Expression of RAG and secondary gene rearrangement of BCR in mature peripheral B lymphocytes in Takayasu arteritis.

To evaluate the expression of recombinant activating gene (RAG) and B cell receptor (BCR) gene rearrangements in mature peripheral B lymphocytes in Takayasu arteritis (TA) to explore the possible mechanism of humoral immune response in TA. Ten patients with TA and 10 age- and sex-matched healthy volunteers (control group) from Beijing Shijitan Hospital, Capital Medical University and Peking Union Medical College Hospital, between 2022 and 2023, were included in this study. The mRNA of the RAG was measured using real-time quantitative PCR (RT-PCR). Western blotting was used to detect RAG protein expression levels. NGS technology was used to detect BCR gene rearrangement. The mRNA expression level of RAG1 and RAG2 in peripheral mature B lymphocytes in patients with TA was significantly higher than in the control group (RAG1 5.56 ± 1.71 vs. 1.94 ± 0.86, p < 0.05; RAG2 5.26 ± 1.59 vs. 1.65 ± 0.64, p < 0.05), respectively. The protein expression level of the RAG1 and the RAG2 in peripheral mature B lymphocytes in patients with TA was significantly higher than in the healthy control group (RAG1 4.33 ± 1.58 vs. 1.52 ± 0.59, p < 0.001; RAG2 4.67 ± 1.88 vs. 1.59 ± 0.56, p < 0.001). The number of peripheral B lymphocyte BCR clonotypes in the group of patients with TA was significantly higher than in the normal control group (1574 ± 317.7 vs. 801.3 ± 202.1, p < 0.05). The abundance of IGHV clones in patients with TA was higher than in the normal control group (31.185% vs. 13.449%), which was positively correlated with the expression levels of RAG1 and RAG2 (correlation coefficient r = 1.00, p < 0.001), respectively. High expression of the RAG gene coexists with secondary BCR gene rearrangement in mature peripheral B lymphocytes in patients with TA, providing important clues regarding the potential humoral response in TA; however, further studies with larger samples are needed.

The efficacy of stenting in the iliofemoral vein of patients with venous obstruction and secondary lymphedema from malignancy.

OBJECTIVE: To investigate the safety and effectiveness of venous stenting in patients with chronic iliofemoral venous obstruction and secondary lymphedema from malignancy. METHODS: From July 2012 to December 2020, patients with iliofemoral venous obstruction and secondary lymphedema who underwent venous stenting in our institution were reviewed retrospectively. Clinical characteristics, surgical complications, and symptom relief were assessed. Stent patency was evaluated with duplex ultrasound or computed tomographic venography. Twelve-month outcomes were reported. RESULTS: Fifty-three patients with concurrent secondary lymphedema who had stents placed for iliofemoral venous obstruction were included. There were 42 females, and the mean age was 56.9 years. Nonthrombotic iliac vein lesions were identified in 16 patients (30.1%). Immediate technical success was 100%, with an average of two stents implanted. The median Villalta score, and Chronic Venous Disease Quality of Life quality of life questionnaire scores decreased from 12 (IQR, 10-15) and 58 (IQR, 50-66) at baseline, respectively, to 5 (interquartile range [IQR], 4-6) and 28 (IQR, 22-45) at 12 months after the procedure (P < .05), showing significant improvement in the quality of life. At the end of a median follow-up of 12 months (range, 3-25 months), the cumulative primary, assisted primary, and secondary patency rates were 70.8%, 76.9%, and 90.1%, respectively. CONCLUSIONS: In patients with secondary lymphedema from malignancy, venous stent placement is safe and effective for iliofemoral venous obstruction.

Cystic Adventitial Disease of the Popliteal Vein: A Case Report.

Venous cystic adventitial disease (VCAD) is a rare vascular anomaly located in the common femoral vein in most cases. We describe the case of a 59-year-old female patient with right leg edema who was misdiagnosed with deep vein thrombosis of the lower extremity at another hospital. Magnetic resonance angiography revealed a round mass in the popliteal vein, with a narrow lumen. Considering the location of the lesion, absence of a history of deep venous thrombosis and trauma, and clinical manifestations, the diagnosis is likely a popliteal vein adventitial cyst. Segmental popliteal vein resection and reconstruction were performed using a cylindrical great saphenous vein graft. No joint connection was found during the operation, and the postoperative pathology confirmed VCAD.