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Abstract Periodontitis is a chronic inflammatory disease initiated by biofilm microorganisms and mediated by host immune imbalance. Uncontrolled periodontal infections are the leading cause of tooth loss in adults. Thrombotic diseases can lead to partial or complete obstruction of blood flow in the circulatory system, manifesting as organ or tissue ischemia and necrosis in patients with arterial thrombosis, and local edema, pain and circulatory instability in patients with venous thrombosis, which may lead to mortality or fatality in severe case. Recent studies found that periodontitis might enhance thrombosis through bacterial transmission or systemic inflammation by affecting platelet-immune cell interactions, as well as the coagulation, and periodontal therapy could have a prophylactic effect on patients with thrombotic diseases. In this review, we summarized clinical findings on the association between periodontitis and thrombotic diseases and discussed several novel prothrombotic periodontitis-related agents, and presented a perspective to emphasize the necessity of oral health management for people at high risk of thrombosis.

Abstract Background Although associations have been reported linking pretreatment thrombocytosis to cancer survival outcomes, the validity and strength of existing observational evidence have been contested. This study aimed to conduct an umbrella review to comprehensively appraise the strength, validity and credibility of these reported associations. Methods We searched Medline, Embase and Cochrane Database of Systematic Reviews from inception to 8 April 2023 to retrieve meta-analyses of observational studies. Meta-analyses were re-performed using a random-effect model and the strength of evidence was graded as convincing, highly suggestive, suggestive and weak according to seven pre-defined quantitative criteria reflecting statistical significance, amount of data, heterogeneity, and evidence of bias. The quality of review was appraised using the AMSTAR2 checklist. The umbrella review was reported adhering to the PRISMA guideline and was registered on PROSPERO (CRD42023455391). Results A total of 21 unique meta-analyses investigating ten cancer subtypes were included. All meta-analyses reported inferior survival outcome in cancer patients with pretreatment thrombocytosis, and 18 of them (85.7%) yielded statistically significant results (P 300 or 400 × 109 /L) to define thrombocytosis. Although evidence appraisal did not identify convincing evidence (Class I), the associations of thrombocytosis with inferior overall survival of lung, gastric, colorectal cancer and malignant mesothelioma were classified as highly suggestive evidence (Class II). According to AMSTAR2 ratings, no meta-analysis was identified with high or moderate quality. Conclusions Our findings consolidated the association between pretreatment thrombocytosis and poor survival outcomes in various cancers. Nonetheless, the absence of convincing associations indicates a need for further large-scale, high-quality evidence to confirm whether platelets can serve as a prognostic predictor or a therapeutic target.

ObjectiveTo evaluate the effect of malnutrition assessed by the Geriatric Nutritional Risk Index (GNRI) on major adverse cardiac and cerebrovascular events (MACCE) in the elderly patients after endovascular aortic aneurysm repair (EVAR).Materials and methodsThis was a retrospective cohort study of elderly patients who underwent EVAR in a tertiary hospital. Malnutrition status was assessed by the GNRI. The primary outcome was MACCE. The predictive ability of the GNRI was compared with both the Revised Cardiac Risk Index (RCRI) and the modified Frailty Index (mFI) using Receiver operating characteristic (ROC) curve.ResultA total of 453 patients underwent EVAR November 2015 and January 2020 was retrospectively analyzed, equally divided into three (low/medium/high) groups according to GNRI values which ranked from low to high. Five (1.10%) patients were lost in follow-up after surgery, and the median length of follow-up was 28.00 (15.00–47.00) months. The high GNRI values reduced length of hospital stay following EVAR in comparison to patients in low GNRI values group (β 9.67, 95% CI 4.01–23.32, p = 0.0113; adjusted β −1.96, 95% CI −3.88, −0.05, p = 0.0454). GNRI status was associated with a significantly increased risk of long-term mortality after EVAR (Medium GNRI, unadjusted HR 0.40, 95%CI 0.23–0.70, p = 0.0014; adjusted HR 0.47, 95%CI 0.26–0.84, p = 0.0107; high GNRI, 0.27 95%CI 0.14–0.55; p = 0.0003; adjusted HR 0.32 95%CI 0.15–0.68, p = 0.0029). Both medium and high GNRI values were linked to significantly reduced risks of MACCE compared to low GNRI score patients (Medium GNRI, unadjusted HR 0.34, 95%CI 0.13–0.88, p = 0.00265; adjusted HR 0.37, 95%CI 0.14–0.96, p = 0.0408; High GNRI, 0.26 95%CI 0.09–0.78; p = 0.0168; adjusted HR 0.21 95%CI 0.06–0.73, p = 0.0029). Compared with the RCRI and mFI, the GNRI had better discrimination in predicting long-term MACCE. An area under the curve (AUC) for GNRI mFI, and RCRI is 0.707, 0.614 and 0.588, respectively. (Z statistic, GNRI vs. mFI, p = 0.0475; GNRI vs. RCRI, p = 0.0017).ConclusionMalnutrition assessed by the GNRI may serve as a useful predictor of long-term MACCE in elderly patients after EVAR, with preferable discrimination abilities compared with both RCRI and mFI.

Introduction Endovascular therapy has emerged as a prominent strategy for managing femoropopliteal peripheral artery disease, offering acceptable safety and efficacy compared with open surgical bypass. Both paclitaxel-eluting stents and heparin-bonded covered stents have exhibited enhanced clinical outcomes compared with bare metal stents. However, there is currently a lack of level I evidence comparing the safety and efficacy of paclitaxel-eluting stents and heparin-bonded covered stents. Therefore, the primary objective of this study is to systematically evaluate the efficacy and safety outcomes of these two types of stents.Methods and analysis The ELITE trial is a prospective, multicentre, parallel, randomised controlled trial. A total of 450 patients will be recruited. The primary endpoints of the study include primary patency at 1 year post-index procedure.Ethics and dissemination Ethical approval for this study was obtained from the Ethics Committee of West China Hospital of Sichuan University (approval number: 2023–1186). The results will be submitted to a major clinical journal for peer review and publication.Trial registration ELITE trial was registered on 27 September 2023 in the Chinese Clinical Trials Registry (ChiCTR2300076236).

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract which affects millions of individuals worldwide. Despite advancements in treatment options, there is increasing interest in exploring natural interventions with minimal side effects. Cruciferous vegetables, such as broccoli, cabbage, and radishes, contain bioactive compounds known as glucosinolates (GLSs), which have shown promising effects in alleviating IBD symptoms. This review aims to provide a comprehensive overview of the physiological functions and mechanisms of cruciferous GLSs and their metabolites in the context of IBD. Reviewed studies demonstrated that GLSs attenuated all aspects of IBD, including regulating the intestinal microbiota composition, exerting antioxidant and anti-inflammatory effects, restoring intestinal barrier function, and regulating epigenetic mechanisms. In addition, a few interventions with GLS supplementation in clinical studies were also discussed. However, there are still several challenges and remaining knowledge gaps, including variations in animals’ experimental outcomes, the bioavailability of certain compounds, and few clinical trials to validate their effectiveness in human subjects. Addressing these issues will contribute to a better understanding of the therapeutic potential of cruciferous GLSs and their metabolites in the management of IBD.

Abstract Background and aim Surgery is the mainstay of treatment and completeness of surgical resection is critical to achieve local control for retroperitoneal sarcoma (RPS). En-bloc resection of adjacent organs, including major abdominal vessels, is often required to achieve negative margins. The aim of this review was to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with vascular resection in patients with retroperitoneal sarcoma (RPS). Methods We searched PubMed, the Cochrane Library, and EMBASE for relevant studies published from inception up to August 1, 2022. We performed a systematic review of the available studies to assess the safety and long-term survival results of vascular resection for RPS. Results We identified a total of 23 studies for our review. Overall postoperative in-hospital or 30-day mortality rate of patients with primary iliocaval leiomyosarcoma was 3% (11/359), and the major complication rate was 13%. The recurrence-free survival (RFS) rates after the follow-up period varied between 15% and 52%, and the 5-year overall survival (OS) rates ranged from 25 to 78%. Overall postoperative in-hospital or 30-day mortality rate of patients with RPSs receiving vascular resection was 3%, and the major complication rate was 27%. The RFS rates after the follow-up period were 18–86%, and the 5-year OS rates varied between 50% and 73%. There were no significant differences in the rates of RFS (HR: 0.97; 95% CI: 0.74–1.19; p = 0.945) and OS (HR: 1.01; 95% CI: 0.66–1.36; p = 0.774) between the extended resection group and tumour resection alone group. Conclusions With adequate preparation and proper management, for patients with RPSs involving major vessels, aggressive surgical approach with vascular resection can achieve R0/R1 resection and improve survival.

IntroductionDyslipidemia is common in patients with abdominal aortic aneurysm (AAA). However, there is insufficient research on the impact of dyslipidemia on the postoperative outcomes of patients with AAA after endovascular aortic aneurysm repair (EVAR). This study aimed to determine the impact of dyslipidemia on the prognosis of patients with AAA treated with EVAR.MethodWe retrospectively reviewed patients with AAA who underwent EVAR at our hospital between 2010 and 2020. The baseline characteristics and prognoses of patients in the dyslipidemia and non-dyslipidemia groups were analyzed.ResultsA total of 641 patients were included; the prevalence of dyslipidemia in patients with AAA was 42.3% (271/641), and the mean follow-up time was 63.37 ± 26.49 months. The prevalence of diabetes (10.0% vs. 15.1%, P = 0.050), peripheral arterial disease (17.3% vs. 25.8%, P = 0.018), and chronic kidney disease (3.0% vs. 6.3%, P = 0.043) was higher in the dyslipidemia group. The three-year all-cause mortality rate after EVAR was 9.98% (64/641), and there was no difference in the incidence of all-cause mortality (10.27% vs. 9.59%, P = 0.778) between the two groups. A total of 36 (5.62%) major adverse cardiovascular and cerebrovascular events (MACCEs) were observed within 3 years and were more common in patients with dyslipidemia (2.97% vs. 9.59%, P

Introduction The best lifestyle for small abdominal aortic aneurysms (sAAA) is essential for its conservative management. Physical exercise can improve the cardiopulmonary function of the patients, but it remains unclear which specific type of exercise is most beneficial for individuals with sAAA. The current study was designed to investigate the effect of physician-guided enhanced physical exercise programme on the aorto-cardiac haemodynamic environment, aneurysm sac wall, cardiac function and growth rate of sAAA by multimodality MRI.Methods and analysis AAA MOVE study is a prospective, parallel, equivalence, randomised controlled trial. Eligible individuals will be recruited if they are diagnosed with sAAA (focal dilation of abdominal aorta with maximum diameter

Phlegmasia cerulea dolens (PCD) is a rare yet severe complication of deep vein thrombosis (DVT), characterized by a high amputation rate and mortality. Early diagnosis and treatment are crucial in managing this condition. PCD predominantly affects the lower extremities rather than the upper extremities. We herein present a rare upper extremity PCD case accompanied with supra vena cava and pulmonary embolism in a cervical cancer patient, who presented to our institution with severe pain, edema and irreversible venous gangrene of right upper limb with no response to anticoagulation therapy. Emergency fasciotomy and amputation were performed due to the progressed venous gangrene, however, the patient developed severe infection and coagulation disorders, gastrointestinal bleeding and disseminated intravascular coagulation after the surgery. Despite medical interventions, her family chose to withdraw treatment and the patient died in ICU at the fourth day following emergency surgery.

Hybrid thoracic endovascular aortic repair (TEVAR) has been proved to be an effective and reliable treatment option for aortic arch diseases requiring extension of the proximal landing zone. However, hybrid TEVAR was associated with potential risk of post-operative complications, including cerebral infarction, endoleaks and paraplegia. Here we reported a rare case of bypass graft infection complicated with mitral valve aneurysm and perforation following landing zone 2 hybrid TEVAR procedure, who presented with symptoms of fever, major bleeding and anastomotic pseudoaneurysm and received emergency bypass graft removal and stent implantation with acceptable short and midterm follow-up results.

The five-hole pressure probe based on Micro-Electro-Mechanical Systems (MEMS) technology is designed to meet the needs of engine inlet pressure measurement. The probe, including a pressure-sensitive detection unit and a five-hole probe encapsulation structure, combines the advantages of a five-hole probe with fiber optic sensing. The pressure-sensitive detection unit utilizes silicon-glass anodic bonding to achieve the integrated and batch-producible manufacturing of five pressure-sensitive Fabry–Perot (FP) cavities. The probe structure and parameters of the sensitive unit were optimized based on fluid and mechanical simulations. The non-scanning correlation demodulation technology was applied to extract specific cavity lengths from multiple interference surfaces. The sealing platform was established to analyze the sealing performance of the five-hole probe and the pressure-sensitive detection unit. The testing platform was established to test the pressure response characteristics of the probe. Experimental results indicate that the probe has good sealing performance between different air passages, making it suitable for detecting pressure from multiple directions. The pressure responses are linear within the range of 0–250 kPa, with the average pressure sensitivity of the five sensors ranging from 11.061 to 11.546 nm/kPa. The maximum non-linear error is ≤1.083%.

Abstract. Background:. Endovascular abdominal aortic aneurysm repair (EVAR) is the major treatment for abdominal aortic aneurysm (AAA); however, EVAR still carries a considerable risk of acute kidney injury (AKI). The present study aimed to investigate the risk factors for AKI after elective EVAR procedures. Methods:. This was a retrospective observational study. Eligible patients who underwent EVAR from September 2011 to March 2019 in West China Hospital were included. The primary outcome was the occurrence of AKI within two days after EVAR, which was defined by the Kidney Disease Improving Global Outcomes Clinical Practice Guideline. Demographics, comorbidities, medications, laboratory tests, anatomical parameters of AAA, and relative operative details were collected as variables. Univariable and multivariable logistic regression analyses were applied to identify the risk factors among variables, and covariate interactions were further assessed. Results:. A total of 679 eligible patients were included. The incidence of postoperative AKI was 8.2% (56/679) in the whole cohort, and it was associated with a lower 5-year survival rate (63.5% vs. 80.9%; χ2 = 4.10; P = 0.043). The multivariable logistic regression showed that chronic kidney disease (OR, 5.06; 95% CI: 1.43–17.95; P = 0.012), angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) (OR, 2.60; 95% CI: 1.17–5.76; P = 0.019), and short neck (OR, 2.85; 95% CI: 1.08–7.52; P = 0.035) were independent risk factors for postoperative AKI. In the covariate interaction analysis, the effect of ACEIs/ARBs use on postoperative AKI was similar across all subgroups (P > 0.05), thereby suggesting a robust effect of ACEIs/ARBs use in all patients undergoing elective endovascular abdominal aortic aneurysm repair. Conclusions:. Postoperative AKI was associated with lower survival rate, and the use of ACEIs/ARBs was the only adjustable independent risk factor. Clinicians should consider withdrawing ACEIs/ARBs in high-risk patients undergoing elective endovascular abdominal aortic aneurysm repair to prevent postoperative AKI.

Abstract. Background:. For patients with severe neck angulation (SNA), hemodynamic and clinical outcomes following endovascular aneurysm repair (EVAR) are still unclear. This study aimed to explore the influence of SNA on hemodynamic and clinical outcomes following EVAR. Methods:. This study included a hemodynamic analysis and a retrospective cohort study from West China Hospital of Sichuan University between January 2011 and December 2020. The Cox regression model, inverse probability of treatment weighting (IPTW) analysis, sensitivity analysis, and subgroup analysis were applied. Primary outcome was type IA endoleak (T1AEL). Results:. In this hemodynamic analysis, nine non-severe neck angulation (nSNA) and 16 SNA idealized models were constructed. We found a significant difference in drag force between SNA and nSNA models (7.016 ± 2.579 N vs. 4.283 ± 1.460 N, P = 0.008), and proximal neck angles were significantly associated with the magnitude of drag force (F = 0.082 × α–0.006 × β + 2.818, α: 95% confidence interval [CI] 0.070–0.094; P = 0.001; β: 95% CI −0.019 to 0.007; P = 0.319). In our cohort study, 514 nSNA patients (71.5 ± 8.5 years; 459 males) and 208 SNA patients (72.5 ± 7.8 years; 135 males) were included, with a median follow-up duration of 34 months (16–63 months). All baseline characteristics were well balanced after IPTW matching. We found that SNA was associated with a significant risk of adverse limb event (hazard ratio [HR] 2.18, 95% CI 1.09–3.12), yet was not associated with T1AEL, overall survival, or reintervention. In patients without proximal or distal additional procedures (DAP), subgroup analyses suggested a significant risk of T1AEL (Proximal: HR 5.25, 95% CI 1.51–18.23; Distal: HR 5.07, 95% CI 1.60–16.07) and adverse limb event (Proximal: HR 2.27, 95% CI 1.01–5.07; Distal: HR 2.91, 95% CI 1.30–6.54) in SNA patients. However, no noticeable difference was observed in patients with proximal or DAP. Conclusions:. SNA has a critical influence on hemodynamic and clinical outcomes following EVAR. Appropriate additional procedures may be of great benefit to SNA patients.

ObjectiveThe aims of the present study were to explore the risk factors for type 2 endoleaks (T2ELs) after endovascular aneurysm repair (EVAR) and the association between T2ELs and the iliolumbar artery.Materials and methodsA single-center, retrospective case–control study in West China Hospital was conducted among patients with infrarenal abdominal aortic aneurysm (AAA) who underwent EVAR between June 2010 and June 2019. The associations of patient characteristics, anatomical factors, internal iliac artery embolization, and ILA with the primary outcome were analyzed. The secondary objective was to analyze survival and reintervention between the T2EL group and the non-T2EL group. Kaplan–Meier survival, propensity matching analysis and multivariate logistic regression analysis were used.ResultsA total of 603 patients were included. The median follow-up was 51 months (range 5.0–106.0). There was a significant difference in the diameter of the lumbar artery (LA), middle sacral artery (MSA) and inferior mesentery artery (IMA), proportion of thrombus and LA numbers. The univariate analysis showed that T2ELs were more likely to develop more thrombus in aneurysm cavity (OR = 0.294, p = 0.012), larger MSA (OR = 1.284, p = 0.04), LA (OR = 1.520, p = 0.015), IMA (OR = 1.056, p

This study investigated the alterations in the phytochemical components and the antioxidant abilities of brine- and NaCl-fermented carrots and their effects on the lipid metabolism and microbial community in high-fat diet (HFD)-fed mice. Results showed that brine-fermentation significantly improved the contents of total dietary fiber, total phenols and β-carotene by 57 %, 48 % and 117 %, respectively. Fermented carrots possessed a higher level of antioxidant activities (P

Abstract Background Covered stent has become one of the mainstream therapies for aortoiliac obstructive disease (AIOD), with a higher patency rate than bare metal stent. Covered balloon-expandable (CBE) stent can be placed more accurately with higher a radial support force, while covered self-expanding (CSE) stent has greater elasticity and higher trackability. However, there is no level I evidence regarding the comparison safety and efficacy between the CSE stent and CBE stent in AIOD to date. Therefore, this study aims to compare the efficacy and safety of CBE stent (BARD®LIFESTREAM™) and CSE stent (GORE® VIABAHN™) in AIOD. Methods This trial is a prospective, single-center, parallel, noninferiority, randomized controlled trial. A total of 106 patients will be enrolled and these patients will be randomized to either the CBE stent group or the CSE stent group. The primary end point of the study is the occurrence of target lesion revascularization (TLR) at 12 months after the intervention. Discussion To our knowledge, the ballooN sElf cOver steNt AorToiliAc occuLusive (NEONATAL) trial is the first RCT to compare CBE and CSE stent in AIOD patients. The main aim is to compare the TLR of the target lesion between CBE stent and CSE stent at 12 months post-procedure. The results of clinical trials may contribute to establishing a strategic guideline for choosing the optimal type of covered stent in the treatment of AIOD patients. Trial registration Chinese Clinical Trials Registry ChiCTR2100046734. Registered on 27 May 2021

Hippocrates, the father of medicine, claimed that “All disease begins in the gut”, while modern scientific studies show that a lot of diseases are at least correlated to the gut, which contains trillions of microbes [...]

Introduction Postoperative renal function decline is a major concern for thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Diluting contrast medium in the power injector may be helpful in reducing the risk of contrast-induced nephropathy, but it can also blur fluoroscopic vision during surgery. The quality of the current evidence is very low; thus, this study is designed to investigate the effect of contrast dilution in the power injector on renal function changes in patients after endovascular aortic repair.Method and analysis The study is a prospective, single-blind, parallel, non-inferiority, randomised controlled trial with two independent cohorts: Cohort TEVAR and EVAR. Individuals will enter the appropriate cohort based on clinical interviews if they meet the eligibility criteria. Participants in Cohort TEVAR and EVAR will be randomly allocated to the intervention group (diluting contrast medium to 50% in the power injector) and control group (pure contrast medium in the power injector) separately in a 1:1 ratio. The primary study points consist of the proportion of patients who develop acute kidney injury within 48 hours after TEAVR or EVAR (first stage) and freedom of major adverse kidney events at 12 months after TEAVR or EVAR (second stage). The safety endpoint is freedom of all types of endoleaks at 30 days after TEVAR or EVAR. Follow-up will be conducted at 30 days and 12 months after intervention.Ethics and dissemination The trial was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (approval number: 20201290). The results of the study will be disseminated through publications in peer-reviewed journals and presentations at academic conferences.Trial registration number Chinese Clinical Trial Registry (ChiCTR2100042555).

Background: Predicting the development of sporadic type B aortic dissection (TBAD) always remains a difficult issue. This study aimed to identify high-risk patients for development of TBAD based on morphological parameters.Methods: This propensity-score-matched case-control study collected and reconstructed the computed tomography angiography of acute TBAD patients and hospital-based control participants without aortic dissection from January 2013 to December 2016. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). Discriminant and reclassification abilities were compared between our model and a previously established model.Results: Our study included 76 acute TBAD patients and 79 control patients (48 cases and 48 controls after propensity-score matching). The degree of question mark (aOR 1.07, 95% CI 1.04–1.11), brachiocephalic trunk diameter (aOR 1.49, 95% CI 1.20–1.85), brachiocephalic trunk angle (aOR 0.97, 95% CI 0.94–0.99), aortic root diameter (aOR 1.31, 95% CI 1.15–1.48), and aortic width (aOR 1.12, 95% CI 1.07–1.17) were associated with a significantly increased risk of TBAD formation. Similar findings were observed in the propensity-score matching and sensitivity analysis only including hyperacute TBAD patients. A novel prediction model was established based on the aforementioned parameters. The new model showed significantly improved discriminant ability compared with the previously established model (c-index 0.78 [95% CI 0.71–0.85] vs. 0.67 [95% CI 0.58–0.75], p = .03), driven by increased reclassification ability in identifying TBAD patients (NRI for events 0.16, 95% CI 0.02–0.30, p = .02).Conclusion: Morphological predictors, including the degree of question mark, aortic width, aortic root diameter, brachiocephalic trunk angle, and brachiocephalic trunk diameter, may be used to identify patients at high risk of TBAD.

BackgroundHostile anatomy, especially severely angulated neck and tortuous iliac arteries, has always been a conundrum in endovascular aneurysm repair (EVAR). Crossed limb (CL) graft, also called the “ballerina technique,” has been utilized to address this problem by facilitating gate cannulation. In terms of short and long-term outcomes, correlated studies have made inconsistent conclusions and this issue remains controversial. Based on a previous cohort study conducted in our center, we aim to prospectively compare the safety and efficacy between CL and standard limb (SL) configuration in patients receiving EVAR.MethodsThis is a prospective, single-center, non-randomized controlled trial. A total of 275 patients who meet the inclusion criteria will be enrolled and allocated with a 4:11 ratio of CL to SL, which is based on results of our previous study. All patients will receive same perioperative management and postoperative medications. All EVAR procedures will be performed under standard protocol, utilizing Endurant II or IIs Stent Graft. The configuration of the graft stent will be decided by surgeons and confirmed by final angiography. The primary outcome is 3-year freedom from major adverse limb-graft events (MALEs). Endpoints will be assessed at the following time points: 1, 6, 12, 24, and 36 months.DiscussionTo our best knowledge, this crosseD vs. stANdard Configuration in Endovascular Repair (DANCER) trial is the first non-randomized controlled trial to compare these two graft configurations in EVAR. The main aim is to compare the MALEs between two groups at 3 years postoperatively. This trial will hopefully provide high-level evidence for employing CL in EVAR.Clinical trial registration[www.chictr.org.cn], identifier [ChiCTR2100053055].

Abstract Background Carotid body tumors (CBTs) are rare neuroendocrine neoplasms, but the prognosis of patients with resected CBTs has seldom been elucidated. This study was conducted to investigate the association between variables, especially sex, and the prognosis of carotid body tumor resection. Methods This was a large-volume single-center retrospective cohort study. Patients who were diagnosed with CBTs between 2009 and 2020 at our center were analyzed retrospectively. Their preoperative, surgical, and follow-up data were collected, and the association between variables and outcomes of CBT resection was assessed by correlation analysis, multivariate logistic regression, and multivariate Cox regression as appropriate. Results A total of 326 patients (66.6% were females) were included. Males developed larger CBTs than females (4.3 ± 1.8 cm vs. 3.8 ± 1.4 cm, P = .003). Males were more likely to develop succinate dehydrogenase B (SDHB) mutations (P = .019) and had worse relapse-free survival rates (P = .024). Although tumor size and Shamblin classification had positive relationships with neurological complications and intraoperative blood loss, they did not affect the overall survival rate of patients, which was only influenced by remote metastasis (P = .007) and local recurrence (P = .008). Conclusions Compared to females, males with CBT resection were found to have more SDHB mutations and worse relapse-free survival rates, which may lead to the deterioration of prognosis. Tumor size and Shamblin classification cannot predict the overall survival rate of patients with excised CBTs. Graphical abstract

BackgroundEndovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have become the first-line treatment for aortic diseases, but current evidence is uncertain regarding whether a percutaneous approach has better outcomes than cutdown access, especially for patient-centered outcomes (PCOs). This study is designed to compare these outcomes of percutaneous access vs. cutdown access after endovascular aortic repair.MethodThe SWEET study is a randomized, controlled, single-blind, single-center non-inferiority trial with two parallel groups in two cohorts respectively. After eligibility screening, subjects who meet the inclusion criteria will be divided into Cohort EVAR or Cohort TEVAR according to clinic interviews. And then participants in two cohorts will be randomly allocated to either intervention groups receiving percutaneous access endovascular repair or controlled groups receiving cutdown access endovascular repair separately. Primary clinician-reported outcome (ClinRO) is access-related complication, and primary patient-centered outcome (PCO) is time back to normal life. Follow-up will be conducted at 2 weeks, 1 month, 3 months postoperatively.DiscussionThe choice of either percutaneous or cutdown access may not greatly affect the success of EVAR or TEVAR procedures, but can influence the quality of life and patient-centered experience. Given the very low evidence for ClinROs and few data for PCOs, comparison of the percutaneous vs. cutdown access EVAR and TEVAR is essential for both patient-centered care and clinical decision making in endovascular aortic repair.Trial registrationChinese Clinical Trial Registry ChiCTR2100053161 (registered on 13th November, 2021).

Hepatic artery pseudoaneurysm is a rare arterial disease. This case report describes a patient with hepatic artery pseudoaneurysm who presented with recurrent epigastric pain over a 4-month period. Computed tomography angiography (CTA) showed aneurysmal enlargement of the hepatic artery measuring 55 mm × 46 mm. The angiographic information is as follows: (1) the common hepatic artery originated from the superior mesenteric artery; (2) the proper hepatic artery originated from the common hepatic artery; (3) the proper hepatic aneurysmal disease had no collateral circulation. After careful consideration, the patient underwent an open surgical repair (OSR). The patient recovered well without any associated complications. The 1-year follow-up of patients did not reveal any relevant complications. The treatment choice, puzzles, and reflections of this case are all discussed in this article.

BackgroundDefinitive evidence to guide clinical practice on the principles of surgery for retroperitoneal sarcomas (RPSs) is still lacking. This study aims to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with contiguous organ resection in patients with RPS, the association between surgical resection margins and survival outcomes, and the role of surgery in recurrent RPS.MethodsWe searched PubMed, the Cochrane Library, and EMBASE for relevant randomised trials and observational studies published from inception up to May 1, 2021. Prospective or retrospective studies, published in the English language, providing outcome data with surgical treatment in patients with RPS were selected. The primary outcome was overall survival (OS).FindingsIn total, 47 articles were analysed. There were no significant differences in the rates of OS (HR: 0.93; 95% CI: 0.83-1.03; P = 0.574) and recurrence-free survival (HR: 1.00; 95% CI: 0.74-1.27; P = 0.945) between the extended resection group and the tumour resection alone group. Organ resection did not increase postoperative mortality (OR: 1.00; 95% CI: 0.55-1.81; P = 0.997) but had a relatively higher complication rate (OR: 2.24, 95% CI: 0.94-5.34; P = 0.068). OS was higher in R0 than in R1 resection (HR: 1.34; 95% CI: 1.23-1.44; P < 0.001) and in R1 resection than in R2 resection (HR: 1.86; 95% CI: 1.35-2.36; P < 0.001). OS was also higher in R2 resection than in no surgery (HR: 1.26; 95% CI: 1.07-1.45; P < 0.001), however, subgroup analysis showed that the pooled HR in the trials reporting primary RPS was similar between the two groups (HR, 1.14; 95% CI, 0.87-1.42; P = 0.42). Surgical treatment achieves a significantly higher OS rate than does conservative treatment (HR: 2.42; 95% CI: 1.21-3.64; P < 0.001) for recurrent RPS.ConclusionsFor primary RPS, curative-intent en bloc resection should be aimed, and adjacent organs with evidence of direct invasion must be resected to avoid R2 resection. For recurrent RPS, surgical resection should be considered as a priority. Incomplete resection remains to have a survival benefit in select patients with unresectable recurrent RPS.

BackgroundThe appropriate surgical procedure for early-stage retroperitoneal sarcoma (RPS) is unclear. Thus, we used a national database to compare the outcomes of radical and non-radical resection in patients with early stage RPS.MethodsThis retrospective study included 886 stage I RPS patients from 2004 to 2015 in the SEER database. Outcomes were compared using the multivariate Cox proportional hazards models and the results were presented as adjusted hazards ratio (AHR) with corresponding 95% confidence intervals (95%CIs). Propensity score-matched analyses were also performed for sensitive analyses.ResultsFor the 886 stage I RPS patients, 316 underwent radical resection, and 570 underwent non-radical resection, with a median follow-up of 4.58 (2.73-8.35) years. No difference was observed in overall mortality (AHR 0.84, 95%CI 0.62-1.15; P = 0.28) or RPS-specific mortality (AHR 0.88, 95%CI 0.57-1.36; P = 0.56) between groups. The results were similar in propensity score-matching analyses. However, subgroup analysis revealed that radical resection was associated with significantly decreased risks of overall mortality in male (AHR 0.61, 95%CI 0.38-0.98; P = 0.04) and in patients with radiotherapy (AHR 0.56, 95%CI 0.32-0.98; P = 0.04).ConclusionRadical resection did not improve midterm survival outcomes compared with non-radical resection in overall patients with early stage RPS. However, male patients or patients who received radiotherapy might benefit from radical resection with improved overall survival.

We investigated the effect of polyphenols extracted from M. angusticepes Peck (PMP) on D-galactosamine/lipopolysaccharide (D-GalN/LPS) induced acute hepatic failure (AHF) in mice. Results indicated that administration of PMP relieved the leakage of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The level of serum ALT was reduced in groups of P-H (800 mg PMP/kg BW) and P-L (400 mg PMP/kg BW) by 44.6% and 31.8%, respectively. RT-PCR and Western blot analyses showed that NF-E2-related factor 2 (Nrf2), PPARα, PPARγ gene and protein were up-regulated after injection D-GalN/LPS. In contrast, PMP pretreatment noticeably prevented D-GalN/LPS-induced hepatocyte apoptosis and steatosis. It suggested that PMP attenuated D-GalN/LPS-induced AHF in mice, which was likely attributed to the co-activation of Nrf2, PPARα, PPARγ and alleviating the oxidative stress reaction, reducing the body inflammatory response and regulating the lipid metabolism.

Objective: To report a numerical research on the effect of a renal artery arising from false lumen (FL) on the treatment outcome of thoracic endovascular repair (TEVAR) for complicated type B aortic dissection (TBAD). Methods: The original patient-specific model with the right renal artery (RRA) partially supplied by the FL (TFM) was reconstructed from its postoperative computed tomography images. Two additional models were reconstructed by artificially modifying the RRA either fully arising from the FL(CFM) or true lumen (CTM). Computational fluid dynamics (CFD) simulations were performed. Results: First, for all the models, the flow splits to all the visceral arteries were much less than those of a healthy aorta. Second, the flow split to RRA in the CFM and in CTM was the least and largest respectively. Third, in TFM, the pressure gradient between the true lumen (TL) and FL was negative at the proximal FL and the entire FL was full of active blood flow. In the contrast, in CTM and CFM, the pressure differences between the two lumens remained positive and little flow was present in FL. Finally, both TL and proximal FL of this particular patient expanded and the diameters of all visceral arteries decreased at one-year follow-up. Conclusions: Compared to a healthy aorta, a renal artery arising from FL following TEVAR would result in severe visceral ischemia including RA and superior mesenteric artery (SMA). In addition, our numerical simulation of the postoperative hemodynamics of this particular patient perfectly matched with its TL remodeling, FL expansion and contraction of the visceral arteries at one-year follow-up, and a patient-specific CFD simulation may be adopted to obtain information on visceral perfusion after endovascular repair for TBAD patients.

The study investigated the polyphenol of Coreopsis tinctoria buds extract (CTBE) and its protective effects on cognitive dysfunction and brain damage induced by d-galactose in mice. Three polyphenols and nine flavonoids were characterized by UPLC/Q-TOF-MS, with major components as flavanomarein (13.644 mg/g dry weight) and marein (13.387 mg/g dry weight). Results showed CTBE significantly improved the learning, memory, and cognitive abilities and brain index of aging mice. Besides, CTBE reduced the content of malondialdehyde while increased the activity of glutathione peroxidase and superoxide dismutase and the the total antioxidants in brain. CTBE reversed the abnormality of Ach level, AChE activity, and hippocampus changes in aging mice. Therefore, CTBE, as a novel nutraceutical, could attenuate the cognitive damage and improve parameters related to brain senescence, partly by reducing the oxidative stress and hippocampal damage.

Hepatic antioxidative substances are critical indicators to characterize the degree of oxidative stress in the body. The overall effects of probiotic administration on hepatic superoxide dismutase (SOD) activity and glutathione peroxidase (GSH-PX) activity and malondialdehyde (MDA) content were systematically evaluated through determining standardised mean difference (SMD). As a result, the meta-analysis of 23 research papers involving five kinds of oxidative stress models revealed that probiotic intervention significantly increased the levels of SOD by 114% (95% confidence interval (CI): 0.70, 1.59; P

This study investigated the effect of anthocyanin extracts from purple-fleshed sweet potato (PSP-AE) on ultraviolet B (UVB)-induced skin photoaging in BALB/c-nu mice. UPLC-QTOF-MS analysis showed six compounds were identified from PSP-AE. Administration of PSP-AE ameliorated the UVB-irradiated macroscopic and histopathological lesions of the skin via suppressing epidermal hyperplasia and collagen degradation, while improving the content of skin moisture and hydroxyproline. Additionally, PSP-AE inhibited the UVB-induced oxidative stress and increased the antioxidant enzyme activities. Results showed PSP-AE inhibited the UVB-irradiated levels of pro-inflammatory cytokines, such as tumor necrosis factor α and interleukin 6. Furthermore, Western blot analysis revealed PSP-AE remarkably decreased the protein levels of phosphorylated c-Jun-Nterminal kinase, extracellular signal-regulated kinase, and p38. Likewise, UVB induced nuclear translocation of nuclear factor kappa-B and the expression of matrix metalloproteinase 1 were diminished by pretreatment of PSP-AE. Therefore, PSP-AE had the potential to attenuate the UVB-irradiated skin oxidative stress and inflammatory response.

Ulcerative colitis (UC) is a chronic and nonspecific inflammatory disease of the colon and rectum, and its etiology remains obscure. Cherry polyphenols showed potential health-promoting effects. However, both the protective effect and mechanism of cherry polyphenols on UC are still unclear. This study aimed to investigate the potential role of the free polyphenol extract of cherry in alleviating UC and its possible mechanism of action. Our study revealed that the free polyphenol extract of cherry management significantly alleviated UC symptoms, such as weight loss, colon shortening, the thickening of colonic mucous layer, etc. The free polyphenol extract of cherry treatment also introduced a significant reduction in levels of malondialdehyde (MDA), myeloperoxidase (MPO) and nitric oxide (NO), while causing a significant elevation in levels of catalase (CAT), glutathione (GSH-Px), superoxide dismutase (SOD), as well as the downregulation of pro-inflammatory cytokines. This indicated that such positive effects were performed through reducing oxidative damage or in a cytokine-specific manner. The immunofluorescence analysis of ZO-1 and occludin proteins declared that the free polyphenol extract of cherry had the potential to prompt intestinal barrier function. The reduced expression levels of β-catenin, c-myc, cyclin D1 and GSK-3β suggested that the cherry extract performed its positive effect on UC by suppressing the Wnt/β-ctenin pathway. This finding may pave the way into further understanding the mechanism of cherry polyphenols ameliorating ulcerative colitis.

This review evaluates the evidence from animal studies for the protective effects of probiotics administration on d-galactose-induced oxidative stress. Of 192 articles identified from Web of Science, Embase and PubMed, 8 articles were included in the meta-analysis. The studies included 280 mice in total. Estimates of plasma superoxide dismutase (SOD), glutathione peroxidase (GSH-PX) and malondialdehyde (MDA) were examined using Review Manager Version 5.3. Based on the standardised mean difference (SMD), beneficial effects of probiotics administration were observed in the intervention group compared to the d-galactose model as follows: SOD activity (SMD: 1.59; 95% CI: 0.67, 2.50, P = 0.0007); GSH-PX levels (SMD: 2.93; 95% CI: 1.85, 4.02; P

Abstract In this study, three-dimensional printing (3Dp) models and simulation surgeries (SSs) were applied in two challenging aortic cases. The first was an abdominal aortic aneurysm with a complex neck, and the second was a thoracic aortic dissection aneurysm (TADA) with an angled arch. In order to avoid unpredictable obstacles and difficulties, we made optimal surgical plans by using 3D models and virtual simulations. Based on preoperative evaluation system, the surgical plans seemed more reasonable and time-saving.

The aim of this study was to investigate the protective effects and its underlying signaling pathways of Coreopsis tinctoria flowers extract (CTE) on D-galactose induced aging in mice. UPLC/Q-TOF-MS analysis of CTE identified 12 active compounds, including three phenolic acids and nine flavonoids. The extract showed superior antioxidant activities in vitro using DPPH, FRAP, and ORAC assay. Administration with CTE remarkably improved body weight, organ indexes of aging mice, and liver histological injury as well as decreased oxidative stress markers levels of aged mice. Further studies showed CTE treatment significantly enhanced Sirt1 expression and activated the Nrf2 signaling pathway by the increase of Nrf2 nuclear translocation, NQO-1 and HO-1 expression. Furthermore, CTE treatment resulted in the increase of Sirt3 and the suppression of p53. These results demonstrated that the promising anti-aging effects of Coreopsis tinctoria flowers extract might be related to up-regulation of Sirt1-Nrf2 signaling pathway.

Hybrid visceral-renal debranching procedures with endovascular repair have been proposed as a less invasive alternative to conventional thoracoabdominal aortic aneurysm or dissection (TAAA or TAAD) surgery. Up to now, there has been no information about the hemodynamic effects of retrograde visceral reconstruction (RVR) for Crawford type II/III/IV TAAA patients undergoing hybrid treatment. The aim is to provide insights in the abnormal hemodynamics of RVR from unilateral or bilateral common iliac arteries (CIAs). Idealized three-dimensional AAs with RVR from unilateral CIA or bilateral CIAs were generated and computationally simulated. The results show that RVRs from CIA lead to a dramatic decrease in flow to the visceral organs compared with a healthy AA and that the anastomosis region is most dangerous to graft occlusion and the initiation of an aneurysm. In addition, compared with a quar-furcated graft, the employment of bilateral bi-furcated grafts have better performance in terms of the wall shear stress (WSS) and flow filed but result in less flow to the celiac and mesenteric arteries. This study has revealed the potential risks after an RVR operation, and points out the advantages and disadvantages of different approaches for the visceral reconstruction, which the vascular surgeons are not fully aware of. According to our results, bilateral bi-furcated grafts are recommended to the TAAA patients when the CIAs are unique inflow sites for visceral reconstruction. A precise plan with patient specific for TAAA or TAAD will be designed for better long-term outcome.

OBJECTIVES: Limited information is available concerning the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients who receive conservative therapy. Accordingly, this study was designed to evaluate the predictive value of the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients without surgery. METHOD: From January 2009 to January 2011, critical limb ischemia patients were admitted to a vascular center. The demographic data, patient histories, comorbidities and risk factors were documented, and the differential cell count was determined at admission and seven days later after conservative therapy. The cutoff value of the post-treatment neutrophil-lymphocyte ratio was determined by an ROC curve. Patients were divided into groups A and B according to the cutoff value. Amputation-free survival was compared between groups. Univariate and multivariate analyses were used to identify independent risk factors. RESULT: A total of 172 patients were identified with a mean age 71.98±10.09 years; among them, 122 were male. A value of 3.8 was identified as the cutoff value of the post-treatment neutrophil-lymphocyte ratio. Groups A (post-treatment neutrophil-lymphocyte ratio ≥3.8) and B (post-treatment neutrophil-lymphocyte ratio

OBJECTIVES:This systematic review and meta-analysis aims to determine the current evidence on risk factors for type II endoleaks after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS:A systematic literature search was carried out for studies that evaluated the association of demographic, co-morbidity, and other patient-determined factors with the onset of type II endoleaks. Pooled prevalence of type II endoleaks after EVAR was updated. RESULTS:Among the 504 studies screened, 45 studies with a total of 36,588 participants were included in this review. The pooled prevalence of type II endoleaks after EVAR was 22% [95% confidence interval (CI), 19%-25%]. The main factors consistently associated with type II endoleaks included age [pooled odds ratio (OR), 0.37; 95% CI, 0.31-0.43; P

OBJECTIVE:General malnutrition usually occurs in critical limb ischemia (CLI) patients because of shortness of appetite and sleeplessness leaded by chronic pain. And amputation frequently is end-point of CLI patients. So the aim of this study was to assess the predictive ability of Geriatric nutritional risk index (GNRI) for predicting amputation in patients with CLI. METHODS:A retrospective study was designed. Demographics, history, comorbidity, and risk factors for peripheral vascular disease of admitted patients, and laboratory study were documented. Patients' height, weight and BMI were recorded. Amputation was identified as end-point during follow-up. Patients' amputation-free survival (AFS) was recorded. RESULT:172 patients were identified, with mean age 71.98±3.12. Geriatric nutritional risk index (GNRI) = 90 was taken as cutoff value of high risk of amputation for CLI patients via using receiver operating characteristic (ROC) curve. Span of follow-up was 12-48 months. During follow-up, 60 patients (36.04%) received amputation surgery. And analyzed by Cox proportional hazards model, it is found that GNRI was the independent predictive factor for amputation in long term. CONCLUSION:This study revealed that GNRI was a reliable and effective predictive marker for AFS. GNRI could identify patients with high risk for amputation in early time.

To evaluate the 8-year long-term outcome after internal iliac artery (IIA) coverage with or without embolization in EVAR.From January 2006 to December 2013, abdominal aortic aneurysm (AAA) subjects that underwent EVAR and IIA exclusion were recruited and analyzed retrospectively. All the subjects were divided into group A or B based on the presence or absence of intraoperative IIA embolization before coverage (group A: without embolization; group B: with embolization). The 30-day mortality, stent patency, and the incidences of endoleaks and ischemia of the buttocks and lower limbs were compared. The follow-up period was 96 months.There were 137 subjects (A: 74 vs. B: 63), 124 male (91.1%) and 13 female (9.5%), with a mean age of 71.6 years. There were no significant differences in the early outcomes of intraoperative blood loss (87.23±14.07 ml; A: 86.53±9.57 ml vs. B: 88.06±18.04 ml, p = .545) and surgery time (87.13±9.25 min; A: 85.99±7.07 min vs. B: 88.48±11.19 min, p = .130). However, there were significant differences in contrast consumption (65.18±9.85 ml; A: 61.89±7.95 ml vs. B: 69.05±10.50 ml, p

BACKGROUND: Salvage liver transplantation (SLT) is restricted to patients who develop hepatocellular carcinoma (HCC) recurrence within Milan criteria (MC). Little is known about outcomes for SLT in patients with recurrent HCC within University of California San Francisco (UCSF) criteria after liver resection (LR). METHODS: Between January 2001 and December 2011, 380 patients with HCC meeting UCSF criteria, 200 of which were resected (LR group) from a perspective of SLT in case of recurrence, and 180 directly underwent LT (PLT). We compared patient characteristics, perioperative and long-term outcomes between SLT and PLT groups. We also assessed the outcome of LR and PLT groups. RESULTS: Among the 200 patients in LR group, 86 (43%) developed HCC recurrence and 15/86 (17%) of these patients presented HCC recurrence outside UCSF criteria. Only 39 of the 86 patients underwent SLT, a transplantation rate of 45% of patients with HCC recurrence. Compared with PLT group, LR group showed lower overall survival rate (P = 0.005) and higher recurrence rate (P = 0.006). Although intraoperative blood loss and required blood transfusion were more frequent in SLT group, the perioperative mortality and posttransplant complications were similar in SLT and PLT groups. The overall survival and recurrence rates did not significantly differ between the two groups. When stratifying by graft type in the SLT group, overall survival and recurrence rates did not significantly differ between deceased donor LT (DDLT) and living donor LT (LDLT) groups. In the subgroup analysis by MC, similar results were observed between patients with recurrent HCC meeting MC and patients with recurrent HCC beyond MC but within UCSF criteria. CONCLUSION: Our single institution experience demonstrated that prior hepatectomy and SLT for recurrent HCC within UCSF criteria was feasible and SLT could achieve the same outcome as PLT.