Endovascular repair with a physician-modified fenestrated endograft to treat abdominal aortic pseudoaneurysm with Behcet's disease: a case report.

BACKGROUND: Aortic involvement in patients with Behcet's disease (BD) is rare, but it is one of the most severe manifestations. Open surgical repair of aortic aneurysm is challenging considering the high risk of postoperative recurrent anastomotic pseudoaneurysms and is associated with a much higher mortality rate. Recently, endovascular treatment has proven to be a feasible, less invasive alternative to surgery for these patients. CASE PRESENTATION: We report a total endovascular repair of a paravisceral abdominal aortic pseudoaneurysm in a 25-year-old male patient with BD. The pseudoaneurysm was successfully excluded, and the blood supply of visceral arteries was preserved with a physician-modified three-fenestration endograft under 3D image fusion guidance. Immunosuppressive therapy was continued for 1 year postoperatively. At 18 months, the patient was asymptomatic without abdominal pain. Computed tomography angiography demonstrated the absence of pseudoaneurysm recurrence, good patency of visceral vessels. DISCUSSION AND CONCLUSIONS: Endovascular repair using physician-modified fenestrated endografts is a relatively safe and effective approach for treating paravisceral aortic pseudoaneurysm in BD patients. This technique enables the preservation of the visceral arteries and prevents aneurysm recurrence at the proximal and distal landing zones, which are common complications of open surgical repair in these patients. Furthermore, we emphasize the importance of adequate immunosuppressive therapy before and after surgical repair in BD patients, which is a major risk factor for recurrence and poor prognosis.

Drug-coated balloon for treatment of non-atherosclerotic renal artery stenosis-a multi-center study.

INTRODUCTION: Renal artery stenosis (RAS) is a significant reason for secondary hypertension. Impaired renal function and subsequent cardiopulmonary dysfunction could also occur. Patients of non-atherosclerotic RAS has a relatively young age and long life expectancy. Revascularization with percutaneous transluminal angioplasty (PTA) is a viable treatment option. However, restenosis is unavoidable which limits its use. Drug-coated balloon (DCB) has been proven to be effective in restenosis prevention in femoropopliteal arterial diseases and in patients with renal artery stenosis. And PTA for Renal artery fibromuscular dysplasia is safe and clinically successful. Therefore, we could speculate that DCB might have potential efficacy in non-atherosclerotic RAS treatment. METHODS AND ANALYSIS: This will be a randomized multi-center-controlled trial. Eighty-four eligible participants will be assigned randomly in a 1:1 ratio to the control group (plain old balloon, POB) and the experimental group (DCB). Subjects in the former group will receive balloon dilatation alone, and in the latter group will undergo the DCB angioplasty. The DCB used in this study will be a paclitaxel-coated balloon (Orchid, Acotec Scientific Holdings Limited, Beijing, China). Follow-up visits will be scheduled 1, 3, 6, 9, and 12 months after the intervention. Primary outcomes will include controlled blood pressure and primary patency in the 9-month follow-up. Secondary outcomes will include technical success rate, complication rate, and bail-out stenting rate. TRIAL REGISTRATION: ClinicalTrials.gov (number NCT05858190). Protocol version V.4 (3 May 2023).

Case report: Multiple arterial stenoses induced by autosomal-recessive hypophosphatemic rickets type 2 associated with mutation of ENPP1: a case study.

Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1)-related multiple arterial stenoses is a rare clinical syndrome in which global arterial calcification begins in infancy, with a high probability of early mortality, and hypophosphatemic rickets develops later in childhood. The vascular status of an ENPP1-mutated patient when they enter the rickets phase has not been thoroughly explored. In this study, we presented a case of an adolescent with an ENPP1 mutation who complained of uncontrolled hypertension. Systematic radiography showed renal, carotid, cranial, and aortic stenoses as well as random calcification foci on arterial walls. The patient was incorrectly diagnosed with Takayasu's arteritis, and cortisol therapy had little effect on reducing the vascular stenosis. As a result, phosphate replacement, calcitriol substitution, and antihypertensive medication were prescribed, and the patient was discharged for further examination. This research presented the vascular alterations of an ENPP1-mutanted patient, and while there is less calcification, intimal thickening may be the primary cause of arterial stenosis.

Iliac Artery Tortuosity Index in Chinese Patients with or without Aortic Artery Aneurysms and Related Influencing Factors.

BACKGROUND: Iliac artery tortuosity is an important anatomical factor that influences the endovascular repair of aortic artery aneurysms. The influencing factors of the iliac artery tortuosity index (TI) have not been well studied. TI of iliac arteries and related factors in Chinese patients with and without abdominal aortic aneurysm (AAA) were studied in this study. METHODS: One hundred and ten consecutive patients with AAA and 59 patients without AAA were included. For patients with AAA, the diameter of the AAA was 51.9 ± 13.3 mm (24.7-92.9 mm). Those without AAA had no history of definite arterial diseases and came from a cohort of patients diagnosed with urinary calculi. The central lines of the common iliac artery (CIA) and external iliac artery were depicted. The actual length and the straight distance were measured and used to calculate the TI (actual length/straight distance). Common demographic factors and anatomical parameters were analyzed to identify any related influencing factors. RESULTS: For patients without AAA, the total TI of the left and right side was 1.16 ± 0.14 and 1.16 ± 0.13, respectively (P = 0.48). For patients with AAAs, the total TI in the left and right side was 1.36 ± 0.21 and 1.36 ± 0.19, respectively (P = 0.87). The TI in external iliac artery was more severe than that in CIA both in patients with and without AAAs (P < 0.01). Age was the only demographic factor found to be associated with TI in patients with AAA (Pearson's correlation coefficient r ≈ 0.3, P < 0.01) and without AAA (r ≈ 0.6, P < 0.01). For anatomical parameters, the diameter was positively associated with the total TI (left side: r = 0.41, P < 0.01; right side: r = 0.34, P < 0.01). The ipsilateral CIA diameter was also associated with the TI (left side: r = 0.37, P < 0.01; right side: r = 0.31, P < 0.01). The length of the iliac arteries was not associated with age or AAA diameter. Reduction of the vertical distance of the iliac arteries may be a common underlying reason for age and AAA. CONCLUSIONS: Tortuosity of the iliac arteries was probably an age-related problem in normal individuals. It was also positively correlated with the diameter of the AAA and the ipsilateral CIA in patients with AAA. Attention should be paid to the evolution of iliac artery tortuosity and its influence when treating AAAs.

One-stage resection of intravascular leiomyomatosis involving the right heart chamber through a single laparotomy.

Objectives: This retrospective study aimed to summarize the feasibility and experience of utilizing a one-stage operation via single laparotomy to treat intracardiac leiomyomatosis (ICL). Materials and methods: A retrospective study of 13 patients with ICL who underwent one-stage resections was conducted at Peking Union Medical College Hospital from June 2015 to December 2021. All patients had their tumors removed by single laparotomy and were divided into a short venotomy group (6 cases) and an extensive venotomy group (7 cases). We reviewed the patient characteristics, surgical procedures, postoperative pathology, and perioperative and follow-up outcomes of all patients. Results: All patients underwent surgery for ICL resection using single laparotomy with a 100% success rate. Two patients had tumors distal to the right ventricle (RV), 2 patients had tumors that protruded into the RV in diastole and were confined to the right atrium (RA) in systole, and the other 9 patients had tumors confined to the RA that did not involve the tricuspid valve. The tumor was completely resected in 10 patients, yet 3 patients had a residual tumor. Six patients completed the surgery with short venotomy, 7 completed the surgery with extensive venotomy, and 9 underwent simultaneous total hysterectomy and bilateral adnexal resection. The mean operative time was 370.8 ± 111.0 min, and the mean blood loss was 992.3 ± 994.5 mL. Intraoperative blood loss was lower (483.3 ± 213.7 ml vs. 1429.2 ± 1208.0 ml; P = 0.020) and operative time was shorter (286.5 ± 71.9 min vs. 443.1 ± 84.4 min; P=0.004) in the short venotomy group than in the extensive venotomy group. At a mean follow-up of 26.3 ± 18.8 months, 1 patient had a local recurrence in the pelvis, and 1 patient died of pancreatic cancer, while the remaining patients had no recurrence during follow-up. Conclusion: One-stage resection of ICL patients by means of a single laparotomy is feasible and effective.

Effect of Endovascular Treatment on Urinary Obstruction Caused by Iliac Artery Aneurysm: A Case Series and Review of the Literature.

BACKGROUND: Endovascular aneurysm repair is superior to open surgical repair (OSR) in multiple aspects and is the mainstay for noninflammatory iliac artery aneurysm (IAA) treatment. However, for noninflammatory IAAs with neighboring structures compressed, the experience of endovascular treatment is limited. This case series study aimed to describe the experience of endovascular aneurysm repair of noninflammatory IAAs with urinary obstruction and to review the limited reports in the literature. METHODS: From December 2012 to July 2020, we reported 7 cases of noninflammatory IAAs combined with urinary obstruction that was treated successfully with endovascular treatment. The literature on noninflammatory IAAs combined with urinary obstruction was reviewed using the online databases PubMed, Embase, and the Cochrane Library. RESULTS: Thirty nine articles were found in the literature. OSR accounted for 80% of the treatment options in previous publications, while only 20% of patients accepted endovascular treatment. Hydronephrosis remission was observed in all patients treated by OSR, while the endovascular treatment group lacked long-term follow-up. In our retrospective study containing 7 cases, no complications, reintervention, or mortality was observed, all stents were patent, and all symptoms were relieved after the operation. Diameter reduction of the aneurysms was observed in 6/7 cases and the average aneurysm reduction was -24.1 ± 15.8 mm (P = 0.0097). Urinary obstruction faded in 5/7 cases where aneurysm shrinking was found simultaneously. CONCLUSIONS: This case series and literature review on noninflammatory IAAs combined with urinary obstruction suggests that the diameter of the responsible aneurysm may be reduced after endovascular treatment, which may also alleviate symptoms of urinary obstruction caused by noninflammatory IAAs.

Irisin Suppresses Nicotine-Mediated Atherosclerosis by Attenuating Endothelial Cell Migration, Proliferation, Cell Cycle Arrest, and Cell Senescence.

Atherosclerotic disease has become the major cause of death worldwide. Smoking, as a widespread independent risk factor, further strengthens the health burden of atherosclerosis. Irisin is a cytokine that increases after physical activity and shows an atheroprotective effect, while its specific mechanism in the process of atherosclerosis is little known. The reversal effect of irisin on intimal thickening induced by smoking-mediated atherosclerosis was identified in Apoe -/- mice through the integrin αVß5 receptor. Endothelial cells treated with nicotine and irisin were further subjected to RNA-seq for further illustrating the potential mechanism of irisin in atherosclerosis, as well as the wound healing assays, CCK-8 assays, ß-gal staining and cell cycle determination to confirm phenotypic alterations. Endothelial differential expressed gene enrichment showed focal adhesion for migration and proliferation, as well as the P53 signaling pathway for cell senescence and cell cycle control. Irisin exerts antagonistic effects on nicotine-mediated migration and proliferation via the integrin αVß5/PI3K pathway. In addition, irisin inhibits nicotine-mediated endothelial senescence and cell cycle arrest in G0/G1 phase via P53/P21 pathway. This study further illustrates the molecular mechanism of irisin in atherosclerosis and stresses its potential as an anti-atherosclerotic therapy.

Sophocarpine Alleviates Injury-Induced Intima Hyperplasia of Carotid Arteries by Suppressing Inflammation in a Rat Model.

INTRODUCTION: Balloon angioplasty is a commonly applied procedure for treating atherosclerotic vascular diseases. However, the maintenance of long-term lumen patency is relatively difficult due to the occurrence of restenosis. Previous research has shown that the occurrence of vascular wall inflammation is associated with higher rates of restenosis. Sophocarpine (SPC) can exert various therapeutic effects such as anti-oxidation, anti-inflammation, anti-tumor, antivirus and immune regulation. This study aimed to investigate whether SPC can alleviate intimal hyperplasia following balloon injury in a rat carotid artery model. METHODS: Twenty Sprague-Dawley rats were randomly assigned to four groups: (i) control, (ii) balloon injury, (iii) balloon injury followed by saline injection, and (iv) balloon injury followed by SPC administration. Each group contained five rats. A high-pressure balloon of 3 mm × 20 mm was placed in the carotid artery. The balloon was inflated to a pressure of 8 atmospheres to carry out rat carotid artery balloon injury model. The areas of neointimal and media were determined by Verhoeff_Van Gieson staining, and the intima-to-media (I:M) ratios were subsequently evaluated. After that, the protein levels of IL-6, IL-1ß, MCP-1, NF-κB, TNF-α, VCAM-1, ICAM-1 and eNOS were measured. RESULTS: The ratio of I:M was remarkably higher in the balloon injury group than in the control group (p < 0.01). SPC could significantly decrease the ratio of I:M compared with the balloon injury group (p < 0.01). Besides, the protein levels of IL-6, IL-1ß, MCP-1, NF-κB, TNF-α, ICAM-1 and VCAM-1 were increased in rat carotid arteries exposed to balloon injury (p < 0.01), and treatment with SPC could attenuate these effects (p < 0.05). Furthermore, balloon injury inhibited the protein expression of eNOS (p < 0.01), and SPC could elevate its level (p < 0.05). CONCLUSIONS: SPC could alleviate an intimal hyperplasia in balloon-injured carotid artery, and the mechanisms underlying this protective effect might be due to its inhibitory potency against inflammation signals. Our study also implies the potential applicability of SPC in treating restenosis after balloon angioplasty.

Surgical Excision of a Functional Carotid Body Tumor Presenting Intraoperative Hypertensive Crisis: A Case Report and Literature Review.

Carotid body tumor (CBT) is a rare neoplasm arising from the carotid bifurcation. Functional CBTs are extremely rare and are usually associated with elevated serum catecholamine and catecholamine-induced symptoms such as paroxysmal hypertension, palpitations, dizziness, flushing and tachycardia. We reported a 47-year-old female with a functional CBT that was biochemically silent and had no catecholamine-induced symptoms preoperatively, but experienced hypertensive crisis during surgical excision of the lesion. Postoperative pathology confirmed the diagnosis of CBT, and a functional tumor was considered due to the hypertensive crisis during surgical manipulation of the lesion. Under careful management of intraoperative blood pressure and close monitoring of vital sign along with adequate crystalloid infusion after surgery, the tumor was successfully excised and the patient recovered uneventfully during a follow-up period of 12 months. To the best of our knowledge, this is an unusual report of functional CBT presenting merely hypertensive crisis during surgery, with no elevated serum catecholamine or catecholamine-induced symptoms preoperatively. Clinicians should be aware of such lesions so that appropriate medication and gentle manipulation are given when encountering hypertensive crisis during surgical excision of CBTs, to prevent life-threatening cardiovascular complications. The appropriate management and recognition of functional CBTs were also discussed by means of a review of the literature.

An image analysis of the major angles along the pathway of iliac veins involved in endovenous interventions.

OBJECTIVE: The specific anatomic characteristics of the iliac veins are often important reasons for stent failure. However, to the best of our knowledge, the inherent angles and configurations of the iliac veins have not been thoroughly studied. METHODS: Fifty patients without venous diseases who had undergone computed tomography urography for diagnosis of urolithiasis were included in this study. The pathways of the iliac veins were mapped out, and the major angles were measured. The factors associated with steep angles were also evaluated. RESULTS: There were two relatively constant angles on the right side and three on the left side along the common femoral vein, external iliac vein, and common iliac vein. All these were measured with the patients in the supine position. The angles at the inguinal region (γ) and internal-external iliac vein confluence (ß) were at similar sites for both sides. There was a third angle in front of the fifth vertebra for the left side (α). The γ angle was 125.03 ± 11.68 degrees for the right side and 122.26 ± 9.64 degrees for the left side. The ß angle was 136.91 ± 14.24 degrees for the right side and 125.61 ± 20.76 degrees for the left side. According to the ß angle of the left side, the iliac veins could be categorized into three types. For type I, the angle was >150 degrees (14% [7/50]). For type II, it was 120 to 150 degrees (50% [25/50]). For type III, it was ≤120 degrees (36% [18/50]). The angles between the anterior border of the fifth vertebra and pelvic inlet plane (0.866; 95% confidence interval, 0.777-0.966) and age (1.087; 95% confidence interval, 1.004-1.177) were related to type III configurations on multilogistic regression analysis. CONCLUSIONS: There were several relatively constant angles along the pathway of the iliac veins. The pathway of the left side was more complex than that of the right side. This difference in the angles might be related to the patients' age and bone structures. These angles should be considered in planning iliac vein stenting as well as in designing stents specifically for the iliac veins.

Sophocarpine prevents cigarette smoke-induced restenosis in rat carotid arteries after angioplasty.

BACKGROUND: Cigarette smoking is one of the main predisposing factors for atherosclerosis, which can lead to vascular inflammation. Emerging research has demonstrated that the rate of restenosis is increased following angioplasty in smokers. Sophocarpine, one of the Sophora alkaloids, can play the antiinflammatory role in cells. This study aimed to assess whether sophocarpine can alleviate the restenosis induced by cigarette smoke in rats post-angioplasty. METHODS: Fifteen male Sprague-Dawley rats were randomized into three groups (control group, smoking group, smoking and injected with sophocarpine group). An established balloon-induced carotid artery injury was performed to all the groups. For the balloon-injured carotid arteries, Verhoeff-Van Gieson stain was used to detect the area of neointima and media. Then the ratio of neointima to media (I/M ratio) was calculated. For the contralateral carotid arteries, the level of MAP kinase kinase 3 (MKK3), MAP kinase kinase 6 (MKK6), Phospho-MKK3/6, p38, Phospho-p38, interleukin-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α) were measured. RESULTS: The I/M ratio of smoking group is larger than that of control group. However, sophocarpine could dramatically reduce the I/M ratio compared to smoking group. Cigarette smoke could induce the expression of Phospho-MKK3/6, Phospho-p38, IL-1ß and TNF-α, and treatment with sophocarpine could inhibit such effects. The levels of MKK3, MKK6 and p38 were not under the influence of cigarette smoke or sophocarpine. CONCLUSIONS: Sophocarpine could alleviate the cigarette smoke-induced restenosis in rat carotid arteries after balloon injury and the mechanism of its protective effect might be the inhibition of the inflammatory reaction. This also implies sophocarpine has the potential therapeutic applicability in preventing restenosis after angioplasty in smokers.

Total Endovascular Repair of a Juxta-vertebral Subclavian Artery Pseudoaneurysm and Flow Preservation of a Dominant Vertebral Artery Using Parallel Stent Grafts.

The endovascular repair of subclavian aneurysms or pseudoaneurysms is now widely adopted. However, controversies still prevail in the management of dominant vertebral arteries originating close to aneurysms, as coverage of the vertebral artery might be complicated by either endoleaks or ischemic events. Here, we present a rare case of multiple aneurysmal lesions involving the right subclavian artery and bilateral internal carotid arteries treated by way of a total endovascular method using parallel stent grafts for the simultaneous exclusion of a subclavian artery pseudoaneurysm and flow preservation of the adjacent vertebral artery. To the best of our knowledge, this is the first study to report the use of this technique for the endovascular repair of juxta-vertebral subclavian artery pseudoaneurysms.

Popliteal artery entrapment syndrome as a cause of failed treatment of a false popliteal aneurysm.

OBJECTIVE: Popliteal artery entrapment syndrome is a rare cause of popliteal artery aneurysms. We present a rare case of a false aneurysm associated with popliteal artery entrapment syndrome that was treated with endovascular repair that initially failed. CASE REPORT: A 60-year-old man with a false popliteal artery aneurysm and limb ischemia was treated with endovascular repair that initially failed. The popliteal artery was suspected to be compressed by an abnormal bundle of muscle according to the findings of a subsequent magnetic resonance imaging examination. The popliteal artery was entrapped by an abnormal slip of the medial gastrocnemius muscle head. Parts of the popliteus muscle were also involved in compression of the popliteal artery, which was not distinguished on preoperative magnetic resonance imaging. Thus, the patient was diagnosed with a mixed type of popliteal artery entrapment syndrome (types III and IV). Bypass with the small saphenous vein was then performed. The patient was finally discharged with satisfactory relief of his ischemic symptoms. CONCLUSION: Popliteal artery entrapment syndrome should be considered before treating popliteal artery aneurysms, especially atypical pseudoaneurysms without significant atherosclerosis. Definitive surgical management rather than endoluminal treatment is required unless combined with open decompressive surgery to correct the musculotendinous anatomy.

Melatonin alleviates cigarette smoke-induced endothelial cell pyroptosis through inhibiting ROS/NLRP3 axis.

Endothelial dysfunction (ED) is a crucial and initial stage for the development of cardiovascular diseases. Accumulated evidence has demonstrated causative links between cigarette smoke (CS) and ED. However, the underlying mechanisms remain largely unknown. Pyroptosis is a unique form of inflammatory cell death. In this study, we found that cigarette smoke extract (CSE) increased pyroptosis in endothelial cells (ECs) as evidenced by increasing lactate dehydrogenase release and the number of propidium iodide (PI) positive cells. A specific NOD-like receptor family, pyrin domain-containing 3 (NLRP3) inhibitor (MCC950) pretreatment dramatically reduced CSE-induced pyroptosis. Additionally, we also observed that N-Acetylcysteine (NAC, a ROS scavenger) pretreatment inhibited NLRP3 inflammasome activation as evidenced by suppressing the upregulation of NLRP3, ASC, cleaved-caspase-1, GSDMD-N, IL-1ß and IL-18 protein levels in CSE-treated ECs. Meanwhile, NAC pretreatment also remarkably inhibited CSE-induced EC pyroptosis. Melatonin is a hormone synthesized and secreted by mammalian pineal gland and plays a protective role in various cardiovascular diseases through its powerful anti-inflammatory and antioxidant properties. In this study, melatonin was observed to inhibit ROS production, NLRP3 inflammasome activation and pyroptosis in CSE-treated ECs. Moreover, oxidative stress and NLRP3 inflammasome activation in carotid arteries of smoking rats was also inhibited by melatonin. In conclusion, our study generated two novel findings, (i) CS activates ROS/NLRP3 axis and induces EC pyroptosis; (ii) melatonin attenuates CS-induced EC pyroptosis by inhibiting ROS/NLRP3 axis.

Melatonin attenuates smoking-induced hyperglycemia via preserving insulin secretion and hepatic glycogen synthesis in rats.

Epidemiology survey indicated that cigarette smoking is a risk factor of diabetes. However, the precise mechanisms remain to be clarified. In this study, we found that smoking caused metabolic malfunctions on pancreas and liver in experimental animal model. These were indicated by hyperglycemia, increased serum hemoglobin A1c level and decreased insulin secretion, inhibition of liver glycogen synthase (LGS), and hepatic glycogen synthesis. Mechanistic studies revealed that all these alterations were caused by the inflammatory reaction and reactive oxygen species (ROS) induced by the smoking. Melatonin treatment significantly preserved the functions of both pancreas and liver by reducing ß cell apoptosis, CD68-cell infiltration, ROS production, and caspase-3 expression. The siRNA-knockdown model identified that the protective effects of melatonin were mediated by melatonin receptor-2 (MT2). This study uncovered potentially underlying mechanisms related to the association between smoking and diabetes. In addition, it is, for first time, to report that melatonin effectively protects against smoking-induced glucose metabolic alterations and the signal transduction pathway of melatonin is mainly mediated by its MT2 receptor. These observations provide solid evidence for the clinically use of melatonin to reduce smoking-related diabetes, and the therapeutic regimens are absent currently.

The long non-coding RNA MALAT1 activates Nrf2 signaling to protect human umbilical vein endothelial cells from hydrogen peroxide.

The potential effect of the long non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) against hydrogen peroxide (H2O2)-induced oxidative injury in endothelial cells was tested. We show that forced-expression of MALAT1 using a lentiviral vector ("LV-MALAT1") significantly attenuated H2O2-induced death and apoptosis of human umbilical vein endothelial cells (HUVECs). Conversely, knocking down of MALAT1 by targeted siRNA exacerbated H2O2-induced HUVEC injury. For the mechanism study, we show that LV-MALAT1 induced Keap1 downregulation, leading to nuclear-factor-E2-related factor 2 (Nrf2) stabilization and activation. Critically, Nrf2 shRNA almost completely abolished LV-MALAT1-mediated HUVEC protection against H2O2. Significantly, H2O2-induced oxidative stress, lipid peroxidation and DNA damages in HUVECs were attenuated by LV-MALAT1, but were intensified with MALAT1 siRNA. In summary, we identified a novel signaling axis involving MALAT1, Keap1 and Nrf2, which in turn protects HUVECs from oxidative injury.

The p-ERK-p-c-Jun-cyclinD1 pathway is involved in proliferation of smooth muscle cells after exposure to cigarette smoke extract.

An epidemiological survey has shown that smoking is closely related to atherosclerosis, in which excessive proliferation of vascular smooth muscle cells (SMCs) plays a key role. To investigate the mechanism underlying this unusual smoking-induced proliferation, cigarette smoke extract (CSE), prepared as smoke-bubbled phosphate-buffered saline (PBS), was used to induce effects mimicking those exerted by smoking on SMCs. As assessed by Cell Counting Kit-8 detection (an improved MTT assay), SMC viability increased significantly after exposure to CSE. Western blot analysis demonstrated that p-ERK, p-c-Jun, and cyclinD1 expression increased. When p-ERK was inhibited using U0126 (inhibitor of p-ERK), cell viability decreased and the expression of p-c-Jun and cyclinD1 was reduced accordingly, suggesting that p-ERK functions upstream of p-c-Jun and cyclinD1. When a c-Jun over-expression plasmid was transfected into SMCs, the level of cyclinD1 in these cells increased. Moreover, when c-Jun was knocked down by siRNA, cyclinD1 levels decreased. In conclusion, our findings indicate that the p-ERK-p-c-Jun-cyclinD1 pathway is involved in the excessive proliferation of SMCs exposed to CSE.

[Establishment and functional identification of a stable cell line overexpression heme oxygenase-1].

OBJECTIVE: To establish a stable cell line overexpression heme oxygenase-1 (HO-1) mediated by a modified lentivirus system and identify its function. METHODS: The HO-1 gene was amplified by polymerase chain reaction and cloned into the modified pLentiLox3.7 expression vectors. The recombinant plasmids were transfected into HEK293T cells and the HO-1 was detected by Western blot. The recombinant plasmids were transfected into HEK293T cells to produce the viruses, with the helping plasmids including plp1, plp2, and VSVG. HEK293T cells were infected by the viruses and the cells that can express HO-1 were identified by Western blot. The reactive oxygen species were detected in the HO-1-overexpression HEK293T cells and the normal cells after the adding of hydrogen peroxide. The same experiment was performed with human umbilical vein endothelial cells. RESULTS: The stable cell line that can overexpress HO-1 was established, which was verified by Western blot. The reactive oxygen species in the HO-1-overexpression HEK293T cells and human umbilical vein endothelial cells decreased obviously after exposure to hydrogen peroxide. CONCLUSIONS: The lentivirus-carrying HO-1 was successfully packaged and the stable cell line overexpression HO-1 was established. HO-1 can play a protective role in the course of oxidative damage.

[Efficacy and prognosis of endoluminal treatment of femoropopliteal chronic total occlusions].

OBJECTIVES: To evaluate the efficacy and prognosis of endoluminal treatment of superficial femoral artery and proximal popliteal artery chronic total occlusions. METHODS: A prospectively collected database of 148 patients (156 limbs) between January 1, 2009 and December 31, 2012 was retrospectively analysed. All the patients were treated with endoluminal interventions. The mean lesion length was (14 ± 11) cm (0.5-41.0 cm). According to Trans-Atlantic Inter-Society Consensus II (TASC II), 47 lesions were type A, 40 were type B, 26 were type C and 43 were type D. Technical success rate, clinical success rate, perioperative limb salvage rate and complication rate were evaluated. Primary patency rate, secondary patency rate, limb salvage rate and survival rate were calculated with Kaplan-Meier analysis. Cox-regression analysis was used to evaluate risk factors associated with loss of primary patency. RESULTS: Technical success rate was 98.7%, clinical success rate was 96.2%, perioperative limb salvage rate was 99.4%, local complication rate was 4.5% and systemic complication rate was 1.9%. At 3, 6, 12, 24 and 36 months after surgery, the primary patency rates were 95.1% ± 1.8%, 80.2% ± 3.4%, 65.6% ± 4.3%, 60.9% ± 4.6% and 53.7% ± 5.8%, respectively. The secondary patency rates were 97.9% ± 1.2%, 94.2% ± 2.0%, 89.6% ± 2.8%, 81.4% ± 3.9% and 78.0% ± 5.0%, respectively. The limb salvage rates were 99.4% ± 0.6%, 99.4% ± 0.6%, 97.8% ± 1.2%, 97.8% ± 1.2%, and 97.8% ± 1.2%, respectively. The survival rates were 99.2% ± 0.8%, 98.4% ± 1.1%, 97.5% ± 1.5%, 94.9% ± 2.3% and 91.2% ± 4.2%, respectively. TASC II C/D lesions (OR = 1.776, 95%CI 1.013~3.116) and runoff score (OR = 1.138, 95%CI 1.016-1.275) were found to be associated with loss of primary patency. CONCLUSION: Endoluminal intervention was a safe and efficacious method for treating femoropopliteal artery chronic total occlusions.Satisfactory limb salvage rate can be reached despite of the high restenosis rate. TASC II C/D lesions and runoff score were found to be risk factors associated with restenosis.