[Analysis of the short-term results of pre fenestration and external branched thoracic endovascular aortic repair for aortic lesions].

Objective: To evaluate the short-term effect of left subclavian artery (LSA) reconstruction with pre fenestration and external branch thoracic endovascular aortic repair (TEVAR) in the treatment of aortic arch descending lesions. Methods: The clinical data of 79 patients with aortic diseases who received LSA reconstruction in Tianjin Medical University General Hospital from November 2015 to October 2019 were analyzed retrospectively. According to different LSA reconstruction methods, they were divided into the fenestrated group (group f) 50 cases and the external branched group (group b) 29 cases. The surgical success rate, intraoperative and postoperative complication rate, re-intervention rate, mortality rate, and the change of the true and false lumen area of the dissection were compared and analyzed. Results: There were no significant differences in the perioperative and recent total complication rate, secondary intervention rate and mortality between the two groups (χ²=0, 1.246, 0.156, all P>0.05). The operation time of group f [(123.0±40.7 min)] was significantly longer than that of group b ((84.2±16.3) min, t=2.173, P=0.034). The degree of false lumen thrombosis of the stent segment was better than that of the non-stent segment (χ²=7.213, 14.359, both P<0.05) in the two groups after surgery, but no significant difference between the two groups (χ²=1.510, 0.886, both P>0.05). There was no significant difference in the change rate of the true and false lumen on each plane of the dissection between the two groups (all P>0.05). Conclusions: Both fenestrated and external branched TEVAR reconstruction LSA have good safety and effectiveness in treating aortic arch descending lesions. The external branched TEVAR takes less time, has higher effectiveness for lesions with shorter landing zone, and has better aortic remodeling effect in the stent segment soon; and the fenestrated TEVAR has better economy.

Prediction of prostate cancer aggressiveness with a combination of radiomics and machine learning-based analysis of dynamic contrast-enhanced MRI.

AIM: To investigate whether the combination of radiomics and automatic machine learning-based classification of original images from multiphase dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) can predict prostate cancer (PCa) aggressiveness before biopsy. MATERIALS AND METHODS: Forty consecutive biopsy-confirmed PCa patients were included. Biopsy was performed within 4 weeks after the DCE-MRI examinations. According to the time-signal-intensity curve, lesion segmentation was performed on the first and on the strongest phase of the enhancement on the original DCE-MRI images, and 1,029 quantitative radiomics features were calculated automatically from each lesion, wherein there were three datasets available (Dataset-F, Dataset-S and Dataset-FS). The variance threshold method, select k-best method and least absolute shrinkage and selection operator (LASSO) algorithm were used to reduce the feature dimensions. Five machine learning approaches leveraging cross-validation were employed, and the clinical value of each model was evaluated by area under the receiver operating characteristic curve (AUC). Correlation analysis was performed between the features of the machine learning model that achieved the best classification performance and the Gleason score (GS) of the PCa lesion. RESULTS: Eight, four, and 16 features were selected as optimal subsets in Dataset-F, -S and -FS, respectively. Among all three datasets, logistic regression (LR)-based analysis with Dataset-FS had the highest predication efficacy (AUC=0.93). Ten features in Dataset-FS showed significantly positively correlation with GS. The model performance of Dataset-F was generally better than that in Dataset-S. CONCLUSIONS: A combination of radiomics and machine learning-analysis based analysis of the union of the first and strongest phases of original DCE-MRI images can predict PCa aggressiveness non-invasively, accurately, and automatically.

[Early results of fenestrated endovascular aortic repair for the treatment of patients with thoracoabdominal pathologies].

Objective: To evaluate the early results of fenestrated endovascular aortic repair (FEVAR) using physician-modified stent grafts (PMSGs) for the treatment of patients with thoracoabdominal pathologies. Methods: Nineteen consecutive patients who underwent FEVAR using PMSGs between April 2012 and September 2017 were retrospectively reviewed. The modality of FEVAR technique was assessed, perioperative clinical data was recorded and the early results were evaluated. Results: Indications were thoracoabdominal aortic pathologies, including juxtarenal abdominal aortic aneurysm (JAAA) (n=12), chronic thoracoabdominal aortic dissection with aneurysmal dilatation (n=3), thoracoabdominal aortic aneurysm (TAAA) (n=1), infrarenal AAA with an accessory renal artery in the segment of the aneurysmal neck (n=2) and type Ⅰ endoleak after EVAR for AAA(n=1). Nineteen fenestrated stent grafts were deployed , including custom-made Cook Zenith fenestrated stent graft(n=1), home-made Cook Zenith TX2 fenestrated stent graft(n=6), home-made Cook Zenith TFFB fenestrated stent graft(n=9), home-made Cook Zenith Cuff fenestrated stent graft(n=2), home-made Gore C3 fenestrated stent graft(n=1). Mean duration for stent graft modification was 110 (90-140) min. Mean operative time was 268.0 (59.0-334.0) min, and fluoroscopy time was 66.0 (15.0-175.0) min. There were a total of 50 target vessels, of which 45 (95%) were stented. Bare metal stents were used in 28 vessels, and covered stents were used in 17 vessels. Technical success rate was 100%. No intraoperative target vessel loss was observed. Perioperative mortality was 5.3% (1/19). Endoleaks were persisted even after ballooning in five patients. A small type Ⅰ proximal endoleak and type Ⅲ endoleak were found in 2 and 1 patients, respectively. Type Ⅲ endoleak combined with type Ⅱ endoleak were observed in 2 patients. All the endoleaks were accepted and needed watching. In two patients, iliofemoral artery problems were resolved after local endarterectomy and stenting. Two patients presented renal deterioration postoperatively and recovered after the conservative therapy. Median length of stay was 6.6 (2.0-12.0)d. No early reintervention (<30 days) was performed. The mean duration of follow-up was 11.2 (2.0-41.0) months. One patient died 6 months after FEVAR due to advanced renal carcinoma. All target vessels remained patent except for one accessory artery occlusion. Conclusion: FEVAR using PMSGs may be a viable alternative for high-risk patients with thoracoabdominal pathologies.

[Preliminary study of endovascular aneurysm repair using fenestration on table for abdominal aortic aneurysm with short proximal neck].

Objective: To investigate the clinical value of endovascular aneurysm repair(EVAR) using fenestration on table for abdominal aortic aneurysm(AAA) with short proximal neck. Methods: A retrospective analysis of four cases with short proximal neck AAA from Aug. 2015 to May. 2016 of Tianjin Medical University General Hospital treated by EVAR using fenestration on table. Fenestrated stent-grafts were designed according to the preoperative computer tomography angiography(CTA) data. All cases underwent EVAR with the fenestrated stent-grafts on table to revascularize visceral branches. Results: FEVAR was performed in all of the 4 cases successfully. Device deploying success rate was 100%. No type Ⅰ endoleak was found in all of the 4 cases. Transient renal dysfunction occurred in two cases during 7 post-operative days and improved with the medical treatment. Mean follow-up period was 4.7 months(range, 1-9 months). CTA (3 cases) and ultrasonic imaging(1 case) were performed postoperatively. No endoleak was found around fenestrated stent graft and patency of visceral stent grafts were maintained in all of the 4 cases. Conclusion: EVAR using fenestration on table for short proximal neck AAA is safe and feasible, which expand the indication of EVAR for AAA, and the long-term safety and outcomes of this technique need to be assessed in the future.

Cycloartane saponins from Astragalus peregrinus as modulators of lymphocyte proliferation.

From Astragalus peregrinus, four cycloartane-type saponins have been isolated and their structures elucidated by spectral means as 20(R),24(S)-epoxy-9 beta,19-cyclolanostane-3 beta,6 alpha,16 beta,25-tetrol 3-O-beta-D-glucopyranoside (1), 20(R),24(S)-epoxy-9 beta,19-cyclolanostane-3 beta,6 alpha,16 beta,25-tetrol 3-O-alpha-L-rhamnopyranosyl-(1-->4)-beta-D-glucopyranoside (2), 20(R),24(S)-epoxy-9 beta,19-cyclolanostane-3 beta,6 alpha,16 beta,25-tetrol 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranoside (3) and 20(R),25-epoxy-9 beta,19-cyclolanostane-3 beta,6 alpha,16 beta,24(S)-tetrol (24-O-acetyl)- 3-O-alpha-L-rhamnopyranosyl-(1-->2)-(6'-O-acetyl)-beta-D-glucopyranoside (4). Compounds 2 and 3 showed to stimulate the proliferation of mouse splenocytes and were not significantly cytotoxic.

Effects of cocaine on the immune system of Balb/C mice.

Cocaine was given to Balb/C mice by intramuscular injection to assess the effects of the drug on their immune system. An injection of 5 mg/kg of cocaine 24 hr before assay suppressed phagocytic activity of peritoneal macrophages and decreased the numbers of thymocytes and white blood cells in a dose-dependent manner. The suppression appeared to be reversible. Tumor-implanted mice received 10 consecutive days of injections of smaller doses of cocaine (0.05, 0.25, or 5 mg/kg), also resulting in a dose-dependent suppression of phagocytosis 24 hr after the last injection. Cocaine decreased the number of plaque-forming cells when 5 mg/kg of cocaine was injected on the day of immunization but no inhibition was detected if the drug was given later. The size of tumors appeared to be increased in mice injected with cocaine for 10 consecutive days in comparison to the control mice. The effects were concentration dependent. Our study showed that cocaine had general suppressive effects on the mouse immune system.

Effects of cannabinoids and cocaine on the mitogen-induced transformations of lymphocytes of human and mouse origins.

The effects of delta 9-tetrahydrocannabinol (d9THC), delta 6-tetrahydrocannabinol (d6THC), and cocaine on the mitogen-induced transformations of lymphocytes of human and mouse origins were examined in an in vitro system. None of the three compounds is mitogenic in nature. The effects of the two components of marijuana on the mitogen-induced transformation are biphasic. Both compounds stimulated the lymphocyte transformation at low concentrations and inhibited mitogenesis at high concentrations. Cocaine, on the other hand, neither affected mitogen-induced lymphocyte transformations nor altered d9THC's transformation effects when both compounds were added together. Human lymphocytes and mouse splenocytes appeared to respond in similar patterns.

Immunomodulating activities of cocaine--evaluation of lymphocyte transformation related to other immune functions.

Cocaine dosages ranging from 2.5 mg/kg/day to a highly toxic dose of 50 mg/kg/day were injected intramuscularly or intraperitoneally into different groups of mice for 4-10 days. The effects of cocaine were evaluated by tumor growth, lymphocyte transformation, phagocytosis, and IgM plaque-forming cells. At all dosages, including toxic doses, cocaine does not inhibit lymphocyte transformation of the splenic or the peripheral blood lymphocytes. However, all other immunological parameters of the same animal were suppressed. These results suggest that lymphocyte transformation may not be a proper indicator for the immune status of mice treated with cocaine. The same may be true when testing human drug abusers.

Immunomopharmacological effects of polysaccharides from Acanthopanax senticosus on experimental animals.

Polysaccharides PES isolated from a common Oriental herb Acanthopanax senticosus were found to have a wide spectrum of immunomodulatory activities on experimental animals. The potential usefulness of these polysaccharides is suggested in the observations that PES inhibited transplanted tumor growths and ameliorated toxicities of the toxic substances in experimental animals. Of most interest is the observations that they suppressed human TB propagation in mice and guinea pigs, as evaluated by lymph node responses and OT skin tests in the guinea pig model, and the quantitation of the TB in the lungs in the mouse model.

Cycloartane triterpene glycosides from the roots of Astragalus melanophrurius.

From the roots of Astragalus melanophrurius eight known saponins (1-8) were isolated. Based on spectral data (IR, 1H- and 13C-NMR, and FABMS), the structures were established as astrasieversianins II (1) and X (4), astragalosides I (2), II (3), IV (5) and VI (7), and cyclocanthosides E (6) and G (8). The isolates were evaluated in a broad range of bioassay systems and found to be inactive. Modest antibacterial activity was observed, however, as was immunomodulatory activity, as indicated by stimulation of isolated human lymphocytes.