Study on glomerular microvascular injury and repair in patients with IgA nephropathy and its relationship with intermedin / 中华肾脏病杂志

Objective To investigate the glomerular microvascular injury and repair in patients with IgA nephropathy (IgAN) as well as its relationship with intermedin (IMD).Methods Eighty cases of renal tissue taken from patients first diagnosed as IgAN in Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University and 15 cases of normal renal tissue were detected by the expression of glomerular IMD,CD31,and VE-cadherin through immunohistochemical method.ELISA method was used to detect VEGF and IMD of plasm from 31 normal subjects and 36 cases chosen from the IgAN patients.Their changes and internal relationship were analyzed according to Lee's and chronic kidney disease (CKD) classification.Results (1) Compared with the control group the expressions of CD31,IMD,and VE-cadherin in IgAN patients were statistically significant (P ＜0.01).Compared with the control group the levels of IMD and VEGF in plasma of IgAN patients in early stage of CKD group and late stage of CKD group were statistically significant (P ＜ 0.01).(2)Correlation analysis:the expression of glomerular CD31 and Lee's classification were negatively correlated (r=-0.232,P ＜ 0.05);glomerular IMD was negatively correlated with Lee's classification (r=-0.241,P＜0.05),while positively correlated with glomerular VE-cadherin (r=0.417,P＜ 0.01).VEGF in plasma of IgAN patients was positive correlated with CKD classification,BUN (r=0.458,0.409,P＜0.05),and negatively correlated with serum ALB (r=-0.532,P＜0.01).Conclusion Microvascular injury exists in patients with IgAN.The expression of VE-cadherin and IMD are positively correlated,suggesting that IMD may be involved in the progression of vascular protection and angiogenesis in IgAN.The contents of IMD and VEGF in plasma of IgAN patients increase,indicating that they may play a role in the progression of IgAN.

Crocin promotes mobilization of EPCs and re-endothelialization of damaged blood vessels in mice with carotid artery injury / 中国病理生理杂志

AIM:To study the effect of crocin on the mobilization of endothelial progenitor cells (EPCs) in the peripheral blood of the mice with carotid arterial injury and its mechanism.METHODS:The carotid artery injury model of the C57BL/6 mice was established by the method of wire injury.The animals were divided into sham operation group,saline-treated model group,and low dose,medium dose and high dose (10,50 and 100 μ mol· kg-1 · L-1,respectively) of crocin treatment groups.The mobilization of the EPCs in peripheral blood of the mice with carotid artery injury was detected by flow cytometry at 3 d.The changes of vascular endothelial growth factor (VEGF),stromal-derived factor-1 (SDF-1),basic fibroblast growth factor (bFGF),epidermal growth factor (EGF) and matrix metalloproteinase-9 (MMP-9) in the peripheral blood of the mice with carotid artery injury were detected by enzyme-linked immunosorbent assay at 7 d.The vascular re-endothelialization and intimal hyperplasia of the mice with carotid artery injury were detected by Evans blue and hematoxylin-eosin staining.At the same time,real-time PCR was used to detect the mRNA expression of vascular repair factor-related receptors,vascular endothelial growth factor receotor-2 (VEGFR-2),CXC chemokine receptor-4 (CXCR4),basic fibroblast growth factor receptor (bFGFR) and epidermal growth factor receptor (EGFR),in the injured segments of carotid arteries.RESULTS:Compared with sham group,the EPCs mobilization and the content of vascular repair factors VEGF,SDF-1,bFGF,EGF and MMP-9 in peripheral blood were increased in model group (P ＜0.05).The area of vascular endothelium was decreased,while the area of intimal hyperplasia and the ratio of intimal to medial membrane area were increased significantly (P ＜ 0.05).The expression levels of VEGFR-2,CXCR4,bFGFR and EGFR were also increased in the injured segments of carotid arteries (P ＜ 0.05).Compared with model group,the EPCs mobilization and the content of vascular repair factors VEGF,SDF-1,bFGF,EGF and MMP-9 in peripheral blood were significantly increased in different concentrations of crocin-treated mice with carotid artery injury (P ＜ 0.05).The area of vascular endothelium was gradually increased,while the area of intimal hyperplasia and the ratio of intimal to medial membrane area were gradually decreased (P ＜ 0.05).The expression levels of VEGFR-2,CXCR4,bFGFR and EGFR were also gradually increased in the injured segments of cartid arteries (P ＜ 0.05).CONCLUSION:Crocin promotes the mobilization of EPCs and the re-endothelialization of damaged blood vessels in the mice with carotid artery injury,thus repairing the injured vasculature.

Crocin promotes mobilization of EPCs and re-endothelialization of damaged blood vessels in mice with carotid artery injury / 中国病理生理杂志

AIM:To study the effect of crocin on the mobilization of endothelial progenitor cells (EPCs) in the peripheral blood of the mice with carotid arterial injury and its mechanism.METHODS:The carotid artery injury model of the C57BL/6 mice was established by the method of wire injury.The animals were divided into sham operation group,saline-treated model group,and low dose,medium dose and high dose (10,50 and 100 μ mol· kg-1 · L-1,respectively) of crocin treatment groups.The mobilization of the EPCs in peripheral blood of the mice with carotid artery injury was detected by flow cytometry at 3 d.The changes of vascular endothelial growth factor (VEGF),stromal-derived factor-1 (SDF-1),basic fibroblast growth factor (bFGF),epidermal growth factor (EGF) and matrix metalloproteinase-9 (MMP-9) in the peripheral blood of the mice with carotid artery injury were detected by enzyme-linked immunosorbent assay at 7 d.The vascular re-endothelialization and intimal hyperplasia of the mice with carotid artery injury were detected by Evans blue and hematoxylin-eosin staining.At the same time,real-time PCR was used to detect the mRNA expression of vascular repair factor-related receptors,vascular endothelial growth factor receotor-2 (VEGFR-2),CXC chemokine receptor-4 (CXCR4),basic fibroblast growth factor receptor (bFGFR) and epidermal growth factor receptor (EGFR),in the injured segments of carotid arteries.RESULTS:Compared with sham group,the EPCs mobilization and the content of vascular repair factors VEGF,SDF-1,bFGF,EGF and MMP-9 in peripheral blood were increased in model group (P ＜0.05).The area of vascular endothelium was decreased,while the area of intimal hyperplasia and the ratio of intimal to medial membrane area were increased significantly (P ＜ 0.05).The expression levels of VEGFR-2,CXCR4,bFGFR and EGFR were also increased in the injured segments of carotid arteries (P ＜ 0.05).Compared with model group,the EPCs mobilization and the content of vascular repair factors VEGF,SDF-1,bFGF,EGF and MMP-9 in peripheral blood were significantly increased in different concentrations of crocin-treated mice with carotid artery injury (P ＜ 0.05).The area of vascular endothelium was gradually increased,while the area of intimal hyperplasia and the ratio of intimal to medial membrane area were gradually decreased (P ＜ 0.05).The expression levels of VEGFR-2,CXCR4,bFGFR and EGFR were also gradually increased in the injured segments of cartid arteries (P ＜ 0.05).CONCLUSION:Crocin promotes the mobilization of EPCs and the re-endothelialization of damaged blood vessels in the mice with carotid artery injury,thus repairing the injured vasculature.

EFFECT OF MACROPHAGE MIGRATION INHIBITORY FACTOR ON VASCULAR REPAIR OF STEROID-INDUCED AVASCULAR NECROSIS OF FEMORAL HEAD IN VITRO / 中国修复重建外科杂志

CONCLUSIONS: In hypoxia environment, the proliferation and migration of ECs is enhanced, and the secretion of VEGF and MIF is increased. High concentration of dexamethasone will suppress the process above, which induces vascular repair disorders and aggravating SANFH.

Relations between timing of treatment in stanford B acute aortic dissection vascular repair and prognosis / 中国基层医药

Objective To investigate clinical relevance of the acute Stanford B aortic dissection vascular repair time for treatment and prognosis.Methods A retrospective clinical data of our hospital treated 1 10 cases of vascular repair of acute aortic dissection type Stanford B were analyzed according to the onset to treatment time.They were divided into three groups:group A (onset to treatment time of 7 days),group B (onset to treatment time 14) and group C (onset to treatment time than 14 days);the three groups were observed after aortic repair status and prognosis related indicators.Results The true lumen false lumen diameter and maximum diameter ratio in group A was the largest (1.8 ±0.5),which was significantly higher than that of group B and group C (1.3 ±0.3)and (1.3 ± 0.2),the difference was statistically significant (F=7.352,P<0.05).Ratio of preoperative minimum true lumen diameter and the maximum diameter of the false lumen,ratio of postoperative maximum true lumen diameter and the maximum diameter of the false lumen were associated with the onset of the endovascular repair time,showed a negative correlation (r=-0.452,-0.281,all P<0.05).postoperative complication rate of group A was 12.8%,complica-tion rate of group B was 29.5%,complication rate of group C was 33.3%,data of group A was significantly lower than those of group B and group C,the difference were statistically significant (χ2 =4.024,4.721,all P<0.05).group A died three cases,group B had 1 patient died and in group C there was no deaths.Hospital stay and hospital costs of group A were significantly lower than those of group B and group C,the difference werestatistically significant (F=4.125,7.375,all P<0.05).Conclusion As soon as possible to implement acute aortic dissection stanford B aortic vascular repair could better improve outcomes,and reduce the cost of hospitalization and treatment.At the same time, it can reduce the incidence of complications and improve clinical safety.

Microsurgical treatment of the brachial plexus cord terminal branch injuries with concomitant major vessel injuries / 中华显微外科杂志

Objective To explore the clinical outcomes of surgical treatment of brachial plexus cord terminal branch injuries combined with rupture of major upper limb vessels and discuss the optimal timing and surgical procedures.Methods From June,2007 to June,2012,there were 9 cases of the brachial plexus cord terminal branch injuries with concomitant major vessel injuries.Two cases had combined subclvian arterial injuries,1 had combined the first part of axillary arterial injuries,1 had the third part of axillary arterial injuries and 5 had brachial arterial injuries.Depending on the region,type and severity of the injuries,nerve and vascular reconstruction was done simultaneously in the acute phase of the injuries in 3 cases and in the subacute phase in another 2 cases.In 4 cases,the vessels were repaired acutely while nerve reconstruction was carried out in a second stage.Results Nine patients were followed-up from 50 to 78 months with an average of 61.8 months.There was no necrosis of the affected limbs.CTA showed that all the artificial blood vessels were patent after surgery.Nerve functions recovered to various extents.The muscle strength was recovered to grade 3 or better in 9 patients,except 3 cases in which the intrinsic muscles were control by ulnar nerve.(S) or better sensory recovery was seen in all repaired nerve area in 4 patients,and S3 or better sensory recovery was seen in part of the repaired nerve area in 5 patients.Conclusion The brachial plexus cord terminal branch injury is rare and complicated,which request a reasonable treatment program.Under the guideline of saving life first,primary and simultaneous reconstruction of both the nerves and vessels should be attempted by microsurgical treatment whenever possible for improving the success rate of surgery and a better functional recovery.

Pulse Oximetry for the Diagnosis and Prediction for Surgical Exploration in the Pulseless Perfused Hand as a Result of Supracondylar Fractures of the Distal Humerus

BACKGROUND: The management of the pulseless perfused hand in association with a supracondylar humerus fracture following operative stabilisation remains controversial. Previous authors have suggested the use of color-flow duplex monitoring, magnetic resonance angiography and segmental pressure monitoring as objective steps to ascertain blood flow following adequate internal fixation. We examine the use of the waveform of the pulse oximeter in objectively determining a perfused limb and in predicting the need for surgical exploration in patients who present with a pulseless perfused hand after operative stabilisation for supracondylar fracture of the humerus. METHODS: A retrospective review of all supracondylar fractures over a 60 month duration (2005-2009) in our instituition was performed. Each electronic record was reviewed and limbs which had absent radial pulse following admission were identified. X-ray films of each of the patients were reviewed. A search using the Pubmed database was performed with the following keywords, supracondylar humerus fracture, pediatric, pulseless, vascular injury, arterial repair. RESULTS: In this series of pulseless perfused hands following operative fixation of supracondylar fracture, a total of 26 patients were reviewed. All were Gartland grade III extension type fractures. Postoperative pulse oximeter waveforms were present in all but 4 patients. These patients subsequently had exploration of the brachial artery with significant findings. In the remaining 22 patients, waveforms were present and the child had return of the radial pulse soon after operative fixation without any further need for surgical exploration. At 24 months follow-up, all children were well with no neurovascular compromise. CONCLUSIONS: The presence of a waveform on a pulse oximeter is a sensitive and easily available modality in determining vascular perfusion as compared to other more complex investigations. The high sensitivity of this test will allow surgeons to objectively determine the requirement for surgical exploration of the brachial artery.

Improved vascular repair is relevant to enhanced renal function with vasodilators in early stage of chronic kidney disease

Background: Treatment with vasodilators can improve renal function in early stage of chronic kidney disease (CKD) patients. Objective: Study the mechanism of vascular repair in 20 CKD patients associated with actual creatinine clearance greater than 60 mL/min/1.73m2 (mean 84+24 mL/min/1.73m2) who had been under treatment with vasodilators. Results: Initial study on angiogenic factors revealed a low value of VEGF, no significant change in VEGF-R1, whereas antiangiogenic factors showed elevated angiopoietin-2 and no significant change in VEGF-R2. Initial actual creatinine clearance was significantly depleted and fractional excretion of magnesium (FE Mg) was elevated significantly. Follow-up study showed improved VEGF and a significant decline in angiopoietin-2. Such improved vascular repair coincided with enhanced creatinine clearance. Conclusion: Improved renal function can be achieved by vasodilators under environment favourable for adequate vascular repair.

Vascular homeostasis and disease progression in chronic kidney disease

Background: Vascular disease is unfortunately an asymptomatic process that is responsible for a variety of organ damages such as chronic kidney disease (CKD). Present therapeutic strategy in CKD which is usually initiated at the late stage of CKD fails to enhance renal perfusion or restore function.Objective: To summarize the mechanism of vascular homeostasis in different stages of CKD to explain the present therapeutic failure. Furthermore, the authors propose an innovative strategy to restore effectively renal perfusion and function in CKD.Results: Altered vascular homeostasis with impaired vascular repair is observed in late stage of CKD and would explain the present therapeutic failure. However, an adequate vascular repair is observed in early stage of CKD, which would provide an alternative innovative approach to restore renal function in this early stage under environment favorable for renal angiogenesis and regeneration.Conclusion: A restoration of renal perfusion and function can be accomplished in early stage of CKD with multidrug vasodilators.

Photochemical tissue bonding in tissue repair / 上海交通大学学报（医学版）

Suture was a traditional method for tissue repair. However, sutures used in the closure of surgical wounds can induce inflammation and lead to scarring that appears as crosshatch marks. Threads used for sutures may cause immune response and surgical infection. In this review, we introduce a novel sutureless technique for wound repair, called photochemical tissue bonding (PTB). Absorption of visible light by a photosensitizing dye initiates photochemical reactions leading to covalent protein-protein crosslinks that bridge the wound surfaces, thus producing an immediate seal between the wound surfaces. This technique has been applied in various tissues including skin, cornea, nerve, blood vessels, et al. PTB reduces inflammation resulting in less scarring in skin. PTB dramatically improves the incidences of vascular anastomotic leakage and stricture. In addition, PTB enhances the recovery of nerve function after nerve repair.