Search

Abstract Background Extracranial carotid artery aneurysm (ECAA) is a rare peripheral arterial disease. The main treatment strategies include conservative treatment, open surgery, endovascular treatment, and hybrid techniques, and there is no expert consensus or guidelines, with only a few case reports. Method This article reviewed 10 cases diagnosed with "extracranial carotid artery aneurysm" and received invasive treatment from January 2013 to July 2023 in our medical center. Results There were 10 patients with ECAA admitted to our center, including seven cases of true aneurysms, two cases of pseudoaneurysms, and one case of dissecting aneurysm. There were 3 females and 7 males aged between 24–61 years. Based on the characteristics of ECAA, we designed the individualized procedure including open surgery, endovascular treatment, and hybrid treatment. Procedures were technically successful for all patients, and none of them had any adverse events during the follow-up period except for one patient who developed cerebral hemorrhage on the third postoperative day and recovered after cerebral puncture and drainage. Conclusion The current invasive treatments for ECAA mainly include open surgery, endovascular treatment, and hybrid treatment, and they all appear to be safe and effective.

Abstract Background Carotid endarterectomy (CEA) is a surgical procedure that can reduce the risk of stroke in patients with carotid artery stenosis. However, controversy still exists regarding the optimal surgical technique for CEA. Objective To compare the safety and effectiveness of different techniques. Methods Data on baseline characteristics as well as perioperative and postoperative complications from patients who underwent CEA at the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, were retrospectively collected and analyzed. Results A total of 262 CEA patients included in study, with a total of 265 CEA operations. The mean age of 69.95 ± 7.29 (range, 44–89) years. 65 (24.5%) patients underwent cCEA, 94 (35.5%) underwent pCEA, and 106 (40.0%) underwent eCEA. The use of shunt (1.9%) and the mean operation time were lower in eCEA group (P

PURPOSE: To evaluate 6-month outcomes of drug-coated balloon (DCB) angioplasty of infrapopliteal lesions in patients with diabetic foot. METHODS: We analyzed 6-month follow-up data from the prospective PRIME-WIFI study with 203 consecutive patientswith diabetic foot who underwent DCB angioplasty for infrapopliteal arterial occlusive disease. The primary outcome was freedom from major adverse event (MAE), a composite of major amputation, all-cause death, and clinically-driven target limb reintervention (CD-TLR). Secondary outcomes included amputation-free survival (AFS), freedom from each primary outcome component, and complete wound healing. RESULTS: The mean age was 69.78 ± 9.50 years and 61 were female. A total of 271 lesions, with an average length of 26.02 ± 12.94 cm, accepted DCB angioplasty. Both infrapopliteal runoff score and pedal runoff score improved significantly after procedure compared with baseline. The score changes were − 5.73 and − 0.39, respectively (P < 0.001 for both). Within 6-month follow-up, 16 of the 203 patients died and 32 (15.76%) were lost to follow-up. By Kaplan–Meier analysis, at 6 months postprocedure, freedom from MAE was 85.77% (95% confidence interval [CI], 80.92%–90.91%); AFS was 88.88% (95% CI, 84.49%–93.49%); and freedom from major amputation, all-cause death, and CD-TLR were 95.65% (95% CI, 92.73%–98.65%), 92.57% (95% CI, 88.88%–96.4%), and 95.51% (95% CI, 92.51%–98.61%), respectively. During the 6-month follow up, complete wound healing was achieved in 67.11% patients. CONCLUSION: In patients with diabetic foot, DCB angioplasty of infrapopliteal lesions was effective and safe.

OBJECTIVE: Takayasu arteries (TAK) is a rare and unexplained inflammatory arterial disease that can occur in both children and adults. Our goal was to clarify the clinical features and surgical outcomes of aortitis in children and adults. METHODS: A retrospective cohort study was conducted on patients with TAK treated at tertiary care centers between 2012 and 2020. The American College of Rheumatology’s TAK criteria were used to select patients. Study results were reported using descriptive statistics and Kaplan–Meier methods. RESULTS: The cohort included 106 TAK patients with a median follow-up of 69 (interquartile range 80) months. Childhood TAK (c-TAK) differed from adult TAK (a-TAK) in terms of baseline: the predominant Nomo staging for c-TAK was Type IV (70.4), while the predominant staging for a-TAK was Type I (68.4%). Sixty-eight of them underwent surgical intervention, with a total of 85 vascular procedures (77 endoluminal procedures and 8 open procedures). c-TAK group had more endoluminal interventions (100%), while the a-TAK group had a higher proportion of open procedures (17.8%) than the c-TAK group, and the main complication in both groups was restenosis. Kaplan–Meier curves showed that c-TAK had a significantly higher rate of restenosis than a-TAK and had a significantly higher reintervention rate (logrank, P < 0.001). CONCLUSION: In conclusion, the main difference between c-TAK and a-TAK is that Nomo typing c-TAK is mainly Type IV, while a-TAK is mainly Type I. Furthermore, c-TAK has a higher rate of reintervention after surgical treatment than a-TAK, more attention should be paid to the postoperative follow-up of c-TAK patients, and further large sample studies are needed to confirm this.

Abstract Objective This study aims to establish and validate a nomogram model for the all-cause mortality rate in patients with diabetic nephropathy (DN). Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. A random split of 7:3 was performed between the training and validation sets. Utilizing follow-up data until December 31, 2019, we examined the all-cause mortality rate. Cox regression models and Least Absolute Shrinkage and Selection Operator (LASSO) regression models were employed in the training cohort to develop a nomogram for predicting all-cause mortality in the studied population. Finally, various validation methods were employed to assess the predictive performance of the nomogram, and Decision Curve Analysis (DCA) was conducted to evaluate the clinical utility of the nomogram. Results After the results of LASSO regression models and Cox multivariate analyses, a total of 8 variables were selected, gender, age, poverty income ratio, heart failure, body mass index, albumin, blood urea nitrogen and serum uric acid. A nomogram model was built based on these predictors. The C-index values in training cohort of 3-year, 5-year, 10-year mortality rates were 0.820, 0.807, and 0.798. In the validation cohort, the C-index values of 3-year, 5-year, 10-year mortality rates were 0.773, 0.788, and 0.817, respectively. The calibration curve demonstrates satisfactory consistency between the two cohorts. Conclusion The newly developed nomogram proves to be effective in predicting the all-cause mortality risk in patients with diabetic nephropathy, and it has undergone robust internal validation.

Abstract A tapered stent with inclined proximal end is designed for fitting the iliac anatomically. The aim of the present study was to evaluate the safety and performance of the new stent in ovine left iliac veins. The experiment was performed in 30 adult sheep, and one nitinol-based VENA-BT® iliac venous stent (KYD stent) was implanted into each animal’s left common iliac vein. Follow-up in all sheep consisted of angiographic, macroscopic, and microscopic examinations at Day 0 ( 0.05), indicating no serious lumen loss occurred during the follow-up period. Common iliac venous pressure was further measured and the results further indicated the lumen patency at follow-up. Histological examinations indicated that no vessel injury and wall rupture, stent damage, and luminal thrombus occurred. There was moderate inflammatory cell infiltration around the stent in Day-0 and Day-30 groups with the average inflammation score of 2.278 and 2.167, respectively. The inflammatory reaction was significantly reduced in Day-90, Day-180 and Day-360 groups and the average inflammation scores were 0.9444 (p

PurposeFemoropopliteal artery disease (FPAD) is a common vascular disease that usually requires surgical treatment. The aim of this study was to apply predictive modeling to develop predictive models for predicting clinically driven target revascularization (CD-TLR) events 1 year after intervention in patients with FPAD.Materials and methodsIn this study, clinical data were collected from a total of 484 patients who underwent FPAD endovascular intervention from 2014 to 2019. According to the inclusion and exclusion criteria, 400 patients will be finally included and assigned to the training cohort and test cohort in the ratio of 7:3. By analyzing these data through statistical methods, we will explore the effects of different factors on target revascularization events 1 year after intervention in FPAD patients, and build the corresponding prediction model of the column line graph.ResultsThe final nomogram model consisted of 5 independent predictors: history of cerebrovascular disease, lesion length >15 cm, no atherectomy device used, no medicated balloon used and procedure time. The C-index of the model was 0.766 and 0.726 for the training cohort and validation cohort, respectively. The calibration curves also showed that the model had satisfactory agreement in both cohorts.ConclusionsThe newly developed prediction model can accurately predict clinically driven target revascularization events at 1 year in patients with FPAD, providing valuable information for the development of individualized treatment plans.

BackgroundDrawing on prospective data from the National Health and Nutrition Examination Survey (NHANES), our goal was to construct and validate a 5-year survival prediction model for individuals with cognitive impairment (CI).MethodsThis study entailed a prospective cohort design utilizing information from the 2011–2014 NHANES dataset, encompassing individuals aged 40 years or older, with updated mortality status as of December 31, 2019. Predictive models within the derivation and validation cohorts were assessed using logistic proportional risk regression, column-line plots, and least absolute shrinkage and selection operator (LASSO) binomial regression models.ResultsThe study enrolled a total of 1,439 participants (677 men, mean age 69.75 ± 6.71 years), with the derivation and validation cohorts consisting of 1,007 (538 men) and 432 (239 men) individuals, respectively. The 5-year mortality rate stood at 16.12% (n = 232). We devised a 5-item column-line graphical model incorporating age, race, stroke, cardiovascular disease (CVD), and blood urea nitrogen (BUN). The model exhibited an area under the curve (AUC) of 0.772 with satisfactory calibration. Internal validation demonstrated that the column-line graph model displayed strong discrimination, yielding an AUC of 0.733, and exhibited good calibration.ConclusionTo sum up, our study successfully developed and internally validated a 5-item nomogram integrating age, race, stroke, cardiovascular disease, and blood urea nitrogen. This nomogram exhibited robust predictive performance for 5-year mortality in individuals with CI, offering a valuable tool for prognostic evaluation and personalized care planning.

The anatomy of the human shoulder predisposes the neurovascular bundle to compression at different levels of the thoracic outlet during abduction of the arm. There are four possible levels of compression at the thoracic outlet pathway: at the costo-clavicular angle, the inter-scalenic angle, under the pectoralis minor muscle or at the level of the humeral head. The positional thoracic outlet compression (TOC) often remains completely asymptomatic. When symptomatic, compressions are collectively referred to as thoracic outlet syndrome (TOS) and may require surgery if physical therapy fails to improve symptoms. The “thoracic outlet compression with complications or sequelae” (the acronym of which is “TOC-CS”, which can be simplified as “TOX”) will almost invariably lead to surgery to release the compression, and other possible treatment targeting the complications as required. There is a continuum between TOC, TOS and TOX, which are simply different clinical stages of the same mechanical issue, just like the Rutherford grades represent different stages of lower extremity arterial disease. We believe that discriminating between TOC, TOS and TOX clarifies clinical definitions and their respective treatment options. TOC is to be considered as a physiological positional phenomenon, TOS requires medical or surgical treatment and surgery should be considered as a primary option in TOX.

Conclusion: The newly developed nomogram has proved to be an important tool for accurately predicting cognitive impairment in elderly patients with diabetes, providing important information for targeted prevention and intervention measures.

At present, research on blunt abdominal aortic injury (BAAI) is limited, with the majority being case reports. Consequently, there is a significant knowledge gap concerning this condition. To address this, we conducted a systematic review by extensively searching major databases. We included all literature that provided individual (non-identifiable) data on BAAI patients, irrespective of the study design. Furthermore, we undertook regression analyses to identify predictors of death after BAAI. The search yielded 2,099 results, leading to the inclusion of 102 case reports and one conference abstract. Using the Joanna Briggs Institute (JBI) checklist for assessment, all studies were deemed of medium to high quality. In total, 133 patients were included, with a median age of 34 years, and 73.7% being male. The predominant clinical manifestation was pain, reported in 65.6% of patients. The most frequently observed aortic lesion severity was grade A (intimal tear or intramural hematoma) at 46.9%, and the most common lesion location was zone III (infrarenal aorta) in 88.3% of cases. The overall mortality after BAAI was 15.3%. Multivariate regression analyses revealed the following predictors of death after BAAI: lower limb ischemia (relative risk [RR] = 7.137, 95% confidence interval [CI] 1.154 - 44.161), cardiopulmonary arrest (RR = 10.250, 95% CI 1.452 - 72.344), and injuries to body parts other than the abdomen and lumbar spine (RR = 2.593, 95% CI 1.189 - 5.655). In conclusion, this review provides a detailed quantitative summary of BAAI's clinical manifestations, diagnosis, treatment, and prognosis, emphasizing its high mortality rate and identifying three critical variables as predictors of death.

Thoracic endovascular repair (TEVAR) is currently the recommended and most widely used treatment for type B aortic dissection. A major challenge is revascularization of the left subclavian artery in order to extend the landing zone to zone 2 (Ishimaru classification). Various strategies have been used for revascularization, including branched stent graft, fenestrated stent graft, the chimney technique, the parallel technique, and bypass surgery. Single-branched stent graft is one of the most promising strategies, and several products have recently been reported as potential candidates for use with this approach. The Castor single-branched stent graft is the only off-the-shelf product available; this product has been developed through collaboration between Chinese corporations and clinicians. In this Perspective article, clinical experience and data obtained from TEVAR with the Castor single-branched stent graft are summarized by experienced Chinese experts.

ABSTRACT Spinal cord ischemia due to decreased cord perfusion is a devastating complication in patients with thoracoabdominal dissection following frozen elephant trunk (FET) repair surgery. However, rare occurrence of spinal cord ischemia leading to paraplegia after long-term follow-up of FET repair has been reported. Here, we describe a case of spinal cord ischemia resulting in paraplegia nine years after hybrid total arch repair with FET. Cerebrospinal fluid drainage and serial treatment were utilized to decrease intraspinal pressure and increase blood flow to the spinal cord. Three months after the onset of paraplegia and with treatment and rehabilitation, the patient recovered to walk.

ObjectiveTo compare the clinical efficacy of covered stents and bare-metal stents in the endovascular treatment of subclavian artery occlusive disease.MethodsBetween January 2014 and December 2020, 161 patients (112 males) underwent stenting of left subclavian arteries; CSs were implanted in 55 patients (34.2%) and BMSs in 106 (65.8%). Thirty-day outcomes, mid-term patency, and follow-up results were analyzed with Kaplan-Meier curves. Relevant clinical, anatomical, and procedural factors were evaluated for their association with patency in the two groups using Cox proportional hazards regression.ResultsMean follow-up was 45 ± 18 months. The primary patency was 93.8% (95% CI, 81.9%–98.0%) in the covered stent group and 73.7% (95% CI, 63.2%–81.6%; P = 0.010) in the bare-metal stent group. The primary patency in the total occlusion subcategory was significant in favor of CS (93.3%, 95% CI, 61.26%–99.0%) compared with BMS (42.3%, 95% CI, 22.9%–60.5%; P = 0.005). Cox proportional hazards regression indicated that the use of BMSs [hazard ratio (HR), 4.90; 95% CI, 1.47–16.31; P = 0.010] and total occlusive lesions (HR, 7.03; 95% CI, 3.02–16.34; P

Abstract Objective This study identified underlying genetic molecules associated with histologically unstable carotid atherosclerotic plaques through bioinformatics analysis that may be potential biomarkers and therapeutic targets. Methods Three transcriptome datasets (GSE41571, GSE120521 and E-MTAB-2055) and one non-coding RNA dataset (GSE111794) that met histological grouping criteria of unstable plaque were downloaded. The common differentially expressed genes (co-DEGs) of unstable plaques identified from three mRNA datasets were annotated by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomics (KEGG). A protein–protein interaction (PPI) network was constructed to present the interaction between co-DEGs and screen out hub genes. MiRNet database and GSE111794 dataset were used to identify the miRNAs targeting hub genes. Associated transcription factors (TFs) and drugs were also predicted. These predicted results were used to construct miRNA/TFs-hub gene and drug-hub gene regulatory networks. Results A total of 105 co-DEGs were identified, including 42 up-regulated genes and 63 down-regulated genes, which were mainly enriched in collagen-containing extracellular matrix, focal adhesion, actin filament bundle, chemokine signaling pathway and regulates of actin cytoskeleton. Ten hub genes (up-regulated: HCK, C1QC, CD14, FCER1G, LCP1 and RAC2; down-regulated: TPM1, MYH10, PLS3 and FMOD) were screened. HCK and RAC2 were involved in chemokine signaling pathway, MYH10 and RAC2 were involved in regulation of actin cytoskeleton. We also predicted 12 miRNAs, top5 TFs and 25 drugs targeting hub genes. In the miRNA/TF-hub gene regulatory network, PLS3 was the most connected hub genes and was targeted by six miRNAs and all five screened TFs. In the drug-hub gene regulatory network, HCK was targeted by 20 drugs including 10 inhibitors. Conclusions We screened 10 hub genes and predicted miRNAs and TFs targeting them. These molecules may play a crucial role in the progression of histologically unstable carotid plaques and serve as potential biomarkers and therapeutic targets.

Introduction Femoropopliteal artery in-stent restenosis (FP-ISR) represents one of the main obstacles for stent implantation in peripheral artery disease patients, especially Tosaka III FP-ISR, which is also referred to as in-stent occlusion. Diverse endovascular treatments of Tosaka III FP-ISR are available, and the results are unequivocal. However, real-world data are limited. This study aims to evaluate the efficacy, safety and health economics evaluation of various endovascular procedures in the treatment of Tosaka III FP-ISR.Method and analysis This study is a prospective, multicentre, real-world, observational clinical study. Patients diagnosed with Tosaka III FP-ISR and treated with endovascular procedures in nine centres from 1 April 2021 to 31 December 2022 will be recruited. The relevant clinical information, Ankle-Brachial Index and CT angiography will be collected. All the participants will undergo follow-up at 1, 6, 12, 18 and 24 months after the operation. The primary outcome is freedom from clinically driven target lesion revascularisation at 24 months. Safety and health economics issues will also be reported.Ethics and dissemination The FP-RESTORE clinical trial has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/). This study was also approved by the Institutional Review Board and Human Research Ethics Committee of Zhongshan Hospital, Fudan University (approval number: B2021-427). Moreover, written informed consent will be obtained at the time of recruitment. The study outcomes will be disseminated by publication in a peer-reviewed journal to provide information for further clinical practice.Trial registration number NCT04801004.

BackgroundEndovascular treatment has become the first-line therapy for infrapopliteal artery occlusive disease (IPOD), while the optimal endovascular method remains to be determined. We performed a network meta-analysis (NWM) of randomized controlled trials (RCTs) to simultaneously compare the outcomes of different endovascular modalities for IPOD.Methods and resultsThe Pubmed, Embase, and Cochrane databases were used as data sources. The NWM approach used random-effects models based on the frequentist framework. In total, 22 eligible RCTs (44 study arms; 1,348 patients) involving nine endovascular modalities or combinations [balloon angioplasty (BA), drug-coated balloon (DCB), drug-eluting stent (DES), atherectomy device + BA (AD + BA), AD + DCB, balloon-expandable bare metal stent (BMS), self-expanding stent (SES), absorbable metal stents (AMS), and inorganics-coated stent (ICS)] were included. BA had a lower 12-month primary patency rate than DCB (RR 0.50, CI 0.27, 0.93) and AD + DCB (RR 0.34, CI 0.12, 0.93). AD + DCB decreased 6-month TLR compared with AMS (RR 0.15, CI 0.03, 0.90), and DES decreased it compared with BMS (RR 0.25, CI 0.09, 0.71). DCB had a lower 6-month TLR rate than AMS (RR 0.26, CI 0.08, 0.86) and BA (RR 0.51, CI 0.30, 0.89). BA had a higher 12-month TLR rate than DCB (RR 1.76, CI 1.07, 2.90). According to the value of the surface under the cumulative ranking curve (SUCRA), AD + DCB was considered the best treatment in terms of primary patency at 6 months (SUCRA = 87.5) and 12 months (SURCA = 91). AD + BA was considered the best treatment in terms of 6-month TLR (SUCRA = 83.1), 12-month TLR (SURCA = 75.8), and 12-month all-cause mortality (SUCRA = 92.5). In terms of 12-month major amputation, DES was considered the best treatment (SUCRA = 78.6), while AD + DCB was considered the worst treatment (SUCRA = 28.8). Moreover, AD + BA always ranks higher than AD + DCB in the comparison including these two combinations. Subgroup analyses of modalities without stenting did not significantly change the primary outcomes.ConclusionADs showed noteworthy advantages in multiple terms for IPOD except for 12-month major amputation. AD + BA may be a better method for IPOD than AD + DCB. The efficacy and safety of ADs are worthy of further investigation.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022331626].

IntroductionCurrent evidence indicates endovascular intervention is a safe and effective treatment for peripheral artery disease of the lower extremity. However, the clinical outcome of endovascular intervention for femoropopliteal lesions has been shown to be affected by the status of tibial runoff. It remains unclear whether endovascular intervention for tibial runoff is associated with additional benefits.Methods and analysisThis prospective, multicenter, real-world observational study is carried out from January 2021 to December 2022 in 8 designated centers across China with an estimated sample size of 1200 patients with severe femoropopliteal disease. The pre-procedural status of tibial runoff is evaluated with the modified SVS score and categorized as good (SVS 10). Whether the patient will be treated with endovascular intervention for tibial runoff is determined by the treating vascular surgeons. Patients are dichotomized into the intervention group and the non-intervention group, with each group further divided into the good, compromised and poor tibial run-off subgroup, yielding 6 subgroups in total. Patients within various subgroups are compared with regard to the primary patency rate of the femoropopliteal artery, changes in quality of life, changes of Rutherford category, improvement of the Wound, Ischemia, and Foot Infection Classification, and incidence of major adverse events over 24-months follow-up. The results of this study may provide important information to help vascular sspecialists to decide whether the tibial runoff should be endovascularly intervened and which patient population benefits most from tibial runoff intervention.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04675632?id=NCT04675632&draw=2&rank=1, NCT04675632.

ObjectivesPeripheral artery disease with calcification is extremely prevalent in the elderly. Due to the calcification, it requires a different clinical approach than the more common arteriosclerosis obliterans of the lower extremity. The introduction of novel technologies such as the drug-coated balloon, directional atherectomy, supera and drug-eluting stent has improved the prognosis of these patients. This study will contribute to the development of higher-quality evidence-based medicine for clinical treatment by assessing the quality of life (QOL), clinical treatment effect, and health economics of patients with calcification.Method and analysisThe Evolution study is designed as a prospective, multicenter, observational, real-world study. From January 2021 to December 2022, 600 patients with moderate to severe femoropopliteal artery calcification will be recruited from ten locations in China. After discharge, information on demographics, disease history, procedure details, imaging findings, and follow-up will be collected. Patients will undergo follow-up at 1, 6, 12, 18, and 24 months after operation. Technical success rate, vascular quality of life questionnaire, primary patency rate of the target lesion, clinically driven target lesion revascularization rate (CD-TLR), and health economics evaluation are all included as outcome measures.ConclusionsThe Evolution study helps to investigate the clinical and financial results of various endovascular therapy modalities for patients with moderate and severe femoropopliteal artery calcification. These actual facts may help to harmonize therapy recommendations for peripheral artery disease.Clinical trial registrationThe study protocol was registered at www.clinicaltrials.gov (registration number: NCT04716361).

OBJECTIVE: The objective of this study was to investigate the safety and efficacy of hepatocyte growth factor (HGF) gene therapy in the patients with diabetic lower limb arteriosclerosis obliterans, provide theoretical support for better coordination of clinical operation and anesthesia, ensure medical safety, and improve the quality of nursing. MATERIALS AND METHODS: Twenty-one patients with Grade 4–6 (Rutherford classification) and limb ischemia who met the inclusion criteria were divided into four dose groups, including three cases in the 4 mg group, six cases in the 8 mg group, five cases in the 12 mg group, and seven cases in the 16 mg group. The dosage of each group was divided into equal doses, which were injected intramuscularly on the 1st and 15th days of treatment, respectively. The dosage of each injection point was 0.25 mg/0.5 ml. Adverse reactions, visual analog scale (VAS) scores for pain and ulcer healing were observed on the 1st, 8th, 15th, 21st, 28th, 59th, and 91st days after the treatment. The ankle-brachial index (ABI) was measured on the 1st, 28th, 59th, and 91st days after the treatment. RESULTS: Complications, serious adverse reactions, and abnormal test results did not occur in the patients during the operation. After the operation, the pain had significantly reduced in 17 cases, the average VAS score of all cases decreased from 5.95 to 1.64 (P < 0.05), and the pain disappeared completely in four cases. The average ABI of all cases increased from 0.49 to 0.63 (P < 0.05), five cases had ulcer, and four cases had gangrene. After treatment, one case of ulcer and one case of gangrene healed completely, and three cases of ulcer and one case of gangrene improved significantly, and one case of ulcer and two cases of gangrene had no significant change. CONCLUSION: HGF gene therapy can effectively treat diabetic lower limb arteriosclerosis obliterans, relieve the clinical symptoms and improve the quality of life. The smooth operation is inseparable from the cooperation of nurses, including careful preoperative visit, strict aseptic operation during the operation, follow-up visit regularly after the operation, and mastering the changes in patients' condition in the whole process to provide high-quality nursing for patients.

OBJECTIVE: This study examined the psychological impact of the coronavirus disease 2019 (COVID-2019) outbreak on medical staff in China. MATERIALS AND METHODS: In February 2020, an online survey was carried out by using an online survey tool (WeChat) to evaluate the effects of the outbreak on the mental health of medical staff in China. RESULTS: A total of 11,118 medical staff responded to the survey. About 4.98% of the respondents reported middle and high levels of anxiety, while 13.47% of the respondents reported middle and high levels of depression since the COVID-19 outbreak. Nurses, frontline medical staff, and younger medical staff were more likely to have anxiety and depression than physicians, nonfrontline medical staff, and older medical staff. CONCLUSIONS: Although the serious psychological impact of COVID-19 is not so common in medical staff in China, programs are needed to protect them against the negative impacts of COVID-19.

OBJECTIVE: This study investigated the psychological effect of the coronavirus disease 2019 (COVID-19) outbreak on medical students in China. METHODS: In February 2020, an online survey was performed using a WeChat app with an online survey program to collect and analyze the effects of the COVID-19 outbreak on the mental health of medical students across China. RESULTS: Overall, 757 medical students responded to the survey. About 2.24% reported middle and high levels of anxiety since the COVID-19 outbreak began, and 14.40% reported middle and high levels of depression. Bachelor's students and those whose residence registration was located in a rural area were more likely to have anxiety and depression, compared with postgraduates and students whose residence registration location was an urban area, respectively. CONCLUSIONS: The COVID-19 epidemic is associated with a low but real rate of psychological trauma in the medical students of China, and protective programs are needed to lessen this adverse effect.

OBJECTIVE: To examine the difference in safety and effectiveness of directional atherectomy (DA) and plain balloon angioplasty with adjunctive stenting (BA-STENT) in the treatment of de novo femoropopliteal artery occlusive lesions. MATERIALS AND METHODS: This prospective, randomized trial of DA versus BA-STENT in femoropopliteal arteries was carried out in a single medical center. Demographic data, procedural characteristics, and follow-up information were recorded. The technical, procedural, and clinical outcomes were reported. The primary endpoint was the primary stenosis-free patency rate at 12 and 18 months after the intervention. The secondary endpoints included the rates of technical success, freedom from clinically driven target lesion revascularization (TLR), limb amputation, and all-cause mortality. RESULTS: A total of 188 patients were included in this study. The DA group consisted of 89 (47.3%) patients, and the BA-STENT group consisted of 99 (52.7%) patients. There were 134 males and 54 females with an average age of 68 years, all of which had lesions of Rutherford Grade 2 and above. There was no statistically significant difference in age, gender, smoking, or comorbidities between two groups. The technical success rates were 98.9% in the DA group and 100% in the BA-STENT group (P = 0.47). There was no statistically significant difference in primary stenosis-free patency (90.0% vs. 90.6% at 6 months, 76.7% vs. 77.8% at 12 months, and 72.3% vs. 68.9% at 18 months after the intervention) or freedom from TLR (96.3% vs. 95.8% at 6 months, 88.3% vs. 91.6% at 12 months, and 86.1% vs. 85.4% at 18 months after the procedure) between the DA and the BA-STENT groups. There was no statistically significant difference in terms of distal embolization, thrombosis, and mortality between two groups. No patient underwent major amputation. CONCLUSION: For the treatment of de novo Trans-Atlantic Inter-Society Consensus (TASC) II A-C femoropopliteal artery lesions, DA demonstrated comparable results with the plain balloon angioplasty with adjunctive stenting.

OBJECTIVE: We sought to determine the psychological impact of the COVID-2019 outbreak on general population in China. MATERIALS AND METHODS: In 20–22 February 2020, an online survey was implemented using an internet survey tool to collect the information and analyze the effects of the outbreak on the mental health of public population around China. RESULTS: A total of 6471 person responded the survey. About 3.46% of the respondents reported middle and high levels of anxiety while 0.62% of the respondents reported middle and high levels of depression since the COVID-19 outbreak. Respondents who were female younger or had middle-level education were more likely to have anxiety and depression than those who were male, older or had high-level education, respectively. CONCLUSIONS: The prevalence of COVID-19-related anxiety was higher among female and younger respondents, and those with low education. Preventing, detecting, and intervention to mental health conditions should be an important component of public health policy during COVID-19 outbreak.

Abstract Background For patients with thromboangiitis obliterans (TAO), revascularization with bypass or angioplasty is frequently not feasible due to the poor outflow of the distal small vessels. We evaluated the long-term results of our experience treating patients with TAO with autologous bone marrow-derived mononuclear cells (ABMMNCs) to determine the safety and efficacy of ABMMNC therapy in patients with critical limb ischemia due to TAO. Methods This was a retrospective chart review from a single university hospital vascular surgery center between January 2005 and July 2006. Patients were treated with smoking cessation and either aspirin (100 mg/day) alone or aspirin and ABMMNC injection according to patient preference. Groups were compared for demographics, clinical characteristics, and short-term and long-term results. Results Of 59 patients with TAO who were treated, 19 patients elected aspirin alone and 40 patients elected aspirin and ABMMNC injection. No patients suffered perioperative complications and 49 (83%) patients remained smoke-free for 10 years. The 10-year amputation-free survival was 85.3% (29/34) in patients treated with ABMMNCs compared to 40% (6/15) in patients treated with aspirin alone (p = 0.0019). Ulcer area (p

CONTEXT: Sleep disturbance and proinflammatory markers were reported to link to the development of type 2 diabetes mellitus and glucose homeostasis. METHODS: A clinical laboratory–based analysis was performed on 14 normal volunteers, 11 diabetic patients and 16 non-diabetic patients form department of vascular surgery conducted between January 2013 and March 2013. Continuous polysomnographic monitoring was performed on 2 nights in the intensive care unit (IUC). Blood glucose level was controlled by insulin infusion. Concentrations of IL-6 and CRP levels were determined by enzyme-linked immunoassays. OBJECTIVE: To raise awareness of risk factors among postsurgery type 2 diabetes with foot ulcers. DESIGN: A clinical laboratory-based analysis was performed on 14 normal volunteers, 11 diabetic patients, and 16 nondiabetic patients from Department of Vascular Surgery conducted between January 2013 and March 2013. SETTING: This trial was admitted to Siping hospital affiliated to China Medical University, China. PATIENTS: Twenty-seven patients were postthrombolytic therapy and 14 healthy controls. INTERVENTIONS: Continuous polysomnographic monitoring was performed on 2 nights in the Intensive Care Unit (ICU). Blood glucose level was controlled by insulin infusion. Concentrations of interleukin-6 (IL-6) and C-reactive protein (CRP) levels were determined by enzyme-linked immunoassays. MAIN OUTCOME MEASURE: Changes in exogenous insulin requirements, while IL-6 and CRP levels. RESULTS: Insulin requirements on admission in ICU 48-h treatment increased 21.2% in diabetic patients compared to 24-h postsurgery. All postsurgical patients elevated IL-6 and CRP levels compared to normal individuals in the morning after 24 h and 48 h of sleep restriction. Fasting concentrations of IL-6 were distinctly increased 23.6% and 42.9%, respectively, after 24 h and 48 h of sleep restriction in diabetic patients compared to normal individuals and 18.5% and 21.8%, respectively, compared to nondiabetic patients. CRP levels are similar to IL-6 levels among these partners. CONCLUSIONS: Our study elucidated that sleep disruption aggravates disturbed glucoregulatory and systemic inflammation among postsurgical diabetic patients, which might contribute to understand these disorders for diabetic patients in immunological pathways.

OBJECTIVE: To compare the effectiveness of surgical bypass and endovascular therapy for juxtarenal abdominal aortic occlusion. METHODS: Data of 37 patients treated with open arterial bypass surgery or endovascular therapy for juxtarenal abdominal aortic occlusion in the last 10 years were retrospectively analyzed. RESULTS: Of the 37 cases, 32 were male and five were female; the mean age was 58.5 years; the mean disease history was 8.2 months. Open surgery was performed in 18 cases and endovascular treatment was done in 19 cases. No significant differences in either technical success rate or perioperative symptom improvement rate were found between the open surgery and endovascular therapy groups. There w as much more blood loss, hospital stay time, and fewer hospitalization expenses in the open group than the endo group. In the open group, the mean follow-up time was 60.5 months and graft patency rate was 94.4%; in the endo group, the mean follow-up was 52.5 months but the patency rate was 82.4% (P = 0.009). CONCLUSIONS: Both open surgery and endovascular treatment are effective for juxtarenal aortic occlusion. In comparison, open surgery has lower cost with better long-term eff icacy, while endovascular therapy has less invasiveness with faster postoperative recovery. O perative approach should be made according to the patient's clinical conditions.

Transcutaneous oxygen pressure measurement (TcPO2) is well known as a useful tool for the evaluation of critical limb ischemia, but it is rarely used during exercise (Ex-TcPO2). We have used exercise oximetry, in Angers, as a noninvasive vascular investigation for about >15 years to detect regional blood flow impairment at the proximal and distal levels simultaneously and on both sides. The use of a chest electrode is required to calculate the Delta from rest of oxygen pressure index (DROP) and account for eventual systemic exercise-induced hypoxemia. The DROP index that we proposed in our first publication in 2003, because of its mathematical formula, is independent of the absolute oxygen pressure starting values which result in improved reliability of Ex-TcPO2 as compared to the regional perfusion index. The present review is of specific interest at a time when the technique is rapidly spreading in France and Abroad.

We report the outcomes of directional atherectomy using a distal protective device and drug-coated balloon angioplasty in four patients with severe atherosclerotic vertebral artery stenosis. All cases were clinically successful with complete resolution of the symptoms. Immediate and postoperative results showed a good technical success. These results suggest that vertebral artery stenosis treated with directional atherectomy is technically feasible and may be a safe and effective option when performed by experienced endovascular surgeons.

Induced pluripotent stem cells (iPSC) represent an innovative, somatic cell-derived, easily obtained and renewable stem cell source without considerable ethical issues. iPSC and their derived cells may have enhanced therapeutic and translational potential compared with other stem cells. We previously showed that human iPSC-derived smooth muscle cells (hiPSC-SMC) promote angiogenesis and wound healing. Accordingly, we hypothesized that hiPSC-SMC may be a novel treatment for human patients with chronic limb-threatening ischemia who have no standard options for therapy. We determined the angiogenic potential of hiPSC-SMC in a murine hindlimb ischemia model. hiPSC-SMC were injected intramuscularly into nude mice after creation of hindlimb ischemia. Functional outcomes and perfusion were measured using standardized scores, laser Doppler imaging, microCT, histology and immunofluorescence. Functional outcomes and blood flow were improved in hiPSC-SMC-treated mice compared with controls (Tarlov score, p < 0.05; Faber score, p < 0.05; flow, p = 0.054). hiPSC-SMC-treated mice showed fewer gastrocnemius fibers (p < 0.0001), increased fiber area (p < 0.0001), and enhanced capillary density (p < 0.01); microCT showed more arterioles (p < 0.05) and increased numbers of M2-type macrophages (p < 0.0001). Vascular endothelial growth factor (VEGF) expression in ischemic limbs was significantly elevated with hiPSC-SMC treatment (p < 0.05), and inhibition of VEGFR-2 with SU5416 was associated with fewer capillaries in hiPSC-SMC-treated limbs (p < 0.0001). hiPSC-SMC promote VEGF-mediated angiogenesis, leading to improved hindlimb ischemia. Stem cell therapy using iPSC-derived cells may represent a novel and potentially translatable therapy for limb-threatening ischemia.