[Endovascular treatment for Stanford type B aortic dissection in Marfan syndrome patients: a series of 23 cases].

Objective: To evaluate the clinical outcomes of thoracic endovascular aortic repair (TEVAR) in the treatment of Stanford type B aortic dissection (TBAD) in Marfan syndrome patients who had no history of aortic arch replacement. Methods: This is a retrospective case-series study. From January 2009 to December 2019,the clinical data of Marfan syndrome patients who underwent TEVAR for TBAD at the Department of Vascular Surgery were collected. A total of 23 patients were enrolled,including 15 males and 8 females. The age was (38.0±11.0) years (range:24 to 56 years). Among them,12 patients had history of ascending aortic surgery. Details of TEVAR,perioperative complications and reintervention were recorded and survival rate was analyzed by Kaplan-Meier curve. Results: Technical success was 91.3% (21/23). Two patients with technical failure were as follows:one patient had type Ⅰa endoleak at the completion angiography,which healed spontaneously during the follow-up,and the other patient suffered aortic intimal intussusception after the deployment of the first stent-graft, and the second stent-graft was deployed. However, type Ⅲ endoleak was detected,which disappeared during the follow-up. One patient died during hospitalization. The median follow-up time (M(IQR)) was 60 (48) months (range:12 to 132 months). Reintervention was performed on 7 patients,including 3 distal stent-graft-induced new entry,2 distal aortic dilation,1 Ⅰa endoleak and 1 retrograde type A aortic dissection,respectively. Five-year cumulative survival rate was 86.7% (95%CI:86.6% to 86.8%) and the 5-year freedom from reintervention rate was 81.8% (95%CI:61.8% to 92.8%). Conclusions: TEVAR is feasible in the treatment of TBAD in Marfan syndrome patients who has no history of aortic arch replacement. It has high technical success rate and low perioperative complication.

[Surgical strategies and efficacy analysis for aortic dissection complicating intractable mesenteric artery ischemia].

Objective: To explore the surgical strategies and clinical efficacy for aortic dissection combined with refractory superior mesenteric artery (SMA) ischemia. Methods: This is a retrospective case series study. Clinical data of 24 patients with aortic dissection and refractory SMA ischemia admitted to the Department of Vascular Surgery, Zhongshan Hospital, Fudan University from August 2010 to August 2020 were retrospectively collected. Of the 24 patients, 21 were males and 3 were females, with an age of (50.3±9.9) years (range: 44 to 72 years).Among them, 9 cases were Stanford type A aortic dissection, and 15 cases were type B. All patients underwent CT angiography upon admission, and based on imaging characteristics, they were classified into three types. Type Ⅰ: severe stenosis/occlusion of the SMA true lumen only; Type Ⅱ: stenosis of the true lumens in the descending aorta and SMA (isolated type); Type Ⅲ: stenosis of the true lumens in the thoracoabdominal aorta and SMA (continuation type). Surgical procedures, complications, mortality, and reintervention rates were recorded. Results: Among the 24 patients, 17 (70.8%) were classified as Type Ⅰ, 4 (16.7%) as Type Ⅱ, and 3 (12.5%) as Type Ⅲ. Fourteen cases of Type Ⅰ underwent thoracic endovascular aortic repair combined with SMA stent implantation. Additionally, 3 Type Ⅰ and 1 Type Ⅱ patients underwent only SMA reconstruction (with one case of chronic TAAD treated with iliac artery-SMA bypass surgery). Moreover, 3 Type Ⅱ and 3 Type Ⅲ patients underwent descending aorta combined with SMA stent implantation. There were 5 patients (20.8%) who underwent small bowel resection, either in the same sitting or in a staged procedure. During hospitalization, 4 patients died, resulting in a mortality rate of 16.7%. Among these cases, two patients succumbed to severe intestinal ischemia resulting in multiple organ dysfunction syndrome. The follow-up duration was (46±9) months (range: 13 to 72 months). During the follow-up, 2 patients died, unrelated to intestinal ischemia. The 5-year freedom from reintervention survival rate was 86.1%, and the 5-year cumulative survival rate was 82.6%. Conclusions: Patients with aortic dissection and refractory SMA ischemia have a high perioperative mortality. However, implementing appropriate surgical strategies according to different clinical scenarios can reduce mortality and alleviate intestinal ischemia.

[Application and value of intravascular ultrasound for excimer laser ablation combined with drug-coated balloon in the treatment of lower limb arteriosclerotic obliterans].

Objective: To examine the value of intravascular ultrasound (IVUS) for excimer laser ablation (ELA) combined with drug-coated balloon (DCB) in treating lower limb arteriosclerotic obliterans (ASO). Methods: As a prospective case series study, patients who underwent ELA combined with DCB for lower limb ASO with the guidance of IVUS from September 2021 to March 2022 at Department of Vascular Surgery, Zhongshan Hospital, Fudan University were enrolled prospectively. Lesion characteristics, procedure-related outcomes and complications were collected. The therapy outcomes were compared with baseline data by paired t test. Results: There were 8 males and 2 females, aged (72.0±5.9) years (range: 61 to 81 years). Of all the 11 lesions, there were 8 lesions in superficial femoral artery and 3 in popliteal artery. The lesion length was (7.0±2.4) cm (range: 3.2 to 9.8 cm). There were 4 chronic totally occlusion and 7 severe stenosis. All patients underwent the operation successfully. The technical success rate was 10/11. Bailout stenting was performed in one lesion because of flow-limiting dissection. Four lesions were grade 3 to 4 in peripheral artery calcium score system, and 9 lesions with calcification arc≥180°. Larger diameter drug-coated balloons were selected in 5 lesions after measurement of intravascular ultrasound. The follow-up time was (6.0±1.9) months (range: 3 to 9 months). The ankle-brachial index of the patient was significantly improved immediately after surgery (0.97±0.13 vs. 0.48±0.18, t=-7.60, P<0.01) and at 3 months after surgery (0.95±0.12 vs. 0.48±0.18, t=-7.17, P<0.01). The 3-month primary patency rate was 11/11, the target lesion reintervention was 0 and ulcer healing rate was 3/4. Conclusion: IVUS assisted ELA in the treatment of lower limb artery lesions is safe and effective in early stage.

[Application value of excimer laser ablation combined with drug-coated balloon in non-stent atherosclerotic lesions of lower extremity arteries].

Objective: To examine the effect of excimer laser ablation (ELA) combining with drug-coated balloon (DCB) for atherosclerotic lesions in no-stenting zones (NSZ) of the lower extremity. Methods: From June 2019 to December 2021, 46 patients who underwent ELA combining with DCB in lesions of NSZ at Zhongshan Hospital, Fudan University and Jinshan Hospital, Fudan University were retrospectively enrolled, including 29 males and 17 females. The age was (72.5±11.7) years (range: 42 to 93 years). Among them, 44 lesions (95.7%, 44/46) were in popliteal artery and 2 lesions (4.3%, 2/46) were in common femoral artery. Chronic total occlusion (CTO) was observed in 31 patients (76.4%, 31/46), and stenotic lesions were observed in 15 patients (32.6%, 15/46). The length of lesions was (7.3±2.7) cm (range: 3.0 to 13.2 cm). Patients were followed at 6, 12 months after surgery and every year thereafter, and they underwent Doppler and CT angiography examination at each follow-up point. The primary endpoint was primary patency. The secondary endpoints included major amputation-free survival (MAFS) rate, technical success, bailout stent, ankle-brachial index (ABI), target lesion reintervention (TLR). Student t test was applied to compare the difference between ABI of 6 or 12 months after surgery and the baseline. Primary patency, freedom from TLR, and MAFS rate were calculated by Kaplan-Meier method. Results: The technical success rate was 91.3% (42/46). The rate of procedure-related complication was 6.5% (3/46), and all the complications were distal embolization. The rate of flow-limiting dissection was 8.7% (4/46). ABI was significantly increased at 6 and 12 months compared to preoperatively (0.90±0.10 vs. 0.42±0.10, t=-4.48, P<0.01; 0.87±0.12 vs. 0.42±0.10, t=-5.21, P<0.01). The follow-up time[M(IQR)] was 22.5 (8.8) months (range: 6 to 32 months). TLR was performed in 4 patients (4/46, 8.7%). The 2-year primary patency was 86.2% (95%CI: 71.8% to 93.5%). The 2-year freedom from TLR and MAFS rate were 90.7% (95%CI: 77.0% to 96.4%) and 97.8% (95%CI: 85.6% to 99.7%), respectively. Conclusion: ELA combining with DCB can be applied to treat atherosclerotic lesions in NSZ.

[Early outcomes of excimer laser atherectomy for below-the-knee lesions in patients with diabetic foot].

Objective: To evaluate the clinical outcomes of excimer laser atherectomy (ELA) in the treatment of diabetic foot with below-the-knee(BTK) lesions. Methods: The clinical data of 11 patients with diabetic foot with BTK lesions who underwent ELA at Department of Vascular Surgery,Zhongshan Hospital of Fudan University and Department of Vascular and Wound Treatment Center,Jinshan Hospital of Fudan University from September 2019 to May 2021 were retrospectively analyzed.There were 10 males and 1 female,aged 70.5 years(range:41 to 83 years).There were 20 lesions in 12 limbs,including 19 chronic total occlusion.All of the limbs were classified as Rutherford class 5 and suffered ulceration.The surgical efficacy,complications and ankle brachial index(ABI) after operation were record. Results: All patients underwent the operation successfully,the technical success rate was 12/12.No distal embolization,flow-limiting dissection,perforation or bailout stenting was occurred.The follow-up period was 8.2 months(range:3 to 13 months).The ABI increased from 0.58(range:0.24 to 1.57) before operation to 0.88(range:0.68 to 1.05) after operation.At 3 months after the operation,1 limb (1/12) underwent endovascular operation again due to restenosis,ulcers were healed in 5 limbs(5/12),and no amputation (limb/toe),death or loss of follow-up patients.Six months after the operation,2 patients were lost to follow-up and 2 died,ulcers were healed in 6 limbs(6/8),1 limb (1/8) underwent toe amputation due to prolonged healing of ulcers of toe. Conclusion: ELA is feasible and effective in the treatment of DF with BTK lesions,providing a new option of debulking atherectomy in such a group of patients.

[Debulking strategy of endovascular treatment for lower extremity artery lesions].

Objective: To explore the debulking strategy of lower extremity artery lesions. Methods: Retrospectively analyzed the clinical data of 101 patients underwent debulking therapy at Department of Vascular Surgery,Zhongshan Hospital,Fudan University from June 2019 to June 2020.There were 74 males and 27 females,aged (73.2±11.7)years (range:35 to 93 years).There were 31 cases in Rutherford class 3,39 cases in class 4 and 31 cases in class 5. Hypertension occurred in 72 patients. One hundred and forty lesions were treated in 101 patients. Among them, there were 13 lesions(9.3%) in iliac artery,72 lesions(51.4%) in superficial femoral artery,41 (29.3%) lesions in popliteal artery,10 lesions(7.1%) in tibiofibular trunk,and 4 lesions(2.9%) in below the knee artery.Percutaneous mechanical thrombectomy (PMT) was mainly used in acute thrombosis,excimer laser ablation (ELA) was mainly used for chronic in-stent restenosis and chronic stenosis or totally occlusive lesions,while directional atherectomy (DA) was mainly used for short calcified lesions. Results: All of the patients underwent debulking therapy. Eighty-two lesions(58.6%,82/140) were treated by PMT, 56 (40.0%,56/140) were treated by ELA,and 2 (1.4%,2/140) were treated by DA.The ankle-brachial index of the patient was 0.44±0.19 before surgery, 0.87±0.17 immediately after surgery (t=-16.26, P<0.01), and 0.81±0.20 at 6 months after surgery(t=-14.67,P<0.01),and 0.79±0.15 (t=-14.12,P<0.01) at 12 months after surgery. At 12 months,the primary patency was 86.1% (87/101),mortality was 5.0% (5/101), freedom from major-amputation survival rate was 93.1% (94/101),and target lesion reintervention rate was 9.9% (10/101). Conclusions: Debulking is feasible and effective to eliminate the arterial contents and maximize the acquisition of lumen.Selection of suitable debulking methods for different segments and lesions would be helpful to improve the technical success and obtain satisfactory results.

[Application and value of excimer laser ablation in the treatment of lower limb atherosclerotic obliterans].

Objective: To evaluate the results of excimer laser ablation (ELA) in the treatment of lower limb atherosclerotic obliterans (ASO). Methods: From June 2019 to March 2020, patients who underwent ELA combined with drug-coated balloon (DCB) for lower limb atherosclerotic obliterans (ASO) were enrolled. Demographics, lesion characteristics, procedure-related outcomes and complications were collected and analyzed. Results: Thirty patients were enrolled, including 21 males and 9 females. The mean age was (76.5±10.5) years. The mean lesion length was (11.7±6.4) cm. A total of 41 lesions, including in-stent restenosis (ISR) in 12 (29.3%), chronic totally occlusion (CTO) at initial treatment in 24 (58.5%), and severe stenosis in 5 (12.2%) patients. Sixteen (51.6%) patients were classified as Peripheral Arterial Calcium Scoring System (PACSS) category 4. The technical success rate was 93.5%. Incidence of distal embolization and bailout stenting was 12.9% and 6.5%, respectively. The mean follow-up time was (6.6±3.0) months. Ankle-brachial index (ABI) was significantly increased from 0.43(0.32,0.55) preoperatively to 0.91(0.87,1.01) postoperatively (Z=-5.43, P<0.01) and 0.82(0.73,1.02) (Z=-3.99, P<0.01) three months after surgery. The 3-month major-amputation free survival rate was 96.7%, primary patency rate was 100%, the target lesion reintervention (TLR) rate was 0 and ulcer healing rate was 76.9%. Conclusion: Debulking of ELA is feasible and effective for both ISR and CTO at initial treatment, providing a new option for DCB preparation and reducing stent implantation.

CircPSMC3 inhibits cell proliferation and induces cell apoptosis in nasopharyngeal carcinoma by downregulating ROCK1.

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "CircPSMC3 inhibits cell proliferation and induces cell apoptosis in nasopharyngeal carcinoma by downregulating ROCK1, by D.-Q. Guo, F. Liu, L. Zhang, N.-N. Bian, L.-Y. Liu, L.-X. Kong, Z.-G. Wang, published in Eur Rev Med Pharmacol Sci 2020; 24 (3): 1219-1225-DOI: 10.26355/eurrev_202002_20174-PMID: 32096151" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/20174.

CircPSMC3 inhibits cell proliferation and induces cell apoptosis in nasopharyngeal carcinoma by downregulating ROCK1.

OBJECTIVE: Currently, the importance of circular RNAs in malignant tumors has attracted much attention. However, the role of circPSMC3 in nasopharyngeal carcinoma (NPC) remains unclear. The aim of this study was to investigate the function of circPSMC3 in the proliferation and apoptosis of NPC and to explore its possible underlying mechanism. PATIENTS AND METHODS: Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) was utilized to determine the level of circPSMC3 in NPC tissues and cell lines. The association between circPSMC3 expression and patients' prognosis was analyzed. CircPSMC3 lentivirus was constructed and transfected into NPC cells. Cell growth ability and apoptosis were detected through Cell Counting Kit-8 (CCK-8) assay, colony formation assay, and flow cytometry, respectively. Western blot was performed to analyze the target protein of circPSMC3. Furthermore, the function of circPSMC3 was explored in nude mice. RESULTS: CircPSMC3 was lowly expressed in NPC tissues compared with adjacent normal tissues. Low circPSMC3 expression was associated with poor prognosis of NPC patients. Meanwhile, the expression of circPSMC3 was significantly down-regulated in NPC cell lines as well. The growth ability of NPC cells was markedly inhibited after circPSMC3 was overexpressed. Overexpression of circPSMC3 significantly promoted the apoptosis of NPC cells in vitro. ROCK1 expression decreased markedly via overexpression of circPSMC3. Furthermore, tumor formation was inhibited after the up-regulation of circPSMC3 in vivo. CONCLUSIONS: CircPSMC3 could suppress cell growth and promote cell apoptosis in NPC by downregulating ROCK1.

MiR-126 promotes endothelial cell apoptosis by targeting PI3K/Akt in rats with lower limb arteriosclerosis obliterans.

OBJECTIVE: To investigate the influence of micro ribonucleic acid (miR)-126 on the rats with lower limb arteriosclerosis obliterans (ASO). MATERIALS AND METHODS: Male Sprague- Dawley rats aged 3 months old were randomly divided into Sham operation group (Control group, n=10) and Model group (n=10), and the model of lower limb ASO was established. After modeling, the expression of miR-126 in arteries was detected using quantitative Real Time-Polymerase Chain Reaction (qRT-PCR), and the change in the downstream signaling pathway was examined via Western blotting. The human umbilical vein endothelial cells (HUVECs) were induced by oxidized low-density lipoprotein (Ox-LDL) to establish the model of endothelial injury, followed by detection of miR-126 expression. Then, the Luciferase assay was performed to verify the downstream target gene of miR-126. After being cultured, HUVECs were set as Control group, Ox-LDL induction group, and Ox-LDL + miR-126 inhibitor group, and the expressions of phosphorylated-protein kinase B (p-Akt) and cleaved cysteine-aspartic protease-3 (Caspase-3) were detected in the above groups. RESULTS: After the establishment of the model, the expression level of miR-126 was raised in vessels, but the phosphatidylinositol 3-hydroxy kinase (PI3K)/Akt signals were weakened (p<0.01). Ox-LDL-induced endothelial cell apoptosis promoted the expression of miR-126, and the difference was statistically significant. The bioinformatics analysis results showed that PI3KR2 was a direct target of miR-126, which was also proven via the Luciferase assay. Moreover, the transfection with miR-126 inhibitor into endothelial cells suppressed Ox-LDL-induced cell apoptosis, thereby persistently activating the PI3K/Akt signaling pathway (p<0.01). CONCLUSIONS: In rats with lower limb arteriosclerosis obliterans (ASO), miR-126 represses the PI3K/Akt signaling pathway to accelerate endothelial cell apoptosis.

Diagnostic and prognostic implications of serum miR-101 in osteosarcoma.

Blood-circulating microRNAs (miRNAs) have been reported to be used as potential biomarkers in various cancers. MiR-101 has been found to act as a tumor suppressor in many tumor types, but little is known for osteosarcoma. The purpose of this study was to investigate miR-101 expression in osteosarcoma patients and assess its correlation with clinical features and prognosis. Serum samples from 152 osteosarcoma patients and 70 healthy controls were detected using quantitative reverse-transcription polymerase chain reaction (qRT-PCR). The data showed that miR-101 expression levels were remarkably underexpressed in serum samples from osteosarcoma patients compared to controls, and the post-treatment serum miR-101 expression was significantly higher than that in the pre-treatment expression. Low serum miR-101 expression was positively associated with advanced clinical stage and distant metastasis. Receiver operating characteristic (ROC) curve analysis showed that serum miR-101 could serve as a useful marker for osteosarcoma diagnosis, with a high sensitivity and specificity. Moreover, patients with high miR-101 expression had longer overall survival and recurrence free survival than those with low miR-101 expression. In addition, both univariate and multivariate analyses showed that serum miR-101 downregulation was associated with shorter overall survival and recurrence free survival. Our present results implicated serum miR-101 might be a useful biomarker for the clinical diagnosis and prognosis of osteosarcoma.

[Endovascular aortic repair of abdominal aortic aneurysm of short neck with Endurant stent graft].

Objective: To evaluate the safety and effectiveness of the Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length <10 mm. Methods: This study was a retrospective analysis. From January 2010 to May 2015, 22 consecutive abdominal aortic aneurysm patients with proximal neck length <10 mm were treated with endovascular aortic repair by Endurant stent graft in Department of Vascular Surgery, Zhongshan Hospital, Fudan University. There were 19 (86.3%) male cases, aging from 57 to 84 years. All patients underwent preoperative CT angiography and the anatomic parameters of abdominal aortic aneurysm were measured. All patients performed standard endovascular aortic repair first and if there was obvious proximal typeⅠ endoleak, the CUFF or the chimney technology were applied to observed the perioperative technical and the clinical success rate. During follow-up, the incidence of adverse events and the reintervention rate were observed. Results: These 22 cases had proximal neck length 5 to 9 mm with the average of (7.2±1.4) mm. Immediate endoleak occurred in 5 patients with 4 cases of proximal typeⅠ endoleak, 3 cases were implanted proximal CUFF, 1 case implanted CUFF and left renal artery chimney. One case died perioperatively, the clinical success rate was 95.4%, the technical success rate was 77.3%. During the follow-up of 6 to 54 months, there was 1 case with delayed proximal type-1 endoleak, during operation the patient had no endoleak, but disappeared 6 months later without further intervention. So the incidence of adverse event was 4.5% and reintervention rate was 0. Conclusion: The Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length < 10 mm is safe and effective.

Tumor necrosis factor employs a protein-tyrosine phosphatase to inhibit activation of KDR and vascular endothelial cell growth factor-induced endothelial cell proliferation.

Vascular endothelial cell growth factor (VEGF) binds to and promotes the activation of one of its receptors, KDR. Once activated, KDR induces the tyrosine phosphorylation of cytoplasmic signaling proteins that are important to endothelial cell proliferation. In human umbilical vein endothelial cells (HUVECs), tumor necrosis factor (TNF) inhibits the phosphorylation and activation of KDR. The ability of TNF to diminish VEGF-stimulated KDR activity was impaired by sodium orthovanadate, suggesting that the inhibitory activity of TNF was mediated by a protein-tyrosine phosphatase. KDR-initiated responses specifically associated with endothelial cell proliferation, mitogen-activated protein kinase activation and DNA synthesis, were also inhibited by TNF, and this was reversed by sodium orthovanadate. Stimulation of HUVECs with TNF induced association of the SHP-1 protein-tyrosine phosphatase with KDR, identifying this phosphatase as a candidate negative regulator of VEGF signal transduction. Heterologous receptor inactivation mediated by a protein-tyrosine phosphatase provides insight into how TNF may inhibit endothelial cell proliferative responses and modulate angiogenesis in pathological settings.

[Relationship between apo-protein in renal disease patients with diagnosis and TCM syndrome differentiation].

UNLABELLED: The relationship between the level of apo-protein in 132 renal disease patients with diagnosis and TCM Syndrome Differentiation was analysed. The serum apo-protein level of 132 patients group and 135 healthy adults group were monitored with radioimmunodiffusion assay. The patients were divided into three groups. Spleen Qi and Kidney Qi Deficiency (SQKQD), both Qi and Yin Deficiency (QYD), and the Liver Yin and Kidney Yin Deficiency (LYKYD) group. All patients were divided into with-Dampness and without-Dampness group according to their clinical symptoms and signs. Comparison was also made between different groups. RESULTS: Renal diseases including nephrotic syndrome, chronic nephritis, chronic renal failure and patients with SQKQD, QYD, LYKYD, the levels of apo-B and apo-B/apo-A-I were higher than that of normal (P < 0.01) in various degree, while the level of apo-A-I, was not changed or lower than the normal. In TCM Syndrome differentiation, apo-B and apo-B/apo-A-I in the SQKQD group were higher than those in QYD and LYKYD group (P < 0.05). Moreover, these two values in cases with Dampness were much higher than those without Dampness (P < 0.01). Therefore, it is important to treat this secondary abnormality of lipid metabolism for reducing the further deterioration of renal diseases. When primary renal disease was treated, elimination and removal the dampness might reduce the further damage of hyperlipidemia in renal diseases.