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Background The aim of this study was to summarize the experience and outcomes of total endovascular repair of aortic arch disease using three-dimensional (3D) printing to guide the application of modified prefenestrated/branched stent grafts. Patients and methods From April 2018 to March 2019, 17 patients with aortic arch disease were treated in our department. Five patients had an aortic arch aneurysm and 12 had undergone an aortic arch dissection. Thirteen men and 4 were women, with an average age of 57.82 ± 10.47 years. Preoperatively, a 3D-printed model of the aorta was made according to computed tomography data. Then, under the guidance of the 3D-printed aortic model, modified prefenestrated/branched stent grafts were prepared, and the diameter of the stent grafts was reduced intraoperatively by a physician for total endovascular repair. Aortic computed tomography angiography was performed 3 and 6 months after the surgery. Results All procedures were completed in one stage with no conversions to sternotomy. Among all 17 patients, the operation was successful in 16. One patient was treated with a chimney graft and a stent graft fenestrated in situ because of distortion of the stent. The success rate of the technique was 94.18%. The average operation time was 4.18 ± 1.57 hr, and no patients died. No neurologic complications, such as cerebral infarction or paraplegia, were observed during the follow-up period. Conclusions Three-Dimensional printing can be used to help guide the treatment of aortic arch disease using modified prefenestrated/branched stent grafts. This minimally invasive total treatment technique is accurate, allows quick recovery, and has a low complication rate. The short-term follow-up data show the safety and reliability of the method; however, further research and development are needed.

Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.

NL003 is a plasmid engineered to simultaneously express two isoforms of hepatocyte growth factor. This phase II study was performed to assess the clinical safety and efficacy of intramuscular injection of NL003 in critical limb ischemia (CLI) patients for 6 months. Two hundred patients (Rutherford scale 4-5) were randomly assigned: placebo (n = 50), low-dose NL003 (n = 50), middle-dose NL003 (n = 50), or high-dose NL003 (n = 50). The drug was administered in the affected limb of 197 patients on days 0, 14, and 28. No significant differences in the incidence of adverse events (AEs) or serious AEs were found among the groups. At 6 months, pain severity was significantly reduced in all NL003 groups, but not in the placebo group (p 0.05). The proportion of patients with complete ulcer healing in the high-dose group was significantly higher than that of the placebo group (p = 0.0095). There were no statistically significant differences in transcutaneous oxygen pressure (TcPO

Purpose: To report a novel internal and external blood bypass method for cerebral protection during in situ triple-fenestrated stent-graft repair in the aortic arch. Technique: A method was devised to combine internal and external blood bypass circuits to preserve cerebral blood flow when all 3 supra-aortic branches are covered by the stent-graft. Long 14-F to 18-F introducers are placed retrogradely into the right and left common carotid arteries (CCAs). Smaller sheaths are placed antegradely into the internal carotid arteries (ICAs) bilaterally and into the right CCA introducer, which has had an aperture cut into it for flow to pass into the smaller sheath. The right CCA introducer is positioned in the ascending aorta to supply the innominate artery; the smaller sheath in the right CCA introducer is positioned at the aperture. The small sheath in the right CCA is connected to the left ICA sheath, and the left CCA fenestration is made and stented. The left ICA sheath is connected to the right ICA sheath, and the right CCA introducer is pulled back to the origin of the innominate artery and the smaller sheath removed. The fenestrations for the innominate and left subclavian arteries are opened sequentially. In 8 patients, complete bypass to maintain brain perfusion was performed for an average 17.6±6.9 minutes; intraoperative transcranial Doppler monitoring during flow bypass showed no notable decline in intracranial blood flow velocity. Two patients suffered stroke; one recovered completely. Conclusion: A cerebral protection strategy that integrates internal and external blood flow bypass techniques to maintain adequate brain blood flow is simple and feasible for in situ triple-fenestration aortic arch stent-graft repairs. However, neurological complications were not avoided with this method; thus, further research and development are required.

To report the early results of castor device, a kind of unibody single-branched stent graft, in the treatment of type B aortic dissection (TBAD) involving the LSA. From April 2013 to February 2014, 21 patients with TBADs underwent TEVAR with LSA revascularization by unibody single-branched stent grafts. Three patients with penetrating aortic ulcers in the aortic arch received additional reconstruction of left common carotid artery with chimney technique. Follow-up evaluations were conducted with computed tomography angiography (CTA) at 6, 12 months and annually after that. All of the proximal entry tears were completely excluded. Good patency of the grafts was found in all cases. A small type I endoleak occurred in one patient during the procedure. Perioperative mortality is null, and there was no occurrence of serious complications. All patients completed the follow-up except one lost contact after discharge. One death occurred within 6 months after the operation, resulting from myocardial infarction, considered unrelated to the stent implantation. No endoleak occurred during follow-up. One compression of a chimney stent and one twist of side branch graft of castor were observed in 2 different patients, respectively. In other cases, CTA scans showed good patency of both the branched and chimney grafts. Two patients had partial thrombosis of the false lumen during follow-up. In other patients, complete thrombosis in the false lumen in thoracic aorta was revealed. The single-branched stent graft was safe and efficient in the 1-year follow-up. Further studies are required to determine its long-term outcomes.

Objective This study aimed to describe treatment of serious complications after primary thoracic endovascular aortic repair (TEVAR) in type B aortic dissection. Methods From June 2008 to March 2016, serious complications occurred in 58 patients without Marfan syndrome who received TEVAR for type B aortic dissection. Results Complications included endoleak, distal true lumen collapse, retrograde dissection, stroke, stent–graft (SG) migration and mistaken deployment, lower limb ischaemia, and SG fracture. Treatment included endovascular repair, surgical procedures, or conservative medication. Forty-six patients recovered from complications. Twelve patients were not cured. The median follow-up time was 29.5 months (2–61 months). The overall 30-day mortality rate was 1.7% (1/58) and the total mortality rate following secondary complications was 8.6% (5/58). The causes of death were stroke and aortic rupture. Conclusion Some treatments need to be performed after TEVAR because of severe complications. A reduction in these complications can be achieved by optimal evaluation of patients, selection of SGs, and specialized endovascular manipulation.

Objective Previous studies have suggested that stromal-derived factor 1 (SDF1) plays a pivotal role in abdominal aortic aneurysm (AAA) development. The SDF1-3′A polymorphism (G to A, rs1801157), located in the 3′ untranslated region, could influence the expression of SDF1. The aim of our study was to investigate the relationship of SDF1-3′A polymorphism with the risk of AAA occurrence and size. Methods A total of 205 AAA patients and 216 age- and sex-matched controls were recruited. The SDF1-3′A polymorphism was evaluated by polymerase chain reaction, followed by restriction enzyme analysis. Results The frequency of A allele was similar between groups. The genotype distribution also displayed no statistically significant differences under both the dominant model (odds ratio [OR], 0.922; P = .678) and the recessive model (OR, 1.617; P = .300). The multiple logistic regression analysis indicated that the association between the polymorphism and AAA remained insignificant when applied to the dominant model. However, AAA patients with GG genotype were more likely to develop aneurysms larger than 50 mm (OR, 0.497; P = .014). AAA patients with SDF1-3′A allele have reduced plasma SDF1α levels. In addition, plasma SDF1α levels were positively correlated with AAA size. Conclusions Our study suggests that SDF1-3′A polymorphism is associated with size but not occurrence of AAA, providing further evidence that SDF1 is implicated in AAA progression.

Yepeng Zhang,1 Hanfei Tang,1 JianPing Zhou,2 Zhao Liu,1 Changjian Liu,1 Tong Qiao,1 Min Zhou1 1Department of Vascular Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 2Department of General Surgery, Yixin People’s Hospital, Yixin, People’s Republic of China Background: Endovascular option has been proposed for a very limited and selected number of Stanford type A aortic dissection (TAAD) patients. We have performed a computed tomography (CT)-based TAAD study to explore appropriate endograft configurations for the ascending aortic pathology. Methods: TAAD patients treated with optimal CT scans were retrospectively reviewed, and their entry tears (ETs) were identified using three-dimensional and multiplanar reconstructions in an EndoSize workstation. After generating a centerline of flow, measurements, including numerous morphologic characteristics of anatomy, were evaluated and a selected subset of patients were determined to be suitable for endovascular treatments. Proximal diameter and distal diameter of endograft were selected based on diameters measured at the ET level and at the innominate artery (IA) level, with 10% oversizing with respect to the true lumen, but not exceeding the original aortic diameter. The length of the endograft was determined by the distance from the sinotubular junction to IA. Results: This study covered 126 TAAD patients with primary ET in ascending aorta, among which, according to the assumed criteria, 48 (38.1%) patients were deemed to be suitable for endovascular treatment. The diameters of ascending aorta from the sinotubular junction to the IA level presented a downward trend, and the proximal diameters differed significantly from distal diameters of the endograft for TAAD (39.9versus 36.2mm, P

In varicose veins, vascular smooth muscle cells (VSMCs) often show abnormal proliferative and migratory rates and phenotypic transition. This study aimed to investigate whether microRNA (miR)-202 and its potential target, peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), were involved in VSMC phenotypic transition. miR-202 expression was analyzed in varicose veins and in VSMCs conditioned with platelet-derived growth factor. The effect of miR-202 on cell proliferation and migration was assessed. Furthermore, contractile marker SM-22α, synthetic markers vimentin and collagen I, and PGC-1α were analyzed by Western blot analysis. The modulation of PGC-1α expression by miR-202 was also evaluated. In varicose veins and proliferative VSMCs, miR-202 expression was upregulated, with decreased SM-22α expression and increased vimentin and collagen I expression. Transfection with a miR-202 mimic induced VSMC proliferation and migration, whereas a miR-202 inhibitor reduced cell proliferation and migration. miR-202 mimic constrained luciferase activity in HEK293 cells that were cotransfected with the PGC-1α 3'-untranslated region (3'-UTR) but not those with mutated 3'-UTR. miR-202 suppressed PGC-1α protein expression, with no influence on its messenger RNA expression. PGC-1α mediated VSMC phenotypic transition and was correlated with reactive oxygen species production. In conclusion, miR-202 affects VSMC phenotypic transition by targeting PGC-1α expression, providing a novel target for varicose vein therapy.

To compare the short-term efficiency of two different endovascular repairs for type B aortic dissection involving the left subclavian artery. From February 2013 to March 2016, a cohort of 43 patients with TBADs involving the LSA underwent thoracic endovascular aortic repair (TEVAR) in two departments, consisting of 22 (Group A) with chimney grafts (CGs) and 21 (Group B) with single-branched stent graft (SBSG). Results of the two groups in perioperative and follow-up period (≥ 3 months) were comparatively analyzed, especially on aortic remodeling. Endoluminal repair of the two groups was successfully carried out. The median follow-up period was 19 months (range, 3–43 months) in Group A and 12 months in Group B (range, 6–32 months). During the TEVAR, one CG compression occurred in Group A and one type I endoleak in Group B. During follow-up, four complications occurred in Group A (two CGs occlusion, one type I endoleak and one death from dissecting aneurysm rupture), compared with two occurred in Group B (one sidearm graft twist and one death from myocardial infarction). Complete thrombosis of the false lumen (FL) in thoracic aorta was revealed in 83.3% (15/18) cases in Group A and 89.5% (17/19) in Group B. Partial thrombosis of the FL was revealed in 16.7% (3/18) cases in Group A and 10.5% (2/19) in Group B. In the abdominal aorta, complete thrombosis of the FL was noted in 23.1% (3/13) cases in Group A and 36.4% (4/11) in Group B. Partial thrombosis of the FL was revealed in 76.9% (10/13) cases in Group A and 63.6% (7/11) in Group B. Significant true lumen re-expansion and false lumen regression were observed in different levels of the descending aorta by computed tomography angiography (CTA) in both Groups A and B (P

In recent years, there has been increasing demand for personalized anatomy modelling for medical and industrial applications, such as ergonomics device development, clinical radiological exposure simulation, biomechanics analysis, and 3D animation character design. In this study, we constructed deformable torso phantoms that can be deformed to match the personal anatomy of Chinese male and female adults. The phantoms were created based on a training set of 79 trunk computed tomography (CT) images (41 males and 38 females) from normal Chinese subjects. Major torso organs were segmented from the CT images, and the statistical shape model (SSM) approach was used to learn the inter‐subject anatomical variations. To match the personal anatomy, the phantoms were registered to individual body surface scans or medical images using the active shape model method. The constructed SSM demonstrated anatomical variations in body height, fat quantity, respiratory status, organ geometry, male muscle size, and female breast size. The masses of the deformed phantom organs were consistent with Chinese population organ mass ranges. To validate the performance of personal anatomy modelling, the phantoms were registered to the body surface scan and CT images. The registration accuracy measured from 22 test CT images showed a median Dice coefficient over 0.85, a median volume recovery coefficient (RC (vlm)) between 0.85 and 1.1, and a median averaged surface distance (ASD)

Aim Vascular endothelial-cadherin (VE-cadherin) is specifically expressed by outgrowth endothelial cells (OECs). Zwitterionic stent showed high antifouling and excellent blood compatibility. Therefore, we hypothesized that anti-VE-cadherin antibody-coated zwitterionic stents (VE-cad-Z stents) would promote re-endothelialization, reduce neointimal formation, and resist thrombus. Methods VE-cad-Z stents were examined using platelet adhesion test, platelet activation, and OEC capture ability in vitro. In vivo effect of VE-cad-Z stents on re-endothelialization, thrombus-resistance, and neointima hyperplasia was investigated in left common carotid arteries of rabbits (n=15). Results In vitro, VE-cad-Z stents showed better platelet-resistance and OEC-capture ability (DNA concentration: 297.23±22.71 versus 67.49±15.26 ng/µL, P＜0.01). In vivo, VE-cad-Z stents exhibited better patency rate than bare metal stents (BMS) (15/15 versus 12/15), and it significantly reduced platelet adhesion and neointima formation (neointima area: 1.13±0.05 versus 1.00±0.05mm(2), P＜0.01 and 3.04±0.11versus 1.05±0.06mm(2), P＜0.01, at 3 and 30 days, respectively; % stenosis: 20.99±0.98 versus 18.72±0.97, P＜0.01 and 56.46±2.20 versus 19.45±1.24, P＜0.01, at 3 and 30 days, respectively). Conclusion These data suggested that VE-cad-Z stents could specifically capture OECs, consequently promote endothelial healing, and also reduce platelet adhesion and neointima formation.

Background A custom-made unibody single-branch endograft (USBE) could provide great gains in the landing zone, while maintaining a left subclavian artery (LSA) perfusion in some patients with Stanford type B dissections (TBADs). We performed a computed tomography (CT)-based planning study to determine the proportion of TBAD patients who could benefit from this custom-made USBE and ascertained the possibility of an off-the-shelf USBE in an emergency setting. Methods We carried out a retrospective study of TBAD patients with optimal CT scans at our center from 2007 to 2013. Patients' CT scans were analyzed using 3-dimensional reconstruction software. After generating a centerline of flow, measurements (including numerous morphologic characteristics of anatomy) were evaluated. A selected subset of patients suitable for USBE was determined. Finally, the most frequently used configurations of endografts were figured out by subgroup analysis. Results A total of 314 patients with optimal digital imaging communications in medicine (DICOM) data were included in our study. The main primary entry tears (MPETs) were located at 22.8 ± 17.3 and 36.3 ± 18.6 mm distal to the LSA and the left common carotid artery, respectively. Overall, 169 (54.2%) patients with MPET distal to LSA (＞20 mm) could be treated by tubular stent grafts. Of the 143 patients who had intimal tears adjacent to the LSA (≤20 mm), there were 111 (35.4%) patients who could benefit from treatment using USBE based on our selection criteria. Subgroup analysis estimated the number of graft configurations needed to treat a proportion of patients: 1 design would treat 6.7% of the population, 5 designs would treat 23.1%, 10 designs would treat 37.6%, and 20 configurations would treat 54.8% . Conclusions In all, 35.4% patients with TBAD could potentially benefit from USBE. The use of off-the-shelf endografts might be possible in cases of emergency, given the evidence of recurrent configurations.

Objectives To report the midterm safety and efficacy of the Aegis™-B (Microport, Shanghai, China) unibody bifurcated stent graft for endovascular treatment of isolated abdominal aortic dissection (IAAD). Background Isolated abdominal aorta dissection (IAAD) is a rare event. Endovascular stent grafts seem to offer an efficient therapeutic approach to treat IAAD. However, the relatively small diameter of the infrarenal aorta and aortic bifurcation remains the main anatomical limitation to endovascular repair. Methods Between 2008 and 2015, we retrospectively evaluated 32 IAAD patients (21 men; mean age 58 ± 18 years), who underwent endovascular repair using Aegis™-B unibody bifurcated stent graft. Narrow proximal landing zone and narrow distal aorta was present in 11 (34.4%) patients and 10 (31.3%) patients, respectively. In the follow-up period, aortic remodeling was observed with computed tomography angiography. Results All patients were treated by endovascular means, with a primary technical success rate of 100%. During a mean follow-up period of 30.71 ± 16.36 months (range, 8–56 months), no death, rupture, stent fracture, material failure, or device migration was observed. Complete false lumen thrombosis was observed in all patients at 1 year, and all patients were free from false lumen growth in the follow-up. Conclusions Endovascular treatment of IAAD using the Aegis™-B system appears to be safe and effective. Results from this study suggest this algorithm can provide stable, secure fixation for IAAD patients with narrow proximal landing zone, and distal aorta.

We investigated the hypothesis that an antioxidant, Vitamin C, could attenuate abdominal aortic aneurysm (AAA) development in a rat model.An AAA model induced by intraluminal infusion was created in 36 male Sprague Dawley rats, which were randomly distributed into three groups: Sham (saline infused, placebo treated), Control (elastase infused, placebo treated), and Vitamin C (elastase infused, vitamin C treated). Vitamin C and placebo were intraperitoneally injected, initiating 1 wk before the infusion and continuing throughout the study. The aortic dilatation ratio was measured, and aortic tissues were further examined using biochemical and histologic techniques.Vitamin C attenuated the development of AAA, decreasing maximal aortic diameter by 25.8% (P 0.05) and preserving elastin lamellae (P 0.05). Vitamin C also decreased 8-hydroxyguanine (a marker of oxidative damage to DNA) and 8-isoprostane content (a marker of oxidative stress) in aortic tissues (P 0.05, respectively). The proteins of matrix metalloproteinase (MMP)-2, MMP-9, and interleukin 6 were markedly downregulated (P 0.05, respectively), accompanied with notably reduced messenger RNA expression of tumor necrosis factor-α, MMP-2/9, and interleukin 1β (P 0.05, respectively). However, messenger RNA of tissue inhibitors of metalloproteinase-1 and tissue inhibitors of metalloproteinase-2 were both significantly upregulated in Vitamin C group. Vitamin C treatment had no significant effect on systolic blood pressure (P 0.05).Vitamin C attenuated AAA development in an elastase-induced rat model via crucial protective effect, which was mediated by an increased level of antioxidant in cooperation with preserving elastin lamellae, inhibiting matrix-degrading proteinases and suppressing inflammatory responses.

Complex aortic aneurysms are difficult to treat endovascularly and so techniques have been developed to broaden the management options. We report a case of 51-year-old man with several thoracoabdominal aortic aneurysms (TAAAs) who underwent endovascular repair with “off-label” stent grafts. Three aortic stent grafts and four branched stent grafts were used in the procedure using chimney and periscope techniques. The patient was followed for three years with regular computed tomography angiography (CTA). Scans at 3 and 12 months showed that the TAAAs were repaired and all visceral arteries were patent. Although, scans at the two- and three-year follow-ups showed that the stent graft in the superior mesenteric artery was occluded, the patient did not have any complications probably as a result of coeliac artery compensation.

The purpose of this study was to determine whether myeloid differentiation factor88-dependent Toll-Like Receptor-4 (TLR-4) signaling contributed to the inhibition of abdominal aortic aneurysm (AAA) by Tanshinone IIA (Tan IIA).Male Sprague-Dawley rats (n = 12 / group) were randomly distributed into three groups: Tan IIA, control, and sham. The rats from Tan IIA and control groups under-went intra-aortic elastase perfusion to induce AAAs, and those in the sham group were perfused with saline. Only the Tan IIA group received Tan IIA (2 mg / rat / d). Aortic tissue samples were harvested at 24 d after perfusion and evaluated using reverse transcriptase-polymerase chain reaction, Western blot, immunohistochemistry and immunofluorescence.The over-expression of Toll-Like Receptor-4 (TLR-4), Myeloid Differentiation factor 88 (MyD88), Phosphorylated Nuclear Factor κB (pNF-κB) and Phosphorylated IκBα (pIκBα) induced by elastase perfusion were significantly decreased by Tan IIA treatment.Tan IIA attenuates elastase-induced AAA in rats possibly via the inhibition of MyD88-dependent TLR-4 signaling, which may be one potential explanation of why Tan IIA inhibits AAA development through multiple effects.Hintergrund: Das Ziel dieser Studie war es, festzustellen, ob das vom myeloischen Differenzierungsfaktor88 (MyD88)-abhängige Toll-like-Rezeptor-4 (TLR-4) Signal zur Hemmung des Bauchaortenaneurysmas (BAA) durch Tanshinone IIA (Tan IIA) beiträgt. Material und Methoden: Männliche Sprague-Dawley Ratten (n = 12 pro Gruppe) wurden zufällig in drei Gruppen aufgeteilt: Tan IIA, Kontrolle und Scheinbehandlung. Die Ratten von Tan IIA und der Kontrollgruppe wurden einer intraaortalen Elastase Perfusion unterzogen, um ein BAA zu induzieren, und in der Gruppe mit Scheinbehandlung wurde mit Kochsalzlösung perfundiert. Nur die Tan IIA Gruppe erhielt Tan IIA (2 mg / Ratte / Tag). Aortale Gewebeproben wurden 24 Tage nach Perfusion genommen und mit Reverse Transkriptase Polymerase Kettenreaktion, Western Blot, Immunhistochemie und Immunfluoreszenz ausgewertet. Ergebnisse: Die Überexpression von TLR-4, MyD88, phosphoryliertem nuclear factor kappaB (pNF-κB) und phosphoryliertem IκBα (pIκBα), welche durch Elastase Perfusion induziert waren, wurden wesentlich durch Tan IIA Behandlung verringert. Schlussfolgerungen: Tan IIA dämpft das Elastase-induzierte BAA in Ratten möglicherweise über die Hemmung der MyD88-abhängigen TLR-4-Signalisierung, was eine Erklärung dafür sein kann, warum Tan IIA die Entwicklung eines BAA durch mehrere Effekte verringert.

Objective To investigate the abnormal expressions of Tie1 on the valves of great saphenous varicose vein, and to discuss the relationship between the phenomenon and pathogenesis of varicose vein of lower extremity. Methods Varicose veins group 18 samples, normal control group 14 samples. Immunohistochemistry staining has investigated the expression of CD31 and Tie1 in the first valves of great saphenous veins. Semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) has checked mRNA expression of Tie1. Western blot has checked the expression of Tie1 protein in venous valves. Results In normal control group valves, there was no difference between proximal and distal sides endothelium, which expressing CD31 in both valvar basement and valve cusp (positive endothelial cells [ECs] percentage: P > 0.05, P > 0.05). However, the endothelium of the proximal side demonstrates Tie1 stronger than distal side in valvar basement (positive ECs percentage: P < 0.05), which was not found at valve cusp (positive ECs percentage: P > 0.05). In varicose veins group, the endothelium of proximal side cells expresses CD31 weaker than distal side at both valvar basement and valve cusp (positive ECs percentage: P < 0.05, P < 0.05) besides the morphological alteration of valves. Moreover, it expresses Tie1 much weaker than diatal side (positive ECs percentage: P < 0.01). Semi-quantitative RT-PCR showed that valves of varicose veins group expressed Tie1 much weaker than the normal control group ( P < 0.01). Western blot could not detect the expression of Tie1 in venous valves. Conclusion The decreasing expression of Tie1 may play an important role in the pathogenesis of primary lower extremity varicose veins.

BACKGROUND Varicose veins (VVs) have a substantial impact on patients' quality of life. OBJECTIVE The study aimed to retrospectively compare the short-term clinical outcomes of 2 treatment methods for VVs, namely high ligation and stripping (HL/S) of the great saphenous vein combined with foam sclerotherapy (FS), and FS alone. MATERIALS AND METHODS Totally, 180 patients with VVs were included and treated with FS alone or HL/S+FS. Assessments included the first injection efficacy, postoperative status, complications, operative time, and recovery time. A follow-up duration was performed. Patient satisfaction was also recorded. RESULTS No significant differences in the complete occlusion rate of the varicose tributaries, as well as in postoperative complications, were found between the treatment groups (p > 0.05). The complete occlusion rates of the varicose tributaries in the FS and HL/S+FS groups were 90% and 90%, respectively. Although mild phlebitis and local pigmentation were found in both groups, they disappeared during the follow-up period. Operative and recovery times were higher in the HL/S+FS group than in the FS group. CONCLUSION The HL/S+FS and FS alone showed equivalent efficacy for treating patients with VVs. Considering the increased operative and recovery times, FS alone is recommended to treat VVs in clinical practice.

Typical iliac vein compression syndrome (IVCS) is characterized by compression of left common iliac vein (LCIV) by the overlying right common iliac artery (RCIA). We described an underestimated type of IVCS with dual compression by right and left common iliac arteries (LCIA) simultaneously. Thirty-one patients with IVCS were retrospectively included. All patients received trans-catheter venography and computed tomography (CT) examinations for diagnosing and evaluating IVCS. Late venography and reconstructed CT were used for evaluating the anatomical relationship among LCIV, RCIA and LCIA. Imaging manifestations as well as demographic data were collected and evaluated by two experienced radiologists. Sole and dual compression were found in 32.3% (n = 10) and 67.7% (n = 21) of 31 patients respectively. No statistical differences existed between them in terms of age, gender, LCIV diameter at the maximum compression point, pressure gradient across stenosis, and the percentage of compression level. On CT and venography, sole compression was commonly presented with a longitudinal compression at the orifice of LCIV while dual compression was usually presented as two types: one had a lengthy stenosis along the upper side of LCIV and the other was manifested by a longitudinal compression near to the orifice of external iliac vein. The presence of dual compression seemed significantly correlated with the tortuous LCIA (p = 0.006). Left common iliac vein can be presented by dual compression. This type of compression has typical manifestations on late venography and CT.

The etiology of thoracic aortic aneurysm and dissection (TAAD) is complex and heterogeneous. Emerging evidence has demonstrated that genetic causes may be a consideration in early‑onset TAAD. Owing to overlapping clinical phenotypes and the genetic heterogeneity of TAAD, it is challenging for clinicians to make a molecular diagnosis of TAAD, particularly in those who present with non‑specific syndromic features. In order to identify the causative mutation in two young patients with acute type B aortic dissection without syndromic features, whole exome sequencing (WES) was performed in the present study. A missense mutation (c.G6953A:p.C2318Y) and a nonsense mutation (c.C4786T:p.R1596X) were identified in the fibrillin 1 gene in patients T287 and T267, respectively. The present study emphasized the necessity of genetic testing for young patients with type B aortic dissection. WES is a timely, robust and inexpensive technique for molecular diagnosis, particularly for TAAD caused by numerous genes. Genetic diagnosis of Marfan syndrome could aid in periodic surveillance, prophylactic surgical measures, and genetic counseling.

Recent advances in understanding the interaction between electricity and cells/biomolecules have generated great interest in developing biocompatible electrically conductive materials. In this study, we investigated the biocompatibility of a myo-inositol hexakisphosphate gelated polyaniline hydrogel using in vitro and in vivo experiments in a rat model. The polyaniline hydrogel was used to coat a polycaprolactone scaffold and was cultured with rat endothelial progenitor cells differentiated from rat adipose-derived stem cells. Compared with the control sample on a pristine polycaprolactone scaffold, the treated polyaniline hydrogel had the same non-poisonous/cytotoxicity grade, enhanced cell adhesion, and a higher cell proliferation/growth rate. In implant studies, the polyaniline hydrogel sample induced milder inflammatory responses than did the control at the same time points. Combining the advantages of a biocompatible hydrogel and an organic conductor, the inositol phosphate-gelated polyaniline hydrogel could be used in bioelectronics applications such as biosensors, neural probes, cell stimulators, medical electrodes, tissue engineering, and electro-controlled drug delivery.

Our study suggests that aquaporins 4 and 5 (AQP4 and AQP5) in the middle ear cavity may play a vital role in the homeostasis of the tubotympanum and in the course of the accumulation of the effusion in secretory otitis media (SOM).To explore the pathological change in water homeostasis in the middle ear in SOM and to observe the expression and regulation of AQP4 and AQP5 in the middle ear cavity in SOM.Reverse transcriptase polymerase chain reaction (RT-PCR) and Western blotting were used to detect AQP4 and AQP5 in the bullae of animal models of SOM and normal animals. The expression patterns of AQP4 and AQP5 in the SOM group were compared with those in the normal group.RT-PCR and immunoblot analyses revealed that mRNAs encoding AQP4 and AQP5 were expressed in the middle ear membrane of the guinea pigs in both groups; AQP4 was also detected as 33 kDa protein in both groups. Quantitative analysis of RT-PCR and Western blotting revealed that expression of AQP4 and AQP5 was higher in the SOM group than in the control group.

To evaluate the feasibility of a swine model of thrombotic inferior vena cava (IVC) occlusion (IVCO) created by autologous thrombus injection with assistance of intra-caval net knitting. Sixteen pigs were included and divided into two groups: Group A (n = 10), IVCO model created by knitting a caval net followed by autologous thrombus injection; Group B (n = 6), control model created by knitting a net and normal saline injection. Venography was performed to assess each model and the associated thrombotic occlusion. The vessels were examined histologically to analyse the pathological changes postoperatively. IVCO model was successfully created in 10 animals in Group A (100%). Immediate venography showed extensive clot burden in the IVC. Postoperative venography revealed partial caval occlusion at 7 days and complete occlusion coupled with collateral vessels at 14 days. Histologically, Group A animals had significantly greater venous wall thickening, with CD163-positive and CD3-positive cell infiltration. Recanalization channels were observed at the margins of the thrombus. By contrast, no thrombotic occlusion of the IVC was observed in Group B. The thrombotic IVCO model can be reliably established in swine. The inflammatory reaction may contribute to the caval thrombus propagation following occlusion.

To compare the differences between macromolecular and small molecular contrast agents in interstitial magnetic resonance (MR) lymphography.In two groups of rabbits (N = 12 each), 0.5-mL volumes of 0.5 M and 0.1 M gadodiamide, respectively, were injected subcutaneously into the dorsal feet of both hind legs. After a 24-hour interval, 0.5 mL of Gd [DTPA-bis (2-aminoethoxy) ethane] polymeric contrast agent (Gd-poly-DTPA-EOEA) injection (0.1 M) was injected into the same sites in each rabbit. T1-weighted three-dimensional gradient-echo and maximum intensity projection (MIP) images were obtained before and after the administration of each agent. The nodal maximum short-axis diameter (MSAD) and signal-to-noise ratio (SNR) at each time point were measured. Postmortem measurements of nodal MSADs were also performed. The nodal MSAD measurements obtained by MR lymphography were compared with the postmortem measurements. As an additional control experiment, six rabbits received a subcutaneous injection of 0.5 mL of 0.1 M gadodiamide at the same sites as those described above. This procedure was repeated after a 24-hour interval to determine whether the first injected gadodiamide had any effect on the performance of the subsequently injected agent, by comparing the differences in nodal MSADs obtained by MR lymphography after each injection.Gd-poly-DTPA-EOEA showed a significantly longer enhancement plateau compared to gadodiamide. In comparison with postmortem measurements, nodal measurements by MR lymphography with Gd-poly-DTPA-EOEA at the peak-enhancement phase revealed no significantly different MSADs (P0.05), whereas nodal measurements by MR lymphography with gadodiamide showed significantly smaller MSADs (P0.05). A comparison of the nodal MSADs measured in two gadodiamide-enhanced MR examinations after the 24-hour interval showed no significant difference (P0.05).Interstitial MR lymphography with polymeric Gd-poly-DTPA-EOEA enhancer enables more sufficient and reliable visualization of lymph nodes compared to small molecular gadodiamide.

Objectives Abdominal aortic aneurysm (AAA) is often asymptomatic until rupture occurs. Although ultrasound screening has significantly improved the early diagnosis of AAA, the timely biomarker-based diagnosis of AAA remains a major clinical challenge. In this study, we aimed to assess plasma microRNAs (miRNAs) as promising novel biomarkers in patients with AAA. Methods Pooled plasma samples from 10 AAA and 10 healthy controls were profiled by microarray. The differentially expressed miRNAs were evaluated in a separate cohort of 120 subjects, including 60 AAA patients and 60 normal controls. Results The initial profiling study identified 151 miRNAs that showed more than two-fold change. Among them, three miRNAs, miR-191-3p, miR-455-3p and miR-1281 exhibited the largest increase in the patient group (fold change > 5). A subsequent validation study confirmed the elevation of these three miRNAs. Receiver operator characteristic curve analysis using the expression ratio of miR-191-3p, miR-455-3p and miR-1281 showed an area under the curve of 0.9700, 0.9825 and 0.9206, respectively. Conclusion Our results suggest that plasma miR-191-3p, miR-455-3p and miR-1281 may be used as potential diagnosis biomarkers for AAA.

To characterize type A aortic dissection (TAAD) in the Chinese population using high-resolution computed tomography (CT) and explore potential candidacy for endovascular repair of TAAD.The imaging studies and medical records of all 302 patients presenting with TAAD at two Chinese hospitals from 2010 to 2013 were reviewed. Of these, 221 patients were excluded because of missing/inadequate preoperative CT scans. The remaining 91 patients (64 men; mean age 51.1±7.5 years) had CT data adequate to assess anatomical suitability for endovascular treatment. Entry tears were identified using multiplanar reconstructions, while morphological measurements were based on a centerline of flow (CLF) technique. Suitability for endovascular treatment was based on a proximal landing zone ≥20 mm long, a true lumen aortic diameter ≤38 mm, and a total aortic diameter ≤46 mm; no coronary bypass grafts originating from the ascending aorta; no malfunctioning aortic valve; and good cerebral and cardiac perfusion.In the 91 patients, the precise location of the primary proximal entry tear could be identified in only 34 (37.4%) patients; in these patients, the identifiable intimal tears were located 36.4±41.0 mm distal to the closest coronary artery. The CLF was successfully generated in the CT scans of all patients; the mean lumen and total aortic lumen diameters at the entry tear level were 37.6±6.3 and 44.3±13.3 mm, respectively. Based on the CT measurements, stent-graft repair would have been anatomically feasible in 35 (38.5%) patients. No proximal landing zone (n=23), large aortic diameter (n=15), abnormal aortic valve (n=10), previous coronary bypass graft surgery (n=5), and poor cerebral and cardiac perfusion (n=3) were obstacles that affected the suitability for this treatment.Based on high-resolution CT scans, our pilot study suggested that 38% of Chinese patients with TAAD could potentially be treated by stent-grafting based on the anatomical characteristics of the proximal dissection.

Min Zhou, Dian Huang, Chen Liu, Zhao Liu, Min Zhang, Tong Qiao, Chang-Jian Liu Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China Objective: To compare outcomes of hybrid (combined surgical and endovascular) procedures (HYBRID) with open surgical reconstructions (OPEN) in patients with multilevel infrainguinal artery occlusive diseases. Design: Case series study with retrospective analysis of prospectively collected nonrandomized data.Methods: Between 2008 and 2012, 64 patients underwent OPEN and 43 underwent HYBRID. Patient characteristics, technique success, clinical improvement, and procedure-related morbidity were reviewed and compared. Patency rates and limb salvages were analyzed and compared using Kaplan–Meier life tables. Cox regression analyses were used to assess the influence of various risk factors on primary patency.Results: HYBRID patients were older and presented with worse New York Heart Association function compared with OPEN patients. The increase in the ankle-brachial index and improvement of Ruthford category after procedures were equivalent between two groups, but HYBRID patients had shorter hospital length of stay (7.6±12.0 versus 15.5±17.3; P= 0.018) and less overall perioperative morbidity (12% versus 28%; P=0.042) compared with OPEN patients. No statistically significant difference in 36-month primary (47.1%±7.1% versus 50.1%±9.4%; P=0.418), assisted primary (57.0%±7.9% versus 62.4%±9.2%; P=0.517), or secondary (82.0%±6.8% versus 83.1%±7.3%; P=0.445) patency was seen between the two groups. Limb salvage rates of HYBRID vs OPEN at 3 years were similar (76.3%±9.3% versus 80.4%±8.2%; P=0.579). Critical limb ischemia was a negative predictor of long-term patency of patients in both the HYBRID and OPEN groups (P=0.012 and P

A rapid, sensitive and high-throughput liquid chromatography-tandem mass spectrometry was established and validated to assay the concentrations of 3,29-dibenzoyl rarounitriol in rat plasma. Plasma samples were processed by liquid-liquid extraction with ethyl acetate and separated on a Hypersil Gold C18 column (50 × 4.6 mm, 3 µm) at an isocratic flow rate of 0.5 mL/min using methanol-10 mm ammonium acetate-formic acid (90:10:0.1, v/v/v) as mobile phase. The total run time was 5 min for each sample. MS/MS detection was accomplished in selected reaction monitoring mode with positive electrospray ionization. The calibration curve was linear over the concentration range of 0.125-50 ng/mL with lower limit of quantification of 0.125 ng/mL. The intra- and inter-day precisions were10.1% in terms of coefficient of variation, and the accuracy was within ±11.7% in terms of relative error. The developed method was successfully applied to a pharmacokinetic study of 3,29-dibenzoyl rarounitriol following intragastric administration of 3.65 mg/kg to Wistar rats.

To observe the occurrence condition of endoleak after endovascular aneurysm repair (EVAR) operation for abdominal aortic aneurysm (AAA), and to analyze the factors of the endoleak.Between July 2005 and June 2013, 210 cases of AAA were treated with EVAR. Of 210 patients, 175 were male and 35 were female, aging 42-89 years (mean, 65.7 years). The patients were all proved to have infrarenal AAA by computed tomography angiography (CTA). The disease duration ranged from 1 week to 2 years (median, 11.3 weeks). The maximum diameter of the aneurysms was 44-72 mm (mean, 57.3 mm). The proximal landing zone was longer than 1.5 cm. CTA was performed routinely at 2 months after operation to detect the endoleak of contrast agent. If endoleak was found, CTA was performed again at 6 months. If obvious endoleak still existed, digital subtraction angiography (DSA) would be performed to clarify the character and the degree of the endoleak, and EVAR should be done if necessary.Endoleak occurred in 31 cases (14.8%) during operation, including 11 cases of type I endoleak (8 cases of type IA and 3 cases of type IB), 18 cases of type II endoleak, and 2 cases of type III endoleak (type IIIB). The patients were followed up 2-8 months (mean, 3.1 months). At 2 months after operation, contrast agent endoleak was found in the remnant aneurysm cavity of 12 cases (5.7%). At 6 months after eperation, contrast agent endoleak was found in 10 cases (4.8%) by CTA. In 8 patients receiving DSA, there were 4 cases of type I endoleak (3 cases of type IA and 1 case of type IB), 3 cases of type II endoleak, and 1 case of type III (type IIIB) endoleak. In 5 patients having type I and type III endoleak, collateral movement of stent graft was observed in different degree; after increased stent graft was implanted, the endoleak disappeared after 2-4 months. The patients having type II endoleak were not given special treatment, endoleak still existed at 2 months after reexamination of CTA, but the maximum diameter of AAA had no enlargement.The collateral movement of stent graft is a very important factor to cause type I and type III endoleak in the patients of AAA after EVAR, and endoleak can be plugged by EVAR again.

To evaluate the immediate and mid-term effectiveness of hybrid procedures (combined open surgery and endovascular therapy) for multilerel femoral and popliteal artery occlusive disease.Between June 2009 and June 2012, 22 cases of severe femoral and popliteal artery occlusive disease were treated by hybrid surgery. There were 15 men and 7 women with an age range of 52-78 years (mean, 66.2 years) and with a disease duration of 6 months to 5 years (mean, 1.5 years). Of 22 patients, 13 had a history of smoking; 8 were classified as Fontaine III and 14 as Fontaine IV. The complications included diabetes (8 patients), hypertension (16 patients), hyperlipemia (10 patients), coronary heart disease (11 patients), and chronic kidney failure (1 patient). Patency analyses were performed using Kaplan-Meier life tables and log-rank test.All patients underwent successfully procedures. The time of operation was 70-160 minutes (mean, 137 minutes). Acute myocardial infarction, hematoma of incision, fracture of stent, and stent thrombosis occurred in 1 case, respectively. At 6 months after surgery, the ankle brachial index (ABI), the transcutaneous oxygen pressure (TcpO2), and the average intermittent claudication distance were significantly increased when compared with preoperative ones [0.79 +/- 0.33 versus 0.32 +/- 0.18, (42.7 +/- 15.7) kPa versus (17.6 +/- 11.6) kPa, and (420 +/- 80) m versus (160 +/- 54) m, P0.05]. The patients were followed up 6-24 months (mean, 14.5 months). The primary patency rate, primary assisted patency rate, and second patency rate were 77.3% (17/22), 90.9% (20/22), and 95.5% (21/22) respectively, showing no significant difference among them (P0.05). No significant difference was found in various-stage patency rates between patients at Fontaine III and IV (P0.05).Hybrid procedures provide an effective treatment of multilevel femoral artery and popliteal artery disease while there is good outflow.

The purpose of the present study was to investigate whether tanshinone IIA (Tan IIA), one of the major lipophilic components of Salvia miltiorrhiza Bunge, could inhibit the development of elastase-induced experimental abdominal aortic aneurysms (AAAs).Male Sprague-Dawley rats (n = 12/group) were randomly distributed into three groups: Tan IIA, control, and sham. The rats from the Tan IIA and control groups underwent intra-aortic elastase perfusion to induce AAAs, and the rats in the sham group were perfused with saline. Only the Tan IIA group received Tan IIA (2 mg/rat/d). The maximum luminal diameter of the abdominal aorta was measured before and 5, 12, 18, and 24 d after perfusion. The systolic blood pressure was measured twice using the tail cuff technique before administration and death. Aortic tissue samples were harvested at 24 d and evaluated using reverse transcriptase-polymerase chain reaction, Western blot, immunohistochemistry, and Miller's elastin-Van Gieson staining.The rats in the control group had significantly increased aortic sizes compared with the sham group after 24 days (P0.05), and the Tan IIA group had a significant reduction in aortic size (Tan IIA versus control, P0.05) without affecting blood pressure (P0.05). The overexpression of matrix metalloproteinase-2, metalloproteinase-9, monocyte chemotactic protein-1, and inducible nitric oxide synthase and the depletion of elastic fibers and vascular smooth muscle cells induced by elastase perfusion were significantly decreased by Tan IIA treatment (P0.05).Tan IIA inhibited the development of elastase-induced experimental AAAs by suppressing proteolysis, inflammation, and oxidative stress and preserving vascular smooth muscle cells. It could be a new pharmacologic therapy for AAAs.

To compare the early complications of carotid stenting (CAS) and carotid endarterectomy (CEA) in treatment of carotid artery stenosis.Between January 2005 and December 2007, 63 patients with carotid artery stenosis were treated with CEA in 36 cases (CEA group) and with CAS in 27 cases (CAS group). There were 42 males and 21 females with an average age of 67.5 years (range, 52-79 years). The locations were the left side in 28 cases and the right side in 35 cases. The carotid stenosis was 60%-95% (mean, 79%). The major clinical symptoms were stroke and transient ischemic attack. The cranial CT showed old cerebral infarction in 24 cases, lacunar infarction in 22 cases, and no obvious abnormal change in 17 cases. The encephalon, heart, and local complications were compared between 2 groups within 7 days after operation.In CEA group, encephalon complications occurred in 3 cases (8.3%), heart complications in 2 cases (5.6%), and local complications in 5 cases (13.9%); while in CAS group, encephalon complications occurred in 8 cases (29.6%), heart complications in 1 case (3.7%), and local complications in 3 cases (11.1%). The encephalon complication ratio of CAS group was significantly higher than that of CEA group (chi2 = 4.855, P = 0.028); and there was no significant difference in other complications ratios between 2 groups (P0.05).CEA is the first choice to treat carotid artery stenosis.

To investigate the efficacy of autologous bone marrow mononuclear cells transplantation in treating lower limb thromboangiitis obliterans (TAO).From January 2005 to November 2008, 25 patients (27 limbs) with lower limb TAO were treated. There were 24 males (26 limbs) and 1 female (1 limb), aging 16-44 years (33 years on average). Fifteen left limbs and 12 right limbs were involved. The median duration of disease was 2 years (from 3 months to 9 years). Intermittent claudication was observed in 5 cases (5 limbs), 16 patients (17 limbs) had symptom of rest pain, 4 patients (5 limbs) suffered ulcer on the distal limbs. The results of visual analogue scale (VAS), maximum walking distance (MWD), ankle/brachial index (ABI), and transcutaneous oxygen pressure (TcPO2) before operation were (7.16 +/- 1.12) points, (0.098 +/-0.043) km, 0.20 +/- 0.09, and (11.78 +/- 3.46) mm Hg (1 mm Hg=0.133 kPa), respectively. A total of 300 mL bone-marrow blood was extracted from the iliac bone. And then the mononuclear cells were isolated from the bone-marrow blood. All patients received cell transplantation only one time. The amount of transplantation bone marrow mononuclear cells was (1.82-29.46) x 10(9) (mean 13.33 x 10(9)).All patients were followed up for 1 years. After 4 weeks of implantation, the results of VAS, MWD, ABI, and TcPO2 were (2.39 +/- 0.51) points, (0.783 +/- 0.176) km, 0.28 +/- 0.16, (21.33 +/- 6.57) mm Hg, respectively, showing significant difference compared with preoperative results (P0.05). The VAS, MWD, ABI, and TcPO2 increased to (2.44 +/- 0.67) points, (1.199 +/- 0.304) km, 0.37 +/- 0.09, (27.90 +/- 5.23) mm Hg after 1 year of implantation, showing significant differences compared with preoperative results (P0.05). One ulcer healed well and the improvement was obtained in other 3 cases after 4 weeks of implantation (80%). Four ulcers healed well after 1 year of implantation (80%). After 1 year of implantation, angiography revealed 37.04% affected limbs had a satisfactory neovascularization. The angiographic levels were grade 0 in 5 cases, grade 1 in 12 cases, grade 2 in 4 cases, and grade 3 in 6 cases.Autologous bone marrow mononuclear cells transplantation could be a simple, safe, effective method to treat TAO.

Endothelial progenitor cells (EPCs) have been proposed as a promising tool for therapeutic neovascularization, vascular repair, tumor pathology and tissue engineering, though their identification is still a subject of much discussion. EPCs consist of two different subpopulations, termed endothelial cell (EC)-like cells and endothelial outgrowth cells (EOCs). Both types of EPCs are derived from mononuclear cells, but they have different characteristics. Our aim was to characterize and compare the two types of EPCs to find reliable biological features of EPCs that can be used for identification of EPCs. In this study, human peripheral blood mononuclear cells were isolated by density gradient centrifugation and cultured on fibronectin-coated culture plates. While adherent cells were maintained, EC-like cells appeared within 4-7 days of culture, and EOCs developed after 2-3 weeks of culture. EOCs, which were characterized by high proliferation potential, were able to form capillary tubes on Matrigel, but not EC-like cells, despite the higher concentrations of three angiogenic cytokines, vascular endothelial growth factor, granulocyte colony-stimulating factor, and interleukin 8, in the conditioned medium of EC-like cells. In contrast, endothelial nitric oxide synthase (eNOS) was expressed in both types of EPCs, and both cell types could produce nitric oxide (NO), as judged by measuring the total amounts of nitrites and nitrates in culture media. In conclusion, the expression of eNOS and the production of NO could be used as common biological features to identify EPCs. These findings provide new insights into the identification of EPCs.

To investigate the etiology, diagnosis, revascularization of upper limb ischemia and the complications.From March 2003 to February 2008, 72 cases of upper limb ischemia were treated. There were 44 males and 28 females, aged 19-90 years old (median 63 years old). The duration of the disease was 1 hour to 2 years. All cases had symptoms of limb ischemia such as paleness, coldness, paralysis. According to individual condition, 72 patients accepted revascularizations including thromboembolectomy, reconstruction after traumatic injuries, pseudoaneurysm excision and angioplasty, balloon dilatation and stent implant, arterial repair, patch, vascular prosthesis or vein bypass/transplantation, and ligation or coarctation of fistula.Sixty patients (83.3%) recovered well after operation. Re-occlusion following thromboembolectomy was found in 6 patients (8.3%). And there were 4 patients (5.6%) with limbs disturbance and muscles contracture and 2 patients (2.8%) with compartment syndrome in this series. The affected limb had to be amputated in 2 patients (2.8%). And 1 patient (1.4%) died of cerebral hemorrhage because of anticoagulation 3 days after operation. All patients were followed up 1-6 years (mean 52 months) after operation. Four patients recurred and got improved after retreatments. The others got a good result with normal skin color and temperature, restoration of the radial and ulnar pulses, normal saturation of blood oxygen of finger tip (90%) and patent blood flow of affected arteries was shown by color Doppler ultrasound.The study indicates that identifying the biology of upper limb ischemia before operation and active revascularizations consistent with different causes are the key to treat the upper limb ischemia.

To develop an experimental model of abdominal aorta transplantation with nano-biomimetic tissue engineered blood vessel (NBTEBV) and to investigate the change of histomorphology in evolutionary process of degradation and remodeling.Twenty 6-month-old New Zealand rabbits were included, weighing 2-3 kg, male or female. The autologous seed cells of rabbits were harvested to build NBTEBV in vitro. After the branch of abdominal aorta under kidney was ligated, about 10 mm abdominal aorta was cut and replaced by NBTEBV; the anastomotic stoma was marked by Ti clips. NBTEBV's evolutionary processes of degradation and rebuilding were observed. Twelve weeks after operation, DSA and color Doppler examinations were made. At 1, 4 and 12 weeks after operation, the gross and histological observations were made and 14C binding in PLGA was detected with X-ray photon spectroscopy.Of 20 rabbits, 17 showed that the NBTEBV was patency; 3 died from NBTEBV occlusion 36 or 72 hours after operation. The results of DAS and color Doppler showed the blood flow was patency, the blood flow rate was normal and there was no angiectasis. The lumen of transplanted blood vessel was covered with monolayer endothelial cells. At 1 week, smooth muscle cells (SMCs) arranged regularly and much PLGA distributed in the EMCs. At 4 weeks, SMCs arranged in a layer, ECM was forming, mimic ECM degraded partly; PLGA decreased obviously. At 12 weeks, the SMCs arranged regularly, ECM formed, mimic ECM degraded, no PLGA was seen in the wall, the shape of graft was similar to the natural vessel. The decreasing crest value of 14C in specimen showed the degradation of PLGA.NBTEBV has a good surgical maneuverability and histocompatibility, its remodeling evolutionary process fits in with tissue engineering specification. Building NBTEBV with ELSP is feasible.

To build nano-biomimetic tissue engineered blood vessel (NBTEBV) with nanotopology by using electrospinning (ELSP) technology.Cony vascular endothelial cell (VEC) on tubiform tooting in vitro was cultured. NBTEBV was built by use of multi-row nozzle with the suspension of cony vascular smooth muscle cell (VSMC) and mimic ECM (MECM) solution. NBTEBV was cultured with bioreactor in vitro. VEC and VSMC viability and proliferation were observed with MTT; and HE staining, scanning electron microscopy (SEM) observation and biomechanical test were carried out after 24 hours of static culture and 7 days of dynamic culture.After 7 days of culture, the length of NBTEBV was 57 mm, the external diameter was 4 mm and the thickness of wall was 0.4 mm. The NBTEBV's color was white and the texture was even and flexible. MTT results indicated the viability of cells cultured on NBTEBV for 7 days was normal (8.9 x 10(6)/mg, 3.5 x 10(5)/mg for 24 hours). SEM and HE staining indicated that the topologic character of NBTEBV was similar to that of the natural blood vessel. The NBTEBV showed a network scaffolds structure with 100 nm thick fiber and 600 nm aperture. The HE staining result showed that the NBTEBV was composed of VEC and VSMC by layer. Vascular mechanical results showed that the NBTEBV ultimate hydrostatic pressure was 950 mmHg, the compliance of the NBTEBV under physio-pressure (110/70 mmHg) was 3.0%; the ultimate tensile strength of 20 mm x 5 mm tissue slice was 18.5 MPa.The technology of ELSP can use VSMC and MECM scaffold simultaneously to build tissue engineered blood vessel with nanotopology mimic native blood vessel.

Objective: To explore the pathological change of water homeostasis in the secretory otitis media (SOM) middle ear, we observed the expression and regulation of aquaporin 1 (AQP1) in the SOM middle ear cavity. Methods: Reverse transcriptase polymerase chain reaction (RT-PCR), Western blotting and immunohistochemical staining were used to detect AQP1 in the bullae of SOM models and normal animals. The expression patterns of AQP1 in the SOM group were compared with those in the normal animal group. Results: RT-PCR and immunoblot analyses revealed that mRNAs encoding AQP1 were expressed in the middle ear membrane of the guinea pigs of both groups; AQP1 was also detected as 28-kDa proteins in both groups. Immunohistochemical analysis showed that AQP1 was localized on capillary endothelial cells and fibroblasts in the lamina propria mucosae as well as on flat and cubical epithelial cells. Quantitative analysis of RT-PCR and Western blotting revealed that AQP1 expression was higher in the SOM group than in the control group. The cellular expression of AQP1 was somewhat altered in the SOM middle ear. Conclusions: Our study suggests that AQP1 in the middle ear cavity may play a vital role in the accumulation of the effusion. It might work on the vessel-caused hydrops in the middle ear cavity.

PURPOSE To present results of a 9 year followup of percutaneous transluminal angioplasty (PTA) and stents placement in patients with Budd-Chiari Syndrome (BCS) and to evaluate the clinical value and applicability of this approach. MATERIALS AND METHODS 44 consecutive patients with BCS (25 male and 19 female; average age, 42.6 years; age range, 19-77 years) were treated with PTA and stents during a 9-year period. The mean duration of symptoms was 46 months. Underlying active malignancy was the cause of occlusion in 5 patients. 3 patients had a history of taking oral contraceptives. The obstructed inferior vena cava (IVC) or hepatic vein (HV) were first dilated by a percutaneous transluminal balloon, and then a self-expanding stent was placed. Clinical patency was defined as absence or improvement of symptoms. Clinical follow-up was supplemented with colour Doppler sonography, CT scan, or both. RESULTS Technical success was achieved in 97.2% (35/36) IVC and 83% (10/12) HV PTA and stents. Significantly, the IVC pressure decreased from 2.7 kPa (SD = 0.3) to 1.5 kPa (SD = 0.4) and HV pressure dropped from 2.3 kPa (SD = 0.4) to 1.3 kPa (SD = 0.2). The symptoms and signs disappeared or were relieved after operation in most of the patients. A few serious related complications including one stent migration and one pulmonary emboli occurred and were resolved in time. Patients were followed for a mean of 44 months (range 3-102). Short- and long-term results were satisfactory except for 3 patients (9.4%, 1 IVC, 2 HV) who presented with a restenosis or thrombosis and underwent additional therapy. There were 5 deaths owing to underlying malignant disease 3-17 months after the procedures. CONCLUSION PTA and stent placements proved a safe and effective treatment in BCS and had a good long-term outcome and should be considered in patients who have symptoms or have no adequate alternative therapy.