Comparison of mid-outcome among bare metal stent, atherectomy with or without drug-coated balloon angioplasty for femoropopliteal arterial occlusion.

This study evaluated the outcomes of a bare metal stent (BMS), DCB alone, atherectomy plus a drug-coated balloon (AT + DCB) and AT alone for the treatment of femoropopliteal artery occlusion. Four groups were included in this retrospective cohort study: 119 patients underwent the BMS procedure, 89 patients underwent DCB alone, 52 patients underwent AT + DCB, and 61 patients underwent AT alone. Patients were followed-up at 1, 6, 12 and 24 months after the procedure, the clinical outcomes and complications were assessed, and the primary outcomes were primary patency and restenosis. AT + DCB showed a lower bailout stent, and BMS displayed a higher retrograde puncture, flow-limiting dissection and postdilation (p < 0.05). For all procedures, the walking distance, ABI and pain score post-procedure were significantly improved compared with the pre-procedure values (p < 0.001). The restenosis rate was higher in BMS (21.0%) and AT alone (24.6%) than in DCB (10.1%) alone and AT + DCB (11.5%) (p = 0.04); there was no difference in amputation or clinically driven target lesion revascularization among procedures. The primary patency rates were 77.7%, 89.4%, 88.0% and 73.7% in the BMS, DCB alone, AT + DCB and AT alone groups at 24 months, respectively (p = 0.03), while the secondary patency and main adverse events (stroke, MI and death) were similar. Proximal concavity, proximal target vessel diameter ≥ 5 mm, runoff number ≥ 2 and DCB use were protective factors for primary patency. Our results suggested that AT + DCB and DCB alone were associated with higher primary patency, and DCB devices (combined with/without AT) should be the preferred choice for FP lesions.

Hybrid endovenous laser ablation reduces the recurrence of varicose veins below the knee compared with radiofrequency ablation: a real-world study.

Introduction: This study aimed to investigate the outcome of hybrid endovenous laser ablation (EVLA, 1470 nm) and radiofrequency ablation (RFA) procedures for varicose veins (VVs). Material and methods: We retrospectively analysed the clinical data of patients from July 2019 to December 2020. Eighty-four patients (121 limbs) underwent a hybrid EVLA procedure, and 108 patients (151 limbs) underwent an RFA procedure. The outcomes, venous clinical severity score (VCSS), chronic venous disease quality-of-life questionnaire (CIVIQ-20) score, and recurrence at 1, 6, and 12 months were collected. Results: No differences in complications or 24-h pain scores were noted between the 2 procedures, but a lower dosage of foam sclerosant was used in the EVLA procedure than in the RFA procedure (p < 0.02). The postoperative VCSS and CIVIQ-20 scores in the 2 groups were significantly decreased compared with the scores before the procedure, and no differences in scores were noted between the 2 procedures at 1 month. However, the VCSS and CIVIQ-20 scores for the EVLA procedure were significantly better than those for the RFA procedure at 6 and 12 months (p < 0.05). Both procedures showed a similar great saphenous vein closure rate at 12 months. The EVLA procedure showed lower rates of overall recurrence (4.96% vs. 14.57%, OR = 3.27, 95% CI: 1.33-8.00, p = 0.01) and recurrence below the knee (4.13% vs. 11.92%, OR = 3.14; 95% CI: 1.18-8.35, p = 0.02). Moreover, the patient satisfaction score was greater for the EVLA procedure than for the RFA procedure (p < 0.02). Conclusions: The hybrid EVLA (1470 nm) procedure reduces VV recurrence below the knee and results in better quality-of-life scores.

Identification of prognosis value and immune microenvironment features of ceRNAs in NSCLC with distinct gene mutation.

Non-small cell lung cancer (NSCLC), representing about 85% of all lung cancer (LC) cases, is by far the most common form of LC. High-throughput technology largely expands our ability to analyze the transcriptome data and a plethora of cancer-driving genes has been identified, paving the path to immune therapy, where the effects of cancer-causing mutations are countered with microenvironment complexity. Given that competing endogenous RNAs (ceRNAs) participate in diverse cellular processes by a broad array of mechanisms in cancer, we scrutinized the immune microenvironment and ceRNA signatures in mutation-specific NSCLC by integrating TCGA-NSCLC and NSCLS-associated GEO datasets. The results suggested that RASA1mutation clusters in LUSC had a better prognosis and immunity. Immune cell infiltration analysis indicated that the cluster with RASA1 mutation had a significantly high level of NK T cells and a low level of memory effector T cells. Further analysis of immune-related ceRNAs in LUSC showed that hsa-miR-23a was significantly associated with survival in RASA1-mutation samples, indicating that there may be specific ceRNAs in mutation-specific subgroups in NSCLC. In conclusion, this study verified the presence of complexity and diversity of NSCLC gene mutations and highlighted the intricate links between gene mutation and tumor environment features.

Comparison of 5-year outcomes and quality of life between endovenous laser (980†nm) and microwave ablation combined with high ligation for varicose veins.

Our study aims to evaluateand compare the long-term results of endovenous laser (EVLA) and microwave ablation (EMA) combined with high ligation in treating varicose veins (VVs). A total of 122 patients (150 legs) underwent EMA combined with high ligation, and 127 patients (167 legs) underwent EVLA procedures (980 nm) combined with high ligation in this retrospective study. Outcomes included the Aberdeen Varicose Vein Questionnaire (AVVQ) score, the Venous Clinical Severity Score (VCSS), clinical recurrence of VVs and patient satisfaction duringthe 5-year follow-up.During the 5-year follow-up, patients who underwent the EVLA procedure showed a higher recurrence of VVs than those who underwent the EMA procedure (22.75% vs. 13.33%, P = 0.03, odds ratio (OR): 1.91, 95% confidence interval (CI): 1.06-3.45), especially at the primary site (6% vs. 14.37%, P = 0.01; OR: 2.63; 95% CI: 1.21-5.72). VV recurrence within 3 years was higher in patients who underwent EVLA than in those who underwent the EMA procedure (73.68% vs. 40%, P = 0.01; OR: 4.2; 95% CI: 1.37-12.86). Compared with those at baseline, the AVVQ score, VCSS and EQ-5D score improved significantly at 5 years for patients who underwent either procedure (P < 0.01); however, the VCSS and AVVQ score were higher for patients who underwent the EVLA procedure (P = 0.05). The patient reintervention rate was higher for EVLA than for EMA (14.79% vs. 7.33%, P = 0.033; OR: 2.19; 95% CI: 2.06-5.34). Our results confirmed that EMA and EVLA improve the QoL of patients and that EMA combined with high ligation demonstrates lower 5-year recurrence, especially at primary sites.

Clinical outcomes of different endovenous procedures among patients with varicose veins and iliac vein compression: A retrospective cohort study.

OBJECTIVE: This study aimed to investigate the short-term outcomes of three endovenous procedures in patients with varicose veins (VVs) and severe iliac vein compression syndrome (IVCS). METHODS: A total of 158 consecutive patients were included in this multicenter retrospective study from May 2017 to December 2019; 54 patients underwent endovenous laser ablation (EVLA) alone, 47 patients underwent EVLA and balloon angioplasty (BA), and 57 patients underwent EVLA and stenting angioplasty (SA). Clinical outcomes and complications were assessed at one and twelve months post-surgery. The Quality of life (QoL) was assessed by the venous clinical severity score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ). RESULTS: Patients who underwent the SA procedure were older (P < 0.05). Incidence of laser ablation complications was similar among the three procedures; closure rates of the great saphenous vein were 96.8%, 98.0%, and 98.4%, respectively, at 12 months. Reflux times in the SA procedure were lower than those in the EVLA and BA procedures at 12 months, while ulcer healing time was faster with the SA procedure (P < 0.05) than with the other procedures. The VCSS and AVVQ values were significantly improved post-procedure (P < 0.05), with lower AVVQ scores in the SA procedure than in the EVLA and BA procedures at 12 months post-surgery. The EVLA and BA procedures (stenosis >70%) caused a significantly higher symptom recurrence than the SA procedure, with an odds ratios of 14.04 (95% confidence interval (CI), 1.99-99.18) and 10.50 (95% CI, 1.26-87.15), respectively. CONCLUSIONS: Our results demonstrate that EVLA and SA procedures relieve symptoms, improve the QoL, and decrease symptom recurrence in patients with VVs and severe IVCS (stenosis >70%).

MicroRNA-148b-colony-stimulating factor-1 signaling-induced tumor-associated macrophage infiltration promotes hepatocellular carcinoma metastasis.

BACKGROUND: MicroRNAs (miRNAs) are small non-coding molecules that exhibit important regulatory roles in various biological or cellular functions, including tumor metastasis. However, the detailed mechanisms of the expression and functions of miRNAs in hepatocellular carcinoma (HCC) have not yet been completely investigated. METHODS: In this study, the levels of miR-148b in HCC cells and patient specimens were determined using qPCR assays. MiR-148b-overexpressing HCC cells were used to investigate the effect of miR-148b in vitro and in vivo. The relationship between the expression of miR-148b and colony stimulating factor-1 (CSF1) in HCC patients and the infiltration of macrophages into the tumor microenvironment were assessed by immunohistochemical staining. RESULTS: MiR-148b expression was decreased in metastatic HCC cells. A positive association between downregulated miR-148b expression and several clinical parameters, including recurrence, metastasis, and poor prognosis, was observed in patients with HCC. The results of bio-functional experiments indicated that the biological characteristics of HCC cells were not affected by miR-148b deficiency in vitro. However, miR-148b deficiency significantly enhanced the progression and metastasis of HCC in nude mice. By analyzing the gene expression profiles, we demonstrated that CSF1 was regulated by miR-148b and that miR-148b deficiency promoted HCC growth and metastasis through CSF1/CSF1 receptor (CSF1R)-mediated tumor-associated macrophage (TAM) infiltration. These results were supported by the negative relationship between miR-148b and CSF1 expression and TAM infiltration in HCC patients. Moreover, HCC patients with low miR-148b levels and high TAM infiltration were associated with poorer prognosis. CONCLUSION: MiR-148b-CSF1 signaling-induced TAM infiltration promotes HCC metastasis. Therefore, miR-148b plays a suppressor role in HCC and might be a potential prognostic factor and therapeutic candidate for HCC.

Metformin's antitumour and anti-angiogenic activities are mediated by skewing macrophage polarization.

Beneficial effects of metformin on cancer risk and mortality have been proved by epidemiological and clinical studies, thus attracting research interest in elucidating the underlying mechanisms. Recently, tumour-associated macrophages (TAMs) appeared to be implicated in metformin-induced antitumour activities. However, how metformin inhibits TAMs-induced tumour progression remains ill-defined. Here, we report that metformin-induced antitumour and anti-angiogenic activities were not or only partially contributed by its direct inhibition of functions of tumour and endothelial cells. By skewing TAM polarization from M2- to M1-like phenotype, metformin inhibited both tumour growth and angiogenesis. Depletion of TAMs by clodronate liposomes eliminated M2-TAMs-induced angiogenic promotion, while also abrogating M1-TAMs-mediated anti-angiogenesis, thus promoting angiogenesis in tumours from metformin treatment mice. Further in vitro experiments using TAMs-conditioned medium and a coculture system were performed, which demonstrated an inhibitory effect of metformin on endothelial sprouting and tumour cell proliferation promoted by M2-polarized RAW264.7 macrophages. Based on these results, metformin-induced inhibition of tumour growth and angiogenesis is greatly contributed by skewing of TAMs polarization in microenvironment, thus offering therapeutic opportunities for metformin in cancer treatment.

Activation of AMPK by simvastatin inhibited breast tumor angiogenesis via impeding HIF-1α-induced pro-angiogenic factor.

Substantial data from preclinical studies have revealed the biphasic effects of statins on cardiovascular angiogenesis. Although some have reported the anti-angiogenic potential of statins in malignant tumors, the underlying mechanism remains poorly understood. The aim of this study is to elucidate the mechanism by which simvastatin, a member of the statin family, inhibits tumor angiogenesis. Simvastatin significantly suppressed tumor cell-conditioned medium-induced angiogenic promotion in vitro, and resulted in dose-dependent anti-angiogenesis in vivo. Further genetic silencing of hypoxia-inducible factor-1α (HIF-1α) reduced vascular endothelial growth factor and fibroblast growth factor-2 expressions in 4T1 cells and correspondingly ameliorated HUVEC proliferation facilitated by tumor cell-conditioned medium. Additionally, simvastatin induced angiogenic inhibition through a mechanism of post-transcriptional downregulation of HIF-1α by increasing the phosphorylation level of AMP kinase. These results were further validated by the fact that 5-aminoimidazole-4-carboxamide ribonucleotide reduced HIF-1α protein levels and ameliorated the angiogenic ability of endothelial cells in vitro and in vivo. Critically, inhibition of AMPK phosphorylation by compound C almost completely abrogated simvastatin-induced anti-angiogenesis, which was accompanied by the reduction of protein levels of HIF-1α and its downstream pro-angiogenic factors. These findings reveal the mechanism by which simvastatin induces tumor anti-angiogenesis, and therefore identifies the target that explains the beneficial effects of statins on malignant tumors.

Decision of surgical approach for advanced gallbladder adenocarcinoma based on a Bayesian network.

BACKGROUND AND OBJECTIVES: To determine whether radical resection can benefit patients with advanced gallbladder adenocarcinoma using a Bayesian network (BN) with clinical data. METHODS: In total, 362 patients who had undergone surgical treatment of gallbladder adenocarcinoma at a tertiary institute were evaluated to establish two BN models using a tree-augmented naïve Bayes algorithm. We then chose 250 patients with T3-4N0-2M0 stage gallbladder adenocarcinoma to test the posterior probability after the surgical type was taken into account. RESULTS: In total, 170 patients (≤7 months) and 137 patients (>7 months) were correctly classified in the median survival time model (accuracy, 84.81%), and 204 patients (≤12 months), 15 patients (12-36 months), 17 patients (36-60 months), and 34 patients (>60 months) were correctly classified in the 1-, 3-, and 5-year survival model (accuracy, 74.59%), respectively. Every posterior probability in the two models upregulated the ratio of the longer survival time and suggested a better prognosis for gallbladder adenocarcinoma that can be improved by R0 resection. CONCLUSIONS: These BN models indicate that stages T4 and N2 gallbladder adenocarcinoma are not contraindications for surgery and that R0 resection can improve survival in patients with advanced gallbladder adenocarcinoma.

Analysis of prognostic factors for survival after surgery for gallbladder cancer based on a Bayesian network.

The factors underlying prognosis for gallbladder cancer (GBC) remain unclear. This study combines the Bayesian network (BN) with importance measures to identify the key factors that influence GBC patient survival time. A dataset of 366 patients who underwent surgical treatment for GBC was employed to establish and test a BN model using BayesiaLab software. A tree-augmented naïve Bayes method was also used to mine relationships between factors. Composite importance measures were applied to rank the influence of factors on survival time. The accuracy of BN model was 81.15%. For patients with long survival time (>6 months), the true-positive rate of the model was 77.78% and the false-positive rate was 15.25%. According to the built BN model, the sex, age, and pathological type were independent factors for survival of GBC patients. The N stage, liver infiltration, T stage, M stage, and surgical type were dependent variables for survival time prediction. Surgical type and TNM stages were identified as the most significant factors for the prognosis of GBC based on the analysis results of importance measures.