[Analysis of death-related factors of type B aortic dissection treated medically during the acute phase].

OBJECTIVE: To analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection. METHODS: Clinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 +/- 12) years old. Therapy included analgesia, controlled hypotension and beta-receptor blocker, the mortality in acute phase was 33.3% (14/42). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase. RESULTS: In univariate logistic regression analysis, the malperfusion of aortic branches (P = 0.018) and maximum aortic diameter (P = 0.002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches (P = 0.041) and maximum aortic diameter (P = 0.005) were also considered as the significant death-related factors.Risk of death augmented significantly (P = 0.000) when the maximum aortic diameter over 40 mm. CONCLUSION: Malperfusion of aortic branches and the large maximum aortic diameter (> 40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.

[Diagnosis and treatment of aneurysm in the common trunk of malformed superior mesenteric artery and celiac trunk].

OBJECTIVE: To explore the diagnosis and treatment of the aneurysm in the common trunk of malformed superior mesenteric artery and celiac trunk, especially the approach how to expose and excise such aneurysm. METHODS: The clinical data of 6 patients with aneurysm in the common trunk of malformed superior mesenteric artery and celiac trunk, who were operated on under general anesthesia from 1998 to 2006, were analyzed. At first, the body of pancreas was isolated and retracted, the malformed celiac trunk and its ramification were blocked and ablated, the initial part of the celiac trunk and the distant end of left gastric artery were ligated, and then by-pass operation was operated from infra-renal aorta to the visceral arteries (hepatic, splenic, and superior mesenteric arteries) with artificial blood vessels. Follow-up was conducted for 1 - 8 years. RESULTS: Five cases underwent aneurysm ablation and by-pass from aorta to hepatic, splenic, and superior mesenteric arteries; while 1 case underwent aneurysm ablation and spleen ablation, superior mesenteric artery reconstruction, and by-pass from aorta to hepatic artery simultaneously. All patients were cured without complication and recurrence. No arterial anastomosis stricture or stenosis was found in the 5 patients who received by-pass from aorta to hepatic, splenic, or superior mesenteric artery; however, slight stricture was found at the repaired portion of superior mesenteric artery in another one patient, but without any arterial anastomosis stricture in aorta or hepatic artery. CONCLUSION: It is an effective and safe method to treat the aneurysm common trunk of malformed superior mesenteric artery and celiac trunk by using the artificial blood vessel by-pass from aorta to visceral arteries (hepatic, splenic, and superior mesenteric arteries) after controlling the initial part of common trunk and cutting off the aneurysm there.

[Evaluation by perfusion-weighted magnetic resonance to hemodynamic character and surgical effect of carotid system stenoses or occlusion].

OBJECTIVE: To evaluate hemodynamic character and surgical effect of stenoses or occlusion of carotid artery system by perfusion-weighted MRI. METHODS: Twenty-one patients with stenoses or occlusion of carotid artery system underwent surgical treatment. Two patients underwent endarterectomy, extracranial-intracranial arterial bypass to 10 patients, and percutaneous stent angioplasty to 9 patients. RESULTS: Preoperative perfusion-weighted magnetic resonance (MR) revealed normal regional cerebral blood flow in all patients, with delayed time to peak in both middle cerebral artery distribution and border zone. Postoperative perfusion-weighted MR revealed normal time to peak in border zone, but abnormal in middle cerebral artery distribution. Evaluated by perfusion-weighted MR, it showed that surgical method can improve the hemodynamic disorder of this kind of disease. The early curative effect of endarterectomy and percutaneous stent angioplasty is better than extracranial-intracranial arterial bypass. CONCLUSIONS: Perfusion-weighted MR is a good method to evaluate hemodynamic character of stenoses or occlusion of carotid artery system. Surgical method is helpful to this kind of disease, and its curative effect can be evaluated impersonally and accurately by this new technique.

Sex difference in the prevalence of metabolic syndrome and cardiovascular-related risk factors in urban adults from 33 communities of China: The CHPSNE study.

Little is known about the epidemiology of metabolic syndrome in urban areas of China. To estimate the prevalence of MetS and identify its cardiovascular-related factors in men and women, a representative sample of 15,477 urban adults aged 18-74 years in Northeast China was selected from 2009 to 2010. The diagnosis of metabolic syndrome was based on criteria set by the National Cholesterol Education Program/Adult Treatment Panel. The overall prevalence of metabolic syndrome was 27.4% (men 27.9% and women 26.8%). Multivariable logistic regression analysis revealed that a higher education level and a higher family income were associated with a higher prevalence of metabolic syndrome in men, but associated with lower prevalence of metabolic syndrome among women. Higher physical activity was associated with a decreased prevalence of metabolic syndrome in men (adjusted odds ratios (aORs) = 0.88, 95% confidence interval (CI): 0.79-0.99), but associated with an increased prevalence of metabolic syndrome in women (aOR = 1.14, 95% CI: 1.00-1.29). Compared with rice as the major staple food, cooked wheaten foods were associated with lower adjusted odds for metabolic syndrome both in men (aOR = 0.72, 95% CI: 0.58-0.90) and in women (aOR = 0.72, 95% CI: 0.56-0.92). In conclusion, metabolic syndrome is highly prevalent in urban areas of China, and there is heterogeneity by sex in the relationships between risk factors and metabolic syndrome prevalence.

Batroxobin reduces intracellular calcium concentration and inhibits proliferation of vascular smooth muscle cells.

BACKGROUND: Batroxobin (BX), a serine protease used in defibrinogenation and thrombolysis, also has an effect on c-fos gene and growth factor. This study attempted to determine the effects of BX on the proliferation of vascular smooth muscle cells (VSMCs) and calcium metabolism. METHODS: VSMCs were treated with BX at concentrations of 0.1, 0.3, or 1.0 mmol/L and cell numbers were determined at 0, 24, 48, and 72 hours. Intracellular calcium concentration ([Ca2+]i) was measured using direct fluorescence methods. RESULTS: BX was found to suppress proliferation of VSMCs in a dose-dependent fashion with inhibition rates of 18% and 31% by 48 and 72 hours, respectively. In addition, BX decreases basal [Ca2+]i significantly. The basal level in untreated cells was 162.7 +/- 33.8 nmol/L, and decreased to 131.5 +/- 27.7 nmol/L, 128.3 +/- 28.5 nmol/L, and 125.6 +/- 34.3 nmol/L with the three concentrations of BX, respectively. Noradrenaline (NE)-induced [Ca2+]i stimulation was also attenuated by BX (0.1 mmol/L BX, 20% +/- 8% inhibition; 0.3 mmol/L BX, 54% +/- 11% inhibition; 1.0 mmol/L BX, 62% +/- 15% inhibition). The ability of NE to stimulate [Ca2+]i was attenuated in cultures in Ca(2+)-free medium, as was the ability of BX to blunt NE-induced stimulation. CONCLUSION: These findings demonstrate that BX can effectively inhibit proliferation of VSMCs, probably by blocking the release and uptake of Ca2+, thus influencing [Ca2+]i.

[Strategy for the treatment of intractable aneurysms].

OBJECTIVE: To summarize the treatment of various intractable aneurysms and analyze the results. METHODS: A retro-respective review was made to the clinical data of 24 patients, 20 males and 4 females, aged 15 approximately 71 with an average age of 45.8, with intractable aneurysms, caused by arteriosclerosis in 13 cases, by trauma in 8 cases, and by vascular deformity. RESULTS: The 24 patients were diagnosed as intractable aneurysms by color Doppler ultrasonic examination or digital subtraction angiography. They all underwent different operations with a general mortality of 8.39%. CONCLUSION: Enough preoperative evaluation based on the size, location, relation with nearby organs and systematic complications. for different intractable aneurysm is necessary. Incision design and operation method are important for the treatment.

[Combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke institute of brain vascular diseases].

OBJECTIVE: To test feasibility, safety and efficacy of combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke. METHODS: From 2001-5 to 2002-8, 19 patients with acute onset of stroke were treated with intraaterial thrombolysis followed by intra-cerebral stent. 9 located in middle cerebral artery (MCA), 10 located in basal artery (BA). For each patient, intraarterial thrombolysis of MCA or BA was applied at first, stent angioplasty was applied at the stenosis left after the thrombolysis by using the stent for coronary artery. RESULTS: All the 19 patients left stenosis after intraaterial thrombolysis, and the average stenosis was 85% in diameter. After the operation of stent, the images showed the vascular is smooth and had no stenosis left. The symptoms were disappeared or improved. Thrombus formation in the stent occurred on 1 patient 24 hours after the operation. TIA never occurred in the left 18 patients then. TCD follow up showed blood flow is normal. CONCLUSIONS: It is feasibility of intraaterial thrombosis followed by intra-cerebral stent. And it is valid for preventing occlusion again of the vessel and decreasing the rate of TIA occurring.

[Complications of stent-assistant angioplasty of symptomatic intracranial artery stenosis].

OBJECTIVE: To discuss the safety of intracranial stenting for refractory symptomatic intracranial artery stenosis. METHODS: Forty-eight patients with symptomatic intracranial artery stenosis were treated by transluminal stent-assistant angioplasty. Of them, 40 cases were selected because they had recurrent TIAs or mild stroke despite of antiplatelet or anticoagulation therapy; 8 cases with high-grade stenosis after acute cerebral artery theromblysis. Lesions involved MCA (17/48); Basilar artery (8/48); intracranial vertebral artery (18/18); and distal ICA (5/18). RESULTS: For 46 of 48 cases the flexible coronary stent were successfully deployed. The average stenosis reduced from 83% to 5%, short-term follow-up showed good clinical improvement. Complications include vessel rupture (1/18); acute thrombosis within stent (1/48); perforation of cortical artery (1/18) and perforate vessel occlusion (1/18). CONCLUSION: Stent-assistant angioplasty are effective for treatment of symptomatic intracranial stenosis, the higher rate of complications may be because of the limited experiences of this technique. it need further practise and long term follow-up study.