"Vessels Collateral Theory", as the inherit and development of "blood vessels" in Huangdi Neijing, is a systematic system by integrating severe vascular diseases. In this article, by taking cardiovascular diseases (CVD) as a cut-in point, roles of "minute collateral-microvascular" lesions in the occurrence and development of CVD were further explored. The interventional effect of collateral-unblocking medicines under the guidance of Vessels Collateral Theory was also in-depth explored, hoping to leading Chinese medical prevention and treatment of CVD.
Cardiovascular Diseases ; drug therapy ; Humans ; Medicine, Chinese Traditional ; Research

Aim To study the effect of Tongxinluo on the polarization of macrophages to type M2 and M1, and on Notch signaling pathway.Methods THP-1 was respectively induced by PMA and IL-4 or LPS to M2 and M1 type polarized macrophages, and treated by Tongxinluo.The expressions of marker molecules IL-10, TNF-α, IL-6 and protein of Notch signaling pathway were detected.Results The level of IL-10 increased in M2 group and there was no statistical difference on the level of IL-6 and TNF-α;the level of IL-10 decreased and IL-6, TNF-α increased in M1 group;the level of IL-10 increased and IL-6,TNF-α decreased in TXL group.There was no statistical difference in the expression of active Notch-1, DLL4 and Hes-1 between control group and M2 group;the expression of active Notch-1, DLL4 and HES-1 increased significantly in M1 group;the expression of active Notch-1, DLL4 and HES-1 decreased significantly in TXL group;there was no significant difference in the expression of Notch-1 protein in each group.Conclusion The polarization of macrophages to M1 type can be inhibited by Tongxinluo, and its mechanism may be related to the inhibition of activation of Notch-1 signaling pathway.

BACKGROUNDNon-valvular atrial fibrillation is associated with an increased risk of ischemic stroke; however, the appropriate intensity of anticoagulation therapy for Chinese patients has not been determined. The purpose of this study was to compare the safety and the efficacy of standard-intensity warfarin therapy, low-intensity warfarin therapy, and aspirin therapy for the prevention of ischemic events in Chinese patients with non-valvular atrial fibrillation (NVAF).

METHODSA total of 786 patients from 75 Chinese hospitals were enrolled in this study and randomized into three therapy groups: standard-intensity warfarin (international normalized ratio (INR) 2.1 to 2.5) group, low-intensity warfarin (INR 1.6 to 2.0) group and aspirin (200 mg per day) group. All patients were evaluated by physicians at 1, 3, 6, 9, 12, 15, 18, 21 and 24 months after randomization to obtain a patient questionnaire, physical examination and related laboratory tests.

RESULTSThe annual event rates of ischemic stroke, transient ischemic attack (TIA) or systemic thromboembolism were 2.6%, 3.1% and 6.9% in the standard-intensity warfarin, low-intensity warfarin and aspirin groups, respectively (P = 0.027). Thromboembolic event rates in both warfarin groups were significantly lower than that in the aspirin group (P = 0.018, P = 0.044), and there was no significant difference between the two warfarin groups. Severe hemorrhagic events occurred in 15 patients, 7 (2.6%) in the standard-intensity warfarin group, 7 (2.4%) in the low-intensity warfarin group and 1 (0.4%) in the aspirin group. The severe hemorrhagic event rates in the warfarin groups were higher than that in the aspirin group, but the difference did not reach statistical significance (P = 0.101). The mild hemorrhagic and total hemorrhagic event rates in the warfarin groups (whether in the standard-intensity warfarin group or low-intensity warfarin group) were much higher than that in the aspirin group with the annual event rates of total hemorrhages of 10.2%, 7.6% and 2.2%, respectively, in the 3 groups (P = 0.001). Furthermore, there was no significant difference in all cause mortality among the three study groups.

CONCLUSIONIn Chinese patients with NVAF, the warfarin therapy (INR 1.6 - 2.5) for the prevention of thromboembolic events was superior to aspirin.

Aged ; Aged, 80 and over ; Anticoagulants ; administration & dosage ; therapeutic use ; Aspirin ; administration & dosage ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Warfarin ; administration & dosage ; therapeutic use

OBJECTIVETo provide anatomic evidence for identification of "holy plane" between fascia propria and its adjacent fascia in total mesorectal excision.

METHODSA total of 26 pelvic specimens of adult male preserved in 10% formalin solution were used in this study. Twenty pelvis were employed for topographic anatomy, six for sectional anatomy.

RESULTSRectovesical septum was formed by the ventral part of the fascia propria and Denonvilliers' fascia, with no blood vessel and nerve coursed between two layers. Dorsal part of the fascia propria parallelled with the presacral fascia, with no blood vessel and nerve coursed between two layers in 80% of the pelvis. However, anatomic variations was encountered occasionally--with muscle-like tissue or fusion of presacral fascia interposed between them for 20%. The lateral space of rectum was between lateral part of the fascia propria and parietal fascia which witnessed pelvic nerve plexus and lateral ligament of the rectum traveling. Pelvic nerve plexus was categorized as two types according the relation between fascia propria and nerve plexus: fusion type accounting for 85% and rarefaction type for 15%.

CONCLUSION'holy plane' is sandwiched between the fascia propria and its adjacent fascia--ventrally Denonvilliers fascia, dorsally presacral fascia and laterally parietal fascia.

Adult ; Autopsy ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Male ; Rectum ; anatomy & histology ; surgery

Objective:To explore anti-platelet/anti-coagulation treatment and their influence on prognosis in advanced aged patients with acute coronary syndrome (ACS)complicated atrial fibrillation (AF)after percutaneous coronary intervention (PCI).Methods:A total of 204 advanced aged ACS + AF patients treated in our heart center were se-lected.All patients received CHA2 DS2 Vasc score assessment,male had score ≥2 scores and female had score ≥3 scores.A total of 160 cases received dual anti-platelet therapy combined anticoagulant treatment of warfarin,and they were randomly divided into low intensity group [n=80,international normalized ratio (INR)remained 1.8~2.3]and high intensity group (n=80,INR remained 2.3~2.8),both groups were followed up for 18 months.Inci-dence rates of major adverse cardiovascular and cerebrovascular events (MACCE),ischemic and hemorrhage events were observed.Results:Both groups were followed up for a mean 18 months,and there were no significant differ-ence in all-cause mortality,incidence rates of MACCE and fatal hemorrhage between two groups,P > 0.05 all.Compared with low intensity group,there were significant rise in incidence rates of severe hemorrhage (3.8% vs. 12.5%),P <0.05.Conclusion:Low intensity warfarin anticoagulant therapy can effectively reduce incidence rates of MACCE and ischemic events,and incidence rate of hemorrhage events is low in advanced aged ACS + AF pa-tients after PCI.

Objective To evaluate the relationship between G894T(Glu298Asp) polymorphism in the endothelial nitric oxide synthase (eNOS)gene and essential hypertension in Chinese population from difierent regions.Methods Odds ratios(Ors) of G894T genotype and allele distributions in essential hypertension patients against healthy controls were analyzed.All the relevant studies were screened with poor-qualified studies eliminated.Meta-analysis software MIX(Meta-analysis with interactive explanations-version 1.71),was applied for investigating and analyzing heterogeneity among individual studies and summarizing the effects across studies,and the risk of publication bias was evaluated.Results A total of 1900 cases and 1216 controls from 10 studies were included.The heterogeneity between studies Was significant(P=0.013;P=0.011) and there were substantial sources of Publication bias(P=0.049;P=0.038).The pooled OR(with 95% CI) of GT+TT vs.GG genotype was 1.79(1.33-2.42)(Z=3.83,P<0.001),and the pooled OR (with 95% CI) of T vs.G allele Was 1.73(1.32-2.27)(Z=3.92,P<0.001).Conclusion In Chinese population,mainly the Hans ethnic group,894G→T mutation in the eNOS appeared to be related to essential hypertension.

Objective: To know the pre-treatment drug resistance ( PDR ) status of newly reported human immunodeficiency virus type 1 ( HIV-1 ) infected individuals in Wenzhou, so as to provide guidance for antiretroviral therapy ( ART ). Methods: Totally 232 plasma samples of newly reported HIV-1 infected individuals who had not received ART were collected in Wenzhou in 2019. Virus ( HIV-1 ) RNA was extracted, followed by reverse transcription PCR and nested PCR to amplify the pol region and sequence. Resistance mutations and resistance to non-nucleoside reverse transcriptase inhibitors ( NNRTIs ), nucleoside reverse transcriptase inhibitors ( NRTIs ) and protease inhibitors ( PIs ) was analyzed. Results: The pol region sequences from 199 infected patients were obtained and the incidence of PDR was 8.04% ( 16/199 ). Eight genotypes were detected, including circulating recombinant forms ( CRFs ) CRF07_BC ( 47.24%, 94/199 ) and CRF01_AE ( 29.15%, 58/199 ) which were the dominant types. Two unique recombinant forms ( URFs ) were detected, namely URF( CRF01_AE/BC ) and URF( B/C ) . Thirty-one cases ( 15.58% 31/199 ) had drug-resistant mutations. For NNRTIs, NRTIs and PIs, 20 cases ( 64.52% ) , 2 cases ( 6.45% ) and 9 cases ( 29.03% ) with drug resistance mutations were detected, respectively. The resistance mutations to NNRTIs included K101E, K103N/R, V106I, E138K, V179D/E/T, Y181C, G190A and H221Y. Four cases each had two resistance mutations to NNRTIs. The resistance mutations to NRTIs were V75M and M184V. The resistance mutations to PIs were M46I, L33F and Q58E. For the newly released NNRTI drug Doravirine ( DOR ), two cases were found to have mutations of resistance. Conclusions The incidence of PDR among newly reported HIV-1 patients in Wenzhou is 8.04%, mainly caused by NNRTIs drug-resistant mutation. Resistance to the new drug DOR has emerged. The surveillance of drug resistance should continue to be strengthened.

OBJECTIVETo study the efficacy of the protocol of combination of lamivudine with low dosage hepatitis B immuno-globulin (HBIG) to prevent HBV reinfection and of the treatment for HBV reinfection after liver transplantation.

METHODSFrom December 2000 to May 2003, 11 patients (follow-up is more than 1 year) had been transplanted due to HBV related end-stage liver disease or hepatocellular carcinoma. All patients received the protocol of combination of lamivudine with low dosage HBIG to prevent HBV reinfection after liver transplantation. Lamivudine was administered for more than 2 weeks. Preoperatively patients with HBV-DNA(-) and HBeAg(-) accepted HBIG 2000 IU intramuscular injection. Patients with HBV-DNA(+) or HBeAg(+) before operation accepted HBIG 4000 IU intramuscular injection, and patients with both HBV-DNA(+) and HBeAg(+) before operation accepted HBIG 6000 IU intramuscular injection. All patients took long-term lamivudine postoperatively. They accepted HBIG 800 IU/d for 1 week after transplantation. Two weeks after operation, dosage of HBIG was adjusted so that the titer of HBsAb was higher than 500 IU/L, but lower than 1000 IU/L, and this treatment lasted for 6 months. 6 months after operation, dosage of HBIG was adjusted so that tite of HBsAb higher than 300 IU/L but lower than 500 IU/L, and this treatment lasted for 6 months. One year after operation, dosage of HBIG was adjusted so that tite of HBsAb was higher than 100 IU/L but lower than 300 IU/L, and this treatment lasted for a long time. Examinations of liver function, HBV-DNA and hepatitis B were regularly taken. To observe the early turning to be negative rate, the later HBV reinfection rate, and the efficacy of the treatment for HBV reinfection.

RESULTSHBsAg, HBeAg and HBV-DNA in all patients turned to be negative in 1-4 days after operation. All patients responded to HBIG, and level of titer of HBsAb was elevated gradually. All patients was alive during the observation time. The regular examination of HBsAb showed that of HBsAb was in line with our expectation. Hepatitis B recurrence occurred in 1 patient 25 months after transplantation. Through using adefovir and adding the dosage of HBIG, the hepatitis B is in control.

CONCLUSIONSThe protocol of combination of lamivudine with low dosage HBIG proved to be highly effective and safe in preventing the recurrence of HBV after liver transplantation. It also reduced the cost obviously.

Administration, Oral ; Adult ; Antiviral Agents ; therapeutic use ; Carcinoma, Hepatocellular ; surgery ; Combined Modality Therapy ; Female ; Hepatitis B, Chronic ; prevention & control ; Humans ; Immunization, Passive ; Immunoglobulin G ; administration & dosage ; Injections, Intramuscular ; Lamivudine ; therapeutic use ; Liver Failure ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Retrospective Studies ; Secondary Prevention

OBJECTIVETo investigate the correlation of vascular endothelial growth factor D (VEGF-D) expression, microlymphatic density (MLD) and microvessel density (MVD) levels with the development and metastasis of rectal cancer.

METHODSEighty specimens from resected middle-lower rectal cancer diagnosed by pathology were examined by immunohistochemistry for VEGF-D,MLD and MVD. Simultaneously, 40 biopsy specimens from rectal polyps and 80 specimens from normal rectal tissue were examined as controls. Correlation between the expression of above three factors and the tumor size, gross morphology, histological type, metastasis, differentiation grade, infiltration depth, Dukes stage, lymph node metastasis and long-distance metastasis before operation were investigated with Spearman method.

RESULTS(1) Positive expression rate of VEGF-D was 55 % (44/80) in rectal cancer, and zero in rectal polyps and normal rectal tissues. The expression of VEGF-D in rectal cancer was significantly higher than that in rectal polyps and normal rectal tissues(P<0.05). MLD was significantly higher in rectal cancer (2.80+/-1.31) than that in rectal polyps (0.50+/-0.72) and normal rectal tissues(0.25+/-0.44)(P<0.05).Meanwhile MVD was significantly higher in rectal cancer (80.10+/-23.18) than that in rectal polyps (27.00+/-11.01) and normal rectal tissues (10.45+/-5.34) (P<0.05). (2) VEGF-D, MLD and MVD were positively correlated with lymph node metastasis and long-distance metastasis before operation (P<0.05). (3) VEGF-D was positively correlated with MLD (P<0.05) and MLD was positively correlated with MVD as well(P<0.05).

CONCLUSIONSLymphangiogenesis exists in rectal cancer tissues. VEGF-D and MLD can be used as good predictors of lymphangiogenesis and they are the important factors affecting biological behavior of rectal cancer. Lymphangiogenesis and angiogenesis may have a cooperative function in the development of rectal cancer.

Female ; Humans ; Lymphangiogenesis ; Lymphatic Metastasis ; Male ; Microcirculation ; Microvessels ; pathology ; Middle Aged ; Neoplasm Staging ; Neovascularization, Pathologic ; pathology ; Rectal Neoplasms ; blood supply ; pathology ; Vascular Endothelial Growth Factor D ; genetics ; metabolism

OBJECTIVETo explore the association of the expression of hypoxia-inducible factor 1α (HIF-1α) with microlymphatic vessel density(MLVD) and lymph node micro-metastasis in rectal cancer.

METHODSThe experimental group consisted of 40 middle-low rectal cancer specimens pathologically confirmed at the First Affiliated Hospital of Anhui Medical University between 2000 and 2003. Forty samples of normal tissues taken from the corresponding area around the cancer were used as the control group. Immunohistochemistry was used to detect HIF-1α expression and MLVD in both the tumor tissues and the adjacent normal tissues. Lymph node micrometastasis was ascertained using immunohistochemical staining with CK20.

RESULTSIn rectal cancer tissues, the HIF-1α expression was 77 386±14 911 and MLVD was 7.3±0.7, significantly higher than those in normal adjacent tissues(33 092±5877 and 0.3±0.2, both P<0.01). The HIF-1α expression was positively correlated with MLVD in rectal cancer(r=0.781, P<0.01). Thirty-one patients had no lymph nodes metastasis and 10 had micrometastasis. The HIF-1α expression and MLVD in specimens with lymph node micrometastasis was significantly higher than that in those without lymph node micrometastasis(P<0.05).

CONCLUSIONHIF-1α and MLVD play important roles in the development of rectal cancer,which may promote lymphatic micrometastasis in rectal cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Lymphatic Vessels ; pathology ; Male ; Middle Aged ; Neoplasm Micrometastasis ; Rectal Neoplasms ; metabolism ; pathology