Objective To explore the clinical experience of endovascular treatment for arteriosclerosis obliterans (ASO) of lower extremities.Methods Endovascular treatment were performed on 22 patients (26 limbs) suffering from ASO which were diagnosed by magnetic resonance angiography (MRA).The clinical efficacy after operation was analyzed.Results Twenty-two lower extremities of 18 patients successfully accepted endovascular treatment with 12 stents planted without major complications.Four cases failed to endovascular treatment and 2 of them converted to bypass surgery.The clinical symptoms of limb ischemia vanished or significantly improved after treatment.The ankle brachial index (ABI) of affected extremities increased from 0.35?0.13 (before operation) to 0.70?0.15 (after operation),P

Objective To evaluate the clinical efficacy of transplantation of autologous peripheral blood stem cells(PBSC) for the treatment of toe or heel ulcer and of rest pain in patients with lower limb arterial ischemic diseases.Methods To mobilize patients' own stem cells with G-CSF for 5 days.At the sixth day,PBSC are collected with a blood-cells separator.The PBSC were then intramuscularly injected into ischemic areas of the lower limbs.Results After transplantation,all patients are followed up from 3 to 24 months.The rest pain disappeares in 12 patients,while toe or heel ulcers are cicatrized in 11 cases.However,4 patients lost in following up.ConclusionTransplantation of autologous peripheral blood stem cells is an effective method for the treatment of arterial ischemic disease.

Objective To explore the methods of the endovascular repair of aortic disease(aortic dissection and aortic aneurysm).Methods We retrospectively analysed 64cases of aortic diseases treated with endovascular repair,including 42cases of aortic dissection(38 were Stanford B,4 were Stanford A) and 22 cases of aortic aneurysms.The stent-grafts were set into the aorta cavity to cover the damaged aortic intima through the femoral artery under local or general anesthesia;4 cases also underwent by-pass vascular operations.In 6 cases the left subclavian artery(LSA) was covered by stent-graft at the endovascular therapy without by-pass operation.Results Eighteen cases of immediate inner-leak were found after the stent placement,a rate of 28.13 %(18/64).No other severe complications occurred,such as stent-graft shift or error placement,aortic rupture,conversion to open-operation or paraplegia.The blood flow of all the vital branches of aorta were obviously improved.The mortality in the perioperative period was 6.25 %(4/64),the time of follow-up was 1-78 months(mean 32 months).Reoperation was done in 2 cases of aortic aneurysm group and 2 cases of aortic dissection group.Conclusions The endovascular repair is a good method for aortic disease.The short and middle term result is satistactory,and the long term follow-up needs to be studied.

Objective To study the management of femoral artery pseudoaneurysm caused by heroin (injection).Methods 11 cases of femoral artery pseudoaneurysm were treated. 4 cases presented with ruptured aneurysm and were treated emergently by direct ligation of the aneurysmal artery through a femoral incision. 2 cases (underwent) elective operation in which the iliac artery was initially exposed through an extraperitoneal (lower) (abdominal) incision to control bleeding, and then the aneurysmal artery was ligated through a femoral (incision).Results All of the operations were successful, and no gangrene of the affected limb occurred.(Conclusions) Arterial ligation for femoral artery pseudoaneurysm caused by heroin injection is simple and (effective). (Intraoperative) observation of distal arterial backflow,measurement of (arterial) pressure and (intraoperative) (arteriography) can improve the safety of the operation.

Objective:To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair (F/B-TEVAR) in patients with complex aortic arch disease.Methods:The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed .Results:There were 46 cases suffering from postoperative complications (22.8%). The risk factors with statistical significance included aortic atherosclerotic plaque [ OR=2.843; 95% CI (1.4-5.6); P<0.01], aortic intramural thrombosis [ OR=2.358; 95% CI (1.2-4.6), P=0.011], the aortic dilatation [ OR=4.219; 95% CI (1.6-11.3), P<0.01], the history of stroke [ OR=2.088; 95% CI (1.1-4.1), P=0.032], smoking history [ OR=2.680; 95% CI: (1.3-5.5); P<0.01], duration of surgery [ OR=1.9; 95% CI: (1.2-2.9); P=0.042].While the application of 3D printing assistive technology [ OR=0.392; 95% CI: (0.2-0.9); P=0.048] was in a negative correlation with postoperative complication. Conclusions:The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque, aortic intramural thrombosis, the aortic dilatation, the history of stroke, smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.

Objective:To study the application of 3D printing technology in multi-center fenestrated/branched endovascular repair (F/B-EVAR) for endovascular repair of abdominal aortic diseases.Methods:From Feb 2018 to Mar 2023, The clinical and followup data of 316 cases of abdominal aortic lesions undergoing repair with F/B-EVAR at 69 medical centers nationwide using 3D printing technology to guide physician-modified stent graft were retrospectively analyzed.Results:The mean follow-up time of the patients was 23 months (2-60 months), and 24 cases were lost to follow up, the follow-up rate was 92.4% (292/316), the mean postoperative hospitalization time was (8.2±4.9) days. A total of 944 main abdominal branch arteries were reconstructed. Intraoperative reconstruction of 11 branches failed, with a success rate of 98.8% (933/944). Within 30 days after surgery, 8 patients died (2.5%), and 6 patients died during follow-up, a total of 14 patients died (4.4%). There were 11 cases (3.5%) of spinal cord ischemia and no patient suffered from permanent paraplegia. There were 19 patients (6.0%) with postoperative renal function injury. Internal leakage was found in 26 patients, and the rate of internal leakage was 8.2%.Conclusion:3D printing technology can accurately locate the location of branch arteries, simplifing the surgical process, shortening the learning curve , and improving clinical efficacy.

Approximately 140 million people worldwide are homozygous carriers of APOE4 (ε4), a strong genetic risk factor for late onset familial and sporadic Alzheimer's disease (AD), 91% of whom will develop AD at earlier age than heterozygous carriers and noncarriers. Susceptibility to AD could be reduced by targeted editing of APOE4, but a technical basis for controlling the off-target effects of base editors is necessary to develop low-risk personalized gene therapies. Here, we first screened eight cytosine base editor variants at four injection stages (from 1- to 8-cell stage), and found that FNLS-YE1 variant in 8-cell embryos achieved the comparable base conversion rate (up to 100%) with the lowest bystander effects. In particular, 80% of AD-susceptible ε4 allele copies were converted to the AD-neutral ε3 allele in human ε4-carrying embryos. Stringent control measures combined with targeted deep sequencing, whole genome sequencing, and RNA sequencing showed no DNA or RNA off-target events in FNLS-YE1-treated human embryos or their derived stem cells. Furthermore, base editing with FNLS-YE1 showed no effects on embryo development to the blastocyst stage. Finally, we also demonstrated FNLS-YE1 could introduce known protective variants in human embryos to potentially reduce human susceptivity to systemic lupus erythematosus and familial hypercholesterolemia. Our study therefore suggests that base editing with FNLS-YE1 can efficiently and safely introduce known preventive variants in 8-cell human embryos, a potential approach for reducing human susceptibility to AD or other genetic diseases.
Humans ; Apolipoprotein E4/genetics* ; Cytosine ; Mutation ; Blastocyst ; Heterozygote ; Gene Editing ; CRISPR-Cas Systems