Radiological measurement and analysis of trans-inferior alveolar nerve implantation / 口腔医学

Objective@#To measure the position of the mandibular nerve canal at the mandibular second molar by CBCT image data, analyze the theoretical implantation range of trans-alveolar implantation, and provide a theoretical solution to insufficiency of posterior mandibular bone volume in clinical practice. @*Methods@#Eighty patients with missing mandibular second molars whose vertical bone height of the edentulous area was less than 9 mm were selected for CBCT image measurement, and the distances from the mandibular nerve canal to the buccal cortex, lingual cortex, and alveolar crest were measured to simulate trans-inferior alveolar nerve implantation. The angular range of the buccolingual inclination of the implant was also measured.@*Results@#The distances from the mandibular nerve canal to the buccal cortex, lingual cortex and alveolar crest at the mandibular second molar were(6.913±1.222)mm, (2.859±0.891)mm and (7.991±0.783)mm, respectively. The distance from the mandibular nerve canal to the buccal cortex was significantly greater than that to the lingual cortex. And, 75% of the patients could be implanted by the inferior alveolar nerve. The minimum angle of buccolingual inclination of the simulated implant was 19.360°±7.086°, and the maximum angle was 39.462°±6.924°. @*Conclusion@#The mandibular nerve canal at the mandibular second molar is inclined toward the lingual side, which ensures sufficient buccal bone volume. Most patients with severe mandibular atrophy can still adopt implants of conventional length by trans-inferior alveolar nerve implantation to keep a safe distance from the nerve canal.

Differentially expressed microRNAs at different stages of atherosclerosis in ApoE-deficient mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Atherosclerosis is the primary cause of cardiovascular disease, carotid artery disease, and peripheral vascular disease. However, it is hard to obtain human arterial tissue at different stages of atherosclerosis for a systematic study. The ApoE-deficient (ApoE(-/-)) mice predictably develop spontaneous atherosclerotic plaques with numerous features similar to the human lesions and contain nearly the entire spectrum of lesions observed during atherogenesis in humans. MicroRNA expression profiles at different stages of atherosclerosis in ApoE-deficient mice were screened to find out the differentially expressed microRNAs.</p><p><b>METHODS</b>ApoE-deficient mice were euthanized at 4, 8, and 20 weeks of age and divided into three groups according to the three time points, including groups A4 (fed a Western-type diet for 0 week), A8 (fed a Western-type diet for 4 weeks), and A20 (fed a Western-type diet for 16 weeks). Atherosclerotic lesions were analyzed. Fifteen aortas were collected and combined into three pools (five aortas in one pool) in each group. MicroRNA microarray analysis was replicated thrice in each group. The threshold of fold change ≥ 2.0 was used to screen up or down-regulated microRNAs. Differentially expressed microRNAs were subsequently verified with quantitative real-time polymerase chain reaction. Those increasingly up or down-regulated microRNAs during the progression of atherosclerosis were selected.</p><p><b>RESULTS</b>Atherosclerotic lesions first appeared in the aortic arch in group A8. Severe atherosclerotic lesions were observed in group A20. In group A8, seven MicroRNAs were up-regulated while two were down-regulated. In group A20, 15 microRNAs were up-regulated while two were down-regulated. miR-34a-5p and miR-497-5p were increasingly up-regulated, while miR-434-3p was progressively down-regulated when atherosclerosis progressed.</p><p><b>CONCLUSIONS</b>In this study, we described that microRNAs are differentially expressed at different stages of atherosclerosis in ApoE-deficient mice. Those increasingly up or down-regulated microRNAs during the progression of atherosclerosis may play an important role in the pathogenesis of atherosclerosis and provide us opportunities for investigating atherosclerosis from early to advanced stages.</p>

HPLC evaluation on 3-n-butylphthalide distribution.

A rapid, sensitive and specific reversed-phase high-performance liquid chromatographic method was developed for the determination of 3-n-butylphthalide, a drug currently being developed for treatment of stroke, in mice tissue. Ultraviolet detection were monitored at 228 nm for quantification of 3-nbutylphthalide. Ibuprofen was used as internal standard. The peak area ratio vs concentration in tissue was linear over the range of 25.625–1025.000 ng/mL and the limit of quantification was 25.625 ng/mL. The method was successfully applied to pharmacokinetic investigation in mice. The mean distribution half-life was 5.471 ± 4.736 min and elimination half-life was 58.459 ± 34.370 min. Finally, a preclinical biodistribution research of 3-n-butylphthalide in mice following intravenous administration had been studied. Brain targeting of 3-n-butylphthalide was strong and metabolism in the liver and blood was rapid.

Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.</p><p><b>DATA SOURCES</b>We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.</p><p><b>STUDY SELECTION</b>According to the inclusion criteria, 76 articles were finally analyzed to compare patient characteristics, clinical success, complications, and prognosis.</p><p><b>RESULTS</b>We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group). There was no significant difference in the success rate of the procedures. Operative time, length of ICU stay, fasting time, duration of total postoperative stay, blood loss, and blood transfusion requirements during the procedure were significantly lower in the EVAR group. A 30-day follow up revealed more cardiac, renal, pulmonary, and visceral complications in the OS group (P < 0.01). Low-limb ischemia, however, was more common in the EVAR group (P < 0.05). The 30-day mortality rate, including aorta-related and non-aorta related mortality, was significantly lower in the EVAR group (P < 0.01). In the follow-up period, there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P < 0.01). The overall late mortality rate was higher in the OS group (P < 0.01), especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P < 0.01).</p><p><b>CONCLUSIONS</b>EVAR was safer and less invasive for AAA patients. Patients suffered fewer complications and recovered sooner. However, complications such as artificial vessel occlusion, low-limb ischemia, and endoleak were common in EVAR. Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.</p>

Assessment of the mechanical properties and biocompatibility of a new electrospun polyurethane vascular prosthesis / 南方医科大学学报

<p><b>OBJECTIVE</b>To develop a small-caliber vascular grafts and study its morphologies, mechanical properties and biocompatibility.</p><p><b>METHODS</b>The effects of electrospinning conditions on the microstructure and porosity of the resulting scaffolds were investigated for preparation of a small-caliber (4 mm) polyurethane vascular grafts with optimum microstructures and mechanical properties. The mechanical properties and biocompatibility of the prepared grafts were evaluated.</p><p><b>RESULTS</b>The polyurethane vascular grafts showed a three-dimensional reticular structure consisting of nanofibers, with an average porosity of (51.48∓4.47)% and tensile strength of 5.85 ∓ 0.62 MPa. The grafts provided a better long-term support than e-PTFE graft for endothelial cell growth and endothelialization.</p><p><b>CONCLUSION</b>The polyurethane vascular prosthesis possessed favorable microstructures, excellent mechanical properties and good biocompatibility for potential clinical application.</p>

Clinical analysis of vascular anomalies: a hospital-based retrospective study of 592 patients in southeast China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Vascular anomalies are common and multidisciplinary involved diseases. The greatest impediment to their treatment in the past was their confusing terminology and clinical heterogeneities. This hospital-based retrospective study assessed some clinical characteristics, diagnosis, therapies and outcomes of patients with vascular anomalies in southeast China.</p><p><b>METHODS</b>A total of 592 vascular anomalies patients (patients with intracranial tissues or viscera involved were excluded), admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2006 to September 2009, were enrolled in the study. Data for clinical characteristics, diagnosis, therapies and outcomes were collected and analyzed.</p><p><b>RESULTS</b>Of the 592 patients, the male:female ratios in the vascular tumor group (n = 187) and the vascular malformation group (n = 405) were 1:1.49 and 1:1.06 respectively, with no significant difference between them. The mean onset age of the vascular tumor group was significantly younger than that of the vascular malformation group (p < 0.001). The head and neck were the most commonly (31.4%) involved areas in vascular anomalies. A total of 23.8% of the patients with vascular anomalies had definite symptoms caused by the vascular lesions. In the vascular tumor group, 94.1% of them were infantile hemangiomas. Venous malformation was the most common (41.0%) subtype of vascular malformations. Surgical therapy was undertaken in 94.2% of the patients with vascular anomalies. Of the 519 patients available for the 16 - 58 month follow-up, 322 patients (62.0%) were cured, 108 patients (20.8%) were markedly improved, 57 patients (11.0%) were partially improved, and 32 patients (6.2%) were uncured.</p><p><b>CONCLUSIONS</b>Vascular anomalies are clinically heterogeneous. While the outcome is generally favorable, further effort should be made to determine the appropriate terminology and management.</p>

Endovascular repair of abdominal aortic aneurysm: a clinical report of 81 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), and to compare the prognosis between patients of different ages.</p><p><b>METHODS</b>The hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed. All the patients were divided into advanced age group (age ≥ 75 years, 24 cases) and relatively young group (age < 75 years, 57 cases). General conditions, comorbidity, procedure, in-hospital complications, and follow-up were compared between these two groups.</p><p><b>RESULTS</b>All covered stents were successfully deployed, a technical success rate of 91.4% (74/81) was achieved. There was no intraoperative death. In-hospital mortality was 1.2% (1/81). The follow-up rate was 91.4% (74/81), with a mean follow-up of 47.5 months. Twelve deaths were recorded during follow-up, 1, 2, 3, 4, and 5-year survival rates were 98.6%, 92.2%, 80.8%, 58.7%, and 44.1%, respectively. When compared with relatively young group, the advanced age group had a lower rate of abdominal pain as the major symptom, but a higher rates of renal diseases and coronary artery diseases. Furthermore, the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks, and also tended to have increased rates of pulmonary infection and access site hematoma, while the other parameters were similar between the two groups.</p><p><b>CONCLUSIONS</b>EVAR of AAA is less invasive, safe, and effective during short to mid-tern follow-up. The patients of advanced age suffer from higher rates of some complications, thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.</p>

Potential causes and optimal treatment strategy of recurrent venous ulceration in lower limb / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the potential causes and the optimal treatments of recurrent venous ulceration of lower limbs after initial operation.</p><p><b>METHODS</b>Data of patients admitted between January 2000 and June 2010 for recurrent ulceration in lower limbs after previous operation were retrospectively analyzed. Altogether 81 limbs in 73 patients were recruited. There were 55 male patients (60 limbs) and 18 female patients (21 limbs). The average age was 52.6 years (ranging from 31 to 73 years). All the patients had received at least one surgery procedures before recurrence. The average time between ulceration recurrence and the last operation was 10.6 months (ranging from 5 to 37 months). Average diameter of ulcers was 3.7 cm (ranging from 1.3 to 6.5 cm). Color duplex sonography before re-treatment revealed incompetent calf perforators in 57 limbs (70.4%), primary deep vein insufficiency in 38 limbs (46.9%), post-DVT syndrome in 16 limbs (19.8%), reflux of accessory saphenous veins in 11 limbs (13.6%) and residual/re-opened great saphenous vein in 8 limbs (9.9%). Managements including stripping of great saphenous vein, ligation around the ulcer, percutanous ligation of varicose veins, valvoplasty, and adjuvant compressive therapy were adopted according to different venous abnormality.</p><p><b>RESULTS</b>All the patients were followed. All the ulcers healed and hemodynamic indexes were greatly improved 6 months after re-operation. Only 3 limbs (3.7%) suffered again from recurrence 1 year after re-operation.</p><p><b>CONCLUSIONS</b>Incompetent perforators in calf, primary or secondary deep vein insufficiency and incorrectly treated saphenous veins are main causes for recurrent venous ulceration in our series. Management of residual vein abnormalities can still achieve satisfying clinical outcome.</p>

Stable transfection of estrogen receptor-alpha suppresses expression of cyclooxygenase-2 and vascular endothelial growth factor-C in MDA-MB-231 breast cancer cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Estrogen receptor (ER)-negative breast cancer cells are more aggressive than ER-positive cells. Elevated levels of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor-C (VEGF-C) expression have been detected in cultured human breast cancer cells and are associated with negative hormone receptor status. In this study, we created ERalpha stable transfectants in MDA-MB-231 cells to explore the effect of ERalpha on cell growth and COX-2 and VEGF-C expression.</p><p><b>METHODS</b>The green fluorescent protein (GFP)-ERalpha plasmids were stably transfected into ER-negative MDA-MB-231 cells. The proliferation and migration of untransfected MDA-MB-231 cells, ERalpha-transfected MDA-MB-231 cells and ER-positive MCF-7 cells were determined. The expression of COX-2, and the levels of VEGF-C mRNA and the VEGF-C secretion concentration were assayed in these cell lines.</p><p><b>RESULTS</b>The proliferation and migration capacities of ERalpha-tranfected MDA-MB-231 cells were significantly decreased (P < 0.05). The expression of COX-2 was significantly lower in ERalpha-tranfected MDA-MB-231 cells than in untranfected MDA-MB-231 cells. The mRNA and protein levels of VEGF-C were lower in ERalpha-tranfected MDA-MB-231 cells than in untransfected MDA-MB-231 cells (P < 0.05).</p><p><b>CONCLUSIONS</b>ERalpha stable transfection inhibits proliferation and migration capacities of MDA-MB-231 cells and decreases expression of COX-2 and VEGF-C. The decreases of proliferation and migration capacities may be related to suppression of COX-2 and VEGF-C expression.</p>

Stent-grafting for unfavorable abdominal aortic aneurysm: a practical challenge / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The endovascular treatment of abdominal aortic aneurysm (AAA) has improved greatly in the last 15 years. The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm (uAAA).</p><p><b>METHODS</b>During December 2001 and December 2007, 41 patients with uAAA were treated with endografting using concomitant techniques. Patients were followed up for 1 to 48 months (mean 20.5 months).</p><p><b>RESULTS</b>Technical success rate was 97.6% (40/41) with 1 failure converted to open surgery for an unaccessed iliac stenosis. Nine (22.5%) type I endoleaks (5 proximal and 4 distal) were observed on the completion angiograms and successfully corrected with aortic cuffs and iliac extensions during the procedure. Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation. There were 2 (5.0%) type I endoleaks at 30 days; one type I patient was treated by open conversion, another type I patient died from a rupture before treatment in the ward, causing a 2.5% of initial mortality. The two type II endoleaks were observed without aneurismal expansion. No buttock or leg claudication or ischemic colitis occured. During late follow-up, one additional death occurred from stroke. One new type I endoleak was encountered from thrombocytopenia, which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month. All type II endoleaks had disappeared in the third and sixth month. The Endografts did not present signs of material fatigue and no other type of endoleak formed. One patient presented with left limb ischemia, which underwent percutaneous transluminal angioplasty. There was no additional aneurysm rupture or any endograft imgration.</p><p><b>CONCLUSION</b>The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs, achieving low morbidity and mortality rates and has a good clinical outcome.</p>

Etiological analysis and treatment of the complications of hybrid procedure in the treatment of aortic arch diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the reasons of complications after hybrid procedure in the treatment of aortic arch diseases.</p><p><b>METHODS</b>Data from 34 consecutive patients (28 male and 6 female) of aortic arch diseases treated with hybrid procedure between January 2001 and December 2008 was analyzed retrospectively. The mean age of the patients was 56.7 years (ranged from 34 to 75 years). Of the 34 patients, 27 were aortic dissections (21 cases of Stanford type A dissections and 6 cases of Stanford type B dissections) and 7 were aortic arch aneurysms. Hybrid procedure included ascending aorta (AA)-innominate artery-left common carotid artery (LCCA) bypass (n = 3), AA-LCCA-left subclavian artery (LSA) bypass (n = 2), AA-LCCA bypass and coronary artery bypass (n = 1), LCCA-right common carotid artery (RCCA) bypass (n = 13), RCCA-LCCA and LCCA-LSA bypass (n = 3), LSA-LCCA-RCCA bypass (n = 2) and LCCA-LSA bypass (n = 9). All the patients received single stage (n = 26) or staged (n = 8) endovascular repairs.</p><p><b>RESULTS</b>The complications occurred in 32.4% (11/34), with 11.8% (4/34) of all patients having lethal complications. The complications included 1 case of rupture of aortic dissection (2.9%), 2 cases of stroke (5.9%), 2 cases of stomal leak and pseudoaneurysm (5.9%), 1 case of myocardial infarct (2.9%), 1 case of pulmonary embolism (2.9%), 1 case of neck hematoma (2.9%) and 3 cases of endoleak (8.8%). In the period of follow-up (6 to 50 months), all patients were alive except for 4 perioperative deaths.</p><p><b>CONCLUSIONS</b>Complication rate of hybrid procedure in the treatment of aortic arch diseases is higher than that of simple endovascular repair of descending aortic diseases. Reducing the lethal complications is the key to disseminate this technique.</p>

Construction of an expression vector carrying short hairpin RNA targeting hTERT gene and its effects on breast cancer cell telomerase activity and proliferation in vivo / 南方医科大学学报

<p><b>OBJECTIVE</b>To construct a RNA interference expression vector targeting human telomerase reverse transcriptase gene (hTERT) gene and investigate its effects on telomerase activity and proliferation in breast cancer cells in vitro.</p><p><b>METHODS</b>The shRNA sequences targeting hTERT gene were designed and recombined into pSuper-retro-puro vector. The breast cancer cell lines MCF-7 and MDA-MB231 were transfected with the recombined vector, and the telomerase activity of the cells was tested by telomerase repeat sequence amplification-enzyme linked immunosorbent assay (TRAP-ELISA). The proliferation of the transfected cells was assessed using MTT and soft-agar clone formation assays.</p><p><b>RESULTS</b>The recombinant plasmids pSuper-retro-puro-TERT RNAi#1 and #2 were successfully constructed as confirmed by enzymatic digestion and DNA sequencing. The telomerase activity in the transfected breast cancer cells were down-regulated significantly as compared with that in negative control cells (Plt;0.005). The transfection resulted in significant inhibition of the proliferation of both MCF-7 and MDA-MB231 cells as detected by MTT assay (Plt;0.05) and soft agar clone formation assay (Plt;0.001).</p><p><b>CONCLUSION</b>Transfection with the recombinant plasmid containing the shRNA targeting hTERT gene can down-regulate telomerase activity and inhibit proliferation of breast cancer cells in vitro, suggesting the potential of gene therapy targeting telomerase in the treatment of breast cancer.</p>

RANTES expression in venous ulceration of lower limbs / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the expression of RANTES in venous ulceration.</p><p><b>METHODS</b>From patients with lower limb venous ulceration, patients with non-ulcerous venous insufficiency, and healthy individuals, peripheral blood was collected from the lower limb veins for measurement of RANTES mRNA using RT-PCR.</p><p><b>RESULTS</b>In the ulceration group, the expression of RANTES mRNA was significantly increased as compared with the other two groups (P<0.01). RANTES mRNA expression was also significant higher in the non-ulcerous group than the control group (P<0.01).</p><p><b>CONCLUSION</b>High expression of RANTES mRNA may be one of the important mechanisms of venous ulceration.</p>

Early to mid-term results of endovascular repair of aortic dissection: report of 165 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early and midterm outcomes of endovascular repair of aortic dissection (AD).</p><p><b>METHODS</b>Between January 2001 and December 2006, 165 patients (145 male and 20 female) with AD were treated with endovascular repairing. The mean age of the patients was 52.8 years (range, 30-82 years). Among them, 36 patients had Stanford type A dissection, 121 had type B dissection and 8 had aortic ulcer. Among the dissection patients, 47 were acute AD (the interval between onset and surgery was < or = 7 days), 69 were subacute AD (the interval between onset and surgery was 8-30 days) and 41 were chronic AD (the interval between onset and surgery was > 30 days).</p><p><b>RESULTS</b>The stents were placed technically successfully in 164 patients (99.4%). The rate of endoleak within 30 days after placement of stents was 7.3% (12/165) and neurologic complication rate was 2.5% (4/165). The mortality rate within 30 days was 6.1% (10/165), and the mortality of acute, subacute and chronic AD was 12.8%, 1.4% and 7.3%, respectively. One hundred and forty-five cases were followed up for 6 to 75 months (median, 28.2 months). Complete thrombosis in false lumen was achieved in 62 patients (42.8%), while partial thrombosis was achieved in 83 patients (57.2%). Nine patients died during fellow-up.</p><p><b>CONCLUSION</b>It's indicated that endovascular repair of AD is a microinvasive, safe and effective methods for aortic dissection. However, the long-term efficacy needs to be evaluated further.</p>

Role of interleukin-8 in the progression of estrogen receptor-negative breast cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Estrogen receptor (ER) is a very important biomarker of breast cancer. ER deletion has been consistently associated with tumor progression, recurrence, metastasis and poor prognosis, but the biological mechanism is still unclear. ER negative breast cancer expresses high levels of interleukin-8 (IL-8). ER expression can downregulate IL-8 promotor activity. As a multifunctional cytokine, IL-8 has many important biological activities in tumor genesis and development. With the goal of investigating the role of IL-8 in ER-negative breast cancer progression, we applied RNA interference technology to specifically knockdown the IL-8 expression in ER-negative breast cancer cell line MDA-MB-231.</p><p><b>METHODS</b>Interfering pRNA-IL-8 and the control was transfected into ER (-) MDA-MB-231. The proliferation, cell apotosis, and invasive ability were recorded in transfected, untransfected and negative transfected cells. These cells were injected into nude mice to assess tumorigenicity, proliferation, metastasis and microvessel density (MVD).</p><p><b>RESULTS</b>In vitro, decreased expression of IL-8 was associated with reduced cell invasion (P < 0.001), but had no effect on cell proliferation (P > 0.05). In vivo, neutrophils infiltration was significantly inhibited in pRNA-IL-8 transfected cells compared with untransfected and negatively transfected cells (P = 0.001, P < 0.001). Less metastasis was found in transfected cells compared with negatively transfected cells (0% vs 80%, P = 0.048). Nevertheless, we observed less MVD in transfected cells compared with control in nude mice (P < 0.001).</p><p><b>CONCLUSIONS</b>IL-8 inhibits ER-negative breast cancer cell growth and promotes its metastasis in vivo, which may be correlated with neutrophils infiltration induced by IL-8.</p>

Study on culture, identification and differentiation of CD133+ endothelial progenitor cells from human umbilical cord blood / 中华外科杂志

<p><b>OBJECTIVE</b>To study the isolation, culture and identification of CD133+ endothelial progenitor cells (EPCs) from human umbilical cord blood in vitro.</p><p><b>METHODS</b>EPC separation was performed with density gradient centrifugation and MACS separation. Purity of EPCs was determined by flow cytometry. EPC was cultured with EBM-2 to study the cultivate features of EPC. Uptake test of Dil-LDL and FITC-Lectin and immunohistochemistry were performed.</p><p><b>RESULTS</b>According to flow cytometry, (1.13 +/- 0.10)% of mono-nuclear cells were CD133+ and the purities of CD133+ EPCs were (91.45 +/- 1.04)% on average. CD133+ EPCs became adherent, spindle-shaped and formed cluster during culture. Uptake test of Dil-LDL and FITC-Lectin were positive. (95.83 +/- 1.72)% of CD133+ cells were found positive in both uptake tests. The positive rates of immunostaining of cell markers CD34 and factor VIII were (95.83 +/- 2.23)% and (95.92 +/- 1.43)% after cultured for one week, which showed no significant differences between CD133+ EPCs and human umbilical vein endothelial cells. Capillary structures were formed by CD133+ EPCs after cultured for 4 and 7 d in vitro.</p><p><b>CONCLUSIONS</b>High purity of CD133+ EPCs can be obtained by MACS separation. CD133+ EPCs can differentiate into mature endothelial cells with the effects of stimulating factors.</p>

Endovascular stent-graft repair for Stanford type A aortic dissection with extra-anatomic bypass / 中华外科杂志

<p><b>UNLABELLED</b>OBJECTIVE To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass.</p><p><b>METHODS</b>To perform endovascular repair for Stanford type A aortic dissection, we tried to extend the landing zone by extra-anatomic bypass to reconstruct the innominate artery, the left common carotid artery or the left subclavian artery, and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach.</p><p><b>RESULTS</b>Thirty-four patients with ascending aortic dissection (n=8) and aortic arch dissection (n=26) were treated with this technique. Thirty three patients were successfully done aortic endovascular repair, only one died during the operation. The thirty-day mortality rate was 8.8% (3/34), endoleak incidence rate was 11.8% (4/34) and incidence rate of cerebral infarction was 5.9% (2/34). Twenty-nine patients were followed-up for 6-70 months (mean, 24. 5 months). Complete (n=16) and partial (n=13) thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning.</p><p><b>CONCLUSIONS</b>Endovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection; it is safe, less invasive, and with fewer complications. Nevertheless, indications need further consideration.</p>

Selection of the initial surgery extent for differentiated thyroid cancer without metastasis / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the selection of the initial surgery extent for differentiated thyroid cancer (DTC) without metastasis.</p><p><b>METHODS</b>The clinical data of 504 cases with DTC, who accepted the surgical treatment from Jan 1995 to Dec 2004, were analyzed and studied. There were 329 cases without metastasis. The operative extents less than total thyroidectomy were performed on 93 cases (92.1%) with stage T(1), 166 cases (88.3%) with stage T(2), 22 cases (91.7%) with stage T(3) and 12 cases (75.0%) with stage T(4). The recurrence situation after the initial surgery was compared between different T-stage groups and between different surgical extents, total and less than total thyroidectomy.</p><p><b>RESULTS</b>The recurrence of DTC was found in 37 cases of the follow-up cases (8.9%), including 29 cases without metastasis in the initial surgery. There was no significant difference in the recurrent rate between T(1) and T(2) groups (P>0.05). The significant difference was found in recurrent rate between T(1) and T(3) or T(4) groups, T(2) and T(3) or T(4) groups (P<0.05). No significant difference in the ratio of the initial surgical extent less than total thyroidectomy was found between stage T(1) and T(2) cases without metastasis (P>0.05). The rate of the recurrent laryngeal nerve injury was 1.2%. The transient hypoparathyroidism happened in 2% of the cases, without the permanent hypoparathyroidism.</p><p><b>CONCLUSIONS</b>The surgical extent less than total thyroidectomy, especially subtotal thyroidectomy, is rational and available to stage T(1) and T(2) cases of DTC without metastasis. It can effectively remove the tumor and avoid postoperative complications. Total thyroidectomy should be performed on stage T(3) and T(4) cases of DTC.</p>

Endovascular stent-graft treatment for DeBakey I aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To study endovascular treatment of DeBakey type I aortic dissecting aneurysm.</p><p><b>METHODS</b>Seven patients with DeBakey I aortic dissecting aneurysms were treated. Diagnoses were confirmed by MRA, CT and angiography. The intimal tear entry was in the ascending aorta, 2.5 approximately 6.0 cm from the ostia of the coronary arteries, and 0.5 approximately 4.0 cm from the brachiocephalic trunk opening. Endovascular stent-grafts were deployed via a left common carotid artery (LCCA) approach in 2 cases and right femoral artery (RFA) approach in 5 cases. Prior to treatment, a left subclavicular artery (LSA)-LCCA shunt was established to ensure blood supply to the LCCA during surgery in 2 cases via LCCA approach, and a LSA-LCCA-right common carotid artery (RCCA) synthetic bypass was established to ensure blood supply to the brain in 2 cases in RFA approach.</p><p><b>RESULTS</b>The operative success rate was 100%. In 3 cases, endoleak persisted after the first stent was placed, but this was eliminated by placement of a second stent. All patients survived except one who died of acute massive hemorrhage from the upper gastrointestinal tract one month postoperatively. The false lumen in all 6 cases became thrombosed and no endoleak or new aortic dissecting aneurysms developed.</p><p><b>CONCLUSIONS</b>Endovascular treatment of DeBakey type I aortic dissecting aneurysm is feasible, minimally invasive, and effective. Case selection depends on the distance of the coronary artery ostia from the tear entry.</p>

Diagnosis and treatment of chronic venous ulcer: research status and new strategies / 中国医学科学院学报

The persistent venous hypertension is the primary cause of venous ulcer, and leukocyte activation plays an important role in the formation of venous ulcer. Venous ulcer should be differentiated from ulcers resulted from other diseases. Treatment options include conservative/medical therapies and surgical therapies. Injection sclerotherapy, superficial vein ligation and stripping, deep vein valve reconstruction, perforator ligation, and skin grafting favor the healing of ulcers.