Clinical implications of diverse calcification patterns in endovascular therapy for femoral-popliteal arterial occlusive disease.

OBJECTIVE: The aim of this study was to investigate whether intimal arterial calcification (IAC) and medial arterial calcification (MAC) are correlated with the various clinical outcomes following endovascular therapy (EVT) for peripheral arterial disease (PAD). METHODS: This single-center retrospective study comprised 154 consecutively hospitalized individuals with PAD who underwent EVT for de novo femoral-popliteal calcific lesions from January 2016 to July 2021. The predominant calcification patterns of IAC and MAC were assessed using a semi-quantitative computed tomography scoring system. The Kaplan-Meier method and Cox regression were conducted to evaluate the correlations between calcification patterns and medium- to long-term outcomes. RESULTS: The distribution of calcification patterns was as follows: IAC in 111 patients (72%) and MAC in 43 patients (28%). No remarkable variation was noted between the IAC and MAC groups regarding age (P = .84) and gender (P = .23). The MAC group indicated lower rates of 4-year primary patency, assisted primary patency, secondary patency, and amputation-free survival (AFS) compared with the IAC group (24% ± 7% vs 40% ± 6%; P = .003; 30% ± 8% vs 51% ± 6%; P = .001; 51% ± 8% vs 65% ± 5%; P = .004; and 43% ± 9% vs 76% ± 5%; P < .001, respectively). There was no significant difference in the rate of freedom from clinically driven target lesion revascularization between the MAC and IAC groups (63% ± 10% vs 73% ± 5%; P = .26). Stepwise multivariable Cox regression analysis demonstrated that MAC was associated with poor patency (hazard ratio, 1.81; 95% confidence interval, 1.12-2.93; P = .016) and AFS (hazard ratio, 2.80; 95% confidence interval, 1.52-5.16; P = .001). CONCLUSIONS: Compared with IAC, MAC is independently associated with lower medium- to long-term patency and AFS after EVT for de novo femoral-popliteal occlusive lesions.

Pathomics and single-cell analysis of papillary thyroid carcinoma reveal the pro-metastatic influence of cancer-associated fibroblasts.

BACKGROUND: Papillary thyroid carcinoma (PTC) is globally prevalent and associated with an increased risk of lymph node metastasis (LNM). The role of cancer-associated fibroblasts (CAFs) in PTC remains unclear. METHODS: We collected postoperative pathological hematoxylin-eosin (HE) slides from 984 included patients with PTC to analyze the density of CAF infiltration at the invasive front of the tumor using QuPath software. The relationship between CAF density and LNM was assessed. Single-cell RNA sequencing (scRNA-seq) data from GSE193581 and GSE184362 datasets were integrated to analyze CAF infiltration in PTC. A comprehensive suite of in vitro experiments, encompassing EdU labeling, wound scratch assays, Transwell assays, and flow cytometry, were conducted to elucidate the regulatory role of CD36+CAF in two PTC cell lines, TPC1 and K1. RESULTS: A significant correlation was observed between high fibrosis density at the invasive front of the tumor and LNM. Analysis of scRNA-seq data revealed metastasis-associated myoCAFs with robust intercellular interactions. A diagnostic model based on metastasis-associated myoCAF genes was established and refined through deep learning methods. CD36 positive expression in CAFs can significantly promote the proliferation, migration, and invasion abilities of PTC cells, while inhibiting the apoptosis of PTC cells. CONCLUSION: This study addresses the significant issue of LNM risk in PTC. Analysis of postoperative HE pathological slides from a substantial patient cohort reveals a notable association between high fibrosis density at the invasive front of the tumor and LNM. Integration of scRNA-seq data comprehensively analyzes CAF infiltration in PTC, identifying metastasis-associated myoCAFs with strong intercellular interactions. In vitro experimental results indicate that CD36 positive expression in CAFs plays a promoting role in the progression of PTC. Overall, these findings provide crucial insights into the function of CAF subset in PTC metastasis.

Influence of Abdominal Aortic Calcification on the Distal Extent and Branch Blood Supply of Acute Aortic Dissection.

BACKGROUND: This study aimed to investigate the influence of abdominal aortic calcification on the distal extent, blood supply, and mid-term outcomes of acute aortic dissection (AAD). METHODS: This single-centre retrospective study was conducted from August 2014 to May 2021. The aortic calcification index was used to evaluate abdominal aortic calcification. The standardized method provided by the Society for Vascular Surgery was used to evaluate the distal extent of AAD. Patients were divided into 3 groups as per the degree of calcification: no calcification (NC), low calcification (LC), and high calcification (HC). RESULTS: In a cohort of 723 patients, abdominal aortic calcification was present in 424 (58.6%) patients. The prevalence of coronary heart disease increased with the degree of calcification (NC versus LC versus HC: 8.4% vs. 9.5% vs. 19.3%, P < 0.001). The aortic calcification index of the distal extent at zone 9 was higher than that of the distal extent exceeding zone 9 (P = 0.001). The proportions of the NC, LC, and HC groups with distal extents exceeding zone 9 were 65.9% vs. 56.2% vs. 37.7%, P < 0.001. In a multivariate logistics analysis, the calcification grade was a protective factor of distal extents exceeding zone 9 (P < 0.001, odds ratio [OR] = 0.592). Hypertension (P = 0.019, OR = 1.559) and D-dimer (P < 0.001, OR = 1.045) were risk factors. There was a higher proportion of branch-vessels on the abdominal aorta supplied by the true lumen in the calcification group (NC versus LC versus HC: 27.8% vs. 43.8% vs. 51.1%, P < 0.001). There were no significant differences in the mid-term outcomes among the groups. CONCLUSIONS: Abdominal aortic calcification could limit the distal extent in patients with AAD and increase the proportion of branch-vessels on the abdominal aorta supplied by the true lumen.

Comparison of midterm outcomes between surgical treatment and endovascular reconstruction for chronic infrarenal aortoiliac occlusion.

PURPOSE: To compare the midterm results of aortoiliac stent (AIS) placement with those of surgical treatment in patients with chronic infrarenal aortoiliac occlusion. MATERIALS AND METHODS: Midterm outcomes in patients treated at a single center from 2005 to 2010 were retrospectively reviewed. Correlations between baseline clinical factors and midterm outcomes were assessed. RESULTS: The technical success rate was significantly lower in the AIS group than in the surgery group (83.3% vs 100%; P = .016). Of 68 technically successfully treated patients, 33 underwent surgical revascularization and 35 received AIS placement. There were no significant differences in patient demographics, Rutherford classification, cardiovascular risk factors, and 30-day mortality rates. Surgically treated patients had a longer average postoperative hospital stay (P = .001) and higher rates of postoperative complications, including respiratory failure (P = .010), transient renal dysfunction (P = .002), and multiple organ dysfunction (P = .023). Mean ankle-brachial index increased significantly in both groups (P < .001), but to the same extent. The primary 1-, 3-, and 5-year patency rates were 93.6%, 90.2%, and 90.2%, respectively, in the surgery group, and 91.4%, 81.8%, and 64.2%, respectively, in the AIS group (P = .054). No differences were observed in survival rate (P = .945), limb salvage (P = .860), or secondary patency (P = .916). CONCLUSIONS: AIS for chronic infrarenal aortoiliac occlusion is associated with a shorter hospital stay and lower postoperative morbidity rates. Although midterm primary patency rate was lower than for traditional open surgery, AIS appears to be a safe, minimally invasive, and reliable procedure for patients with chronic infrarenal aortoiliac occlusion.

[Comparison of mid-term outcomes between surgical treatment and endovascular reconstruction for chronic aortoiliac occlusion].

OBJECTIVE: To compare mid-term results of surgical treatment with aortoiliac stenting (AIS) in patients with chronic aortoiliac occlusion. METHODS: A retrospective review of 68 patients treated between January 2005 and December 2010 was performed. Thirty-three patients underwent surgical revascularization (surgical group) and 35 patients underwent AIS (AIS group). Preoperative clinical factors and outcome data including complications, ankle-brachial index and mortality were collected. Kaplan-Meier estimates for survival, limb salvage and patency were analyzed. RESULTS: Preoperative risk factors were similar between the two groups. Surgical group were younger than AIS group ((56±11) years vs. (65±10) years, t=-2.789, P=0.008) with more patients manifesting rest pain (23/33 vs.15/35, χ2=4.963, P=0.026) and relative higher perioperative mortality (3/33 vs. 0/35, P=0.109). Mean ankle-brachial index increased significantly in both groups after operation (Surgical group 0.90±0.15 vs. 0.43±0.20, t=-7.849, P=0.000; AIS group 0.85±0.20 vs. 0.41±0.25, t=-5.379, P=0.000). Postoperative complications occurred, with statistically higher rates of respiratory failure, transient renal dysfunction and multiple organ dysfunction syndrome in surgical group (χ2=6.98, P=0.010; χ2=9.62, P=0.000; P=0.023). The 5-year primary patency in surgical group was 90.2%, compared with 64.2% in AIS group (χ2=3.717, P=0.054). No difference was observed in survival rate, limb salvage and secondary patency between the two groups. CONCLUSIONS: Five-year primary patency of endovascular reconstruction for chronic aortoiliac occlusion is lower than that for traditional open surgery. Open surgery is still the first choice for the patients who can endure the surgery. Endovascular treatment is an option for patients with high risk. However, additional interventional treatment is needed in some cases.

[A comparative study on medium-long term results of conventional and eversion endarterectomy in management of carotid artery stenosis: a meta-analysis].

OBJECTIVE: To evaluate the medium-long term effectiveness of eversion (eCEA) and conventional (cCEA) carotid endarterectomy on carotid artery stenosis. METHODS: We searched MEDLINE (1970-2012.12), Ovid (1970-2012), CBM (1970-2012.12) and CNKI (1970-2012.12) database. Relevant journals and dissertation were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed through software STATA 11.2. RESULTS: A total of 21 studies were deemed eligible (8 617 eCEA and 7 830 cCEA procedures), six of which were randomized and 14 non-randomized. Base on 15 121 patients underwent carotid artery stenosis including 16 447 cases, eCEA was association with a shorter mean operation time (WMD -85.00 min, P < 0.001), internal carotid artery clamp time (WMD -3.9 min, P < 0.01) and less shunt usage (OR = 0.20, P < 0.01). Furthermore, eCEA was associated with significant reduction in 30-day mortality (OR = 0.59, P = 0.013), perioperative stroke (OR = 0.63, P = 0.044), residual restenosis (OR = 0.51, P = 0.019) and carotid artery occlusion (OR = 0.44, P = 0.001). Although eCEA did not reduce medium-long term all-caused mortality (OR = 0.81, P = 0.143) during follow-up time, eCEA presented with a significant reduction in late residual restenosis (OR = 0.34, P < 0.01) and carotid artery occlusion (OR = 0.30, P < 0.01). A sub-analysis was performed on studies directly comparing eCEA with patch CEA (CEA+P), eCEA replicated the finding on perioperative stroke, 30-day mortality, and stroke-related death within short term and late residual restenosis. Concerning outcomes of RCT, eCEA presents with a significant reduction in the residual restenosis (OR = 0.43, 95%CI: 0.27, 0.69, P < 0.01) and carotid artery occlusion (OR = 0.11, 95%CI: 0.02, 0.62, P = 0.012) during following-up time. CONCLUSIONS: Eversion CEA compared to conventional CEA may be associated with a short operation time and a short block time. eCEA appears to be associated with better 30-day mortality and stroke outcome than cCEA. Eversion CEA may be more effective for long-term prevention of restenosis, however, in the long term, it is not associated with a reduction in all-cause mortality.

The Prognostic Value and Potential Immune Mechanisms of lncRNAs Related to Immunogenic Cell Death in Papillary Thyroid Carcinoma.

Background: Long non-coding RNAs (lncRNAs) associated with immunogenic cell death (ICD) play a pivotal role in tumorigenesis and offer prognostic insights for papillary thyroid carcinoma (PTC) patients. This study delves into the impact of ICD-related lncRNAs on the prognosis of PTC. Methods: PTC samples were accessed from The Cancer Genome Atlas-Thyroid carcinoma database (TCGA-THCA) and consensus cluster analysis to elucidate the influence of ICD-related lncRNA expression. To gauge the prognostic significance of these lncRNAs, we developed a prognostic model. Additionally, we conducted GO and KEGG enrichment analyses, assessed immune cell infiltration (ICI) using CIBERSORT and ssGSEA, examined immune checkpoint expression, tumor mutation burden (TMB), tumor microenvironment (TME), T-cell dysfunction and exclusion (TIDE), TCIA, and drug sensitivity across various groups. A comprehensive suite of in vitro experiments, encompassing EdU labeling, wound scratch assays, Transwell assays, and flow cytometry, were conducted to elucidate the regulatory role of LINC00924 in two PTC cell lines, BCPAP and TPC1, transfected with LINC00924 overexpression plasmids. Results: Two distinct clusters demonstrated varying TME, BRAF, NRAS, and ICI characteristics, suggesting potential immune mechanisms in PTC. Our prognostic model identified seven lncRNAs: SRRM2-AS1, AC008556.1, BHLHE40-AS1, EGOT, AL39066.1, LINC00924, and PICART1. The expression of ICD-related lncRNAs correlated with progression-free interval (PFI) in PTC patients. Overexpression of LINC00924 significantly reduced cell proliferation, migration, and invasion, while augmenting apoptosis in PTC cells. Conclusion: Our findings highlight the potential of ICD-related lncRNAs as prognostic biomarkers for PFI in PTC. In vitro experiments suggest a protective role of LINC00924 in PTC progression.

Traumatic Aortic Dissection as a Unique Clinical Entity: A Single-Center Retrospective Study.

BACKGROUND: This study aimed to compare the clinical characteristics, treatment approaches, and outcomes of the Stanford Type B traumatic aortic dissection (TAD) with non-traumatic aortic dissection (NTAD), and assess better management for TAD. METHODS: We retrospectively analyzed patients who underwent thoracic endovascular aortic repair for Stanford type B aortic dissection at The First Hospital of China Medical University between 2014 and 2022. The patients were divided into TAD and NTAD groups based on whether they had a history of acute trauma. This study ultimately included 65 patients with TAD and 288 with NTAD. We assessed and compared the baseline characteristics, laboratory indicators, imaging features, surgical procedures, and follow-up results between the groups. RESULTS: The TAD group was younger compared to the NTAD group (50.00 [IQR40.00-59.00] vs. 55.00 [IQR 47.00-61.00] years, p = 0.020). A lower percentage of the TAD group had a history of hypertension (20% vs. 71.18%, p < 0.001). The length of aortic dissection was shorter in the TAD group compared to the NTAD group (30.00 [IQR 22.00-40.00] vs. 344.00 [IQR 237.25-400.00] mm, p < 0.001). All patients with TAD underwent TEVAR following the same strategy as NTAD. The mean preoperative duration was 7.00 (IQR 2.00-14.00) days in the TAD group and 11.00 (IQR 8.00-15.00) days in the NTAD group (p < 0.001). TAD showed fewer complications after TEVAR in mid-to-long-term follow-up. CONCLUSIONS: TAD is distinct from NTAD. TAD typically presents with more localized lesions than NTAD, and the patients experience a shorter preoperative duration and a better mid-to-long-term outcome.

Epigenetic regulation of regulatory T cells in patients with abdominal aortic aneurysm.

Abdominal arterial aneurysm (AAA) shares many features with autoimmune diseases and appears to be a T-cell-mediated process. In addition, certain epigenetic changes, including DNA methylation, are associated with AAA. In this study, we investigated epigenetic modifications in regulatory T cells (Tregs) from AAA patients. We used flow cytometry to sort FOXP3+ CD4+ CD25+ Tregs from the peripheral blood of AAA patients and from healthy controls (HC), and then detected DNA methylation and histone modifications by ELISA. The DNA methylation rate of Tregs was significantly higher in AAA patients than in the HC group (0.159 ± 0.08% vs 0.098 ± 0.03%, P < 0.05), while the acetylation rates of H3 and H3K9 histones were lower in the AAA than in the HC group. We also examined the expression of mRNA encoding enzymes that catalyze making and removing epigenetic modifications by real-time PCR: we found that mRNA levels of DNA methyltransferase (DNMT) 1 and DNMT3A were higher in the AAA than in the HC group, mRNA levels of methyl-CpG-binding domain protein (MBD) 2 and MBD4 were higher in the AAA than in the HC group (MBD2: 6.21 ± 2.57 vs 3.04 ± 1.45; MBD4: 7.76 ± 3.48 vs 4.97 ± 3.10; both P < 0.05), and mRNA levels of histone deacetylase (HDAC) 1 and HDAC5 were significantly up-regulated in the AAA compared with the HC group (HDAC1: 2.17 ± 1.18 vs 1.51 ± 0.99; HDAC5: 1.35 ± 0.49 vs 0.94 ± 0.76; both P < 0.05). Together, our results reveal that rates of DNA methylation and histone modifications of Tregs are significantly altered in AAA patients.

Coexistence of thyroglobulin antibodies and thyroid peroxidase antibodies correlates with elevated thyroid-stimulating hormone level and advanced tumor stage of papillary thyroid cancer.

The correlation between thyroglobulin antibodies (TgAb) or thyroid peroxidase antibodies (TPOAb) and papillary thyroid cancer (PTC) remains controversial. This histological study aimed to explore the correlation between thyroid autoantibodies (TAb), thyroid-stimulating hormone (TSH), and PTC in patients with thyroid nodules (TN). This was a retrospective study. 2,132 non-autoimmune thyroid diseases (AITD) patients who underwent thyroidectomy were subdivided into: TgAb or TPOAb single positive (TgAb+ or TPOAb+) TN group; TgAb and TPOAb double positive or negative (TAb+ or TAb-) TN group. PTC patients showed a higher rate of TAb+ TN (10.24 vs. 4.89 %; P = 0.000) and a higher TSH level (1.83 ± 0.07 vs. 1.39 ± 0.03 mIU/L; P = 0.000) than patients with benign nodules. TAb+ TN patients showed a higher TSH level and PTC frequency than those with TAb- TN (1.91 ± 0.17 vs. 1.47 ± 0.03 mIU/L; P = 0.011) (41.35 vs. 22.08 %; P = 0.000). In PTC, TAb+ TN patients showed a higher TSH level (2.57 ± 0.35 vs. 1.79 ± 0.07 mIU/L; P = 0.032), a greater frequency of lymph node metastasis (52.73 vs. 36.51 %, P = 0.026), and a lower micro-PTC frequency (16.36 vs. 39.51 %; P = 0.001) than TAb- TN patients. PTC was correlated with TgAb+ TN (OR = 1.921, CI 1.431-2.580; P = 0.000), TPOAb+ TN (OR = 1.945, CI 1.195-3.165; P = 0.007), TAb+ TN (OR = 2.393, CI 1.635-3.501; P = 0.000), and serum TSH >1.35 mIU/L (OR = 1.742, CI 1.089-2.786; P = 0.021). Serum positive TgAb or TPOAb is an independent predictor for PTC regardless of AITD. The coexistence of TgAb and TPOAb confers a greater risk for PTC than isolated positive TgAb or TPOAb, and is correlated with elevated TSH level and advanced PTC stage.

Cystic adventitial disease of the common femoral vessels: report of 2 cases and literature review.

Cystic adventitial disease (CAD) is a rare vascular disorder that is most seen in the popliteal artery. Only a small number of cases involved in femoral artery or vein have been reported and it becomes more difficult to be recognized preoperatively, especially when the femoral artery or vein is affected. We presented 2 cases of CAD affecting the femoral artery or vein, all of which received the "circumferential removal of the adventitia" with promising results. The presentation, investigation, and treatment of CAD were discussed.