BACKGROUND:To explore the methods for secondary limb revascularization after endovascular repair is one of the most urgent research topics.
OBJECTIVE:To investigate the biological mechanism about the transplantation of autologous peripheral blood stem cel s to lead and perfect the effect of ischemic tissue for secondary revascularization.
METHODS:Forty-two patients with critical low limb ischemia were selected and treated with endovascular repair as first revascularization and transplantation of autologous peripheral blood stem cel s as secondary revascularization. The secondary revascularization was carried out at 3 months after the first blood flow remodeling. The patients receiving secondary revascularization were fol owed for 4 years.
RESULTS AND CONCLUSION:After transplantation of autologous peripheral blood stem cel s, the patients complained that the rest pain of the lower leg was relieved obviously and intermittent claudication distance was significantly lengthened. Limb salvage rate was 100%. Skin temperature index was 1.6±0.3, transcutaneous oxygen pressure was (5.00±1.26) kPa, ankle-brachium index was 0.9±0.2, photoplethysmograpy index was 0.8±0.1, saturation of blood oxygen was (79.4±20.4)%, and digital subtraction angiography score was (1.3±0.2)
points. After transplantation, local blood flow indicators of the low limbs were positively correlated to local symptom indicators of the limbs (0.6

Clinical data management,a critical part of clinical trials,plays a decisive role in assuring the accuracy and reliability of the trail results.This article discusses the quality standards of clinical data,introduces the important rules and principles for standardized clinical data management,and reviews the development and current status of clinical data management home and abroad.It is proposed that we should learn the advanced clinical data management modes from international partners and introduce standardized clinical management software from abroad,so as to improve the clinical data management in China.

Objective To explore the expression of(hyopxia inducible factor-α,HIF-1α)and gax genes on the intimal hyperplasia for venous autografts in rat.Methods Sixteen Wistar rats were randomLy divided into 2 groups,a control group and an experimental group,8 rats in each group.A rat model of venous autografts was established by transplanting the right external jugulars vein into right common carotid artery in 16rats.The transplanted vein in the experimental group was immersed in solution with recombinant adeno-associated virus(rAAV)and HIF-1α by incubation for 45 minutes at 0℃-4℃ before anastomosis and coated using glue gel in which rAAV-gax added just after anastomosis,the control ones were immersed only in the physiological solution in which rAAV solution without HIF-1α gene added,nothing to be coated except for glue gel only.The vein grafts were taken at 14 days after operation,RT-PCR technique,Western blotting and electric microscopy were used to detect the expression of HIF-1α mRNA and protein,gax mRNA and protein,phenotypic switch of VSMC.Results The expression of HIF-1α mRNA,the experimental group(93.1±22.9)bP,the con trol group(42.7±15.9)bP,P<0.01;the exprossion of gax mRNA,the experimental group(106.9±38.7)bP,the contrd group(50.7±25.8)bP,P<0.01;the exprossion of HIF-1α protein,the experimental group(10.86±2.76)kD,the control group(4.52±1.90)kD,P<0.01;the expression of gax protein,the experimental group(13.65±3.35)kD,the control group(5.40±2.26)kD,P<0.01;VSMC proliferation,the experinental group(21.3±5.4)%,the control group(41.2±8.6)%,P<0.05.Conclusion The present study demonstrated that HIF-1α and gax genes transfection could inhibit proliferation of VSMC and their phenotypic conversion from contractile phenotype to synthetic phenotype in venous autografts.

Objective To investigate the efficiency of autologous transplantation of peripheral blood stem cell for treatment of patients with chronic lower limb ischemia. Methods Forty-six patients with chronic lower limb ischemia were treated by autologous peripheral blood stem cell transplantation. Results Fortytwo patients had pain relief on legs, and cold and cool feelings in lower limbs disappeared. Thirty-five patients had pain relief on feet, and 29 of them had disappearance of cold and cool feelings. Due to necrosis in middle and lower part of leg, 4 patients took extremity amputation after 4 weeks of the transplantation. In the 42 patients who kept their legs 3 months after transplantation, the distance of anginacruris extended from (87. 45 ±41.22) m to (348.52 ± 147.24) m, skin temperature increased from(28.52 ±0.51 ) ℃ to(33.56±0.62) ℃ ,and ankle-brachial index (ABI) increased from(0.48 ±0.06)to(0.75 ±0.07). There were statistical differences, and the scores of the distance of anginacruris, skin temperature, and ABI after transplantation were better than before. six months after transplantation autobiography of lower extremity was used, and neonatal lateral vessels of different degrees were found in 37 patients. Conclusion Autologous transplantation of peripheral blood stem cell is a simple, safe, and effective method, especially in treating patients with lower limb ischemia in which no arterial reconstruction is feasible.

Objective To investigate the effect of the down regulation of matriptase expression on invasion of human pancreatic cancers cells SW1990.Methods Small interfering RNA targeting at matriptase (Ma-siRNA) was transfected into human pancreatic cancers SW1990 cells,and nonsense siRNA (NC-siRNA) group was used as control.Real time PCR assay and Western blot were used to detect the expression of matriptase mRNA and protein.Transwell assay was used to examine the invasion ability of cancer cells.The enzymatic activity of matriptase and MMP-9 was determined by gelatin zymography assay.Results The expression level of matriptase mRNA in NC-siRNA group,12.5,25,50 nmol/L Ma-siRNA group were 1.000,0.417 ± 0.006,0.233 ± 0.068,0.221 ± 0.092;and the protein expression of matriptase were 0.736 ± 0.066,0.498 ± 0.036,0.341 ± 0.118,0.239 ± 0.050,respectively.The matriptase mRNA and protein expression in Ma-siRNA groups was significantly lower than those in NC-siRNA group,and the difference between the two groups was statistically significant (P ＜ 0.05).The enzymatic activity of matriptase were 1.501 ±0.165,1.211 ±0.265,0.645 ±0.165,0.620 ±0.003,and the enzymatic activity of MMP-9 were 0.929 ± 0.260,0.484 ± 0.364,0.352 ± 0.113,0.346 ± 0.121,and the enzymatic activity of matriptase and MMP-9 in 25,50 nmol/L Ma-siRNA groups was significantly lower than that in NC-siRNA group,and the difference was statistically significant (P ＜ 0.05 or ＜ 0.01).The number of transmembrane cell was (256 ± 1)/per 200 power field,and it was (109 ± 3)/per 200 power field in 25 nmol/L Ma-siRNA group,and the invasion ability of the cells in 25 nmol/L Ma-siRNA group was decreased by (57.4 ± 5.4) ％ when compared with that of control group.Conclusions Down-regulation of matriptase inhibits invasion ability of pancreatic cancer SW1990 cells,and this result may be due to the down regulated enzymatic activity of matriptase and MMP-9.

Objective To investigate the relationship between renin (REN) gene G10631A, angiotensinogen (AGT) gene T704C mononucleotide polymorphisms and cerebral infarction and to investigate the mechanisms and characteristics of cerebral infarction from molecular level. Methods REN gene G1063A and AGT gene T704C polymorphisms in 82 patients with cerebral infarction and 89 controls were detected with polymerase chain reactionrestriction fragment length polymorphism. The differences of the genotypes and allele frequencies were compared between the patient group and the control group. Results The frequency of REN 10631AA genotype (31. 7% vs. 10. 1%,χ2 =12. 816, P = 0. 002) and the frequency of A genotype (49. 4% vs. 30. 3% χ2 = 12. 969, P =0. 000), as well as the frequency of AGT 704 CC genotype (63. 4% vs. 34. 8% χ2 = 15. 029, P = 0. 001) and the frequency of A genotype (79. 9% vs. 61. 2% χ2 = 14. 173, P = 0. 000) in the cerebral infarction group were all significantly higher than those in the control group; the frequency of haplotype 704C 10631A was also significantly higher than that in the control group (P=0. 000). Conclusions REN 10631AA genetype and A allele as well as AGT 704 CC genetype and C allele may be the susceptible factors of cerebral infarction. Haplotype 704C-10631 A may be a genetic risk factor for the occurrence of cerebral infarction.

Objective:To report the diagnosis and surgical treatment of a special type of Maisonneuve injury.Methods:A total of 4 patients were treated at Department of Orthopaedics, Beijing Chao Yang Hospital from January 2015 to July 2019 for Maisonneuve injury. They were 3 males and one female, aged from 34 to 61 years (average, 45.3 years). All injuries were closed, initially manifested as posterior dislocation of the ankle on X-ray films and X-ray and CT re-exams after manual reduction showed fine reduction with no obvious fracture of the ankle joint. Consequently the diagnosis of their Maisonneuve injury was missed in emergency visits, but re-exams in outpatient visits showed separation of distal tibiofibular syndesmosis. All the patients were treated by restoration of the fibular length, fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate functional recovery of the ankle joint at 12 months after operation.Results:All the 4 patients were followed up for 12 to 14 months (average, 12.7 months). The fractures united after 110 to 185 days (average, 149.3 days). No post-operative complications like infection, delayed union or nonunion were observed. The AOFAS score at 12 months ranged from 82 to 96 points (average, 90.5 points), giving 3 excellent and one good cases.Conclusions:The Maisonneuve injury which is clinically manifested as posterior dislocation of the ankle with no obvious fracture of the ankle joint is likely to be missed in clinical diagnosis. Therefore, X-ray exam of the full length tibia and fibula should be taken in physical examination after reduction for the patients with simple posterior dislocation of the ankle. Once the special type of Maisonneuve injury is diagnosed, surgical treatment is indicated. Satisfactory treatment efficacy can be achieved by fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament.

The effects of positive end-expiratory pressure (PEEP) on pulmonary shunt were studied during gen- eral anesthesia and postoperative period.Twenty cholecystectomy patients were randomly divided into experiment group (group P) and control group (group Z). PEEP and ZEEP were used separately after induction. Artery blood and mixed blood from the right ventricle were taken for blood gas analysis and determine the amount of pulmonary shunting before anesthesia. half and hour, one and half an hour and two and half an hour after anesthesia and one hour after the operation.The results showed that shunt in group P decreased gradually during general anesthesia and returned to the level of preoperation at an hour after operation. Shunt in group Z was increased continually and the level was significantly higher than preoperation an hour after operation. Shunt between two groups was significant difference (P

Objective To investigate the protective effects of hyperbaric oxygen(HBO)against brain dam- age from hypoxic ischemia(HIBD)in neonatal rats.Methods One hundred and seventeen 7-day-old Sprague- Dawley rats were randomly divided into 4 groups:a control group(n=32),a hypoxic ischemia brain damage group (HIBD group,n=30),a hyperbaric air group(HBA group,n=27),and a hyperbaric oxygen group(HBO group, n=28).The HIBD model was established by permanent occlusion of the left common carotid artery followed by expo- sure to a mixture of 8% oxygen/92% nitrogen for 2 h(at 37℃).HBO therapy was administered to the HBO group after the hypoxia exposure once a day for 7 d,as was HBA therapy to the HBA group.Apoptotic cells in the cortex and hippocampus(A_(CH)cells)were measured using TUNEL at 9 d after birth,and the ratios of left and right cerebral hemisphere weight(R_(L/R))and rate of weight gain(GRW)were recorded 14 d after birth.A radial arm maze acquisi- tion test(RAMAT)was administered at 30 to 35 days.Lastly,the neuron density in the CA_1 subfield of the rats' hip- pocampi(ND_(CAI)was measured with Nissl staining.Results R_(L/R)and GRW in the HIBD group were significantly lower than in the control group(P＜0.01),while R_(L/R)was increased in the HBO and HBA groups,especially in the HBO group(P＜0.01),although there was no significant difference in GRW between the groups.Compared with the control group,A_(CH)cells were increased and ND_(CAI)was decreased in the HIBD group(P＜0.01),while A_(CH)cells were decreased and ND_(CAI)was elevated in the HBO group in comparison with the HIBD group(P＜0.01).There was no change in A_(CH)cells or ND_(CAI)in the HBA group.The RAMAT results for the HIBD group,including the time to find the arms baited with water,average times of working errors and reference memory errors,were significantly high- er than those of the control group,while these values for the HBO group were obviously lower than for the HIBD group,and there was no change for the HBA group(P＞0.05).Conclusion HBO therapy might increase the re- covery of learning and memory function by attenuating HIBD in neonatal rats.

Objective To explore factors related to the development of segmental instabilities in lumbar spine. Methods Fifty-seven patients with lumbar segment instabilities at L 4～5 were selected as illness group, 22 patients with facetectomy at L 4～5 as post-operation control group, and 19 healthy subjects as normal control. X-ray plain films were taken in sagittal,flexion and extension positions. Computed tomographic scans were taken to define the axial morphology of the facet joint. Magnetic resonance scans were taken to describe disc degeneration of 36 patients in illness group. Results The facet joint was oriented sagittally in the forward translation patients in flexion. The disc degeneration was slight in the rotational instability patients. The patients with total facetectomy exited forward translation in flexion. Conclusion A more sagittally oriented facet and disc degeneration are associated with forward translation in flexion and may be the cause of degenerative spondylolisthesis, whereas ligament failure is associated with rotational instability.