Identification of Potential Neddylation-related Key Genes in Ischemic Stroke based on Machine Learning Methods.

Ischemic stroke (IS) is a complex neurological disease that can lead to severe disability or even death. Understanding the molecular mechanisms involved in the occurrence and progression of IS is of great significance for developing effective treatment strategies. In this context, the role of neddylation refers to the potential impact of neddylation on various cellular processes, which may contribute to the pathogenesis and outcome of IS. First, differential analysis was conducted on the GSE16561 dataset from the GEO database to identify 350 differentially expressed genes (DEGs) between the IS and Control groups. By intersecting the differential genes with neddylation-related genes, 11 neddylation-related DEGs were obtained. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses showed that the DEGs were mainly enriched in hematopoietic cell lineage and neutrophil degranulation, while the neddylation-related DEGs were mainly enriched in apoptosis and post-translational protein modification. Further Lasso-Cox and random forest analyses were performed on the 11 neddylation-related DEGs, identifying key genes SRPK1, BIRC2, and KLHL3. Additionally, validation of the key genes was carried out using the GSE58294 dataset and clinical patients. Finally, the correlation between the key genes and ferroptosis and cuproptosis was analyzed, and a ceRNA network was constructed. Our study helps to elucidate the complex role of neddylation in the mechanism of ischemic stroke, providing potential opportunities for the development of therapeutic interventions.

Cardiomyocytes disrupt pyrimidine biosynthesis in nonmyocytes to regulate heart repair.

Various populations of cells are recruited to the heart after cardiac injury, but little is known about whether cardiomyocytes directly regulate heart repair. Using a murine model of ischemic cardiac injury, we demonstrate that cardiomyocytes play a pivotal role in heart repair by regulating nucleotide metabolism and fates of nonmyocytes. Cardiac injury induced the expression of the ectonucleotidase ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), which hydrolyzes extracellular ATP to form AMP. In response to AMP, cardiomyocytes released adenine and specific ribonucleosides that disrupted pyrimidine biosynthesis at the orotidine monophosphate (OMP) synthesis step and induced genotoxic stress and p53-mediated cell death of cycling nonmyocytes. As nonmyocytes are critical for heart repair, we showed that rescue of pyrimidine biosynthesis by administration of uridine or by genetic targeting of the ENPP1/AMP pathway enhanced repair after cardiac injury. We identified ENPP1 inhibitors using small molecule screening and showed that systemic administration of an ENPP1 inhibitor after heart injury rescued pyrimidine biosynthesis in nonmyocyte cells and augmented cardiac repair and postinfarct heart function. These observations demonstrate that the cardiac muscle cell regulates pyrimidine metabolism in nonmuscle cells by releasing adenine and specific nucleosides after heart injury and provide insight into how intercellular regulation of pyrimidine biosynthesis can be targeted and monitored for augmenting tissue repair.

miR-150 regulates endothelial progenitor cell differentiation via Akt and promotes thrombus resolution.

BACKGROUND: Deep venous thrombosis (DVT) constitutes a major global disease burden. Endothelial progenitor cells (EPCs) have been described in association with recanalization of venous thrombus. Furthermore, emerging evidence suggests microRNAs are involved in this progression. The goal of this study was to investigate the influence of miR-150 on the behavior of EPCs and its potential contribution in venous thrombosis resolution. METHODS: We isolated and cultured EPCs from healthy adults. Next, early EPCs or endothelial colony-forming cells (ECFCs or late EPCs) were transfected with miR-150 agomir and antagomir. Gene expression profiles, proliferation, cytokine secretion, and angiogenic capacity of early EPCs and ECFCs were examined. The effects of miR-150 on c-Myb expression and Akt/FOXO1 signaling were also evaluated. Furthermore, a rat model of venous thrombosis was constructed to determine the in vivo function of EPCs. RESULTS: Our results showed that miR-150 overexpression in early EPCs significantly promoted differentiation to ECFCs and contributed to proliferation and tube formation. However, suppression of miR-150 in late EPCs inhibited proliferation and tube formation. Moreover, we identified that this progression is regulated by inhibition of c-Myb and activation of the Akt/FOXO1 pathway. Our findings also showed that miR-150 led to the enhanced resolution ability of EPCs in a rat venous thrombosis model. CONCLUSIONS: In this study, we present a novel mechanism of miRNA-mediated regulation of EPCs and Akt activation in thrombus resolution.

The capacity of goat epidermal adult stem cells to reconstruct the damaged ocular surface of total LSCD and activate corneal genetic programs.

Epidermal adult stem cells (EpiASCs) have the potential for unlimited proliferation and differentiation, however, the ability of these stem cells to activate corneal genetic programs in response to corneal stroma stimulation needs to be further validated. Herein, a feasible strategy was developed to reconstruct the damaged corneal surface in a goat model with total limbal stem cell deficiency (LSCD) by transplanting EpiASCs, which had been explanted and cultured from the skin of an adult ram goat and were then purified by selecting single cell-derived clones and cultivating them on a denuded human amniotic membrane (HAM). These artificial tissues were then successfully transplanted into ewe goats with total LSCD. Binding of EpiASCs to the base membrane of an EpiASCs-HAM-Sheet (EHS) indicated their proliferating status. After transplantation, the EpiASCs could survive in the host tissue and they reconstructed the damaged ocular surface of total LSCD. The crystal reconstructed corneal epithelium expressed CK3 and Pax-6 similar to normal corneal epithelium and expressed the Sry gene after transplantation. These results demonstrated that EpiASCs could be induced to differentiate into corneal epithelial cell types in a corneal microenvironment and had the ability to activate corneal genetic programs. This work offer a foundation for promoting tissue-engineered cornea into clinical application.

Identifying fates of cancer cells exposed to mitotic inhibitors by quantitative phase imaging.

Cell cycle deregulation is a cancer hallmark that has stimulated the development of mitotic inhibitors with differing mechanisms of action. Quantitative phase imaging (QPI) is an emerging approach for determining cancer cell sensitivities to chemotherapies in vitro. Cancer cell fates in response to mitotic inhibitors are agent- and dose-dependent. Fates that lead to chromosomal instabilities may result in a survival advantage and drug resistance. Conventional techniques for quantifying cell fates are incompatible with growth inhibition assays that produce binary live/dead results. Therefore, we used QPI to quantify post-mitotic fates of G0/G1 synchronized HeLa cervical adenocarcinoma and M202 melanoma cells during 24 h of escalating-dose exposures to mitotic inhibitors, including microtubule inhibitors paclitaxel and colchicine, and an Aurora kinase A inhibitor, VX-680. QPI determined cell fates by measuring changes in cell biomass, morphology, and mean phase-shift. Cell fates fell into three groups: (1) bipolar division from drug failure; (2) cell death or sustained mitotic arrest; and (3) aberrant endocycling or multipolar division. In this proof-of-concept study, colchicine was most effective in producing desirable outcomes of sustained mitotic arrest or death throughout its dosing range, whereas both paclitaxel and VX-680 yielded dose-dependent multipolar divisions or endocycling, respectively. Furthermore, rapid completion of mitosis associated with bipolar divisions whereas prolonged mitosis associated with multipolar divisions or cell death. Overall, QPI measurement of drug-induced cancer cell fates provides a tool to inform the development of candidate agents by quantifying the dosing ranges over which suboptimal inhibitor choices lead to undesirable, aberrant cancer cell fates.

High-Speed Live-Cell Interferometry: A New Method for Quantifying Tumor Drug Resistance and Heterogeneity.

We report the development of high-speed live-cell interferometry (HSLCI), a new multisample, multidrug testing platform for directly measuring tumor therapy response via real-time optical cell biomass measurements. As a proof of concept, we show that HSLCI rapidly profiles changes in biomass in BRAF inhibitor (BRAFi)-sensitive parental melanoma cell lines and in their isogenic BRAFi-resistant sublines. We show reproducible results from two different HSLCI platforms at two institutions that generate biomass kinetic signatures capable of discriminating between BRAFi-sensitive and -resistant melanoma cells within 24 h. Like other quantitative phase imaging (QPI) modalities, HSLCI is well-suited to noninvasive measurements of single cells and cell clusters, requiring no fluorescence or dye labeling. HSLCI is substantially faster and more sensitive than field-standard growth inhibition assays, and in terms of the number of cells measured simultaneously, the number of drugs tested in parallel, and temporal measurement range, it exceeds the state of the art by more than 10-fold. The accuracy and speed of HSLCI in profiling tumor cell heterogeneity and therapy resistance are promising features of potential tools to guide patient therapeutic selections.

Application of unibody single-branch endografts in Stanford type B dissections with primary entry tear adjacent to the left subclavian artery: a computed tomography-based planning study.

BACKGROUND: A custom-made unibody single-branch endograft (USBE) could provide great gains in the landing zone, while maintaining a left subclavian artery (LSA) perfusion in some patients with Stanford type B dissections (TBADs). We performed a computed tomography (CT)-based planning study to determine the proportion of TBAD patients who could benefit from this custom-made USBE and ascertained the possibility of an off-the-shelf USBE in an emergency setting. METHODS: We carried out a retrospective study of TBAD patients with optimal CT scans at our center from 2007 to 2013. Patients' CT scans were analyzed using 3-dimensional reconstruction software. After generating a centerline of flow, measurements (including numerous morphologic characteristics of anatomy) were evaluated. A selected subset of patients suitable for USBE was determined. Finally, the most frequently used configurations of endografts were figured out by subgroup analysis. RESULTS: A total of 314 patients with optimal digital imaging communications in medicine (DICOM) data were included in our study. The main primary entry tears (MPETs) were located at 22.8 ± 17.3 and 36.3 ± 18.6 mm distal to the LSA and the left common carotid artery, respectively. Overall, 169 (54.2%) patients with MPET distal to LSA (＞20 mm) could be treated by tubular stent grafts. Of the 143 patients who had intimal tears adjacent to the LSA (≤20 mm), there were 111 (35.4%) patients who could benefit from treatment using USBE based on our selection criteria. Subgroup analysis estimated the number of graft configurations needed to treat a proportion of patients: 1 design would treat 6.7% of the population, 5 designs would treat 23.1%, 10 designs would treat 37.6%, and 20 configurations would treat 54.8% . CONCLUSIONS: In all, 35.4% patients with TBAD could potentially benefit from USBE. The use of off-the-shelf endografts might be possible in cases of emergency, given the evidence of recurrent configurations.

[Effects of carotid endarterectomy on cognitive function in patients with carotid stenosis].

OBJECTIVE: To investigate the theraputic effects of carotid endarterectomy (CEA) on cognitive function in patients with carotid stenosis (CAS) and congnitive impairment. METHODS: CEA was performed on 38 patients with CAS from December 2011 to July 2013. There were 26 male and 12 female patients, with an average age of (70 ± 7) years. Patients was underwent neuropsychological examinations (NPEs) including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at 1 week before and 6 weeks after treatment. Cerebral perfusion was assessed with MR perfusion-weighted imaging and diffusion-weighted inmaging at 1 week before and 6 weeks after treatment. RESULTS: All of the 38 patients completed NPEs and MRI at baseline and 6 weeks after CEA. After therapy, the parameters and the extents of abnormal perfusion was improved, including the decrease of time to peak (29 ± 9 vs. 23 ± 4), relative mean transit time (22 ± 8 vs. 14 ± 6), arrive time (21 ± 8 vs. 15 ± 4) and relative cerebral blood volume (11.6 ± 3.5 vs. 7.5 ± 3.2) (t = 1.31 to 5.24, all P < 0.05). Significant improvement in MoCA (20.4 ± 1.5 vs. 22.0 ± 1.6, t = -4.25, P = 0.000) but MMSE (26.16 ± 1.35 vs. 26.47 ± 1.52, t = -0.96, P = 0.341) was observed. CEA significantly improved the assessment of visuospacial/constructive abilities (2.4 ± 0.9 vs. 2.8 ± 0.7), naming (2.0 ± 0.7 vs. 2.3 ± 0.6), abstraction (1.2 ± 0.7 vs. 1.6 ± 0.6) and attention (2.3 ± 0.6 vs. 2.6 ± 0.5) (t = 0.015 to 0.029, P = 0.015). CONCLUSION: CEA can improve the cognitive function of patients with carotid stenosis as well as the cerebral perfusion of patients and has therapeutic effects on vascular mild cognitive impairment.

Computed tomography-based study exploring the feasibility of endovascular treatment of type A aortic dissection in the Chinese population.

PURPOSE: To characterize type A aortic dissection (TAAD) in the Chinese population using high-resolution computed tomography (CT) and explore potential candidacy for endovascular repair of TAAD. METHODS: The imaging studies and medical records of all 302 patients presenting with TAAD at two Chinese hospitals from 2010 to 2013 were reviewed. Of these, 221 patients were excluded because of missing/inadequate preoperative CT scans. The remaining 91 patients (64 men; mean age 51.1±7.5 years) had CT data adequate to assess anatomical suitability for endovascular treatment. Entry tears were identified using multiplanar reconstructions, while morphological measurements were based on a centerline of flow (CLF) technique. Suitability for endovascular treatment was based on a proximal landing zone ≥20 mm long, a true lumen aortic diameter ≤38 mm, and a total aortic diameter ≤46 mm; no coronary bypass grafts originating from the ascending aorta; no malfunctioning aortic valve; and good cerebral and cardiac perfusion. RESULTS: In the 91 patients, the precise location of the primary proximal entry tear could be identified in only 34 (37.4%) patients; in these patients, the identifiable intimal tears were located 36.4±41.0 mm distal to the closest coronary artery. The CLF was successfully generated in the CT scans of all patients; the mean lumen and total aortic lumen diameters at the entry tear level were 37.6±6.3 and 44.3±13.3 mm, respectively. Based on the CT measurements, stent-graft repair would have been anatomically feasible in 35 (38.5%) patients. No proximal landing zone (n=23), large aortic diameter (n=15), abnormal aortic valve (n=10), previous coronary bypass graft surgery (n=5), and poor cerebral and cardiac perfusion (n=3) were obstacles that affected the suitability for this treatment. CONCLUSION: Based on high-resolution CT scans, our pilot study suggested that 38% of Chinese patients with TAAD could potentially be treated by stent-grafting based on the anatomical characteristics of the proximal dissection.

[Combined iliac artery stenting and open femoral endarterectomy in the treatment of multi-level iliac and common femoral occlusive disease].

OBJECTIVE: To evaluate the feasibility and efficacy of hybrid procedure for the treatment of multi-level iliac and common femoral occlusive disease. METHODS: From January 2008 to June 2011, 36 lower limbs with sever iliac and common femoral occlusive diseases were treated by iliac artery stenting combined with open femoral endarterectomy. The mean age of the whole study population was 65 years (range 49 to 87 years) with a male predominance (26 males, 72.2%). The early clinical results were determined by ankle brachial index and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analysis were used to assess the influence of various risk factors on primary patency. RESULTS: All lower limbs underwent successful hybrid surgical and endovascular therapy. Clinical improvement was seen in 94.4% of patients. The mean duration of follow-up was 24.2 months, overall, the primary patency rates, primary assisted patency rates and second patency rates were 72.2%, 83.3% and 94.4% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P = 0.041, 0.012). Cox regression analysis did not reveal any independent predictor of primary patency. CONCLUSION: Hybrid procedures provided an effective treatment management of multilevel iliac-femoral arterial occlusive disease.

Hybrid procedures for thoracoabdominal aortic pathologies.

We report our three-year experience with the visceral hybrid procedure for patients with thoracoabdominal aortic aneurysms, dissections and Takayasu's arteritis. We also evaluate and discuss the outcomes of hybrid procedures. Hybrid procedures include debranching of the visceral or renal arteries followed by endovascular repair of the disease. The surgical strategy was designed individually to reduce trauma and minimize stent coverage area. A series of 11 patients (9 men, mean age 52 years) were treated between June 2008 and September 2011. The pathologies were aneurysmal disease (thoracoabdominal aortic aneurysms) (5, 45.5%), aortic dissection (thoracoabdominal aortic dissection) (4, 36.4%) or true/false aneurysm formation after Takayasu's arteritis (2, 18.2%). Simultaneous approach (9, 81.8%) and staged approach (2, 18.2%) were performed. The mean follow-up was 13.5 months (range 1­36). The technical success was 100%. Stent grafts were implanted in the entire or part of the thoracoabdominal aorta. The overall mortality rate was 9.1% (1/11) with no aneurysm-related death. The permanent paraplegia and bypass graft occlusion rate was 0%. The overall morbidity was 36.4% with two endoleaks (2/11, 18.2%). In conclusion, hybrid procedures can minimize surgical invasiveness in treatments of thoracoabdominal aortic pathologies, and it is a safe method with acceptable morbidity and mortality.

[Analysis of endoleak in short term after endovascular aneurysm repair for abdominal aortic aneurysms].

OBJECTIVE: To observe the occurrence condition of endoleak after endovascular aneurysm repair (EVAR) operation for abdominal aortic aneurysm (AAA), and to analyze the factors of the endoleak. METHODS: Between July 2005 and June 2013, 210 cases of AAA were treated with EVAR. Of 210 patients, 175 were male and 35 were female, aging 42-89 years (mean, 65.7 years). The patients were all proved to have infrarenal AAA by computed tomography angiography (CTA). The disease duration ranged from 1 week to 2 years (median, 11.3 weeks). The maximum diameter of the aneurysms was 44-72 mm (mean, 57.3 mm). The proximal landing zone was longer than 1.5 cm. CTA was performed routinely at 2 months after operation to detect the endoleak of contrast agent. If endoleak was found, CTA was performed again at 6 months. If obvious endoleak still existed, digital subtraction angiography (DSA) would be performed to clarify the character and the degree of the endoleak, and EVAR should be done if necessary. RESULTS: Endoleak occurred in 31 cases (14.8%) during operation, including 11 cases of type I endoleak (8 cases of type IA and 3 cases of type IB), 18 cases of type II endoleak, and 2 cases of type III endoleak (type IIIB). The patients were followed up 2-8 months (mean, 3.1 months). At 2 months after operation, contrast agent endoleak was found in the remnant aneurysm cavity of 12 cases (5.7%). At 6 months after eperation, contrast agent endoleak was found in 10 cases (4.8%) by CTA. In 8 patients receiving DSA, there were 4 cases of type I endoleak (3 cases of type IA and 1 case of type IB), 3 cases of type II endoleak, and 1 case of type III (type IIIB) endoleak. In 5 patients having type I and type III endoleak, collateral movement of stent graft was observed in different degree; after increased stent graft was implanted, the endoleak disappeared after 2-4 months. The patients having type II endoleak were not given special treatment, endoleak still existed at 2 months after reexamination of CTA, but the maximum diameter of AAA had no enlargement. CONCLUSION: The collateral movement of stent graft is a very important factor to cause type I and type III endoleak in the patients of AAA after EVAR, and endoleak can be plugged by EVAR again.

[Comparison of early complications in treatment of carotid artery stenosis with carotid endarterectomy and carotid stenting].

OBJECTIVE: To compare the early complications of carotid stenting (CAS) and carotid endarterectomy (CEA) in treatment of carotid artery stenosis. METHODS: Between January 2005 and December 2007, 63 patients with carotid artery stenosis were treated with CEA in 36 cases (CEA group) and with CAS in 27 cases (CAS group). There were 42 males and 21 females with an average age of 67.5 years (range, 52-79 years). The locations were the left side in 28 cases and the right side in 35 cases. The carotid stenosis was 60%-95% (mean, 79%). The major clinical symptoms were stroke and transient ischemic attack. The cranial CT showed old cerebral infarction in 24 cases, lacunar infarction in 22 cases, and no obvious abnormal change in 17 cases. The encephalon, heart, and local complications were compared between 2 groups within 7 days after operation. RESULTS: In CEA group, encephalon complications occurred in 3 cases (8.3%), heart complications in 2 cases (5.6%), and local complications in 5 cases (13.9%); while in CAS group, encephalon complications occurred in 8 cases (29.6%), heart complications in 1 case (3.7%), and local complications in 3 cases (11.1%). The encephalon complication ratio of CAS group was significantly higher than that of CEA group (chi2 = 4.855, P = 0.028); and there was no significant difference in other complications ratios between 2 groups (P > 0.05). CONCLUSION: CEA is the first choice to treat carotid artery stenosis.

[Clinical efficacy of autologous bone marrow mononuclear cell transplantation in treating lower limb thromboangiitis obliterans].

OBJECTIVE: To investigate the efficacy of autologous bone marrow mononuclear cells transplantation in treating lower limb thromboangiitis obliterans (TAO). METHODS: From January 2005 to November 2008, 25 patients (27 limbs) with lower limb TAO were treated. There were 24 males (26 limbs) and 1 female (1 limb), aging 16-44 years (33 years on average). Fifteen left limbs and 12 right limbs were involved. The median duration of disease was 2 years (from 3 months to 9 years). Intermittent claudication was observed in 5 cases (5 limbs), 16 patients (17 limbs) had symptom of rest pain, 4 patients (5 limbs) suffered ulcer on the distal limbs. The results of visual analogue scale (VAS), maximum walking distance (MWD), ankle/brachial index (ABI), and transcutaneous oxygen pressure (TcPO2) before operation were (7.16 +/- 1.12) points, (0.098 +/-0.043) km, 0.20 +/- 0.09, and (11.78 +/- 3.46) mm Hg (1 mm Hg=0.133 kPa), respectively. A total of 300 mL bone-marrow blood was extracted from the iliac bone. And then the mononuclear cells were isolated from the bone-marrow blood. All patients received cell transplantation only one time. The amount of transplantation bone marrow mononuclear cells was (1.82-29.46) x 10(9) (mean 13.33 x 10(9)). RESULTS: All patients were followed up for 1 years. After 4 weeks of implantation, the results of VAS, MWD, ABI, and TcPO2 were (2.39 +/- 0.51) points, (0.783 +/- 0.176) km, 0.28 +/- 0.16, (21.33 +/- 6.57) mm Hg, respectively, showing significant difference compared with preoperative results (P < 0.05). The VAS, MWD, ABI, and TcPO2 increased to (2.44 +/- 0.67) points, (1.199 +/- 0.304) km, 0.37 +/- 0.09, (27.90 +/- 5.23) mm Hg after 1 year of implantation, showing significant differences compared with preoperative results (P < 0.05). One ulcer healed well and the improvement was obtained in other 3 cases after 4 weeks of implantation (80%). Four ulcers healed well after 1 year of implantation (80%). After 1 year of implantation, angiography revealed 37.04% affected limbs had a satisfactory neovascularization. The angiographic levels were grade 0 in 5 cases, grade 1 in 12 cases, grade 2 in 4 cases, and grade 3 in 6 cases. CONCLUSION: Autologous bone marrow mononuclear cells transplantation could be a simple, safe, effective method to treat TAO.

[Hybrid surgical and endovascular therapy in TASC type D atherosclerotic occlusive disease: a retrospective analysis of 48 cases].

OBJECTIVE: to retrospectively analyze 4-year results after hybrid (combined surgical-endovascular) therapy in patients with complex peripheral TASC type D atherosclerotic occlusive disease. METHODS: from January 2006 to December 2009, 48 lower limbs in 46 patients with TASC type D atherosclerotic occlusive disease were treated by hybrid surgical and endovascular therapy. There were 32 male and 16 female, age ranged from 54 to 85 years with an average of 67 years. The early clinical results were determined by ankle brachial index (ABI) and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analyses were used to assess the influence of various risk factors on primary patency. RESULTS: all lower limbs underwent successful hybrid surgical and endovascular therapy. The average ABI before and after hybrid therapy were 0.63 ± 0.18 and 0.24 ± 0.13 (P < 0.05). The average intermittent claudication distance significantly increased from (87 ± 48) m to (247 ± 62) m (P < 0.05). The mean duration of follow-up was 21.7 months (ranging 1 to 46 months). Over all, the primary patency rates, primary assisted patency rates and second patency rates were 79.2%, 83.3% and 95.8% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P < 0.05). Primary patency rates were lower in patients who underwent open surgery with both proximal and distal endoluminal procedures when compared with endovascular reconstruction proximal or distal to the site of open reconstruction (P < 0.05). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency rate (P = 0.013 and P = 0.008, respectively). CONCLUSIONS: Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease.

[The treatment of complications of endovascular repair of aortic dissection].

OBJECTIVE: To discuss the experience with special consideration for the occurrence and management of complications after thoracic aortic stent-graft treatment (EVAR). METHODS: Retrospectively review the 33 cases with complications following EVAR from July 2002 to March 2008. There were 21 male patients and 12 female patients with a mean age of 46.3 years and mean postoperative period of 12.3 d. There were 5 cases with left carotid artery covered, 5 cases with proximal or distal endoleak, 4 cases with limbs artery injuries, 3 cases with entire stent in false lumen, 3 cases with retrogression dissections, and 2 cases with Stanford A type dissection. In addition, there were 1 case of acute cerebral infarction during the procedure, 1 case of cerebral haemorrhage 2 d after endovascular repair and 1 case of pseudoaneurysm of the left brachial artery. The procedures for the complications included second stent grafts placement in 13 cases, right-left carotid and left carotid-subclavian bypass in 7 cases, iliac-femoral artery repair or graft implantation in 4 cases, abdominal aortic dissection windowing in 2 cases, one artery thrombectomy and one Beutall's procedure. RESULTS: Follow-up consisted of a CTA, MRI and office visit at 1, 6, 12 months and yearly thereafter. All the endoleak and retrogression dissections disappeared after secondary endovascular procedure. The ischemic complication of limbs, central nervous system and intestinal were cured after artery bypass. One case died of cardiac tamponade due to Stanford A aortic dissection and another case died of cerebral hemorrhage. CONCLUSIONS: The complication should be corrected as soon as possible and it might get more success to combine the endovascular approach and open surgery. Meanwhile, enhanced follow-up would help to find correlative complications in time.

[Eversion carotid endarterectomy for carotid stenosis].

OBJECTIVE: To observe the effect of using eversion carotid endarterectomy (eCEA) for carotid stenosis. METHODS: Twenty four patients with carotid stenosis (stenosis grade 65% approximately 95%), of which 18 were symptomatic and 6 were asymptomatic, were treated by eCEA under regional anesthesia. All patients underwent preoperative cervical duplex and DSA, CT or MRA scanning examination. The eversion technique involved an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque. RESULTS: There was no perioperative mortality and stroke. Transient ischemic attacks (TIA) disappeared, cerebral ischemia symptom improved in our patients. But there were mini chronic symptom of cerebral ischemia in 4 patients with both carotid arterial stenosis. CONCLUSION: Carotid eversion endarterectomy appears to be a universally applicable, safe, and durable operative technique.