Objective To report the preliminary results of drug eluting stents (DES) in infrapopliteal bifurcation lesions after failed angioplasty.Methods From April 2011 to December 2013, 21 patients with critical limb ischemia and infrapopliteal atherosclerotic disease underwent DES placement in tibial bifurcation using 4 techniques: balloon and stent (single stent), T-shape double-stent, Crush double-stent and Culotte double-stent.Clinical and angiographic end points included: Amputation-free survival, target lesion revascularization (TLR)-free survival, target vessel revascularization (TVR)-free survival.Angiographic primary and secondary patency of DES, 2-vessel primary patency (2VPP), and 1-vessel primary patency (1VPP).Results Technical success was achieved in all patients (100％) without major intraoperative complications.ABI increased from 0.23 ± 0.07 to 0.67 ± 0.24 (P ＜ 0.05) after 1 week.The mean follow-up intervals were 23 ± 7 months;amputation-free survival, TLR-free survival and TVR-free survival were 100％, 90.5％ and 79.1％, respectively, at 1 year.8 patients underwent angiography reevaluation.The angiographic primary and secondary patency of DES were 62.5％, 87.5％, respectively.The primary patency of 2VVP and 1VVP were 28.6％, 57.1％, respectively at 1 year.Conclusions Bifurcation stenting techniques utilized in coronary arteries can be used in the infrapopliteal arteries.Although provisional stenting in the origin of tibial bifurcation cannot inhibit restenosis in distal lesions treated with balloon angioplasty, clinical outcomes and limb salvage rates are acceptable for these techniques.

BACKGROUND: As the preliminary experiment for gene therapy in intervertebral disc degeneration, this study aims to construct a recombinant plasmid containing fluorescent pAAV-hSOX9-IRES-tdTomato for adeno-associated virus packaging, in a broader attempt to lay the foundation for late experiments in vitro and in vivo.OBJECTIVE: To construct human SOX9 gene overexpressing adeno-associated virus, pAAV-hSOX9-IRES-tdTomato, packaging. METHODS: The plasmid pAAV-IRES-tdTomato and plasmid pUC57-hSOX9 were connected into pAAV-hSOX9-IRES-tdTomato by enzyme digestion method. The adeno-associated virus was packaged with plasmid co-transfections method. The recombinant pAAV-hSOX9-IRES-tdTomato was transfected into 293AAV cell by calcium phosphate transfection. The purification and drop of adeno-associated virus was tested by determination of biological titer. RESULTS AND CONCLUSION: The results of BLAST sequence comparison analysis showed that, pAAV-hSOX9-IRES-tdTomato exactly matched the synthetic gene sequence hSOX9. The titer is 1×107 TU/mL. Human gene SOX9 recombinant adenoviruses, pAAV-hSOX9-IRES-tdTomato, have been constructed successfully.

Objective: The molecular classification system of endometrial carcinoma (EC) in ‘The Cancer Genome Atlas’ is widely acknowledged for its prognostic utility. Subsequently, more simplified classification system that incorporate DNA polymerase epsilon (POLE) exonuclease domain mutations, mismatch repair deficiencies (MMRd), and abnormal p53 (P53abn) has also demonstrated its clinical utility. These classifications helped identifying a ‘POLE ultramutated’ (POLEmut) category of patients, most of whom show excellent prognoses despite having high-grade ECs. We aimed to investigate the clinicopathological and molecular characteristics of high-grade ECs with POLEmut. Methods: We investigated 414 patients with high-grade ECs (including endometrioid carcinomas grade 3, serous carcinomas, clear cell carcinomas, mixed carcinomas, undifferentiated and dedifferentiated carcinomas, and carcinosarcomas) by sequencing and immunohistochemical staining. Results: Forty-three tumors (10.4%) were classified as POLEmut, including 2 with new, possibly pathogenic POLE mutations at P286C and L424V. These patients had very good prognoses except for 1 with stage IV disease and residual tumor. Eleven patients in this group also had P53abn and 4 had MMRd; molecular analysis revealed that patients with synchronous POLE pathogenic mutation and other mutations had a POLEmut or MMRd phenotype; survival analysis found no difference in prognosis between these patient categories. The prognoses of patients in the POLEmut EC group were not significantly influenced by treatment or risk category. Conclusions Patients with high-grade EC exhibiting POLEmut have very good clinical outcomes, and should be identified urgently in daily work owing to their conflicting morphology. Our findings also provide guidance on subclassifying ECs with poor histological appearance.