Abstract:Minimally invasive treatment for aortic lesions has been realized with the emergence of endovascular era. Treating high risk and complicated aortic diseases with minimal traumatic techniques will be one of the future directions of aortic surgery. With the rapid improvement of endovascular instruments and development of endovascular techniques, many vascular surgery diseases previously dependent only on open surgery, have now been applicable to endovascular treatment. It is believed that minimally invasive endovascular interventions will be the mainstream practice in vascular surgery during the forthcoming two decades.

Abstract:The catastrophe of isolated superior mesenteric artery dissection (ISMAD) includes intestinal ischemia and rupture of dissection aneurysm. Conservative therapy (anticoagulation plus blood pressure control), surgery and stenting are the common treatments for ISMAD. However, there are diverse views on the indications for and timing of its treatment, as well as the selection of stent types. Western scholars consider that guideline for treatment of ISMAD cannot be derived because it is extremely rare. However, the reported number of cases of ISMAD in China indicates that ISMAD is not actually rare. So, there are opportunities to conduct clinical studies on ISMAD in the area of vascular surgery in China, and thereby may provide substantial clinical evidence for the establishment of guideline for ISMAD treatment.

Abstract:Objective: To investigate the clinical strategies and safety of “one-stop" solution by combination of percutaneous coronary intervention (PCI) endovascular aortic repair (EVAR) for concomitant coronary heart disease and aortic atherosclerotic disease. Methods: The clinical data of 7 patients with aortic atherosclerotic disease and concomitant coronary heart disease undergoing endovascular treatment in Fuwai Hospital from January 2016 to June 2016 were retrospectively analyzed. Of the patients, 6 cases were male and 1 case was female, with an average of 76.2 (64–86) years of age; the co-existence of aortic atherosclerotic disease and coronary heart disease was confirmed by preoperative aortic and coronary CT imaging, and all underwent “one-stop” operation after verification of indications for interventional therapy in both aortic and coronary artery lesions by intraoperative angiography. Results: The operative success rate was 100% and no perioperative death occurred. Postoperative complications included subcutaneous ecchymosis near the incision site in 2 cases, of whom, 1 case complicated with hematoma and given transfusion received 2 U packed red blood cells due to hemoglobin decline. One case with descending aortic arch ulcer undergoing reconstruction of the left subclavian artery by chimney technique, developed pseudoaneurysm at the puncture site of the left brachial artery, and then underwent surgical repair. All patients were followed up by outpatient visit or telephone contact, and during the follow-up period of 7 (6–10) months, their symptoms had disappeared or were significantly alleviated, with improved quality of life; no repeat operation was required and no death occurred. Conclusion: “One-stop” treatment by PCI and EVAR for concomitant coronary heart disease and aortic atherosclerotic disease has satisfactory short- and mid-term efficacy, and precaution should be taken for the hemorrhagic complications in the incision and puncture site. Postoperative medications should be strictly given according to the principle for coronary heart disease treatment.

Abstract:Objective: To investigate the clinical indications and effectiveness of endovascular aortic repair (TEVAR) emergency treatment of thoracic aortic rupture, and overview the relevant clinical experience. Methods: The clinical data of patients with thoracic aortic rupture admitted and treated from January 2006 to September 2015 in Department of Cardiothoracic Surgery, Wuhan General Hospital of PLA were retrospectively analyzed. Results: A total of 51 patients with thoracic aortic rupture (due to rupture of thoracic aortic dissecting aneurysm in 15 cases, thoracic aorta trauma in 32 cases and aortoesophageal fistula in 4 cases) who underwent emergency treatment of TEVAR procedure were retrieved. Of the 51 patients, 4 cases died during the initial treatment prior to TEVAR, and 47 cases received successful TEVAR operation; 6 cases (3 cases having aortoesophageal fistula) died after operation, while no serious complications occurred in the remaining 41 cases, in whom, no death occurred within postoperative one month. All cases were followed up at postoperative 3 months, 6 months and one year. By the end of May 2016, 36 cases received complete follow- up, the mean follow- up time was 56.6 months (range, 6 to 123 months); of these, the follow-up time after operation in one case was 6 months, in 4 cases was 12 months and in one case was 24 months. At follow-up, all the patients were in good health, and with no complications such as endoleak, stenosis or blockage of the bypass graft. Conclusion: TEVAR is a rapid and effective treatment modality for thoracic aortic rupture.

Abstract:Objective: To investigate the influence of thoracic endovascular aortic repair (TEVAR) combined with restrictive bare stent (RBS) implantation on postoperative aortic remodeling in treatment of aortic dissection. Methods: The data of 20 patients with type B aortic dissection treated from August 2012 to August 2014 were retrospectively analyzed. Of the patients, 11 cases underwent TEVAR alone (TEVAR group), and 9 cases received TEVAR plus RBS implantation (TEVAR+RBS group). According to the preoperative and postoperative follow-up CTA data, the relevant variables related to postoperative aortic remodeling were compared between the two groups of patients. Results: The operative success rate was 100% for either group, and no postoperative complications such as paraplegia, stroke, and aortic rupture occurred. The mean overlap length of RBS and covered stent was 36.5 mm in TEVAR+RBS group. Compared with TEVAR group, the oversizing rate of entire true lumen volume (34.9% vs. 64.9%, P=0.011), the area distal to the covered stent graft (43.5% vs. 107.3%, P=0.006) and the longest diameter distal to the covered stent graft (–12.2% vs. 18.5%, P=0.002) in TEVAR+RBS group were all significantly reduced. There was no significant difference between TEVAR group and TEVAR+RBS group in shrinkage rate of the false lumen volume (74.8% vs.65.3%, P=0.328) and the false lumen thrombosis rate (56.8% vs. 47.3%, P=0.271). Conclusion: Compared with TEVAR alone, TEVAR combined with RBS for aortic dissection shows no superiority in improving postoperative aortic remodeling. However, it can effectively decrease the oversizing of the area (or longest diameter) of the true lumen distal to the stent, and thereby may reduce the incidence of distal stent graft-induced new entry.

Abstract:Objective: To investigate the short- to mid-term clinical efficacy of endovascular intervention for spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: The clinical data of 16 patients with SISMAD treated from March 2009 to August 2016 were retrospectively analyzed. Of the patients, the dissection was classified as type I in 3 cases (18.75%), type II in 3 cases (18.75%) and type III in 10 cases (62.5%) according to Sakamoto’s classification. Results: One type I patient underwent conservative treatment with satisfactory results, 2 type I patients, 3 type II patients and 5 type III patients underwent single-stent implantation, and 5 type III patients underwent double-stent implantation (one type III case with nearly 95% stenosis in the true lumen had balloon dilation before placement of two stents). All the stents used were self-expanding type. Follow-up was conducted for 1 month to 34 months with a median follow-up time of 16 months, no disease-associated abdominal pain was noted, and CTA showed no flow of contrast in the false lumen and no stent migration or deformation and intra-stent stenosis or occlusion occurred. Conclusion: Endovascular intervention offers favorable short- to mid-term results in treatment SISMAD and however, its long-term outcomes should be further determined.

Abstract:Objective: To investigate the effect of surgical treatment and preoperative assessment methods for symptomatic internal carotid artery (ICA) occlusion. Methods: The clinical data of 11 patients with symptomatic ICA occlusion undergoing surgical treatment from January 2010 to March 2016 in Department of Vascular Surgery of Hainan General Hospital were analyzed retrospectively. Of the patients, 2 cases underwent carotid endarterectomy (CEA) and 9 cases underwent CEA plus embolectomy. Before operation, all patients underwent intracranial and cervical CTA and carotid duplex ultrasonography, and some patients underwent head CT perfusion, transcranial Doppler and whole-brain angiography. The perioperative and long-term results of the patients were observed. Results: All patients had unilateral ICA occlusion, and 4 cases of them had a less than 50% diameter stenosis in the contralateral ICA. Occlusion was mainly located in the initial segment of ICA, and occlusive lesion extended to the skull base in 8 cases, and the length of occlusion ranged from 16 to 85 mm. The blood flow of ICA was detected in the skull base by color Doppler ultrasound in all patients before operation. Recanalization was successfully achieved in 10 patients and failed in 1 case. After operation, the symptoms of cerebral ischemia were significantly relieved in the 10 patients, of whom 3 cases developed hyperperfusion syndrome. During the follow-up period, ICA occlusion occurred in 1 patient at 3 months after operation, and 1 patient died 18 months after operation. Conclusion: For ICA occlusion, surgical treatment offers satisfactory and safe perioperative efficacy as well as good mid- and long-term results. Accurate preoperative assessment is essential for surgical success.

Abstract:Objective: To evaluate the effectiveness and safety of using catheter directed thrombolysis (CDT) technique in treatment of femoropopliteal long segment thrombotic occlusion. Methods: The clinical data of 71 patients with femoropopliteal long segment thrombotic occlusion undergoing CDT procedure from 2012 to 2016 were retrospectively analyzed. Results: CDT procedures were successfully performed in the whole group of 71 patients. The length of the target lesions ranged from 7 to 42 cm, with an average length of 28.2 cm, and the duration of continuous thrombolysis ranged from 6 to 168 h, with an average duration of 70.6 h. After CDT, complete thrombus removal was 74.6% (53/71), partial thrombus removal was 14.1% (10/71) and thrombolysis failure was 11.3% (8/71). No major bleeding occurred in the entire group of patients, the incidence of “trash foot” was 22.5% (16/71), and the incidence of arterial approach-related complications was 8.6% (6/71). One patient died of acute myocardial infarction after CDT procedure and one patient underwent a foot amputation. The plasma fibrinogen and the hemoglobin levels decreased more evidently in patients complicated with bleeding at the puncture site compared with those without bleeding at the puncture site (both P<0.05). Conclusion: CDT technique can effectively remove the thrombus, and is a safe and effective treatment method for femoropopliteal long segment thrombotic occlusion.

Abstract:Objective: To investigate the efficacy of paclitaxel-eluting drug-coated balloon (DCB) in treatment of atherosclerosis obliterans (ASO) of the lower extremities. Methods: Twenty-eight eligible patients with femoropopliteal disease were enrolled to study. All patients had moderate or severe intermittent claudication or ischemic rest pain (Rutherford grade 2–4), the degree of stenosis ranging from 70% to 99%, and simultaneously with length of lesion between 4 and 20 cm or occlusive lesion ≤10 cm involving the superficial femoral artery to proximal popliteal artery. Of the patients, 17 cases received DCB treatment (DCB group), and 11 cases received bare metal stent (BMS) implantation (BMS group). The end-point measurements of the main efficacy were the patency rates, and revascularization and restenosis in the region of the target lesion at 12 months after operation. Results: There was no statistical difference in all clinical variables between the two groups before operation (all P>0.05). At follow-up 12 months after operation, the primary patency rates between DCB group and BMS group showed no significant difference (88.2% vs. 72.7%, P=0.35), but the revascularization rate in the region of the target lesion in DCB group was significantly better than that in BMS group (5.9% vs. 45.5%, P=0.02). In both groups, no intraoperative or procedure-related death occurred and no major amputation was required. The thrombosis formation rate in the region of the target lesion in DCB group and BMS group was 5.9% and 9.1%, respectively. The functional improvements of the two groups were similar at follow-up 12 months later. Conclusion: DCB has a good clinical efficacy in treatment of ASO of the lower limbs, and is not inferior to BMS in terms of patency rate and restenosis prevention as well as safety. DCB may be an important therapeutic alternative for patients with femoropopliteal lesions.

Abstract:Objective: To investigate the therapeutic effect of tamoxifen on abdominal aortic aneurysm (AAA) and gender difference in its efficacy in mice. Methods: Aged C57BL/6 mice (60-week old) were used to conduct experiment in 3 batches, in which, the mice underwent AAA model creation (induced by elastase) alone, prophylactic tamoxifen administration plus AAA model creation or AAA model creation followed by tamoxifen treatment, respectively. In each batch of experiment, half of the mice were male and half were female, and sham operation controls were used, and the specimens of abdominal aorta in all mice were harvested on postoperative day 14 for observing the relevant parameters. Results: In the first batch of experiment, the AAA formation rate was 100% in either male or female mice. In the second batch of experiment, the AAA formation rate in female mice was significantly lower than that in male mice (30% vs. 80%, P<0.05), and pathologic changes were remarkably milder, the levels of estrogen receptor α and catalase were significantly higher, while the levels of PCNA, inflammatory cells and cytokines were significantly lower in vascular tissues of female mice than those in vascular tissues of male mice (all P<0.05). In the third batch of experiment, the AAA formation rate in female mice was significantly lower than that in male mice (50% vs. 100%, P<0.05), with the milder pathologic changes, proliferative responses and inflammatory responses in vascular tissues of female mice than those in vascular tissues of male mice (all P<0.05). Conclusion: Tamoxifen has significant inhibitory effect on the occurrence and development of AAA. However, its action has gender difference which shows better preventive and therapeutic effect in female mice, and relative preventive effect but little therapeutic effect in male mice, and the mechanism may probably be associated with its strong estrogen receptor induction in female animals.

Abstract:Objective: To establish a canine model of chronic deep venous thrombosis (DVT) of the lower limbs. Methods: Nine mongrel dogs were used, in which, the femoral vein on one side was selected at random and narrowed down by 80% to 90% of the lumen area, and the femoral vein on contralateral side served as control; a catheter was inserted from the branch of the femoral vein at the distal end of the narrowing site, followed by 300 U thrombin injection and then underwent blood flow blockage for 1 h; the catheter was indwelled for venography pathway. The general conditions of lower limbs of the dogs after operation were observed, the parameters of coagulation function before and after operation were compared, and the prograde angiographic and pathological examinations were performed. Results: Model creation was successfully performed in 8 of the 9 dogs. After that, claudication and increased skin temperature of the affected lower limb were observed in all of them; the D-dimer and fibrinogen levels were significantly increased and the prothrombin time was significantly decreased in the dogs after operation compared with their values before operation, and all these variables along with the difference in leg circumferences between affected and control side reached their peak values on postoperative day (POD) 14, and then gradually alleviated (all P<0.05); the chronic venous thrombosis was verified by both venography and pathological examination on POD 28. Conclusion: The established chronic DVT model is relatively relevant to the cause and process of thrombosis in clinical setting, and also offers a continuous access to venography. So it can be used for studies on clinical treatment and imaging diagnosis of DVT.

Abstract:Objective: To construct novel RNAi expression cassettes targeting hTERT and hTR, and then observe the effects of hTERT and hTR gene interference alone or in combination on telomerase activity, cell apoptosis and cell cycle in tumor cells, so as to find new strategies for tumor gene therapy. Methods: The RNAi expression cassettes targeting hTERT or hTR gene were synthesized by overlap extension PCR. After identification, the established cassettes were transfected into A549 cells alone or in combination, and then the telomerase activity was detected by TRAP-silver staining and TRAP-qPCR, and cell apoptosis rate and cell cycle were determined by flow cytometry. Results: The novel RNAi expression cassettes targeting hTERT and hTR were successfully constructed. Comparing with blank control group or negative control group, the telomerase activities were significantly reduced, the cell apoptosis rates were significantly increased and the G1 cell cycle arrest was significantly increased in A549 cells after transfection of the cassettes targeting either hTERT or hTR gene, and further, the above changes were more significant in A549 cells after combined transfection of the cassettes targeting hTERT and hTR gene than in those transfected with either of them alone (all P<0.05). Conclusion: The expression cassettes of novel RNAi targeting hTERT and hTR can effectively inhibit the telomerase activity, induce the cell apoptosis and change the cell cycle in A549 cells. Novel RNAi technology based on the artificial miRNA expression cassettes is expected to become a new tool in tumor gene therapy.

Abstract:Objective: To investigate the clinical significance of accessory hepatic vein (AHV) pressure reduction in treatment of Budd-Chiari syndrome (BCS). Methods: The clinical data of 27 BCS patients treated during March 2007 to July 2015 were retrospectively analyzed. Of the patients, 11 cases were male and 16 cases were female, with an average of (46±8) years old; 9 cases had lesions in the opening of AHV, 12 cases had occlusion in the inferior vena cava (IVC) and 6 cases had mixed lesions of AHV and IVC. Results: All patients underwent venography and manometry of the AHV and endovascular treatment. Nine patients with AHV disease underwent balloon dilatation angioplasty of the AHV, and their preoperative AHV pressure dropped from (25±4) cmH2O to (17±3) cmH2O; in the 12 patients with IVC disease, 10 cases underwent balloon dilatation angioplasty of the IVC and 2 cases underwent open surgery, and the preoperative AHV and intrahepatic IVC pressure decreased from (27±6) cmH2O to (15±4) cmH2O and from (27±5) cmH2O to (14±3) cmH2O, respectively; in the 6 cases with both AHV and IVC involvements, the preoperative pressure of AHV and IVC declined from (28±6) cmH2O to (14±4) cmH2O and from (26±5) cmH2O to (13±4) cmH2O, respectively. The abdominal symptoms were significantly relieved 3 days after operation in all patients and the edema in lower limbs was remarkably alleviated in those with IVC lesion, with treatment effective rate of 100%. No complications such as bleeding and pulmonary embolism occurred. Twenty-three patients were followed up for 4 to54 months, doppler ultrasound at 6 months after operation showed that the patency rate of original lesion was 100% and, at a later time, IVC re-occlusion occurred in 2 cases which were resolved by second balloon dilatation. Conclusion: AHV pressure reduction can help to alleviate the symptoms of BCS patients, and attention should be paid to the existence of the AHV and the treatment of its problems.

Abstract:Objective: To investigate the clinical efficacy of endovascular therapy for iliac vein compression syndrome (IVCS). Methods: The clinical data of 244 patients with IVCS undergoing endovascular treatment from January 2014 to December 2015 were retrospectively analyzed. Results: No surgical death occurred in the entire group, and endovascular treatment was abandoned in one case due to complete occlusion of the left iliac vein, so the technical success rate was 99.6% (243/244). Of the 243 patients, 94 cases underwent balloon dilatation alone, and 149 cases received balloon dilatation with stent implantation; 175 cases with varicose veins of lower limbs were subjected to a second stage operation. Two hundred and twenty-four patients were followed up for 3 to 27 months, during which time, no relapse of varicose veins was observed; the lower limb swelling was alleviated with varying degrees in all patients, and the treatment effective rate was 100%; hyperpigmentation was reduced with varying degrees in 63 patients, and alleviation or healing was seen in 30 patients with venous ulcer. The rate of complete relief of the left lower limb swelling, complete ulcer healing and restenosis or thrombosis formation in the iliac vein showed no significant difference on postoperative 6 months between patients undergoing balloon dilatation alone and balloon dilatation plus stent implantation (96.0% vs. 99.0%, 84.6% vs. 100.0% and 5.3% vs. 2.0%, all P>0.05), but were significantly better in the latter than the former on postoperative 12 and 24 months (70.0% vs. 96.0%, 61.5% vs. 94.1% and 12.8% vs. 2.0%; 60.9% vs. 94.8%, 53.8% vs. 94.1% and 23.5% vs. 2.1%, all P<0.05). Conclusion: In treatment of IVCS, endovascular therapy offers favorable short- and mid-term efficacy and the mid-term efficacy of balloon dilatation plus stenting is better than that of balloon dilatation alone. Selection of the suitable type, diameter and length of stents, accurate and appropriate stent placement, and regular and sufficient anticoagulant therapy have great importance for better long-term results.

Abstract:Objective: To investigate the association between single nucleotide polymorphisms (SNPs) at C677T of methylenetetrahydrofolate reductase (MTHFR) gene and susceptibility to splanchnic vein thrombosis (SVT). Methods: The relevant case-control studies regarding MTHFR C677T SNPs and SVT were collected by searching several national and international online databases. The associations of the genotypes and allelic genes of MTHFR with SVT were analyzed by Stata 12.0 software. Results: Nineteen studies were finally included involving 1 194 SVT patients and 1 988 control subjects. SVT were divided into 3 subgroups: portal vein thrombosis (PVT), Budd-Chiari syndrome (BCS) and mesenteric vein thrombosis (MVT). MTHFR C677T SNPs were significantly associated with SVT under dominant model CC vs. (CT+TT) (OR=0.51, 95% CI=0.34–0.76, P=0.001) and additive model CC vs. TT (OR=0.33, 95% CI=0.23–0.47, P<0.001); MTHFR C677T SNPs were significantly associated with SVT (OR=2.27, 95% CI=1.77–2.90, P<0.001) and PVT subgroup (OR=2.23, 95% CI=1.57–3.17, P<0.001) under recessive model TT vs. (CT+CC); MTHFR C677T SNPs were significantly associated with SVT (OR=1.84, 95% CI=1.33–2.55, P<0.001) and MVT subgroup (OR=1.64, 95% CI=1.14–2.36, P=0.008) under allele gene model. Conclusion: There is an association between MTHFR C677T SNPs and SVT susceptibility, and those with TT genotype and T alleles may have increased risk of SVT.

Abstract:Objective: To analyzed the risk factors for the formation of portal vein thrombosis (PVT) after splenectomy for portal hypertension due to liver cirrhosis, and to establish a Logistic regression model for predicting the occurrence of PVT. Methods: The relevant perioperative factors in 236 eligible patients undergoing splenectomy were determined by univariate analysis and multiple Logistic regression analysis, respectively, and Logistic regression prediction model was established based on the results of the multivariate analysis. Subsequently, Logit P was calculated and the ROC curve of each independent factor for estimating PVT was drawn. Results: Logistic regression analysis showed that preoperative velocity of portal venous blood flow (VPBF), postoperative mean platelet volume (MPV), postoperative D-dimer (D-D), and intraoperative free portal venous pressure difference (FPPD) were the independent risk factors while postoperative usage of anticoagulation therapy (UAT) was an independent protective factor for postoperative PVT (all P<0.05). According to the above factors, Logistic regression prediction model was established and expressed as Logit P=–5.715–0.558×VPBF (cm/s)+ 0.592×MPV (fL)+0.707×D-D (mg/L)+0.573×FPPD (cmH2O)–0.872×UAT (yes=1, no=0), and the cut off value of Logit P was -0.96, the area under ROC (AUROC) and the accuracy were 0.898 and 86.9%, and the cut off value for VPBF, MPV, D-D and FPPD was 13.85 cm/s, 10.92 fL, 3.54 mg/L and 6.99 cmH2O, respectively. Conclusion: Factors that include VPBF≤13.85 cm/s, MPV≥10.92fL, D-D≥3.54 mg/L and FPPD≥6.99 cmH2O may increase the risk of postoperative PVT, while postoperative UAT may decreased the risk of postoperative PVT; the established prediction model has relatively high accuracy for predicting PVT in those patients, and has certain reference value in clinical practice.

Abstract:Objective: To summarize the experience in treatment of venous thromboembolism (VTE) in late pregnancy and analyze the related risk factors. Methods: The clinical data of 43 women with VTE during late pregnancy treated from January 2011 to September 2015 were analyzed retrospectively. Of the patients, 35 cases had deep venous thrombosis (DVT), 7 cases had DVT and concomitant pulmonary thromboembolism (PTE), and one case had PTE only. The clinical manifestations and treatment methods of the patients were overviewed, and using women in late pregnancy without VTE during the same period as control, the related risk factors for VTE were analyzed. Results: All patients received anticoagulant therapy, 31 cases of them received lone anticoagulation therapy, and combined with thrombolytic therapy through superficial instep vein in 1 case, catheter-directed thrombolysis (CDT) through posterior tibial vein puncture in 3 cases, inferior vena cava filter (IVCF) implantation under ultrasound guidance in 2 cases, CDT plus IVCF implantation in 3 cases, and CDT plus IVCF implantation and catheter fragmentation of pulmonary embolism in 3 cases. Six infants had a premature delivery. After treatment, the symptoms were significantly improved in all patients. No symptomatic DVT or PTE occurred during follow-up. Family history of thrombosis, smoking, long-term bed rest, sedentariness, primipara were association with autoimmune disorders, and severe ovarian hyperstimulus syndrome were high risk factors for VTE during late pregnancy (all P<0.05). Conclusion: For patients with VTE in late pregnancy, anticoagulation is the basic treatment, and CDT should be performed in some cases with phlegmasia cerulean dolens, and catheter fragmentation of pulmonary embolism and IVCF implantation should be performed as soon as possible after an occurrence of PTE. Aggressive prevention should be considered for those pregnant women with high risk factors.

Abstract:Objective: To investigate the clinical efficacy of balloon dilatation angioplasty in treatment of stenosis of hemodialysis arteriovenous fistula (AVF). Methods: The clinical data of 31 patients undergoing balloon dilatation angioplasty for stenosis of hemodialysis AVF from May 2014 to December 2015 were retrospectively analyzed. Results: Of the 31 patients, 18 cases were male and 13 cases were female; 27 cases had radial artery to cephalic vein AVF, 2 cases had radial artery to basilica vein AVF, and 2 cases had ulnar artery to basilic vein AVF; all cases underwent balloon dilatation angioplasty. Technical success was achieved in 28 patients (90.3%), and no perioperative death occurred. After operation, pseudoaneurysm at puncture site, thrombosis in AVF and forearm hematoma occurred in one case each, and arteriovenous fistula patency was restored which provided normal blood flow for hemodialysis. Postoperative followed-up was conducted for 3 to 12 months, the 3-, 6-, 12-month primary patency rate was 92.9%, 75.0% and 50.0%, respectively. Conclusion: For stenosis of AVF, balloon dilatation angioplasty is minimally invasive and safe, and is a proper treatment method. However, its mid- and long-term efficacy needs further improvement.

Abstract:Objective: To investigate the clinical value of perioperative use of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) in patients undergoing radical surgery for colon cancer. Methods: Ninety-seven patients undergoing radical surgery for colon cancer in Gansu Provincial Hospital from February 2014 to February 2015 were selected and randomly designated to observation group and control group. Patients in observation group received ω-3 PUFAs combined with conventional intravenous nutritional support and control group received conventional intravenous nutritional support only during perioperative period. In these patients, the serum nutrition indicators and tumor markers were detected before and after surgery, and serum inflammation indicators as well as immune regulatory molecules in the serum and surgical specimens were determined after surgery. Results: The levels of serum nutrition indicators that included transferrin, prealbumin, retinol conjugated protein, insulin-like growth factor 1, hemoglobin and nutritional risk index, and the tumor markers that included CEA, CA19-9, CA125 and CA74-2 all showed no significant difference between the two groups (all P>0.05), but all the nutrition indicator levels were significantly better in observation group than those in control group on preoperative day 1 and postoperative day 3, and all the tumor marker levels in observation group were significantly lower than those in control group (all P<0.05). On postoperative day 3, the serum levels of proinflammatory factors that included IL-1, IL-6, IL-8 and TNF-α were significantly lower and the level of anti-inflammatory factor TGF-β was significantly higher in observation group than those in control group (all P<0.05); the levels of tumor metastasis promoting immune molecules that included CD44, CD168 and CD133 were significantly lower while the tumor metastasis promoting immune molecule CD63 was significantly higher in the tumor tissue in observation group than those in control group (all P<0.05). Conclusion: Perioperative use of ω-3 PUFAs in patients undergoing radical surgery for colon cancer can effectively improve their nutritional status, reduce postoperative inflammatory response, and enhance the immune function and anti-tumor ability.

Abstract:Long non-coding RNAs (lncRNAs) are a class of non-coding RNAs with a length more than 200 nucleotides. They regulate gene expressions at epigenetic, transcriptional, and translational levels, and coordinate and integrate multiple signaling pathways involving cellular differentiation, proliferation, homeostasis and organ development. Researches showed that LncRNAs may play a role in preventing and reducing the occurrence of vascular diseases by regulating the proliferation, migration and apoptosis of vascular smooth muscle cells and endothelial cells. Here, the authors address the research progress in relationship between lncRNAs and vascular diseases as well as the mechanisms.

Abstract:In-stent restenosis (ISR) is the common clinical problem in treatment of peripheral vascular diseases. However, there is no uniform and effective interventional method for ISR at present. Drug-coated balloon (DCB) provides a new strategy in treatment of femoropopliteal ISR and some preliminary attempts have been done in recent years. For ISR, DCB has higher patency rate and lower target lesion revascularization rate at postoperative 6 months and even 1 year compared with common balloon, but its long-term efficacy still needs further verification. Studies demonstrated that long segment stenosis in the stent or in the lumen of occlusive disease have higher rate of recurrent stenosis. The combination of DCB and debulking technique has been given great expectation, but it currently lacks enough study results. Besides, for femoropopliteal ISR, no study comparing the effects between DCB and new metal stent, drug-eluting stent or covered stent and so on has been performed as yet, and whether the combination of DCB with those techniques will bring better results is not clear. Thus, more high-quality randomized controlled trials are urgently needed to answer these questions.