Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection.

BACKGROUND: Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR. MATERIALS AND METHODS: ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis. RESULTS: The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5-71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent. CONCLUSIONS: The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication. GRAPHICAL ABSTRACT: [Formula: see text].

Discovery of New Inhibitors of Transforming Growth Factor-Beta Type 1 Receptor by Utilizing Docking and Structure-Activity Relationship Analysis.

The transforming growth factor-beta (TGF-ß) plays an important role in pathological fibrosis and cancer transformation. Therefore, the inhibition of the TGF-ß signaling pathway has therapeutic potential in the treatment of cancer. In this study, the binding modes between 47 molecules with a pyrrolotriazine-like backbone structure and transforming growth factor-beta type 1 receptor (TßR1) were simulated by molecular docking using Discovery Studio software, and their structure-activity relationships were analyzed. On the basis of the analysis of the binding modes of ligands in the active site and the structure-activity relationships, 29,254 new compounds were designed for virtual screening. According to the aforementioned analyses and Lipinski's rule of five, five new compounds (CQMU1901-1905) with potential activity were screened through molecular docking. Among them, CQMU1905 is an attractive molecule composed of 5-fluorouracil (5-FU), 6-mercaptopurine (6-MP), and 5-azacytosine. Interestingly, 5-FU, 6-MP, and 5-azacytidine are often used as anti-metabolic agents in cancer treatment. Compared with existing compounds, CQMU1901-1905 can interact with target proteins more effectively and have good potential for modification, making them worthy of further study.

Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair.

OBJECTIVE: Stent graft (SG)-induced new entry (SINE) and retrograde type A dissection (RTAD) are serious device-related complications occurring after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) and may lead to endograft-related complications including retrograde dissection and death. The purpose of this study was to investigate the incidence and risk factors for the development of RTAD and SINE after TEVAR for TBAD and to identify the complications associated with this. METHODS: From April 2005 to October 2013, there were 997 patients who underwent TEVAR for TBAD; 852 were followed up (0-6 years; mean, 2.6 years), and 59 SINEs developed in 53 patients. The oversizing ratio and incidence of RTAD and SINE were compared between proximal bare stent (PBS) and non-PBS groups and RTAD and SINE and non-RTAD and non-SINE groups. The baseline characteristics and SG configurational factors potentially affecting both RTAD and distal SINE were analyzed. RESULTS: There was no significant difference between PBS and non-PBS groups in the incidence of RTAD. A greater oversizing ratio was related to a higher distal SINE rate. SINE was seen more frequently in smokers and in patients with hypertension, Marfan syndrome, and TEVAR in the chronic phase and less frequently in complicated dissection cases. Device-related factors for SINE were SG with a connecting bar and SG length <165 mm. The SG length <165 mm increased the overall proximal and distal SINE incidence in multivariate analysis. CONCLUSIONS: The presence of a PBS is not associated with a higher RTAD rate, whereas the use of an SG with a connecting bar and length <165 mm increases the risk of RTAD and SINE after TEVAR.

Endovascular Management of a Ruptured Aortic Arch Pseudoaneurysm Using the Snorkel Technique and Coil Embolization.

We report a reoperation case of a ruptured infectious aortic arch pseudoaneurysm, which was stabilized with thoracic endovascular aortic repair and snorkel bypass of the innominate artery (IA) and the left common carotid artery (LCCA). A 57-year-old Chinese woman with multiple comorbidities and previous open repair for Stanford type A aortic dissection 5 years ago presented with a ruptured 10.7 cm × 7.3 cm aortic arch pseudoaneurysm involving the origins of the LCCA and the left subclavian artery. The patient underwent emergent endovascular aortic repair with placement of a stent graft in both IA and left carotid artery coursing parallel to the aortic arch endograft.

Pomegranate Seed Oil Exerts Synergistic Effects with trans-Resveratrol in a Self-nanoemulsifying Drug Delivery System.

Pomegranate seed oil (PSO) has diverse bioactivities. It was hyphothesized that if PSO were employed to construct a trans-resveratrol-loaded self-nanoemulsifying drug delivery system (RES SNEDDS-PSO), not only could PSO serve as an oil phase but also exert synergistic effects with resveratrol to yield better therapeutic outcomes. In this study, we prepared RES SNEDDS-PSO for the first time to validate that hypothesis. The anti-inflammatory and anticancer activities of RES SNEDDS-PSO were compared with another SNEDDS composed of oil phase isopropyl palmitate (RES SNEDDS-IP). The results showed that upon exposure to a 10-fold amount of water, RES SNEDDS-PSO was converted into nanoemulsions with a mean size of 44 nm. Nanoemulsions enhanced the water solubility of resveratrol by 20-fold, significantly improved resveratrol stability in intestinal fluid, and slowed the decomposition of resveratrol in water by 1-fold. An in vivo anti-infection test showed that the degree of inflammatory swelling in mice given RES SNEDDS-PSO was only 60 and 76% that of the group fed with RES SNEDDS-IP at doses of 10 and 20 mg/kg, respectively. An in vitro anticancer study showed that the inhibitory rate of RES SNEDDS-PSO against MCF-7 breast cancer cells was 2.03- and 1.24-fold that of RES SNEDDS-IP at a concentration of 12.5 and 25 µg/mL, respectively. This study demonstrated that the newly developed SNEDDS may be a prospective formulation in the functional food and clinical fields.

[Endovascular repair for isolated iliac artery aneurysm].

OBJECTIVE: To evaluate the short and middle-term efficacies of endovascular repair for isolated iliac artery aneurysms (IIAAs). METHODS: Retrospective analyses were performed for the clinical and follow-up data of 27 patients undergoing endovascular repair at Department of Vascular Surgery, Affiliated Zhongshan Hospital, Fudan University from January 2008 to December 2012. For asymptomatic aneurysms, repair criterion was a diameter over 3 cm while under 3 cm for symptomatic aneurysms. RESULTS: There were 19 asymptomatic and 8 symptomatic cases. And 25 selective and 2 emergent operations were performed. The interventions included endovascular stent grafts (n = 17), coil embolization (n = 1), both stent grafts and coils (n = 7) and hybrid operations (n = 2). Technical success was achieved in all cases. No delayed healing or infection of inguinal access sites occurred. In-stent thrombosis could be observed in 2 cases. Buttock claudication was observed in one case. Sexual dysfunction occurred in three cases. Endoleaks were confirmed by intraoperative digital subtraction angiography in three cases. There was no occurrence of colorectal ischemia or postoperative aneurysmal rupture. Patients were followed up for a mean period of 33 ± 18 months. One patient died of recurrent renal cell carcinoma. CONCLUSION: Endovascular repair of isolated iliac artery aneurysms provides good short and middle-term patency. It may become a first-choice for treating isolated iliac artery aneurysms in the future.

[The development of a type II endoleak domesticated pig model with continuous pressure monitor].

OBJECTIVE: To develop a type II endoleak porcine model with continuous pressure monitor by the strain-gauge pressure transducer and the patch. METHODS: Nine tamed porcine was randomized as the experiment group of 6 domesticated pigs and the control group of 3 domesticated pigs. When the abdominal aortic aneurysm (AAA) was created, the 2(nd) and 3(rd) pair of infrarenal lumber arteries were preserved in the experiment group, while ligated in the control group. The stent-graft was implanted in the endovascular repair. CT angiography was performed to seek endoleak, and the angiography was performed to excluded the type I and type III endoleak. The pressure in the excluded AAA monitored by the strain-gauge pressure transducer was recorded and compared in both groups to evaluated the effect of type II endoleak in the experiment group. RESULTS: The AAA porcine model with pressure monitor were successfully developed in all 9 porcine. The endoleak and the retrograde flow of the lumber arteries were confirmed by CT angiography in the experiment group. The ratio of the average pressure after the procedure to before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020). The ratio of the pulse pressure after the procedure to the average pressure before the procedure was higher in the experiment group than the control group (U = 0.000, P = 0.020). CONCLUSION: It is feasible to develop type II endoleak domesticated pig model by preserving the lumber arteries for the retrograde flow, and the AAA model with pressure monitor by the strain-gauge pressure transducer and the patch.

[Complications in endovascular repair of abdominal aortic aneurysms: treatment and prevention].

OBJECTIVE: To review the prevention and treatment strategies in the complications after endovascular repair (EVAR) of abdominal aortic aneurysms, retrospectively in a single medical center. METHODS: From January 2003 to December 2010, clinical data of 344 EVAR cases were analyzed retrospectively, including postoperative period and long-term results. There were 302 male and 42 female patients, with a mean age of (69 ± 8) years. Patients were followed up at 3 months, 6 months, and then every year with abdominal x-ray and spiral CT angiography. RESULTS: The surgical success rate was 99.7% (343/344). The mortality with elective and emergency surgery was 0.30% (1/334) and 1/10 respectively. The average follow-up time was 3 to 84 months with a mean of 32.9 months. The follow-up rate was 81.8% (279/341). The mortality was 1.1% (3/279), the re-intervention rate was 10.4% (29/279) and the overall complication rate was 12.9% (36/279), including endoleak 5.7% (16/279), stent-graft migration 1.1% (3/279), aneurysm expansion or rupture 5.4% (15/279), limb occlusion 2.5% (7/279) and stent-graft infection 1.4% (4/279). CONCLUSION: EVAR has allowed a minimally invasive approach to aortic pathology. A careful preoperative assessment is the key for EVAR. Endoleak continues to be the major long-term complication of the endoluminal grafting technique, and the major cause for re-intervention. Life-long follow-up is an integral part of EVAR.

Discovery of the EL-0052 as a potential anesthetic drug.

As a γ-aminobutyric acid A receptor (GABAAR) inhibitor, etomidate fulfills several characteristics of an ideal anesthetic agent, such as rapid onset with rapid clearance and high potency, along with cardiovascular stability. Unfortunately, etomidate has been reported to inhibit CYP11B1 at hypnotic doses, which is associated with a marked increase in patient deaths due to this unexpected off-target effect. In this study, molecular docking was used to simulate the binding mode of etomidate with GABAAR and CYP11B1. Based on the in-depth analysis of the binding mode, strong electron-withdrawing group on the C4 position of the imidazole ring was introduced to reduce the charge density of the nitrogen, which is beneficial in reducing the coordination bond between the imidazole nitrogen and heme iron in CYP11B1, as well as in reducing the adrenocortical suppression. Based on the results of ADMET property prediction, MEP analysis, and molecular docking simulation, 4-fluoroetomidate (EL-0052) was designed and synthesized. In vivo studies in rats and mice confirmed that EL-0052 had the efficacy similar to etomidate, but without adrenocortical suppression. These findings suggested that EL-0052 was superior to etomidate and support the continued development of EL-0052 as a preclinical candidate as an anesthetic.

Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection.

BACKGROUND: Retrograde type A aortic dissection has been deemed a rare complication after endovascular stent graft placement for type B dissection. However, this life-threatening event appears to be underrecognized and is worth being investigated further. METHODS AND RESULTS: Eleven of 443 patients developed retrograde type A aortic dissection during or after stent grafting for type B dissection from August 2000 to June 2007. Of these 11 patients, 3 had Marfan syndrome. The Kaplan-Meier estimate of the rate of freedom from this event at 36 months is 97.4% (95% confidence interval, 0.95 to 0.99). The new entry was located at the tip of the proximal bare spring of the stent graft in 9 patients, was within the anchoring area of the proximal bare spring in 1, and remained unknown in 1 patient. Eight patients were converted to open surgery, and 2 received medical treatment. One patient suddenly died 2 hours after the primary stent grafting, and 2 died within 1 week after the surgical conversion, so mortality reached 27.3%. During the follow-up from 3 to 50 months, type I endoleak was identified in 1 patient 3 months after the surgical exploration and disappeared at 6 months. CONCLUSIONS: Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting-related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.

[Analysis of contrast medium induced pancreatitis].

OBJECTIVE: To report the contrast medium induced pancreatitis after angiography or endovascular therapy, analyze the possible cause of this complication, the treatment specialty and the prognosis. METHOD: The patients suffered from contrast medium induced pancreatitis after angiography or endovascular therapy during last 10 years were retrospectively analyzed. The patients' comorbidity, the onset time of the pancreatitis, the specialty of the pancreatitis, the treatment method and the prognosis were documented. The relative literature was retrieved and reviewed. The clinical data was compared with the relative literature and analyzed. RESULTS: Three cases of contrast medium induced pancreatitis were documented. One case was a young man, received angiography because of renal artery stenosis. He was suffered from moderate abdominal pain 2 hours after the procedure. Pancreatitis of edema type was confirmed by CT scan. He recovered thoroughly after the medical treatment. One case was an old man, underwent angiography for renal artery stenosis and abdominal aortic aneurysm. He was suffered from acute abdominal pain during the procedure. The CT scan revealed as edema pancreatitis. He died from cardiac infarction during the treatment. The last case was an old female, suffered from sustained abdominal distension after endovascular treatment of endoleak post AAA EVAR. Edema pancreatitis was confirmed by CT scan. The symptom was not alleviated well after the treatment. Finally she was died from MOSF. CONCLUSION: The incidence of contrast medium induced pancreatitis is relatively low. It's not easy to detect in early stage. Early diagnosis and treatment is the key to improve the therapeutic effect. The prognosis of patient with multiple comorbidity is poor.

Docking-based virtual screening of TßR1 inhibitors: evaluation of pose prediction and scoring functions.

To improve the reliability of virtual screening for transforming growth factor-beta type 1 receptor (TßR1) inhibitors, 2 docking methods and 11 scoring functions in Discovery Studio software were evaluated and validated in this study. LibDock and CDOCKER protocols were performed on a test set of 24 TßR1 protein-ligand complexes. Based on the root-mean-square deviation (RMSD) values (in Å) between the docking poses and co-crystal conformations, the CDOCKER protocol can be efficiently applied to obtain more accurate dockings in medium-size virtual screening experiments of TßR1, with a successful docking rate of 95%. A dataset including 281 known active and 8677 inactive ligands was used to determine the best scoring function. The receiver operating characteristic (ROC) curves were used to compare the performance of scoring functions in attributing best scores to active than inactive ligands. The results show that Ludi 1, PMF, Ludi 2, Ludi 3, PMF04, PLP1, PLP2, LigScore2, Jain and LigScore1 are better scoring functions than the random distribution model, with AUC of 0.864, 0.856, 0.842, 0.812, 0.776, 0.774, 0.769, 0.762, 0.697 and 0.660, respectively. Based on the pairwise comparison of ROC curves, Ludi 1 and PMF were chosen as the best scoring functions for virtual screening of TßR1 inhibitors. Further enrichment factors (EF) analysis also supports PMF and Ludi 1 as the top two scoring functions.

Long-term results of extensive aortoiliac occlusive disease (EAIOD) treated by endovascular therapy and risk factors for loss of primary patency.

BACKGROUND: Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency. METHODS: Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis. RESULTS: A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ±â€Š29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47-28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92-31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79-36.90; P < 0.01) were independent risk factors for the loss of primary patency. CONCLUSION: Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.

[Surgical treatment of renal stenosis: a report of 80 cases].

OBJECTIVE: To evaluate the curative effect of surgical treatment for renal stenosis. METHODS: Eighty cases from November 1997 to August 2008 were reviewed, including 53 males and 27 females, aged from 9 to 80 years old. There are 42 atherosclerosis, 23 Takayasu arteritis and 11 fibrodysplasia patients. Surgical procedures included aorto-renal bypass for 13 cases, autogenous renal transplantation for 5 cases, nephrectomy for 1 case, renal endarterectomy for 1 case, lesion resection and reconstruction for 1 case, balloon angioplasty for 14 cases, and stent implantation 48 cases. RESULTS: There were 1 mortality peri-operation. During follow-up (1 to 129 months), 2 among 63 patients died. Significant decline of blood pressure [(135.7 +/- 15.8)/(80.1 +/- 8.5) mm Hg (1 mm Hg = 0.133 kPa) vs. (149.8 +/- 18.3)/(88 +/- 13.6) mm Hg, P < 0.01] and totally 65.6% effective rate were observed. Atherosclerosis, Takayasu arteritis and fibrodysplasia group all presented positive anti-hypertension results with 50%, 73.3% and 100% effective rate respectively (P < 0.05). The creatine level also underwent significant decrease [(112.7 +/- 53.6) micromol/L vs. (131.7 +/- 91.7) micromol/L, P < 0.05], mainly in atherosclerosis group [(127.2 +/- 56.6) micromol/L vs. (138.0 +/- 87.0) micromol/L, P < 0.05]. CONCLUSIONS: Surgical treatment of renal stenosis can achieve improvement in hypertension and renal function. Endovascular stent and angioplasty are the first choices for atherosclerotic and fibrodysplasia patients respectively, while open surgery is better for Takayasu arteritis ones.

[Prospective study of coverage of left subclavian artery during thoracic endovascular aortic repair in a single center].

OBJECTIVE: To describe observation of security and availability of covering left subclavian artery during thoracic endovascular aortic repair (TEVAR) in follow-up. METHODS: From December 2007 to December 2008, 111 consecutive patients received stent grafts to treat lesions involving thoracic aorta. According to the covering of left subclavian artery, four groups including total covering (TC), less-than 50% covering (LTC), more-than 50% covering (MTC) and non-covering (NC) were formed. Difference of blood pressure between two upper extremities was required before TEVAR and 1st, 3rd, 5th, 30th day after TEVAR. Patients were evaluated postoperatively and at follow-up for stroke as well as symptoms of paraplegia, hemiparalysis or left upper extremity claudication. RESULTS: Fifty-five (49.6%), 18 (16.2%), 7 (6.3%) and 31 (27.9%) cases were divided into TC, LTC, MTC and NC groups, respectively. Difference of blood pressure between TC and the 3 latter groups were significantly different (P<0.01). Complications appeared as followed during one week after TEVAR: 13 patients in dizziness, among which 5 patients suffered from amaurosis and spotted vision, and 7 patients in left upper extremity claudication. No stroke, paraplegia or hemiparalysis in TC. Thoracic aortic lesions were successfully excluded in all patients. CONCLUSIONS: Intentional coverage of left subclavian artery to obtain an adequate proximal landing zone during TEVAR is safe and well-tolerated. But it may be managed expectantly with some exceptions for further lasting efficacy.

[The indication and time of treatment of thoracic endovascular aortic repair in acute Stanford B dissection].

OBJECTIVE: To study the indication of thoracic endovascular aortic repair (TEVAR) in acute Stanford B dissection. METHODS: From February 2004 to June 2008, 464 cases of Stanford B dissection (391 males and 73 females, age from 26 to 88 with a mean of 56.6 years) underwent TEVAR. Patients were divided into group A (acute, n=298) and group B (chronic, n=166). Risk factors of rupture were evaluated and results were compared between the two groups. RESULTS: The incidence of persistent or recurrent pain and hemothorax in ruptured patients was 83.3% and 94.4%, greater than 10.4% and 14.1% in the non-ruptured patients (P<0.01). The mean maximal diameter of the descending thoracic aorta in the rupture group was 49.4 mm, greater than 35.1 mm in the non-rupture group (P<0.01). Aortic branch vessel ischemia was greatly alleviated after TEVAR. Resolution of the proximal false lumen was 51.7% in group A, 19.5% in group B, and the rate of patent distal false lumen was 59.2% in group A, 79.3% in group B (P<0.01). Four out of 24 cases of intramural hematoma had recurrent dissection. CONCLUSIONS: Acute dissection with a patent proximal false lumen is an indication for TEVAR. Intramural hematoma could be given medical treatment under close follow-up. Persistent or recurrent pain, hemothorax, descending thoracic aorta greater than 4.5 cm, or aortic branch vessels ischemia warrant prompt TEVAR.

Investigation of transcriptional gene silencing and mechanism induced by shRNAs targeted to RUNX3 in vitro.

AIM: To investigate transcriptional gene silencing induced by short hairpin RNAs (shRNAs) that target gene prompter regions of RUNX3 gene, and whether shRNAs homologous to DNA sequences may serve as initiators for methylation. METHODS: According to the principle of RNAi design, pSilencer3.1-H1-shRNA/RUNX3 expression vector was constructed, The recombinant plasmid shRNA was transfected into human stomach carcinoma cell line SGC7901 with Lipofectamine 2000. Then, the positive cell clones were screened by G418. The mRNA and protein expression level of RUNX3 in the stable transfected cell line SGC7901 were determined by RT-PCR, Western blotting and immunocytochemistry. Characteristics of the cell lines including SGC7901, pSilencer3.1-H1/SGC7901 and pSilencer3.1-H1-shRNA/RUNX3/SGC7901 were analyzed with growth curves, clone formation rate and cell-cycle distribution. The activated level of RUNX3 was examined after treatment with the different density of 5'-aza-2'-deoxycytidine (5-Aza-CdR) by using semi-quantitative RT-PCR and Western blotting. RESULTS: In the cell line SGC7901 transfected with pSilencer3.1-H1-shRNA/RUNX3, mRNA and protein expression of the RUNX3 gene was lost identified by RT-PCR, Western blotting and immunocytochemistry assay. The growth of pSilencer3.1-H1-shRNA/ RUNX3/SGC7901 cells without expression of RUNX3 was the fastest (P < 0.05), its rate of clone formation was the highest (P < 0.01), and the cell distribution in G(0)/G(1) and S/M phases was lowest and highest, respectively (P < 0.05), compared with that of the transfected pSilencer3.1-H1 and non-transfected cells. Through RT-PCR and Western blot assay, inactivated RUNX3 could not be reactivated by 5-Aza-CdR. CONCLUSION: We found that, although shRNAs targeted to gene prompter regions of RUNX3 could effectively induce transcriptional repression with chromatic changes characteristic of inaction promoters, this was independent of DNA methylation, and the presence of RNA-dependent transcriptional silencing showed that RNA-directed DNA methylation might be an existing gene regulatory mechanism relative to the methylated in humans.

[Short to midterm results of endovascular for 105 case of infrarenal abdominal aortic aneurysms].

OBJECTIVE: To assess short to midterm outcome of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA) in 105 cases. METHODS: Stent-grafts were placed into 105 patients with infrarenal AAA between January 2001 and February 2007. The clinical data of those cases were retrospectively analyzed. RESULTS: Primary technical success rate was 100%. Eighty-two cases (78.09%) were followed-up for 1 to 73 months (mean, 8.9 +/- 5.8 months). Three cases (2.86%) died during peri-operative period, from acute cardiac infarction, multi-organ failure and significant upper gastrointestinal bleeding, respectively. Another one died from hepatic cancer 30 months after EVAR. Twenty-one cases experienced primary endoleak. Eighteen were type I, among which 10 underwent secondary intervention in the form of balloon dilatation (n = 9) and stent-graft placement (n = 1), 8 sealed spontaneously. Two cases were type II and sealed spontaneously. One type III was treated by placing a stent-graft. An emergent femorofemoral crossover was performed for one graft limb thrombosis 2 weeks after EVAR. Four late type I endoleaks occurred. One stent-graft migration without endoleak was cured conservatively. Two stent-graft infections occurred 1 month and 3 months after EVAR respectively, and were cured with debridement, drainage and antibiotics. Nine femorofemoral or iliofemoral bypass and three internal iliac bypasses were all patent during the follow-up period. CONCLUSION: Endovascular repair is a safe and effective method for infrarenal AAA with perfect short to midterm outcomes.

[Endovascular stent-grafts for the treatment of isolated iliac artery aneurysms: a report of 14 cases].

OBJECTIVE: To evaluate the efficacy of endovascular repair (EVR) for isolated iliac artery aneurysms (II AA). METHODS: Fourteen patients were treated with transluminally placed endovascular stent-grafts from October 2004 to May 2006. In eight patients, the aneurysms involved the right common iliac arteries. In five cases, left common iliac arteries were involved. The aneurysm involved the left internal iliac artery and ruptured in the other case. Criteria for repair were a diameter over 3.0 cm for true aneurysms. RESULTS: Technical success was achieved in all cases. Eight cases with right common iliac artery aneurysms were treated with bifurcated aorto-iliac stent-grafts after ipsilateral internal iliac artery embolization with coils. One case with right common iliac artery aneurysm involved the bottom of abdominal aorta was treated with AUI stent-graft and femorofemoral bypass. Five cases involved left common iliac arteries were treated with tubular stent-grafts after ipsilateral internal iliac artery embolization with coils. One case with ruptured left internal iliac artery aneurysm was treated emergent with tubular stent-graft after ipsilateral internal iliac artery embolization with coils. Aortography carried out immediately after the procedure showed the II AA were completely excluded by stent-grafts and no serious endoleaks both on the proximal or distal connections. One case with acute left ventricular dysfunction and alveolar edema postoperatively recovered after emergent treatment No complications in thirteen cases. All patients were followed up for a mean of 10.2 months (3 to 19 months) by CTA, no aneurysms enlargement, no stent-grafts migration, no endoleak, femorofemoral bypass was patent. CONCLUSIONS: Endovascular repair of isolated iliac artery aneurysms is a minimally invasive,safe and feasible technique and provides good short-term patency. Long-term patency is followed.

[Recent results of carotid stenting for treatment of extracranial carotid occlusive disease].

OBJECTIVE: To analyze the recent results of CAS performed by vascular surgeons to treat extracranial carotid occlusive disease (ECOD) retrospectively in a single medical center. METHODS: Forty-eight carotid arteries underwent CAS. Procedures were transfemoral. The postoperative follow-up was separated to 2 periods (30 d). The mortality and all kinds of complications were analyzed. RESULTS: 91.7% of them were men; 8.3% were women; mean age was (70.6 +/- 5.9) years. Preoperative asymptomatic cases were 37.5%; symptomatic cases were 62.5%. Mean internal carotid artery diameter stenosis was (71.2 +/- 14.8)%. 43.8% patients had single preoperative risk factors; two or more of these risk factors were present in 47.9%. In 33.3% cases the contralateral carotid artery had 50% or greater stenosis or was completely occluded. Technical success was achieved in 100%. There were no death, no major or minor stroke but 4.2% TIA. Carotid sinus compression syndrome occurred in 18.8% of patients. At follow-up > 30 days, there had been 4.2% instances of in-stent recurrent stenosis great than 50%, noted by color doppler ultrasound scanning. No stent deformity happened. CONCLUSION: CAS can be preformed safely enough in patients with ECOD at high CEA risk, with lower perioperative morbidity and mortality.