[Comparison of three dimensional CT venography and ascending phlebography based on propensity score matching in the evaluation of recurrent varicose veins].

Objective: To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins. Methods: A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results: One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group(M(IQR),3.0(4.3) vs.4.0(5.8),Z=-2.038,P=0.040).Additionally, the chronic venous insufficiency patients' quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217,P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference (χ2=0.453,P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference (χ2=4.800,P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions: CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

[Effect analysis of the modified wire-loop snare technique in retrieving severely tilted inferior vena cava filters].

Objective: To examine the application effect of the modified wire-loop snare technique in retrieving severely tilted inferior vena cava filters (IVCF). Methods: The clinical data of 18 patients (12 males and 6 females, aged (62.1±13.1) years (range: 29 to 78 years)) who underwent the modified wire-loop snare technique to retrieve IVCF at the Affiliated Hospital of Qingdao University, Qingdao Eighth People's Hospital, and Jimo District Hospital of Traditional Chinese Medicine from November 2017 to April 2022 were retrospectively analyzed. The applied filters included drum-type filters (OptEase in 7 cases, Aegisy in 2 cases) and conical filters (Celect in 6 cases and Denali in 3 cases). Preoperative CT angiography and intraoperative digital subtraction angiography showed that the filter was severely tilted and the hook was covered by hyperplastic intima of the vena cave vein. A modified wire-loop snare technique was used to retrieve drum-type filters and conical filters via femoral and jugular vein approaches, respectively. After successful puncture, the long sheath was placed, the 4 F (1 F≈0.33 mm) vertebral catheter and a snare were inserted through the long sheath, and the 5 F pigtail catheter was inserted simultaneously to guide a 0.035 inch soft guide-wire (260 cm in length) to pass through the top of the filter and turning back. The tip of the soft guide-wire was snared by the vertebral catheter and pulled out of the sheath. The 4 F vertebral catheter was inserted following the tip of the guide-wire to form a wire-loop using the vertebral catheter and the pigtail catheter. After fixing the tip and tail of the soft guide-wire in vitro, the long sheath was pushed forward to cut the hyperplastic intima and the hook was pulled away from the vena cava wall to retrieve the filter under the support of two catheters. Results: The filters were successfully retrieved in 17 cases, the operation time was (25.5±8.7) minutes (range: 15 to 45 minutes), no complication occured. The hook of one filter (Celect) penetrated out of the vena vava wall and the wire-loop could not pull the hook back into the vena cava. Then the filter was removed by laparotomy. Conclusion: The modified wire-loop snare technique could retrieve the severely tilted retrivable drum-type filters and conical filters, even when serve adhesion exists between the filter and the vena cava wall.

[Long-term efficacy of radiofrequency closure in the treatment of great saphenous vein varicose].

Objective: To examine the long-term efficacy of radiofrequency closure in the treatment of great saphenous vein varicose. Methods: The clinic data of 185 patients with varicose veins of lower limbs treated with radiofrequency closure admitted at Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University from July 2016 to January 2017 was analyzed retrospectively. A total of 203 limbs were treated by radiofrequency closure. The long-term efficacy of radiofrequency closure was evaluated by analyzing the closure rate, clinical-etiology- anatomy-pathophysiology (CEAP) grading, venous clinical severity score (VCSS), chronic venous insufficiency questionnaire (CIVIQ) score, and complications, using repeated measures analysis of variance. Results: All procedures were successful. The closure rate was 98.0% (199/203) at one year and two years postoperative, which was still maintained at 97.5% (198/203) at 3 years of follow-up. Postoperative CEAP grading was significantly downgraded compared with that before the operation. Totally 88.4% (76/86) of C5 to C6 grade patients downgraded to C2 to C4 grade at 6 months, and 95.3% (82/86) downgraded to C0 to C2 garde at 3 years postoperative. VCSS and CIVIQ score in both groups significantly improved at all follow-up time points compared to preoperative scores (VCSS: F=1 064.7, P=0.003; CIVIQ score: F=2 984.3, P=0.001). The most common complication was subcutaneous blood stasis (10.8%), most of which disappeared within 1 month after the surgery. Other complications included pigmentation and thrombophlebitis (5.9% and 3.9%, respectively). Conclusion: The long-term efficacy of radiofrequency closure of the great saphenous vein is satisfactory.

Expression of recombinant BMP-7 gene increased ossification activity in the rabbit bone mesenchymal stem cells.

OBJECTIVE: The mesenchymal stem cells (MSCs), which were distributed in the bone marrow stroma, become ideal progenitor cells in bone tissue engineering because of their convenient isolation, small injury when obtained, and strong osteogenic capacity. The osteogenic differentiation of MSCs, which is indicated by the increased alkaline phosphatase (ALP) activity and the enhanced accumulation of collagen, could be induced by a strong osteogenic capacity biological factor termed bone morphogenetic protein-7 (BMP-7). Although the chemically synthesized BMP-7 was widely applied to study the osteogenic differentiation of MSCs, transferring and expressing BMP-7 gene in target cells is more desirable, especially for gene therapy, given the advantages and convenience on the stable expression of BMP-7. The aim of this study was to determine whether recombinant BMP-7-expressing MSCs would induce bone formation in vitro. MATERIALS AND METHODS: BMP-7 gene was cloned from human placental tissue to construct a recombinant eukaryotic expression plasmid carrying BMP-7 gene by conjugating with eukaryotic expression vector pcDNA3.1. MSCs were isolated from rabbit bone marrow and cultured in vitro. Then they were divided into 3 groups: pcDNA3.1-BMP-7-transfected, pcDNA3.1-transfected, and untransfected. Human healthy fresh placental tissue was provided by the Department of Gynaecology and Obstetrics, Second Affiliated Hospital of Harbin Medical University. Written informed consent was obtained from the women. One healthy male New Zealand rabbit was provided by the Laboratory Animal Center, Harbin Medical University. RESULTS: A significant increase of ALP activity was detected in the supernatant of pcDNA3.1-BMP-7 transfected MSCs, and the enhanced collagen accumulation, which was inferred by the increased hydroxyproline content and RT-PCR. CONCLUSIONS: These results implied that BMP-7 gene was expressed in MSCs sufficiently and was involved in inducing differentiation of MSCs into osteoblast.