[Comparison of the massive pulmonary embolism of the animal model stabled by different methods].

OBJECTIVE: To contrast the massive pulmonary embolism of the animal model had been stabled by inserting the animal's own blood clots or through use of detachable latex balloons. METHODS: Eighteen healthy sheep were separated as three groups with random. We established the animal lung, PE model by inserting the animal's own blood clots at right lung artery in 6 sheep, and 6 sheep were through used of detachable latex balloons to substitute the blood clots. Six healthy sheep were used as controls. Each sheep was anesthetized. Both sides of the region inguinalis were applied 21 transfixion pins to one femoral artery and two femoral veins on the left side, and one femoral vein on the right side. All vessels were inducted into the 5 F vagina vasorum except one vein for which 12 F was inducted. 50 ml blood was taken from vagina vasorum from each animal and stabilized for 2 h for later use as a body blood clot. Guided and visualized by X-ray, a 5 F pigtail catheter was inserted on the left side to measure arterial pressure, central venous pressure and pulmonary arterial pressure; a 12 F guiding catheter was then inserted through right side femoral vein into the right lung artery to inject 8 ml 350 mg I ultravist at 6 ml/s for pulmonary arteriography, After the animal was stabilized for 30 min, we input their own body blood clots (0.6 ml/kg) using a 12 F guiding catheter or, alternatively, to release a self-made, detachable latex balloon. We measured arterial pressure, central venous pressure, pulmonary arterial pressure, heart rate, blood oxygen saturation, partial pressure of oxygen in artery and partial pressure of carbon dioxide in artery etc. of the animals both immediately before inputting their own body blood clots or detachable latex balloons, immediately afterwards, immediately before interfering with airflow and at 3 min, 6 min, 10 min, 15 min, 20 min, 30 min, 45 min and 60 min after the interference. RESULTS: Heart and breath rates of all 12 sheep increased, blood oxygen saturation and partial pressure of oxygen in artery decreased, and pulmonary arterial pressure increased after inputting their own body blood clots or inserting latex balloons with statistical significance that were compared with controls. Blood oxygen saturation decreased, on average, by more than 25% within 30 min. Two hours after, all 12 experimental animals showed stable. Index of sheep in latex balloons group were increased slowly but stabilized at a lower level in blood clots group with statistical significance. CONCLUSION: This animal experiment demonstrates that balloon can establish a physico- affection and blood clot can establish a chemical action for massive PE.

Interventional and synthetic therapy of advanced hepatocellular carcinoma.

OBJECTIVE: To evaluate the clinical efficacy of interventional therapy in the treatment of hepatocellular carcinoma (HCC). METHODS: Thirty-three patients with HCC were synthetically treated by systematic measures. Among them, percutaneous port-catheter system (PCS) implantation via the femoral artery was performed in 21 cases. Patients with haemorrhage were treated with prothrombin complex concentrate and fibroraas, and patients with hepatic encephalopathy by branched-chain amino acids and arginine. RESULTS: All indwelling catheters of PCS were patent and no catheter tip dislocations were observed. Of 33 patients with advanced HCC, the mean survival rate was 20.1 months and 12 (36%) patients survived more than 2 years. CONCLUSION: Patients with advanced HCC were treated by synthetic measures. Survival was prolonged, quality of life was improved significantly, and the effectiveness of interventional therapy was further improved.

[Effect of castration on restenosis after precutaneous transluminal angioplasty in male rats].

OBJECTIVE: To observe the developing changes of adventitia in restenosis after precutaneous transluminal angioplasty(PTA), and investigate the effect of androgen on restenosis through contrasting the castrated male rat models and its mechanism. METHODS: Models were constructed of castrated male rats and restenosis of the common carotid artery, and specimens were collected at the 3rd, 7th, 14th and 28th day respectively after modeling. Hematoxylin and eosin staining, immunohistochemical staining, and electronic microscopy were performed to observe the condition of restenosis. RESULTS: Proliferating cells occurred in adventitia first and phenotype of adventitial cells was changed at the 3rd day after PTA. The adventitial proliferating index was the highest at the 7th day after PTA, and proliferating migration towards intimal was observed. The proliferating cells mostly occurred in the middle layer and neointima at the 14th day after PTA. The areas of adventitia and neointima were larger and the degrees of restenosis were higher in the castrated rats than in the non-castrated ones at different time points. Take the 14 d group, the adventitial area was[(3,566 +/- 337) micron2 vs (2,751 +/- 401) micron2, P = 0.008], the neointimal area[(3,553 +/- 477) micron2 vs (2,757 +/- 435) micron2, P = 0.025], the restenosis rate[(76 +/- 2)% vs (60 +/- 8)%, P = 0.005], and the proliferating index [(29 +/- 2)% vs (13 +/- 1)%, P < 0.001]. CONCLUSION: Adventitial proliferation and migration contribute to restenosis after PTA; Androgen in rats can physiologically relieve restenosis, probably through intervening in the activation of adventitia.

The effect of short-term intra-arterial delivery of paclitaxel on neointimal hyperplasia and the local thrombotic environment after angioplasty.

PURPOSE: To evaluate the effects of short-term intra-arterial delivery of paclitaxel on neointimal hyperplasia and the local thrombotic environment after angioplasty. METHODS: An experimental common carotid artery injury model was established in 60 rats, which were divided into experimental groups (40 rats) and controls (20 rats). Local intra-arterial administration of paclitaxel was applied at 2 doses (90 and 180 µg/30 µl), and the effects of short-term delivery of paclitaxel on neointimal hyperplasia and the expression of tissue factor (TF), plasminogen activator inhibitor-1 (PAI-1) and tissue-type plasminogen activator (t-PA) were evaluated at days 15 and 30 by hematoxylin and eosin staining and immunohistochemistry. RESULTS: At 15 and 30 days after injury, neointimal thickness and area, the ratio of intimal area to medial area and the stenotic rate were all significantly decreased in the group provided the high concentrations (180 µg/30 µl) of paclitaxel for 2 min or 10 min and in the group provided the low concentration (90 µg/30 µl) of paclitaxel for 10 min (p < 0.05). At 30 days after injury, there were no significant changes in TF expression among all experimental groups. PAI-1 expression increased in the neointima of the high concentration 10 min group (p < 0.05), while t-PA expression decreased in the neointima of the high concentration 2 min group (p < 0.05). CONCLUSION: In the rat common carotid artery injury model, the short-term delivery of paclitaxel could effectively inhibit neointimal hyperplasia in the long term, with very little influence on the local expression of TF and PAI-1.

Balloon occlusion of the right main bronchus in an ovine model provides sufficient time for emergent interventions in massive pulmonary embolism.

PURPOSE: Massive pulmonary embolism (PE) causes hemodynamic compromise and is associated with a high rate of mortality. We sought to create a model of massive PE and to determine whether occlusion of the right main bronchus could mitigate the physiological effects of massive PE in this model. MATERIALS AND METHODS: We used 27 female sheep to generate a model of massive PE by either autologous blood clot injection (n=18) or detachable balloon release (n=9) into the right main pulmonary artery. Four sheep were excluded after blood clot injection, as they did not exhibit adequate declines in blood oxygen saturation (SaO(2)). Nine of the sheep that received autologous blood clot and nine that received detachable balloons went on to treatment with right main bronchus occlusion. The control group (n=5) received the autologous blood clot, but no occlusion of the right main bronchus. All sheep underwent continuous monitoring of pulmonary arterial mean pressure (PAMP), SaO(2), arterial partial pressure of oxygen (PaO(2)), and arterial partial pressure of carbon dioxide. RESULTS: Twenty-three sheep (85%) subjected to PE demonstrated immediate tachycardia, tachypnea, and decline in SaO(2) of at least 25% within 30 min. After right main bronchus occlusion, 18 sheep (100%) survived for the length of the experiment and exhibited persistently higher SaO(2) and PaO(2) levels, as well as decreased PAMP compared with the controls. In the control group, two out of five sheep died within 30 min, and the three surviving subjects demonstrated significantly decreased SaO(2) and PaO(2) levels. CONCLUSION: Occlusion of the right main bronchus in an ovine model of massive PE effectively extends life and provides favorable physiological parameters to allow emergent interventions.

Prevention of iodinated contrast-induced nephropathy.

OBJECTIVE: To lessen the occurrence of contrast-induced nephropathy (CIN), the preventive measures of CIN were reviewed. DATA SOURCES: The data used in this review were from PubMed with relevant English articles and from Chinese Knowledge Information (CNKI) published from 1989 to 2009. The search terms were "contrast medium", "contrast-induced nephropathy" and "prevention". Articles involved in prevention of CIN were selected. STUDY SELECTION: CIN is the third most common cause of acute kidney injury and is associated with an unfavorable prognosis. The best treatment is prophylaxis because CIN can not be reversed or ameliorated. RESULTS: Thirty articles were included. Among various preventive measures, pericatheterization hydration is almost universally accepted as an appropriate and safe measure to prevent CIN, although there is no agreement as to composition, amount, and timing of hydration. Based on the use of concomitant nephrotoxic agents or high doses of contrast medium (CM) is one of risk factors for CIN, discontinuation of potentially nephrotoxic drugs 2 - 3 days before and after the procedure until renal function recover, and using the lowest possible dose of CM can decrease the risk of CIN. It is promising that removing the majority of CM from the coronary sinus, before it enters the systemic circulation, during coronary angiography can reduce the risk for CIN in animal studies and in limited clinical trials. Inconsistent data exist with respect to application of some vasodilators (endothelin antagonists and adenosine antagonists) and antioxidants (N-acetylcysteine and statins) in preventing CIN in high-risk patients, and new vasodilators and antioxidants continue to be tested. CONCLUSIONS: Pericatheterization hydration, discontinuation of nephrotoxic drugs, and using the lowest possible dose of CM are effective measures to lessen the risk for CIN. Other prophylactic strategies and some drugs are promising, but further confirmation is required.

Percutaneous transluminal angioplasty (PTA) alone versus PTA with balloon-expandable stent placement for short-segment femoropopliteal artery disease: a metaanalysis of randomized trials.

PURPOSE: To evaluate and compare the results of percutaneous transluminal angioplasty (PTA) and stent placement to treat femoropopliteal artery occlusive disease. MATERIALS AND METHODS: Published data of randomized clinical trials comparing the results of PTA and stent placement for femoropopliteal artery occlusive disease were analyzed. Proportions were combined, and the odds ratio (OR) with its 95% CI was used as the effect size estimate. RESULTS: Seven studies published in 1999 or later (614 limbs in 519 patients) were included in this metaanalysis, in which 323 limbs underwent PTA and 291 limbs underwent PTA followed by balloon-expandable stent placement. In the combined results of PTA versus PTA plus stent placement, a significant difference in primary patency at 6 months (OR, 0.47; 95% CI, 0.27-0.84; P < .05) was found, but no significant difference could be found in primary patency at 12 months (OR, 1.27; 95% CI, 0.87-1.86; P > .05) or 24 months (OR, 1.22; 95% CI, 0.81-1.82; P > .05) or in secondary patency at 12 months (OR, 1.34; 95% CI, 0.78-2.30; P > .05). CONCLUSIONS: In the treatment of femoropopliteal artery occlusive disease (< or =10 cm), higher primary patency rates can be expected at 6 months with PTA followed by implantation of balloon-expandable stents versus PTA alone, but PTA with stent placement does not produce better long-term primary results and secondary patency rates than PTA alone.