Y chromosome loss is associated with age-related male patients with abdominal aortic aneurysms.

PURPOSE: Abdominal aortic aneurysm (AAA) demonstrates many features of autoimmune diseases. Y chromosome, sex-determining region of the Y chromosome (SRY) gene, androgen receptor (AR) gene, and androgen appear as potential candidates for influence of the male immune function. This study investigated Y chromosome numbers, SRY gene, AR gene, and androgen levels in male AAAs. We also investigated the correlation between Y chromosome loss (LOY) ratio, SRY expression, androgen levels, and age. PATIENTS AND METHODS: We investigated LOY by fluorescence in situ hybridization (FISH) in 37 AAAs and compared with 12 patients with abdominal aortic atherosclerotic occlusive disease (AOD) and 91 healthy controls (HC). We investigated SRY and AR expression at mRNA level by real-time PCR in peripheral T lymphocytes in AAA compared with AOD and HC, and AR protein levels by immunohistochemistry (IHC) in AAA. LOY, SRY expression, androgen levels, and age were examined for correlations using the Spearman's rank correlation coefficient. RESULTS: LOY ratio in peripheral T lymphocytes was significantly higher in the AAA group compared with the HC (9.11% vs 5.56%, P<0.001) and AOD groups (9.11% vs 6.42%, P=0.029). The SRY mRNA expression in peripheral T lymphocytes was 4.7-fold lower expressed in the AAA group than in the HC group (P<0.001). Free plasma testosterone levels were lower in the AAA group compared with the HC group (P=0.036), whereas sex hormone-binding globulin levels were higher (P=0.020). LOY ratio and expression of SRY mRNA level increased with age in the AAA group (R=0.402 and, R=0.366, respectively). A significant correlation between AR mRNA level (R=0.692) and aortic diameter was detected. Simultaneously, in AAA tissue, the rate of LOY increased with age (R=0.547) and also positively associated with LOY in peripheral blood T lymphocytes (R=0.661). CONCLUSION: This study identified a prominent Y chromosome loss in male AAAs, which is correlated to age, lower level of SRY expression and free testosterone, providing a new clue for the mechanisms of AAA.

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.

Interstitial fibrosis in papillary thyroid microcarcinoma and its association with biological behavior.

Previous studies have revealed that fibrosis may affect the biological behavior of tumors, however associated research on papillary thyroid microcarcinoma (PTMC) is rare. The aim of the present study was to explore the association between interstitial fibrosis (IF) and the biological behavior of PTMC. In the present study, a total of 511 consecutive cases of PTMC were evaluated for the presence of IF and its association with clinical parameters and pathologic biomarkers. IF was identified in 340 of the 511 consecutive cases and it was significantly associated with the age (P=0.033), tumor diameter (P=0.017) and lymphocytic metastasis (P<0.001) of the patient. There were significantly more female in the fibrosis group than in fibrosis-absent group (P=0.024). In the analysis of clinical biomarkers using immunohistochemistical staining, IF was significantly associated with cytokeratin 19 (P=0.008) and galectin-3 (P=0.022). Analysis of patient outcomes indicated that IF was an independent prognostic factor of recurrence (hazard ratio = 2.181; 95% confidence interval = 1.163-4.090; P=0.015). These findings suggest that the combined effect of a patient's age, sex and tumor size may potentially contribute to fibrotic lesions and IF was a factor contributing to poor prognosis in patients with PTMC.

SIRT1-Regulated Abnormal Acetylation of FOXP3 Induces Regulatory T-Cell Function Defect in Hashimoto's Thyroiditis.

BACKGROUND: Hashimoto's thyroiditis (HT) is an autoimmune thyroid disease characterized by low expression of transcription factor Forkhead Box P3 (FOXP3) and functional deficiency of a cluster of differentiation regulatory T cells (Tregs). This study aimed to investigate the mechanism of Treg dysfunction in HT. METHODS: The number of CD4+CD25+FOXP3+ T cells was determined by flow cytometry. Expression of FOXP3 and Sirtuin type 1 (SIRT1) was evaluated by Western blot analysis. Acetylation of FOXP3 was analyzed by immunoprecipitation and Western blot analysis. The suppressive function of Treg was analyzed by the 5,6-carboxyfluorescein diacetate succinimidyl ester (CFSE) assay. RESULTS: The percentage of CD4+CD25+FOXP3+ T cells, expression of FOXP3, and FOXP3 acetylation level in the HT group were significantly lower than in the control groups. Conversely, SIRT1 expression was significantly higher in the HT group than in the other two groups. After Ex-527 treatment, the CD4+CD25+FOXP3+ T cells percentage, FOXP3 expression, and FOXP3 acetylation level in the HT group were significantly increased. HT Tregs exhibited less suppressive activity, but Ex-527 treatment significantly increased their suppressive activity. CONCLUSIONS: The findings demonstrate that the reduced FOXP3 expression level and Treg function defect in HT patients are regulated by SIRT1-mediated abnormal FOXP3 acetylation. Ex-527 may upregulate the FOXP3 acetylation level and subsequently increase the number and suppressive function of Treg cells.

[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.

[Comparative study in clinical features and managements of aortic dissection between Chinese and Caucasians].

OBJECTIVE: To explore differences in the clinical characteristics, treatment methods and progness of Chinese (Han) and Western populations (Caucasia) aortic dissection (aortic dissection, AD) patients. METHODS: According to the requirements of systematic review, We searched MEDLINE (1980-2014), Emabse (1980-2014), CBM (1980-2014) and CNKI (1980-2014) database overall, the meta-analyses were performed through STATA 12.0. RESULTS: A total of 6 697 Stanford A AD and 3 381 Stanford B AD Caucasian patients and 850 Standford A AD and 4 745 Stanford B AD Chinese Han patients were deemed eligible. It showed that average age of Han patients was lower, the proportion of Han group was 84.5%, while Cuacasian group was 66.9%, the differences were statistically significant (χ² = 365.37, P < 0.01). Han patients with history of smoking and that of coronarty heart diseases accounted for 53.0%, 13.8% separately, which were higher than those of Caucasian group, the differences were also statistically significant (χ² = 264.23, 68.417, P < 0.01).Besides these,the proportions of Han Stanford B AD patients who had hypertension, diabetes were also statistically significant higher than Caucasian group (χ² = 264.23, 68.417, P < 0.01). The Chinese group was more likely to appear nervous system and heart damages before surgery while the Caucasian group mostly appeared kidney and peripheral vascular damages. In the choice of treatment, the number of open surgery patients was significantly higher than that in Caucasian group. Domestic acute AD patients were more likely to accept TEVAR. The 30-day mortality of Chinese Han group in Stanford B was 2.4%, while Caucasians' mortality was 11.2%, the differences were statistically significant (χ² = 142.96, P < 0.01). CONCLUSIONS: The incidence of Chinese AD patients who are younger with more basic diseases has been increasing gradually, Although the 30-day mortality and complications rates of Chinese patients accepting early surgery intervention are lower than Caucasians, due to the less available data, large sample researches and further long-term follow-up will be needed.

Abnormal Epigenetic Modifications in Peripheral T Cells from Patients with Abdominal Aortic Aneurysm Are Correlated with Disease Development.

BACKGROUND: Increasing evidence suggests that abdominal aortic aneurysm (AAA) is a T-cell-mediated autoimmune condition. This study investigates the epigenetic modifications that occur in the T cells of AAA patients and evaluates the correlation of these modifications with disease development. METHODS AND RESULTS: Peripheral T cells were collected from 101 AAA patients and 102 healthy controls (HCs). DNA methylation and histone acetylation levels were measured by ELISA. Methyl-CpG-binding domain, DNA methyltransferase (DNMT) and histone deacetylase (HDAC) mRNA levels were determined by real-time PCR. DNA from the T cells of the AAA patients exhibited significant hypomethylation compared with the HCs (1.6-fold, p < 0.0001). Expression of DNMT1 at the mRNA level in the T cells of the AAA patients was 1.52-fold lower than that of the HCs (p < 0.0001). The extent of DNA methylation in the AAA patients was negatively correlated with the corresponding aortic diameter (r = -0.498, p < 0.0001). H3 (1.59-fold, p < 0.0001) and H3K14 (2.15-fold, p < 0.0001) acetylation levels in the T cells of the AAA patients were higher than those of the HCs, but the HDAC1 mRNA level was 2.33-fold lower than that of the HCs (p < 0.0001). CONCLUSIONS: DNA methylation and the histone modification status are significantly altered in the T cells of AAA patients. These changes could play a pivotal role in the activation of pathological immune responses and may influence AAA development.

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.

Surgical treatment of celiomesenteric trunk aneurysm-7 case report.

The celiomesenteric trunk is a rare anomaly characterized by a common origin of the celiac axis and superior mesenteric artery from the aorta, which accounts for less than 1% of all celiac artery anomalies, so the aneurysm occurred in such trunk is even rarer. There have been few reports on how to diagnose and deal with such malformed celiomesenteric trunk aneurysms till now. This paper tries to summarize the experience of how to expose and excise such kind of aneurysm according to the seven cases' data. The clinic data were collected retrospectively. There were seven cases with celiomesenteric trunk aneurysm from February 2000 to February 2013, including 5 males and 2 females aged 35~62. The operations were done including aneurysm resection and vascular reconstruction under general anesthesia. The operated patients were followed-up at the sixth month and each year post operation. The vascular stomas were detected or examined by Color Doppler Sonography, spiral Computed Tomography angiography (SCTA). The seven operated patients were cured and discharged from hospital, and they were followed up for 3~10 years (mean time 5 years), with four patients being followed up longer than 5 years. No sign of intestinal ischemia or hepatic ischemia or splenic ischemia was found, and no image of anastomosis stricture or stenosis was found during the follow-up. Five patients are alive now while two patients were dead, with one dying of large area myocardial infarction unexpectedly at 6 years post operation and the other dying of cerebral infarction abruptly at 4 years post operation. It is an effective and safe method to treat the celiomesenteric trunk aneurysm by using by-pass operation with artificial blood vessels, originating from inferior kidney aorta to visceral arteries including hepatic artery, splenic artery and superior mesenteric artery. Its short-term and middle-term effects are relatively better.

Successful treatment of posttraumatic phlegmasia cerulea dolens by reconstructing the external iliac vein: a case report.

INTRODUCTION: Phlegmasia cerulea dolens is a rare condition caused by complete venous occlusion leading to impaired arterial flow. To prevent progression to limb gangrene, prompt diagnosis and treatment initiation are paramount. Here we report a rare case of posttraumatic phlegmasia cerulea dolens after ligation of the iliac vein to save the patient's life, with successful treatment by reconstructing the external iliac vein. This is the first report of posttraumatic phlegmasia cerulea dolens induced by iliac vein ligation. CASE PRESENTATION: A 49-year-old Chinese man was admitted to a local hospital for severe knife trauma with massive intraperitoneal bleeding. During exploratory laparotomy, he was diagnosed with traumatic rupture of his left external iliac vein without injury to the iliac artery. The proximal and distal parts of his injured external iliac vein were ligated to control the bleeding and rescue him, but his left leg quickly became severe swollen, cyanotic and pulseless. He was diagnosed with posttraumatic phlegmasia cerulea dolens after being transferred to our university hospital. After a retrievable filter was placed in his inferior vena cava via his right femoral vein, he underwent reopening of his abdomen followed by successful surgical reconstruction of his left iliac vein. He was treated with anticoagulation therapy postoperatively and his signs and symptoms improved markedly. He was discharged in a stable condition, with nearly full resolution of symptoms, 35 days after the operation. CONCLUSIONS: Our case demonstrates that ligation of an injured iliac vein may induce phlegmasia cerulea dolens in a posttraumatic scenario; prompt reconstruction of the iliac vein to restore the venous drainage is an effective treatment for phlegmasia cerulea dolens with impending gangrene.

[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.

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.

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.

A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms.

BACKGROUND: Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR). METHODS: A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. RESULTS: A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR = 1.81, P = 0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR = 1.53, P = 0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P = 0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P < 0.001) and a shorter total postoperative stay (WMD 6.27 days, P < 0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR = 0.48, P < 0.001 and OR = 0.28, P = 0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70, P < 0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR = 1.13, P = 0.381) and re-intervention rate (OR = 2.19, P = 0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR = 0.33, P = 0.039) at late follow-up period. CONCLUSIONS: On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.

Prevalence and trends of the abdominal aortic aneurysms epidemic in general population--a meta-analysis.

OBJECTIVE: To conduct a meta-analysis assessing the prevalence and trends of the abdominal aortic aneurysms (AAA) epidemic in general population. METHOD: Studies that reported prevalence rates of AAA from the general population were identified through MEDLINE, EMBASE, Web of Science, and reference lists for the period between 1988 and 2013. Studies were included if they reported prevalence rates of AAA in general population from the community. In stratified analyses possible sources of bias, including areas difference, age, gender and diameter of aneurysms were examined. Publication bias was assessed with Egger's test method. RESULTS: 56 studies were identified. The overall pooled prevalence of AAA was 4.8% (4.3%, 5.3%). Stratified analyses showed the following results, areas difference: America 2.2% (2.2%, 2.2%), Europe 2.5% (2.4%, 2.5%), Australia 6.7% (6.5%, 7.0%), Asia 0.5% (0.3%, 0.7%); gender difference: male 6.0% (5.3%, 6.7%), female 1.6% (1.2%, 1.9%); age difference: 55-64years 1.3% (1.2%, 1.5%), 65-74 years 2.8% (2.7%, 2.9%), 75-84 years1.2%(1.1%, 1.3%), ≥85years0.6% (0.4%, 0.7%); aortic diameters difference: 30-39 mm, 3.3% (2.8%, 3.9%), 40-49 mm,0.7% (0.4%,1.0%), ≥50 mm, 0.4% (0.3%, 0.5%). The prevalence of AAA has decreased in Europe from 1988 to 2013. Hypertension, smoking, coronary artery disease, dyslipidemia, respiratory disease, cerebrovascular disease, claudication and renal insufficiency were risk factors for AAA in Europe. CONCLUSION: AAA is common in general population. The prevalence of AAA is higher in Australia than America and Europe. The pooled prevalence in western countries is higher than the Asia. Future research requires a larger database on the epidemiology of AAA in general population.

Skull metastasis revealing a papillary thyroid carcinoma.

Although thyroid carcinoma is a relatively common form of malignancy, metastatic spread to the skull is rare. Here, we report a case of papillary thyroid carcinoma with frontal and parietal metastasis. A 61-year-old Chinese woman presented with a one year history of a growing mass on the center of the frontal and parietal bone, initially thought to be meningioma. Biopsy of the skull base mass after intracalvarium excision, indicated a tumor of thyroid origin. One month later the patient underwent a total thyroidectomy. Pathological examination confirmed a diagnosis of papillary thyroid carcinoma with frontal and parietal bone metastasis. Based on this experience, the key to successful management of the skull metastasis of thyroid carcinoma is prompt diagnosis and appropriate treatment. Skull metastasis should be considered at the outset of the clinical course of papillary thyroid cancer. To facilitate this, patients should be meticulously investigated by a multidisciplinary team to improve quality of life.

[Critical limb ischemia during perioperative period of open surgery for rupture abdominal aortic aneurysm: treatment and prognosis].

OBJECTIVE: To explore the treatment and prognosis of critical limb ischemia during perioperative period of open surgery for ruptured abdominal aortic aneurysm (AAA). METHODS: Retrospective reviews were conducted for the clinical data of unstable ruptured AAA patients with open repair at our hospital from June 2002 to June 2012 to examine the characteristics and treatment regimens for associated critical limb ischemia. RESULTS: A total of 46 unstable AAAs were enrolled. There were 37 males and 9 females with an average age of 69 years. All AAAs were repaired by a bifurcated polytetrafluoroethylene graft via a transperitoneal midline incision. Critical limb ischemia was found in 8 patients during or after the procedure. Treatments included additional graft-distal iliac artery bypass (n = 2), anastomotic stoma stenting (n = 2), Fogarty catheter embolectomy plus local thrombolysis (n = 2), Fogarty catheter embolectomy (n = 1) and venous thrombolysis (n = 1). Lower limb necrosis developed in 5 patients (4 unilateral, 1 bilateral) and all of them died. CONCLUSION: Open repair of ruptured AAA may be associated with a considerate morbidity of critical limb ischemia. Early reconstruction of blood flow improves the prognosis.

Hashimoto's thyroiditis as a risk factor of papillary thyroid cancer may improve cancer prognosis.

OBJECTIVE: Hashimoto's thyroiditis (HT) has been associated with an elevated risk of papillary thyroid cancer (PTC). To investigate the possible influence of HT on the prognosis of PTC patients, we assessed the related clinical factors linking these conditions, especially serum thyroid-stimulating hormone (TSH) concentration. STUDY DESIGN: Case-control study. SETTING: The First Hospital of China Medical University. SUBJECTS AND METHODS: The demographic and histological characteristics of 2478 patients who underwent thyroidectomy at our center from 2004 to 2012 were analyzed. RESULTS: Compared with patients with benign thyroid nodular disease, patients with PTC showed a significantly higher prevalence of HT (18.8% vs 7.2%, P < .001), mean TSH concentrations (2.02 ± 1.76 vs 1.46 ± 1.21 mIU/L, P < .001), and positivity rates for anti-thyroglobulin antibodies (TGAB; 40.0% vs 20.4%, P < .001) and anti-thyroid peroxidase antibodies (24.8% vs 12.5%, P < .001). These differences remained after excluding all HT patients. The TSH concentrations were significantly higher in PTC patients with HT than in those without HT (2.54 ± 2.06 vs 1.90 ± 1.66 mIU/L, P = .001). Patients with PTC and HT were younger, with a female predominance, and had smaller sized tumors with less advanced TNM stage compared with those without HT, indicating a better prognosis. Multivariate analysis showed that HT, higher TSH concentration, male sex, and TGAB positivity were independent risk factors for PTC development. CONCLUSION: Histologically confirmed HT is associated with a significantly higher risk of PTC, due primarily to the higher serum TSH concentrations resulting from the tendency to hypothyroidism in HT. Autoimmunity is another independent risk factor for PTC but may be associated with a better prognosis.

[Effects of left renal vein division on postoperative renal function during open repair of abdominal aortic aneurysm].

OBJECTIVE: To explore the effects of left renal vein division (LRVD) on postoperative renal function and examine the overall prognosis in patients undergoing open repair of abdominal aortic aneurysm (AAA). METHODS: Retrospective analyses were conducted for the clinical data of AAA patients with open repair at our hospital from January 2000 to December 2011. They were divided into LRVD (n = 35) and non-LRVD (n = 141) groups. The 30-day mortality, cardio-cerebrovascular complications, pulmonary complications, preoperative and postoperative levels of creatinine and glomerular rate filtration (GFR), aortic cross-clamping time, blood loss volume, intensive care duration and dialysis or continuous renal replacement therapy (CRRT) rate were compared between two groups. RESULTS: A total of 189 AAA repair were performed. And 13 patients with suprarenal clamping were excluded. The LRVD group had a significant higher proportion of ruptured AAA (48.6% vs 27.7%, P < 0.01), higher 3-day postoperative creatinine (P < 0.01), longer intensive duration (P < 0.05) and decreased 3-day postoperative GFR (P < 0.01). No significant difference existed in 30-day mortality, incidence of major complications, creatinine or GFR at discharge (P > 0.05). CONCLUSIONS: LRVD during open surgery of AAA has no effect on the postoperative mortality and renal function.