BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate ...BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate risk prediction is essential for optimized clinical management.AIM To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.METHODS This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center(2019–2024).Based on European guidelines,patients were categorized into adverse remodeling(aortic growth rate>2.9 mm/year,n=45)and favorable remodeling groups(n=95).Comprehensive variables(clinical/imaging/surgical)were analyzed using multivariable logistic regression to develop a predictive model.Model performance was assessed via receiver operating characteristic-area under the curve(AUC)and Hosmer-Lemeshow tests.RESULTS Multivariable analysis identified several strong independent predictors of negative aortic remodeling.Larger false lumen diameter at the primary entry tear[odds ratio(OR):1.561,95%CI:1.197–2.035;P=0.001]and patency of the false lumen(OR:5.639,95%CI:4.372-8.181;P=0.004)were significant risk factors.False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor,significantly increasing the risk of adverse remodeling(OR:11.751,95%CI:9.841-15.612;P=0.001).Conversely,false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect(OR:0.925,95%CI:0.614–0.831;P=0.015).The prediction model exhibited excellent discrimination(AUC=0.968)and calibration(Hosmer-Lemeshow P=0.824).CONCLUSION This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters.False lumen involvement thoracoabdominal aorta is the strongest predictor(11.751-fold increased risk).The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.展开更多
BACKGROUND Carotid atherosclerosis is a complex disease involving multiple cellular and molecular pathways.Mesenchymal stem cells(MSCs)show therapeutic potential,but their optimal targets and efficacy are still under ...BACKGROUND Carotid atherosclerosis is a complex disease involving multiple cellular and molecular pathways.Mesenchymal stem cells(MSCs)show therapeutic potential,but their optimal targets and efficacy are still under study.MiR-126 enhances endothelial function and promotes angiogenesis by relieving vascular endothelial growth factor signaling suppression,suggesting its potential in vascular rege-neration.However,its role in directing stem cell differentiation toward endo-thelial lineages remains unclear.We hypothesize that miR-126 may influence MSCs’immunomodulatory and vascular reparative functions via the mitogen-activated protein kinases/extracellular signal-regulated kinase(MAPK/ERK)pathway,thereby improving carotid atherosclerosis.This study explores this mechanism to provide novel insights and support the development of miR-126-based therapeutic strategies.AIM To verify if miR-126 inhibits carotid atherosclerosis via the MAPK/ERK pathway.METHODS Rat bone marrow MSCs(product No.CP-R131,Wuhan,China)were verified by flow cytometry.The effects of miR-126 on MSCs’proliferation,migration,apoptosis,and cytokine expression were explored using microRNA mimics and inhibitors.Fluorescence staining quantified CD31+cells to evaluate endothelial differentiation.In vivo differentiation was assessed,and MSCs were transplanted into a rat carotid artery balloon dilatation model.Rats were randomly divided into five groups:Control,negative control mimics,miR-126 mimics,negative control inhibitor,and miR-126 inhibitor.RESULTS In vitro,MSCs treated with miR-126 mimics demonstrated enhanced proliferation,increased migration,and reduced apoptosis.These miR-126 mimics also significantly increased the secretion of vascular endothelial growth factor and basic fibroblast growth factor.Fluorescence and tissue staining indicated a higher proportion of CD31+cells in the miR-126 mimics group.Additionally,the expression of endothelial-related genes(von Willebrand factor,endothelial nitric oxide synthase,and vascular endothelial-cadherin)was upregulated in this group.In vivo,miR-126-transfected MSCs effectively reduced neointimal thickness and promoted endothelial coverage in rats.MiR-126 stimulated MSC proliferation in a dose-dependent manner and reduced p38 and ERK1/2 phosphorylation.Conversely,miR-126 inhibition or blank controls resulted in opposing effects.CONCLUSION MiR-126 exerts significant modulatory effects on the immunoregulatory and vascular reparative functions of MSCs through the MAPK/ERK signaling pathway,promoting their differentiation into endothelial cells and thereby mitigating atherosclerosis.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such a...BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.展开更多
Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is th...Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms(VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the firstline therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.展开更多
Over the past two decades,transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis.Advances in catheter-ba...Over the past two decades,transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis.Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options,have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications,such as peptic ulcerbleeding,malignant disease,hemorrhagic Dieulafoy lesions and iatrogenic or trauma bleeding.Transcatheter interventions include the following:selective embolization of the feeding artery,sandwich coil occlusion of the gastroduodenal artery,blind or empiric embolization of the supposed bleeding vessel based on endoscopic findings and coil pseudoaneurysm or aneurysm embolization by three-dimensional sac packing with preservation of the parent artery.Transcatheter embolization is a fast,safe and effective,minimally invasive alternative to surgery when endoscopic treatment fails to control bleeding from the upper gastrointestinal tract.This article reviews the various transcatheter endovascular techniques and devices that are used in a variety of clinical scenarios for the management of hemorrhagic gastrointestinal emergencies.展开更多
This study aimed to evaluate the feasibility and safety of a novel stent manufactured by metal injection molding(MIM)in clinical practice through animal experiments.Vessel stents were prepared using powder injection m...This study aimed to evaluate the feasibility and safety of a novel stent manufactured by metal injection molding(MIM)in clinical practice through animal experiments.Vessel stents were prepared using powder injection molding technology to considerably improve material utilization.The influence of MIM carbon impurity variation on the mechanical properties and corrosion resistance of 316L stainless steel was studied.In vitro cytotoxicity and animal transplantation tests were also carried out to evaluate the safety of MIM stents.The results showed that the performance of 316L stainless steel was very sensitive to the carbon content.Carbon fluctuations should be precisely controlled during MIM.All MIM stents were successfully implanted into the aortas of the dogs,and the MIM 316L stents had no significant cytotoxicity.The novel intravascular stent manufactured using MIM can maintain a stable form and structure with fast endothelialization of the luminal surface of the stent and ensure long-term patency in an animal model.The novel intravascular stent manufactured using MIM demonstrates favorable structural,physical,and chemical stability,as well as biocompatibility,offering promising application in clinical practice.展开更多
Objective： Type 2 diabetes coexistent with lower extremity artery disease （peripheral arterial disease （PAD）） can be observed in numerous patients. The mechanism compensating for ischemia and contributing to heal...Objective： Type 2 diabetes coexistent with lower extremity artery disease （peripheral arterial disease （PAD）） can be observed in numerous patients. The mechanism compensating for ischemia and contributing to healing is angiogenesis-the process of forming new blood vessels. The purpose of this study was to assess the likely impact of type 2 diabetes on the plasma levels of proangiogenic factor （vascular endothelial growth factor A （VEGF-A）） and angiogenesis inhibitors （soluble VEGF receptors type 1 and type 2 （sVEGFR-1 and sVEGFR-2）） in patients with PAD. Methods： Among 46 patients with PAD under pharmacological therapy （non-invasive）, we identified, based on medical history, a subgroup with coexistent type 2 diabetes （PAD-DM2＋, n=15） and without diabetes （PAD-DM2-, n=31）. The control group consisted of 30 healthy subjects. Plasma levels of VEGF-A, sVEGFR-1, and sVEGFR-2 were measured using the enzyme-linked immunosorbent assay （ELISA） method. Results： The subgroups of PAD-DM2＋ and PAD-DM2- revealed significantly higher concentrations of VEGF-A （P=-0.000007 and P=0.0000001, respectively） and significantly lower sVEGFR-2 levels （P=-0.02 and P=-0.00001, respectively）, when compared with the control group. Patients with PAD and coexistent diabetes tended to have a lower level of VEGF-A and higher levels of sVEGFR-1 and sVEGFR-2 comparable with non-diabetic patients. Conclusions： The coexistence of type 2 diabetes and PAD is demonstrated by a tendency to a lower plasma level of proangiogenic factor （VEGF-A） and higher levels of anglogenesis inhibitors （sVEGFR-1 and sVEGFR-2） at the same time. Regardless of the coexistence of type 2 diabetes, hypoxia appears to be a crucial factor stimulating the processes of angiogenesis in PAD patients comparable with healthy individuals, whereas hyperglycemia may have a negative impact on angiogenesis in lower limbs.展开更多
BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons.Ex vivo or in situ repair combined with renal artery revascularizat...BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons.Ex vivo or in situ repair combined with renal artery revascularization is the classical procedure for these complicated cases,which are not suitable for endovascular repair.The choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous graft.CASE SUMMARY A 39-year-old female patient presented with left lumbar pain for more than 3 mo.Computed tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal branches.This patient met the criteria for surgical repair due to symptoms of threatened rupture.According to the anatomy and location of multiple RAAs,ex vivo revascularization with saphenous vein graft (SVG) was performed.At the 3-year follow-up,computed tomography angiography demonstrated the aneurysmal degeneration of the Yshaped SVG.The patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG aneurysm.CONCLUSION SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft,especially for solitary kidney patients.展开更多
The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells （HVECs） was investigated. HVECs from one case of hemangioma in proliferative phase were cult...The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells （HVECs） was investigated. HVECs from one case of hemangioma in proliferative phase were cultured. Both primary culture and sub-culture were conducted in M199 medium. The HVECs of passage 3 were divided into 4 groups based on the concentrations of anti-KDR antibody. Cell count was performed and inhibitory rate of HVECs was measured before and 9 days after interference. The results showed that the number of HVECs in the anti-KDR anti- body-treated groups was significantly decreased and the inhibitory rate of HVECs by anti-KDR antibody （50, 10 and 2 μg/mL） was 84%, 63% and 39% respectively at 9th day after interference, with the difference being significant. In the control group, the number of HVECs was increased significantly. In was concluded that the anti-KDR antibody could suppress the activity of VEGF through blocking the KDR, indicating the potential clinical applications of anti-KDR antibody in the treatment of hemangioma.展开更多
BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major c...BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major concern in percutaneous techniques.Herein,we present a case of successful control of continuous oozing using a vascular closure device(VCD)and the application of Surgicel(Johnson&Johnson,United States)over the access tract.CASE SUMMARY An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm×75 mm.The patient had a medical history of atrial fibrillation and was receiving rivaroxaban(15 mg/d).Routine pEVAR was performed using the preclose technique with ProGlide(Abbott,Santa Clara,CA,United States).Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site.A sheet of Surgicel was applied to the suture thread using a surgical needle.Surgicel was applied to the surface of the artery along the access tract using a pusher,and hemostasis was immediately attained.CONCLUSION This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.展开更多
Background:Here we analyzed mid-term data of thoracic endovascular aneurysm repair(TEVAR)surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection(STBAD)involvin...Background:Here we analyzed mid-term data of thoracic endovascular aneurysm repair(TEVAR)surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection(STBAD)involving the left subclavian artery(LSA).Methods:Between April 2014 and February 2019,32 patients with STBAD involving a Castor single-branched stent graft were included.We analyzed their outcomes,including technical success rate(TSR),surgical duration(SD),presence of ischemia,perioperative complications,LSA patency,and survival rate(SR),using computed tomography angiography and clinical evaluation during mid-term follow-up.Results:The mean patient age was 54.63±12.37 years(range,36–83 years).The TSR was 96.88%(n=31/32).The mean SD was 87.44±10.89 with a mean contrast volume of 125.31±19.30 mL.No neurological complications or deaths occurred during the study period.The patients had a mean hospital stay of 7.84±3.20 days.At a mean follow-up of 68.78±11.26 months,four non-aortic deaths(12.5%)were observed.The LSA patency rate was 100%(n=28/28).There was only one case of type I endoleak immediately after surgery(3.12%)(type I from LSA).However,none of the patients experienced type II endoleaks,and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry.Finally,all patients exhibited good LSA patency.Conclusion:TEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.展开更多
After organ transplantation,rapid repair of injured vascular endothelial cell(VEC)is a key to prevent graft chronic dysfunction besides control of immunological rejection.Many studies have confirmed that vascular endo...After organ transplantation,rapid repair of injured vascular endothelial cell(VEC)is a key to prevent graft chronic dysfunction besides control of immunological rejection.Many studies have confirmed that vascular endothelial growth factor 165(VEGF165)could accelerate the repair of VEC injury,decrease thrombosis and thrombotic occlusion,and inhibit hyperplasia of the intima.This study was designed to construct eukaryotic expression plasmid pBudCE4.1/VEGF165,and observe its effect on the prolife ration of VEC.METHODS:The VEGF165 gene cloned from human heart tissue by RT-PCR was cloned into eukaryotic expression plasmid pBudCE4.1.The recombinant expression plasmid pBudCE4.1/VEGF165 was identified by restriction enzyme(Hind III and BamH I)digestion analysis,and was sequenced.The pBudCE4.1/VEGF165 was introduced into VEC through lipofection transfection.The VEGF165 mRNA expression by Northern blot and VEGF165 protein expression was detected by immunocytochemical staining.The effect of expression protein on VEC proliferation was detected by flow cytometry.RESULTS:The RT-PCR product of the VEGF165 gene was about 576bp.Sequencing analysis revealed that the sequence of the amplified VEGF165 gene was identical with that in GenBank.Restrictive enzyme digestion analysis showed that recombinant expression plasmid pBudCE4.1/tVEGF165 had been constructed successfully.The expression of VEGF165 at mRNA and protein levels in the transformed VSMCs had been demonstrated by Northern blot and immunocytochemical staining respectively.The expressed product of VEGF165 could notably accelerate the proliferation of VECs.CONCLUSIONS:pBudCE4.1/VEGF165 is successfully cons-tructed and is expressed in VECs.Expressed VEGF165 can accelerate the VEC proliferation.The present study has laid a foundation for potential use of VEGF165 gene transfection to prevent and treat vascular stenosis in the transplanted organ.展开更多
Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily.Vascular injuries as par...Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily.Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage,duration of limb ischemia,patient’s medical status and presence of associated injuries.The management of these injuries is challenging and requires a specific algorithm of action,because they are usually characterized by increased morbidity,amputation rate,infection,neurological and functional deficits,and they could be life threatening.Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma,the high index of suspicion,imaging control,and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases.Even after a successful initial treatment of a combined trauma pattern,long-term follow-up is crucial to prevent and detect early possible complications.The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities,from an orthopedic point of view.展开更多
BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft ...BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.展开更多
A 57-year-old man has 20-year history of hypertension presented with intermittent chronic pain in the chest area and shoulder blades over the last three months.Computed tomographic angiography(CTA)on admission reveale...A 57-year-old man has 20-year history of hypertension presented with intermittent chronic pain in the chest area and shoulder blades over the last three months.Computed tomographic angiography(CTA)on admission revealed a chronic type B aortic dissection(TBAD)with an aberrant right subclavian artery(ARSA)crossed behind the trachea and bovine aortic arch(Figure IB).展开更多
Objective： To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor（VEGF）, as preparation for genetic transfection that follows. Methods： Rat VEGF was obtained by using RT-PCR...Objective： To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor（VEGF）, as preparation for genetic transfection that follows. Methods： Rat VEGF was obtained by using RT-PCR amplification and then cloned into the shutter plasmid pDC316. Subsequently, this newly constructed plasmid pDC316-VEGF, after identification by nuclease digestion analysis and sequencing analysis, was transfected into human embryonic kidney cells HEK293 by Lipofectamine 2000 mediation, together with adenovirus-packaging plasmid pBHGE3. Based on the homologous recombination of the two plasmids within HEK293 cells, the recombinant adenovirus vector carrying VEGF and VDC316-VEGF was created. VDC316-VEGF was subsequently identified using PCR, purified using repeated plaque passages, proliferated using freezing and melting within HEK293 cells, and titrated using 50% Tissue Culture Infective Dose（TCID50） assay. Results：The newly constructed recombinant adenovirus was confirmed to carry rat VEGF based on PCR results, and its titration value determined based on TCID50 assay was 3 × 10^9 pfu/ml. Conclusion：The recombinant adenovirus carrying rat VEGF was successfully constructed. The newly constructed adenovirus can produce a ufficiently high titration value within HEK293 cells, providing a reliable tool for genetic transfection in further gene therapy researches.展开更多
BACKGROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors a...BACKGROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with PAD.AIM To examine the association between the control of modifiable risk factors,estimated by the novel PAD-medical score,and the incidence of MACE in people with PAD and diabetes.METHODS Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and diabetes.Control of reversible risk factors was assessed by a new composite measure,the PAD-medical score.This score takes into account the control of low-density lipoprotein cholesterol,blood pressure,blood glucose,smoking and prescription of an anti-platelet.Participants were followed to record incidence of myocardial infarction,stroke and cardiovascular death(MACE).The association of PAD-medical score with MACE was assessed using Cox proportional hazard analyses adjusting for age,sex and prior history of ischemic heart disease and stroke.RESULTS Between 2002 and 2020,a total of 424 participants with carotid artery disease(n=63),aortic or peripheral aneurysm(n=121)or lower limb ischemia(n=240)were prospectively recruited,and followed for a median duration(inter-quartile range)of 2.0(0.2–4.4)years.Only 33(7.8%)participants had the optimal PAD-medical score of five,with 318(75%)scoring at least three out of five.There were 89(21.0%)participants that had at least one MACE during the follow-up period.A one-unit higher PAD-medical score was associated with lower risk of MACE(HR=0.79,95%CI:0.63-0.98)after adjusting for other risk factors.CONCLUSION The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.展开更多
The vascular graft with 4 mm diameter was prepared by casting one layer of polyurethane (PU) film onto the knitting tubular fabric as the reinforced support. The effects of different PU content and wall thickness on t...The vascular graft with 4 mm diameter was prepared by casting one layer of polyurethane (PU) film onto the knitting tubular fabric as the reinforced support. The effects of different PU content and wall thickness on the longitudinal mechanical properties of vascular graft were investigated. The breaking elongation, breaking force, initial modulus and breaking work were studied. The results showed that the longitudinal mechanical properties of vascular graft were enhanced as the content of polyurethane increased, which resulted from the combination of PU excellent elasticity and fabric preferable strength.展开更多
Aortic dissection involving a right-sided aortic arch（RAA）is extremely rare with an incidence in adults of 0.04%to 0.1%^（[1]）.Thoracic aortic dissection associated with RAA is even a more uncommon and life-threate...Aortic dissection involving a right-sided aortic arch（RAA）is extremely rare with an incidence in adults of 0.04%to 0.1%^（[1]）.Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening condition.For complicated aortic dissection,conventional open surgical repair is considered a standard therapy^（[2]）.However,展开更多
基金Supported by Zhangjiajie"Xiao He(Young Talent)"Project,No.2024XHRC03Jishou University School-Level Research Project.
文摘BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate risk prediction is essential for optimized clinical management.AIM To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.METHODS This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center(2019–2024).Based on European guidelines,patients were categorized into adverse remodeling(aortic growth rate>2.9 mm/year,n=45)and favorable remodeling groups(n=95).Comprehensive variables(clinical/imaging/surgical)were analyzed using multivariable logistic regression to develop a predictive model.Model performance was assessed via receiver operating characteristic-area under the curve(AUC)and Hosmer-Lemeshow tests.RESULTS Multivariable analysis identified several strong independent predictors of negative aortic remodeling.Larger false lumen diameter at the primary entry tear[odds ratio(OR):1.561,95%CI:1.197–2.035;P=0.001]and patency of the false lumen(OR:5.639,95%CI:4.372-8.181;P=0.004)were significant risk factors.False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor,significantly increasing the risk of adverse remodeling(OR:11.751,95%CI:9.841-15.612;P=0.001).Conversely,false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect(OR:0.925,95%CI:0.614–0.831;P=0.015).The prediction model exhibited excellent discrimination(AUC=0.968)and calibration(Hosmer-Lemeshow P=0.824).CONCLUSION This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters.False lumen involvement thoracoabdominal aorta is the strongest predictor(11.751-fold increased risk).The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.
基金Supported by Hangzhou Bio-Medicine and Health Industry Development Support Science and Technology Project,No.2022WJC005,No.2024WJC105.
文摘BACKGROUND Carotid atherosclerosis is a complex disease involving multiple cellular and molecular pathways.Mesenchymal stem cells(MSCs)show therapeutic potential,but their optimal targets and efficacy are still under study.MiR-126 enhances endothelial function and promotes angiogenesis by relieving vascular endothelial growth factor signaling suppression,suggesting its potential in vascular rege-neration.However,its role in directing stem cell differentiation toward endo-thelial lineages remains unclear.We hypothesize that miR-126 may influence MSCs’immunomodulatory and vascular reparative functions via the mitogen-activated protein kinases/extracellular signal-regulated kinase(MAPK/ERK)pathway,thereby improving carotid atherosclerosis.This study explores this mechanism to provide novel insights and support the development of miR-126-based therapeutic strategies.AIM To verify if miR-126 inhibits carotid atherosclerosis via the MAPK/ERK pathway.METHODS Rat bone marrow MSCs(product No.CP-R131,Wuhan,China)were verified by flow cytometry.The effects of miR-126 on MSCs’proliferation,migration,apoptosis,and cytokine expression were explored using microRNA mimics and inhibitors.Fluorescence staining quantified CD31+cells to evaluate endothelial differentiation.In vivo differentiation was assessed,and MSCs were transplanted into a rat carotid artery balloon dilatation model.Rats were randomly divided into five groups:Control,negative control mimics,miR-126 mimics,negative control inhibitor,and miR-126 inhibitor.RESULTS In vitro,MSCs treated with miR-126 mimics demonstrated enhanced proliferation,increased migration,and reduced apoptosis.These miR-126 mimics also significantly increased the secretion of vascular endothelial growth factor and basic fibroblast growth factor.Fluorescence and tissue staining indicated a higher proportion of CD31+cells in the miR-126 mimics group.Additionally,the expression of endothelial-related genes(von Willebrand factor,endothelial nitric oxide synthase,and vascular endothelial-cadherin)was upregulated in this group.In vivo,miR-126-transfected MSCs effectively reduced neointimal thickness and promoted endothelial coverage in rats.MiR-126 stimulated MSC proliferation in a dose-dependent manner and reduced p38 and ERK1/2 phosphorylation.Conversely,miR-126 inhibition or blank controls resulted in opposing effects.CONCLUSION MiR-126 exerts significant modulatory effects on the immunoregulatory and vascular reparative functions of MSCs through the MAPK/ERK signaling pathway,promoting their differentiation into endothelial cells and thereby mitigating atherosclerosis.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.
文摘Visceral artery aneurysms(VAA) include splanchnic and renal artery aneurysms. They represent a rare clinical entity, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. In addition, increased percutaneous endovascular interventions have raised the incidence of iatrogenic visceral artery pseudoaneurysms(VAPAs). For this reason, elective repair is preferable in the appropriately chosen patient. Controversy still exists regarding their treatment. Over the past decade, there has been steady increase in the utilization of minimally invasive, non-operative interventions, for vascular aneurysmal disease. All VAAs and VAPAs can technically be fixed by endovascular techniques but that does not mean they should. These catheter-based techniques constitute an excellent approach in the elective setting. However, in the emergent setting it may carry a higher morbidity and mortality. The decision for intervention has to take into account the size and the natural history of the lesion, the risk of rupture, which is high during pregnancy, and the relative risk of surgical or radiological intervention. For splanchnic artery aneurysms, we should recognize that we are not, in reality, well informed about their natural history. For most asymptomatic aneurysms, expectant treatment is acceptable. For large, symptomatic or aneurysms with a high risk of rupture, endovascular treatment has become the firstline therapy. Treatment of VAPAs is always mandatory because of the high risk of rupture. We present our point of view on interventional radiology in the splanchnic arteries, focusing on what has been achieved and the remaining challenges.
文摘Over the past two decades,transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis.Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options,have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications,such as peptic ulcerbleeding,malignant disease,hemorrhagic Dieulafoy lesions and iatrogenic or trauma bleeding.Transcatheter interventions include the following:selective embolization of the feeding artery,sandwich coil occlusion of the gastroduodenal artery,blind or empiric embolization of the supposed bleeding vessel based on endoscopic findings and coil pseudoaneurysm or aneurysm embolization by three-dimensional sac packing with preservation of the parent artery.Transcatheter embolization is a fast,safe and effective,minimally invasive alternative to surgery when endoscopic treatment fails to control bleeding from the upper gastrointestinal tract.This article reviews the various transcatheter endovascular techniques and devices that are used in a variety of clinical scenarios for the management of hemorrhagic gastrointestinal emergencies.
基金the Major Project of the Ministry of Science and Technology of Changsha,China(No.kh2003014)the Hunan Provincial Natural Science Foundation,China(Nos.2018JJ2584,2018JJ3507)+1 种基金the Beijing Municipal Science and Technology Comission,China(No.D171100002917004)the Guangxi Science and Technology Plan Project,China(No.AD16380019).
文摘This study aimed to evaluate the feasibility and safety of a novel stent manufactured by metal injection molding(MIM)in clinical practice through animal experiments.Vessel stents were prepared using powder injection molding technology to considerably improve material utilization.The influence of MIM carbon impurity variation on the mechanical properties and corrosion resistance of 316L stainless steel was studied.In vitro cytotoxicity and animal transplantation tests were also carried out to evaluate the safety of MIM stents.The results showed that the performance of 316L stainless steel was very sensitive to the carbon content.Carbon fluctuations should be precisely controlled during MIM.All MIM stents were successfully implanted into the aortas of the dogs,and the MIM 316L stents had no significant cytotoxicity.The novel intravascular stent manufactured using MIM can maintain a stable form and structure with fast endothelialization of the luminal surface of the stent and ensure long-term patency in an animal model.The novel intravascular stent manufactured using MIM demonstrates favorable structural,physical,and chemical stability,as well as biocompatibility,offering promising application in clinical practice.
基金supported by the Nicolaus Copernicus University in Toruń,Ludwik Rydygier Collegium Medicum in Bydgoszcz,Poland(Grant No.2/WF-SD)
文摘Objective： Type 2 diabetes coexistent with lower extremity artery disease （peripheral arterial disease （PAD）） can be observed in numerous patients. The mechanism compensating for ischemia and contributing to healing is angiogenesis-the process of forming new blood vessels. The purpose of this study was to assess the likely impact of type 2 diabetes on the plasma levels of proangiogenic factor （vascular endothelial growth factor A （VEGF-A）） and angiogenesis inhibitors （soluble VEGF receptors type 1 and type 2 （sVEGFR-1 and sVEGFR-2）） in patients with PAD. Methods： Among 46 patients with PAD under pharmacological therapy （non-invasive）, we identified, based on medical history, a subgroup with coexistent type 2 diabetes （PAD-DM2＋, n=15） and without diabetes （PAD-DM2-, n=31）. The control group consisted of 30 healthy subjects. Plasma levels of VEGF-A, sVEGFR-1, and sVEGFR-2 were measured using the enzyme-linked immunosorbent assay （ELISA） method. Results： The subgroups of PAD-DM2＋ and PAD-DM2- revealed significantly higher concentrations of VEGF-A （P=-0.000007 and P=0.0000001, respectively） and significantly lower sVEGFR-2 levels （P=-0.02 and P=-0.00001, respectively）, when compared with the control group. Patients with PAD and coexistent diabetes tended to have a lower level of VEGF-A and higher levels of sVEGFR-1 and sVEGFR-2 comparable with non-diabetic patients. Conclusions： The coexistence of type 2 diabetes and PAD is demonstrated by a tendency to a lower plasma level of proangiogenic factor （VEGF-A） and higher levels of anglogenesis inhibitors （sVEGFR-1 and sVEGFR-2） at the same time. Regardless of the coexistence of type 2 diabetes, hypoxia appears to be a crucial factor stimulating the processes of angiogenesis in PAD patients comparable with healthy individuals, whereas hyperglycemia may have a negative impact on angiogenesis in lower limbs.
文摘BACKGROUND Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons.Ex vivo or in situ repair combined with renal artery revascularization is the classical procedure for these complicated cases,which are not suitable for endovascular repair.The choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous graft.CASE SUMMARY A 39-year-old female patient presented with left lumbar pain for more than 3 mo.Computed tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal branches.This patient met the criteria for surgical repair due to symptoms of threatened rupture.According to the anatomy and location of multiple RAAs,ex vivo revascularization with saphenous vein graft (SVG) was performed.At the 3-year follow-up,computed tomography angiography demonstrated the aneurysmal degeneration of the Yshaped SVG.The patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG aneurysm.CONCLUSION SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft,especially for solitary kidney patients.
文摘The suppressive effect of anti-KDR antibody against VEGF on proliferation of hemangioma-derived vascular endothelial cells （HVECs） was investigated. HVECs from one case of hemangioma in proliferative phase were cultured. Both primary culture and sub-culture were conducted in M199 medium. The HVECs of passage 3 were divided into 4 groups based on the concentrations of anti-KDR antibody. Cell count was performed and inhibitory rate of HVECs was measured before and 9 days after interference. The results showed that the number of HVECs in the anti-KDR anti- body-treated groups was significantly decreased and the inhibitory rate of HVECs by anti-KDR antibody （50, 10 and 2 μg/mL） was 84%, 63% and 39% respectively at 9th day after interference, with the difference being significant. In the control group, the number of HVECs was increased significantly. In was concluded that the anti-KDR antibody could suppress the activity of VEGF through blocking the KDR, indicating the potential clinical applications of anti-KDR antibody in the treatment of hemangioma.
文摘BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major concern in percutaneous techniques.Herein,we present a case of successful control of continuous oozing using a vascular closure device(VCD)and the application of Surgicel(Johnson&Johnson,United States)over the access tract.CASE SUMMARY An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm×75 mm.The patient had a medical history of atrial fibrillation and was receiving rivaroxaban(15 mg/d).Routine pEVAR was performed using the preclose technique with ProGlide(Abbott,Santa Clara,CA,United States).Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site.A sheet of Surgicel was applied to the suture thread using a surgical needle.Surgicel was applied to the surface of the artery along the access tract using a pusher,and hemostasis was immediately attained.CONCLUSION This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.
文摘Background:Here we analyzed mid-term data of thoracic endovascular aneurysm repair(TEVAR)surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection(STBAD)involving the left subclavian artery(LSA).Methods:Between April 2014 and February 2019,32 patients with STBAD involving a Castor single-branched stent graft were included.We analyzed their outcomes,including technical success rate(TSR),surgical duration(SD),presence of ischemia,perioperative complications,LSA patency,and survival rate(SR),using computed tomography angiography and clinical evaluation during mid-term follow-up.Results:The mean patient age was 54.63±12.37 years(range,36–83 years).The TSR was 96.88%(n=31/32).The mean SD was 87.44±10.89 with a mean contrast volume of 125.31±19.30 mL.No neurological complications or deaths occurred during the study period.The patients had a mean hospital stay of 7.84±3.20 days.At a mean follow-up of 68.78±11.26 months,four non-aortic deaths(12.5%)were observed.The LSA patency rate was 100%(n=28/28).There was only one case of type I endoleak immediately after surgery(3.12%)(type I from LSA).However,none of the patients experienced type II endoleaks,and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry.Finally,all patients exhibited good LSA patency.Conclusion:TEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.
文摘After organ transplantation,rapid repair of injured vascular endothelial cell(VEC)is a key to prevent graft chronic dysfunction besides control of immunological rejection.Many studies have confirmed that vascular endothelial growth factor 165(VEGF165)could accelerate the repair of VEC injury,decrease thrombosis and thrombotic occlusion,and inhibit hyperplasia of the intima.This study was designed to construct eukaryotic expression plasmid pBudCE4.1/VEGF165,and observe its effect on the prolife ration of VEC.METHODS:The VEGF165 gene cloned from human heart tissue by RT-PCR was cloned into eukaryotic expression plasmid pBudCE4.1.The recombinant expression plasmid pBudCE4.1/VEGF165 was identified by restriction enzyme(Hind III and BamH I)digestion analysis,and was sequenced.The pBudCE4.1/VEGF165 was introduced into VEC through lipofection transfection.The VEGF165 mRNA expression by Northern blot and VEGF165 protein expression was detected by immunocytochemical staining.The effect of expression protein on VEC proliferation was detected by flow cytometry.RESULTS:The RT-PCR product of the VEGF165 gene was about 576bp.Sequencing analysis revealed that the sequence of the amplified VEGF165 gene was identical with that in GenBank.Restrictive enzyme digestion analysis showed that recombinant expression plasmid pBudCE4.1/tVEGF165 had been constructed successfully.The expression of VEGF165 at mRNA and protein levels in the transformed VSMCs had been demonstrated by Northern blot and immunocytochemical staining respectively.The expressed product of VEGF165 could notably accelerate the proliferation of VECs.CONCLUSIONS:pBudCE4.1/VEGF165 is successfully cons-tructed and is expressed in VECs.Expressed VEGF165 can accelerate the VEC proliferation.The present study has laid a foundation for potential use of VEGF165 gene transfection to prevent and treat vascular stenosis in the transplanted organ.
文摘Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily.Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage,duration of limb ischemia,patient’s medical status and presence of associated injuries.The management of these injuries is challenging and requires a specific algorithm of action,because they are usually characterized by increased morbidity,amputation rate,infection,neurological and functional deficits,and they could be life threatening.Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma,the high index of suspicion,imaging control,and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases.Even after a successful initial treatment of a combined trauma pattern,long-term follow-up is crucial to prevent and detect early possible complications.The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities,from an orthopedic point of view.
基金Supported by National Natural Science Foundation of China,No.81600375
文摘BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.
文摘A 57-year-old man has 20-year history of hypertension presented with intermittent chronic pain in the chest area and shoulder blades over the last three months.Computed tomographic angiography(CTA)on admission revealed a chronic type B aortic dissection(TBAD)with an aberrant right subclavian artery(ARSA)crossed behind the trachea and bovine aortic arch(Figure IB).
基金Natural Science Foundation of Jiangsu Province(BK2005158)
文摘Objective： To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor（VEGF）, as preparation for genetic transfection that follows. Methods： Rat VEGF was obtained by using RT-PCR amplification and then cloned into the shutter plasmid pDC316. Subsequently, this newly constructed plasmid pDC316-VEGF, after identification by nuclease digestion analysis and sequencing analysis, was transfected into human embryonic kidney cells HEK293 by Lipofectamine 2000 mediation, together with adenovirus-packaging plasmid pBHGE3. Based on the homologous recombination of the two plasmids within HEK293 cells, the recombinant adenovirus vector carrying VEGF and VDC316-VEGF was created. VDC316-VEGF was subsequently identified using PCR, purified using repeated plaque passages, proliferated using freezing and melting within HEK293 cells, and titrated using 50% Tissue Culture Infective Dose（TCID50） assay. Results：The newly constructed recombinant adenovirus was confirmed to carry rat VEGF based on PCR results, and its titration value determined based on TCID50 assay was 3 × 10^9 pfu/ml. Conclusion：The recombinant adenovirus carrying rat VEGF was successfully constructed. The newly constructed adenovirus can produce a ufficiently high titration value within HEK293 cells, providing a reliable tool for genetic transfection in further gene therapy researches.
基金The National Health and Medical Research Council,No.1063476 and No.1022752James Cook University and Queensland Government supported this work.JG holds a Practitioner Fellowships from the National Health and Medical Research Council,No.1117061.
文摘BACKGROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with PAD.AIM To examine the association between the control of modifiable risk factors,estimated by the novel PAD-medical score,and the incidence of MACE in people with PAD and diabetes.METHODS Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and diabetes.Control of reversible risk factors was assessed by a new composite measure,the PAD-medical score.This score takes into account the control of low-density lipoprotein cholesterol,blood pressure,blood glucose,smoking and prescription of an anti-platelet.Participants were followed to record incidence of myocardial infarction,stroke and cardiovascular death(MACE).The association of PAD-medical score with MACE was assessed using Cox proportional hazard analyses adjusting for age,sex and prior history of ischemic heart disease and stroke.RESULTS Between 2002 and 2020,a total of 424 participants with carotid artery disease(n=63),aortic or peripheral aneurysm(n=121)or lower limb ischemia(n=240)were prospectively recruited,and followed for a median duration(inter-quartile range)of 2.0(0.2–4.4)years.Only 33(7.8%)participants had the optimal PAD-medical score of five,with 318(75%)scoring at least three out of five.There were 89(21.0%)participants that had at least one MACE during the follow-up period.A one-unit higher PAD-medical score was associated with lower risk of MACE(HR=0.79,95%CI:0.63-0.98)after adjusting for other risk factors.CONCLUSION The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.
基金Supported by Education Depart ment of Hubei Province,China (No. Z200717001)
文摘The vascular graft with 4 mm diameter was prepared by casting one layer of polyurethane (PU) film onto the knitting tubular fabric as the reinforced support. The effects of different PU content and wall thickness on the longitudinal mechanical properties of vascular graft were investigated. The breaking elongation, breaking force, initial modulus and breaking work were studied. The results showed that the longitudinal mechanical properties of vascular graft were enhanced as the content of polyurethane increased, which resulted from the combination of PU excellent elasticity and fabric preferable strength.
文摘Aortic dissection involving a right-sided aortic arch（RAA）is extremely rare with an incidence in adults of 0.04%to 0.1%^（[1]）.Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening condition.For complicated aortic dissection,conventional open surgical repair is considered a standard therapy^（[2]）.However,
