BACKGROUNDCatheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) of the lower extremity has good effect, but whether iliac vein stent placement after thrombolytic therapy is still controversial. The goal of this study was to evaluate the efficacy of stent placement in the iliac vein following CDT in lower extremity DVT.

METHODSThis was a single-center, prospective, randomized controlled clinical trial. After receiving CDT, the major branch of the distal iliac vein was completely patent in 155 patients with lower extremity DVT, and 74 of these patients with iliac vein residual stenosis of >50% were randomly divided into a control group (n = 29) and a test group (n = 45). In the test group, stents were implanted in the iliac vein, whereas no stents were implanted in the control group. We evaluated the clinical indicators, including patency of the deep vein, C in CEAP classification, Venous Clinical Severity Score (VCSS), and Chronic Venous Insufficiency Questionnaire (CIVIQ) Score.

RESULTSAll patients had postoperative follow-up visits for a period of 6-24 months. Venography or color ultrasound was conducted in subjects. There was a significant difference between the patency rate at the last follow-up visit (87.5% vs. 29.6%) and the 1-year patency rate (86.0% vs. 54.8%) between the test and control groups. The change in the C in CEAP classification pre- and post-procedure was significantly different between the test and control groups (1.61 ± 0.21 vs. 0.69 ± 0.23). In addition, at the last follow-up visit, VCSS and CIVIQ Score were both significantly different between the test and control groups (7.57 ± 0.27 vs. 0.69 ± 0.23; 22.67 ± 3.01 vs. 39.34 ± 6.66, respectively).

CONCLUSIONThe stenting of iliac vein obstruction following CDT in lower extremity DVT may increase the patency of the deep vein, and thus provides better efficacy and quality of life.

Adolescent ; Adult ; Aged ; Catheterization, Peripheral ; methods ; Female ; Humans ; Iliac Vein ; Lower Extremity ; pathology ; Male ; Middle Aged ; Stents ; Thrombolytic Therapy ; methods ; Venous Thrombosis ; therapy ; Young Adult

BACKGROUNDInterventional therapy is widely accepted as the first choice for the treatment of the Budd-Chiari syndrome, but the use of radical correctional therapy should not be discarded. This study describes radical correction by controlling bleeding from distal end of pathological segment of the inferior vena cava (IVC) and discusses potential surgical errors and postoperative complications.

METHODSOf the 216 patients in the study, 78 were treated with simple membranectomy, 64 with dissection of the pathological segment of the IVC and vascular prosthesis or pericardial patch plasty, 60 with resection of the pathological segment of the IVC and orthotopic graft transplantation with vascular prosthesis, and 14 with resection of the occlusive main hepatic vein and its upper IVC, hepatic venous outflow plasty and vascular prosthesis orthotopic graft transplantation from the hepatic venous entrance to the IVC of right atrial ostium.

RESULTSExcept 14 cases who were discharged after hepatic vein outflow plasty, four cases died postoperatively, and 198 patients were discharged without complications. The symptoms of 15 patients were relieved partially and 2 without any change. There were no deaths intraoperatively. Of the 112 cases who were followed up for 72 months, 13 suffered from a relapse.

CONCLUSIONSRadical correction is a beneficial therapy in the treatment of Budd-Chiari syndrome.

Adolescent ; Adult ; Budd-Chiari Syndrome ; pathology ; surgery ; Child ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Vascular Surgical Procedures ; methods ; Vena Cava, Inferior ; surgery

OBJECTIVETo discuss the cause and treatment of acute limb ischemia in endovascular therapy of the lower extremity arterial occlusive disease.

METHODSClinical data of 54 cases of acute limb ischemia in the endovascular treatment of 685 cases of lower extremity arterial occlusive disease from June 2003 to April 2012 was analyzed retrospectively. There were 43 male and 11 female patients, with a mean age of 72.3 years (ranging from 56 to 82 years). The major causes which resulted in acute limb ischemia included: arterial embolization of 43 cases, arterial thrombosis of 8 cases, arterial dissection of 3 cases. The acute limb ischemia occurred in the process of balloon angioplasty/stent in 36 cases, catheter-directed thrombolysis in 17 cases, Silverhawk atherectomy in 1 cases. Thirty-two cases were treated by endovascular treatment, 9 cases by surgical procedures (bypass or embolectomy), 13 cases by the combination of endovascular therapy and surgical procedures.

RESULTSTreatment were successfully accomplished in 50 of 54 cases, and failed in 4 cases which had surgical amputation. There were no deaths in all the patients. Forty-five of 54 cases were followed up for the average of 40.3 months. Six cases had ischemic symptoms recurrence in 43 artery embolization patients, in whom 4 cases were cured by endovascular treatment, 2 cases were cured by toe amputation. One case of bypass anastomotic stenosis and one case of stent restenosis were successfully cured by endovascular treatment in 8 arterial thrombosis patients. One cases of below-knee artery stent occlusion in 3 arterial dissection patients was cured by medical treatment. Four cases of amputation patients were followed up in good condition.

CONCLUSIONSMost patients of acute limb ischemia complicated in endovascular therapy could be treated by endovascular therapy. Surgical procedures in time is still the best choice for the patients in whom the endovascular therapy was not satisfied.

Acute Disease ; Aged ; Aged, 80 and over ; Arterial Occlusive Diseases ; therapy ; Atherectomy ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Ischemia ; etiology ; prevention & control ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Retrospective Studies ; Stents

OBJECTIVETo investigate the effect of puerarin on the neural function and the histopathological changes after ischemic spinal cord injury in rabbits.

METHODSThirty male New Zealand white rabbits were randomly divided into three groups as follows: puerarin group (n=10) receiving intravenous infusion of 30 mg/kg puerarin for 10 minutes, control group (n=10) receiving intravenous infusion of the same volume of normal saline as puerarin for 10 minutes, and sham operation group (n=10) undergoing only the surgical exposure of the abdominal aorta. Temporary spinal cord ischemia was induced by infrarenal aortic occlusion for 20 minutes and followed by reperfusion. The neural status was scored with the Tarlov criteria at 8, 12, 24 and 48 hours after reperfusion. All the animals were killed at 48 hours after reperfusion and the spinal cords (L5) were removed immediately for histopathological study.

RESULTSThe neural function scores at 8, 12, 24 and 48 hours after reperfusion were higher in the puerarin group and sham operation group than those in the control group (P<0.05). More normal motor neurons in the anterior horn of spinal cord were present in the puerarin group and sham operation group than those in the control group (P<0.01). There was a strong correlation between the final neural function scores and the number of normal motor neurons in the anterior horn of spinal cord (r=0.839, P<0.01).

CONCLUSIONSPuerarin can significantly ameliorate the neural function and the histopathological damages after transient spinal cord ischemia in rabbits.

Animals ; Isoflavones ; pharmacology ; Male ; Motor Neurons ; pathology ; Rabbits ; Spinal Cord Ischemia ; drug therapy ; pathology ; physiopathology ; Vasodilator Agents ; pharmacology

BACKGROUNDPost-resuscitation myocardial dysfunction has been implicated as a major cause of fatal outcome in patients who survive initially successful cardiopulmonary resuscitation (CPR). In our previous study, we found that impaired myocardial β-adrenergic receptor (AR) signaling is a key mechanism in post-resuscitation myocardial dysfunction and Shen-Fu injection (SFI) can attenuate post-resuscitation myocardial dysfunction. However, whether SFI can prevent impaired post-resuscitation myocardial β-AR signaling is not yet known. In this study, we investigated the effect of SFI on impaired myocardial β-AR signaling occurring post-resuscitation in a porcine model of cardiac arrest.

METHODSVentricular fibrillation was induced electrically in anesthetized male landrace domestic pigs. After 4 minutes of untreated ventricular fibrillation, cardiopulmonary resuscitation was initiated. Sixteen successfully resuscitated pigs were randomized to receive a continuous infusion of either SFI (0.5 ml/min; n = 8) or saline (placebo; n = 8) for 6 hours, beginning 15 minutes after the return of spontaneous circulation (ROSC). Hemodynamic and echocardiographic data were recorded. β-AR signaling was assessed at 6 hours after the intervention by measuring myocardial adenylate cyclase activity, β-AR density and β-AR kinase expression.

RESULTSTreatment with SFI produced better maximum rate of left ventricular pressure increase (dp/dt(max)) and maximum rate of left ventricular pressure decline (-dp/dt(max)), cardiac output, and ejection fraction after ROSC. SFI treatment was also associated with lower myocardial β-adrenergic receptor kinase expression, whereas basal and isoproterenol-stimulated adenylate cyclase activity and the total β-AR density were significantly increased in the SFI group when compared with the placebo group.

CONCLUSIONSFI attenuated post-resuscitation myocardial dysfunction by preventing impaired myocardial β-AR signaling after CPR.

Animals ; Cardiopulmonary Resuscitation ; adverse effects ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Male ; Receptors, Adrenergic, beta ; metabolism ; Signal Transduction ; drug effects ; Swine

OBJECTIVETo explore the association between chronic periodontitis and hypertension in rural adult Uygur residents.

METHODSA total of 1415 Uygur residents aged 18 and over were selected by random multistage and probability proportional to size from 364 villages in Moyu county of Xinjiang Uygur autonomous region, all subjects received questionnaire, physical examination and biochemical analysis and oral examination. The subjects were categorized as periodontitis group and no periodontitis group, the periodontitis group was further categorized as mild, moderate and severe periodontitis subgroup. The relationship between chronic periodontitis with hypertension was analyzed by Spearman correlation. Binary logistic regression was used to calculate the influential factors for hypertension.

RESULTSThe prevalence rates of chronic periodontitis and hypertension were 66.0% (934/1415) and 33.8% (478/1415), respectively. The prevalence rates of hypertension were 18.7% (90/481), 35.1% (131/373), 32.3% (62/192), 52.8% (195/369) in no periodontitis, mild, moderate and severe periodontitis groups, respectively. Spearman correlation showed an association of chronic periodontitis with hypertension (r(s) = 0.273, P < 0.01). After adjustment for age, gender, body mass index, waist circumference, glycometabolism disorder, hyperlipidemia, chronic kidney disease, multiple logistic regression analysis showed that periodontitis was significantly associated with hypertension (OR = 1.75, 95%CI: 1.30 - 2.36, P < 0.01). Compared with no periodontitis, mild (OR = 1.76, 95%CI: 1.26 - 2.48, P < 0.01) and severe (OR = 2.26, 95%CI: 1.57 - 3.26, P < 0.01) periodontitis were significantly associated with hypertension while moderate periodontitis was not significantly associated with hypertension (OR = 1.21, 95%CI: 0.80 - 1.84, P > 0.05).

CONCLUSIONThis study showed an independent association of periodontitis with hypertension in this study cohort.

Adult ; Asian Continental Ancestry Group ; China ; epidemiology ; Chronic Periodontitis ; epidemiology ; Female ; Humans ; Hypertension ; epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Rural Population ; Surveys and Questionnaires

BACKGROUNDIliac vein compression syndrome (IVCS), the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS.

METHODSBetween January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.

RESULTSThe stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.

CONCLUSIONSEndovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

Adolescent ; Adult ; Angioplasty, Balloon ; Female ; Humans ; Iliac Vein ; pathology ; Male ; Middle Aged ; Peripheral Vascular Diseases ; pathology ; therapy ; Phlebography ; Stents ; Young Adult

BACKGROUNDCholesterol-lowering therapy with statins has been reported to reduce the morbidity and mortality of cardiovascular diseases. This study aimed to investigate the effects of combined application of extended-release niacin and atorvastatin on lipid profile modification and the risks of adverse events in patients with coronary artery disease.

METHODSConsecutive 108 patients with coronary artery disease and serum total cholesterol (TC) > or = 3.5 mmol/L were randomized into two groups: group A using atorvastatin and group B using extended-release niacin (niacin ER) and atorvastatin. Plasma lipid profile, glucose, and adverse events were assessed at the hospitalization, and 6 and 12 months after treatment. In addition, clinical cardiovascular events were evaluated after 12 months of treatment.

RESULTSThe levels of TC, low density lipoprotein cholesterol (LDL-C) were significantly decreased (P < 0.05) in groups A and B, but the levels of high density lipoprotein cholesterol (HDL-C) and ApoA increased by 29.36% and 40.81% respectively after 12 months of treatment in group B (P < 0.01). The medications were generally well tolerated in the two groups. No significant difference of adverse events was found between the two groups (group A: 3.2% vs group B 5.1%, P > 0.05).

CONCLUSIONSCombined use of extended-release niacin with atorvastatin was superior to atorvastatin monotherapy alone in lipid profile regulation. Combination therapy with niacin ER and atorvastatin was well tolerated and safe in patients with coronary artery disease.

Aged ; Anticholesteremic Agents ; pharmacology ; therapeutic use ; Apolipoproteins A ; blood ; Atorvastatin Calcium ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Coronary Artery Disease ; drug therapy ; Female ; Heptanoic Acids ; pharmacology ; therapeutic use ; Humans ; Lipid Metabolism ; drug effects ; Male ; Middle Aged ; Niacin ; pharmacology ; therapeutic use ; Pyrroles ; pharmacology ; therapeutic use

Purpose: Radiomic models elaborate geometric and texture features of tumors extracted from imaging to develop predictors for clinical outcomes. Stereotactic body radiation therapy (SBRT) has been increasingly applied in the ablative treatment of thoracic tumors. This study aims to identify predictors of treatment responses in patients affected by early stage non-small cell lung cancer (NSCLC) or pulmonary oligo-metastases treated with SBRT and to develop an accurate machine learning model to predict radiological response to SBRT. Materials and Methods: Computed tomography (CT) images of 85 tumors (stage I–II NSCLC and pulmonary oligo-metastases) from 69 patients treated with SBRT were analyzed. Gross tumor volumes (GTV) were contoured on CT images. Patients that achieved complete response (CR) or partial response (PR) were defined as responders. One hundred ten radiomic features were extracted using PyRadiomics module based on the GTV. The association of features with response to SBRT was evaluated. A model using support vector machine (SVM) was then trained to predict response based solely on the extracted radiomics features. Receiver operating characteristic curves were constructed to evaluate model performance of the identified radiomic predictors. Results: Sixty-nine patients receiving thoracic SBRT from 2008 to 2018 were retrospectively enrolled. Skewness and root mean squared were identified as radiomic predictors of response to SBRT. The SVM machine learning model developed had an accuracy of 74.8%. The area under curves for CR, PR, and non-responder prediction were 0.86 (95% confidence interval [CI], 0.794–0.921), 0.946 (95% CI, 0.873–0.978), and 0.857 (95% CI, 0.789–0.915), respectively. Conclusion Radiomic analysis of pre-treatment CT scan is a promising tool that can predict tumor response to SBRT.

BACKGROUND/AIMS: To investigate the effects of esomeprazole and rebamipide combination therapy on symptomatic improvement in patients with reflux esophagitis. METHODS: A total of 501 patients with reflux esophagitis were randomized into one of the following two treatment regimens: 40 mg esomeprazole plus 300 mg rebamipide daily (combination therapy group) or 40 mg esomeprazole daily (monotherapy group). We used a symptom questionnaire that evaluated heartburn, acid regurgitation, and four upper gastrointestinal symptoms. The primary efficacy end point was the mean decrease in the total symptom score. RESULTS: The mean decreases in the total symptom score at 4 weeks were estimated to be −18.1±13.8 in the combination therapy group and −15.1±11.9 in the monotherapy group (p=0.011). Changes in reflux symptoms from baseline after 4 weeks of treatment were −8.4±6.6 in the combination therapy group and −6.8±5.9 in the monotherapy group (p=0.009). CONCLUSIONS: Over a 4-week treatment course, esomeprazole and rebamipide combination therapy was more effective in decreasing the symptoms of reflux esophagitis than esomeprazole monotherapy.
Esomeprazole* ; Esophagitis, Peptic* ; Heartburn ; Humans