Volume 27,Issue 12,2018 Table of Contents

1 New concepts in diagnosis and treatment of acute deep vein thrombosis

LIU Jianlong , ZHANG Yunxin

2018, 27(12):1495-1504. DOI: 10.7659/j.issn.1005-6947.2018.12.001

[Abstract](615) [HTML](1316) [PDF 1.18 M](1141)

Abstract:
Acute deep vein thrombosis (DVT) is a clinically frequently-occurring disease. It still has high risk of sudden death, unfavorable short-term results, and high incidence of long-term complications and recurrence, due to the regional differences in medical services and imbalances in economic development, especially the outdated diagnostic concepts. Preventive screening programs for high-risk population of venous thromboembolism (VTE) are urgently required to be carried out at the medical centers of all levels, even the community centers for disease control and prevention. Enhancing the physical and medical preventive measures and increasing the early diagnosis of the latent DVT are essential approaches for preventing lethal pulmonary embolism. According to the subjective and objective needs of the stage of disease, performing a timely “thrombotic clearance” by means of advanced medical equipment is the effective way to reduce long-term complications. Opportune elimination of the anatomic and pathologic causes for DVT recurrence is surely necessary. Strict management during treatment and comprehensive interventions may improve the quality of life for the patients as much as possible.

2 Interpretation of the Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

WANG Lei , PAN Baihong , YANG Pu , WANG Wei , HUANG Jianhua

2018, 27(12):1505-1510. DOI: 10.7659/j.issn.1005-6947.2018.12.002

[Abstract](790) [HTML](1240) [PDF 1.10 M](1430)

Abstract:
In accordance to the principle of evidence-based medicine and based on the systematic review, the Society for Vascular Surgery (SVS) released the practice guidelines on the care of patients with an abdominal aortic aneurysm (AAA) in January 2018, which provides 111 specific recommendatory opinions with their levels of evidence and grades of recommendations based on GRADE criteria targeting toward five aspects that include diagnostic assessment, treatment modalities, anesthetic considerations, perioperative treatment, postoperative management, follow-up, and economics analysis. The authors interpret the new perspectives and recommendatory opinions as well as issues closely related to the clinical diagnosis and treatment in the revised guidelines, so as to help the readers in their understanding of the guidelines.

3 Multicenter prospective clinical study of diosmin in treatment of lower-limb chronic venous diseases

HUANG Jianhua , YAO Kai , ZHENG Yide , KANG Yougen , XIONG Jianming , XIONG Guozuo

2018, 27(12):1511-1516. DOI: 10.7659/j.issn.1005-6947.2018.12.003

[Abstract](496) [HTML](1291) [PDF 1.05 M](1210)

Abstract:
Objective: To observe the efficacy and safety of diosmin administration for patients with lower-limb chronic venous diseases (CVD) of different CEAP grades.
Methods: Two hundred and forty patients with CEAP class C0-C3 CVD and reflux of the lower limb without prior surgical treatment, and 240 patients with CEAP class C4-C6 CVD and reflux of the lower limb after long saphenous vein (LSV) stripping were enrolled, and were randomly assigned to respective study group (oral administration plus compression stocking therapy) and control group (compression stocking therapy alone). The calf circumference and subjective symptoms of the patients were examined before and after treatment, and the safety variables such as blood routine, liver function, renal function and blood glucose were determined, and the adverse events were also recorded.
Results: In the 480 patients, 24-week study was completed in 438 cases and 42 cases (8.75%) dropped out from the study. In patients with C0-C3 CVD without prior surgical treatment, the ankle circumferences of the affected leg at 4, 12 and 24 weeks after treatment were all significantly decreased in both study group and control group compared with their values before treatment, but the decreasing amplitudes were significantly greater in study group than those in control group at 12 and 24 weeks after treatment (all P<0.05); the subjective symptoms were all improved in both groups, but study group was superior to control group in terms of improving sensation of heaviness and swelling of the leg at 24 weeks after treatment (both P<0.05). In patients with C4-C6 CVD having prior surgical treatment, the ankle circumferences of the affected leg in study group at 4, 12 and 24 weeks after treatment and in control group at 12 and 24 weeks after treatment were all significantly decreased compared with their values before treatment, but the decreasing amplitudes were significantly greater in study group than those in control group at 12 and 24 weeks after treatment (all P<0.05); the subjective symptoms were all improved in both groups, but study group was superior to control group in terms of improving sensation of heaviness and swelling of the leg at 24 weeks after treatment (both P<0.05). During the study, gastrointestinal reactions occurred in 7 patients (1.60%), and those were all tolerable without causing discontinuation of medication; the observed biochemical parameters were all normal in all of the patients.
Conclusion: Diosmin can effectively alleviate the edema and symptoms of lower-limb CVD patients of different severities, and with good safety. Therefore, it is recommended to be used as a basic medication for lower-limb CVD during the entire treatment course, with an administration time of at least 3 to 6 months.

4 Analysis of causes for reintervention of Budd-Chiari syndrome after endovascular treatment and the countermeasures

CHEN Shiyuan , YU Chaowen , NIE Zhonglin , LU Ran , SONG Tao , SUN Yong , GUAN Zeyu , TANG Wenbo , WANG Xiaogao , XU Chao , GAO Yong

2018, 27(12):1517-1524. DOI: 10.7659/j.issn.1005-6947.2018.12.004

[Abstract](439) [HTML](943) [PDF 2.77 M](840)

Abstract:
Objective: To investigate the causes for reintervention of Budd-Chiari syndrome (BCS) after endovascular treatment and the countermeasures.
Methods: The clinical data of 81 BCS patients undergoing two or more endovascular treatments from January 2013 to December 2016 were retrospectively analyzed.
Results: Of the 81 patients, 3 cases (3.70%) were simple membranous obstruction of the inferior vena cava (lesion length ≤5 mm), 46 cases (56.79%) were short segmental obstruction of the inferior vena cava (lesion length >1~<5 cm), 17 cases (20.99%) were short segmental obstruction of the inferior vena cava (lesion length ≥5 cm), and 15 cases (18.52%) were obstruction of the inferior vena cava with complicating thrombosis of the inferior vena cava; 51 cases received two endovascular treatments, 21 cases had three, 8 cases had four and 1 case had eight endovascular treatments, respectively. In the entire group of patients, no death, pericardial tamponade, and no thoracic or abdominal hemorrhage caused by rupture of the inferior vena cava as well as pulmonary embolism occurred. All patients were discharged from the hospital uneventfully. Logistic regression analysis showed that the lesion length was an independent influential factor for repeated operation (P=0.000). Elastic retraction, no suitable stent for use and persistence of the etiological factor were the main reasons for repeated operation.
Conclusion: In BCS patients with short segmental occlusion (>1 cm), long segmental occlusion or complicated by thrombosis of the inferior vena cava, repeated endovascular treatment is unavoidable. Regular follow-up and timely intervention are effective measures to prevent recurrence of symptoms.

5 Efficacy comparison of thrombus aspiration plus catheter directed thrombolysis and catheter thrombolysis alone for acute mixed deep venous thrombosis of lower extremities

LI Changhai , LIU Xiang

2018, 27(12):1525-1530. DOI: 10.7659/j.issn.1005-6947.2018.12.005

[Abstract](358) [HTML](1094) [PDF 1.04 M](939)

Abstract:
Objective: To compare the efficacy of thrombus aspiration combined with catheter directed thrombolysis (CDT) and CDT alone in treatment of acute mixed lower extremity deep venous thrombosis (LEDVT).
Methods: The clinical data of 121 patients with acute mixed LEDVT treated during June 2012 to June 2017 were retrospectively analyzed. Of the patients, 60 cases underwent CDT after thrombus aspiration (thrombus aspiration plus CDT group) and 61 cases underwent direct CDT (CDT alone group). The main clinical variables between the two groups of patients were compared.
Results: The general preoperative data showed no significant differences between the two groups (all P>0.05). In thrombus aspiration plus CDT group compared with CDT alone group, the average length of hospital stay
(6.2 d vs. 10.5 d, P<0.05) and average amount of urokinase used (17×104 U vs. 290×104 U, P<0.05) were significantly reduced. In thrombus aspiration plus CDT group and CDT alone group, the cure rate and effective rate in thrombus aspiration plus CDT group on one week after treatment were 75% and 91.67% and on two weeks after treatment were 83.33% and 96.72%, and in CDT alone group on one week after treatment were 45.9% and 91.67% and on two weeks after treatment were 62.3% and 96.72%, respectively. The cure rates in thrombus aspiration plus CDT group were significantly higher than those in CDT alone group (both P<0.05), but the effective rates showed no significant differences between the two groups (both P>0.05). Follow-up was conducted at 12 months after operation, the incidence of complications, the decreasing amplitudes in differences in the circumferences at 15 cm below the knee between healthy and affected limb, the vein patency rates and normal venous valve function rates as well as the overall effective rates showed no significant differences between the two groups (all P>0.05).
Conclusion: Compared with CDT alone, thrombus aspiration plus CDT can obviously decrease the length of hospitalization, decrease the dose of urokinase infusion and increase the cure rate for acute mixed LEDVT, while its mid- and long-term efficacy shows no obvious superiority.

6 Correlation of peripheral blood eosinophils with platelets, coagulation parameters and C-reactive protein in patients with venous thromboembolism

HE Jing , WANG Jun , YANG Tao

2018, 27(12):1531-1538. DOI: 10.7659/j.issn.1005-6947.2018.12.006

[Abstract](603) [HTML](1125) [PDF 1.04 M](993)

Abstract:
Objective: To investigate the potential correlation between absolute count of peripheral blood eosinophils (EOS) and platelet (PLT) count, coagulation parameters, and C-reactive protein (CRP) in patients with venous thromboembolism (VTE).
Methods: The clinical data and results of hematological tests at the first time after admission of 908 patients with deep venous thrombosis (DVT) or pulmonary thromboembolism (PE) admitted from April 2014 to June 2017 were collected retrospectively. The differences of absolute peripheral blood EOS count along with PLT count, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer (D-D), antithrombin III (AT-III) activity, and CRP among patients with different characteristics were compared, and the correlations between peripheral blood EOS count and all other above variables were analyzed.
Results: The absolute peripheral blood EOS counts were significantly different between patients with different sex, different DVT classifications, different stages, which was in male patients significantly higher than that in female patients, in patients with mixed type significantly higher than that in patients with peripheral type, and in patient in subacute and chronic stage significantly higher than in patient in acute stage (all P<0.05); all other studied parameters also showed significant differences between or among groups stratified by some of the predefined characteristics (all P<0.05). The absolute peripheral blood EOS count was significantly correlated with PLT count, PT, INR, APTT, D-D, and CRP, and the degrees of correlation changed with the age of the patients (all P<0.05).
Conclusion: EOS can induce thrombosis by activating the coagulation system through multiple pathways and meanwhile affecting the anticoagulant system. There are differences in peripheral blood EOS levels in VTE patients of different types, and peripheral blood EOS is potentially correlated with PLT count, coagulation parameters and CRP. The results suggest that peripheral blood EOS has certain clinical significance in the judgment of disease state and estimation of prognosis for VTE.

7 Analysis of risk factors and prognosis for acute kidney injury in patients with Stanford type B aortic dissection after thoracic endovascular aortic repair

SHEN Tianjiao , HU Hejie , WANG Xiaotian , FANG Zhengdong , SUN Xiaojie , GE Xinbao , CHENG Can

2018, 27(12):1539-1545. DOI: 10.7659/j.issn.1005-6947.2018.12.007

[Abstract](282) [HTML](1129) [PDF 1.07 M](916)

Abstract:

Objective: To investigate the risk factors associated with acute kidney injury and prognosis in patients with Stanford type B aortic dissection after thoracic endovascular aortic repair (TEVAR).
Methods: The clinical data of 193 patients with Stanford type B aortic dissection undergoing TEVAR from December 2013 to December 2016 in Anhui Provincial Hospital were retrospectively analyzed. The acute kidney injury was diagnosed according to the criteria proposed by Acute Kidney Injury Network (AKIN).
Results: In the 193 patients, acute kidney injury after TEVAR occurred in 36 cases (18.7%). Univariate analysis indicated that the history of diabetes, systolic blood pressure at admission, diastolic blood pressure at admission, dose of contrast agent administered during operation and scope of involvement of the renal artery were significantly related to post-TEVAR acute kidney injury (all P<0.05). Multivariate Logsitic regression analysis demonstrated that the history of diabetes (OR=4.458, 95% CI=1.176–16.897, P=0.028), systolic pressure at admission (OR=1.036, 95% CI=1.011–1.063, P<0.01); dose of contrast agent administered during operation (OR=1.025, 95% CI=1.012–1.038, P<0.01); renal artery involvement (OR=3.130, 95% CI=1.222
–8.017, P=0.017) were independent risk factors for post-TEVAR acute kidney injury. Analysis of the follow-up results showed that the early mortality in patients who developed acute kidney injury was significantly higher than that in patients without acute kidney injury (22.6% vs. 6.3%, χ2=8.00, P<0.005), and the survival rate in patients having a history of diabetes was significantly lower than that in patients without a history of diabetes (P<0.05).
Conclusion: High systolic blood pressure at admission, history of diabetes, dose of contrast agent used and involvement of bilateral renal arteries are closely related to the occurrence of acute kidney injury in patients with Stanford type B aortic dissection after TEVAR. The patients with post-TEVAR acute kidney injury have an increased risk of early death, and the history of diabetes has predictive value for the prognosis of the patients after operation.

8 Surgical treatment and wound management of femoral artery infected false aneurysms: an analysis of 16 cases

HE Zhibin , ZHANG Xuemin , JIAO Yang , LI Qingle , ZHANG Xiaoming

2018, 27(12):1546-1550. DOI: 10.7659/j.issn.1005-6947.2018.12.008

[Abstract](285) [HTML](1387) [PDF 1.20 M](952)

Abstract:
Objective: To investigate the surgical methods for the treatment of femoral artery infected false aneurysm and evaluate the therapeutic effect and application value of using vacuum-assisted closure (VAC) device in infected wound management.
Methods: The clinical data of 16 patients with femoral artery infected false aneurysms and underwent surgical treatment from July 2015 to April 2018 were retrospectively analyzed.
Results: Of the16 patients, 5 cases underwent direct suture of the vascular breach, 6 cases underwent wound repair with autogenous vein, 3 cases underwent autogenous vein replacement, and the other 2 cases received aneurysm resection and local exclusion. All patients underwent drainage of the infected wounds with VAC device. Twelve patients healed after second stage suture, and 4 cases received skin flap transplantation, with an average wound healing time of 34.2 d. Follow-up for 6 months was obtained in 13 patients, and except one patient who had a wound rupture and received debridement, no wound reinfection or rupture occurred in any of the remaining 12 patients, and no relapse of arterial false aneurysm occurred in any of the patients followed up.
Conclusion: For femoral artery infected false aneurysms, surgical treatment with debridement should be performed as early as possible. VAC device is safe and effective in management of the infected wounds.

9 Interventional therapy for pancreaticoduodenal artery aneurysm with celiac axis stenosis: a report of 6 cases

BI Guoshan , DAI Xianpeng , SHEN Xin , DENG Liming , HU Bingbing , CHEN Jie , XIONG Guozuo

2018, 27(12):1551-1555. DOI: 10.7659/j.issn.1005-6947.2018.12.009

[Abstract](705) [HTML](1011) [PDF 1.57 M](864)

Abstract:
Objective: To investigate the treatment timing and method for pancreaticoduodenal artery aneurysm (PDAA) accompanied with celiac axis stenosis.
Methods: The clinical data of 6 patients with PDAA were retrospectively analyzed. Diagnosis was made in 4 patients due to aneurysm rupture/bleeding and in 2 patients by accident. All the 6 patients had a concomitant celiac axis stenosis or occlusion, and all of them underwent endovascular aneurysm embolization.
Results: Of the 6 patients, 5 cases were males and one case was female, whose age ranged from 42 to 81 years, with an average age of 59.8 years; the aneurysm size ranged from 8 to 21 mm, with an average of 14.6 mm; 2 cases had a true aneurysm and 4 cases had a pseudoaneurysms; the lesion was located in the posterior inferior pancreaticoduodenal artery in 4 cases, and in the anterior inferior pancreaticoduodenal artery in 2 cases; 5 patients had celiac axis stenosis, the stenosis rate ranged from 68% to 92%, with an average of 81%, and one patient had complete celiac axis occlusion. All the 6 patients underwent embolization coil occlusion of the PDAA and, in all of them, no treatment was performed for the celiac axis stenosis. The operative time ranged from 60 to 110 min, with an average of (76.7±13.5) min. After aneurysm embolization, the bleeding stopped in the 4 patients with ruptured aneurysm, and the aneurysm spontaneously disappeared in the two patients with unruptured aneurysm. The length of postoperative hospital stay ranged from 7 to 13 d, with an average of (10±2.3) d. Followed-up was conducted for 9 to 15 months, and no aneurysm recurrence or visceral ischemia occurred.
Conclusion: Embolization alone is safe and effective treatment for PDAA with celiac axis stenosis. Leaving the celiac axis stenosis untreated will not result in visceral ischemia, and increase the risk of aneurysm recurrence.

10 Application of carotid shunt tube in surgical resection of complex carotid body tumor

LI Jing , JIANG Jingjun , ZHANG Xiaoming , LI Wei , ZHANG Xuemin , LI Qingle , JIAO Yang

2018, 27(12):1556-1562. DOI: 10.7659/j.issn.1005-6947.2018.12.010

[Abstract](866) [HTML](889) [PDF 1.05 M](1004)

Abstract:
Objective: To investigate the safety and timing selection of using shunt tube during surgery for complicated carotid body tumor (CBT).
Methods: The clinical data of 85 patients with Shamblin II or III CBT undergoing surgical resection in the Department of Vascular Surgery, Peking University People’s Hospital between January 2002 and March 2018 were retrospectively analyzed. Of the patients, the carotid shunt tube was used in 33 cases (shunt tube group), and was not used in the other 52 cases (non-shunt tube group). The main clinical variables of the two groups of patients were analyzed and compared.
Results: The proportion of cases with ShamblinIII tumor was significantly higher in shunt tube group than that in non-shunt tube group (P<0.05), but no significant differences were noted in other preoperative data between the two groups (P>0.05). In shunt tube group, all the 33 cases underwent internal carotid artery reconstruction, 9 cases had repair with a great saphenous vein patch, and 24 cases underwent reconstruction by end-to-end anastomosis due to severe rupture. Of the 52 patients in non-shunt tube group, 2 cases underwent internal carotid artery reconstruction and simultaneous external carotid artery ligation, 14 cases underwent simple external carotid artery ligation, and 6 cases underwent external carotid artery reconstruction. The operative time, intraoperative blood loss and incidence of short-term neurological complications were significantly increased in shunt tube group compared with non-shunt tube group (all P<0.05), while no statistical differences were found in incidence of postoperative arterial stenosis and long-term neurological injury between the two groups (both P>0.05).
Conclusion: Using a carotid shunt tube in surgery for complex Shamblin II orIII CBT is a safe and effective procedure, with no risk of increasing cerebrovascular complications and vascular shunt application, nor influence on long-term nerve injury. Once carotid artery is ruptured, shunt tube should be used immediately in order to maintain the cerebral circulation, which may be helpful for reducing bleeding and operative time, as well as the occurrence of irreversible nerve injury.

11 Mechanism of venous molecular fingerprint EphB4 in regulating vein graft adaptation to the arterial hemodynamic environment

WU Guangmin , GUO Yuanyuan , ZHU Fan , ZHANG Kai , LIU Xiyu , ZHU Bo

2018, 27(12):1563-1569. DOI: 10.3978/j.issn.1005-6947.2018.12.011

[Abstract](235) [HTML](1010) [PDF 1.52 M](983)

Abstract:
Objective: To investigate the regulatory effect of EphB4 in the process of vein graft adaptation to arterial blood flow and the mechanism.
Methods: The animal model of artery reconstruction with vein graft was established by transplantation of the superior vena cava of a donor rat to the abdominal aorta of a recipient rat with an end-to-end pattern. The experiment was divided into simple model group (wild type rats were used for both donors and recipients), EphB4 enhancing group (wild type rats were used for both donors and recipients, and the adventitia of the vein graft was continuously stimulated by the EphB4 ligand ephrinB2) and EphB4 lessening group (EphB4+/– transgenic rats were used for donors and wild type rat were used for recipients). The vein grafts in each group of rats were removed for histopathological examinations at 1 week and 4 weeks after model creation. The vein endothelial cells were isolated from wild type and EphB4+/– type rats and cultured, and then, the degrees of phosphorylation of the EphB4 membrane receptor (EphBR) and ERK1/2 in the downstream transduction pathway as well as the migration abilities in the two types of cells were compared.
Results: Compared with the normal rat superior vena cava, the intima-media thickness, and the contents of smooth muscle actin and collagen fiber in the vein grafts of each experimental group of rats were significantly and increasingly elevated (all P<0.05). The increasing amplitudes of all above variables showed no significant difference among the experimental groups at 1 week after model creation (P>0.05), but were significantly less in EphB4 enhancing group than those in the other two groups at 4 weeks after model creation (all P<0.05). Under the stimulation of same concentration of ephrinB2, the degrees of phosphorylation of EphBR and ERK1/2, transcriptional activity of EphB4 mRNA and migration ability in vein the endothelial cells from the EphB4+/–type rats were significantly reduced compared with those from the wild type rats (all P<0.05).
Conclusion: The expression level of the molecular fingerprint EphB4 may play a key role in the remodeling pattern of the vein grafts, and the mechanism is probably associated with its influencing the function of the endothelial cells via ERK1/2 pathway.

12 Relations of blood glucose and lipid with the intraluminal thrombus in abdominal aortic aneurysm

JIANG Shanshan , HU Xinhua , WU Mengran , LI Nan , LI Xiaodong , CHEN Kang , ZHOU Yao , JING Yuntian , WANG Jian , ZHANG Jian , XIN Shijie

2018, 27(12):1570-1576. DOI: 10.7659/j.issn.1005-6947.2018.12.012

[Abstract](263) [HTML](1108) [PDF 1.05 M](896)

Abstract:
Objective: To investigate the relations of blood glucose and lipid as well as other factors with the intraluminal thrombus (ILT) in abdominal aortic aneurysm (AAA) patients.
Methods: The clinical data of 151 AAA patients treated in the Department of Vascular Surgery of the First Affiliated Hospital of China Medical University from July 2014 to October 2017 were analyzed retrospectively. The factors associated with ILT in AAA were determined by using statistical methods.
Results: Of the 151 patients, 132 cases were found having ILT and 19 cases without ILT. In patients with ILT compared with those without ILT, the proportions of male cases and cases with peripheral artery disease were elevated, and the levels of triglyceride (TG), creatinine (Cr) and D-dimer (D-D) were increased (all P<0.05). As for the ILT thickness, the ILT thickness in male patients was greater than that in female patients, and patients with diabetes mellitus (DM) was less than that in patients without DM (both P<0.05); the results of grouped comparison according to the ILT thickness showed that the aneurysm diameter of AAA was smaller, the proportion of DM cases and the fasting blood-glucose (FBG) level were higher, the levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and D-D were lower in thin ILT group than those in thick ILT group (all P<0.05). Correlation analysis shows that the ILT thickness were positively correlated with TC (r=0.206, P=0.018) and LDL-C (r=0.227, P=0.009).
Conclusion: Blood lipid is an important factor for the occurrence and development of ILT, while the impacts of blood glucose and DM on ILT still need to be further explored.

13 Changes in HMGB1 and RAGE levels in patients with lung injury induced by acute aortic dissection and the clinical significance

ZENG Zhaofan , LI Zhenzhen , WU Hongfei , ZHANG Wenbo , QI Youfei , XIAO Zhanxiang

2018, 27(12):1577-1582. DOI: 10.7659/j.issn.1005-6947.2018.12.013

[Abstract](295) [HTML](806) [PDF 1.28 M](859)

Abstract:
Objective: To investigate the association of the serum levels of high mobility group protein B1 (HMGB1) and advanced glycosylation end-product receptor (RAGE) in patients with acute lung injury secondary to acute aortic dissection (AAD).
Methods: From March 2016 to May 2018, 56 consecutive patients with AAD who were diagnosed by CTA of the whole aorta and echocardiography were enrolled. According to the values of oxygenation index (PaO2/FiO2) during oxygen inhalation in a resting state, the patients were divided into lung injury group (21 cases) and non-lung injury group (35 cases), and 30 individuals undergoing health maintenance examination were randomly selected as control group. Blood samples were drawn once per 4 h in the AAD patients after admission, and in the control group, fasting blood samples were taken only once from the elbow vein in the morning. The serum levels of HMGB1 and RAGE were measured by ELISA and PaO2 values were detected for calculating PaO2/FiO2.
Results: In both groups of AAD patients, the serum levels of HMGB1 and RAGE at 24 h after admission were significantly higher than those in the healthy control group, and which were also significantly higher in lung injury group than those in non-lung injury group (all P<0.05). In both groups of AAD patients, the serum levels of HMGB1 and RAGE were continuously increased, while the PaO2/FiO2 values were gradually decreased, and all reached a peak value within 48-60 h after admission. The changing amplitudes of the 3 variables were all significantly greater in lung injury group than those in non-lung injury group (all P<0.05). After they reached the peak values, the HMGB1 and RAGE levels gradually decreased, while the PaO2/FiO2 values correspondingly increased as time elapsed. In AAD patients, both HMGB1 and RAGE levels presented a significantly negative correlation with PaO2/FiO2 value (r=–0.940, –0.794).
Conclusion: The HMGB1/RAGE signaling pathway may play an important role in the occurrence of lung injury in AAD, and lung injury may be worsened with the increase of HMGB1 and RAGE levels. Monitoring of the HMGB1 and RAGE levels can help to evaluate the risk of lung injury after AAD. Further investigations of the HMGB1/RAGE signaling pathway may provide interventional targets for lung injury after AAD.

14 Application of endoscopic upper mediastinal lymph node dissection in treatment of papillary thyroid carcinoma

ZHANG Deguang , CHEN Jian , HE Gaofei , GAO Li , FANG Liang , CHEN Zhoumiao

2018, 27(12):1583-1588. DOI: 10.7659/j.issn.1005-6947.2018.12.014

[Abstract](412) [HTML](1033) [PDF 1.51 M](966)

Abstract:
Objective: To evaluate the feasibility of endoscopic-assisted or endoscopic-assisted combined with thoracoscopic upper mediastinal lymph node dissection (UMLND) via transcervical approach for papillary thyroid carcinoma (PTC).
Methods: The clinical data of 11 PTC patients undergoing endoscopic UMLND in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from December 2015 to July 2018 were retrospectively analyzed. Of the patients, 5 cases were males and 6 cases were females with a mean age of (45±18) years. Total thyroidectomy, central neck dissection, and lateral neck dissection were performed by open or endoscopic-assisted approach. UMLND was performed by either transcervical endoscopic-assisted or endoscopic-assisted plus thoracoscopic approach.
Results: Of the 11 patients, operation was successfully completed under endoscopic assistance in 10 cases, and 1 patient was converted to open thoracotomy because of severe adhesion of the metastatic lymph nodes to the innominate vein and it was difficult to ensure a safe separation. The average operative time of endoscope-assisted UMLND was (58.7±12.1) min, and the average length of postoperative hospital stay was (9.5±9.6) d. The average number of lymph nodes obtained from UMLND was 8.4±3.3, with a mean number of metastatic lymph nodes of 3.5±2.6. There were no complications associated with UMLND. The mean follow-up time was (16±7.0) months, the average serum thyroglobulin concentration of the patients was (1.85±2.21) ng/mL, and no tumor residual or recurrence was noted in any of the patients.
Conclusion: Transcervical endoscopic-assisted or endoscopic-assisted plus thoracoscopic UMLND is a safe and reliable approach for the treatment of thyroid papillary carcinoma, with a thorough clearance and minimally invasive operation as well as cosmetic results. So, it has greater clinical application value.

15 Application value of vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer

WU Yongfeng , LIU Xingzhou , LIU Dong , TAO Qingsong

2018, 27(12):1589-1596. DOI: 10.7659/j.issn.1005-6947.2018.12.015

[Abstract](296) [HTML](824) [PDF 1.09 M](841)

Abstract:
Objective: To investigate the application value of vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer.
Methods: The clinical data of 84 patients with advanced gastric cancer undergoing laparoscopic radical gastrectomy were retrospectively analyzed. Of the patients, 42 underwent vessel-guided lymph node dissection (observation group) and 42 cases underwent conventional systemic lymph node dissection (control group) during operation. The serum levels of matrix metalloproteinases (MMPs), vascular endothelial growth factor (VEGF), kallikreins 7 (KLK7), E-cadherin (E-cad) were determined, and the blood and peritoneal micrometastasis were also detected via examining the mRNA levels of carcinoembryonic antigen (CEA) and cytokeratin 19 (CK-19) in the peripheral blood and peritoneal washes.
Results: There were no significant differences in number of dissected lymph nodes, distance between incision margin and tumor, time to postoperative anus gas passage, length of hospital stay and incidence of complications between the two groups (all P>0.05). The operative time and intraoperative blood loss in observation group were significantly decreased compared with control group (both P<0.05). The serum levels of MMP-2, MMP-9, VEGF and KLK7 were significantly decreased and E-cad was significantly increased in both groups after operation, but the decreasing amplitudes of MMP-9, VEGF and KLK7 in observation group were significantly greater than those in control group (all P<0.05). The blood and peritoneal micrometastasis rates showed no significant differences between the two groups before operation (both P>0.05), but were significantly lower in observation group than those in control group after operation (both P<0.05). The overall incidence of postoperative recurrence/metastasis in observation group was significantly lower and the progression-free survival was significantly longer in observation than those in control group (both P<0.05), but there were no significant differences in the overall survival and 1- and 3-year survival rate between the two groups (all P>0.05).
Conclusion: Using vessel-guided lymph node dissection in laparoscopic radical gastrectomy for gastric cancer can shorten the operative time and reduce intraoperative bleeding, and also it may improve long-term prognosis of the patients by reducing the risk of micrometastasis.

16 Research progress of genes associated with vascular remodeling in lower limb primary varicose veins

ZHANG Wan , GUO Zhenyu

2018, 27(12):1597-1602. DOI: 10.7659/j.issn.1005-6947.2018.12.016

[Abstract](309) [HTML](981) [PDF 484.23 K](737)

Abstract:
Lower extremity primary varicose veins (PVVs) can manifest as distended and tortuous veins as well as limb heaviness and swelling, and can be associated with skin changes and refractory ulcers at an advanced stage. PVVs is a multifactorial disease, and although valvular incompetence and venous hypertension are regarded to be the most common causes, the exact pathogenesis remains unclear. Various studies have suggested a potential genetic contribution. Recently, vascular remodeling has been recognized as a trigger factor for PVVs. The authors address the research progress of genes associated with vascular remodeling in PVVs.

17 Progress of diagnosis and treatment of anal fistula and discussion of their practicalities

FAN Wenbin , HOU Yanmei , ZHAO Anqi , KANG Jian , YANG Xiangdong

2018, 27(12):1603-1608. DOI: 10.7659/j.issn.1005-6947.2018.12.017

[Abstract](940) [HTML](1351) [PDF 1.06 M](1019)

Abstract:
Anal fistula is one of the common perianal diseases. How to find a balance between reducing the recurrence rates and choosing an appropriate treatment method so as to improve the patients’ quality of life is always a difficult issue in the treatment of anal fistula. In recent years, the ligation of intersphincteric fistula tract (LIFT) and its combination with anal fistula plug (LIFT-plug) have been reported many times by scholars at home and abroad. The use of biological materials, video-assisted anal fistula treatment (VAAFT), laser fusion technique, and new technologies such as self-injection have realized the improvement of conventional methods, and also shown its advantages. With the aid of diagnosis and assessment by assistant approaches such as electronic computer tomography (CT), endoanal ultrasound (EUS), magnetic resonance imaging (MRI), appropriate treatment selection and performance of individualized comprehensive therapy is development trend of the clinical treatment of anal fistula in the future. The authors address the issues in this field.

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Volume 27,Issue 12,2018 Table of Contents

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