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Study Design: Case report. Objective: To describe a unique case of iliac pseudoaneurysm-complicated lumbar disc surgery performed 13 years ago. Summary Of Background Data: Major vascular injury is an unusual but life-threatening complication of lumbar disc surgery. If a major vascular injury is unnoticed, the late complications, pseudoaneurysm, may be diagnosed years after primary lumbar disc surgery. Pseudoaneurysm can lead to compression of adjacent neurovascular structures; however, erosion into the adjacent vertebras and presentation with symptoms of nerve root irritation are rare. Methods: The patient was a 54-year-old man who presented with pain and numbness in right hip and leg. Examination was normal. A plain radiograph showed destruction of the fourth and fifth lumbar vertebras. Magnetic resonance image showed a retroperitoneal mass eroding into the adjacent vertebras. The mass was primarily misdiagnosed as a neoplasm and a percutaneous needle biopsy was recommended. Before puncture, the computed tomographic angiogram confirmed it to be a pseudoaneurysm of left common iliac artery. Then, implantation of a covered stent was undergone. Results: After implantation of a covered stent, the symptoms were relieved immediately. At the 12-month follow-up, the patient remained asymptomatic, and a computed tomographic angiogram revealed progressive shrinkage of the mass and significant healing of the eroded vertebras. Conclusion: As an unusual complication of lumbar disc surgery, iliac pseudoaneurysm can present with radiating pain even after 13 years and erode into the adjacent vertebras producing appearances mimicking a tumor. For mass located anterior to vertebras, the percutaneous biopsy must be cautiously performed, and a contrast-enhanced computed tomographic scan is necessary. [ABSTRACT FROM AUTHOR]

TCP (TEOSINTE-LIKE1, CYCLOIDEA, and PROLIFERATING CELL FACTOR1) is a plant-specific transcription factor that has garnered significant attention due to its wide-ranging involvement in the regulation of plant growth or developmental processes. However, the molecular mechanisms through which TCP genes orchestrate leaf senescence have not been extensively elucidated. BpTCP19, a member of the PCF subfamily in Betula platyphylla, and has high homology to AtTCP19. BpTCP19 displayed pronounced downregulation in response to methyl jasmonate (MeJA) and dark treatment. Overexpressing BpTCP19 in Betula platyphylla led to a delay in leaf senescence, resulting in prolonged leaf greenness under both MeJA and dark conditions. Transcriptome analysis revealed that overexpression of BpTCP19 induced alterations in the expression levels of genes linked to cell proliferation, hormone signaling transduction, and leaf senescence, including the early responsive factor BpWRKY53. Furthermore, through Yeast one-hybrid assays and GUS analysis, BpTCP19 was shown to bind to the promoter region of BpWRKY53, suppressing its expression and thereby retarding leaf senescence. This study elucidates the physiological and molecular functions of BpTCP19 as a central transcriptional regulatory module in leaf senescence and provides a potential target gene for delaying leaf senescence by mitigating sensitivity to external aging signals such as Jasmonic acid (JA) and darkness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the safety and effectiveness of intra-sac thrombin injection to remedy type II endoleaks (T2ELs) during endovascular aneurysm repair (EVAR)., Materials and Methods: 224 cases abdominal aortic aneurysm (AAA) were treated with EVAR. For the 52 cases of intra-operative type II endoleaks and 8 cases of ruptured AAAs, after the grafts were deployed, thrombin was injected into the aneurysm sac through a preset catheter. The occurrence of endoleaks post-EVAR were followed up with by Computed Tomography (CT) angiogram. The diameter and the volume of the aneurysm sac were also measured. Endpoints included incidence of T2ELs, AAA sac shrinkage and re-intervention rate and all-cause mortality., Results: The overall technical success rate was 100%. Fifty-two patients were followed up with for 9-56 (median 24) months. No serious complications were observed during follow-up. The incidence of endoleak was 5.8% (3/52) during follow-up. The maximum diameter of the aneurysm decreased from 61.1 ± 14.2 mm to 53.7 ± 10.6 mm, 47.9 ± 8.3 mm and 43.7 ± 7.2 mm (87.9%, 78.4% and 71.5% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The volume of the aneurysm sac shrank from 236.2 ± 136.2 cm 3 to 202.6 ± 114.1 cm 3 , 155.6 ± 68.4 cm 3 and 129.7 ± 52.4 cm 3 (85.8%, 65.9%, and 54.9% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The rate of various endoleaks was 5.8% (3/52) and the re-intervention rate was 1.9% (1/52) in this research., Conclusions: Clinical outcomes show that intra-sac injection of thrombin during EVAR is safe and may be effective in remedying small amount and low-velocity endoleaks and promoting shrinkage of the aneurysm sac., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The aim of this study is to compare the efficacy and safety of complete multi-level vs. iliac-only revascularization for the treatment of concomitant iliac and superficial femoral artery (SFA) occlusive disease., Methods: A total of 139 consecutive adult patients with severe stenosis and occlusive iliac and SFA disease with Rutherford categories 2-5 underwent multi-level ( n  = 71) and iliac-only ( n  = 68) revascularization at the Department of Intervention Vascular Surgery, Peking University Third Hospital, and Aerospace Center Hospital, between March 2015 and June 2017. Improvement in Rutherford class, perioperative major adverse events, the length of stay, survival rate, and limb salvage rate were assessed. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were compared between the two groups., Results: At 48 months, improvement in the Rutherford category was observed in the two groups with no significant difference ( P  = 0.809). Additionally, the two groups were similar concerning the primary patency (84.0% vs. 79.1%, P  = 0.717) and limb salvage rate (93.1% vs. 91.3%, P  = 0.781). A higher proportion of the perioperative major adverse events (33.8% vs. 27.9%, P  = 0.455), the all-cause mortality (11.3% vs. 8.8%, P  = 0.632), and the average length of hospital stay [7.0 (6.0, 11.0) vs. 7.0 (5.0, 8.0), P  = 0.037] were seen in the multi-level group compared with the iliac-only group., Conclusion: For concomitant iliac and superficial femoral artery occlusive disease, iliac-only revascularization has favorable efficacy and safety outcomes compared with complete multi-level revascularization in selected patients with patent profunda femoris artery and at least one healthy outflow tract of the infrapopliteal artery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Ren, Li, Zhuang, Li, Luan, Wang and Ding.)

Objective: To evaluate the effectiveness and safety of Rotarex catheter system in treating femoropopliteal artery stenosis accompanied with thrombosis., Methods: From Jun. 2017 to Dec. 2019, the clinical data of 32 femoropopliteal artery stenosis accompanied with thrombosis cases treated with Rotarex catheter system were retrospectively analyzed. There were 23 males and 9 females aged from 50 to 89 years and the mean age was (70.7±10.3) years. Six cases had acute course of disease (≤2 weeks), 17 cases had subacute course of disease (>2 weeks, ≤3 months), and 9 cases had chronic course of disease (>3 months). Mean lesion length was (23.4±13.7) cm, mean occlusion length was (19.9±13.3) cm, and in-stent occlusion 7 cases. The superficial femoral artery (SFA) was involved in 13 cases, the popliteal artery (PA) was involved in 8 cases, and both SFA and PA were involved in the other 11 cases. All the cases were treated with Rotarex catheter system. When necessary, suction with large lumen catheter was enabled. Residual stenosis was treated with percutaneous transluminal angioplasty (PTA). Drug-coated balloon (DCB) was only used in patients with financial status, and stent was used only when it was necessary. Heparin was used for 24 h after procedures, and after that, antiplatelet agents were used. Doppler ultrasonography was taken during the followed-up., Results: Technical success was 100%, and mean procedure time was (107.4±21.5) min. 8F (1F≈0.33 mm) and 6F Rotarex catheter were used in 27 and 5 cases respectively. In 27 cases, forward flow was obtained immediately after debulking with Rotarex catheter, and in the other 5 cases, suction with large lumen catheters were used. PTA was used in all 32 cases. DCB were used in 8 cases, of which 4 were used in in-stent stenosis. Twelve cases were implanted stents. There were no perioperative deaths. The only one procedure related complication was distal embolism. We took out the thrombus with guiding catheter. In all cases, mean hospital stay were (4.6±1.5) d. The ankle brachial index increased from 0.32±0.15 to 0.86±0.10 after treatment ( t =-16.847, P < 0.001). The Rutherford stages decreased significantly ( Z =-4.518, P < 0.001). All the patients were followed up for 6.0-36.0 months, and the median time was 16.0 months. 2 cases stopped antiplatelet agents, which resulted in acute thrombosis. Another percutaneous mechanical thrombectomy and PTA were taken in one of them. Two cases died of cardiovascular disease during the follow-up, and no amputation was observed. Target lesion restenosis occurred in 7 cases during the follow-up, and target lesion revascularization (TLR) was taken in two of them., Conclusion: In treating femoropopliteal artery stenosis accompanied with thrombosis, Rotarex catheter can remove thrombus effectively, and that can expose underlying lesions and reduce stent use and complications rates. It is a safe and effective method.

Objective: To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms., Methods: Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency., Results: A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52)., Conclusion: Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.

A triple-source CT system is proposed for micro-scale testing of geological materials. This study aims at reducing the projection acquisition time by two-thirds compared to a conventional single-source CT system. The proposed system with different positioning errors in the source-to-object distance (SOD) was simulated and tested using the Shepp-Logan phantom model, as well as slices of sand, glass beads, and concrete samples. Furthermore, the imaging quality of a single-source and the triple-source CT system with different dead detector pixels was compared. The results showed that within the maximum allowable positioning error, the pixel differences between the simulated and the original images are close to zero, and the structural similarities are greater than 0.96. In the presence of dead detector pixels, the quality of the simulated images in the triple-source CT system is superior to that of a single-source CT system. The presented triple-source CT system performs well in high-quality image reconstruction., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the effect of mechanical debulking in treating arteriosclerosis occlusive disease of lower extremity. Methods: The clinical data of 52 arteriosclerosis occlusive disease of lower extremity cases treated with Rotarex mechanical debulking system from June 2017 to June 2020 at Department of Intervention Vascular Surgery,Peking University Third Hospital were retrospectively analyzed. There were 37 males and 15 females,aged(69.4±10.1)years(range:47 to 89 years).Lesion length was (21.6±12.9)cm(range:4 to 45 cm),occlusion length was (18.5±11.8)cm(range:4 to 45 cm).The lesion was located in iliac artery(IA) in 6 cases,femoral-popliteal artery(FPA) in 42 cases,and both IA and FPA in 4 cases. All the cases were treated with Rotarex mechanical debulking system. Residual stenosis more than 50% were treated with percutaneous transluminal angioplasty(PTA).Drug coated balloon was used in part of them,and stent was used only when it was necessary. The patient's operation, complications, postoperative target vessel restenosis and reoperation were collected. The paired sample t test and rank sum test was used for data comparison and the postoperative target vessel patency rate was analyzed by Kaplan-Meier survival curve. Results: All the 52 cases obtained technical success. Percutaneous transluminal angioplasty was used in all cases,and drug coated balloon were used in 11 cases. Twenty-six stents were implanted in 24 cases (2 cases implanted 2 stents).Nine stents were implanted in IA and 15 in FPA. The length of stents was (11.3±3.3)cm(range:6 to 23 cm).There were 3 procedure related complications: one of them was acute occlusion in an iliac lesion,and thrombectomy was applied urgently,and the result was good. And the other two were distal embolism. The thrombus were took out with guiding catheter. The hospital stay was (4.8±1.9)days. The ankle brachial index increased from 0.34±0.16 to 0.81±0.16 after treatment( t =-25.160, P <0.01).The Rutherford stages decreased from ( M (IQR)) 3(1) to 1(1( Z =-6.825, P <0.01).The median followed up time was 19 months(range:6 to 42 months).Two cases stopped antiplatelet agents during follow-up and which result in acute thrombosis 2 weeks and 2 months later respectively. One of them was treated with percutaneous mechanical thrombectomy and the other one was not for gastrointestinal hemorrhage. Four cases died during follow-up,one case died of lung cancer,one died of abdominal infection,and the other 2 cases died of cardiovascular disease,and no amputation was observed. Target lesion restenosis(TLR) more than 50% occurred in 13 cases during the follow-up. All TLR were observed in FPA,and target lesion revascularization was taken in 3 of them. According to Kaplan-Meier survival curve analysis,half-year,1-year and 2-year cumulative patency rates of target vessels in this group was 94.2%,87.4% and 51.4%, respectively. And half-year and 1-year cumulative patency rates just in FPA cases was 92.9% and 84.3%, respectively. Conclusions: Percutaneous mechanical debulking using Rotarex catheter combining PTA can reduce the use of stents in femoral-popliteal artery. It is safe and effective in treating with arteriosclerosis obliterans of lower extremity.

Objective: To evaluate the effectiveness and safety of Rotarex mechanical thrombectomy system in treating acute lower limb ischemia., Methods: From December 2017 to December 2019, the clinical data of 23 acute lower limb ischemia cases treated with Rotarex mechanical thrombectomy system were retrospectively analyzed. There were 14 males and 9 females from 53- to 84-year-old patients and the mean age was (69.1±9.1) years. Duration of symptoms was 6 hours to 14 days (median time 7 days). In the study, 8 acute thromboembolism cases and 15 acute thrombosis cases were included (In which, there was one thromboangiitis obliterans case and two in-stent restenosis cases). In 5 cases, the lesions were located above the groin; in 16 cases, the lesions were located below the groin, and in the other 2 cases, the lesions were located both above and below the groin. All the cases were treated with Rotarex mechanical thrombectomy system. When residual stenosis was greater than 50%, percutaneous transluminal angioplasty (PTA) was used, and stent was used only when it was necessary. Heparin was used 24 h after the procedure, and after that, antiplatelet agents were used in acute thrombosis cases, and oral anti-coagulants were used in acute thromboembolism cases. Doppler ultrasonography was taken during the follow-up., Results: In all the 23 cases, there were 22 successful cases and 1 unsuccessful case, the mean procedure time was (68.2±15.6) min. Percutaneous transluminal angioplasty was used in 18 cases, 7 of which were implanted stents (3 stents were implanted in iliac artery and 4 in superficial femoral artery). There were 3 procedure related complications. The first one was arterial wall injury which resulted in contrast medium extravazation, and in this case, we solved it with prolonged balloon inflation. The second one was distal embolism. We took out the thrombus with guiding catheter. The last one was acute occlusion in a stent, and thrombectomy was applied urgently, and the result was good. Mean hospital stay were (3.6±1.7) days. The ankle brachial index (ABI) increased from 0.25±0.10 to 0.85±0.16 after treatment ( t =12.901, P < 0.001). All the patients were followed up for 4.0-28.0 months, and the median time was 12.0 months. One patient stopped antiplatelet agents, which resulted in acute thrombosis 2 months later. Another percutaneous mechanical thrombectomy and PTA were taken. In the failed case, the patient suffered amputation above the knee 3 months later and in another case, the patient died of heart failure 8 months after the procedure. Two target lesion restenosis occurred during the follow-up. Because the patients' symptom was not sever, no procedure was taken., Conclusion: Percutaneous mechanical thrombectomy using Rotarex catheter is safe and effective in treating acute lower limb ischemia. For one side, it can restore blood flow to the affected limbs quickly, and for the other, it has the characteristics of minimally invasive and good repeatability. So it should be considered that this me-thod can be widely used for acute lower limb ischemia.

The glazed tile is an important building material used throughout the history of traditional Chinese architecture. Architectural glazed tiles used to decorate the screen walls of ancient China are studied scientifically for the first time. More than 30 glazed tile samples from the screen walls of the 15th to 18th century AD of the Hancheng Confucian Temple and Town God's Temple in Shaanxi Province were carefully investigated using SEM-EDS and XRD. Microstructure and chemistry indicated the raw materials, the recipes and the technological choices used to produce the paste and glaze of the glazed tile samples studied. The causes for the key degradation processes of these glazed tiles used as building materials in the screen walls have also been discussed. This work has clear implications for the restoration and conservation treatments on these kinds of ancient Chinese building materials.

Objective: To evaluate the role of Rotarex mechanical thrombectomy system in treating instent restenosis of peripheral artery disease (PAD)., Methods: The clinical data of 7 in-stent restenosis (ISR) cases of lower extremity PAD from June 2017 to Dec 2018 were retrospectively analyzed. There were 5 males and 2 females and the mean age was (70.0±7.6) years from 59.0 to 76.0 years. All the cases were treated by Rotarex mechanical thrombectomy system. In the 7 cases, time interval from the previous stent implantation to ischemia recurrence was 1.0 to 72.0 months, and the median time was 6.0 months. The period from ischemia recurrence to endovascular therapy was 3 days to 2 years, and the median time was 62 days. Rotarex mechanical debulking catheter and percutaneous transluminal angioplasty (PTA) were used in all the cases, and the stent was used only when it was necessary. Anticoagulation was used for 24 hours after procedures and then antiplatelet agents were used as usual. Doppler ultrasonography was taken during the followed-up., Results: All the 7 cases were successful in technology, 3 of which were implanted with new stents for the fracture of the old ones. while for the other four cases, no new stent was implanted. The ankle-brachial index (ABI) increased from 0.31±0.08 to 0.86±0.08 after treatment ( t =-12.84, P < 0.001). Thrombectomy was applied urgently in one case because of acute thrombosis in the stent, and the result was good. There was no other complications in hospital. All the patients were followed up for 5.0-22.0 months, and the median time was 14.0 months. No death and amputation occurred during the follow-up. One patient stopped antiplatelet agents because of gastrointestinal bleeding, which resulted in acute thrombosis. in-stent restenosis reappeared in 3 cases., Conclusion: Debulking using Rotarex catheter is safe and effective in treating in-stent restenosis of PAD, especially in reducing stents implantation, but is not good at dealing with old thrombus and proliferating intima, and can do nothing about fractured stents and hyperplasia of intima, so it needs to be combined with stents and drug coated balloons.

Objective: To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound., Methods: Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT ® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed., Results: After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found., Conclusion: The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT ® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.

Objective: To summarize the preliminary experience of hybrid operation for the treatment of symptomatic long-segment chronic internal carotid artery occlusion (CICAO) without stump., Methods: Clinical data of 12 patients of symptomatic long-segment CICAO without stump undergoing hybrid operation treatment from July 2015 to December 2017 were retrospectively analyzed. The safety and efficacy of hybrid operation for the treatment of symptomatic long-segment CICAO without stump were preliminarily assessed. CICAO was defined as occlusion time being more than 4 weeks. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after hybrid operation within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period., Results: In this group, the symptomatic long-segment CICAO of 11 patients were successfully recanalized. Technical success rate was 91.7% (11/12). The main complication rate was 8.3% (1/12). This patient encountered iatrogenic internal carotid artery cavernous sinus fistula caused by micro-guide wire in the midway of the hybrid operation, the proximal segment of this internal carotid artery was ligated and the iatrogenic internal carotid artery cavernous sinus fistula disappeared in the following digital subtraction angiography image. No patient encountered hemorrhagic stroke and ischemic stroke. No death complications occurred. In this group 10 patients of them were followed up. The follow-up period ranged from 10 to 32 months [mean, (19±9) months]. During the follow-up period, 1 patients developed in-stent restenosis and improved after reoperation of percutaneous transluminal angioplasty by the right size balloon without stenting treatment., Conclusion: Hybrid operation for the treatment of highly screened patients with symptomatic long-segment CICAO without stump is safe and effective, could reduce the incidence of complications and improve procedural success rate.

Objective: To assess the safety and efficacy of Neuroform EZ stent used in treatment of symptomatic complex severe intracranial atherosclerotic stenosis (ICAS)., Methods: Clinical data of 18 patients with symptomatic complex severe ICAS undergoing Neuroform EZ stent angioplasty from January 2016 to December 2017 were retrospectively analyzed. All the lesions of the patients in this group were considered as complex ICAS, i.e. with severe tortuous access, long (>10 mm) or occlusive or bifurcation lesions, with concurrent aneurysms near the stenotic lesion. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after stenting procedure within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period., Results: All the 18 patients achieved technical success (100%) and mean stenosis rate was reduced from 85%±7% to 18%±6%. Of the 18 patients included, the 30-day stroke or death was 5.6% (1/18), which presented as basal ganglia region infarction in a patient with tandem lesions on the left vertebral artery. There was no hemorrhagic and death complications that occurred in the patients of this group. One concurrent aneurysm was embolized with micro coil (stent assisted) by stages after 1 month. In this group 12 patients were followed up with digital subtraction angiography (DSA) after hospital discharge. The follow-up period ranged from 8 months to 26 months [mean: (16±8) months]．During the follow-up period 2 patients in the 12 patients (2/12, 16.7%) developed in-stent restenosis (ISR) confirmed by DSA, and one of them was symptomatic restenosis and restored unobstructed blood flow after balloon angioplasty., Conclusion: Neuroform EZ stent for the treatment of highly screened symptomatic complex severe ICAS is safe and effective. It has its advantages over traditional stent.

Objective: To explore the risk factors, clinical characteristics, precaution and treatment of hyper perfusion syndrome (HPS) after carotid artery stenting (CAS)., Methods: From September 2014 to March 2018, the clinical data of 226 patients with severe carotid stenosis (70%-99%) treated with carotid artery stenting (CAS)at Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, were analyzed retrospectively．Five of them developed HPS after CAS．The relationship between the clinical baseline data, imaging characteristics, perioperative management and HPS were assessed., Results: In this group, 5 patients of them (2.21%, 5/226) developed HPS after CAS, and 2 patients of them (0.88%, 2/226) were hyper perfusion induced intracranial hemorrhage (HICH). The 5 patients consisted of 4 men and 1 woman whose age ranged from 58 to 74 years. The symptoms of HPS occurred within 4 hours to 3 days after CAS. Among the 5 cases, the clinical manifestations were that 2 cases with headache, 1 case with delirium,1 case with hemiparesis of left limbs, and 1 case with coma(died ultimately).The main manifestations of case 1 and case 2 were headache in the frontal parietal temporal region of the operative side, accompanied by nausea and vomiting. The symptoms were relieved after blood pressure lowering treatment and mannitol dehydration. The main manifestations of case 3 were excitement and delirium. The symptoms were relieved by a small dose of sedatives, also with blood pressure lowering treatment and mannitol dehydration. The initial symptoms of case 4 were excitement and delirium, accompanied by mild headache of the operative side, and hemiplegia of the contralateral limb occurred within a short time. The main manifestation of case 5 was severe headache and went into deep coma within a short time. This patient died of massive cerebral hemorrhage ultimately., Conclusion: HPS is an uncommon but serious complication after CAS. Improving our understanding and heightening vigilance of HPS is necessary. The earlier diagnosis, the earlier treatment.

Objective: To evaluate the effectiveness and safety of mechanical thrombectomy treatment in patients with acute ischemic stroke (AIS),and to explore influential factors of the clinical prognosis preliminarily., Methods: Clinical data of 26 patients with acute cerebral arterial occlusion treated with mechanical thrombectomy in Peking University Third Hospital from January 2014 to June 2017 were retrospectively collected. The immediate effects of the 26 patients in this group after mechanical thrombectomy treatment were analyzed,The national institutes of health stroke scale (NIHSS) scores between preoperative and at discharge of the 26 patients in this group were compared,and modified Rankin scale (mRS) scores of 90 days post operation were analyzed to assess the prognosis of the 26 patients in this group., Results: (1)In this group, 23 patients (88.5%) achieved vascular recanalization evaluated by thrombolysis in cerebral ischemia scale scores [thrombolysis in cerebral ischemia scale (TICI) scores, 3/2b grades were recognized as vascular recanalization], 19 patients of them reached TICI grade 3 and 4 atients reached TICI grade 2b. In this group 3 patients (11.5%) encountered symptomatic intracranial hemorrhage, 2 patients of them recovered after cerebral hemorrhage absorbed and 1 patient died of massive cerebral hemorrhage. In this group 4 patients (15.4%) died after mechanical thrombectomy treatment,2 patients died of hernia of the brain caused by severe cerebral edema, 1 patient died of symptomatic intracranial hemorrhage and 1 patient died of extensive subarachnoid hemorrhage. (2)The assessment of NIHSS scores at discharge(5.3±2.1)showed significantly lower than those preoperatively(12.6±4.2), P<0.01,and in this group 12 patients (46.2%) achieved favourable prognosis (defined as mRS scores 0-2), 6 patients of them reached mRS 0 score,4 patients reached mRS 1 score and 2 patients reached mRS 2 scores., Conclusion: Mechanical thrombectomy with stent retriever contributed to a high rate of vascular recanalization and favourable prognosis,but some patients had poor prognosis, suggesting that we should screen the enrolled patients strictly.

Objective: To investigate the significance of filtration fraction (FF) and renal artery stenting in the treatment of atherosclerotic renal artery stenosis., Methods: In the study, 42 cases of renal artery stenosis were treated with 52 renal artery stent implantation. Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients' health side kidney, ipsilateral kidney (renal) glomerular filtration rate (GFR), renal effective renal plasma flow effective renal plasma flow (ERPF), kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed., Results: The 52 cases of renal artery stent implantation were all successful. Preoperative ipsilateral GFR was significantly lower than that of normal side (t=-3.989, P=0.000); preoperative ipsilateral ERPF was significantly lower than the contralateral side (t=-4.926, P=0.000). On both sides, the overall FF values were equal (t=1.273, P=0.207). Postoperative ipsilateral renal GFR was increased, but there was no statistical difference (t=-1.411, P=0.164). Postoperative ipsilateral renal ERPF was increased significantly (t=-4.954, P=0.000), and FF lower (closer to the normal value (t=3.274, P=0.002). Postoperative side GFR was significantly reduced (t=2.569, P=0.000), the contralateral ERPF was significantly reduced (t=3.889, P=0.001), and FF had no significant change (t=-0.758, P=0.454). Postoperative side GFR was lower than that of the contralateral (t=-3.283, P=0.002) and postoperative side ERPF was still lower than that of the contralateral (t=-3.351, P=0.001), but on both sides, the FF values were equal (t=-0.361, P=0.719). Preoperative FF was relatively normal in the patients with kidney, and the postoperative FF value change was small (t=0.799, P=0.430); preoperative FF was significantly higher in the patients with kidney, and the postoperative FF value was lower than the preoperative (normal value, t=5.299, P=0.000). Postoperative overall serum creatinine was significantly decreased (t=2.505, P=0.016); but for the patients with unilateral renal artery stenosis, the changes in serum creatinine had no statistical difference (t=1.228, P=0.299); and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative, the changes were decreased significantly (t=2.518, P=0.030); postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t=8.945, P=0.000); antihypertensive drugs taken were decreased significantly compared with the preoperative (t=5.280, P=0.000)., Conclusion: For the patients with renal artery stenosis, FF is a useful index to understand the pathophysiological process of renal ischemia. Whether preoperative FF is significantly increased or FF is relatively normal, should be regarded as the indications of renal artery stent implantation.

Objective: To evaluate the safety and effectiveness of neglecting superficial femoral artery (SFA) recanalization for chronic lower extremity arteriosclerosis obliterans (ASO)., Methods: Thirty-six cases treated for severe stenosis or occlusion of superficial femoral artery resulted from ASO were randomly divided into 2 groups. Twenty of them were treated by endovascular reconstruction of superficial femoral artery and the other 16 cases were not treated with their superficial femoral artery, but were only treated with the accompanied iliac and/or profunda femoral artery lesion., Results: There was no significant difference between the two groups on mean age, gender, ABI before treatment, accompanied diseases, Rutherford classification and trans-atlantic inter-society consensus (TASC) classification (P>0.05).One week after operation, the reconstruction group had better marked effect and total effective rate [75.0% vs.12.5%(P<0.001); 90.0% vs. 37.5%(P=0.001)] and lower no effective rate [10.0% vs. 62.5%(P=0.001)], There was no significant difference between the two groups on effective rate [15.0% vs. 25.0%(P=0.675)]. The deteriorate cases in both groups were zero, and there was no morbidity of complications and death in both groups during the perioperative period. In the 3-month follow up, the reconstruction group had a better marked effect rate [65.0% vs.25.0%(P=0.017)];There was no significant difference between the two groups on the effective rate, no effective rate and total effective rate [20.0% vs.43.8%(P=0.124); 15.0% vs.31.3%(P=0.422); 85.0% vs.68.8%(P=0.422)]. The deteriorate cases and morbidity of complications and death in both groups during the perioperative period were still zero. In the 6- and 12-month follow ups, there were no significant differences between the two groups on marked effect and total effective rate [60.0% vs.37.5%(P=0.180), 80.0% vs.87.5%(P=0.672); 60.0% vs.43.8%(P=0.332), 85.0% vs.87.5% (P=1.000)]. The deteriorate case was zero in both groups, and there was no morbidity of complications and death in both groups. The limb salvage rate in both groups was 100% during the whole follow up period. The reconstruction group had a higher cost[(53 367.4±24 518.3) yuan vs.(30 397.5±15 354.4) yuan(P=0.011)]. There were 8 cases of SFA restenosis/ reocclusion during the follow up,three of which accepted another endovascular treatment, and the reoperation rate was 15.0%. while in the nonreconstruction group, there was no case that needed another endovascular therapy, and the reoperation rate was zero., Conclusion: Only dealing with accompanied iliac and profunda artery lesion and neglecting superficial femoral artery reconstruction is a safe, effective and inexpensive therapy for chronic lower extremity arteriosclerosis obliterans, and should be the preferred alternative for some patients.

Background: Balanced adjustment of the portal vein shunt volume during a transjugular intrahepatic portosystemic shunt (TIPS) is critical for maintaining liver perfusion and decreasing the incidence of liver insufficiency. A stent-graft is proved to be superior to a bare metal stent (BMS) for the construction of a TIPS. However, the clinical results of the combination application of stents and stent-grafts have not been determined. This study aimed to compare the technique of using a combination of stents and stent-grafts with using a single stent-graft to construct a TIPS., Methods: From April 2011 to November 2014, a total of fifty patients were randomly assigned to a stents-combination group (Group I, n = 28) or a stent-graft group (Group II, n = 22). Primary patency rates were calculated. Clinical data, including the technical success rate, bleeding control results, incidence of encephalopathy, liver function preservation, and survival rate, were assessed., Results: Technically, the success rate was 100% for both groups. The primary patency rates at 1, 2, and 3 years for Group I were 96%, 84%, and 77%, respectively; for Group II, they were 90%, 90%, and 78%, respectively. The survival rates at 1, 2, and 3 years for Group I were 79%, 74%, and 68%, respectively; for Group II, they were 82%, 82%, and 74%, respectively. The incidence of hepatic encephalopathy was 14.3% for Group I and 13.6% for Group II. The Child-Pugh score in Group I was stable at the end of the follow-up but had significantly increased in Group II (t = -2.474, P = 0.022)., Conclusions: The construction of a TIPS with either the single stent-graft or BMS/stent-graft combination is effective for controlling variceal bleeding. The BMS/stent-graft combination technique is superior to the stent-graft technique in terms of hepatic function preservation indicated by the Child-Pugh score. However, considering the clinical results of the TIPS, the two techniques are comparable in their primary shunt patency, incidence of encephalopathy and patient survival during the long-term follow-up.

Objective: To study the clinical effects of percutaneous transluminal angioplasty (PTA) versus stent implantation (ST) after PTA for the treatment of femoral and popliteal artery lesion resulted from arteriosclerosis obliterans., Methods: One hundred and three patients (119 limbs) treated for femoral and popliteal artery lesion resulted from arteriosclerosis obliterans for ten years were reviewed, of whom 60 limbs were treated by PTA and the other 47 by PTA combined with stent implantation., Results: Among the 60 limbs of the PTA group, there were 22 limbs involved only in femoral and popliteal artery; 13 limbs combined with iliac artery lesion; 17 limbs combined with infrapopliteal artery lesion; 8 limbs combined with iliac and infrapopliteal artery lesion. Among the 47 limbs of the ST group, there were 18 limbs involved only in femoral and popliteal artery; 8 limbs combined with iliac artery lesion; 15 limbs combined with infrapopliteal artery lesion; 6 limbs combined with iliac and infrapopliteal artery lesion. There was no significant difference between the two groups on age, sex, concomitant disease, ankle brachial index(ABI) before treatment and Rutherford classification (P>0.05). The patients' Trans-atlantic inter-society consensus (TASC) C/D was lower in the PTA group than that in the ST group (58.3% vs.76.6%, P=0.047).The follow-up periods were 48.0 (5.0,108.0) and 40.0 (3.0,96.0) months respectively (P=0.064). Compared with the PTA group, the ST group had a better short-term total effective rate (93.6% vs.80.0%, P=0.044) and a higher cost [(33 882.7 ± 8 695.6) yuan vs. (17 754.8 ± 3 654.2) yuan, P<0.001]. The short-term marked effective rate of the ST group was higher than that of the PTA group, but the difference was not significant (31.9% vs.21.7%, P=0.231). There was no significant difference between the two groups on short-term efficiency, and complication rates (58.3% vs. 58.3%, P=0.724; 1.7% vs.2.1%, P=1.000). There was no death during perioperative period and no short-term deterioration in both the groups. The long-term marked effective rate was lower and the deterioration rate was higher in the ST group than that in the PTA group, but the difference was not significant (8.5% vs. 15.0%, P=0.381; 14.9% vs. 5.0%, P=0.081).There was no significant difference between the two group on long term total effective rate,accumulative limb salvage rate and reoperation rate (66.0% vs. 66.7%, P=0.939; 94.7% vs. 94.1%, P=0.884; 31.9% vs. 31.7%, P=1.000), and the 1 to 10 years primary and secondary patency rates were similar (P=0.837, P=0.622).When compared based on TASC classification, TASC A/B patients in the ST group had a higher short-term marked effective rate, a higher short-term total effective rate and a higher long-term deterioration rate than those in the PTA group, but the difference was not significant (36.4% vs. 24.0%, P=0.353; 100.0% vs. 88.0%, P=0.322; 18.2% vs. 4.0%, P=0.216). TASC C/D patients had a similar result (30.6% vs. 20.0%, P=0.307; 91.7% vs. 74.3%, P=0.050; 13.9% vs. 5.7%, P=0.226). Both TASC A/B and TASC C/D patients in the ST group had a similar accumulative limb salvage rate with that in the PTA group (90.9% vs. 90.6%, P=0.920; 97.1% vs. 94.1%, P=0.796)., Conclusion: Stent implantation can increase the cost and short term effective rate at the same time and is not superior to PTA on the long term effective rate and limb salvage rate for femoral and popliteal artery lesion resulted from arteriosclerosis obliterans.

Objective: To evaluate the effectiveness and safety of endovascular treatment in solving symptomatic cerebral artery tandem lesions., Methods: From June 2012 to February 2014, 12 cases (24 lesions) with symptomatic cerebral artery tandem lesions were accepted for the endovascular treatment. The distributions of the tandem lesions were as follows: the common carotid artery and internal carotid artery (1 case), the internal carotid artery and the proximal of the carotid cavernous sinus segment (3 cases), the internal carotid artery and the distal of the carotid cavernous sinus segment (4 cases), the intracranial segment of internal carotid artery and middle cerebral artery M1 segment (2 cases), the first segment of vertebral artery and intracranial segment of vertebral artery (2 cases). All of these cases were treated from distal lesions to proximal lesions except for tandem lesions in the internal carotid artery and the distal of the carotid cavernous sinus segment in order to obtain better support. Tandem lesions were treated in the same operation with local anesthesia or general anesthesia. The procedures of the 12 cases retrospectively were analyzed and the peri-operation complications and responsibility region recurrent ischemic stroke incidents observed., Results: All tandem lesions were solved successfully all at once. There were no peri-operation complications or recurrent ischemic stroke incidents. There were no recurrent ischemic stroke incidents or stent restenosis cases in the follow-up., Conclusion: It is safe and effective for selective endovascular treatment in solving symptomatic cerebral artery tandem lesions at the same time, but we should take careful preoperative evaluation and improve the operation plan.

Objective: This study investigated the status of isolated superior mesenteric artery (SMA) dissection in the most populous country, China., Methods: The Chinese-language literature published before December 2014 was reviewed. All case reports and series were included. If multiple reports originated from the same hospital and included overlapping time frames, only the most recent report was included. The clinical characteristics, imaging features, and treatment were analyzed. "Symptom relief" was used as the outcome measure., Results: A total of 622 patients (88.5% male) with isolated SMA dissection were found in the Chinese-language literature. Patients were a mean age of 55.4 years. Analysis of the demographic data showed that isolated SMA dissection was most reported from the developed areas of China. The most common symptom (91.1%) was abdominal pain, and 42.7% patients had hypertension as a complication. Contrast-enhanced computed tomography was used to diagnose 95.2% of patients. The mean distance from the SMA ostium to the beginning of the dissection was 20.1 mm (range, 0-65.0 mm). The mean length of dissection was 63.1 mm (range, 10.7-205.9 mm). The percentages of patients who underwent primary conservative, surgical, and endovascular treatments were 63.2%, 3.2% and 33.6%, respectively. As primary management, the symptom relief rate of conservative management, with or without anticoagulation, was 62.6% and 86.5%, respectively. The best result of conservative treatment was achieved in cases of Yun type I and Luan classification type B. The symptom relief rate of surgical and endovascular treatment was 100% and 95.2%, respectively., Conclusions: The incidence of isolated SMA dissection may not be as rare as previously reported. Endovascular treatment of isolated SMA dissection is commonly used in China as a first-line treatment., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To study the clinical effects of endovascular reconstruction versus bypass surgery for TASC II(trans-atlantic inter-society consensus II) C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans., Methods: One hundred and three patients(119 limbs)accepted bypass surgery or endovascular therapy for TASCII C/D femoropopliteal artery lesion between January 2002 and December 2012 at our institution were retrospectively assessed.All the patients were diagnosed with arteriosclerosis obliterins, and all their Rutherford classifications were from 2 to 5 degrees.Among them there were 71 limbs treated by endovascular reconstruction and the other 48 limbs were treated with bypass surgery.We evaluated the short term clinical effect according to the condition when patients left the hospital, and evaluated the long term clinical effect according to the results of the patients' latest follow-up in 2014. Their clinical data before treatment, complication rates, death rates, hospital stays, short term and long term effects, reoperation rates, 1 to 10 years primary and secondary accumulative patency rates and limb salvage rates were compared., Results: There was no significant difference between the bypass group and the endovascular group on the mean age and ankle brachial index before treatment [(67.1 ± 7.1) years(51 to 80 years) vs. (68.0 ± 9.4) years (49 to 91 years), P=0.561;(0.41 ± 0.23) vs. (0.40 ± 0.26), P=0.928]. There were more TASCII D patients in the bypass group than those in the endovascular group (P<0.001), and the rutherford classification was higher in the endovascular group than that in the bypass group. The difference in the mean follow-up between the bypass group and the endovascular group was not significant [(41.7 ± 23.6) months vs. (59.5 ± 41.6) months, P=0.065]. Five peri-operative complication cases occurred in the bypass group, including 2 cases of acute thrombosis,1 case of infection and 2 cases of heart failure, and only 1 complication case occurred in the endovascular group that was heart failure.The complication rate was higher in the bypass group than that in the endovascular group [10.4% vs. 1.4%, P=0.039]. And there was no death in both the groups.Compared with the endovascular group, the bypass group had a longer hospital stays [(13.2 ± 4.7) d vs.(6.5 ± 3.1) d, P<0.001], a higher reoperation rate (58.3% vs.31.0%,P=0.003), a better short term, obvious, and effective rate (25.0% vs. 9.9%, P=0.027), a worse long term deterioration rate (37.5% vs. 18.3%, P=0.019) and higher 1 to 10 years primary and secondary accumulative patency rates(P=0.001, P=0.001).There was no significant difference between the two groups on the increase of ankle brachial index [(0.34 ± .28) vs. (0.31 ± 0.23), P=0.371], and short term and long term total effective rates (89.6% vs.84.5%, P=0.426; 45.8% vs. 56.3%, P=0.260), and limb salvage rate (83.3% vs.94.4%, P=0.051)., Conclusion: Endovascular therapy is a safe, effective and minimally invasive therapy for TASCII C/D femoropopliteal artery lesion resulted from arteriosclerosis obliterans.

Objective: To study the relative factors of type II endoleak after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms., Methods: Twenty-eight cases of abdominal aortic aneurysms treated by EVAR were retrospectively analyzed. The characteristics of the inferior mesentery arteries (IMA), the arc Riolan and the lumbar arteries of the cases with or without type II endoleak were analyzed., Results: Type II endoleak was found in 8 (28.6%) cases, of which, 2 were type IIa and 6 were type IIb. The diameter of the IMA originating part of the cases with type II endoleak [(4.03 ± 1.00) mm] was significantly bigger than that without endoleak [(2.89 ± 0.50) mm, P=0.007]. The number of the lumbar arteries originating from the aneurysm sac in cases with type II endoleak (3.4 ± 0.8) was significantly more than that without endoleak (1.9 ± 1.5, P=0.017). However, type II endoleak was irrelevant to the diameter of originating part of the lumbar arteries and the form of the arc Riolan. After the average 14.5 months follow-up, the aneurysm sac was found with shrinkage in 1 case, no change in 2 cases, and augment in 5 cases. Secondary transarterial embolization was performed for only 1 case., Conclusion: Type II endoleak was much easily found in cases with bigger diameter of originating part of the IMA, or in cases with more lumbar arteries originating from the aneurysm sac.

Objective: To analyze correlation factors of hemodynamic damage after carotid artery stenting., Methods: In this study, 66 cases (71 lesions) who undertook carotid artery stenting were collected and the correlation factors of hemodynamic damage were analyzed., Results: Hemodynamic damage emerged in 23 cases (32.4%), of which, 11.3% developed hypotension. The distance between bifurcation and lesions (P=0.0020), plaque distribution (P=0.0002), plaque character (P=0.0019), post-dilation (P=0.0026) were associated with hemodynamic damage by single factor analysis. However, only eccentric plaque (P=0.0153) and calcified plaque (P=0.0097) were associated with hemodynamic damage by multiple factors analysis. All the patients could reach stable circulation by drugs during operation, and no cerebral ischemic events (transient ischemic attack or stroke) and cardiovascular ischemic events happened., Conclusion: The distance between bifurcation and lesions, eccentric plaques, calcified plaques are correlation factors of hemodynamic damage.

Objective: To analyze the hemodynamic states of vertebrobasilar dolichoectasia based on computational fluid dynamics technique., Methods: The original DICOM format image data from a patient with vertebrobasilar dolichoectasia (VBD), were imported by the Mimics software directly,and the 3D Objects were constructed.The simulation of model was made with Ansys software, the hemodynamic parameters such as streamlines, wall shear stress (WSS) and wall pressure were described., Results: There was stable laminar flow in proximal basilar artery and was no blood flow mixed by bilateral vertebral artery.However, Spiral flows were appeared in distal tortuous basilar artery. The low WSS regions in the vertebrabasilar junction section and inferior segment of basilar artery were coincide with the high wall pressure regions.It could be speculated the initial growth regions might be located in the vertebrabasilar junction section and inferior segment of basilar artery.Local regions with low WSS and high wall pressure might be associated with the occurrence and development of VBD., Conclusion: CFD numerical simulation maybe can provide a theoretical basis for the role of hemodynamic factors in occurrence and development of VBD.

Objective: To study the morphology of middle cerebral artery (MCA) M1 segment., Methods: We selected the MRA data of 794 MCA (400 of the left side and 394 of the right side) from January 1, 2011 to June 30, 2011 consecutively and analyzed the morphology of the MCA M1 segment in axial, anteroposterior and lateral view, measured the length of the M1 segment, and analyzed the similarity of the left and right side M1 segment morphology., Results: In axial, anteroposterior and lateral view, the MCA M1 segment showed C-shape > L-shape > S-shape. In axial view, it was about 373 (47%) M1 segment performance for the C-shape, of which 340 (42.8%) M1 segments showed bowing to the dorsal side, only 33 (4.2%) M1 segments showed bowing to the ventral side. In anteroposterior view, it was about 322 (40.6%) M1 segments of the performance of the C-shape, of which 262(33.0%) M1 segments showed a bowing to the superior, 60 (7.6%) showed bowing to the inferior. The similarity of the left and right MCA M1 segments was 27.2% (114/419) in axial view and 42.7% (179/419) in anteroposterior view. It was more similar in anteroposterior view than in axial view. Along with the increase of age, in the axial view, L-shape converted to C-shape very obviously, but only mildly elevated in S-shape. In anteroposterior view, the L-shape converted to the C-shape or S-shape along with the increase of age., Conclusion: The different morphology of MCA M1 segment in axial and anteroposterior view may be involved in the development of intracranial atherosclerosis.

Objective: To study the importance of the internal iliac artery (IIA) during the endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA)., Methods: Forty-six consecutive cases of AAA treated by EVAR were retrospectively analyzed. The complications after exclusion of the IIA were analyzed., Results: The bilateral IIAs were reserved in 18 cases, in which the follow-up was achieved in 16 cases and no complication was observed. The IIAs were excluded in 28 (60.9%) cases, in which the bilateral, right and left IIAs were excluded in 7 (15.2%), 14 (30.4%) and 7 (15.2%) cases respectively. The follow-up was achieved in 26 cases. Buttock claudication was observed in 12 (46.2%) cases, altered bowel habit was observed in 8 (32.0%) cases, erectile dysfunction was observed in 3 (12.0%) cases, and bloody stool was observed in 2 (8.0%) cases. Comparing the bilateral and unilateral IIA exclusions, the rates of buttock claudication were 50.0% vs. 45.0%, altered bowel habit 33.3% vs. 31.6%, and erectile dysfunction 33.3% vs. 5.3% respectively. And the average duration of buttock claudication of bilateral IIAs exclusion (8.3 months) was longer than that of unilateral exclusion (4.7 months). Moreover, comparing the left and right IIA exclusions, the rates of buttock claudication were 57.1% vs. 38.5%, altered bowel habit 57.1% vs. 16.7%, and bloody stool 28.6% vs. 0 respectively. And the average duration of buttock claudication of left IIA exclusion (6.0 months) was longer than that of right exclusion (3.7 months)., Conclusion: The IIAs, especially the left IIA, should be reserved during the EVAR for AAA.

Objective: To introduce the technological modification of stents placement with combined naked self-expanding stent and stent-graft for the construction of portosystemic shunt during transjugular intrahepatic portosystemic shunt (TIPS)., Methods: In the study, 17 patients who suffered from upper digestive tract hemorrhage due to portal hypertension post liver cirrhosis underwent modified TIPS. The shunts were constructed with stepwise placement of naked self-expanding stent and a stent-graft other than stent-graft only for the purpose of precisely covering the parenchymal segment of the shunt and the active control of portosystemic gradient (PSG). The feasibility, safety, and clinical application results of the new technique were analyzed., Results: Technically, the success rate of operation was 100%. The mean PSG before and after TIPS was (28.2 ± 7.6) mmHg, (12.1 ± 3.5) mmHg, respectively (1 mmHg = 0.133 kPa, P < 0.001). One patient died 6 days after operation. The median follow-up period was 181 days (ranging from 32 days to 563 days) for all the other 16 cases, during which period 3 patients died because of encephalopathy, liver failure and septicemia, respectively, and 2 cases of encephalopathy occurred and were relieved with medical treatment. The shunts patency rate was 100% and no chance of digestive re-bleeding occurred. The mean Child-Pugh score before TIPS and at the end of the follow-up was (7.8 ± 2.0) points and (7.5 ± 1.7) points, respectively (P = 0.584)., Conclusion: The technological modification of TIPS with combined naked self-expanding stent and stent-graft for the precise covering of the parenchymal segment of the shunts was relatively simple to apply, and was helpful for the adjustment of PSG. The preliminary clinical application indicated that it had satisfying results in the matter of shunts patency, incidence of encephalopathy, and the relapse of digestive bleeding during the short-term follow-up.

Objectives: To analyze computed tomography (CT) imaging features of isolated dissection of the superior mesenteric artery (SMA)., Methods: The imaging findings of 20 consecutive patients with isolated dissection of the SMA were retrospectively evaluated and categorized according to a new imaging classification: Type A, dissections localized at the curved part of the SMA and extended proximally; Type B, dissections limited to the curved part; Type C or D, dissections localized at the curved part and extended distally without or with involved ileocolic or distal ileal arteries. The relationship between classification and symptoms and treatment effect is discussed, and prior reported cases where CT images were available were classified and analyzed., Results: The dissections were around the curved part of the SMA in all 20 patients. In symptomatic patients, the true lumen was more stenosed, the dissection started nearer the SMA ostium, and the dissection was longer. The best effect of conservative treatment was achieved in Type B cases. When dissection extended distally, the effect progressively worsened from Type B to Type D., Conclusions: The new classification is useful for describing the imaging features of isolated dissection of the SMA., (Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: We report our experience in the treatment of isolated superior mesenteric artery dissection and review the clinical and imaging features reported in the literature., Methods: A retrospective study was conducted of 18 consecutive patients with isolated superior mesenteric artery dissection who presented at the Peking University Third Hospital between September 2008 and May 2012. Their clinical characteristics, including age, sex, medical history, risk factors, symptoms, diagnostic imaging modality, and treatment, were analyzed. Also reviewed were 278 patients with isolated superior mesenteric artery dissection reported in the English language literature. The epidemiology, mechanism, clinical presentation, imaging features, and treatment were discussed., Results: There were 14 men and four women with a mean age of 55.6 years (range, 41-84 years). Four patients were asymptomatic, and 14 presented with acute-onset abdominal pain. The diagnosis was established by contrast-enhanced computed tomography in 17 patients and ultrasound imaging in one patient. All dissections were located at the anterior wall and around the convex curvature of the superior mesenteric artery. The decision to intervene was based on symptoms. Three asymptomatic patients underwent successful conservative management, and one asymptomatic patient with an aneurysmal dilated false lumen underwent endovascular stent placement. For the 14 symptomatic patients, definitive treatment included catheter-directed infusion of a vasodilator in four and stent placement combined with catheter-directed infusion of a vasodilator in 10, of whom one patient underwent hybrid stent placement. No complications or deaths occurred. During the mean 14.9-month (range, 1-40 month) follow-up period, all patients were asymptomatic, and patency of the superior mesenteric artery was demonstrated by contrast-enhanced computed tomography scan., Conclusions: Conservative management can be applied to asymptomatic patients with isolated superior mesenteric artery dissection. For symptomatic patients, stent placement is the definitive treatment if there is no arterial rupture or intestinal necrosis. Self-expanding bare stents that completely cover the curvature of the superior mesenteric artery are recommended. Catheter-directed infusion of a vasodilator can be an effective accessional process after stent placement., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Isolated iliac aneurysm is rare and difficult for surgery repair because it locates in the deep pelvis. Endovascular repair is preferred currently, and internal iliac artery is generally embolized in order to avoid the endoleak. Embolization of the internal iliac artery can lead to the complications such as buttock claudication, colon ischaemia and erectile dysfunction. Therefore, the antegrade flow of internal iliac artery should be reserved. One seventy-seven-year-old male patient with isolated left common iliac aneurysm, 30 mm in diameter, was successful endovascular repaired using fenestrated covered stent. At 1-month follow up, the patient was asymptomatic. Computed tomography scan shows the iliac aneurysm was completely excluded, and the antegrade flow of the left common, internal and external iliac arteries were normal.

From the water-soluble portion of the methanol extract of stems of Ficus tikoua Bur., a new benzofuran glucoside, named 6-carboxyethyl-5-hydroxybenzofuran 5-O-β-d-glucopyranoside (1), together with one known benzofuran glucoside (2) were isolated. Their structures were elucidated by 1D and 2D ((1)H-(1)H COSY, HMQC, and HMBC) NMR spectroscopy and HRMS techniques. The antioxidant activities of the isolated compounds were assayed based on the scavenging activities of DPPH free radical. Compounds 1 and 2 exhibited moderate antioxidant activities, and the IC(50) values were 242.8 μg·mL(-1) and 324.9 μg·mL(-1), respectively.

Primary erythermalgia (PEM) is recalcitrant and long-term remission is difficult to achieve. Favorable results of treatment using carbamazepine or mexiletine have been identified in some PEM patients with SCN9A gene mutations. However, no therapeutic studies regarding patients without pathogenic SCN9A gene mutation have been reported. Here we present a PEM case with R1150W polymorphism in SCN9A and a five-year remission was achieved by chemical lumbar sympathectomy (CLS). A 15-year-old girl with severe PEM attacks in both feet and lower legs was treated with CLS and followed up for five years. The encoding exons and their flanking sequences in the SCN9A gene were amplified and sequenced. A 50% immediate pain reduction was achieved after CLS. Burning pain, erythema and swelling in the lower legs disappeared in four days, and all ulceration healed in a month. The patient resumed normal exercise five months after CLS. There were no relapses in the following five years. R1150W polymorphism in SCN9A was detected in the patient and her healthy father. Long-term remission was achieved after CLS in this PEM case with R1150W polymorphism in SCN9A. The effectiveness of CLS and phenotype/genotype of PEM should be further studied in larger samples.

Tuberculous aneurysm of the aorta is a very rare disorder. There have been only 50 reported cases of tuberculous aneurysm since 1895 till now, of which 88% were false aneurysms with majority being single in number. And only four were found to have multiple tuberculous aneurysms. The mean ages of the patients were 50+/-16 years. Treatment of tuberculous aortic aneurysm must be a combined medical and surgical approach. Once tuberculous aneurysm is identified, surgery must be performed promptly. The size of the aneurysm does not influence the need for surgery. A 70-year-old male with intermittent episodes of abdominal pain after receiving an inappropriate antitubercular therapy for pulmonary tuberculosis was diagnosed as multiple false tubercular aneurysm of abdominal aorta. An aneurysm of base 3.3 cm and greatest diameter 5 cm x 6 cm was seen just above the opening of Coeliac trunk. Also at the dorsal aspect of abdominal aorta and superior mesenteric artery junction and ventral aspect of renal artery false aneurysms were seen, each with the size of 1 cm in diameter. Apart from antitubercular and antimicrobial treatment, first line surgery Endovascular Exclusion of Abdominal Aortic Aneurysm was performed for ruptured false abdominal aortic aneurysm. Even before the second line surgery, smaller abdominal aortic aneurysms got ruptured and the patient's party gave up further treatment. Finally the patient died of gastrointestinal haemorrhage.

Objective: To summarize the experience in treatment of Raynaud's syndrome with chemical thoracic sympathectomy (CTS) guided by X ray., Methods: From March 2001 to December 2002,35 cases (66 limbs) of Raynaud's syndrome were treated by CTS. Guided by X ray, a needle was punctured through the back skin to the second or third thoracic sympathetic ganglion beside the thoracic vertebrae and 2 ml of 5% phenol was injected., Results: The first CTS treatment produced an excellent effect on 32 limbs, good effect on 12 limbs, and no effect on 22 limbs with an effective rate of 66.7% (44/66). The same treatment was performed on the limbs without effect 1 - 2 days after the first treatment and produce excellent effect on 2 limbs, good effect on 6 limbs, and no effect on 14 limbs with an effective rate of 36.4% (8/22). The efficiency rate of the first hospitalization was 78.8%. The effective rate of treating primary Raynaud's disease by CTS was 88.5% and that of treating secondary one was 42.8%. 85% of the patients were followed up for 9 months on average with an efficiency rate of 61%., Conclusion: CTS is mini-invasive, cheap, easy to popularize, and a relatively ideal choice in treatment of Raynaud's syndrome. Complications can be minimum only if the operation is performed carefully.

Studies on the sound characteristics of phylodendron performed by measuring the power of plant leaves with a laser beam found that the leaves of phylodendron could produce sound waves at relatively low frequencies (from 50 Hz to 120 Hz). Furthermore, it was found that those leaves could accept external sound wave stimulations, with frequencies lower than 150 Hz giving the strongest responses. When the plants were under stress, such as drought, the sound emissions from the plant's leaves increased approximately 20-30 dB, while the range of response to external sound wave stimulation decreased 10-20 dB. However, these increased emissions returned to normal six minutes after watering. When the stainless steel needles were inserted into the petiole of the plant, spontaneous sound production was increased about 40 dB for the main vein and 6 dB for the mesophyll. This is our third report on experimental evidence that plants might have a meridian system as in humans and other animals.