Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism,and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 eases misdiagnosed aorta disease,including clinical manifestation,misdiagnosis,improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first.Three cases were treated with emergent thrombectomy using Fogarty catheter.The correct diagnosis Was achieved by 3-dimensional CT angiography (3DCTA) after operation,and the eitiology of other 6 cases were also pmved as aortic disease by 3DCTA before operation.Among 5 cases of acute aorta dissection with iliac-femoral artery involved,2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged.The other 3 cases were treated with endovascular therapy successfully.One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection.The other 3 caBes of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass.The limbs ischemia were improved in all cases without perioperative death.Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia,mimicking limb artery thrombo-embolism.Preoperative imaging especially 3 DCTA helps to establish correct preoperative diagnosis for a successful treatment.

Objective:To study the effect of ischemic postconditioning(I-postC)on the lung injury following ischemia-reperfusion(I/R)of skeletal muscle in the hind limbs of rats.Methods:The rat model of hind limbs I/R injury was established by subrenal abdominal aorta cross-clamping for 4 hours.Forty-eight rats were divided into 3 groups:I/R group,IPC and I-postC group.Each group received 4 hours of ischemia and then 12 or 24 hours of reperfusion respectively.The tissue morphology,wet-to-dry weight(W/D)ratio,malondialdehyde(MDA)and myeloperoxidase(MPO) of lung tissue were compared.The expression of ICAM-1 mRNA in lung was also studied by RT-PCR or in situ hybridization.The protein product was detected by Western blot.Results:In IPC and I-postC groups,all parameters decreased significantly compared with I/R ischemia group(P

Objective To summarize our experience in treating abdominal aorta saddle embolism(ASE).Methods The clinical data of 21 cases of abdominal ASE were treated with Fogarty catheter and other(methods) during January 2000 to July 2006 were retrospectively assessed.Results After the blood flow was restored by operation,4 died in the postoperative early stage because of sudden cardiac asystole due to(hyperkalemia);in the late stage,6 died of multiple organ dysfunction syndrome socondary from acute renal(failure)(ARF).Eleven patients were cured.Of them,bilateral lower extremites were salvaged in 5 patients;and 6 patients received amputation.Ten patients were followed up,and the blood supply of the salvaged legs was good.Conclusions Early diagnosis and embotism removal are the key points to decrease the mortality and amputation rate of ASE.The intra-operative and post-operative prevention and management of(hyperkalemia) and ARF are important for reduction of mortality.

Objective To assess the treatment of splenic artery aneurysms (SAA) and prognosis.Methods Clinical data of 18 SAA patients treated in our hospital from 1999 to 2011 were retrospectively analyzed. Results There were 18 patients diagnosed as SAA,including 7 males and 11 females.The average age was 53.8 ± 7.3 years.8 patients were asymptomatic found by routine physical examination,7 patients complained upper left abdominal pain,3 cases suffered from aneurysm rupture. Diagnosis was established by three-dimensional computed tomography angiography (3DCTA) in 14,Digital subtraction angiography (DSA) in 3 and magnetic resonance angiography (MRA) in 1 patient.Three patients with ruptured splenic artery aneurysm underwent emergent operations,11 patients underwent elective surgery or interventional therapy.Surgical procedures included aneurysmectomy and splenectomy in 4 patients,distal pancreatectomy in 5 cases; aneurysmectomy and splenic artery ligation in one patient; and aneurysmectomy with splenectomy and colon resection in 1 case.Interventional embolization by coils of the splenic aneurysm in 3 patients.The remaining 4 being asymptomatic and with tumor diameter less than 2 cm were put on a close follow-up.There was no perioperative mortality.Two were lost to follow-up.16 cases were followed-up for averaging 3.2 years. 1 patient died of cerebral hemorrhage after four years. Conclusions Splenic artery aneurysms was a rare disease and with usually occult symptoms,but rupture can leads to abdominal apoplexy.Open surgery and minimally invasive endovascular treatment is effective and offers a good prognosis.

Objective To evaluate surgical therapies in patients with popliteal aneurysms (PA).Method The clinical data of 25 PA patients admitted from January 1988 to January 2012 were retrospectively analyzed.There were 21 men and 4 women,the mean age was (56 ± 16)years.There were 27 PA in these 25 patients,with bilateral PA in 2 cases.The main symptoms were pulsatile mass in the popliteal fossa,limb pain,acute or chronic distal limb ischemia and limb edema.Result In this series 23out of 25 PA cases recieved operations,17 of them were treated with aneurysmectomy and saphenous vein interposition or bypass grafting,4 of them were treated with aneurysmectomy and prosthetic grafts interposition,1 was treated with aneurism ligation and 1 underwent end-to-end anastomosis after aneurysm resection.There was no perioperative mortality.One patient recieved amputation for distal anastomotic thrombosis and severe limb ischemia.The mean follow-up time is (6.5 ± 0.5) years.After 4 years,a right subclavian artery aneurysm was found in a bilateral PA case and treated surgically.Conclusions Early elective surgical treatment is recommended for patients with PA because PA may go rupture or induce dital limb ischemia and these patients may have good outcome after surgical treatment.Long-term follow-up is warranted to detect the new aneurysm formation.

Objective To investigate the relationship between abnormal methylation in promoter regions for OPN and VSMC phenotype switching in varicosity.Methods Immunohistochemistry and Western-blot were used to evaluate the expression of SMA and OPN in VSMC.Methylation-specific PCR was used to evaluate the methylation level of OPN in VSMC of vein samples.Ultrastructure change of VSMC was observed by transmission electron microscope (TEM).Results Compared to normal vein,OPN in VSMCs were significantly highly expressed,mainly in the neointimal region (P ＜ 0.01).SMA in neointima region was in low expression (P ＜ 0.01).The density of OPN in varicose group was significantly higher (P ＜0.01).DNA methylation level of OPN was lower in varicose veins.Conclusions Hypomethylation of the promoter regions for OPN may cause high expression of OPN leading to VSMC phenotype switching and development of varicosity.

Objective To investigate the feasibility of centerline measurement method in estimating aortic diameter at the proximal landing zone in Stanford B type aortic dissection. Methods CT angiography materials of 30 patients with type B aortic dissection were randomly selected from the hospital database (24 males with a median age of 49.5 years), which were retrospectively analyzed with multiplanar reformation (MPR) and centerline technique by two experts in vascular radiology. Difference between two measurement techniques was analyzed by using mixed linear model, and the agreement of measurements between two readers as well as between two techniques were evaluated by Bland-Altman plots. Results The diameters measured with MPR method by two experts were (29.73±2.99) mm and (29.86±2.95) mm respectively, while the diameters measured with centerline measurement method by two experts were (29.66 ±2.81) mm and (29.71 ±2.91) mm respectively. No statistically significant differences in the diameter value existed between the two measurement methods, although the results determined by centerline measurement method were more stable. Conclusion In determining aortic diameter at the proximal landing zone in Stanford B type aortic dissection, the centerline analysis provides a checking method for MPR measurement.

Objective: To investigate the effect of inhibitng C-myc expression by actinomycin D on intimal hy-perplasia in vein graft. Methods: The vein graft model was established in rats. The different dises of actinomycin D (0.015 mg/kg; 0.15 mg/kg) were given just before and after operation. The vein grafts were harvested at 2 hrs and 1 week after grafting. C-myc mRNA was measured by in situ hybridization method. The intimal thickness was measured using a computerised image analysis system. Results: The expression of C-myc mRNA and the intimal thickness were both significantly reduced in large dose (0.15 mg/kg) group of actinomycin D, with 6.5%; 18.7 μm compared with control group in 12.5%; 28.5 μm respectively. Conclusion: Actinomycin D can inhibit expression of C-myc mRNA and intimal hyperplasia in graft. Expression of C-myc plays an important role in inducing proliferation of smooth muscle cell in vein graft.

Objective To construct a double luciferase reporter gene vector with PRDM1 gene promoter as target,and establish drug screening cell model in vitro,hope to find small molecule compounds in Chinese herbal medicine library by this model.Methods Total DNA was extracted from 293T cells and it was used for amplifying the fragment contained PRDM1 gene promoter (267 bp/1 257 bp) by PCR.The amplified product was inserted into pGL3-Basic vector.The PCR product and pGL3-PRDM1 vector were verified by sequencing and alignment.The pGL3-PRDM1 and pRL-TK vector were co-transfected into engineer cells.The activity of PRDM1 gene promoter could be assayed by measuring luciferase.The method was optimized by changing ratio of two vectors.Results The highest transfection efficiency and luciferase activity were found in ratio of n(pGL-PRDM1) ∶ n(pRL-TK)=2 ∶1,and with the recombinant luciferase report gene vector contained the length of 1 257 bp amplified fragment transfecting into U266 cells.Moreover,the inductor (5-Aza-CdR) of PRDM1 gene was used for authenticating the method(P＜0.01),the fluoresscence in tensity and promoter activity of PRDM1 gene were enhanced in a dose dependent manner with 5-Aza-CdR.The activity of the promoter of PRDM1 gene was significantly decreased from the concentration of 5 μmol/L of Artemisinid(P＜0.05).The total glucosides of paeoniflorin promoted the promoter activity of PRDM1 gene at a low concentration,and inhibited the promoter activity of PRDM1 gene at a high concentration.Artesunate has no effect on cell proliferation.The effect of total glucosides of paeony on cell proliferation was more complicated.Conclusion A drug selection model targeting PRDM1 gene promoter has been successfully established,and artesunate has been screened to inhibit the promoter activity of PRDM1 gene.

BACKGROUND: Greater tuberosity of humerus, as the attachment point of rotator cuff, plays a vital role in shoulder.Neer and AO classification for proximal humeral fractures have been accepted extensively. However, the classification for single greater tuberosity fractures of the proximal humerus is little reported, and its fixation method remains controversial.OBJECTIVE: To explore the curative efficacy of the double-row suture anchors under arthroscopy for avulsion-type greater tuberosity fractures (Mutch type Ⅰ) METHODS: Clinical data of 24 patients with avulsion-type greater tuberosity fractures (Mutch type Ⅰ) undergoing double-row suture anchors under arthroscopy were analyzed retrospectively. The displacement distance of the greater tuberosity of humerus was measured on CT before and after fixation. The shoulder joint was evaluated by Constant-Murley Score and the University of California, Los Angeles score at baseline, 1, 3, 6 and 12 months postoperatively. Besides, the visual analogue scale scores were detected at baseline and 12 months postoperatively.RESULTS AND CONCLUSION: (1) Double-row suture anchors effectively improved the displacement of greater tuberosity and rotator cuff injury. (2) The patients accompanied by rotator cuff injury accounted for 79.16%. (3) The Constant-Murley Score and the University of California, Los Angeles scores were significantly improved at each time point (P < 0.05). The visual analogue scale scores after fixation were significantly superior to those before fixation (P < 0.05). (4) These results suggest that the double-row suture anchors under arthroscopy can effectively improve the displacement of greater tuberosity and alleviate the pain. Moreover, it is conductive for early recovery of the shoulder function with little trauma, so it is a good choice for avulsion-type greater tuberosity fractures (Mutch type Ⅰ).