Volume 31,Issue 12,2022 Table of Contents

1 Role of TEVAR in non-complex type B aortic dissection —interpretation of 2022 STS/AATS clinical practice guidelines on the management of type B aortic dissection

SHU Chang

2022, 31(12):1557-1563. DOI: 10.7659/j.issn.1005-6947.2022.12.001

[Abstract](654) [HTML](839) [PDF 667.52 K](1987)

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In the treatment of non-complicated type B aortic dissection (TBAD), disagreement exists between Chinese and Western academic associations, and previous European and American guidelines emphasized conservative treatment. However, with the increase of long-term follow-up data of TBAD patients and the extensive application and improvement of endovascular techniques, the effective role of TEVAR in non-complicated TBAD has gradually been recognized by Western academic community, and has been elaborated in this year's American STS/AATS guideline. Therefore, this paper interprets the relevant parts of the guideline for discussion among professional scholars.

2 Progress and concerns in the field of contemporary venous surgery

ZHANG Fuxian , HOU Benxin , WU Yongjin

2022, 31(12):1564-1568. DOI: 10.7659/j.issn.1005-6947.2022.12.002

[Abstract](851) [HTML](752) [PDF 651.77 K](1807)

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In diagnosing and treating peripheral vascular diseases, venous diseases encompass a large proportion, accounting for more than 60% of the outpatient volume. According to the statistics, the prevalence of venous diseases of lower limbs in China is 8.89%, and varicose veins alone affect hundreds of millions of patients. In recent years, significant advances have been made in the diagnosis and treatment methods, concepts, auxiliary equipment, consumable materials, technology, and basic research of vascular diseases, particularly the breakthroughs in the diagnosis and treatment of venous diseases such as varicose of great saphenous vein, deep vein thrombosis, iliac vein compression syndrome and pelvic congestion syndrome, highlighting the development and progress of modern venous surgery. Here, the authors summarize the progress and concerns relevant to venous surgery.

3 Application of Fc-modified monoclonal antibodies in cancer therapy

WEI Tong , YUAN Peng

2022, 31(12):1569-1577. DOI: 10.7659/j.issn.1005-6947.2022.12.003

[Abstract](1405) [HTML](1542) [PDF 819.01 K](2273)

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Monoclonal antibodies contain an antigen-binding fragment (Fab) and a crystallizable fragment (Fc). Currently, many studies have modified monoclonal antibodies to regulate the interaction between antibodies and the immune system and further improve the therapeutic effect of the tumor. Compared with traditional chemotherapy drugs, therapeutic monoclonal antibodies have the characteristics of high targeting and low toxicity side effects and are an essential auxiliary means of tumor therapy. Among the modification methods, modification of the Fc part of monoclonal antibodies is an important one. The Fc part can recognize and bind to immune cells expressing Fc receptors and bind to the complement components in blood. Compared with traditional monoclonal antibodies, Fc-modified monoclonal antibodies can enhance or weaken the affinity to the receptor and affect the half-life of antibodies and the biological activity of antibodies through antibody-dependent cell-mediated cytotoxicity (ADCC), antibody-dependent cell-mediated phagocytotoxicity (ADCP), complement-dependent cytotoxicity (CDC) and other mechanisms. Among the Fc-modified monoclonal antibodies for cancer treatment in clinical practice, most of them exhibit better anti-tumor potential by affecting the affinity of monoclonal antibodies to their binding Fcγ receptor (FcγR), thereby affecting the function of Fc segment and enhancing or weakening the ADCC effect. In most cases, a monoclonal antibody can kill tumor cells mediated by the ADCC effect, so enhancing the ADCC effect can improve the efficacy of monoclonal antibodies in tumor treatment. However, in monoclonal antibodies that target to block cell surface receptors or cytokines, such as immune checkpoint inhibitor antibodies, the immune response mediated by FcγR and complement may affect the efficacy, and some attenuation of the ADCC effect is required. Currently, the widely used engineering modification methods of the Fc segment include the following directions: the modification of antibody protein sequence, such as protein engineering technology based on amino acid substitution; the modification targeting the post-translational modification of antibody protein, which mainly uses glycosylation modification technology; in addition, the modification of the structural framework of IgG subclasses selecting the framework of new IgG subclass (such as IgG4) to replace the traditional one of IgG1 also exerts function by affecting the affinity of the Fc segment to their FcγR. Many studies have demonstrated that compared with traditional monoclonal antibodies, Fc modified monoclonal antibodies have certain advantages in the clinical and fundamental data of tumor therapy, showing good antitumor activity in breast cancer, hematologic tumors, lung cancer and other tumors. Here, the authors systematically demonstrate the classical structures of monoclonal antibodies, the mechanisms of action as well as the main strategies for Fc part modification of the monoclonal antibody drugs, the clinical application and development prospects.

4 Chinese expert consensus on prevention and treatment of abdominal compartment syndrome after herniorrhaphy (2022 edition)

2022, 31(12):1578-1589. DOI: 10.7659/j.issn.1005-6947.2022.12.004

[Abstract](777) [HTML](789) [PDF 1.30 M](2197)

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Abdominal compartment syndrome (ACS) is one of the most severe complications in clinical practice, which is caused by a series of pathophysiological changes in the body due to the continuous increase of intra-abdominal pressure, thus inducing multiple organ dysfunction or failure. Various reasons can cause ACS. Herniorrhaphy, especially the repair of a vast abdominal wall hernia or a giant inguinal hernia, is one of the important predisposing factors for ACS. Still, there are few specific systematic statements or consensus opinions. This consensus focuses on the postoperative ACS of herniorrhaphy, elaborates on the related risk factors, preoperative preventive measures, intraoperative decision-making, postoperative monitoring, and ACS treatment, and puts forward the focus issues closely related to clinical settings, discusses and gives recommendations based on evidence-based medicine, so as to improve the understanding as well as the prevention and treatment ability of clinicians, especially hernia surgeons, on this condition.

5 Talos distal perforating stent-graft in the treatment of Stanford type B aortic dissection: a first case report (with video)

WU Kemin , HE Xin , LIU Yu , HUANG Jianhua , WANG Wei

2022, 31(12):1590-1596. DOI: 10.7659/j.issn.1005-6947.2022.12.005

[Abstract](1627) [HTML](920) [PDF 1.14 M](1796)

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Background and Aims Thoracic endovascular aortic repair (TEVAR) has become the first-line treatment for type B aortic dissection. Maximizing the aortic dissection coverage and promoting aortic remodeling without increasing the risk of paraplegia has become challenging in clinical practice. Here, the authors report the first case of clinical implantation of the new Talos distal perforating stent (Talos stent) in our country successfully performed in Xiangya Hospital of Central South University after its market release and analyze the related problems.Methods The clinical data of the first case of implantation of Talos Stent in China after its introduction to the market were reported. The advantages and disadvantages of this type of stent were analyzed and reviewed with a literature review.Results A 72-year-old male patient with Stanford type B aortic dissection requiring a long-length stent due to the extensive involvement of the aortic dissection underwent TEVAR with the newly-marketed novel Talos stent with the approval of himself and his family. The stent was easily guided towards the lesion during operation with precise positioning. After stenting, the aortic tears of the patient were thoroughly repaired, the false lumens were thrombosed entirely, and the distal intercostal perforating branches were preserved intact, with no development of aortic-related adverse events.Conclusion The Talos stent has excellent procedural performance, its long body ensures to the maximum extent possible the repair of aortic dissection and promotes aortic remodeling, and the distal perforation design can repair the aortic tears and preserve intercostal branches at the same time, and thereby prevent paraplegia caused by spinal cord ischemia.

6 Efficacy of paclitaxel-coated balloon versus common balloon for popliteal arteriosclerosis obliterans: a propensity score matching analysis

ZHANG Hongsong , ZHAO Yaheng , ZHENG Lihua , ZHANG Lei , ZHANG Feng , HE Xinqi , PENG Junlu , HE Zhaopeng , ZHANG Like , YANG Yan , YANG Lixin , ZHAO Heng , LIU Peng

2022, 31(12):1597-1604. DOI: 10.7659/j.issn.1005-6947.2022.12.006

[Abstract](993) [HTML](715) [PDF 760.27 K](1221)

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Background and Aims Drug-coated balloon (DCB) as a new interventional therapeutic technique has been increasingly used. However, it is currently mainly used in the field of coronary artery disease therapy, while studies on its application in peripheral vascular diseases are relatively limited, and especially rare in popliteal artery that spans the joint. Therefore, this study was performed to compare the short-term efficacy and long-term outcomes of using DCB versus common balloon (CB) in the treatment of popliteal arteriosclerosis obliterans, and investigate the application value of DCB in this field.Methods The clinical data of 65 patients with popliteal arteriosclerosis obliterans undergoing interventional balloon dilatation in the Department of Vascular Surgery of the First Hospital of Hebei Medical University from March 2014 to April 2020 were retrospectively analyzed. Of the patients, 29 cases were treated with DCB (DCB group) and 36 cases were treated with CB (CB group). The two groups of patients were matched with propensity score matching (PSM) method at a 1∶1 ratio. After match, the postoperative patency rate of the popliteal artery, ankle-brachial index (ABI) and Rutherford classification as well as the occurrence of endpoint events such as amputation, thrombosis formation and intravascular restenosis were compared between the two groups of patients.Results Twenty-one pairs of patients in the two groups were successfully matched. The clinical data were balanced and comparable between the two groups after match (all P>0.05). After match, the popliteal artery patency rate and ABI at 3 and 6 months after surgery showed no significant difference between the two groups (all P>0.05). At 12 months after surgery, the popliteal artery patency rate and ABI were significantly higher in DCB group than those in CB group (65.71% vs. 49.55%; 0.71% vs. 0.55%, both P<0.05), and the Rutherford classification in DCB group was significantly superior to that in CB group (P<0.05). At one year after surgery, the overall incidence of endpoint events that included amputation, thrombosis formation and intravascular restenosis in DCB group was significantly lower than that in CB group (23.81% vs. 57.14%, P<0.05). The Log-rank test showed that there was a significant difference in the incidence of endpoint events between the two groups of patients (χ2=5.654, P<0.05).Conclusion DCB offers a similar CB short-term efficacy as CB in the treatment of popliteal arteriosclerosis obliterans, but DCB can significantly improve the popliteal artery patency rate and reduce the occurrence of endpoint events in long-term postoperative period.

7 Analysis of risk factors for stent occlusion after iliac vein stenting

WU Hongfei , XIAO Zhanxiang , ZENG Zhaofan , QI Youfei , ZHANG Kun

2022, 31(12):1605-1611. DOI: 10.7659/j.issn.1005-6947.2022.12.007

[Abstract](839) [HTML](761) [PDF 683.73 K](1368)

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Background and Aims Iliac vein stenting (IVS) can effectively relieve the venous outflow obstruction of the left lower extremity and reduce the incidence of chronic venous insufficiency. However, stent occlusion after IVS is still inevitable. Therefore, this study was conducted to investigate the factors for stent occlusion in patients with lower extremity venous diseases after IVS.Methods The clinical data of 183 patients undergoing IVS in the Department of Vascular Surgery of Hainan General Hospital from March 2015 to August 2020 were collected. The risk factors for stent occlusion in patients were screened by univariate and multivariate Logistic regression analysis, and the predictive efficacy of each risk factor was evaluated using the receiver operating characteristic (ROC) curve.Results A total of 183 patients were included. Of the patients, 47 cases had non-thrombotic iliac vein compression syndrome (NIVCS), 92 cases had acute deep venous thrombosis of the lower extremity (DVT), and 44 cases had post-thrombotic syndrome (PTS). The primary patency rates of NIVCS patients, lower limb DVT patients and PTS patients at 12 months after IVS were 89.4%, 81.5%, and 54.5%, respectively. Results of univariate showed that stent across the inguinal ligament, incomplete coverage of the lesion, postoperative collaterals, inflow thrombus, multiple stent placement, and length of the stent were significantly associated with the occurrence of stent occlusion (all P<0.05); results of multivariate Logistic regression analysis showed that incomplete coverage of the lesion (OR=2.503, 95% CI=1.144-5.477, P=0.022) and presence of postoperative collaterals (OR=2.506, 95% CI=1.155-5.436, P=0.020) were independent risk factors for stent occlusion. ROC curve showed that the area under the curve (AUC) for incomplete lesion coverage was 0.623 (95% CI=0.522-0.725, P=0.015), with a sensitivity of 45.2% and specificity of 79.4%. The AUC for the presence of postoperative collaterals was 0.607 (95% CI=0.506-0.707, P=0.036), with a sensitivity of 47.6% and specificity of 73.8%.Conclusion The possibility of stent occlusion after IVS is increased in patients with incomplete coverage of the lesion and the presence of postoperative collaterals, for whom, follow-up should be strengthened, and anticoagulation should be prolonged accordingly. Meanwhile, surgical intervention should be performed as soon as possible to reduce the incidence of stent occlusion when stent stenosis occurs during follow-up.

8 Surgical treatment for graft infection with aortoesophageal fistula after TEVAR

LIU Bin , FENG Hai , LI Chenyu , GAO Xiang , LIU Mingyuan , CHEN Xueming

2022, 31(12):1612-1618. DOI: 10.7659/j.issn.1005-6947.2022.12.008

[Abstract](1009) [HTML](778) [PDF 1.34 M](1373)

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Background and Aims Aortoesophageal fistula (AEF) is a relatively rare but often life-threatening condition. Although thoracic endovascular aortic repair (TEVAR) has been established as an alternative surgical strategy for thoracic aortic aneurysms and thoracic aortic dissections, the secondary AEF after TEVAR becomes more challenging. Here, the authors report the treatment modalities and outcomes of 7 cases with this disease.Methods The clinical data of 7 patients with secondary AEF complicated with graft infection after TEVAR treated between 2018 and 2021 were retrospectively analyzed. All patients underwent interventional or surgical treatment, including open surgery in 4 cases, that was off-pump extra-anatomical bypass from ascending aorta to abdominal aorta, excision of infected graft and infection lesion, and esophageal fistula drainage; TEVAR in 2 cases; staged TEVAR and open surgery in one case.Results Of the 5 patients who underwent primary and staged open surgery, 2 cases recovered and discharged, and 3 cases died. The 2 patients who underwent TEVAR alone and originally planned to perform open surgery after anti-infection and nutritional support treatment died during the treatment.Conclusion Conservative management or TEVAR alone often fails to save patients due to infected grafts and infection lesions. Although open surgery is associated with high mortality, complete removal of the infected lesions and grafts, extra-anatomical bypass from ascending aorta to abdominal aorta, and adequate drainage of the infected lesions are reasonable strategies for the treatment of graft infection complicated with aortoesophageal fistula after TEVAR under feasible conditions.

9 Safety and feasibility of open surgical retrieval of inferior vena cava filters

LI Jinyong , LIU Jianlong , JIA Wei , TIAN Xuan , JIANG Peng , CHENG Zhiyuan , ZHANG Yunxin , LIU Xiao , TIAN Chenyang , ZHOU Mi

2022, 31(12):1619-1627. DOI: 10.7659/j.issn.1005-6947.2022.12.009

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Background and Aims Inferior vena cava filters (IVCF) are widely used in the prevention of fatal pulmonary embolism (PE) and removed by interventional technique, and surgical removal may be considered for filters that are irretrievable by endovascular approach or exceed the time window for retrieval. This study was performed to evaluate the safety and feasibility of open surgery for removal of the IVCF.Methods The clinical data of 27 patients who underwent open surgery for filter retrieval after IVCF placement from February 2019 to August 2022 in the Vascular Surgery Department of Beijing Jishuitan Hospital was retrospectively analyzed. In all patients, the median number of attempts of interventional filter retrieval was 1 (1-2) before open surgery.Results All filters were removed and the technical success rate was 100%. The median time for filter implantation was 20 (5-48) months. There were 8 cases (29.6%) of Aegisy filter, 1 case (3.7%) of Denali filter, 10 cases (37.0%) of Cordis filter, 1 case (3.7%) of Simon filter, 3 cases (11.1%) of Celect filter, and 4 cases (14.8%) of Tulip filter, respectively. The filter was located in the suprarenal inferior vena cava in 1 case (3.7%), in the retrohepatic inferior vena cava in 1 case (3.7%), and in the subrenal inferior vena cava in 25 cases (92.6%). During the operation, a suture line was placed at the retrieval hook, the filter was removed by direct clamping the retrieval hook without occlusion of the inferior vena cava, and a purse-string suture was performed after removal in 2 cases (7.4%); the filter was directly retrieved to the vascular sheath followed by closure without occlusion of the inferior vena cava in 2 cases (7.4%); the filter was removed by incision of the anterior wall of the inferior vena cava followed by continuous suture of the vessel after blocking the blood flow of the bilateral renal veins and the inferior vena cava at distal and proximal ends of the filter in 1 case (3.7%), blocking the blood flow of the distal inferior vena cava, the first hepatic portal and the second hepatic portal in 1 case (3.7%), and blocking the blood flow of the inferior vena cava at the distal end of the filter in 21 cases (77.8%). The average operative time was (224.15±23.85) min. No deep venous thrombosis or symptomatic PE, no cardiopulmonary complications, and wound infection during the perioperative period. Abdominal pain with bloody gastric juice occurred in 1 case (3.7%), and hematuria occurred in 1 case (3.7%), which were relieved after symptomatic treatment. The average hemoglobin level was (128.59±15.05) g/L before surgery, and (110.56±22.15) g/L after surgery. Six patients (22.2%) received 400 mL of red blood cell suspension transfusion after surgery. No fatal hemorrhage or shock occurred. The median length of postoperative hospital stay was 9 (8-12) d.Conclusion Although open surgical filter removal is difficult and technically complex, filter removal is safe and feasible. Sufficient CT evaluation of the position of the filter and its hook before surgery and using appropriate surgical approach, with specific surgical skills, the safety and success rate of open surgery can be greatly improved.

10 Comparison of ultrasound-guided popliteal vein puncture in supine position versus prone position

CHEN Gang , HONG Xiang , LU Weifeng , CHEN Jieying , HONG Shichai , HUANG Yulong , CHEN Yihui , LIN Yue , XIE Xinsheng , WANG Lixin , FU Weiguo

2022, 31(12):1628-1635. DOI: 10.7659/j.issn.1005-6947.2022.12.010

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Background and Aims Ultrasound-guided popliteal vein puncture is one of the common approaches for the intravenous intervention of the lower limb veins. At present, the prone position is frequently used for this procedure. However, long-time prone-positioned surgery is uncomfortable for patients. Therefore, this study was performed to investigate the feasibility of ultrasound-guided popliteal vein puncture in the supine position and compare the advantages and disadvantages of supine and prone position.Methods Patients with chronic venous disease were randomly assigned to two groups and underwent ultrasound-guided popliteal vein puncture in a supine or prone position, respectively. The variables, such as the operative time for popliteal vein puncture and visual analog score (VAS) for the degree of discomfort of patients and the incidence of postoperative complications, were analyzed.Results A total of 27 patients with iliac vein stenosis were enrolled, including 14 cases (16 limbs) in the supine position group and 13 cases (16 limbs) in the prone position group. There were no significant differences in the baseline data and the treatment methods of the affected veins between the two groups of patients (all P>0.05). The operative time for popliteal vein puncture showed no significant difference between the supine position group and prone position group [3.7 (3.4-6.2) min vs. 4.2 (3.5-4.4) min, P>0.05]. The VAS value was significantly lower in supine position group than that in prone position group [2.0 (1.0-2.8) vs. 6.0 (4.0-8.0), P<0.01]. Bleeding from a branch of the popliteal artery occurred in one supine position group case, which was successfully cured by ultrasound-guided compression of the lesion.Conclusion Popliteal vein puncture in the supine position does not prolong the operative time compared with prone position, but it can significantly reduce the discomfortable suffering of patients. So, it is recommended to be used in clinical practice.

11 Efficacy of subfascial endoscopic perforator surgery combined with endovenous laser closure in the treatment of great saphenous vein varices

WANG Li , ZHANG Hong , DU Jianqing , WU Zhongyin , LI Ronghua , XIAO Yanshang

2022, 31(12):1636-1643. DOI: 10.7659/j.issn.1005-6947.2022.12.011

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Background and Aims Surgery is an effective treatment for great saphenous varicose veins (GSV). However, although traditional perforating vein ligation has demonstrable efficacy, it has many disadvantages, such as relatively large trauma, frequent postoperative complications, and a high postoperative recurrence rate, which increase the risk of secondary treatment. Subfascial endoscopic perforator surgery (SEPS) and endovenous laser treatment (EVLT) are new therapeutic procedures, and each has its advantages. Therefore, this study was performed to investigate the clinical efficacy of EVLT combined with SEPS for the treatment of GSV to provide clinical treatment options.Methods Seventy-eight patients with GSV admitted to Department of Vascular Surgery, Affiliated Hospital of Chengde Medical College from June 2018 to October 2019 were selected and assigned to study group and control group, with 39 cases in each group, using random number table method. Patients in study group underwent SEPS plus EVLT, and those in control group were subjected to conventional perforating vein ligation plus EVLT. The surgical variables, oxidative stress markers, scores for quality of life, incidence of complications and disease recurrence rate were compared between the two groups.Results There were no significant differences in the general data, preoperative levels of oxidative stress markers, and scores for quality of life between the two groups (all P>0.05). The operative time and length of hospital stay were shorter, the intraoperative blood loss and hospitalization costs were less, and the area of petechiae and length of incision on the lower limbs were smaller in study group than those in control group (all P<0.05); the serum levels of malondialdehyde, NO and IL-6 were lower, while glutathione peroxidase was higher at 24 and 72 h after surgery in study group than those in control group (all P<0.05). The scores for psychophysiological state, physical performance, social activity, and pain in study group were superior to those in control group one week after surgery (all P<0.05). The incidence of complications in study group was lower than that in control group (2.56% vs. 20.51%, P<0.05), and the disease recurrence rate on 12 months after surgery in study group was lower than that in the control group (5.56% vs. 26.47%, P<0.05).Conclusion SEPS combined with EVLT for the treatment of GSV has the advantages of less trauma, shorter operative time, faster postoperative recovery, fewer complications, and lower hospitalization costs, as well as improving the patient's quality of life. So, it is recommended to be used in clinical practice.

12 Effect of miR-27b-3p on the function of aortic vascular smooth muscle cells and monocytes and the mechanism

XIAO Yuanyang , LI Liangxue

2022, 31(12):1644-1652. DOI: 10.7659/j.issn.1005-6947.2022.12.012

[Abstract](697) [HTML](302) [PDF 1004.29 K](1299)

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Background and Aims Big data gene chip analysis showed that the expression of miR-27b-3p is significantly up-regulated in abdominal aortic aneurysm (AAA) tissue and patients' serum. However, the function and action mechanism of miR-27b-3p in aortic vascular smooth muscle cells (VSMCs) remains unclear. Therefore, this study was conducted to investigate the function of miR-27b-3p in VSMCs, as well as its effects on macrophages and the extracellular matrix, and the action mechanism.Methods In VSMCs after transfection with miR-27b-3p inhibitor, the cell proliferation activity was detected by CCK-8, and the apoptosis was detected by flow cytometry. In mononuclear macrophage cell line, THP-1 cells after transfection with miR-27b-3p inhibitor, the expressions of inflammatory-associated factors were detected by ELISA, and the expression levels of matrix-related proteins were detected by Western blot. The targeting relationship between miR-27b-3p and PTEN was verified by dual luciferase reporter gene assay and related functional experiments.Results In VSMCs after miR-27b-3p knockdown, the proliferative ability was significantly increased, while the apoptotic rate was significantly decreased (both P<0.05). In THP-1 cells after miR-27b-3p knockdown, the expression levels of pro-inflammatory factors (TNF-α, IL-12) and the matrix metalloproteinase 9 (MMP-9) were significantly decreased, while the expression levels of inflammatory factors (IL-4, IL-10) and metalloproteinase inhibitor 1 (TIMP-1) were significantly increased (all P<0.05). Dual-luciferase experiments confirmed that PTEN was a target gene of miR-27b-3p. The expression level of PTEN protein was significantly down-regulated in VSMCs with miR-27b-3p overexpression, while the proliferation was significantly enhanced and the apoptotic rate was significantly decreased in VSMCs with PTEN overexpression (all P<0.05). The expression levels of TNF-α and IL-12 as well as MMP-9 protein were significantly down-regulated, while the levels of IL-4 and IL-10 as well as TIMP-1 protein were significantly up-regulated in THP-1 cells with PTEN overexpression (all P<0.05). In VSMCs and THP-1 cells with simultaneous miR-27b-3p and PTEN expression, the changes in the above variables showed no significant differences from those in the control group (all P>0.05).Conclusion miR-27b-3p can participate in regulating VSMCs cell proliferation and apoptosis through targeting PTEN, and thereby inhibit the inflammatory response and extracellular matrix protein expression of the mononuclear macrophage cells. The miR-27b-3p/TPEN molecular axis may play an important role in the occurrence and development of AAA.

13 Screening and construction of abdominal aortic aneurysm specific ceRNA regulatory network

HUO Jinlong , WU Lang , ZHAO Jichun , GUO Youming , QU Rui , ZHAO Lijin

2022, 31(12):1653-1659. DOI: 10.7659/j.issn.1005-6947.2022.12.013

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Background and Aims Abdominal aortic aneurysm (AAA) is a disease with high morbidity and mortality in elderly patients. The actions of endogenous competing RNA (ceRNA) networks in the underlying pathogenesis of AAA are unclear at present. Therefore, this study was conducted to investigate the role of ceRNA network in the formation and development of AAA through screening and establishing the AAA-specific long non-coding RNA (lncRNA)-microRNA (miRNA)-mRNA ceRNA network.Methods Firstly, the data set was screened in gene expression database (GEO), and the differentially expressed lncRNAs and mRNAs between AAA and normal abdominal aorta tissues were identified. Lasso regression was used to screen the disease characteristic genes from differentially expressed RNAs. Starbase software was used to search for miRNAs that combined with differentially expressed lncRNAs and specific mRNAs, and Cytoscape software was used to construct the lncRNA-miRNA-mRNA ceRNA network. The cytohubba module in Cytoscape was used to further screen the core ceRNA network.Results Two data sets GSE7084 and GSE57691 were screened, and 144 differentially expressed mRNAs and 13 differentially expressed lncRNAs were obtained. Seventeen specific mRNAs were obtained from differentially expressed mRNAs by Lasso regression. lncRNA HCP5-miR27-FOSB was considered be the most critical ceRNA network for the occurrence and development of AAA.Conclusion The constructed ceRNA network may be involved in the formation and development of AAA. However, this result still needs to be further investigated and verified by subsequent studies.

14 Observation of clinical efficacy of PTCD to decrease bilirubin before laparoscopic pancreaticoduodenectomy (with video)

JIAO Zhendong , GUO Cheng , JIN Shangbo

2022, 31(12):1660-1665. DOI: 10.7659/j.issn.1005-6947.2022.12.014

[Abstract](886) [HTML](718) [PDF 751.48 K](1390)

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Background and Aims A number of studies have proved that percutaneous transhepatic cholangial drainage (PTCD) for jaundice reduction can improve the immunity and digestive function of patients with jaundice after surgery, but the effect of using PTCD during open pancreaticoduodenectomy (OPD) on the incidence of postoperative complications is not significant. However, the application efficacy of PTCD in laparoscopic pancreaticoduodenectomy (LPD) still needs to be studied. Therefore, this study was performed to investigate the effectiveness and safety of preoperative PTCD in patients undergoing LPD.Methods The clinical data of 42 patients undergoing LPD in Baoji People's Hospital from January 2019 to December 2021 were retrospectively analyzed. Of the 42 patients, 25 patients underwent PTCD to decrease bilirubin before surgery (PTCD group), and the remaining 17 patients did not undergo preoperative PTCD (non-PTCD group). The baseline characteristics and perioperative variables of the two groups were compared.Results The mean time of preoperative biliary drainage in PTCD group was (6.81±1.52) d. The intraoperative blood loss was significantly less (322.21 mL vs. 435.17 mL, P=0.000), and the incidence rates of bile leakage (0.00 vs. 23.53%, P=0.012) and the overall complications (16.00% vs. 47.06%, P=0.029) were significantly lower in PTCD group than those in non-PTCD group. There were no significant differences between PTCD group and non-PTCD group in terms of operative time for LPD (366.26 min vs. 381.21 min), time to first postoperative bowel movement (2.36 d vs. 2.51 d), time to drainage tube removal (4.46 d vs. 4.25 d), length of total hospital stay (15.27 d vs. 13.58 d), readmission rate within 30 d (16.00% vs. 17.65%) and incidence rates of other specific complications (all P>0.05).Conclusion Routine performance of preoperative PTCD to decrease bilirubin in patients scheduled to undergo LPD can reduce the amount of intraoperative blood loss, reduce the incidence rates of overall complications and bile leakage, and it is recommended to be used in clinical practice. However, its indications and safety still need to be further investigated and verified by studies with large sample size.

15 Clinical efficacy of endoscopic thyroidectomy via oral vestibule and submandibular approach: a report of 31 cases

OUYANG Hui , ZHOU Di , XIA Fada , BAI Ning , CONG Rong , LI Xinying

2022, 31(12):1666-1673. DOI: 10.7659/j.issn.1005-6947.2022.12.015

[Abstract](586) [HTML](608) [PDF 1.51 M](1320)

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Background and Aims The incidence of thyroid carcinoma is continuously rising throughout the world. In clinical practice, the demand for endoscopic thyroidectomy has also increased. Among various approaches of endoscopic thyroidectomy, transoral endoscopic thyroidectomy vestibular approach (TOETVA) meets the concept of natural orifice transluminal endoscopic surgery (NOTES) better than other approaches. However, TOETVA is obviously associated with complications that may greatly affect patients' quality of life. Therefore, this study was conducted to evaluate the application efficacy of endoscopic thyroidectomy via oral vestibule and submandibular approach (ETOSA) in the treatment papillary thyroid carcinoma (PTC).Methods The clinical data of a total of 31 PTC patients undergoing ETOSA surgery in Xiangya Hospital from March 2022 to June 2022 were reviewed. The operative time, blood loss, postoperative drainage, length of postoperative hospitalization, pathological results, and the scores for neck cosmetic appearance, sensation of the submental area and postoperative pain as well as postoperative complications were analyzed.Results ETOSA procedure was successfully completed in all patients and none of them required a conversion to open surgery. The average operative time was (145.23±35.91) min, the mean intraoperative blood loss was (11.13±4.78) mL, the average drainage volumes were (50.97±26.25) mL on postoperative day (POD) 1 and (22.74±15.10) mL on POD 2 respectively, the average length of postoperative hospitalization was (2.19±0.47) d, and the average number of dissected central lymph node was 7.52±4.34. Complications such as postoperative hoarse voice, mental nerve injury, surgical area infection, swallowing discomfort, cracked corners of the mouth and swelling of the lower lip occurred in none of the patients. Only 2 cases had temporary hyperparathyroidism and 1 case had cervical skin perforation. All patients had no obvious lower lip and skin paresthesia with good cosmetic outcomes. Patients were satisfied with the recovery of the two 5-mm submental incisions.Conclusion ETOSA is a safe and feasible procedure, which can reduce the risks such as mental nerve injury and tears at the corners of the mouth and meanwhile avoid the possible interference between the instruments. So, it has certain clinical application value.

16 Rotarex atherectomy system for the treatment of femoropopliteal in-stent restenosis: current status and perspectives

GUO Xiaobo , LIU Mingyuan , FENG Hai

2022, 31(12):1674-1679. DOI: 10.7659/j.issn.1005-6947.2022.12.016

[Abstract](1129) [HTML](277) [PDF 641.74 K](1490)

Abstract:
In-stent restenosis (ISR) is a challenging clinical problem after intervention therapy of femoropopliteal (FP) arterial occlusive disease. Femoropopliteal artery in-stent restenosis (FP-ISR) rates after primary stent implantation are relatively high, and repeat FP-ISR often requires multiple additional interventions. Previous studies mainly focused on balloon angioplasty, bypass surgery, stent-graft, drug-coated balloon, and debulking therapies. However, the optimal approach remains controversial. Recently, the treatment trend has shifted to a combination of two or more methods. Among them, the combination therapy based on Rotarex atherectomy plus debulking has become a new choice for FP-ISR. Here, the authors analyze the safety and efficacy of Rotarex combination therapy used for FP-ISR and also discuss the future prospects.

17 Research progress of TMED3 in malignant tumor

HUO Jiaxing , ZHU Chunyue , SU Hang , LIN Xunyi , ZHANG Fenghua

2022, 31(12):1680-1685. DOI: 10.7659/j.issn.1005-6947.2022.12.017

[Abstract](1208) [HTML](861) [PDF 691.20 K](1478)

Abstract:
Transmembrane emp24 protein transport domain containing 3 (TMED3) is a member of the P24 protein family, which has become a biological research hotspot in recent years. Its abnormal expression is closely related to the biological behaviors of malignant tumors, such as cell proliferation, invasion, and migration. However, the specific mechanism of TMED3 in various tumors is very complicated. Here, the authors summarize the research status, mechanism, and clinical significance of TMED3 in malignant tumors, aiming to provide a reference for clinical and basic research of malignant tumors.

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Volume 31,Issue 12,2022 Table of Contents

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