The safety and feasibility of using a 5-Fr guiding catheter with a 0.035-inch guidewire in place for cerebral angiography.

BACKGROUND: This study aimed to evaluate the safety and efficacy of performing diagnostic cerebral angiography using a 5-Fr guiding catheter with a 0.035-inch guidewire in place. METHODS: Actual flow rates at different pressures using the 5-Fr guiding catheter with a 0.035-inch guidewire in place were measured in vitro. Integrity of the guidewire surface after high-pressure injection was determined by examination under a light microscope and scanning electron microscope. Injected and unused contrast medium were collected and analyzed using a particle detector. Furthermore, a prospective randomized controlled study was conducted to compare safety and efficacy between the guided (guidewire in place) and conventional methods. RESULTS: The maximum injection pressure at a flow rate of 5 mL/s for the various types of commonly used contrast medium was approximately 350 psi, which is below the pressure limit for cerebral angiography. The guidewire surface remained relatively intact after multiple high-pressure injections. Procedure success and primary success rates did not significantly differ between the guided and conventional methods. However, procedure time (25.93 ± 4.07 vs 31.55 ± 5.49 minutes) and radiation exposure time (12.16 ± 3.82 vs 17.27 ± 6.12 minutes) were significantly shorter in the guided method group. CONCLUSION: The guided catheterization method is safe and feasible for cerebral angiography and has several advantages over the conventional method.

Histological Features of In-Stent Restenosis after Iliac Vein Thrombus Removal and Stent Placement in a Goat Model.

PURPOSE: To establish an animal model for in-stent restenosis (ISR) after postthrombotic iliac vein stent placement and characterize histopathological changes in tissue within the stented vein. MATERIALS AND METHODS: Iliac vein thrombosis was induced using balloon occlusion and thrombin injection in 8 male Boer goats. Mechanical thrombectomy and iliac vein stent placement were performed 3 days after thrombosis induction. Restenosis was evaluated by venography and optical coherence tomography (OCT) at 1 and 8 weeks after stent placement, and stent specimens were taken for pathological examination after the animals were euthanized. RESULTS: Thrombosis induction was successful in all 8 goats, with >80% iliac vein occlusion. After thrombus removal, OCT revealed considerable venous intimal thickening and a small number of mural thrombi. Neointimal hyperplasia with thrombus formation was observed in all goats 1 week after stent implantation; the degree of ISR was 15%-33%. At 8 weeks, the degree of ISR was 21%-32% in 3 goats, and stent occlusion was observed in 1 goat. At 1 week, the neointima predominantly consisted of fresh thrombi. At 8 weeks, proliferplastic fibrotic tissue and smooth muscle cells (SMCs) were predominant, and the stent surfaces were endothelialized in 2 of 3 goats and partially endothelialized in 1 goat. CONCLUSIONS: In the goat model, postthrombotic neointimal hyperplasia in the venous stent may result from time-dependent thrombus formation and organization, accompanied by migration and proliferation of SMCs, causing ISR. These results provide a basis to further explore the mechanism of venous ISR and promote the development of venous stents that reduce neointimal hyperplasia.

Artificial heart valve reinforced with silk woven fabric and poly (ethylene glycol) diacrylate hydrogels composite.

The present study describes the preparation of woven silk fabric (WSF) and poly(ethylene glycol) diacrylate (PEGDA) hydrogel composite reinforced artificial heart valve (SPAHV). Interestingly, the longitudinal and latitudinal elastic modulus of the SPAHV composite can achieve at 54.08 ± 3.29 MPa and 23.96 ± 2.18 MPa, respectively, while its volume/mass swelling ratio and water permeability was 1.9 %/2.8 % and 3 mL/(cm2∙min), respectively, revealing remarkable anisotropic mechanical properties, low water swelling property and water permeability. The in vitro & in vivo biocompatibility and anti-calcification ability of SPAHV were further examined using L929 mouse fibroblasts and Sprague Dawley (SD) male rat model under 8 weeks of subcutaneous implantation. The expression of pro-inflammatory cytokine TNF-α and anti-inflammatory cytokine IL-10 was determined by immunohistochemical staining, as well as the H&E staining and alizarin red staining were accessed. The results showed that the composites possess better biocompatibility, resistance to degradation and anti-calcification ability compared to the control group (p < 0.05). Thus, the SPAHV composite with robust mechanical properties and biocompatibility has potential application for artificial heart valves.

Extraction, structure, pharmacological activities and applications of polysaccharides and proteins isolated from snail mucus.

Snail mucus had medical applications for wound healing as early as ancient Greece and the late Han Dynasty (China). A literature search found 165 modern research papers discussing the extraction methods, chemical compositions, pharmacological activities, and applications of snail mucus. Thus, this review summarized the research progress on the extraction, structure, pharmacological activities, and applications of polysaccharides and proteins isolated from snail mucus. The extraction methods of snail mucus include natural secretion and stimulation with blunt force, spray, electricity, un-shelling, ultrasonic-assisted, and ozone-assisted. As a natural product, snail mucus mainly comprises two polysaccharides (glycosaminoglycan, dextran), seven glycoproteins (mucin, lectin), various antibacterial peptides, allantoin, glycolic acid, etc. It has pharmacological activities that encourage cell migration and proliferation, and promote angiogenesis and have antibacterial, anti-oxidative and anticancer properties. The mechanism of snail mucus' chemicals performing antibacterial and wound-healing was proposed. Snail mucus is a promising bioactive product with multiple medical applications and has great potential in the pharmaceutical and healthcare industries. Therefore, this review provides a valuable reference for researching and developing snail mucus.

Single-Stage Endovascular Thrombectomy and Stenting as the First-Line Strategy in the Treatment of Phlegmasia Cerulea Dolens Caused by Iliac Vein Lesions.

BACKGROUND: Phlegmasia cerulea dolens (PCD) is a rare and serious complication of deep venous thrombosis and iliac vein lesions (IVLs) are the most common cause of PCD. The purpose of this study was to explore the safety and efficacy of single-stage endovascular thrombus removal and stenting to treat PCD caused by IVLs. METHODS: Clinical data of 13 patients with PCD secondary to IVL were retrospectively analyzed. They underwent endovascular thrombus removal, including rheolytic thrombectomy, manual aspiration thrombectomy, and simultaneous iliac vein stenting after thrombus removal. The safety and efficacy of single-stage endovascular thrombectomy and stenting in the treatment of PCD were evaluated. RESULTS: The technical success rate was 100% (13/13). Postoperative symptoms were significantly relieved in all patients. There were no perioperative major bleeding complications or other critical adverse events. Two (15.4%) patients had slightly elevated serum creatinine concentration after surgery, which returned to normal before discharge. At the 12-month follow-up, the stent primary patency rate was 81.8% and there were no cases of severe post-thrombotic syndrome. CONCLUSIONS: Single-stage endovascular thrombectomy and stenting in PCD due to IVLs was minimally invasive, safe, and effective; it is recommended as a first-line treatment for PCD caused by IVLs.

Natural Course and Treatment of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection with Total True Lumen Occlusion.

OBJECTIVE: We retrospectively investigated the association between the imaging features of spontaneous isolated superior mesenteric artery dissection (SISMAD) accompanied by total true lumen occlusion and the clinical symptoms to identify the patients at high risk and establish personalized therapeutic options. METHODS: Among 261 patients with SISMAD, we selected 37 with Yun's type III dissection; 35 patients underwent successful conservative management and 2 patients underwent exploratory laparotomy. After discharge, all patients were periodically followed up on an outpatient basis. We recorded patients' general condition, symptoms, time until symptom relief, imaging findings and follow-up results. RESULTS: All patients experienced acute abdominal pain prior to admission, with an onset time of 29.95 ± 24.66 hours. The mean time until relief of abdominal pain in patients who received conservative treatment was 42.17 ± 38.09 hours. Correlation analysis revealed no correlation between the length of dissection or of the occluded segment and abdominal pain intensity. Pain scores were lower and time until pain relief was shorter in patients with a definite arc of Riolan (AOR) on admission than in those without an AOR. No collateral circulation was observed in the two patients who underwent exploratory laparotomy, and distal intestinal perfusion was poor in these cases. Complete and partial remodeling of the superior mesenteric artery (SMA) was observed in 6 and 16 patients, respectively at the 12-month follow-up. Although the SMA remained occluded in 12 patients, abundant collateral circulation was detected. Three patients were lost to follow-up. CONCLUSION: This study highlights that conservative treatment should be attempted as first-line therapy in most patients with Yun's type III SISMAD. Complete AOR can contribute to remission of clinical symptoms during the acute stage. Poor distal blood flow of occluded vessels may serve as an important indicator for identification of patients at high risk of ischemic intestinal necrosis.

Association Between Functional Nucleotide Polymorphisms Up-regulating Transforming Growth Factor ß1 Expression and Increased Tuberculosis Susceptibility.

Previous studies demonstrated that transforming growth factor (TGT) ß1 plays an immunosuppressive role in clinical tuberculosis. However, the contribution of TGF-ß1 gene polymorphisms to human tuberculosis susceptibility remains undetermined. In this study, we showed that single-nucleotide polymorphisms (SNPs) in TGF-ß1 gene were associated with increased susceptibility to tuberculosis in the discovery cohort (1533 case patients and 1445 controls) and the validation cohort (832 case patients and 1084 controls), and 2 SNPs located in the promoter region (rs2317130 and rs4803457) are in strong linkage disequilibrium. The SNP rs2317130 was associated with the severity of tuberculosis. Further investigation demonstrated that rs2317130 CC genotype is associated with higher TGF-ß1 and interleukin 17A production. The mechanistic study showed that rs2317130 C allele affected TGF-ß1 promoter activity by regulating binding activity to nuclear extracts. These findings provide insights into the pathogenic role of TGF-ß1 in human tuberculosis and reveal a function for the TGF-ß1 promoter SNPs in regulating immune responses during Mycobacterium tuberculosis infection.

Cost-effectiveness Analysis of AngioJet and CDT for Lower Extremity Deep Vein Thrombosis Among Chinese Population.

AngioJet has sufficient safety and efficacy in the treatment of acute and subacute lower extremity deep vein thrombosis (LEDVT). But the price of consumables used by AngioJet is relatively high and there is a lack of relevant research on health economics to measure the benefits to patients. Objective of this study is to estimate the cost effectiveness of AngioJet compared with catheter-directed thrombolysis (CDT) among Chinese population. Using a Markov decision model, we compared the 2 treatment strategies in patients with LEDVT. The model captured the development of post-thrombotic syndrome (PTS), recurrent venous thromboembolism, and treatment-related adverse events within a lifetime horizon and the perspective of a third-party payer. Model uncertainty was assessed with one-way and Monte Carl sensitivity analyses. The clinical inputs were obtained from the literature. Costs obtained from the hospital accounts and the literature are expressed in US dollars ($). Utilities were defined as quality adjusted life years (QALY). In cost-effectiveness analysis, AngioJet accumulated $1064.6445/QALY compared with $2080.1561/QALY after CDT treatment alone. AngioJet has higher long-term cost-effectiveness than CDT at a willingness to pay threshold of $11 233.52. One-way sensitivity analysis showed that the utilities of PTS and post-LEDVT state had significant influence on the results and the model maintained a strong stability under ± 10% fluctuation of utilities. Monte Carl sensitivity analysis shows that AngioJet model has strong stability and AngioJet has higher long-term cost-effectiveness than CDT. AngioJet is likely to be a cost-effective alternative to the CDT for patients with LEDVT.

Elevated antigen-specific IFN-γ responses in bronchoalveolar lavage fluid impervious to clinical comorbidities improve the pulmonary tuberculosis diagnosis.

The extremely slow growth rate of Mycobacterium tuberculosis (Mtb) challenges traditional methods for tuberculosis (TB) diagnosis. Here, we assessed the efficacy of a previously developed Mtb antigen-specific gamma interferon (IFN-γ) enzyme-linked immunospot (ELISPOT) performed on bronchoalveolar lavage fluid (BALF) from a cohort of 414 patients including 333 PTB patients (202/333 were sputum culture positive) for the diagnosis of PTB. We could confirm that antigen-specific IFN-γ-producing CD4+ T cells were concentrated significantly in BALF mononuclear cells (BALMC) compared with that in peripheral blood mononuclear cells (PBMC) assayed in parallel, but not those of CD8+ T cells both in sputum culture-negative and positive PTB. The magnitude of IFN-γ responses in the BALF was associated with bacterial load, and 9/202 of PTB with endobronchial TB (EBTB) were slightly reduced by the anti-TB treatment. Moreover, antigen-specific IFN-γ ELISPOT performed on BALMC showed higher sensitivity than PBMC ELISPOT. In addition, the differences of the BALMC ELISPOT between PTB and PTB with diabetes were not found, whereas PBMC IFN-γ responses were decreased in PTB with diabetes. Combined with the microbiological detection in BALF, such as microscopy and culture, the BALMC ELISPOT offers the opportunity for the more accurate diagnosis of PTB, especially those with clinical comorbidities.

Identification of Mycobacterium abscessus species and subspecies using the Cas12a/sgRNA-based nucleic acid detection platform.

The rapidly growing mycobacterium Mycobacterium abscessus is a clinically important organism causing pulmonary and skin diseases. The M. abscessus complex is comprised of three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Here, we aimed to develop a Cas12a/sgRNA-based nucleic acid detection platform to identify M. abscessus species and subspecies. By designing specific sgRNA probes targeting rpoB and erm(41), we demonstrated that M. abscessus could be differentiated from other major mycobacterial species and identified at the subspecies level. Using this platform, a total of 38 clinical M. abscessus isolates were identified, 18 as M. abscessus subsp. abscessus and 20 as M. abscessus subsp. massiliense. We concluded that the Cas12a/sgRNA-based nucleic acid detection platform provides an easy-to-use, quick, and cost-effective approach for identification of M. abscessus species and subspecies.

[Changes of mean platelet volume, fibrinogen content and blood rheology in peripheral blood of youth patients with cerebral infarction].

This study was aimed to explore the correlation of mean platelet volume (MPV), fibrinogen (FIB) and blood rheology with the youth patients with cerebral infarction, so as to provide the basis for the clinical early diagnosis and treatment. The 109 patients with cerebral infarction aged between 18 - 45 were divided into three group: the large (> 10 cm(3)), middle (4 - 10 cm(3)) and small (< 4 cm(3)) area infarction; 30 healthy persons were served as control group. All the four groups were subjected to 16 examinations, such as MPV, FIB, and rheology (Lηb, Mηb, Hηb, ηp, Lηr, Mηr, Hηr, KVE, EAI, ERI, EDI, EEI, HCT, ESR). The results showed that all the MPV, FIB and rheology indexes of the different infarction groups were higher than those of healthy control group (P < 0.05). The MPV, FIB and rheology indexes in the large area infarction group were all higher than those in the small area infarction group (P < 0.05). The indexes of MPV, FIB and rheology in the various cerebral infarction area groups obviously decreased, but those did not reach to the level in the healthy control group (P < 0.05). The MPV, FIB content and rheology level correlated with infarction areas (r = 0.36, 0.29 and 0.48, respectively). It is concluded that the serious intensity of youth patients with cerebral infarction positively correlated with the levels of MPV, FIB and rheology indexes. Regular examination of above mentioned index may be useful to prevent youth patients from cerebral infraction.

Nonlinear mode coupling and resonant excitations in two-component Bose-Einstein condensates.

Nonlinear excitations in two-component Bose-Einstein condensates (BECs) described by two coupled Gross-Pitaevskii equations are investigated analytically and numerically. The beating phenomenon, the higher-harmonic generation, and the mixing of the excited modes are revealed by both variational approximation and numerical method. The strong excitations induced by the parametric resonance are also studied by time-periodic modulation for the intercomponent interaction. The resonance conditions in terms of the modulation frequency and the strength of intercomponent interaction are obtained analytically, which are confirmed by numerical method. Direct numerical simulations show that, when the resonance takes place, periodic phase separation and multisoliton configurations (including soliton trains, soliton pairs, and multidomain walls) can be excited. In particular, we demonstrate a method for formation of multisoliton configurations through parametric resonance in two-component BECs.