Randomized controlled trial of endovenous N-butylcyanoacrylate endovenous nonthermal ablation and radiofrequency endovenous thermal ablation for incompetent great saphenous veins / 中华普通外科杂志

Objective:To evaluate the safety and efficacy of n-butyl cyanoacrylate (NBCA) in treating great saphenous vein(GSV) incompetence.Methods:60 patients (60 limbs) with GSV incompetence were randomly divided into NBCA glue group (30 cases) and radiofrequency ablation(RFA) group in 30 cases. The clinical outcomes, venous clinical severity score(VCSS), and quality of life using the Aberdeen varicose vein questionnaire(AVVQ) were evaluated. The primary endpoint is the occlusion rate of GSV at 3 months after surgery.Results:For the two groups, the occlusion rate of GSV was 100% immediately after surgery and at 3 months follow-up. AVVQ and VCSS were improved in the two groups( P<0.05). In terms of complications, the NBCA group had scleroma in 3 cases, pain and skin redness in 1 case respectively, but no ecchymosis and numbness. In the RFA group, numbness occurred in 1 case, skin redness in 2 cases, scleroma in 3 cases, ecchymosis and pain in 4 cases respectively. The incidence of ecchymosis and total complications in the NBCA group was significantly lower than that in the RFA group( P<0.05). No DVT or other adverse event occurred in both groups. Conclusion:NBCA and RFA have the same short-term closure rate. Furthermore, the NBCA treatment requires less equipment, no use of tumescent anesthetic, and has lower incidence in terms of complications than that of RFA.

Long-term follow-up result for the foam sclerotherapy in the treatment of lower extremity incompetent perforating veins / 中华普通外科杂志

Objective To evaluate the long-term follow-up results of foam sclerosing agent in the treatment ofincompetent perforating vein.Methods 153 cases (316 incompetent perforating veins)received the treatment of foam sclerotherapy.The closure of perforating branches was followed up by ultrasound.Results 12 cases (27 incompetent perforating veins) were lost to follow up.289 incompetent perforating veins got follow up,The median follow-up time was 17 months (11-36 months).Closure rate was 100％ in vessels less than 3 mm in diameter,while that was 76％ invessels with the diameter between 3-5 mm.Closure rate was 16％ in vessels larger than 5 mm in diameter.Conclusion The long-term efficacy of the foam sclerosing agent in the treatment of incompetent perforating vein depends on the diameter of the vein.

Ultrasound guided foam sclerosis for the treatment of lower extremity incompetent perforating veins / 中华普通外科杂志

Objective To discuss the curative effect and clinical significance of sclerosing foam agent in the treatment of chronic venous diseases (CVD) with incompetent perforating veins.Methods 65 cases of C4,C5,C6 CVD (a total of 84 limbs) underwent foam sclerotherapy closure for incompetent perforating vein.Patients were followed-up for 3 months,ultrasonography was used to observe the closure of perforating veins and the curative effect.Results 7 patients (9 limbs) were lost to follow-up,all with grade C4.In the 66 (C4,C5) limbs,pigmentation significantly subsided in 45,partial regression in 9,no change in 2.In the 9 limbs with grade C6,complete healing of ulcer in 5,partially healed in 3.Ultrasound observed satisfactory perforating vein closure.Conclusion Foam sclerotherapy closure for incompetent perforating vein has satisfactory effect,with good short-term curative result.

Structural basis of heparan sulfate-specific degradation by heparinase III

Heparinase III (HepIII) is a 73-kDa polysaccharide lyase (PL) that degrades the heparan sulfate (HS) polysaccharides at sulfate-rare regions, which are important co-factors for a vast array of functional distinct proteins including the well-characterized antithrombin and the FGF/FGFR signal transduction system. It functions in cleaving metazoan heparan sulfate (HS) and providing carbon, nitrogen and sulfate sources for host microorganisms. It has long been used to deduce the structure of HS and heparin motifs; however, the structure of its own is unknown. Here we report the crystal structure of the HepIII from Bacteroides thetaiotaomicron at a resolution of 1.6 Å. The overall architecture of HepIII belongs to the (α/α)₅ toroid subclass with an N-terminal toroid-like domain and a C-terminal β-sandwich domain. Analysis of this high-resolution structure allows us to identify a potential HS substrate binding site in a tunnel between the two domains. A tetrasaccharide substrate bound model suggests an elimination mechanism in the HS degradation. Asn260 and His464 neutralize the carboxylic group, whereas Tyr314 serves both as a general base in C-5 proton abstraction, and a general acid in a proton donation to reconstitute the terminal hydroxyl group, respectively. The structure of HepIII and the proposed reaction model provide a molecular basis for its potential practical utilization and the mechanism of its eliminative degradation for HS polysaccarides.