Expression of autophagy related genes in peripheral blood cells in Parkinson's disease.

Parkinson's disease (PD) is the second most common neurodegenerative disorder and affects dopaminergic neurons. Autophagy often shows a circadian rhythm pattern under physiological conditions across 24 h. Abnormal autophagy and circadian dysfunction are two characteristics of PD. Whether the rhythm of autophagy is altered in PD has not yet been reported. Therefore, in this study, we collected peripheral blood samples at 6:00 h and 18:00 h from PD patients and age-matched controls, and analyzed the mRNA expressions of ULK1, BECN1, LAMP2, AMPK, and SNCA using real-time quantitative PCR. Blood samples analysis found that BECN1 and LAMP2 levels were decreased in patients with PD. Simultaneously, the rhythm of autophagy in PD is not consistent with that in the Control group, which may be a manifestation of the abnormal biological rhythm of PD.

Hydrogel Complex Electrospun Scaffolds and Their Multiple Functions in In Situ Vascular Tissue Engineering.

Hydrogel complex scaffolds (hydrogel scaffolds) are prepared by coating precursor solutions onto heparin-modified poly(ε-caprolactone) (PCLH) scaffolds followed by subsequent in situ gelation. Here, we show that hydrogel complexation can significantly strengthen the scaffold and slow its degradation. The hydrogel scaffold was implanted into the abdominal aorta of a rat model, and the aneurysm incidence rate of the hydrogel scaffolds sharply decreased compared with that of the hydrogel-free scaffolds. Histological and immunohistological analyses showed that the implanted grafts had good vascular regeneration. The absence of calcification and occurrence of contractile smooth muscle cells (SMCs) at the first month was found in the hydrogel-free PCLH scaffold due to the presence of surface-modified heparin, whereas the hydrogel scaffold exhibited mild calcification and later occurrence of contractile SMCs as the complexed hydrogel covered the fibers and blocked the interaction between heparin and cells. Heparin was further physically encapsulated into the hydrogel before gelation, and its sustainable release was demonstrated by an in vitro release test. A pilot implantation in a rabbit carotid model showed that the encapsulated heparin modulated the scaffold characteristics including anticoagulation, anticalcification, and the early occurrence of contractile SMCs in vivo. Consequently, hydrogel complexation can significantly improve the in vivo regeneration property of the scaffold due to its multiple beneficial characteristics.

Endovascular and hybrid treatments for subclavian artery aneurysms.

OBJECTIVE: This paper retrospectively reviews our experience with endovascular and hybrid treatments for subclavian artery aneurysms (SAA). METHODS: Seventeen patients with SAAs were treated at our center between July 2011 and October 2018. Clinical and follow-up data were extracted from the hospital records and retrospectively reviewed. We routinely use endovascular treatments and stenting or axillary-axillary bypass to treat SAA if vertebral artery blood flow requires restoration. Patients were followed up at 3, 6, and 12 months after their operations and yearly thereafter. RESULTS: Median follow-up was 30.5 months. In 6 patients, the SAAs involved the ipsilateral vertebral artery. Simple coil embolization was performed for 1 patient; endovascular covered stenting and coil embolization for 4 patients; and hybrid treatment for 1 patient. In 11 patients, the SAAs did not involve the ipsilateral vertebral artery. Hybrid treatment was performed for 1 patient; thoracic aortic stent implantation with coil embolization for 1 patient; and covered stent placement in the subclavian artery for 9 patients. Among the 9 patients who were symptomatic at presentation, 8 had relief of symptoms. Leakage was observed in 1 patient, but it stopped spontaneously. Stent occlusion occurred in 18.8% (3/16), but all were asymptomatic, and no interventions were necessary. CONCLUSION: Endovascular and hybrid treatments appear to be effective for SAAs with few complications and good clinical outcomes. KEY WORDS: Covered stent, Coil embolization, Endovascular treatment, Hybrid, Subclavian artery aneurysm.

Long-term outcomes of axillary to carotid bypass for symptomatic patients with chronic common carotid artery occlusion.

OBJECTIVE: Relatively little is known about the natural history of atherosclerotic common carotid artery occlusion and optimal treatment of these patients is still unclear. The aim of this retrospective study was to evaluate the immediate- and long-term outcomes of axillary to carotid bypass with polytetrafluoroethylene graft for symptomatic patients with chronic common carotid artery occlusion. METHODS: From March 2001 to December 2017, 58 symptomatic patients (41 men; mean age 64.7 years) with chronic common carotid artery occlusion underwent axillary to carotid bypass at one academic hospital. The clinical data of this patient cohort were retrospectively analyzed. The cumulative graft patency, overall survival, freedom from symptoms, and freedom from ipsilateral stroke were calculated with Kaplan-Meier method. RESULTS: Thirty-three patients presented with transient ischemic attack and 25 patients presented with minor stroke. At 30 days after bypass, the overall perioperative complication rate was 3.4% (2/58). Mild injuries of brachial plexus occurred in one (1.7%) patient and myocardial infarction occurred in one (1.7%) patient. No perioperative stroke or death occurred. The median follow-up was 51 months (range, 12-203) for this series. The cumulative graft patency rates at 1, 3, 5, and 10 years were 100%, 100%, 94%, and 83%, respectively. The cumulative freedom from symptoms rates at 1, 3, 5, and 10 years were 100%, 100%, 94%, and 75%, respectively. The cumulative freedom from ipsilateral stroke rates at 1, 3, 5, and 10 years were 100%, 100%, 94%, and 82%, respectively. The overall survival rates at 1, 3, 5, and 10 years were 98%, 89%, 81%, and 67%, respectively. CONCLUSIONS: Axillary to carotid bypass with polytetrafluoroethylene graft is safe and durable for symptomatic patients with chronic common carotid artery occlusion. The results of this study should be confirmed with a larger, randomized controlled trial in future.

Cognitive improvement after carotid artery stenting in patients with symptomatic internal carotid artery near-occlusion.

BACKGROUND AND PURPOSE: To investigate the influence of carotid artery stenting (CAS) with embolic protection device (EPD) on the cognitive function of patients with near-occlusion of the cervical internal carotid artery (ICA). METHODS: From February 2014 to December 2017, a total of 79 symptomatic patients were recruited in this study. Of these patients, 31 patients refused to receive CAS therapy. They were divided into the CAS group (48 patients) and the medical treatment group (31 patients). Montreal cognitive assessment (MoCA) instrument was used for the evaluation of cognitive function. The analyzed endpoints included cumulative 12 month incidence of ipsilateral ischemic cerebrovascular events and MoCA scores at 1 month and 12 months after treatment. RESULTS: Cumulative 12 months incidence of ipsilateral ischemic cerebrovascular events was lower in patients who underwent CAS than in patients on medical treatment (P < 0.05). In CAS group, the total MoCA score, scores of attention and delayed recall at months 1 and 12 increased when compared with those at baseline (P < 0.05). In medical treatment group, the total MoCA score and attention score at month 12 decreased when compared with those at baseline (P < 0.05). In CAS group, the total MoCA score, scores of line connection test, drawing clock, attention and delayed recall were improved at 1 and 12 months when compared with medical treatment at the same time points (P < 0.05). CONCLUSIONS: CAS with EPD not only decreases the risk of ipsilateral TIA and stroke but also may improve the cognitive function of symptomatic patients with ICA near-occlusion.

Aspiration therapy for acute embolic occlusion of the superior mesenteric artery.

BACKGROUND: Embolic superior mesenteric artery (SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However, most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure. AIM: To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA. METHODS: This retrospective study reviewed eight patients (six males and two females) from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography (CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed. RESULTS: Six (75%) patients were male, and the mean patient age was 70.00 ± 8.43 years (range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications (the clot broke off during aspiration). CONCLUSION: Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients' death, resolving thrombi, and improving symptoms.

Efficacy, safety and influencing factors of intra-calf muscular injection of bone marrow mononuclear cells in the treatment of type 2 diabetes mellitus-induced lower extremity vascular disease.

The efficacy, safety and impact of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) associated with the intra-calf muscular injection of bone marrow mononuclear cells (BMMCs) in the treatment of type 2 diabetes mellitus (T2DM)-induced lower extremity vascular disease (LEVD) were evaluated. Patients with T2DM-LEVD were randomly divided into a control group and BMMCs group to assess the efficacy and safety of the treatment; serum VEGF and bFGF levels were detected. The BMMCs group was divided into superior genicular artery (SGA) and inferior genicular artery (IGA) subgroups as well as low-dose and high-dose subgroups for the comparison of efficacy indices. The BMMCs group exhibited significantly improved indices (P<0.05) compared with the control group and no fatalities or cancer occurred. There were no significant changes in serum VEGF and bFGF levels (P>0.05). The claudication distance in the IGA subgroup was significantly greater that in the SGA subgroup (P<0.05); the low-dose subgroup and the high-dose subgroup did not demonstrate any significant differences in each index (P>0.05). BMMC treatment for T2DM-LEVD was found to be safe and effective and had no significant impact on serum VEGF and bFGF levels in the short term; However, the degree of LEVD may affect its efficacy.

Establishment and evaluation of a reversible two-kidney, one-clip renovascular hypertensive rat model.

The aim of the present study was to establish and evaluate a novel and reversible two-kidney, one-clip renovascular hypertensive rat model with a titanium vascular clip. A total of 40 male Sprague-Dawley rats were evenly and randomly divided into a sham-operated group, and 3, 7, 12 and 28D groups (namely removing the vascular clip in the renovascular hypertensive model after 3, 7, 12 and 28 days, respectively). The systolic blood pressure (SBP) and plasma renin activity (PRA) were measured, and color duplex imaging was conducted before placing the clips, as well as before and after removing them. After placing the vascular clips, SBP and PRA in the 3, 7, 12 and 28D groups were significantly increased (SBP: Sham-operated vs. 3D groups, P=0.020; 3 vs. 7D groups, P=0.008; 7 vs. 28D groups, P=0.019; 12 vs. 28D groups, P=0.039, and between other groups P<0.001. PRA: 3 vs. 7D groups, P=0.001; 7 vs. 12D groups, P=0.004; 12 vs. 28D groups, P=0.040, and between other groups, P<0.001). After removing the clips, SBP were significantly reduced in the 3 and 7D groups (P=0.023, 0.040, 0.066 and 0.314 in the 3, 7, 12 and 28D groups, respectively), but were still significantly higher than that before placing clips in the 7, 12 and 28D groups (P=0.067, P=0.005, P<0.001 and P<0.001 in the 3, 7, 12 and 28D groups, respectively). After removing the clips, PRA was significantly reduced in each group (P<0.001, P<0.001, P=0.012 and P=0.049 in 3, 7, 12 and 28D groups, respectively), but still higher than that before placing the clips (P<0.001, P=0.001, P=0.001 and P=0.003 in 3, 7, 12 and 28D groups, respectively). Vascular imaging also indicates this model has a reversible property. In conclusion, a reversible renovascular hypertension rat model is feasible, and provides a basis for research on clinical ischemic nephropathy and renal artery revascularization.

The fabrication of double layer tubular vascular tissue engineering scaffold via coaxial electrospinning and its 3D cell coculture.

A continuous electrospinning technique was applied to fabricate double layer tubular tissue engineering vascular graft (TEVG) scaffold. The luminal layer was made from poly(ɛ-caprolac-tone)(PCL) ultrafine fibers via common single axial electrospinning followed by the outer layer of core-shell structured nanofibers via coaxial electrospinning. For preparing the outer layernano-fibers, the PCL was electrospun into the shell and both bovine serum albumin (BSA) and tetrapeptide val-gal-pro-gly (VAPG) were encapsulated into the core. The core-shell structure in the outer layer fibers was observed by transmission electron microscope (TEM). The in vitro release tests exhibited the sustainable release behavior of BSA and VAPG so that they provided a better cell growth environment in the interior of tubular scaffold wall. The in vitro culture of smooth muscle cells (SMCs) demonstrated their potential to penetrate into the scaffold wall for the 3D cell culture. Subsequently, 3D cell coculture was conducted. First, SMCs were seeded on the luminal surface of the scaffold and cultured for 5 days, and then endothelial cells (ECs) were also seeded on the luminal surface and cocultured with SMCs for another 2 days. After stained with antibodies, 3D cell distribution on the scaffold was revealed by confocal laser scanning microscopy (CLSM) where ECs were mainly located on the luminal surface whereas SMCs penetrated into the surface and distributed inside the scaffold wall. This double layer tubular scaffold with 3D cell distribution showed the promise to develop it into a novel TEVG for clinical trials in the near future.

Prospective Randomized Study of Sarpogrelate Versus Clopidogrel-based Dual Antiplatelet Therapies in Patients Undergoing Femoropopliteal Arterial Endovascular Interventions: Preliminary Results.

BACKGROUND: Sarpogrelate is a selective 5-hydroxytryptamine (5-HT) receptor subtype 2A antagonist which blocks 5-HT induced platelet aggregation and proliferation of vascular smooth muscle cells. We compared the efficacy of sarpogrelate-based dual antiplatelet therapies for the prevention of restenosis and target lesion revascularization (TLR) rates comparing with that of clopidogrel after percutaneous endovascular interventions (EVIs) of femoropopliteal (FP) arterial lesions. METHODS: This prospective, multicenter, randomized clinical trial recruited a total of 120 patients with successful EVI of FP lesions at seven centers across China between January 2011 and June 2012. Patients were randomized to receive either sarpogrelate (100 mg trice daily for 6 months, n = 63) or clopidogrel (75 mg once daily for 6 months, n = 57). All patients also received oral aspirin (100 mg once daily for 12 months). Clinical follow-up was conducted up to 12 months postprocedure. RESULTS: There was no significant difference between the two groups in basic demographic data. The restenosis rate was higher in the clopidogrel group (22.80%) than in sarpogrelate group (17.50%), but there was no significant difference between these two groups (P = 0.465). The TLR rate, ipsilateral amputation rate, mortality in all-cause and bleeding rate were also similar in the two groups (P > 0.05). CONCLUSIONS: Aspirin plus sarpogrelate is a comparable antithrombotic regimen to aspirin plus clopidogrel after EVI of FP arterial lesions. Dual antiplatelet therapies might play an important role in preventing restenosis after successful EVI of FP lesions.

Experimental study on the construction of small three-dimensional tissue engineered grafts of electrospun poly-ε-caprolactone.

Studies on three-dimensional tissue engineered graft (3DTEG) have attracted great interest among researchers as they present a means to meet the pressing clinical demand for tissue engineering scaffolds. To explore the feasibility of 3DTEG, high porosity poly-ε-caprolactone (PCL) was obtained via the co-electrospinning of polyethylene glycol and PCL, and used to construct small-diameter poly-ε-caprolactone-lysine (PCL-LYS-H) scaffolds, whereby heparin was anchored to the scaffold surface by lysine groups. A variety of small-diameter 3DTEG models were constructed with different PCL layers and the mechanical properties of the resulting constructs were evaluated in order to select the best model for 3DTEGs. Bone marrow mononuclear cells were induced and differentiated to endothelial cells (ECs) and smooth muscle cells (SMCs). A 3DTEG (labeled '10-4%') was successfully produced by the dynamic co-culture of ECs on the PCL-LYS-H scaffolds and SMCs on PCL. The fluorescently labeled cells on the 3DTEG were subsequently observed by laser confocal microscopy, which showed that the ECs and SMCs were embedded in the 3DTEG. Nitric oxide and endothelial nitric oxide synthase assays showed that the ECs behaved normally in the 3DTEG. This study consequently provides a new thread to produce small-diameter tissue engineered grafts, with excellent mechanical properties, that are perfusable to vasculature and functional cells.

Meso-cavo-jugular shunt for complicated portal hypertension: a case report with 8 years of follow-up.

BACKGROUND: The treatment of portal hypertension caused by an occlusive lesion in the retrohepatic inferior vena cava and terminal portal venules is complicated because both portal and system venous flow are compromised. METHODS: A 47-year-old woman presented with this issue, and we reasoned that the only way to achieve successful management was to create a meso-cavo-jugular shunt. This patient was referred to us after undergoing a splenectomy for hypersplenism, which made her ascites intractable. She had a retrohepatic vena caval stenosis and noncirrhotic portal hypertension. Percutaneous transluminal angioplasty of the inferior vena cava stenosis failed. She underwent substernal placement of a 14-mm ringed GoreTex graft (WL Gore and Associates, Flagstaff, AZ) with end-to-side connections to the superior mesenteric vein, internal jugular vein, and vena cava. RESULT: Her ascites resolved, and at follow-up 8 years later her graft was patent. CONCLUSION: The meso-cavo-jugular shunt can simultaneously decompress both portal and systemic venous systems and is worth considering in the rare circumstance of suprahepatic vena caval obstruction coupled with occlusion of the portal venules.

Totally laparoscopic bypass surgery for aortoiliac occlusive disease in China.

BACKGROUND: Totally laparoscopic aortic surgery is still in its infancy in China. One of the factors preventing adoption of this technique is its steep learning curve. The objective of this study was to evaluate the feasibility and safety of laparoscopic surgery for aortoiliac occlusive disease (AIOD). METHODS: From November 2008 to November 2012, 12 patients were treated for severe AIOD with a totally laparoscopic bypass surgery at our university hospital. The demographic data, operative data, postoperative recovery data, morbidity and mortality were analyzed and compared with those of conventional open approach. RESULTS: Twelve totally laparoscopic aortic surgery procedures, including two iliofemoral bypasses (IFB), three unilateral aortofemoral bypasses (UAFB), and seven aortobifemoral bypasses (ABFB), were performed. Conversion to open procedures was required in three patients. The mean operation time was 518 (range, 325-840) minutes, mean blood loss was 962 (range, 400-2500) ml, and mean aortic anastomosis time was 75 (range, 40-150) minutes. Compared with conventional open approach for aortofemoral bypasses performed concomitantly during this period, laparoscopic patients required fewer narcotics and a shorter in-hospital stay and earlier recovery. Postoperative complications developed in four patients, including a single patient with transient left hydronephrosis, ischemic colonic fistula and pneumonia, residual aortic stenosis proximal to the anastomotic site, and asymptomatic partial left renal infarction. All patients recovered and were discharged on postoperative Days 7-14 except one patient that died of respiratory failure on Day 46. All grafts were patent with follow-up imaging performed by Duplex examination, with a mean follow-up time of 10.7 (range, 2-61) months. CONCLUSION: Totally laparoscopic bypass surgery is a feasible and safe procedure for AIOD, but attention needs to be paid to improve laparoscopic skills of vascular surgery in order to minimize morbidity during the learning curve of this advanced procedure.

Histological and mechanical properties of autologous living tissue biotubes.

The aim of this study was to explore and evaluate biotubes consisting of autologous tissues. The biotubes were prepared by intra-abdominally embedding silicon rods as moulds. The specimens were analyzed by mechanical tests, histological observation and superficial study. The intra-abdominal implantation of the silicone tubes readily stimulated the development of the biotubes. The biotubes consisted of collagen-rich extracellular matrices. Myofibroblasts appeared as elongated cells with circumferential or longitudinal orientations. Subsequent to one month of embedding, the thickness of the tube wall was 70-250 µm. The burst strength was 1100±187 mmHg and the suturability was excellent. Biotubes that have the ability to be widely variable in their shapes are composed of autologous cells and glomerular extracellular matrices. Biotubes are ideal grafts for tissue engineering as they are able to avoid immunological rejection and are of sufficient mechanical strength.

[Outcome comparison of open versus endovascular techniques in the treatment of abdominal aortic aneurysms].

OBJECTIVE: To compare the efficacy, cost and safety of endovascular aortic repair (EVAR) versus open surgery in the treatment of infrarenal abdominal aortic aneurysms. METHODS: Retrospective analyses were conducted for the clinical data and follow-up information of 218 cases from January 2002 to December 2011 at our hospital. Open surgery group included 86 patients with an mean age of 65.5 years and a mean aneurysm diameter of 5.4 cm. In EVAR group, there were 132 cases with an average age of 76.8 years and a mean aneurysm diameter of 5.6 cm. RESULTS: Among 86 open cases, there were inverted "Y" type artificial graft (n = 83) and straight artificial graft (n = 3). The surgical success rate was 98.8%, perioperative period mortality rate was 2.3%, a mean volume of blood loss 450 ml and a mean transfusion volume 320 ml. The mean operative duration was 230 min, a mean hospitalization time (30 ± 3) days and a mean hospitalization cost RMB yuan 58 000. In EVAR group, the surgical success rate was 100% and perioperative period mortality rate 0.8%. Separating stent graft (n = 121, 91.7%), straight stent graft (n = 4, 3%) and one-stent-graft (n = 7, 5.3%). The mean operative duration was 150 min, a mean volume of blood loss 140 ml, a mean hospitalization time 15.5 days and a mean hospitalization cost RMB yuan 104 800. The operative duration, volume of blood loss and length of hospital stay of EVAR group were superior to those of open surgery group (P < 0.05). But the cost of group EVAR was significantly higher than that of group open surgery (P < 0.05). In group open surgery, 80 cases (94.1%) received a mean follow-up period of 46 months. And 79 artificial grafts maintained patency (98.8%) and 8 cases died (10%). There were 125 cases in group EVAR (94.7%) with a mean time of 32.5 months; stent graft patency in 120 cases (96%), 10 death; 8 complication cases (5.6%) involved stent migration (n = 2) and iliac artery branch occlusion (n = 6). Long-term effects had no significant difference between two groups (P > 0.05). In terms of the incidence of complications, group EVAR was significantly more than group open surgery (P < 0.05). CONCLUSION: In terms of operative duration, volume of blood loss and length of hospital stay, EVAR and open surgery treatment for infrarenal abdominal aortic aneurysms group EVAR is significantly better than group open surgery. As far hospitalization cost, group EVAR is significantly higher than group open surgery. But, in terms of incidence of long-term complications, group EVAR is significantly higher than group open surgery while the latter often requires further interventions.

Surgical treatment of carotid body tumor: case report and literature review.

Carotid body tumors (CBT) are rare chemical receptor tumors. We report nine cases of CBT who were diagnosed at our center during 2004 to 2008 with a literature review. Of these nine patients, eight underwent complete resection, one received palliative resection due to the malignant nature of the tumor, and the other one refused surgery. No perioperative mortality and stroke occurred. During a mean follow up of 2.2 years, no deaths related to CBT occurred. Surgical treatment for CBT is relatively safe. The surgeon should be careful to maintain the integrity of carotid artery, and prevent cerebral ischemia and cranial nerve injuries in order to improve outcome.