Search

Objectives Glochidion ellipticum Wight is a medicinal plant, rich in polyphenols, frequently used by the indigenous communities of Bangladesh and possess with multiple health benefits. It exerts anti-inflammatory and antidiarrheal properties, but the detailed chemical constituents are yet to be elucidated. Methods Glochidion ellipticum extracts were analyzed using ultra-high performance liquid chromatography/quadrupole time-of-flight mass spectrometry and then tested by both lipopolysaccharide (LPS) induced inflammation of Raw 264.7 macrophage cells and dextran sulfate sodium (DSS) induced acute colitis model. Blood serum was taken for fluorescein isothiocyanate–dextran (FITC-dextran) measurement and tissue samples were used to perform histology, RT-PCR and Western blotting. Key findings The extracts could lower the levels of nitric oxide (NO), reactive oxygen species (ROS) and pro-inflammatory cytokines significantly in LPS induced macrophage cells. The extracts could also reduce disease activity index (DAI) score, restore antioxidants and pro-oxidants and improve macroscopic and microscopic features of colonic tissues in DSS induced mice. Expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in protein level was markedly diminished (up to 51.21% and 71.11%, respectively) in the treatment groups compared to the model group of colitic mice. Conclusions Our findings suggested that G. ellipticum extracts ameliorate DSS colitis via blocking nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway, which make them to be potential candidates for further research against inflammation and colitis.

Objective To determine whether interval-spaced sessions of partial splenic artery embolization(PSE) is a safe and effective alternative treatment for hypersplenism in juvenile patients. Methods Eight patients(3 males and 5 females) were included in this retrospective study.All patients were diagnosed as hypersplenism and underwent PSE in 2-3 sessions separated by 1-2 month intervals.Immediate,short,and long term follow-up were done.The effectiveness of the treatment was evaluated.Results No major postoperative complication was noted.No patient developed septic shock,splenic abscess,or spleen rupture.Postoperative pain and fever were common and manageable;only two patients developed loculated pleural effusions,which were well alleviated after conservative treatment.All patients showed significant increase in thrombocytes and white blood cells count after the first session of embolization.The cell counts became remarkable after the last session and remained at normal levels during the follow-up period.Conclusions PSE using 2-3 interval-spaced sessions can effectively decrease spleen size and reverse hypersplenism in juvenile patients.Also,it may reduce the postoperative complications commonly seen in traditional PSE.

Reconstruction of the internal carotid artery (ICA) is an operative challenge for lesions involving the lateral skull base because of excessive blood loss, intraoperative cranial nerve injury, and difficulties in cerebral protection.Between January 2010 and October 2014, 9 patients with vascular lesions at the lateral skull base were treated with a "pre-reconstruction" technique, which means reconstruction of the ICA in advance of excising the lesions.All operations were technically successful with no mortality or strokes. The mean blood loss was 921 ± 210 mL. The mean total clamping time was 18 ± 5 minutes. Among the 5 patients without invasion of specific cranial nerves, no long-term sequelae occurred during the follow-up period ranging from 11 to 54 months.With less blood loss, slighter cranial nerve injuries, and shorter clamping time, the "pre-reconstruction" technique was safe and effective for the treatment of vascular lesions at the lateral skull base. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1562-E1567, 2016.

To analyze the effectiveness and costs of the eversion carotid endarterectomy (eCEA) and the carotid endarterectomy with patch angioplasty (pCEA) in treating carotid artery stenosis.Patients with carotid artery stenosis who underwent the carotid endarterectomy in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were enrolled in this study. According to the two different surgical procedures, the patients were divided into eCEA group and pCEA group.The two groups were not significantly different in terms of gender ,age ,risk factors, stenosis degree of carotid artery, and the ratio of bilateral lesions (all P0.05).The ratio of shunt and antibiotics application, operative time, hospitalization cost, and length of hospital stay in the eCEA group were significantly lower than those in pCEA group (P0.05).The therapeutic effectiveness, complications, surgery-related death, restenosis, and ipsilateral stroke were not significantly different between these two groups (P0.05).Both surgical procedures are safe and effective in treating the carotid artery stenosis;however, eCEA has lower cost when compared with pCEA and therefore can be used as the first choice.

To compare clinical effects between percutaneous compressing plating (PCCP) and proximal femoral nail antirotation (PFNA) for the treatment of patients with intertrochanteric fracture with risk external wall.From September 2007 to June 2010, 43 patients with intertrochanteric fracture with risk external wall were treated by PCCP or PFNA according to different kinds of internal fixations. There were 22 cases in PCCP, including 9 males and 13 females with an average age of 68.4 (ranged, 60 to 86) years old, and 13 cases with type A2.2 and 9 cases with type A2.3; while 21 cases in PFNA, including 7 males and 14 females with an average age of 67.7 (ranged, 57 to 93) years old, and 10 cases with type A2.2 and 11 cases with type A2.3. Blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up were observed and compared.All patients were followed up for 12 to 22 (means 18.4) months, and all patients were obtained fracture healing, and recovered walking ability as before injury. There were no significant differences in blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up (P0.05). One case occurred displacement on the top of greater trochanter, and 1 case injuried weakness of hip abduction. One case occurred screw breakage in PCCP, while 1 case occurred hip joint pain in PFNA.Both of PCCP and PFNA in treating patients with intertrochanteric fracture with risk external wall can receive good clinical effects, while the effects and therapy strategy for displacement of bone on the top of lateral wall should further study.

To analyze the efficacy and safety of eversion carotid endarterectomy (eCEA) and carotid endarterectomy with patch angioplasty (pCEA) in the treatment of carotid artery stenosis.The clinical data were collected and analyzed for the patients with carotid artery stenosis undergoing carotid endarterectomy at Department of Vascular Surgery, Peking Union Medical College Hospital from October 2009 to October 2012. According to two different surgical procedures, they were divided into 2 groups of eCEA and pCEA.A total of 248 patients received a follow-up. Among 274 cases of endarterectomy, 101 cases of eCEA and 173 cases of pCEA were performed. No significant difference (P0.05) existed between two groups in gender, age, risk factors, stenotic degree of carotid artery or ratio of bilateral lesions. The ratio of shunt (15.8%) and antibiotics (26.7%) application, the duration of operation (88 ± 20) min, intraoperative blood loss (45 ± 16) ml and the length of stay (16 ± 4) days in the group eCEA were significantly lower than those of group pCEA (P0.05). There was no significant difference (P0.05) between two groups in the ratio of complications, surgery-related mortality, restenosis and ipsilateral stroke.Both surgical procedures are both safe and effective in the treatment of carotid artery stenosis. However eCEA offers potential advantages. The choice of a particular surgical procedure depends on the surgeon experience and specific circumstances of carotid artery lesions.

To investigate the risk factors and surgical management of limb prosthetic vascular graft exposure.The clinical data of 17 patients suffering from limb prosthetic vascular graft exposure in Peking Union Medical College Hospital from August 2006 to December 2011 were retrospectively analyzed. Among 17 cases, 5 suffered from prosthetic vascular graft exposure after vascular bypass for the lower limb ischemia, whereas 12 were affected after the artificial graft arteriovenous fistula construction in the upper limbs for hemodialysis. The surgical procedures mainly included the local debridement as well as the local flap and transferred muscle-cutaneous flap reconstruction to preserve the prosthetic vascular graft.All 17 patients underwent local flap or muscle-cutaneous flap coverage procedure. After the surgery, the prosthetic vascular graft was successfully salvaged in 14 cases. The total successful rate was 82.4%. The surgery failed in three patients, in whom the prosthetic vascular grafts were finally removed.Local flap and transferred muscle-cutaneous flap reconstruction is an effective surgical management to salvage the exposed grafts.

Midkine (MK) is a growth factor that promotes neurite outgrowth and survival of neurons, and enhances the plasminogen activator in endothelial cells. A highly sensitive enzyme-linked immunoassay for MK was developed, involving affinity-purified anti-MK antibodies, their biotinylated form, and avidin-beta-galactosidase. The amount of bound avidin-beta-galactosidase was determined using a fluorogenic substrate, 4-methylumbelliferyl-beta-D-galactoside. This method allowed the detection of human and mouse MK in the range of 50 pg-10 ng. Pleiotrophin, which is related to MK in its amino acid sequence, did not show any cross reactivity. Employing this method, the MK levels in the developing mouse brain were determined. The MK level was 2 micrograms/g of wet tissue on the 12th day of gestation, and then steadily decreased during embryogenesis and postnatal development to 30 ng/g two months after birth. The assay method can also be applied to serum samples. Although the MK levels in the sera of normal human subjects were low or undetectable, 0.6-8 ng/ml of MK was detected in samples in the majority of cases of hepatocellular carcinomas.

To evaluate the results of a variety of alternative endovascular techniques applied to patients with complicated abdominal aortic aneurysm complex abdominal aortic aneurysm (cAAA) and unsuitable for open surgery.From January 2001 to December 2010, charts of all patients having an abdominal aortic aneurysm (AAA) were reviewed. Endovascular aneurysm repair (EVAR) was done in 138 patients, in which 9 patients were defined as cAAA such as juxta-renal AAA, short or angulated AAA neck, AAA with bilateral iliac artery aneurysms. There were 8 male and 1 female patients, aged from 26 to 87 years with a mean of 67 years. All these patients at high risk for open surgery were offered a modified EVAR technique including fenestrated technique, scallop technique, chimney technique, balloon assisted U-turn stenting and reverse-U stent-graft in 2, 5, 1 and 1 patients respectively.All techniques were successful and without severe postoperative complications. An intraoperative endoleak was found in 4 patients and was corrected immediately. One patient with type I and III endoleaks underwent dilatation with a compliant balloon. Two patients with type I endoleak underwent coil embolization (1 patient) and bare stent (1 patient). During follow-up, one patient with a type II endoleak who demonstrated no increase in sac diameter during follow-up was observed. Mean follow-up was 25.9 months (ranging from 4 to 79 months). No rupture occurred and 8 aneurysms shrink significantly. In 7 patients, critical vessels (renal and mesenteric arteries) were protected during the initial procedure and remained patent except in one patient who was performed reverse "U" stent graft with thrombosis in hypogastric artery.High-risk patients with cAAA inappropriate for traditional EVAR can be successfully treated by using simple ancillary endovascular techniques with acceptable short or mid-term results.

To evaluate the application of carotid endarterectomy (CEA) in the treatment of patients with bilateral moderate to severe carotid stenosis.We retrospectively analyzed the clinical data of 82 patients with bilateral moderate to severe carotid stenosis who were admitted to our hospital from January 2006 to December 2009. Of these patients, 64 underwent ipsilateral CEA and 18 underwent bilateral CEA.A total of 100 endarterectomies including 92 patching and 94 carotid shunt were performed. Seventy-six patients smoothly recovered from the surgery. Two patients suffered from cardiac ischemia and infarction and one died of massive cerebral infarction. Three patients presented with hyperperfusion syndrome,and one of them developed cerebral hemorrhage. Of 79 patients who were followed up regularly, 76 (96.2%) had no cerebral ischemia relevant to the operated carotid artery,one developed mild re-stenosis, and 2 suffered from neurological dysfunction.CEA should be performed in patients with bilateral moderate to severe carotid stenosis once the indication is confirmed.

To summarize the incidence, diagnosis and treatment of acute coronary syndrome (ACS) after carotid endarterectomy (CEA).From 2003 to 2009, 159 CEA were performed in 143 cases with severe atherosclerotic carotid artery stenosis. The clinical datas of ACS after CEA were collected.The average age was 66.2 +/- 9.0 years old, varying from 40 to 86. There were 5 cases (3.1%) suffered from 30-day perioperative stroke/death totally, of which 4 cases (3.6%) in the symptomatic carotid stenosis group and 1 case (2.1%) in the asymptomatic group. 13 cases (8.2%) were diagnosed as ACS after CEA, 12 of them recovered after medicine, but one case aggravated even after the conservative treatment. Percutaneous coronary angioplasty and stenting was performed then. All cases were cured without death. Diabetes mellitus (RR = 7.727, P = 0.001), smoking (RR = 8.138, P = 0.020) and cardiac infarction history (RR = 8.138, P = 0.020) are significant risk factors for ACS after CEA.ACS is an important non-neurological complication after CEA. Diabetes mellitus, smoking and cardiac infarction history are significant risk factors for ACS after CEA. Early diagnosis and appropriate medical intervention for ACS can improve the safety of CEA.

To summarize advancement of diagnosis and surgical intervention of popliteal artery entrapment syndrome (PAES).From March 2006 to August 2009, 11 patients (14 limbs) underwent surgical procedures, including 9 males (81.8%), with a median age of 22 years old (arranged from 15 to 56 years old). Three cases (27.2%) had both limbs involved. The chief complaint contained intermittent claudication in 8 cases and rest pain in 3 cases. The time from onset to admission arranged from 3 weeks to 10 years. 14 limbs were diagnosed as PAES through multidetector spiral computed tomography. Eleven cases were diagnosed as Delaney's type II or III, 1 case as type V and 2 cases as type I. Two limbs underwent popliteal artery release only, 8 limbs underwent popliteal artery release, thromboendarterectomy and angioplasty with a venous or prosthetic patch, 2 patients complaining acute limb ischemia underwent catheter-based thrombolysis and popliteal artery release subsequently, 2 patients with a occlusive segment longer than 5 cm in popliteal artery underwent below-knee femoral-popliteal artery bypass with in-situ greater saphenous vein graft. All the patients undertook anticoagulation treatment with coumadin after the operation.All the patients had their clinical symptoms released after the operation. One patient (1 limb) was recurrent 20 months after the operation and underwent embolectomy successfully. At a median follow up of 13 months (range 1 to 36 months), the primary patency rate was 92.9% (13/14), the total patency rate was 100% (14/14) and limb salvage rate was 100%. The ankle brachial index at neutral position improved significantly after the surgery in the 12 occluded limbs (1.11 +/- 0.10 vs. 0.62 +/- 0.14, P0.01).Multidetector spiral computed tomography is much helpful in diagnose and typing of PAES. Surgery should be performed as soon as the PAES is diagnosed. Appropriate surgical intervention can achieve satisfying effect according to different character of popliteal artery occlusions.

To analyze the outcome and risk factors of endovascular revascularization of lower limb artery for elder patients.From January 2006 to November 2008, 86 elder patients (98 ischemia limbs) underwent endovascular revascularization due to lower limb ischemia. Age of this group were 60 to 82 years old with a mean of (70 +/- 6) years old. Fifty-four limbs (55.0%) had severe intermittent claudication, 28 limbs (28.6%) had rest pain, 11 limbs (11.2%) had ulcer, and 5 limbs (5.1%) had gangrene. Sixty-six limbs were mono segment disease, including 25 aorta-iliac lesions, 33 femoral-popliteal lesions and 8 infra-popliteal lesions. Thirty-two limbs were multiple segment disease involving 2 or 3 segment lesions. Mortality, morbidity, primary patency, secondary patency and limb salvage were retrospectively analyzed. Risk factors on outcome were also evaluated.Ten limbs underwent angioplasty, while the rest 88 limbs underwent angioplasty plus primary stent implantation. The total operation success rate was 95.9%. Perioperative mortality within the first 30 d was 0. Perioperative morbidity within the first 30 d was 5 cases (5.1%), including 2 myocardial infarction, 2 major amputations and 1 irreversible contrast-induced nephropathy. Follow-up duration were 1 to 35 months with a mean of (18 +/- 10) months. Eighty-three (96.5%) patients had effectively follow-up. Mortality was 2.3% (2 cases died due to myocardial infarction). Primary patency rate was 83.7%, secondary patency rate was 94.9% and limb salvage rate was 95.9%. Risk factor analysis showed that diabetes mellitus, critical ischemia and multiple segment lesions were associated with worse patency.Endovascular treatment is effective, safe and repeatable revascularization for elder patients of Critical lower limb ischemia. Patients with diabetes mellitus, critical ischemia and multiple segment lesions should be paid more attention because their rather worse outcome.

To evaluate the efficacy of infrapopliteal angioplasty as the first-choice procedure in patients with critical lower limb ischemia.From December 2005 to May 2009, infrapopliteal angioplasty was considered as the first-choice method in consecutive patients with infrapopliteal occlusive disease hospitalized for critical ischemia. Fifty-four patients (61 limbs) with a mean age of 66 years old (37 male and 17 female) underwent infrapopliteal balloon angioplasty. The preoperative ankle branchial index (ABI) was 0.43 + or - 0.27.Iliofemoral artery revascularization (stenting in 28 limbs and bypass in 5 limbs) were successful. Infrapopliteal balloon dilation was success in 57 limbs, the technical success rate was 93.4%. The major complications were calf hematoma in 3 cases (4.9%), and below-the-knee amputation in 2 cases (3.3%). Postoperative ABI increased to 0.86 + or - 0.21(P0.01). Mean follow-up time was (16 + or - 11) months. The primary patency rate was 61.1%, restenosis rate was 38.9% (21 of 54 limbs), and surgical intervention were performed for 10 limbs, the secondary patency rates was 75.9%. Major amputation in 3 limbs during follow-up period, the limb salvage rate was 91.8%.Infrapopliteal balloon angioplasty as the first-choice method is feasible, safe and effective for limb salvage in patients with critical lower limb ischemia.

To find out the distribution of emergent cases of elderly in vascular surgery and to evaluate the complications in peri-operation.We retrospectively analyzed all the vascular emergency operations over 60 years old from Jan. 2006 to Oct. 2008 in Peking Union Medical College Hospital.The emergency operations were increased by 30% annually. The concomitant diseases in patients over the age of 60 are higher than those below 60, in which cardiac diseases included valvular disease of heart, cerebrovascular disease and hypertension are most common. Meanwhile there is no significant in complications during peri-operation between patients over sixties and below sixties.The evaluation before operation and treatment of concomitant diseases in elderly patients should be done in ahead perfectly in order to reduce the complications during perioperation.

To analyze the etiology, characteristics, and treatment outcomes of peripheral arterial disease (PAD) in patients under 45 years old.One hundred and ninety-three cases under 45 years old with PAD were included from January 1999 to January 2009. The demography, etiology, surgical data, treatment outcomes of these patients were evaluated and analyzed. Among these patients, males are 171 cases. The age was 13 to 44 years old (average age 35 years old) and the average time between onsets of PAD to admission was 3.6 months. In the 138 patients who underwent surgical interventions, 30 patients had serologically proven thrombophilia, 50 patients without thrombophilia had other definite reasons but not Burger's disease. A total of 116 cases underwent open operations, 17 cases were received endovascular interventions and 5 cases underwent combinative treatments.Among the 193 patients, 140 cases (72.5%) had definite reasons. Forty patients (28.6%) were diagnosed with congenital or acquired hypercoagulability in the 140 cases. The thrombophilia group had poorer primary patency (70.0% vs. 92.0%, P = 0.010) and secondary patency (83.3% vs. 98.0%, P = 0.016) than non-thrombophilia group and more likely to underwent second revascularization because of recurrent thrombosis within 30 days after operations. After 16 months follow-up, the patients with thrombophilia had lower primary patency (65.0% vs. 75.7%, P = 0.392) and secondary patency (80.0% vs. 91.9%, P = 0.192) than the ones without thrombophilia and the rate of amputation was higher in thrombophilia group (15.0% vs. 5.4%, P = 0.222) but, these didn't achieve statistical significance.A high prevalence rate of thrombophilia is found in patients less than 45 years old with PAD requiring revascularization. Thrombophilia may have contributed to early postoperative thrombosis of the vascular procedure. So the screening and medical therapy to thrombophilia in young adults with PAD should be reinforced before surgical treatment.

To evaluate the diagnostic and treatment of intravenous leiomyomatosis (IVL) with extension to inferior vena cava.The clinical data of 6 cases of IVL involving inferior vena cava were analyzed retrospectively.Three of the 6 patients underwent phase I operation, and 2 underwent phase II operation, all successfully; and 1 did not undergo operation sue to poor cardio-pulmonary function. No peri-operative death and complication were observed. The primary tumor and intravenous tumor embolus were completely resected in 4 out of the 6 patients. One patient who had serious adherence between the tumor and pelvic cavity due to multiple operations had some residual tumors left. However, after anti-estrin treatment, the residual tumors had obviously regressed. All the patients had relapsed after the operation.IVL is very rare. The vascular surgeon must pay more attention to this disease. There are many therapeutic methods to choose when the IVL involves the inferior vena cava, among which operation is the best choice. Completely resection of the tumor is the key of the prevention of recurrence.