Abstract:

Drug-coated balloon (DCB) provides a new treatment strategy for peripheral artery diseases (PAD) and its effectiveness has been tested in several controlled studies in different countries, most of which focused on its use in femoropopliteal leisons. Compared with uncoated balloon, DCB can reduce late lumen loss and restenosis of femoropopliteal TASC-A/B lesions at 6 months and even 1 year after operation and decrease the re-intervention rate, but there is a lack of its mid- and long-term follow-up results as well as its efficacy for TASC-C/D lesions. Studies on using DCB in treatment of infra-popliteal diseases are relatively scarce, in which even more unfortunately, the results are not consistent with each other in terms of comparison between DCB and uncoated balloon. Thus, more high-quality well-controlled studies are urgently needed to answer these questions.

Abstract:

Aortic dissection (AD) is characterized by abrupt onset, high mortality and poor prognosis. With the development of endovascular techniques for the management of aortic diseases in recent years, the therapeutic effect of AD has been greatly improved, and the treatment concept has also significantly changed. In respect of classification, many new classification systems have been proposed to guide the management of AD and, as for treatment of AD, although open surgery is still the main treatment approach for Stanford A dissection, endovascular repair has become the preferred procedure for complicated Stanford B dissection, and meanwhile, accumulating evidences indicate that favorable results may be achieved in non-complicated Stanford B dissection by early endovascular intervention.

Abstract:

There has been much confusion about the understanding of congenital venous malformations for a long time, for which the misdiagnosis and wrong treatment often occur in clinical practice so that standardizing the medical processes is an urgent matter. In Chapter 6 of Management of Chronic Venous Disease Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) published in the ESVS official journal European Journal of Vascular and Endovascular Surgery in June 2015, the classification of congenital vascular malformations was discussed, paying particular attention to the etiology, clinical characteristics, diagnosis and management of congenital venous malformations, as well as the complex congenital venous malformations affecting the venous system, such as Klippel-Trenaunay and Parkes-Weber syndrome. This will be of great significance for the further improvement of their diagnosis and treatment.

Abstract:Objective: To investigate the causes for difficulties in withdrawal of delivery system during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) and solutions. Methods: The clinical data of 305 AAA patients undergoing EVAR from January 2008 to April 2016 were retrospectively analyzed. The causes for occurrence of the difficulties during delivery system withdrawal and corresponding solving strategies were analyzed. Results: Among the 305 patients, difficulties of delivery system withdrawal occurred in 21cases (6.89%), of whom, 18 cases were complex AAA and 3 cases were non-complex AAA; 17 cases were repaired with bifurcated stent grafts and 4 cases with unibody bifurcated stent grafts, and both differences had statistical significance (85.7% vs. 14.3%; 81.0% vs. 19.0%, both P<0.05). All the 18 patients with complex AAA who encountered difficulties of delivery system withdrawal had severe aneurysmal neck angulation, of whom, 7 cases had more than 2 successive aneurysmal neck angulations and 2 cases had concomitant short aneurysmal neck. Among patients with aneurysmal neck angulations, those with more than 2 successive aneurysmal neck angulations had the highest incidence of difficulties of delivery system withdrawal (P<0.05). All withdrawal difficulties were successfully resolved by comprehensive application of corresponding countermeasures. Conclusion: Difficulties in withdrawal of the delivery system are not uncommon during EVAR for complex AAA, especially for those with multiple aneurysmal neck angulations. However, the difficulties can be effectively resolved by comprehensive application of corresponding countermeasures.

Abstract:Objective: To evaluate the efficacy of using unibody bifurcated stent grafts in endovascular aneurysm repair. Methods: The clinical data of 15 patients with abdominal aortic aneurysm, 5 patients with iliac aortic aneurysm and 5 patients with abdominal aortic or iliac aortic dissection undergoing endovascular aneurysm repair with unibody bifurcated stent grafts (Shanghai MicroPort Medical Co., Ltd.) were retrospectively analysed. Results: The surgical success rate was 100% (25/25) with an overage operative time of 42.4 min. No type I or type III endoleak occurred, iliac thrombosis occurred in one case after operation and on death occurred during perioperative period. Follow-up was conducted for 3 to 16 months and no type II endoleak was noted during review visits. Conclusion: Endovascular aneurysm repair using unibody bifurcated stent graft is a preferable choice of the treatment options for abdominal aortic aneurysm or dissecting aneurysm. However, the long term results still need to be verified.

Abstract:

Objective: To review the experience in emergency treatment of ruptured abdominal aortic aneurysm (rAAA) and explore the perioperative risk factors. Methods: The clinical data of 27 patients with rAAA admitted from January 2007 to September 2015 were reviewed. Of the patients, 20 cases were male, and 7 cases were female, with a median age of 72 years; 18 cases underwent open surgery and 6 cases had endovascular repair (including one case of hybrid surgery). The diagnosis and treatment procedures, perioperative conditions and postoperative follow-up results were summarized, and the perioperative risk factors were also analyzed. Results: Pre-, intra- and postoperative death occurred in 3, 1 and 9 cases respectively. The causes for postoperative death included acute renal failure, acute respiratory failure, abdominal compartment syndrome, myocardial infarction and hemorrhage of digestive tract, all which finally led to multiple organ dysfunction syndrome. The overall successful salvage rate was 51.9% (14/27), which in open surgery was 50% (9/18) and in endovascular repair was 83.3% (5/6), respectively. Comparison of the clinical variables between patients who survived and those who died during the perioperative period showed that there was significant difference in time from onset to admission, preoperative systolic blood pressure, preoperative serum creatinine concentration, intraoperative blood loss, volume of transfusion and intraoperative urine output (all P<0.05). Conclusion: As rAAA is a lethal condition with high mortality, definitive diagnosis should be made as soon as possible to ensure emergent surgical repair to control the hemorrhage, and enhanced perioperative management is equally important. Endovascular repair is an effective approach for emergency treatment of rAAA.

Abstract:Objective: To analyze the selection of surgical procedures for aortic dissection involving the aortic arch and the efficacy. Methods: The clinical data of patients undergoing surgical treatment due to aortic arch dissection in Department of Cardiothoracic Surgery, Wuhan General Hospital of Guangzhou Command from February 2010 to May 2015 were collected. The selection of surgical procedures and reason for selection as well as the complications were analyzed. Results: A total of 92 eligible patients were recruited after screening. Of the patients, 36 cases underwent thoracic endovascular aortic repair (TEVAR) alone, 2 cases underwent TEVAR with prefenestrated stent graft, 31 cases underwent TEVAR with left subclavian artery coverage, 17 cases underwent non-open chest aortic arch branch bypass plus TEVAR (4 cases of left common carotid artery-left subclavian artery bypass, 3 cases of right common carotid artery-left common carotid artery-left subclavian artery bypass and 10 cases of right common carotid artery-left common carotid artery plus left subclavian artery coverage), and 6 cases underwent open aortic arch replacement. Death occurred in 2 patients after open aortic arch replacement, but on serious complications occurred in the remaining patients. Conclusion: For aortic dissection involving the aortic arch, open aortic arch replacement is a well-developed treatment method. However, TEVAR is a fast, effective and economical method with low complications, and its application can be expanded by combination with other techniques such as fenestration and branch bypss.

Abstract:Objective: To analyze the risk factors for iliac limb occlusion after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods: The clinical data of patients with abdominal aortic aneurysm undergoing EVAR between January 2011 and December 2015 were collected. By a 1:3 matched case-control design, for each case with iliac limb occlusion, 3 patients of the same sex, age (within 3 year), and receiving stent of the same type and same manufacturer were randomly selected as control. The risk factors for iliac limb occlusion after EVAR were determined by univariate and multivariate Logistic regression analysis. Results: A total of 495 patients with abdominal aortic aneurysm underwent EVAR, among them, 11 cases (2.2%) developed iliac limb occlusion, and the average time to onset was 2-20 weeks after surgery. Univariate analysis showed that preoperative iliac artery angulation/tortuosity≥60° (P=0.001), preoperative iliac artery stenosis≥50% (P=0.002) and graft oversizing of the distal end of the iliac limb>15% (P=0.004) were significantly associated with post-EVAR iliac limb occlusion. Multivariate Logistic regression analysis revealed that all the above variables were independent risk factors for post-EVAR iliac limb occlusion (all P<0.05). Conclusion: Rigorous preoperative surgical plan based on the anatomic features of the iliac artery and selection of appropriate stent size are critical for reducing postoperative iliac limb occlusion. The high-risk patients should be identified and preventive measures of the controllable factors should be taken to avoid or reduce the occurrence of postoperative iliac limb occlusion.

Abstract:Objective: To review the experience in diagnosis and treatment of isolated abdominal aortic dissection (IAAD). Methods: The clinical data of IAAD patients admitted between January 2010 and August 2015 were reviewed, which mainly concentrated on the patients’ data of the general conditions, methods of diagnosis and treatment, and survival status. Results: A total of 27 IAAD patients were enrolled. Among them, 17 cases (63.0%, 17/27) were male and 10 cases (37.0%, 10/27) were female, 9 cases (33.3%, 9/27) had concomitant hypertension, one case (3.7%, 1/27) had post-traumatic IAAD and the remaining 26 cases (96.3%, 26/27) had spontaneous IAAD. In all patients, the definite diagnosis was made by computed tomographic angiography (CTA), and all patients underwent endovascular aortic repair (EVAR) with 100% technical success. During EVAR procedure, bifurcated stent grafts were used in 20 cases (74.1%, 20/27) and straight stent grafts were used in 7 cases (25.9%, 7/27). Followed up was conducted in 26 patients (96.3%, 26/27) for an average time of (11.8±5.0) months. All the follow-up patients were alive and the CTA showed good remodeling of the abdominal aorta without complications such as endoleak, newly developed dissection or stent graft migration. Conclusion: IAAD is a rare clinical entity, with non-specific symptoms such as lower back or abdominal pain, or no symptoms at onset. EVAR is feasible treatment method for IAAD with favorable short-term outcomes, but the long-term results require further follow-up studies.

Abstract:

Objective: To investigate the association between aortic dissection (AD) and functional adrenal tumors. Methods: Two patients with AD and concomitant functional adrenal tumors admitted in recent years were reviewed, and the relationship between the two diseases was analyzed and combined with related literature review. Results: One patient refused surgical treatment, while the other underwent first-stage aortic dissection endovascular repair and second-stage laparoscopic adrenal tumor resection, and recovered after surgery. There were a total of 9 cases with AD and concomitant functional adrenal tumors reported in English literature, and only 2 relevant cases seen in domestic literature. Relationship analysis between the two diseases indicated that the hormones secreted by the functional adrenal tumors may induce the AD formation through secondary hypertension or their direct actions. Conclusion: AD associated with functional adrenal tumors is rare and there may be a connection between the two diseases so, in clinical practice, rigid screening should be performed.

Abstract:Objective: To determine the value of plasma D-dimer level for predicting in-hospital death in patients with acute aortic dissection (AD). Methods: The clinical data of 83 AD patients admitted from January 2013 to December 2015 were collected. The patients were divided into survival group (62 cases) and mortality group (21 cases) according to whether or not they died during hospitalization, and the D-dimer levels and other related clinical variables of the two groups were compared, and the risk factors for in-hospital death of the patients were determined by regression analysis. Results: There were no difference in factors that included age, gender, smoking, hypertension and diabetes between the two groups (all P>0.05), while the proportion of patients with type A disease and D-dimer level were significantly increased in mortality group compared with survival group (both P<0.05). Logistic regression analysis showed that type A disease (OR=0.117, 95% CI=0.021–0.792) and D-dimer level (OR=3.180, 95% CI=1.551–5.984) were risk factors for in-hospital death of the patients (both P<0.05). The area under the receiver operating characteristic curve for D-dimer level predicting death was 0.819 (95% CI=0.807–0.974, P<0.001), with cut-off value of 4.85 μg/mL, and sensibility and specificity of 85.7% and 75.8%, respectively. Conclusion: D-dimer level, as a rapid detecting index, can be used for simple risk assessment of AD patients and aggressive interventions should be made for those with high D-dimer level.

Abstract:

Objective: To investigate the clinical efficacy of percutaneous interventional treatment for complex aortoiliac arterial occlusion. Methods: The clinical data of 16 patients with complex aortoiliac arterial occlusion were retrospectively analyzed. All patients underwent interventional procedures by using subintimal recanalization technique and catheter-capture technique to establish a working guidewire channel via multi-puncture approach, and then underwent balloon dilatation and kissing stent placement. Results: Operation was performed successfully in all the 16 patients with complex aortoiliac arterial occlusion, and the surgical success rate was 100%. Among them, blood flow was completely restored and symptoms were improved significantly in 15 cases, and symptoms were moderately improved in 1 case, in whom the symptoms of lower limb ischemia disappeared. Puncture-site hematoma occurred in one case, and the incidence of postoperative complications was 6.25%. All patients were followed up for 3 to 48 months. Intra-stent stenosis or thrombosis occurred in 5 cases, and blood flow was restored after a second endovascular intervention. The 12-, 24- and 36-month patency rate was 87.5%, 81.25% and 68.75% respectively. Conclusion: For complex aortoiliac arterial occlusion, percutaneous interventional treatment can rapidly recanalize the occlusion and restore the blood flow with low incidence of complications, so it has satisfactory clinical efficacy.

Abstract:Objective: To evaluate the clinical efficacy of hybrid therapy for TASC C/D aortoiliac arteriosclerosis obliterans. Methods: The clinical data of 48 patients (66 limbs) with TASC C/D (including TASC C in 22 cases and TASC D in 26 cases) aortoiliac arteriosclerosis occlusive diseases undergoing hybrid revascularization procedures from May 2012 to May 2014 were analyzed. The perioperative conditions were evaluated, the revascularization results among patients with different Fontaine classifications were compared, and the influential factors for primary patency were analyzed. Results: The hybrid procedures were successfully performed in all 48 patients (66 limbs), and technical success rate was 100%. One patient underwent amputation on postoperative day 5 due to severe gangrene and infection of the lower limb, but no death occurred and the incidence of perioperative complications was 16.67%. The postoperative distance of intermittent claudication (568 m vs. 92 m) and ankle-brachial index (0.75 vs. 0.25) were significantly higher than those before operation (both P<0.05). The average period of follow-up was 24 months, the 6-month and 1- and 2-year primary patency rate was 95.45%, 90.91 % and 87.88%, and secondary patency rate was 98.48%, 96.97% and 92.42%, respectively. The primary patency rate in patients with Fontaine stage II and III were significantly higher than that in patients with Fontaine stage IV (P=0.036, 0.015), which however had no statistical difference between patients with Fontaine stage II and III (P>0.05). The presence of diabetes and dyslipidaemia were independent risk factors for decreased primary patency (P=0.026, 0.003). Conclusion: Hybrid therapy is a safe and effective treatment for TASC C/D aortoiliac arteriosclerosis obliterans.

Abstract:Objective: To evaluate the efficacy of superselective embolization followed by surgical resection in treatment of carotid body tumors. Methods: The clinical data of 26 patients with carotid body tumors treated in China-Japan Friendship Hospital from April 2007 to September 2015 were reviewed. According to whether or not they underwent preoperative superselective embolization, the patients were classified into embolization group (9 cases) and non-embolization group (17 cases). The relevant clinical variables of the two groups of patients were analyzed and compared. Results: Surgical resection was performed in 26 sides of the 26 patients (27 sides). In embolization group compared with non-embolization group, the mean operative time (127.22 min vs. 158.82 min) and intraoperative blood loss (110.00 mL vs. 355.88 mL) were both significantly reduced (both P<0.05), while both operative time and intraoperative blood loss presented an increasing tendency with increase of the severity of the tumor (Shamblin’s classification) in either group. In all the 26 patients, the neck mass disappeared and the accompanied symptoms such as pain and pharyngeal discomfort were relieved after surgery. No death or paralysis occurred during perioperative period, but nervous dysfunction occurred in 7 patients (26.92%) and, in all of them, it had recovered on follow-up 6 months after surgery. Conclusion: For carotid body tumors, surgical resection is safe and reliable, and is the first choice of treatment. Preoperative superseclective embolization can significantly reduce blood loss and shorten operative time.

Abstract:

Objective: To investigate the effective management for different types of peripheral arterial pseudoaneurysms (PSA). Methods: The clinical data of 29 patients with peripheral arterial PSA treated from March 2011 to December 2015 were analyzed retrospectively. Among 11 patients with femoral PSA, 9 cases underwent aneurysm resection and artery ligation and 2 cases were treated by arterial bypass. Four patients with brachial PSA and 2 patients with radial PSA underwent aneurysm resection and aneurysmorrhaphy, 10 patients, that included 2 cases with posterior tibial PSA, 2 cases with spleenic PSA, 3 cases with internal iliac PSA, one case with mesenteric PSA, and 2 cases with external carotid PSA, underwent coil embolization, and 2 patients with external iliac PSA underwent covered stent placement. Results: After operation, the lumen of PSA in all patients was completely occluded. One patient with femoral PSA developed limb ischemia and necrosis, and then was subjected to second stage amputation, and one patient with infectious external carotid PSA died of hemoptysis. Satisfactory results were achieved in all of the other patients. Conclusion: According to the causes and locations of peripheral arterial PSA, appropriate selection of treatment method may be important for satisfactory results.

Abstract:

Objective: To investigate the safety and reliability of using high-frequency electric welding device (HFWD) for arterial closure. Methods: Six Tibetan minipigs were equally randomized into HFWD group and harmonic scalpel group (HS group). Under general anesthesia, carotid and femoral arteries of the pigs were isolated and skeletonized, and were then closed and divided using HFWD or HS, respectively. The bursting pressure of the vessels after sealing, sealing time, maximum temperature during sealing and the pathological injuries in the sealing area were compared between the two groups. Results: In all vessels without distinction of diameter, the average burst pressure after sealing in HFWD group was significantly higher than that in HS group (489.64 mmHg vs. 439.88 mmHg, P<0.05); in vessels with diameter ≤3 mm, the burst pressure showed no significant difference between HFWD group and HS group (593.40 mmHg vs. 572.48 mmHg, P>0.05); in vessels with diameter either >3~5 mm or >5~7 mm, the burst pressure in HFWD group was significantly higher than that in HS group (457.02 mmHg vs. 404.32 mmHg; 418.51 mmHg vs. 342.84 mmHg, both P<0.05). No matter what the vessel diameter was, the sealing time in HFWD group was significantly shorter than that in HS group (all P<0.05). The average maximum temperature during sealing in HFWD group was significantly lower than that in HS group (65.91 ℃ vs. 105.25 ℃, P<0.05). The collagen denaturation and smooth muscle injury in vascular wall of the sealing site were milder in HFWD group than those in HS group. Conclusion: Using HFWD for arterial closure is safe and reliable.

Abstract:

Objective: The investigate the effect of transplantation of bone marrow mesenchymal stem cells (MSCs) transfected with TGF-β1 on survival of prefabricated flap and the mechanism. 
Methods: The rat MSCs were isolated and cultured, and then transfected with pcDNA3.1 (+)/TGF-β1 eukaryotic expression vectors through liposome delivery system. The phenotype and tube formation ability in vitro of the MSCs after transfection were determined. Twelve SD rats were used, and random flaps with 5 cm in length and 1 cm in width were established on the symmetric parts of the back of the rats, and then the bottom of the flap on both sides was injected with MSCs after transfection (experimental side) or vehicle (control side), respectively. The survival rate of flap was calculated and the vessel density in the flap was determined by HE and immunohistochemical staining.
Results: Flow cytometry analysis showed that bone marrow stem cells transfected with TGF-β1 exhibited the characteristics of the naïve MSCs, and had better tube formation ability in vitro. In the flaps on experimental side injected with MSCs transfected with TGF-β1, the survival rate was significantly higher than that in the flaps on control sides (82.83% vs. 61.33%, P<0.05), and meanwhile, the capillary density was significantly greater than that in the flaps on control sides (19.69 vs. 8.19, P<0.05).
Conclusion: Transplantation of MSCs transfected with TGF-β1 can promote angiogenesis in skin flaps and thereby improve the survival of the flaps.

Abstract:Objective: To investigate the causes for the misdiagnosis of nonthrombotic iliac venous compression syndrome (NIVCS) and the efficacy of endovascular therapy for this disease. Methods: The clinical data of 23 misdiagnosed cases of NIVCS from January 2011 to December 2014 were retrospectively analyzed. Results: All the 23 patients were female with an average age of 50.3 (36–64) years. All cases were initially diagnosed as primary varicose veins of left lower extremity and underwent high ligation combined with saphenous trunk stripping plus tributary stab avulsion. The patients had recurrence of varicose vein and pain, swelling or fatigue in the affected leg 6.2 (1–13) months on average after surgery. Then, they were diagnosed as NIVCS by prograde venography of the left lower extremity and were treated with balloon dilatation and stent implantation of the left iliac vein. The symptom score (4.2 vs. 6.9) and pressure difference between the two ends of stent (1.70 cmH2O vs. 5.19 cmH2O) were significantly decreased compared with the pre-treatment values (both P<0.05). Assessment for the effects of endovascular treatment was cure in 7 cases and improvement in 16 cases, respectively. Follow-up was conducted for one month to 24 months and no recurrence or stent-related complications occurred. Conclusion: NIVCS has high misdiagnostic rate, so vigilance should be maintained for this disease in female patients with initial symptoms of left limb varicose veins. Endovascular therapy is effective for NIVCS with few long-term complications.

Abstract:Objective: To investigate the clinical efficacy of endovascular treatment for acute iliofemoral vein thrombosis. Methods: The clinical data of 64 patients with acute iliofemoral venous thrombosis undergoing integrated endovascular therapy from January 2013 to January 2015 were retrospectively analyzed. Results: Fresh thrombus was all effectively dissolved in all patients after the treatment of catheter-directed thrombolysis with inferior vena cava filter insertion, without serious thrombolysis-related complications; 13 patients (13/64) underwent simultaneous balloon dilation due to severe iliac vein stenosis and no evident improvement of the lower limb swelling, of whom 5 cases (5/64) with a poor collateral circulation and iliac vein stenosis greater than 50% as shown by subsequent venography were subjected to second-stage stent implantation. After the integrated endovascular therapy, the postoperative circumference difference between two legs at 15 cm above the knee joint was significantly reduced compared with the preoperative value (3.87 cm vs. 7.56 cm, P<0.05). During the period of follow-up, no lower limb swelling and iliofemoral stenosis recurrence as well as intra-stent thrombosis were noted, and no lower limb pigmentation , ulcer formation, pulmonary embolism or death occurred. Conclusion: Integrated endovascular therapy of the iliac femoral vein is safe and effective for acute iliofemoral venous thrombosis. It can achieve good effect on the removal of thrombus and recanalization.

Abstract:Objective: To evaluate the efficacy of interventional therapy for Budd-Chiari syndrome (BCS) caused by hepatic venous outflow obstruction. Methods: The clinical data of 14 patients with BCS due to hepatic venous outflow obstruction treated in Department of Vascular Surgery, Hainan Provincial People’s Hospital during January 2010 to January 2016 were retrospectively analyzed. Results: All the 14 patients were treated by percutaneous transhepatic angiography combined with superior/inferior vena cava two-way angiography and balloon dilatation, and recanalization was successful in all of them. All patients underwent repeat dilatation with increasing balloon diameter and of them, 9 cases had two and 5 cases had 3 dilatations during half a year. The average hepatic venous pressure of the patients was decreased obviously after the operations (preoperative value: 54 cmH2O; postoperative value: 25 cmH2O), no stent was inserted in any of the patients and the symptoms in all of them were significantly relieved. Followed-up was conducted for 12 to 48 months, no death occurred and no recurrence or severe postoperative complications were found. Conclusion: For BCS secondary to hepatic venous outflow obstruction, percutaneous transhepatic angiography combined with superior/inferior vena cava two-way angiography and balloon dilatation is a safe and effective treatment method, with low incidence of complications and satisfactory results.

Abstract:Objective: To assess the clinical efficacy of laparoscopic repair of recurrent inguinal hernia based on grading of the degree of difficulty. Methods: The clinical data of 34 patients with recurrent inguinal hernia undergoing laparoscopic repair between May 2009 and November 2015 in Xiangya Hospital, Central South University were retrospectively analyzed. Results: The entire group of patients was classified as surgical difficulty grade 1 in 13 cases, grade 2 in 15 cases and grade 3 in 6 cases. Patients with surgical difficulty grade 1 or 2 underwent hernioplasty by using a trans-peritoneal approach (TAPP), while those with surgical difficulty grade 3 underwent hybrid surgery. Operation was successfully completed in all patients, and the mean operative time was (90±27) min. After operation, three patients developed seroma which was resolved by needle aspiration in two cases and healed spontaneously in one case. Visual Analogue Scale (VAS) on postoperative day was 2.0±0.6, and the median Inguinal Pain Questionnaire (IPQ) score was 2.4 (range 0-8) at one month after operation. The median follow-up for all patients was 36 months, during which time, one case (3%) had a recurrence again. Conclusion: For an experienced surgeon, laparoscopic repair of recurrent inguinal hernia based on difficulty grading strategy was safe and effective.

Abstract:

Objective: To investigate the application value of postoperative chemoradiotherapy in elderly patients with stage III rectal cancer. Methods: The clinical data of 128 consecutive elderly patients (≥75 years of age) with stage III rectal cancer treated from January 2010 to January 2014 were retrospectively analyzed. Patients were divided into chemoradiotherapy group (60 cases) and control group (68 cases) according to whether or not they received postoperative chemoradiotherapy. The progression-free survival, 2-year survival, health-related quality of life and postoperative complications between the two groups were compared. Results: In chemoradiotherapy group compared with control group, the progression-free survival was significantly prolonged [(793.58±295.39)d vs. (736.59±305.38)d, P=0.029], 2-year survival had an increasing tendency, but did not reach a statistical significance (91.7% vs. 79.4%, P=0.052), the score of higher health-related quality of life at 12 months after operation was significantly increased (70.25 vs. 63.37, P<0.001), the local recurrence rate was significantly reduced (16.7% vs. 33.8%, P=0.035), and the incidence of radiation enteritis (13.3% vs. 0.0%) and myelosuppression (11.7% vs. 0.0%) were significantly increased (P=0.002, P=0.004). There was no significant difference in incidence of intestinal fistula, intestinal obstruction and anemia between the two groups (all P>0.05). Conclusion: Though postoperative chemoradiotherapy increases the rate of postoperative complications, it can significantly improve the long-term outcomes in elderly patients with rectal cancer.

Abstract:Abdominal aortic aneurysm (AAA) is an urgent clinical condition with high mortality, and its pathogenesis is complicated and has not been elucidated so far. Recent investigations found that the features of participation of a disintegrin and metalloprotease (ADAM) family in inflammatory factor release and degradation of extracellular matrix suggest their involvement in the onset of AAA; miRNAs may also play regulatory roles in occurrence of AAA, because of their specific expression in vascular smooth muscle cells (VSMCs), regulating the proliferation and apoptosis of the VSMCs through the signaling pathways, targeted regulation of inflammatory cell differentiation and the release of inflammatory cytokines, and regulating extracelluar matrix protein expressions. The authors, in this paper, address the actions of ADAM10 and ADAM17 in AAA and the regulatory mechanisms of miRNAs in the pathogenesis of AAA.

Abstract:Diagnosis of deep vein thrombosis (DVT) depends on imaging examination, but imaging examination has a time lag for disease diagnosis. Laboratory test indexes have important value in early detection and helping in the diagnosis of DVT. Since there are a wide variety of test indexes for DVT with different standards in clinical practice, the authors in this article, based on literature review, address some test indexes that include D-dimer, fibrinogen, C-reactive protein, high-sensitivity C-reactive protein, VEGF and Slit2 protein, intending to look for highly sensitive and specific test indexes for providing valuable information to assist clinical decision making in diagnosis and treatment of DVT.