Endovascular repair of a tuberculous aneurysm of descending thoracic aorta.

Tuberculous aortic aneurysm (TBAA) is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial, endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication. The outcome was favorable.

[Evaluation of efficacy of the anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach].

OBJECTIVE: To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. METHODS: There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. RESULTS: Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94.4% vs.69.5%, P < 0.01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85.9% vs. 75.3%, P > 0.05). A mean follow-up period was (43 ± 18) months. There was no significant difference in incidence of complication and recurrence between two groups. CONCLUSIONS: The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.

[Surgical treatment of non-traumatic aneurysm in ilio-femoral arterial region].

OBJECTIVE: To summarize the surgical experiences of treating 61 cases of non-traumatic aneurysms in ilio-femoral arterial region. METHODS: The clinical data of 61 consecutive patients with non-traumatic aneurysms in ilio-femoral arterial region between January 1985 and November 2010 were retrospectively reviewed. RESULTS: There were a total of 76 non-traumatic aneurysms in ilio-femoral arterial region, including solitary iliac aneurysms (n = 29) and femoral aneurysms (n = 32). Seventeen (27.9%) patients had multiple aneurysms, 8 (13.1%) patients ruptured aneurysms and 4 (6.6%) patients coexistent peripheral vascular occlusive disease. Fifty patients underwent electively aneurysm excision and graft (or autogenous vein) replacement. Seven patients with ruptured aneurysms received emergency treatment. And one with multiple aneurysms died intra-operatively from ruptured iliac aneurysm. One patient with common iliac aneurysm underwent endovascular repair without endoleak and 1 with internal iliac aneurysm received embolization. There was no perioperative mortality. But one with femoral aneurysm underwent amputation due to acute thrombosis. Seven patients died during the follow-up period and the survivors remained stable and had a good graft patency without new aneurysm formation. CONCLUSION: Early management of aneurysms in ilio-femoral arterial region is rather important and multiple aneurysms should be considered. Aneurysm excision and arterial reconstruction yield an excellent outcome. Close and long-term follow-up is mandatory for the detection of new aneurysm formation.

[Management and prognosis of acute arterial embolism: a multivariable analysis of 346 patients].

OBJECTIVE: To evaluate the management of acute arterial embolism (AAE) and its prognostic factors. METHODS: The clinical data of 346 AAE patients treated at our hospital between January 1998 and October 2008 were retrospectively reviewed. The prognostic factors, including age, gender, extremities, location of embolism, ischemic duration, ischemic categories, and therapeutic methods, postoperative complications were evaluated by multivariate Logistic regression analysis. RESULTS: There were 210 males and 136 females with a mean age of (63 ± 14) years old. Fifty-six patients occurred in the upper extremities and 290 patients in the lower extremities. The causes included cardiogenic embolism (n = 301), vasogenic embolism (n = 33) and unknown origin (n = 12). The duration of ischemia ranged from 1 h to 7 d. Only 44 patients were admitted ≤ 8 h and the remainder > 8 h. The categories of extremity ischemia were level I (n = 17), level IIA (n = 69), level IIB (n = 221) and level III (n = 39). The procedures included embolectomy (n = 280), interventional thrombolysis (n = 19) and conservative treatment (n = 47). Thirteen patients (3.76%) died of complications during the perioperative periods. And 44 (12.72%) underwent amputations and 289 (83.53%) had excellent clinical outcome with extremity salvage. During a 5-year follow-up period, 38 patients had a recurrent embolism. The Logistic regression analysis showed that ischemic duration, ischemic category, therapeutic methods and complications had significant prognostic influences (all P < 0.05). And other factors such as age, gender, extremities and the location of embolism had insignificant influences (all P > 0.05). CONCLUSION: Embolectomy is the first-choice therapy for AAE with an excellent outcome. Ischemic duration, ischemic grading, surgical treatment and complications have significant prognostic influences. Systematic medical treatments, such as effective anticoagulation, are vital in the prevention of recurrent AAE.

[The study about expression of Gli2 in vein grafts].

OBJECTIVE: To study the expression of cell cycle related factor Gli2 in autogenous vein graft and its relation with neointima formation. METHOD: Autogenous vein graft model were established in 36 male wistar rats of 8 weeks old, 140 g, by transplanting the left jugular vein to intra renal abdominal aorta with microsurgical technique. Graft veins were harvest at 14, 28 days after transplantation. The IF and W-B were used to detect the protein expression in the vein graft. At the same time Gli2- mRNA was measured by RT-PCR. RESULTS: Immunofluorescent staining showed that the Gli2+ cells was only 3.2% ± 0.4% in the normal vein, but was much more in the vein graft after surgery, was 41.3% ± 0.6%, 58.3 ± 0.6% respectively; The expression of Gli2 and PCNA were both elevated in the vein graft. There is a positive correlation between them which indicated by W-B, the relation index was 0.826; the Gli2 mRNA content was also increased in vein graft, was 8.9, 13.6 fold compared with normal vein as 1 respectively. CONCLUSION: Gli2 is upregulated in autogenous vein grafts and may correlated with the proliferation of vascular smooth muscle cells.

[The study of different operative style for abdominal aortic aneurysm during surrounding operation].

OBJECTIVE: To compare the the similarities and differences during the surrounding operation of endovascular repair (EVAR) and open surgical repair (OSR) for abdominal aortic aneurysm. METHODS: 112 patients with abdominal aortic aneurysms (AAA) were selected from 2004 to 2009: among them, 66 patients were treated with EVAR, 46 patients with OSR. Data of two groups were collected and analyzed during surrounding operation. RESULTS: Compared to OSR group, the mean blood lost, blood transfusion and intra-operative fluid in EVAR group were significantly less than OSR group (P < 0.05). The mean time of operation, observation period in ICU and being in hospital in EVAR group were shorter than OSR group (P < 0.05). But the cost of hospitalization in EVAR was far higher than that of OSR group (P < 0.05). In short term postoperative complications the OSR group was higher than the EVAR (P < 0.05), however, there was no statistically significant difference in death rate of the two groups during surrounding operation (P > 0.05). CONCLUSION: EVAR has the advantages of mild trauma, less blood loss, quicker recovery after operation, and less disturbance to internal environment. Especially, it is suitable for the patients who can not undergo open surgery repair, but its cost is still higher.

[The expression of sonic hedgehog in rat vein grafts].

OBJECTIVE: To study the expression of cell cycle related factor sonic hedgehog (SHH) in autogenous vein graft and its relation with neointima formation. METHODS: Autogenous vein graft model were established in 24 male Wistar rats of 8 weeks old and 140 g weight, by transplanting the left jugular vein to intra renal abdominal aorta with microsurgical technique. Graft veins were harvested at 14 d and 28 d after transplantation. The immunohistochemistry and Western blot were used to detect the SHH and PCNA expression in the vein graft. At the same time SHH mRNA was measured by quantitative real-time PCR. The opposite normal veins served as control. RESULTS: Histological staining showed that the percent of SHH+ cells was only (2.0 +/- 0.5)% in the normal vein, but was much more in the vein graft after surgery, as (39.4 +/- 0.4)% and (63.0 +/- 0.3)% respectively (P < 0.01). The expression of SHH and PCNA were both elevated in the vein graft. There was a positive correlation between them which indicated by Western blot (r = 0.808, P < 0.01). The SHH mRNA content also increased in vein graft to 9.5 and 23.8 folds of that in control. CONCLUSION: SHH is upregulated in autogenous vein grafts and may correlated with the proliferation of vascular smooth muscle cells.

Inflammatory abdominal aortic aneurysm: clinical features and long term outcome in comparison with atherosclerotic abdominal aortic aneurysm.

BACKGROUND: Inflammatory abdominal aortic aneurysms (IAAAs) are rare but distinct clinical entities of atherosclerotic abdominal aortic aneurysms (aAAAs). In this study we report a 20-year single institution experience for IAAA and analyze their clinical features and long term outcome in comparison with aAAA. METHODS: Between 1988 and 2008, 412 cases of abdominal aortic aneurysms (AAAs) underwent elective surgical operations, 11 (2.7%) of whom were diagnosed as IAAAs and 389 (94.4%) were diagnosed as aAAAs. The former group was matched in a case control fashion to a group of 33 patients with aAAAs having similar characteristics of age, gender, and preoperative risk factors. All available clinical, pathologic, and postoperative variables were retrospectively reviewed, and the two groups were compared. RESULTS: The two groups did not differ significantly in clinical characteristics and preoperative risk factors, although patients with IAAAs were significantly more symptomatic (100% vs. 42.4%, P = 0.001) and had larger aneurysms on admission ((7.4 +/- 0.7) cm vs. (6.3 +/- 0.9) cm, P = 0.006). In IAAAs, the preoperative erythrocyte sedimentation rate was found to be significantly elevated compared to aAAA group ((44.5 +/- 9.1) mm/h vs. (11.4 +/- 5.4) mm/h, P < 0.05). Surgical morbidity and mortality rates did not differ between the two groups. The operation time for patients with IAAAs was significantly longer than that for patients with aAAAs ((308 +/- 36) minutes vs. (224 +/- 46) minutes, P < 0.05), but the cross-clamp time was similar in both groups ((41.5 +/- 6.2) minutes vs. (41.8 +/- 6.2) minutes, P = 0.92). A five-year survival rate analysis showed no significant difference between the two groups (P = 0.711). CONCLUSIONS: Despite having more symptoms, larger size and longer operation time, patients with IAAA can now be treated with approaches that cause low morbidity and mortality, similar to patients with aAAA. Long term outcome of IAAA patients is of no difference from aAAA patients.