Objective To define the significance of the anatomical division and features of popliteal artery in popliteal angioplasty.Methods This study involved 118 lower limbs in 113 cases of femoropoliteal occlusive disease undergoing angioplasty in our center between August 2011 and July 2013.A bent-knee angiogram was taken before recanalization of the lesion.The flexion pattern and the location of flexion points of popliteal artery were collected to study their relationship with the division of popliteal artery.A post-procedural bent-knee angiogram was taken in case of popliteal stenting to assess any change in flexion angulation and distal flow.Results There are diverse flexion patterns in popliteal artery,75.4％ of the flexion points locate in P2 segment,18.6％ in P1,and 6.0％ in P3.On post-procedural bent-knee angiogram in 73 cases of popliteal stenting,10 had a more acute distal flexion angulation,distal artery kinking was observed in another 6 cases of which 5 had compromised distal flow.Artery kinking only occurred in cross-flexion-point stenting.Conclusions A better understanding of the division and anatomical features of popliteal artery can be obtained via bent-knee angiogram.This is of value to angioplasty for lesions in different popliteal divisions.

Objective To evaluate diagnostic procedures and clinical outcomes of vascular prosthetic and stent graft infection. Methods Clinical data of 15 cases suffering from vascular graft infection between 1985 and 2005 were retrospectively analyzed. Results The rate of vascular graft infection was 1. 14% among our series of 1316 cases of revascularizations. Vascular graft infection occurred within 4 months after graft implantation in 13 cases (86. 7% ). Graft infection developed after 4 months postoperatively in the other 2 cases ( 13. 3% ). Clinical manifestations included wound infection with vascular graft exposure, inguinal swelling or fistula, fever or sepsis, anastomotic hemorrhage, pulse loss of vascular graft or distal lower extremity and gangrene of distal lower extremity. Surgical treatment included en bloc removal of the infected graft and surrounding infected tissue, drainage and local irrigation with antibiotic solution, graft en bloc removal and primary amputation; Graft en bloc removal, drainage and revascularization with a saphenous vein or a new prosthetic graft; Aggressive debridement and local irrigation with antibiotic solution. Four patients died and the others recovered successfully. Conclusion The infection of a vascular graft is a rare complication in vascular surgery. Early diagnosis and aggressive surgical management can improve its prognosis.

Objective To study effect of drug treatment in polycystic ovary syndrome patients withhyperprolactinemia.Methods We retrospectively studied 63 women with polycystic ovary syndrome and hyperprolactinemia from the Reproductive Medicine Center,Provincial Hospital between January 2005 andMarch 2007.According to the beginning time of bromocriptine,all women were divided into two groups.Group Ⅰ was composed of 48 cases who received bromocriptine administration before induction of ovulation cycles,and the dose of bromocriptine was modulated depending on the level of serum prolactin.When serum prolactin was controlled at normal levels,we decreased the dosage of bromocriptine step by step(1.25 mgonce),and then continued the treatment at maintenance dosage for no less than 3 weeks.After a baselineultrasonographic examination on day 3,patients were treated with clomiphene citrate at a dosage of 100 mg (2 tablets/day)for 5 days of a normal cycle or progesterone-induced bleeding.On day 9,we monitored the growth conditions of follicles routinely with trans-vaginal uhrasound.If there was no dominant follicle,we added human menopausal hormone(hMG,75 U/d)to the protocol.Human chorionic gonadotropin(hCG,6000-10000 IU)was given intramuscularly when the mean diameter of a follicle reached at least 18 mm.At the same time we instructed the patients to have sexual intercourses or carried out artificial inseminationsbefore and after ovulation.Group Ⅱ were 15 cases in which induction of ovulations were commenced almostsimultaneously with beginning of bromocriptine.The same protocol was given to patients in group Ⅱ.The procedures of ovulation induction and the outcomes of treatment were analyzed and compared.Results Compared with groupⅡ.the days of using hMG in Group Ⅰ was shorter by instructing the time of sexualintercourse.The difference was significant(P=0.004).And there were similar results in the artificial insemination cycles(P=0.009).The rate of pregnancy in group Ⅰ(40%,19/48)was higher than that in groupⅡ(27%,4/15),but the difference was not obvious(P=0.525).Conclusion Bromocriptine administration before the stimulated ovulation therapy can decrease the total dosage and treatment course of ovulating drugs.Induction of ovulations simultaneously with start of bromocriptine therapy can shorten the treatment time of infertility.

ObjectiveTo compare the therapeutic effects of a new surgical endoscopic technique, the transilluminated powered phlebectomy (TriVex System, Smith+Nephew) and pointed phlebectomy in the treatment of varicosis of the great saphenous vein of the lower limbs. Methods Thirty-nine patients (46 limbs) received TriVex operations under spinal, or epidural anesthesia. The powered vein resector and an irrigated illuminator device-a minimally invasive system was used for varicose vein surgery. During the same period, 41 patients (46 limbs) underwent pointed phlebectomy. Results The average postoperative hospital stay was 4.6 days in patients receiving TriVex, and 8.1 days for pointed phlebectomy. Compared with the pointed phlebectomy, the incision of TriVex procedure was shorter and the number less. Conclusion This new surgical device is easy to operate, minimally invasive, efficacious and time saving with satisfactory results.

Objective To analyze the diagnostic procedures and treatment strategies in the mycotic aneurysm caused by Salmonella enterica serotype choleraesuis infection in a single medical center. Methods From January 2000 to December 2008, clinical data of 8 cases with infected aneurysm caused by Salmonella enterica serotype choleraesuis were analyzed. Results All cases were treated with endovascular stent-graft treatment, including abdominal aortic aneurysm in six cases, thoracic aortic aneurysm in one, and popliteal artery aneurysm in one case. Six bifurcated stent-graft and two tube stent-graft were used. The surgical success rate was 100% with no perioperative or 30-day mortality nor major morbidity. All of the patients recovered uneventfully and were discharged with oral antibacterial agents. During mid-term follow up (range 15-36 months), four patients are alive and well with no signs of persistent or recurrent infection, three cases with recurrent infection were cured by drainage of local abscess and debridement, one case died of rupture of the abdominal aortic aneurysm. Conclusion Endovascular grafting combined with antibiotic therapy and careful surveillance program represent an alternative to conventional surgery in mycotic aneurysms caused by Salmonella enterica serotype choleraesuis.

Objective To investigate the expression of circulating microRNA (miRNA) of rats with hypobaric hypoxia‐induced pulmonary hypertension (HPH) .Methods Commercial rat miRNA microarray was employed to detect and analyze the circulating miRNA profile in the serum samples of Sprague‐Dawley rats with hypobaric hypoxia‐induced HPH and controls .Furthermore ,differentially expressed candidate circulating miRNAs between HPH and control groups were validated by Real‐time quantitative PCR based on the case‐control study ,and receiver operating characteristic curve (ROC ) analysis was used to test the performance of four differentially expressed circulating miRNAs in discriminating HPH and control groups .Results Compared with those in the control group ,13 upregulated miRNAs and 10 downregulated miRNAs were identified in hypobaric hypoxia‐induced HPH rats by using miRNA microarray . And differentially expressed miR‐451 , miR‐505 , let‐7d and miR‐214 were validated by using RT‐PCR .ROC analysis showed that the area under the curve of miR‐451 ,miR‐505 and let‐7d was 0 .979 ,0 .938 and 0 .993 in discriminating HPH and control groups ,respectively .Conclusion The aberrant expression of circulating miR‐451 ,miR‐505 and let‐7d in serum may be correlated with the pathogenesis of HPH .

Objective To understand the depressive status of patients with HIV/AIDS and their family members in order to provide objective information for conducting psychological interventions among them. Method The Self-rating Depression Scale (SDS) questionnaires were used for assessing the depressive status and the SPSS software was applied for data analysis. Results The SDS values among the patients with HIV/AIDS and the family members of died AIDS patients were significantly higher than those of healthy controls. The proportion of HIV/AIDS patients with medium to severe degree of depression was 15.5%, which was higher than that of healthy controls. The SDS values among female family members of HIV/AIDS patients were higher than those in male ones. Conclusion The depression is a negative psychological status usually occurred among the patients with HIV/AIDS and their family members, and the psychological interventions should be conducted based on the characteristics of different populations.

Objective To evaluate the efficacy of endovascular repair (EVR) for aneurysms or dissection aneurysms of the aortic arch. Methods Twelve aortic dissection aneurysm (ADA) patients with the primary entry located within 15 mm beyond the origin of the left subclavian artery (LSA) and two aortic arch aneurysm patients underwent EVR from June 2003 to August 2004. EVR with intentional coverage of the LSA without any supportive bypass was employed in 8 ADA patients, and the preliminary cervical reconstruction combined with EVR in the remaining 6 cases. Results Technical success was achieved in all cases. One case died of postoperative cerebral infarction. No neurological deficits or limb ischemia developed perioperatively or during the follow up period raging from 1 to 14 months and complete thrombosis of the thoracic aortic false lumen and remarkable anenrysmal thrombosis were revealed by CT in all 12 ADA cases and the remaining aneurysm case respectively. Conclusions EVR is effective in the management of aneurysms or dissection aneurysms of the aortic arch.

Objective To evaluate the effect of preoperative localization of Adamkiewicz artery (AKA)by CT for patients undergoing endovascular descending thoracic aortic repair. Methods From May 2003 to April 2005, 12 patients received CT examination for the detection of the AKA before undergoing endovascular descending thoracic aortic repair. Eight patients were of Stanford type B dissecting aortic aneurysm, 2 of Crawford typeⅠthoracoabdominal aortic aneurysm (TAAA) , 1 of descending thoracic aortic pseudoaneurysm and 1 of descending thoracic aortic aneurysm combined with abdominal aortic aneurysm. The inclusion criterion was that the segment from T8 to L1 needed to be partially excluded. The CT assessment accentuated the identification of the level at which the aorta gave rise to the AKA-originating intercostal/lumbar artery and approval of the continuity from the origin of the intercostal/lumbar artery at the aorta to the anterior spinal artery (ASA). Results Thirteen AKAs were identified in 9 patients (75%). A single AKA was visualized in 5 cases and double in 4. Two AKAs arose from the T8 intercostal artery, 2 from T9, 3 from T10, 3 from T11 and 3 from T12. The continuity from the origin of the intercostal artery at the aorta to the ASA was identified in 8 patients. Ultimately, 10 AKAs were preserved while 3 sacrificed. More than 15-mm both proximal and distal landing distance of the stent-graft was achieved in all patients, and no paraplegia occurred perioperatively or during the follow-up raging from 3 to 19 months ( mean 12 months). Complete false lumen thrombosis of the thoracic aorta or aneurysmal thrombosis was evidenced on CT at 3 month in 11 patients while 1 patient with dissecting aneurysm caused by Marian's syndrome died for unknown cause 2 days after being discharged. Conclusion Localization of AKA by CT before stent-grafting in the descending thoracic aorta may enable us to avoid covering the origin of the AKA-originating intercostal/lumbar artery at the aorta, hence, the remaining segment from T8 to L1 could be saved for reliable landing the sten-graft.

Objective To review the prevention and treatment strategies for complications after carotid artery stenting in a single medical center. Methods From December 2004 to December 2009,clinical data of 118 cases of carotid artery stenting with the use of cerebral protective device were analyzed retrospectively. Results The surgical success rate was 100% with no perioperative 30- day mortality or severe complications such as disabling stroke. The overall perioperative complication rate was 32. 20% (38/118), including carotid artery spasm in 10.17% (10/118), bradycardia in 11.02% (13/118), hypotension in 2.54% (3/118), transient ischemic attack in 5.93% (7/118) and false aneurysm of femoral artery in 2. 54% (3/118) cases. The average follow-up time was (28 ± 15) months. The mortality was 2. 38% (2/84) and the overall complication rate was 10. 71% (9/84) , including ischemic stroke in 3. 57% (3/84) , in-stent restenosis in 1. 19% ( 1/84) , stent deformation in 4. 66% (4/84) and stent fracture in 1. 19% (1/84) cases. Conclusion Death or ischemic stroke and other severe complications after carotid artery stenting under cerebral protective device were low. A careful selection of patients and strict indication for surgery is the key to reduce the complication rate.