Measurement and clinical significance of lumbar pedicle CT imaging parameters / 中国组织工程研究

BACKGROUND: Although more and more accurate and personalized detection and assistive tools are used in the field of orthopedics with the development of technology, the preoperative CT is still the first-line examination choice of many orthopedic surgeons. Therefore, to master the lumbar spine CT imaging performance is not only the basis of spine surgeons, but also the cornerstone of spinal nail surgery. OBJECTIVE: Through CT imaging technique, we measured the parameters of lumbar pedicle imaging, and understood its internal structure as the basis for the choice of screws, in order to improve the safety and accuracy of nail surgery. METHODS: Totally 36 cases without lumbar vertebrae-related disease undergoing lumbar vertebra and abdominal cavity CT scan were randomly selected, including 20 males and 16 females at the age of (43.3±12.3) years. PACS was used to reconstruct lumbar vertebrae, and the related imaging parameters were measured. RESULTS AND CONCLUSION: (1) There was no significant difference between the left and right sides of the pedicle for paired t-test (P >0.05). (2) Pedicle sagittal angle had downward trend, the level of change was small; L4increased relative to L3; L5level was minimum at the average of -1.3°. Pedicle transverse angle had gradually increased trend, and maximum at L5; the average was 25.4°. (3) The length of the pedicle channel increased first and then decreased in the lumbar segment; the longest average was 52.2 mm in the L2segment, the shortest at L5, with an average of 47.4 mm. (4) The pedicle height was slightly narrowed at L1-L3levels; the smallest was 15.4 mm (L3mean), and reached the maximum in the L5at 22.7 mm (L5mean). Cancellous bone height also showed the same trend, the minimum in the L3at 10.2 mm, the maximum in the L5at 17.9 mm. (5) Lumbar pedicle width showed an upward trend, L1minimum of 7.7 mm, L5maximum of 12.5 mm. Cancellous bone width also became a similar upward trend; the narrowest L1, averagely 4.9 mm; the maximum L5, averagely 8.5 mm. (6) Overall, the upper lumbar pedicle channel was slender, while the lower lumbar spine was slightly short. (7) The parameters of the pedicle can be used as the basis for selecting the appropriate screw. At the same time, lumbar pedicle morphology has a certain difference, and there is a certain law. Accurately grasping its structure and image characteristics of pedicle screw fixation is the basis of surgery. The preoperative imaging data collection and assessment, combined with the general situation of patients, and the development of personalized programming, will help in improving the safety and accuracy of screw placement.

Research Progress of MALDI-TOF-IMS in Biomedicine and Its Application Prospect in Forensic Sciences / 法医学杂志

Matrix-assisted laser desorption/ionization time-of-flight imaging mass spectrometry (MALDI-TOF-IMS) can analysis unknown compounds in sections and obtain molecule imaging by scanning biological tissue sections,which has become a powerful tool for the research of biomarker,lipid distribution and drug metabolism,etc.This article reviews the application of this technique in protein identification,clinical application,drug discovery,lipid research and brain injury.

Surgical management of ectopic hyperparathyroidism: report of 66 cases / 中华普通外科杂志

Objective To discuss the features and surgical management of ectopic hyperparathyroidism.Methods Clinical data of 66 cases of ectopic hyperparathyroidism were retrospectively analyzed.Results There were 66 cases of ectopic hyperparathyroidism accounting for 11.5％ (66/575) of all ectopic hyperparathyroid cases admitted during the period from 1982-2010.Prevalence of mediastinal ectopic lesions was 71.2％ (47/66),among those 65.2％ (42/66) was in anterosuperior mediastinum,and 28.8％ (19/66) in the non-typical loci of the neck.Radionuclide imaging of parathyroid glands was the most sensitive (87.0％) method among all common positioning examinations.Average number of operation episode was 1.47,and all lesions were finally resected.After surgery 49 cases presented with transient hypocalcemia,and were cured by calcium administration.52 cases were followed up,with recurrent hyperparathyroidism in 1 case.Conclusions Diagnosis and treatment of ectopic hyperparathyroidism are dependent on the understanding of common locations of ectopic parathyroid glands.Preoperative correct location and surgical expertise are helpful for successful resection.

Zinc finger protein-activating transcription factor up-regulates vascular endothelial growth factor-a expression in vitro.

OBJECTIVE: To construct the zinc finger protein-activating transcription factor (ZFP-ATF) plasmid and evaluate its efficacy in inducing vascular endothelial growth factor (VEGF) expression in EY.HY926 endothelial cells. METHODS: Firstly, we constructed the ZFP-ATF plasmid, then testified the quantity of VEGF protein in EY.HY926 endothelial cells after transfected with ZFP-ATP plasmid by Western blot, finally, we used the RT-PCR to testify whether the ZFP-ATF can stimulate expression of VEGF splice variants. RESULTS: The ZFP-ATF DNA sequences were located the multiclone sites of PVAX1 vector between the site of BamH1and Xhol.Western blot result showed VEGF expression in EY.HY926 endothelial cells transfected with ZFP-ATF plasmid was significantly higher than that in cells transfected with VEGF165 (19.95±3.95 vs.12.15±1.55 µg÷µL, P<0.01).RT-PCR result showed VEGF-A mRNA expression level induced by ZFP-ATF was high than that induced by VEGF165. CONCLUSION: ZFP-ATF can up-regulate the VEGF-A expression in comparison with VEGF165, which might have beneficial effects in angiogenesis process.

Expression of Ki-67, galectin-3, fragile histidine triad, and parafibromin in malignant and benign parathyroid tumors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is widely recognized that the diagnosis of parathyroid carcinoma (PC) is often difficult because of the overlap of characteristics between malignant and benign parathyroid tumors, especially at an early stage. Our study aimed to investigate the differential expression of Ki-67, galectin-3, fragile histidine triad (FHIT) gene, and parafibromin in PC, parathyroid adenoma (PA), parathyroid hyperplasia (PH), and normal parathyroid (NP) tissues; then to assess these expression values for use in differential diagnosis of malignant and benign parathyroid tumors.</p><p><b>METHODS</b>Data of 15 cases with PC, 19 PAs, and 8 PHs were retrospectively analyzed for their clinical characteristics. The expression of Ki-67, galectin-3, FHIT, and parafibromin were detected via immunohistochemistry in the above-mentioned specimens and 6 NPs as control.</p><p><b>RESULTS</b>Complete loss of parafibromin expression was seen in 9 of 15 (60%) carcinomas, and all normal parathyroid tissues and parathyroid benign tumors stained positive for parafibromin except for one (4%) adenoma. Galectin-3 staining was positive in 11 of 15 (73%) carcinomas, 5 of 19 (26%) adenomas, 1 of 8 (12%) hyperplasias, and 0 of 6 normal tissues. The Ki-67 proliferative index was high in 4 of 15 (27%) carcinomas, 1 of 19 (5%) adenomas, and none of the hyperplasia or normal tissues. FHIT expression did not differ appreciably among the tumor types. The combination of overexpression of galectin-3 or loss of parafibromin increased sensitivity for PC to 87%, while the specificity of both positive galectin-3 and positive Ki-67 could reach 100%.</p><p><b>CONCLUSIONS</b>These data suggested that loss of parafibromin and overexpression of galectin-3 and Ki-67 might help to distinguish parathyroid carcinoma from other parathyroid tumors. And the combination of two or three of these markers might produce better sensitivity and/or specificity for the diagnosis of parathyroid carcinoma.</p>

Optimal surgery for breast cancer elderly patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the feasibility of optimal surgery for breast cancer in elderly patients.</p><p><b>METHODS</b>The clinical data of 481 patients aged 70 years and above who were treated in our hospital from 1995 to 2009 were retrospectively analyzed.</p><p><b>RESULTS</b>Based on their general conditions and clinical stages, 481 patients were divided into three groups to received different surgical procedures including modified radical mastectomy (MRM group, n=256), tumor extended resection (ER group, n=173), and simple mastectomy (SM group, n=52). The overall 5-and 10-year survival rates were 63.77%and 46.71%, respectively, and the 5-year (p=0.956) and 10-year (p=0.977) survival rates were not significantly among these three groups. However, patients in the ER group had significantly shorter hospital stay, smaller surgical wound, earlier recovery and less complications.</p><p><b>CONCLUSION</b>It is feasible for female breast cancer patients over 70 years old choose the optimal surgical procedures according to their general conditions and clinical stages.</p>

Efficacy of surgical therapy for carotid body tumors.

OBJECTIVE: To evaluate the efficacy of surgical therapy for carotid body tumors. METHODS: A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. RESULTS: Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. CONCLUSION: It is essential to make a proper surgical strategy, which can reduce postoperative complications.

Clinical symptoms in 455 hyperparathyroidism patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the clinical symptoms of patients with hyperparathyroidism.</p><p><b>METHODS</b>The clinical data of 455 patients with hyperparathyroidism who were treated in Peking Union Medical College Hospital from October 1974 to January 2009 were retrospectively analyzed.</p><p><b>RESULTS</b>Out of these 455 patients, there were 156 men (34.3%) and 299 women (65.7%), and the male/female ratio was 1:1.92. The mean onset age was (40.33±16.61) years (range: 5-86 years). Most patients (n=372, 81.8%) with skeletal manifestations, of whom 283 patients (62.2%) presented with ostealgia. The second most common symptom (n=252, 55.4%) was in urinary system, of whom 162 patients (35.6%) had nephrolithiasis. There were 200 patients (44.0%) with digestive system symptoms and 54 patients (11.9%) with neuropsychological symptoms. Twenty-one patients (4.6%) had asymptomatic hyperparathyroidism. There were 133 patients (29.2%) with decreased body height, and the mean decrease was(6.23±5.02)cm. Forty-nine patients (10.8%) presented with hypercalcemia crisis.</p><p><b>CONCLUSIONS</b>Women are more susceptible to hyperparathyroidism, which is featured by symptoms in skeletal system, urinary system, and digestive system. The asymptomatic hyperparathyroidism is relatively rare, which should be carefully considered during clinical practice.</p>

Surgical treatment for hyperparathyroidism in 368 patients / 中华普通外科杂志

Objective To analyze the surgical treatment and pathological manifestations in patients with hyperparathyroidism. Methods The clinical data of 368 patients undergoing parathyroidectomy with hyperparathyroidism in Peking Union Medical College Hospital between Oct 1974 and Jan 2009 were retrospectively analyzed. Results 368 cases underwent parathyroidectomy. There were 249 women (67.7%) and 119 men (32. 3% ). Parathyroid lesions were located in normal positions in 318 cases (86. 4% ), and in ectopic positions in 50 cases (13.6%). The pathology of 264 cases (71.7%) was adenoma, 91cases (24.7%) was hyperplasia, 11 cases (3.0%) was carcinoma, and two cases was parathyroid cyst. Postoperatively 257 cases (68.0%) presented with hypocalcaemia, and 159 cases (66. 0% ) recovered within 7 days. Conclusions The main pathological diagnosis was adenoma. It is common for a ectopic parathyroid gland in which a parathyroid lesion is located.

Diagnosis and treatment of 193 cases under 45 years old with peripheral arterial disease / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the etiology, characteristics, and treatment outcomes of peripheral arterial disease (PAD) in patients under 45 years old.</p><p><b>METHODS</b>One hundred and ninety-three cases under 45 years old with PAD were included from January 1999 to January 2009. The demography, etiology, surgical data, treatment outcomes of these patients were evaluated and analyzed. Among these patients, males are 171 cases. The age was 13 to 44 years old (average age 35 years old) and the average time between onsets of PAD to admission was 3.6 months. In the 138 patients who underwent surgical interventions, 30 patients had serologically proven thrombophilia, 50 patients without thrombophilia had other definite reasons but not Burger's disease. A total of 116 cases underwent open operations, 17 cases were received endovascular interventions and 5 cases underwent combinative treatments.</p><p><b>RESULTS</b>Among the 193 patients, 140 cases (72.5%) had definite reasons. Forty patients (28.6%) were diagnosed with congenital or acquired hypercoagulability in the 140 cases. The thrombophilia group had poorer primary patency (70.0% vs. 92.0%, P = 0.010) and secondary patency (83.3% vs. 98.0%, P = 0.016) than non-thrombophilia group and more likely to underwent second revascularization because of recurrent thrombosis within 30 days after operations. After 16 months follow-up, the patients with thrombophilia had lower primary patency (65.0% vs. 75.7%, P = 0.392) and secondary patency (80.0% vs. 91.9%, P = 0.192) than the ones without thrombophilia and the rate of amputation was higher in thrombophilia group (15.0% vs. 5.4%, P = 0.222) but, these didn't achieve statistical significance.</p><p><b>CONCLUSIONS</b>A high prevalence rate of thrombophilia is found in patients less than 45 years old with PAD requiring revascularization. Thrombophilia may have contributed to early postoperative thrombosis of the vascular procedure. So the screening and medical therapy to thrombophilia in young adults with PAD should be reinforced before surgical treatment.</p>

Endovascular revascularization for lower extremity atherosclerosis obliterans in elderly patients:a report of 86 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the outcome and risk factors of endovascular revascularization of lower limb artery for elder patients.</p><p><b>METHODS</b>From January 2006 to November 2008, 86 elder patients (98 ischemia limbs) underwent endovascular revascularization due to lower limb ischemia. Age of this group were 60 to 82 years old with a mean of (70 +/- 6) years old. Fifty-four limbs (55.0%) had severe intermittent claudication, 28 limbs (28.6%) had rest pain, 11 limbs (11.2%) had ulcer, and 5 limbs (5.1%) had gangrene. Sixty-six limbs were mono segment disease, including 25 aorta-iliac lesions, 33 femoral-popliteal lesions and 8 infra-popliteal lesions. Thirty-two limbs were multiple segment disease involving 2 or 3 segment lesions. Mortality, morbidity, primary patency, secondary patency and limb salvage were retrospectively analyzed. Risk factors on outcome were also evaluated.</p><p><b>RESULTS</b>Ten limbs underwent angioplasty, while the rest 88 limbs underwent angioplasty plus primary stent implantation. The total operation success rate was 95.9%. Perioperative mortality within the first 30 d was 0. Perioperative morbidity within the first 30 d was 5 cases (5.1%), including 2 myocardial infarction, 2 major amputations and 1 irreversible contrast-induced nephropathy. Follow-up duration were 1 to 35 months with a mean of (18 +/- 10) months. Eighty-three (96.5%) patients had effectively follow-up. Mortality was 2.3% (2 cases died due to myocardial infarction). Primary patency rate was 83.7%, secondary patency rate was 94.9% and limb salvage rate was 95.9%. Risk factor analysis showed that diabetes mellitus, critical ischemia and multiple segment lesions were associated with worse patency.</p><p><b>CONCLUSIONS</b>Endovascular treatment is effective, safe and repeatable revascularization for elder patients of Critical lower limb ischemia. Patients with diabetes mellitus, critical ischemia and multiple segment lesions should be paid more attention because their rather worse outcome.</p>

Extra-anatomic bypass for aorto-iliac occlusive disease in the elderly / 中华普通外科杂志

Objective To evaluate the extra-anatomic bypass surgery for aorto-iliac occlusive disease in the elderly. Methods From January 2005 to December 2008,33 elderly patients/39 limbs (age ranged from 70 to 87 years, mean 76.0 ± 3.0 years) with aortoiliac occlusive disease were retrospectively analyzed. According to Fontaine classification, there were 5 phase Ⅱ b cases (7 limbs), 22 phase Ⅲ cases (26 limbs), and 6 phase Ⅳ cases (6 limbs), all cases were with TASC C, D lesions. Results These 33 cases/39 limbs were tr eated with a variety of bypass, including axillobifemoral bypass (6 cases/12 limbs) ,axillofemoral bypass ( 20 cases/20 limbs ), femorofemoral bypass ( 7 cases/7 limbs ). Intermittent claudication improved in 5 cases, rest pain disappeared in 22 cases, and ulcers healed in 6 cases after operations. The mean ABI increased from 0.29 ± 0.11 to 0.66 ± 0.13 ( t = 2.69, P ＜ 0.05 ). All limbs were salvaged and there was no perioperative mortality within 30 days after operations. Postoperative complication rate was 9.1%. Patients were followed up for a median of 12 ±5 months (range, 6 to 28 months), primary patency rate was 89.7% (35/39), secondary patency rate was 94.9% (37/39), limb salvage rate was 92.3% (36/39). After dischargement the mortality was 6.1% (2/33) with one dying of myocardial infarction and another one of malignant tumor (gastric cancer). Conclusions Extra-anatomic bypass for aorto-iliac occlusive disease in the elderly is feasible, safe and effective, and the cardiopulmonary dysfunctions are the major risk factors for perioperative complications.

Association between Bmi1 and clinicopathological status of esophageal squamous cell carcinoma.

AIM: To investigate the clinicopathological roles of Bmi1 in esophageal squamous cell carcinoma (ESCC). METHODS: Quantitative real-time polymerase chain reaction and immunohistochemical staining for Bmi1 were performed in cancerous and adjacent non-cancerous paraffin-embedded esophageal specimens. RESULTS: The Bmi1 expression level was unaffected by gender and age. The level of Bmi1 mRNA in ESCC was significantly higher than that in the adjacent non-cancerous tissues (2.181 +/- 2.158 vs 0.931 +/- 0.894, P = 0.0152), and its over-expression was aggressively associated with lymph node metastasis (3.580 +/- 2.487 vs 1.703 +/- 0.758, P = 0.0003), poorer cell differentiation (P = 0.0000) and advanced pathological stage (3.827 +/- 2.673 vs 1.590 +/- 0.735, P = 0.0001). The patients were divided into high-expression and low-expression groups based on the median expression level of Bmi1 mRNA, and a shorter overall survival time in the former group was observed. Immunohistochemistry for Bmi1 oncoprotein showed diffusely positive, focally positive and negative expression in 44, 16 and 10 of 70 ESCC cases, respectively, compared with three, two and five of 10 adjacent non-cancerous cases (P = 0.027). The positive rate of the oncoprotein in samples of histological grade III was higher than that of grade II (P = 0.031), but its expression had no relation to the lymph node metastasis and pathological staging. In 70 ESCC samples, Bmi1 showed high intense expression in the cytoplasm and less or even no expression in the nucleus. CONCLUSION: Bmi1 was over-expressed in ESCC. Increased Bmi1 mRNA expression was significantly associated with ESCC progression, and the oncoprotein was largely distributed in the cytoplasm of tumor cells.

Nitric oxide regulates shikonin formation in suspension-cultured Onosma paniculatum cells.

Endogenously occurring nitric oxide (NO) is involved in the regulation of shikonin formation in Onosma paniculatum cells. NO generated after cells were inoculated into shikonin production medium reached the highest level after 2 d of culture, which was 16 times that at the beginning of the experiment, and maintained a high level for 6 d. A nitric oxide synthase (NOS) inhibitor, N(omega)-nitro-L-arginine (L-NNA), and a nitrate reductase (NR) inhibitor, sodium azide (SoA), consistent with their inhibition of NO biosynthesis, decreased shikonin formation significantly. This reduction could be alleviated or even abolished by exogenous NO supplied by sodium nitroprusside (SNP), suggesting that the inhibition of NO biosynthesis resulted in decreased shikonin formation. However, when endogenous NO biosynthesis was up-regulated by the elicitor from Rhizoctonia cerealis, shikonin production was enhanced further, showing a dependence on the elicitor-induced NO burst. Real-time PCR analysis showed that NO could significantly up-regulate the expression of PAL, PGT and HMGR, which encode key enzymes involved in shikonin biosynthesis. These results demonstrated that NO plays a critical role in shikonin formation in O. paniculatum cells.

Reinstate the damaged VEGF signaling pathway with VEGF-activating transcription factor / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the role of vascular endothelial growth factor-activating transcriptional factor (VEGF-ATF) on the VEGF signaling pathway in diabetes mellitus.</p><p><b>METHODS</b>Totally, 20 C57BL/6 mice fed with high fat diet was induced into diabetes mellitus. Ten diabetes mellitus mice received a lower limb muscle injection with VEGF-ATF plasmid, and another ten were as control. VEGF-ATF is an engineered transcription factor designed to increase VEGF expression. Three days later, mice were sacrificed and the injected gastrocnemius was used for analysis. VEGF mRNA and protein expressions were examined by real-time PCR and ELISA respectively. VEGF receptor 2 mRNA expression was tested with RT-PCR. Phosphorylated Akt, Akt, endothelial nitric oxide synthase (eNOS), and phosphorylated eNOS were assessed by western blot.</p><p><b>RESULTS</b>At 3 days post-injection, in mice with diabetes mellitus, VEGF gene transfer increased VEGF mRNA copies and VEGF protein expression in injected muscles compared with control; and reinstated the impaired VEGF signaling pathway with increasing the ratios of phosphorylated Akt/Akt and phosphorylated eNOS/eNOS. However, it did not affect the expression of VEGF receptor 2 mRNA.</p><p><b>CONCLUSION</b>Gene transfer with VEGF-ATF is able to reinstate the impaired VEGF downstream pathway, and potentially promote therapeutic angiogenesis in mice with diabetes mellitus.</p>

Pulse wave velocity a sensitive predicator for peripheral artery disease among diabetic patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the role of pulse wave velocity on he predication and diagnosis for peripheral artery diseases among diabetic patients.</p><p><b>METHODS</b>Ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were detected simultaneously in 1500 type 2 diabetic patients which over 50 years old with one or more risk factors.</p><p><b>RESULTS</b>baPWV speeded up in enrolled diabetic patients when ABI showed normal; and more faster in female patients compared with males (male vs. female: right, 1647.0 +/- 347.7 vs. 1714.1 +/- 338.0; left, 1638.1 +/- 368.0 vs. 1708.4 +/- 355.5, P < 0.01). Compared with diabetic patients with PAD vs non-PAD, ABI was less than 0.9, baPWV slowed falling down [right, ABI: 0.82 +/- 0.15, baPWV: (1652.6 +/- 428.7) cm/s vs. (1699.1 +/- 316.3) cm/s; left, ABI: 0.80 +/- 0.16, baPWV: (1655.3 +/- 477.2) cm/s vs. (1677.5 +/- 338.6) cm/s, P < 0.01] ABI and baPWV showed a consistently positive relationship with aging (OR = 0.17, 0.33, P < 0.01), diabetes (OR = 0.07, 0.17, P < 0.01), hypertension (OR = 0.18, 0.39, P < 0.01), and rate of ischemic heart disease (OR = 0.25, 0.10, P < 0.01). Aging was an important risk factor for PAD. For diabetic patients with PAD, baPWV was stepped down with aging (per-decade up: 1681.6 +/- 545.9, 1678.2 +/- 494.9, 1598.5 +/- 417.1, 1493.9 +/- 444.8, P < 0.01). For those without PAD, baPWV was expedited with aging (every 10-age-up: 1570.0 +/- 337.8, 1707.7 +/- 356.4, 1829.0 +/- 378.0, 1955.6 +/- 430.5, P < 0.01).</p><p><b>CONCLUSIONS</b>In type 2 diabetic patients, baPWV shows abnormal even when ABI was normal. When these patients combine with PAD, baPWV slows down, and the phenomena is related with the severity of PAD. These data implicate baPWV could act as a screen and diagnosis factor for PAD as ABI did, and might be a more sensitive alarming predicator for artery lesions.</p>

Carotid endarterectomy versus carotid stenting: a prospective randomized trial / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early and midterm outcomes of carotid endarterectomy (CEA) compared with carotid stenting (CAS) in patients with carotid artery stenosis.</p><p><b>METHODS</b>A prospective randomized single-center clinical trail to compare with endarterectomy and stenting in patients with symptomatic carotid stenosis of at least 50% and asymptomatic stenosis of at least 70%. From May 2004 to December 2006, there were 40 patients who agreed with the treatment were randomly assigned to undergo either CEA or CAS. The primary end point was any stroke or death within 30 d after treatment and the secondary end point was any stroke, myocardial infarction and any complications of the treatment, or death or ipsilateral stroke and carotid restenosis between 1 month and 18 months, and the cost-effectiveness of both groups were analyzed retrospectively as well.</p><p><b>RESULTS</b>There were no significant differences of the characteristics in the two groups. Twenty cases in CEA group underwent 23 endarterectomies (3 cases had bilateral CEA, respectively), in which 9 carotid shunt (39.1%) and 12 patching (52.2%) were used. Twenty cases in CAS group underwent 23 stents (3 cases had bilateral CSA, respectively), in which 21 emboli-protection devices (91.3%) were used. There was no significant difference in 30 d neurological complications (4.3% vs. 8.7%), acute myocardial infarction (4.3% vs. 0), and wound hematoma (8.7% vs. 0) between CEA and CAS, respectively. There was no ipsilateral transient ischemic attack or carotid restenosis at 18 months in each group. The average cost of hospitalization was (16 450.95 +/- 6188.76) vs. (70 130.15 +/- 11 999.02) RMB in CEA and CAS, respectively, with significant difference (P < 0.01).</p><p><b>CONCLUSION</b>The early and midterm outcomes are no significant difference between CEA and CAS, but in China, the cost of hospitalization in CAS is much higher than that of CEA.</p>

Etiology, diagnosis, and treatment of lower limb arterial occlusion in patients below 45 years old / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the etiology, diagnosis, and treatment of lower limb arterial occlusion in patients below 45 years old.</p><p><b>METHODS</b>The clinical data of 58 patients with lower limb arterial occlusion (except for Buerger's disease) below 45 years old admitted to PUMC Hospital from July 1997 to November 2007 were retrospectively analyzed.</p><p><b>RESULTS</b>Among these 58 patients, 31 patients (53.4%) had confirmed thrombophilic risk factors, including 12 patients had two or more thrombophilic risk factors. Follow-up (ranged 2-43 months, mean 10 months) showed higher rates of revascularization and amputation in patients with thrombophilic risk factors (22.6% and 22.6%, respectively) than in those without thrombophilic risk factors (14.8% and 11.1%, respectively) (P > 0.05). Among patients with two or more thrombophilic risk factors, the rates of revascularization and amputation were 25.0% and 33.3%, respectively.</p><p><b>CONCLUSIONS</b>Lower limb arterial occlusion in young adults is often caused by thrombophilic risk factors. Attention should be taken to identify these etiologies before surgical treatment.</p>

Myoglobin over-expression attenuates angiogenic response in hindlimb ischemia in mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myoglobin is expressed exclusively in striated skeletal muscles and has been implicated in nitric oxide scavenging. Accumulating data suggest a critical role for nitric oxide in both the endogenous and therapeutic angiogenic response to ischemia. A clear role for myoglobin in ischemic skeletal muscle is uncertain. We hypothesized that myoglobin overexpression has an adverse impact on the angiogenic response to ischemia.</p><p><b>METHODS</b>Muscle-specific myoglobin over-expressing transgenic mice (MbTG, n = 11), wild type littermates (WT, n = 23) underwent unilateral femoral artery ligation and excision. Laser doppler perfusion imaging was used to monitor changes in hindlimb perfusion before surgery and weekly after surgery up to 28 days. Tissue ischemia was assessed by a necrosis incidence. Upon termination of the experiment (28 days after surgery), skeletal muscles (gastrocnemius, and tibialis anterior) were harvested, the distal part of the muscle was frozen and embedded for histology study, the proximal part was used either to detect vascular endothelial growth factor (VEGF) level with enzyme-linked immunosorbent assays (ELISA) or to determine the proliferation (proliferating cell nuclear antigen (PCNA)) and apoptosis (Bax, and Bcl-2) condition in ischemic muscle by Western blotting. Capillaries were stained with endothelial phosphate alkaline staining and vascular density was expressed in capillaries/fiber.</p><p><b>RESULTS</b>The recovery of perfusion in MbTG mice was similar to that of WT mice on day 7 (0.485 +/- 0.095 vs 0.500 +/- 0.084) but was significantly less on day 14 (0.536 +/- 0.086 vs 0.623 +/- 0.077, P < 0.05), day 21 (0.588 +/- 0.082 vs 0.684 +/- 0.068, P < 0.01) and day 28 (0.606 +/- 0.079 vs 0.733 +/- 0.093, P < 0.01). The necrosis incidence was higher in MbTG than in WT (54.5% vs 21.6%). Vascular density was less in MbTG compared with that in WT (gastrocnemius 0.19 +/- 0.08 vs 0.30 +/- 0.08, P < 0.05; tibialis anterior 0.22 +/- 0.11 vs 0.33 +/- 0.04, P < 0.05). With ischemic injury, the VEGF level was increased in both MbTG and WT (45.2% and 20.4%, respectively). Western blotting showed that after hindlimb ischemia the proliferation was similar in both MbTG and WT, however, apoptosis was increased in MbTG relative to WT, shown as more expression of Bax and less expression of Bcl-2.</p><p><b>CONCLUSION</b>An increase in expression of myoglobin protein in skeletal muscle reduces the endogenous perfusion recovery following surgically induced hind-limb ischemia.</p>

Revascularization of lower limb artery ischemia for elder patients / 中华普通外科杂志

Objective To evaluate the result of revascularization for lower limb artery ischemia in elder patients. Method During Jan 2006 to Nov 2008, 262 elder patients (60 years old and up), underwent artery revascularization for lower limb arterial ischemia. Mortality, morbidity, primary patency, secondary patency and limb salvage were analyzed. Result There were a total of 323 ischemia limbs in those 262 elder patients undergoing revascalarization, among those 102 limbs underwent artery bypass, 98 limbs underwent endoluminal angioplasty with or without stenting, 67 limbs underwent embolectomy or endarterectomy, 56 limbs underwent open surgery combined with endoluminal treatment due to multiple segment lesions. Operation success rate was 94.7%. Two patients died within 30 days. Perioperative morbidity developed in 15 cases. 245 patients (93.5%) were followed-up from 1 month to 35 months. Mortality was 6.1% (15 cases), primary patency was 80.5%, secondary patency was 92.7% and limb salvage rate was 95.2%. Risk factors analysis showed that history of cardiac disease and elder ages were associated with higher mortality. Diabetes mellitus, critical ischemia and multiple segment lesions were associated with poor long term patency and limb salvage. Conclusion Lower limb ischemia is severe disease related to elder patients' death and amputation. Careful patient selection, detailed pre-operation work-up, meticulous operative technique play crucial roles for a successful arterial reconstruction.