Study on the correlation between gene polymorphisms of adiponectin and resistin levels and abdominal aortic aneurysm.

OBJECTIVES: Abdominal Aortic Aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. This study aimed to examine the potential association of the +276G/T and -420C>G polymorphisms in the resistin gene with AAA susceptibility and progression. METHOD: We performed a retrospective study involving AAA patients and healthy controls, assessing the distribution of the +276G/T and -420C>G genotypes in both groups. Hardy-Weinberg equilibrium was assessed for both polymorphisms. Logistic regression was used to explore the influence of these genotypes on AAA occurrence and progression, adjusting for relevant confounders. RESULTS: The distribution of +276G/T polymorphism did not significantly differ between AAA patients and controls. Conversely, a significant difference was observed in the genotype distribution of -420C>G polymorphism between the two groups. The CC genotype and CC/CG genotypes of -420C>G polymorphism were found to be associated with an increased risk and progression of AAA. CONCLUSIONS: The -420C>G polymorphism, particularly the CC genotype and CC/CG genotypes, might play a substantial role in AAA susceptibility and progression. The present findings underscore the need for further investigations to confirm these associations and fully elucidate the role of the resistin gene in AAA.

Serum levels of reduced glutathione, oxidized glutathione, and glutathione reductase activity in minor recurrent aphthous stomatitis patients.

Background/purpose: Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral mucosa diseases with unknown etiology. Reduced glutathione (GSH) is a major intracellular non-protein physiological antioxidant, and it has been demonstrated that GSH deficiency may be related to cardiovascular, immune, and diabetes. The purpose of this investigation was to evaluate the potential roles of GSH, oxidized glutathione (GSSG), and glutathione reductase (GR) in the etiopathogenesis of minor recurrent aphthous stomatitis (MiRAS). Materials and methods: The study comprised 87 patients with idiopathic MiRAS and 90 race-, age-, and gender-matched healthy individuals. The spectrophotometric method was used to determine serum GSH and GSSG concentrations as well as GR activity. The GSSG/GSH ratios were subsequently computed. For statistical evaluation, the independent sample t test, Pearson's chi-square test, Mann-Whitney U test, Kruskal-Wallis H test, and Binary logistic regression analysis were used. Results: The serum GSSG level, GR activity and GSSG/GSH ratio were statistically higher in MiRAS patients, whereas the concentration of serum GSH was significantly decreased. With the exception of GR, serum GSSG, GSH, and GSSG/GSH were all significantly associated with MiRAS. Serum GSSG can be regarded as a risk factor, whereas serum GSH and GSSG/GSH maybe considered as protective factors against the occurrence of MiRAS. Conclusion: GSSG may be a potential danger factor to MiRAS and GSH may be a protective factor, while GR may not play an important role in the aetiopathogenesis of MiRAS.

A novel abdominal aortic aneurysm model produced by periarterial application of hydrochloric acid.

Previous abdominal aortic aneurysm (AAA) animal modeling methodologies were either expensive or complicated. Here, we developed a novel AAA model which was simple to set up and generated minimal calcification. Twenty-four rats were divided randomly into four groups. Groups 1, 2 and 3 underwent surgery in which 15% hydrochloric acid (HCl) was applied periarterially to the abdominal aorta for 5 min, followed by sacrifice 1 week (group 1), 2 weeks (group 2), and 4 weeks (group 3) after surgery. The maximum aortic diameter (MAD) was measured at surgery and before animal sacrifice. Rats in group 4 were sham-treated. The MADs in group 1, 2 and 3 showed significant dilation compared with group 4, with a mean dilation rate of 33.8% in the first week after surgery. Histopathological examination revealed infiltration of macrophages into the adventitia, obvious apoptosis of smooth muscle cells, and rupture and collapse of the elastic fibers. Furthermore, no calcification was observed in the dilated aorta. The mRNA expression levels of inflammatory factors were at least two-fold higher in group 1 than in group 4, indicating significant inflammatory response in the progression of AAA information. In conclusion, periarterial application of 15% HCl is a convenient and reliable model to create an abdominal aortic aneurysm in rats, and the potential development mechanism may be related to the proinflammatory effects of HCl.

Study on the correlation between gene polymorphisms of adiponectin and resistin levels and abdominal aortic aneurysm

Abstract Objectives: Abdominal Aortic Aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. This study aimed to examine the potential association of the +276G/T and −420C>G polymorphisms in the resistin gene with AAA susceptibility and progression. Method: We performed a retrospective study involving AAA patients and healthy controls, assessing the distribution of the +276G/T and −420C>G genotypes in both groups. Hardy-Weinberg equilibrium was assessed for both polymorphisms. Logistic regression was used to explore the influence of these genotypes on AAA occurrence and progression, adjusting for relevant confounders. Results: The distribution of +276G/T polymorphism did not significantly differ between AAA patients and controls. Conversely, a significant difference was observed in the genotype distribution of −420C>G polymorphism between the two groups. The CC genotype and CC/CG genotypes of −420C>G polymorphism were found to be associated with an increased risk and progression of AAA. Conclusions: The −420C>G polymorphism, particularly the CC genotype and CC/CG genotypes, might play a substantial role in AAA susceptibility and progression. The present findings underscore the need for further investigations to confirm these associations and fully elucidate the role of the resistin gene in AAA.

Multislice Computed Tomography Angiography Imaging Diagnosis of Lower Extremity Arteriosclerosis in Patients with Hypertension and Its Correlation with the Level of High-Sensitivity C-Reactive Protein.

The aim of this study was to investigate the relationship between multislice computed tomography (CT) angiography (MSCTA) imaging and high-sensitivity C-reactive protein (hs-CRP) in patients with hypertension and lower extremity arteriosclerosis. 68 hypertensive patients with lower extremity arteriosclerosis were selected as the observation group, and 68 healthy volunteers were selected as the control group to compare the differences in hs-CRP. According to the degree of stenosis, the patients were further divided into five grades: no obvious stenosis, mild stenosis, moderate stenosis, severe stenosis, and occlusion. The correlation between the degree of stenosis and the content of hs-CRP was compared. The changes of hs-CRP content before and after treatment were compared, and the difference of images before and after surgical treatment and the difference of hs-CRP expression in patients with occlusion were compared. Compared with the control group, the content of hs-CRP in the observation group was significantly higher (P < 0.05), and the degree of stenosis was positively correlated with the content of hs-CRP. After two weeks of treatment, the hs-CRP levels of patients with severe stenosis and occlusion were significantly lower than those before treatment (P < 0.01). The level of hs-CRP in patients with occlusion after arterial stent intervention was significantly lower than before, and the images also showed that the blood vessels were significantly expanded. The degree of stenosis in patients with lower extremity arteriosclerosis diagnosed by MSCTA imaging was closely related to the expression of hs-CRP in the patient, and a sustained high concentration of hs-CRP corresponded to a more severe degree of vascular occlusion. In conclusion, the hs-CRP can be used as one of the factors to predict and evaluate the occurrence of cardiovascular and cerebrovascular diseases.

Investigating the inverse association between glycaemia and abdominal aortic dilatation in a large Chinese hypertensive population: a cross-sectional study.

Background: There is epidemiological evidence that diabetes has a protective effect on the occurrence and development of abdominal aortic aneurysms (AAAs). However, information on the role of glucose level on abdominal aortic diameter is limited. This study sought to assess the relationship between fasting plasma glucose (FPG) and infra-renal aortic diameter in a Chinese hypertensive population. Methods: The prospective participants comprised candidates from 2 large population-based studies on the clinical presentation and management of hypertension in China. In total, 18,034 hypertensive participants (6,942 male and 11,092 females, with a mean age of 64.72±7.41 years) were included in the study. The maximal diameter of the infra-renal aorta was measured by ultrasound scanning. Multivariate linear regression analyses were conducted to assess the specific association between FPG and abdominal aortic diameter. The interaction terms between the baseline covariables and the aortic diameter were used to determine if a variable affected the association between FPG and abdominal aortic diameter. Results: Of these, 22 cases of AAA were identified, and the prevalence of diabetes was lower in those with AAA than those without. A significant negative association was also found between FPG and aortic diameter in both sexes. A dose-dependent decrease in the prevalence of diabetes across quartiles of aortic diameter was also observed, with an estimated odds ratio (OR) of 0.60 (95% CI: 0.50-0.72) for men and 0.72 (95% CI: 0.63-0.82) for women for the top quartiles compared to the bottom quartiles. Cigarette smoking only interacted with the association between FPG level and aortic diameter in women. The association did not differ with other subgroups. Conclusions: Our findings indicate that glycaemia may plays a protective role in the early stage of aortic dilatation in both sexes in a Chinese hypertensive population. Prospective studies need to be conducted to confirm our findings and explore the mechanism underlying this association in different populations.

Serum levels of total antioxidant status, nitric oxide and nitric oxide synthase in minor recurrent aphthous stomatitis patients.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is one of the most common inflammatory ulcerative conditions of oral cavity with uncertain etiology. Several studies have reported that oxidative stress may be associated with RAS. The aim of this study was to compare the serum levels of total antioxidant status (TAS), nitric oxide (NO) and nitric oxide synthase (NOS) in minor RAS (MiRAS) patients with healthy individuals and determine the possible association of MiRAS with the 3 physiological parameters mentioned above. METHODS: Ninety patients with idiopathic MiRAS and 90 race-, age- and sex-matched healthy individuals were included in this study. All these subjects were allocated to 3 groups: MiRAS patients in the active stage (Group A); the same MiRAS patients in Group A in the inactive stage (Group B); healthy individuals without MiRAS (Group C). Serum levels of TAS, NO and NOS were determined by the spectrophotometric method. Independent sample t test and paired t test were performed for statistical evaluation. RESULTS: Serum TAS level of Group A was significantly decreased than that of Group C, whereas the serum level of NO was significantly higher in Group A as compared to Group C (P < .05). The serum levels of TAS and NO in Group B were no significant differences when compared with those in Group A or Group C. No significant differences in NOS activities were also found between the 3 groups (P > .05). CONCLUSIONS: MiRAS is associated with decreased TAS and increased NO levels, but NOS may not play an important role in the aetiopathogenesis.

Treatment Strategies and Outcomes of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-analysis.

PURPOSE: To analyze the published treatment experience with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). METHODS: A literature search of the PubMed and Cochrane databases was conducted for articles on symptomatic SISMAD published in English from January 2007 to January 2018. Case series reporting on both treatment modalities and outcomes were included, while those on traumatic or iatrogenic SMA dissection or SMA dissection accompanied by aortic or other visceral artery dissection were excluded. Overall event rates for treated symptomatic SISMAD were calculated using pooled analyses. The rate of initial conservative treatment, the success rate, the rate of conversion to intervention, and the failure rate in patients with vs without antithrombotic therapy were calculated for each study and compared using a meta-analysis of proportions. RESULTS: The 25 articles selected encompassed 616 SISMAD cases, of which 514 were symptomatic cases eligible for the analysis. Among the latter, initial treatment consisted of conservative therapy in 447 (87.0%) patients and surgical interventions in 67 (13.0%) patients [45 (8.7%) endovascular procedures and 22 (4.3%) open surgeries]. Among conservative cases, 238 (53.2%) received antithrombotic therapy while 172 (38.5%) did not; 50 (11.2%) cases were converted to intervention [42 (84%) endovascular]. Conservative treatment was initially used in 85.2% of pooled cases with an 84.7% success rate, a 14.3% rate of conversion to intervention, and conservative treatment failure rates of 17.8% and 10.1% in patients treated with vs without antithrombotic therapy, respectively (p=0.103). CONCLUSION: Conservative treatment appeared safe and effective in >80% of symptomatic SISMAD cases, without apparent benefit for antithrombotic agent use. Initial or secondary intervention was more often endovascular, with favorable success rates and short-term outcomes. Large, prospective randomized trials with long-term follow-up are warranted on the treatment for symptomatic SISMAD.

Recent evolution in use and effectiveness in mainland China of thoracic endovascular aortic repair of type B aortic dissection.

A meta-analysis was performed on 175 studies selected among those published in mainland China between 2008 and 2015 on thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (AD). Most TEVAR were performed in Shanghai, Beijing, Hubei and Guangdong in patients with mean age of 53.9 years, and acute (70%) or chronic (30%) type B AD. Procedural success rate was 99.1 ± 0.8%. Major complication rate was 1.7 ± 2.3%, with paraplegia in 0.4 ± 0.0%. Overall in-hospital mortality rate was 1.6 ± 0.9% with AD rupture in 30% (about 40% during first postoperative day); follow-up mortality rate was 2.3 ± 1.1%, with AD rupture in 39.2% (50% within first year). Compared with 2001-2007 data from China, there appeared to be improvement in rates of major complications, paraplegia and in-hospital mortality. Compared with 1999-2004 Western data, rates of procedural success, stroke, and paraplegia appeared similar, while those for major complications, in-hospital mortality, retrograde type A dissection and follow-up mortality appeared lower. Compared with more recent Western data (2006-2013) on acute complicated type B AD, stroke, paraplegia, in-hospital mortality and follow-up mortality appeared lower. Therefore, in mainland China, safety for TEVAR of type B AD appeared better between 2008 and 2015 than in previous periods in China or Western countries.

Small infrarenal aortic diameter associated with lower-extremity peripheral artery disease in Chinese hypertensive adults.

Several studies suggest that infrarenal aortic diameter is associated with lower-extremity peripheral artery disease (LE-PAD). However, data regarding the associations between infrarenal aortic diameter and LE-PAD are limited, especially in large sample populations and Asian or Chinese populations. Our analysis included 17279 Chinese hypertensive adults comprising 6590 men and 10689 women with a mean age of 64.74 ± 7.41 years. Participants were selected from 22693 candidates from two large population-based cohort-studies. The primary noninvasive test for diagnosis of LE-PAD is the ankle-brachial index (ABI) at rest and typically an ABI ≤ 0.90 is used to define LE-PAD. The prevalence of LE-PAD was found to significantly decrease as the aortic diameter increased according to the tertile of the aortic diameter. LE-PAD was significantly more prevalent in the lowest tertile (OR = 1.58, 95% CI = 1.29-1.94, p < 0.001) and similarly prevalent in the highest tertile (OR = 0.92, 95% CI = 0.73-1.16, p = 0.49) when compared with the median tertile. No significant interactions between the aortic diameter and any of the stratified variables were found (all p > 0.05). In conclusion, Small aortic diameter (as opposed to large aortic diameter) is significantly associated with LE-PAD in Chinese hypertensive adults.

The Significance of the Angle between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection.

BACKGROUND: The aim of this study is to assess the significance of the angle between superior mesenteric artery (SMA) and distal aorta in spontaneous isolated superior mesenteric artery dissection (SISMAD) by clinical and biomechanical analyses. METHODS: Thirty-seven patients with SISMAD (1 asymptomatic) and 148 controls (1:4 matched for age [mean 50.2 years], gender [92% male], and body mass index, and being ruled out for arterial disease) underwent aortic computed tomography angiography. SMA-distal aorta angle, measured on sagittal plane, was compared along with baseline characteristics (body mass index, smoking history, and comorbidities) between groups, and assessed as tool to evaluate SISMAD risk after stratification into 4 angle-interval categories. Flow analysis and fluid-structure interaction study were conducted based on patient-specific models with ultrasound-measured boundary conditions to further reveal the flow pattern and loading distribution in the 4 angle-interval categories. RESULTS: SISMAD patients versus controls had larger mean SMA-distal aorta angle (73 ± 19.8° vs. 50 ± 18.81°, P < 0.001), and more frequently smoking history (62% vs. 40%, P = 0.02) and hypertension (59% vs. 34%, P < 0.001), all multivariate predictors of no SISMAD (odds ratio 0.946 [95% confidence interval 0.927-0.966]; 0.415 [0.198-0.87]; and 0.252 [0.117-0.544], respectively). Odds ratio for SISMAD increased with increasing SMA-distal aorta angle (1, 10, 57, and 73 for <50°, 50-69°, 70-90°, and >90°, respectively; P < 0.05 for >70°). In silico study confirmed that larger angle is associated with higher stress in the arterial wall and higher oscillatory shear index in the vessel lumen at the SMA superior convex, where dissection commonly occurs. CONCLUSIONS: Besides smoking history and hypertension, SISMAD was positively associated with a morphological parameter, the SMA-distal aorta angle. This might be due to the greater wall stress and oscillatory stress index in the arterial convex with a larger angle.

Association between diabetes and prevalence and growth rate of abdominal aortic aneurysms: A meta-analysis.

BACKGROUND: Although the prevalence of abdominal aortic aneurysm (AAA) was lower in diabetes, the relationship between diabetes and AAA prevalence remains unclear. In this meta-analysis, we sought to clarify the effect of diabetes on prevalence and growth rate (GR) of AAA. METHODS: We searched PubMed, Web of Science, Scopus and Cochrane databases. Articles reporting the AAA prevalence in diabetic patients and diabetic effects in GR of AAA were included. RESULTS: Forty-nine studies on AAA prevalence in diabetics and thirteen studies on effect of diabetes in GR of AAA were included for meta-analysis. A strongly negative association was found between diabetes and AAA prevalence in population based screening (odds ratio [OR]adjusted: 0.66; 95% confidence interval [CI]: 0.58-0.75) and prospective studies (ORadjusted: 0.52; 95% CI: 0.43-0.63), but not in case-control studies (ORadjusted: 0.48; 95% CI: 0.20-1.15). Similar association was found in North American (ORadjusted: 0.62; 95% CI 0.54-0.71) and European (ORadjusted: 0.45; 95% CI 0.33-0.62) studies. The strongly negative association remained consistent after stratification by time of data collection (up to -1995 [ORadjusted: 0.65; 95% CI: 0.53-0.80], 1996-2005 [ORadjusted: 0.61; 95% CI: 0.47-0.78], 2006 and beyond- [ORadjusted: 0.67; 95% CI: 0.53-0.85], and data collection time >10years [ORadjusted: OR: 0.44; 95% CI 0.34-0.58]). The annual mean diabetic effect on AAA GR was -0.60mm/y (95% CI: -0.76 - -0.43). CONCLUSION: Diabetes was strongly and negatively associated with AAA prevalence regardless of study type, geography and time of data collection, as well as negative impact of diabetes on GR of AAA.

Chronic obstructive pulmonary disease effect on the prevalence and postoperative outcome of abdominal aortic aneurysms: A meta-analysis.

Epidemiologic evidence suggested chronic obstructive pulmonary disease (COPD) might increase risk for abdominal aortic aneurysm (AAA). However, the association between COPD and AAA remains inconclusive. We searched PubMed and Cochrane databases until June 2015. Forty-eight articles were included for meta-analysis. COPD was found to be positively associated with AAA, regardless of study design and smoking status. AAA mortality is higher among COPD patients compared with non-COPD patients (postoperative [adjusted OR 2.11; 95% CI 1.33-3.34]; long-term [adjusted OR 1.70; 95% CI 1.37-2.12]). But the association between postoperative mortality and COPD was not found to be significant in patients underwent endovascular aneurysm repair (mixed OR 2.53; 95% CI 0.70-9.18). Rupture AAA may increase the postoperative mortality in COPD patients (rupture [adjusted OR 4.75; 95% CI 2.07-10.89]; non-rupture [adjusted OR 1.97; 95% CI 1.11-3.49]). The AAA postoperative morbidity was found to be positively associated with COPD (adjusted OR 1.59; 95% CI 1.14-2.21). Increased COPD severity may increase the long-term mortality (medical versus oxygen dependent: [OR 1.26; 95% CI 1.07-1.49] versus [OR 2.79; 95% CI 2.24-3.49]). In conclusion, COPD may increase the risk of AAA, morbidity and mortality of AAA patients underwent endovascular aortic repair.

[Efficacy and safety analysis of endovascular aortic repair of abdominal aortic aneurysms in patients over eighty years old].

OBJECTIVE: To evaluate the outcome of the endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) in patients over 80 years old and analyze the factors that influence its long-term curative effect. METHODS: Follow-up visits and analysis were conducted from January 2004 to December 2013 on a total of 96 AAA patients aged over 80 years old who had been treated with EVAR and thus met the inclusion criteria. The primary focus of the study was all-cause mortality and secondary focuses included the rate of intervention-related complications, the rate of secondary interventions and procedural data. The Kaplan-Meier survival curve was used to analyze the long-term survival rate and the cumulative probability of intervention-related complications. The Cox proportional hazards regression model was used to analyze factors that could influence the long-term survival rate. RESULTS: Effective follow-up visits were conducted on 76 patients (79.2%). The patients were tracked for an average of 3.63 years, with the longest follow-up lasting 10.34 years. During the study, 27 deaths occurred and the all-cause mortality rate was 28.1%. Furthermore, 8 cases of intervention-related complications (8.3%) were observed, including endoleaks and spinal cord ischemia. A total of 6 secondary interventions were conducted on 6 patients, with the rate of secondary interventions being 6.3%. The five-year cumulative survival rate was 64% (95%CI: 0.53-0.78) and the ten-year cumulative survival rate was 35%(95%CI: 0.15-0.84). The Cox proportional hazards model showed that an ASA classification of Ⅲ/Ⅳ (HR=8.45, 95%CI: 1.26-56.55, P<0.05), smoking (HR=2.08, 95%CI: 0.70-2.63, P<0.05) and cerebrovascular diseases (HR=2.96, 95%CI: 1.06-8.25, P<0.05) could significantly increase the risk of the long-term all-cause mortality of an AAA patient treated with EVAR. While hypertension could significantly decrease the risk (HR=0.25, 95%CI: 0.10-0.66, P<0.05). CONCLUSION: EVAR is safe for senior patients with AAA though personalized preoperative assessment is very important.

[Comparative study of perioperative outcome between endovascular repair and open surgical repair for ruptured abdominal aortic aneurysm].

OBJECTIVE: To compare the perioperative outcome between the endovascular repair (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysm. METHODS: From January 2006 to January 2013, totally 66 patients with ruptured abdominal aortic aneurysm (rAAA) treated by surgery were retrospectively analyzed in Department of vascular surgery, People's Liberation Army General Hospital. According to the repair method, all the subjects were divided into EVAR group and OSR group. EVAR group included 40 patients, 30 patients were male, 10 patients were female, aged from 47 to 78 with a mean of (71 ± 7) years. OSR group included 26 patients, 21 patients were male, aged from 45 to 87 with a mean of (72 ± 9) years. The difference of the operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate and the difference of the two intervention rate were compared between the 2 groups by χ(2) test and t test. RESULTS: There were significant differences between the 2 groups in operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate ((183 ± 44) minutes vs. (384 ± 108) minutes, t = -10.59, P = 0.00; (0.4 ± 0.8) units vs. (1.1 ± 1.8) units, t = -2.19, P = 0.03; (3.0 ± 1.8) d vs. (8.5 ± 5.1) d, t = -6.34, P = 0.00; 20.0% (8/40) vs. 46.2% (12/26), χ(2) = 5.10, P = 0.02; 25.0% (10/40) vs. 53.8% (14/26), χ(2) = 5.67, P = 0.02). There were no significant differences in frozen plasma quantities and the two intervention rate between the 2 groups (t = -1.98, P = 0.05; χ(2) = 0.49, P = 0.48). CONCLUSIONS: EVAR decreases the perioperative mortality and adverse event of rAAA compared with OSR. More studies are necessary to compare the middle and long-outcome between EVAR and OSR of rAAA.

[EFFECTIVENESS OF SURGICAL TREATMENT OF SYMPTOMATIC TORTUOSITY COMMON CAROTID ARTERY].

OBJECTIVE: To investigate the safety and effectiveness of vascular reconstruction in patients with symptomatic tortuosity common carotid artery (SCAT). METHODS: A retrospective analysis was made on the clinical data of 12 cases of SCAT treated with vascular reconstruction between June 2010 and October 2013. There were 11 females and 1 male with the mean age of 54.8 years (range, 48-62 years). The unilateral common carotid artery was involved in all cases. Imaging examination showed C-shaped tortuosity of 4-8 cm in length (mean, 5.4 cm). The CT, brain CT, ultrasound examinations, or angiography was performed at 1, 3, 6, 9, and 12 months, and annually. RESULTS: The surgery success rate was 100% with no perioperative death and serious complications. The mean operation time was 1.98 hours; the mean blood loss was 50 mL; and the mean clamping time was 14.9 minutes. The systolic pressure gradient across the lesion was significantly decreased from (39.58 ± 9.54) mm Hg (1 mm Hg = 0.133 kPa) at pre-operation to (5.50 ± 2.39) mm Hg at immediate after operation (t = 15.492, P = 0.000). No recurrence or stenosis was found at 9 months to 3 years of follow-up. The systolic and diastolic pressures at last follow-up were significantly improved to (132.17 ± 6.24) mm Hg and (82.67 ± 6.51) mm Hg from (152.83 ± 14.80) mm Hg and (94.17 ± 11.30) mm Hg at pre-operation (t = 5.751, P = 0.000; t = 4.976, P = 0.000). CONCLUSION: Vascular reconstruction in SCAT is recommended for good short- and mid-term effectiveness and relatively low complication and mortality after operation. Moreover, the long-term results still need to be investigated.

The value of a new image classification system for planning treatment and prognosis of spontaneous isolated superior mesenteric artery dissection.

OBJECTIVE: To aid diagnosis of spontaneous isolated superior mesenteric artery dissection and planning management, we investigated the role of classification of features as observed on computed tomography angiography images. METHODS: A retrospective study was conducted, comprising computed tomography angiography images and clinical data of 28 consecutive patients with spontaneous isolated superior mesenteric artery dissection. Based on the computed tomography angiography images, a new classification for spontaneous isolated superior mesenteric artery dissection was proposed. Patients with intestinal ischemia not relieved or worsened after 10 days of conservative treatment underwent surgery or stenting. All patients were followed up with computed tomography angiography. RESULTS: Spontaneous isolated superior mesenteric artery dissection was categorized into five types (I-V). Type III was further divided into subtypes IIIa-IIIc. Spontaneous isolated superior mesenteric artery dissection IIIa and IV typified nine (32.1%) and seven (25%) patients, respectively. Six (21.4%) patients had aortic or branch artery abnormalities and 21 (78%) showed prior intestinal ischemia. Four (14.3%) patients had intestinal ischemia and underwent surgery or stenting. CONCLUSIONS: Spontaneous isolated superior mesenteric artery dissection type IIIa is more likely to occur than other types. Long-term computed tomography angiography follow-up is valuable for determining treatment strategy for spontaneous isolated superior mesenteric artery dissection. Conservative therapy with anticoagulants is recommended for five days, and surgery or stenting should be considered if symptoms of intestinal ischemia are not relieved. Stent implantation provides relatively satisfactory mid-term outcome for true lumen construction of the superior mesenteric artery.

[Endovascular aortic repair of infrarenal abdominal aortic aneurysm: a 10-year single center outcomes].

OBJECTIVE: To evaluate the outcome after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) in single center. METHODS: A total of 711 AAA patients treated by EVAR in Department of Vascular Surgery, People's Liberation Army General Hospital and met the inclusion criteria from January 2004 to June 2014 were followed-up and analyzed. There were 612 male and 99 female patients, with a mean age of (69±13) years in this study group. The primary outcome of the study was all-cause mortality, secondary outcome included procedural data, intervention-related morbidity and secondary therapeutic procedures. The endpoint was death. Kaplan-Meier survival analysis were used to analyze long-term survival and cumulative probability of intervention related morbidity. Cox proportional hazards regression was used to analyze factors influenced the survival. Multivariable analysis were adjusted for covariates. RESULTS: There were 74.8% of total patients followed up. The longest follow-up period was 10.4 years (mean 3.8 years). For the primary outcome of all-cause mortality, 140 deaths occurred. Intervention related morbidity was 9.3%, secondary therapeutic procedures was 5.3%.The Kaplan-Meier survival curve showed that cumulative survival is 78% (95% CI: 74% to 82%) in 5 years, 67% (95% CI: 61% to 74%) in 10 years and the cumulative probability of intervention related morbidity is 10.5% (95% CI: 7.3% to 13.7%) in 5 years, 19.3% (95% CI: 11.9% to 26.0%) in 10 years. Cox proportional hazards regression showed that age>75 years, American Society of Anesthesiologists classification III or IV, smoking, diabetes significantly increase the risk of long-term all-cause mortality, while hypertension significantly decreases the risk. CONCLUSIONS: Long-term outcome after EVAR of AAA in the study is similar to those advanced studies.The management of risk factors would improve the prognosis of these patients.

[Effect of coenzyme Q10 on the expression of tumor necrosis factor-α and interleukin-10 in gingival tissue of experimental periodontitis in rats].

OBJECTIVE: To investigate the effect of coenzyme Q10 on the levels of tumor necrosis factor-α(TNF-α) and interleukin-10 (IL-10) in gingival tissue of experimental periodontitis in rats. METHODS: A total of 48 healthy Wistar rats were divided into 3 groups of 16 randomly, normal group, coenzyme Q10 treatment group (Q10 group) and periodontitis group.Normal group was fed with normal diet and water. Periodontitis models were established in other two groups.Q10 group received coenzyme Q10 for 12 weeks and periodontitis group was fed with the same dose of normal saline.Four rats in each group were sacrified before administration and 4, 8 and 12 weeks after administration. Gingival tissue samples from mandiblar first permanent molar were taken. The levels of TNF-α and IL-10 were detected by immunohistochemistry. RESULTS: The expression of TNF-α in periodontitis group [54.9% (52.9%, 57.3%)] was significantly higher than that in Q10 group [15.1% (12.7%, 17.5%)] at 12 weeks (P < 0.0167) . The expression of IL-10 in periodontitis group [8.9% (7.9%, 10.0%)]was significantly lower than that in the Q10 group [38.9% (38.0%, 40.4%)] (P < 0.0167) . The expression of TNF-α in periodontitis group was significantly higher than that in Q10 group at 12th weeks (P < 0.0167) . The expression of IL-10 in periodontitis group was significantly lower than that in the Q10 group (P < 0.0167). CONCLUSIONS: Coenzyme Q10 inhibits the expression of TNF-α and promotes the expression of IL-10 in periodontal tissues of experimental periodontitis rats. Coenzyme Q10 may play a role in treating periodontitis.

Animal model for evaluation of strain gauge in mandibular distraction osteogenesis in rabbits.

AIM: To design and assemble a distraction device with a strain gauge, and establish an animal model for testing it during mandibular distraction osteogenesis. METHODS: An osteotomy was made in the same position at the junction of mandibular angle and body in 12 rabbits. A customised distraction device attached to a strain gauge was used to distract the mandible. To find out which was the better material, both polyurethane and silicone were used as encapsulation material. After distraction, radiographs were taken, and specimens were examined histologically to record bone formation. RESULTS: Distraction osteogenesis was carried out successfully on all rabbits when the device used polyurethanes as the encapsulation material, it did not transfer the strain signals, but those made with silicone did. CONCLUSION: The device with silicone used as the encapsulation material can be used for strain-testing during mandibular distraction osteogenesis in a rabbit model.