The evaluation systems for chronic venous insufficiency of lower extremities play a very important role in standardizing the diagnosis and evaluating the curative effect in patients with the disease. This paper gives an introduction to the CEAP classification system, VSS evaluation system and chronic venous insufficiency questionnaire.

Objective To dynamically observe the concentrations of plasma neuropeptide Y(NPY)in the patients with lower extremity arteriosclerosis obliterans(ASO)before and after vascular interventional therapy.Methods The levels of plasma NPY were detected by radioimmunoassay in 13 patients with lower extremity ASO(ASO group)before vascular intracavitary therapy and immediately,1 d,3 d and 5 d after vascular intracavitary therapy.Meanwhile,15 healthy subjects were served as control group.Besides,the ankle-brachial indexes(ABI)and clinical staging of ASO group were also obtained and compared before and 3 d after vascular intracavitary therapy.Results Compared with control group,the level of NPY in ASO group was much higher before vascular intracavitary therapy[(250.67?88.27)pg/mL vs(168.40?64.64)pg/mL,P

Objective To study endothelial nitric oxide synthase (eNOS) gene transfecting endothelial cells (ECs). Methods eNOS gene was transfected into the steady ECs system by cationic liposomal transduction and check the transfection effect by RT-PCR and immunohistochemistry assay. To test the concentrations of NOS, nitric oxide (NO) and von willebrand factor (vWF) in culture media by colorimetry and ELISA, respectively,and transfected EC function was observed. Results The effect of transfection was satisfactory with RT-PCR products electrophoresis, sequence and immunohistochemistry. The concentrations of NOS and NO in transfected EC culture media increased with time (P

Objective To amplify all immunoglobulin V genes of human atherosclerosis by PCR and to sequence the products of PCR cloned into T-vector. Methods Peripheral blood samples of 50 patients with atherosclerosis were collected,from which lymphocytes were segregated by density gradient centrifugation and total RNA was extracted by TRIzol reagent.V genes of VL(including VK and V?) and VH were amplified by RT-PCR,and the products were digested by restriction enzyme and then cloned into T-vector.Two clones were picked randomly to sequence.(Results)Total RNA were extracted purely with integrity,and all V genes of VL and VH were amplified by PCR successfully.The sequences were highly homologous to human immunoglobulin genes. Conclusion All immunoglobulin V genes of human artherosclerosis were amplified successfully,which lays a foundation for the construction and (selection) of phage library.

OBJECTIVETo explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS).

METHODA total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies: anticoagulant group (41 limbs), thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS.

RESULTSThe average time of follow-up were (41 ± 19) months in anticoagulant group, (52 ± 11) months in thrombolysis group, and (26 ± 10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58.5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS (P < 0.05). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0.5 ± 1.0) cm and (0.7 ± 1.0) cm, which were more obvious compared to other two groups (P < 0.05). Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS.

CONCLUSIONSThe incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheter-directed thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.

Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; therapeutic use ; Female ; Fibrinolytic Agents ; therapeutic use ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Thrombolytic Therapy ; Treatment Outcome ; Venous Thrombosis ; diagnosis ; drug therapy ; Young Adult

OBJECTIVETo evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings in patients with autoimmune pancreatitis (AIP).

METHODSThe imaging findings of pancreas and extra-pancreas in 24 patients with AIP were retrospectively reviewed. Among them, CT scan was performed in 18 patients, MRI in 11, and bGth CT and MRI in 10.

RESULTSThe pancreas showed diffuse enlargement (25%, 6/24), focal enlargement (37. 5%, 9/24), combined enlargement (25%, 6/24) ,and no enlargement (12. 5%, 9/24). Unenhanced CT showed hypoattenuation in AIP area (n = 2) . After intravenous injection of contrast medium, 17 patients showed abnormal contrast enhancement in the affected pancreatic parenchyma, including hypoattenuation during the arterial phase (50%, 9/18) and hyper attenuation during the delayed phase (94. 4%, 17/18). Precontrast MRI showed abnormal signal intense (n =9), including hypointense on T1-weight images (T1 WI) (n = 7), hyperintense (n = 7) and hypointense (n = 2) on T2-weight images (TIWI). Enhanced MRI demonstrated abnormal contrast enhancement within lesions (n = 11), including hypoattenuation during the arterial phase (81. 8%, 9/11) and good enhancement during the delayed phase (100%, 11111). A capsule-like rim was seen around pancreas (37. 5%, 9/24), among which CT detected in 6 out of 18 patients and MRI found in 7 out of 11 patients.The main pancreatic duct lumen within lesions has no visualization (100%, 24/24) and upstream dilation of the main pancreatic duct (n = 8) , ranging from 2. 2 to 4. 5 mm(mean 3. 1 0. 47 mm) in diameter. Narrowing of the common bile duct was shown in 14 patients. Miscellaneous findings were: infiltration of extrapancreatic vein (n = 9) and artery (n = 1); mild fluid collection around pancreas (n = 2); pseudocysts (n = 3). Fourteen patients also presented one or more of the following extrapancreatic imaging findings: narrowing of the intra-hepatic bile duct or hilar duct (n = 5); thickening of gallbladder wall (n = 5); fibrosis in mesenteric (n = 2), in retroperitoneal (n = 2) and in ligamentum teres hepatis (n = 1); renal involvement (n = 3); peri-pancreatic or para-aortic lymphadenopathy (n = 10); and ulcerative colitis (n = 3).

CONCLUSIONAIP display some characteristic CT and MRI imaging features: sausage-like change of the pancreas; capsule-like rims around lesions; delayed contrast enhancement in the affected pancreatic parenchyma; segment or diffuse pancreatic duct stenosis but mild upstream dilation and extrapancreatic organs involvement. CT and MRI findings combining with serological tests and pancreas biopsy can assist physicians to make accurate and timely diagnosis.

Adult ; Aged ; Autoimmune Diseases ; diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; pathology ; Pancreatitis ; diagnosis ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUNDThe influence of inflammatory processes has been one of the hot topics in discussions of the etiology of chronic venous insufficiency (CVI). Erythrocytes are very important in controlling inflammatory immunity and innate immune reactions. The purpose of this study was to analyze the correlation between the development of CVI and the change of CD35, Fy6 on erythrocytes, and interleukin-8 (IL-8) levels.

METHODSA group of 43 patients with CVI were studied in parallel with 8 healthy individuals serving as control subjects. Control subjects were those with normal findings on lower extremity duplex examinations. We used an erythrocyte flow cytometer to examine the expression of both CD35 and Fy6 on red blood cells, and an enzyme-linked immunosorbent assay analysis method to measure plasma IL-8 levels. We also analyzed the change of IL-8 levels under the influence of erythrocytes using a modified method of the hemaimmune reaction.

RESULTSCompared with normal control subjects, CD35 expression increased significantly among patients with CVI classified as C4 without lipodermatosclerosis, but tended to decrease and reach the lowest level among patients classified as C5-C6. Fy6 expression increased significantly among patients in the early stages of CVI, but tended to decrease remarkably among patients classified as C5-C6. The inflammatory response intensified at the C5-C6 classification, where high levels of IL-8 coexisted with a low expression of Fy6. The increase in IL-8 in the CVI group was higher than in the control group in association with the complete blood cells, regardless of the presence of erythrocytes, when inactive tumour cells were added, whereas the level of IL-8 in the CVI group was significantly lower than in the control group.

CONCLUSIONSAbnormalities of erythrocyte innate immunity represents a fundamental derangement in CVI. These inadequate inflammatory responses may lead to local tissue and microvascular damage of the lower extremity.

Chronic Disease ; Duffy Blood-Group System ; blood ; Erythrocytes ; immunology ; physiology ; Humans ; Interleukin-8 ; blood ; physiology ; Leg ; blood supply ; Receptors, Cell Surface ; blood ; Receptors, Complement 3b ; blood ; Venous Insufficiency ; immunology

OBJECTIVETo test the function of endothelial cells transfected eNOS gene.

METHODSTo test the function of eNOS-overexpressing endothelial cells inhibiting smooth muscle cell proliferation and platelet aggregation in vitro by colorimetry, MTT and (3)H-TdR permeate, respectively, in four different endothelial cells groups.

RESULTSThe platelet aggregation is significantly decreasing between the groups of EC and eNOS at the different time (P < 0.05), is 42.2 and 32.6 separately at the time of 120 h. The SMC proliferation is significantly decreasing between the groups of EC and eNOS at the different time (P < 0.05). It is 0.28 and 0.22 by MTT test, 4691 and 3995 by (3)H-TdR permeate separately at the time of 120 h.

CONCLUSIONSeNOS-overexpressing endothelial cells inhibited significantly smooth muscle cells proliferation and platelet aggregation in vitro; which shows powerful effect 48 hours post transfection and lasts up to 120 hours at the least; and were held back by L-NAME.

Animals ; Cell Communication ; Cell Proliferation ; Coculture Techniques ; Dogs ; Endothelial Cells ; cytology ; Endothelium, Vascular ; cytology ; Myocytes, Smooth Muscle ; cytology ; Nitric Oxide ; metabolism ; physiology ; Nitric Oxide Synthase Type III ; genetics ; Platelet Aggregation ; physiology ; Transfection

OBJECTIVETo investigate the patency efficacy of small diameter artificial vascular graft with eNOS gene transfected endothelial cells in canine.

METHODSBy using the two steps high pressure injection, eNOS gene transfected endothelial cells were planted on artificial vascular graft with a diameter of 3 mm. The artificial vascular grafts were transplanted into canine femoral artery, and the patency of the artery was observed through digital subtracted angiography (DSA) and electron telescope 1, 4, 12 and 24 weeks after the operation.

RESULTSThe adherence rate of eNOS gene transfected endothelial cells to artificial vascular grafts was up to 90%. For 10 days, the cells extended and formed a continuous intima. One week after the operation, 3/9 grafts were obstructed in the group of simple artificial vascular grafts; 4 weeks after, all of grafts (9/9) were obstructed in the group of simple artificial vascular grafts and almost half grafts (5/10, 4/9) in un-transfected groups were obstructed; 12 weeks after, all of the grafts were obstructed in the group of simple artificial vascular grafts and in un-transfected groups (9/9, 9/10); 24 weeks after, all of the grafts were obstructed in the groups of un-transfected artificial vascular grafts, while nearly all of grafts (8/10) were open in eNOS groups. Electron microscope scanning showed that endothelial cells of artificial vascular grafts in eNOS transfected groups arranged closely and formed a continuous intima; only few red blood cells, leucocytes, platelets deposited at the surface of endothelial cells in the artificial vascular grafts.

CONCLUSIONSThe patency efficacy of eNOS gene transfected endothelial cells planting on artificial vascular graft is satisfactory. It could provide an experimental basis for further clinical application of the artificial vascular grafts.

Animals ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Cells, Cultured ; Dogs ; Endothelial Cells ; cytology ; metabolism ; Female ; Genetic Vectors ; Male ; Nitric Oxide Synthase ; genetics ; Random Allocation ; Transfection

OBJECTIVETo evaluate the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI).

METHODSNinety-seven limbs in 97 patients who were proved to be PDVI by ascending venography were divided into Group A (79 limbs) and Group B (18 limbs). Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins. And they were also treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins at the same time. Patients of Group B were simply treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins. Ascending venography and CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation.

RESULTSThe difference between preoperative and postoperative scores of Group A and Group B were both remarkable (Group A, P < 0.01; Group B, P < 0.05). The difference of scores, which equated to preoperative scores minus postoperative score, between Group A and Group B were also prominent (P < 0.01). Post-operation ascending venography was performed on 67 limbs in Group A. The effective rate of the operation is 83.58% (28 + 28/67), obviously effective rate is 41.79% (28/67). Same exam was performed on 12 limbs in Group B and the effective rate of the operation is 33.33%. The difference between two groups' effective rate is significant (P < 0.05).

CONCLUSIONSClinical scoring of Group A decreased much more than Group B; The effective rate of Group A in ascending venography is also much higher than Group B. Encircling constriction of superficial femoral vein is useful to relief the symptom and recover the shape and function of the valve of superficial femoral veins. Those who are diagnosed to be PDVI by means of pre-operation ascending venography and Valsalva test should accept the operation of the encircling constriction of superficial femoral vein.

Adult ; Aged ; Aged, 80 and over ; Female ; Femoral Vein ; surgery ; Follow-Up Studies ; Humans ; Ligation ; Male ; Middle Aged ; Saphenous Vein ; surgery ; Treatment Outcome ; Vascular Surgical Procedures ; methods ; Venous Insufficiency ; surgery