OBJECTIVETo assess the value of subintimal angioplasty in treating patients with iliac artery occlusive disease.

METHODSWe retrospectively analyzed the clinical data of 13 patients with iliac artery occlusion who received subintimal wire placement followed by percutaneous transluminal angioplasty and stent placement in our hospital from May 2004 to August 2006.

RESULTSInitial success was obtained in all the 13 patients with an improvement in both the symptoms and the mean ankle-brachial index of 0.55 (range: 0.39-0.94, P = 0.004) without any complication. During the follow-up (range: 3-21 months; mean: 12 months), the one-year stent patency rate reached 100%.

CONCLUSIONSubintimal angioplasty is a valuable approach to treat iliac artery occlusion with reliable efficacy and safety.

Aged ; Angioplasty, Balloon ; methods ; Arterial Occlusive Diseases ; therapy ; Blood Vessel Prosthesis Implantation ; Female ; Humans ; Iliac Artery ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the early and midterm outcomes of carotid endarterectomy (CEA) compared with carotid stenting (CAS) in patients with carotid artery stenosis.

METHODSA prospective randomized single-center clinical trail to compare with endarterectomy and stenting in patients with symptomatic carotid stenosis of at least 50% and asymptomatic stenosis of at least 70%. From May 2004 to December 2006, there were 40 patients who agreed with the treatment were randomly assigned to undergo either CEA or CAS. The primary end point was any stroke or death within 30 d after treatment and the secondary end point was any stroke, myocardial infarction and any complications of the treatment, or death or ipsilateral stroke and carotid restenosis between 1 month and 18 months, and the cost-effectiveness of both groups were analyzed retrospectively as well.

RESULTSThere were no significant differences of the characteristics in the two groups. Twenty cases in CEA group underwent 23 endarterectomies (3 cases had bilateral CEA, respectively), in which 9 carotid shunt (39.1%) and 12 patching (52.2%) were used. Twenty cases in CAS group underwent 23 stents (3 cases had bilateral CSA, respectively), in which 21 emboli-protection devices (91.3%) were used. There was no significant difference in 30 d neurological complications (4.3% vs. 8.7%), acute myocardial infarction (4.3% vs. 0), and wound hematoma (8.7% vs. 0) between CEA and CAS, respectively. There was no ipsilateral transient ischemic attack or carotid restenosis at 18 months in each group. The average cost of hospitalization was (16 450.95 +/- 6188.76) vs. (70 130.15 +/- 11 999.02) RMB in CEA and CAS, respectively, with significant difference (P < 0.01).

CONCLUSIONThe early and midterm outcomes are no significant difference between CEA and CAS, but in China, the cost of hospitalization in CAS is much higher than that of CEA.

Aged ; Carotid Stenosis ; therapy ; Endarterectomy, Carotid ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stents ; Treatment Outcome

Objective To investigate the clinical features of children with early-onset benign occipital epilepsy (EBOS) and children with late-onset benign occipital epilepsy (LOS) and their EEG changes,treatments and prognoses.Methods Sixty children with benign occipital epilepsy,admitted to our hospital from June 2007 to June 2012,were chosen in our study; their clinical data were retrospectively analyzed.According to the recommendations of the 2001 International League against Epilepsy (ILAE),these patients were divided into EBOS group (n=28) and LOS group (n=32); the clinical manifestations,electroencephalogram (EEG) characteristics,medication effectiveness in the two groups of children were compared.Results No significant difference on gender distribution,febrile convulsion histories and family history of epilepsy was noted between the two groups (P＞0.05); however,average ages of onset in the EBOS group were significantly younger than those in the LOS group (P＜ 0.05),and the onset time,seizure frequency,attack mode,seizures associated symptoms and seizure EEG waveforms in the EBOS group were obviously different as compared with those in the LOS group.Single-drug AED treatment could have control effect in 23 of children in the EBOS group and 12 of children in the LOS group; statistical difference was noted between the two groups (P＜0.05).Conclusion The onset time,seizure frequency,attack mode and seizures associated symptoms are obvious different between children with EBOS and LOS,and combined with seizure EEG waveforms,these differences can be used to identify the two.

OBJECTIVETo assess the effectiveness and safety of non-permanent filter in preventing pulmonary embolism (PE) caused by deep venous thromboembolism (DVT).

METHODSThe clinical data of 12 patients who were implanted with non-permanent filter for documented deep venous thromboembolism in Peking Union Medical College Hospital from September 2003 to June 2006 were retrospectively analyzed.

RESULTSAmong these 12 patients, 10 were implanted with temporary filters, and 2 with retrievable filters. All the 12 operations were successful without major complications. In the 10 patients who received temporary filters, filters were smoothly removed after 4 weeks in 9 patients, while one patient was further treated with anticoagulation therapy for 12 weeks because large emboli were entrapped by filter. In the 2 patients who received retrievable filters, filter were smoothly removed 2 weeks later in one patient; however, in another patient, the filter was left inside because large emboli were entrapped by filter. In all the 12 patients, emboli were entrapped in 6 filters (50%), in which the emboli were larger than 2 cm in 2 patients, larger than 1 cm but less than 2 cm in 1 patient, and less than 1 cm in 3 patients. PE scanning was performed in 10 patients before primary implantation, and PE was found in 5 patients. PE scanning was performed in 8 patients 6 months after implantation, and minor PE was found in 4 patients, whose symptoms and affected pulmonary artery were obviously improved. All patients received regular follow-up (ranged from 3 months to 2 years), 1 patient died of malignant tumor 4 months after operation, 1 patient suffered inferior vena cava occlusion due to large emboli entrapped by the temporary filter, and 1 patient experienced the recurrence of symptomatic DVT. Symptoms were improved in all the 5 patients with PE.

CONCLUSIONSNon-permanent filter can safely and effectively protect patients from PE. More standardized criteria for placement and protocols to ensure timely removal should be developed and implemented.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Pulmonary Embolism ; etiology ; prevention & control ; Retrospective Studies ; Vena Cava Filters ; Vena Cava, Inferior ; Venous Thrombosis ; complications

OBJECTIVETo analyze the outcome and risk factors of endovascular revascularization of lower limb artery for elder patients.

METHODSFrom January 2006 to November 2008, 86 elder patients (98 ischemia limbs) underwent endovascular revascularization due to lower limb ischemia. Age of this group were 60 to 82 years old with a mean of (70 +/- 6) years old. Fifty-four limbs (55.0%) had severe intermittent claudication, 28 limbs (28.6%) had rest pain, 11 limbs (11.2%) had ulcer, and 5 limbs (5.1%) had gangrene. Sixty-six limbs were mono segment disease, including 25 aorta-iliac lesions, 33 femoral-popliteal lesions and 8 infra-popliteal lesions. Thirty-two limbs were multiple segment disease involving 2 or 3 segment lesions. Mortality, morbidity, primary patency, secondary patency and limb salvage were retrospectively analyzed. Risk factors on outcome were also evaluated.

RESULTSTen limbs underwent angioplasty, while the rest 88 limbs underwent angioplasty plus primary stent implantation. The total operation success rate was 95.9%. Perioperative mortality within the first 30 d was 0. Perioperative morbidity within the first 30 d was 5 cases (5.1%), including 2 myocardial infarction, 2 major amputations and 1 irreversible contrast-induced nephropathy. Follow-up duration were 1 to 35 months with a mean of (18 +/- 10) months. Eighty-three (96.5%) patients had effectively follow-up. Mortality was 2.3% (2 cases died due to myocardial infarction). Primary patency rate was 83.7%, secondary patency rate was 94.9% and limb salvage rate was 95.9%. Risk factor analysis showed that diabetes mellitus, critical ischemia and multiple segment lesions were associated with worse patency.

CONCLUSIONSEndovascular treatment is effective, safe and repeatable revascularization for elder patients of Critical lower limb ischemia. Patients with diabetes mellitus, critical ischemia and multiple segment lesions should be paid more attention because their rather worse outcome.

Aged ; Aged, 80 and over ; Angioplasty, Balloon ; Arteriosclerosis Obliterans ; surgery ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents ; Treatment Outcome

【Objective】To explore the image evaluation value of multi-model CT in the treatment of acute ischemic stroke with Solitaire stent embolectomy. 【Methods】 A total of 62 patients diagnosed with acute ischemic stroke from January 2015 to June 2016 in Guangdong Second Provincial General Hospital were included in this study. Multi- model CT inspection，including CT scan（NCCT），CT angiography（CTA）and CT perfusion imaging（CTP），was performed in all patients within 3~8 h. The improved vascular TICI classification standard（mTICI）was used to assess vascular embolization，and we evaluated the responsible vessels and blood perfusion state by CTA and CTP blood vessels ，to determine the feasibility of embolectomy with Solitaire stent preliminarily. The patients underwent multi-mode CT examination 24 h after stent embolization to evaluate the responsible vessels. NIHSS was used to assess the neurological function at admission and 72 h after stent embolization.【Results】A total of 34 patients with indication of stent thrombus removal were selected by multi-mode CT examination from 62 patients. Re-examination of multi-mode CT after stent thrombus removal showed that 30 of the 34 cases（30/34，the successful rate was 88.2%）gained success in vascular recanalization. Before the stent thrombus removal of the 34 patients，CTP imaging showed ischemic penumbra（IP），and there was significant decrease in cerebral blood flow（CBF）and slight decrease in cerebral blood volume（CBV），significantly prolonged peak time （TTP） and mean transit time （MTT） compared with the contralateral image area. The difference is statistically significant（P < 0.01）. After the stent thrombus removal，the relative cerebral blood flow（rCBF）and relative cerebral blood volume（rCBV）were elevated，the relative peak time（rTTP）and relative mean transit time（rMTT）were shortened. The difference is statistically significant（P < 0.01）. Compared with admission，there is significant statistical difference in the NIHSS score of patients 72 h after operation（P < 0.01）.【Conclusion】Multi-model CT has guiding effect and important evaluation value in the treatment of acute ischemic stroke patients with Solitaire stent thrombolysis.

OBJECTIVETo evaluate the one year effect of modified Roux-en-Y gastric bypass (RYGP) in the treatment of non-obese type 2 diabetes and to investigate the reasonable indications for surgery.

METHODSTotally 72 patients diagnosed as type 2 diabetes underwent RYGP from May 2009 to June 2010. There were 45 male and 27 female patients, with an average age of (47 ± 10) years. Preoperative body mass index (BMI) of the patients was 18.69 to 31.22 kg/m(2), average (26 ± 4) kg/m(2). The follow-up data included fasting plasma glucose (FPG), 2 h plasma glucose after oral glucose challenge (2hPG), weight, BMI and medication usage in 1, 3, 6 and 12 months postoperative; hemoglobin A1c (HbA1c), fasting C-peptide (C-P), fasting serum insulin (Fins) and homeostasis model assessment of insulin resistance index (HOMA-IR) in 6 and 12 months postoperative, respectively.

RESULTSCompared with the preoperative, FPG, 2hPG, weight and BMI in 1, 3, 6 and 12 months after surgery were improved (t = 7.014 to 10.254, P = 0.000), while HbA1c, C-P and HOMA-IR in 6 and 12 months after surgery were improved (t = 1.782 to 7.789, P = 0.000 to 0.103) and there was no significant difference in Fins (P > 0.05). The rates of complete remission in 1, 3, 6 and 12 months after surgery were gradually improved to 22.2%, 27.8%, 36.1% and 60.6%, respectively, and the rate of remission in 1 year was 94.3%. The complete remission of 1 year after surgery was associated with normal C-P, insulin antibody and oral antidiabetic drugs (χ(2) = 11.730, P = 0.003; χ(2) = 7.131, P = 0.028;χ(2) = 6.149, P = 0.046).

CONCLUSIONSModified RYGP is safely and effectively in the treatment of no-obese type 2 diabetes patients. The function of islet cells is significantly improved after operation. Especially for the patients of whom C-P is normal, insulin antibody is negative before surgery, the rate of complete remission after 1 year is better.

Adult ; Blood Glucose ; metabolism ; Body Mass Index ; C-Peptide ; metabolism ; Diabetes Mellitus, Type 2 ; surgery ; Female ; Follow-Up Studies ; Gastric Bypass ; methods ; Glycated Hemoglobin A ; metabolism ; Humans ; Insulin ; blood ; Insulin Resistance ; Male ; Middle Aged ; Obesity ; Weight Loss

OBJECTIVETo analyze the cause of in-hospital death among acute myocardial infarction patients undergoing primary percutaneous coronary intervention (PPCI) in Beijing area to evoke better individualized preventive approach.

METHODSIn-hospital mortality and causes were analyzed based on database from Beijing percutaneous coronary intervention registry study (BJPCI Registry) in 2010.

RESULTSA total of 4660 PPCI patients from 48 hospitals were included. In-hospital mortality was 2.4% (n = 110). Cardiogenic shock (39.1%, 43/110), mechanical complications (28.2%, 31/110) and intervention-related complications [28.2%, 31/110: procedure related (n = 28), drug related (n = 3)] were the leading causes of in-hospital death. Five deaths was attributed to comorbidity related reason (4.5%, 5/110). The in-hospital mortality had no significant difference among hospitals of different grade or total annual PCI (all P > 0.05). In-hospital mortality was slightly higher in hospital with annual PPCI < 300 than in hospitals with annual PPCI ≥ 300 (2.9% vs. 1.8%, P < 0.05).

CONCLUSIONCardiogenic shock, mechanical complications and intervention-related complications are the main causes of in-hospital death among acute myocardial infarction patients receiving PPCI.

Adult ; Aged ; Aged, 80 and over ; China ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; mortality ; therapy ; Percutaneous Coronary Intervention ; mortality

OBJECTIVETo improve Luo-Ye pump-based stress-forming system and optimize the stimulating effect on smooth muscle cells during cultivation of tissue-engineered blood vessels (TEBV).

METHODSA new Luo-Ye pump-based TEBV 3D culture system was developed by adding an air pump to the output of the bioreactor. A pressure guide wire was used to measure the stress at different points of the silicone tube inside the TEBV bio-reactor, and fitting curves of the stress changes over time was created using Origin 8.0 software. The TEBVs were constructed by seeding vascular smooth muscle cells (VSMCs) isolated from human umbilical artery on polyglycolic acid (PGA) and cultured under dynamic conditions with 40 mmHg resistance (improved group), dynamic conditions without resistance (control group) or static condition (static group) for 4 weeks. The harvested TEBVs were then examined with HE staining, masson staining, α-SMA immunohistochemical staining, and scanning and transmission electron microscopy with semi-quantitative analysis of collagen content and α-SMA expression.

RESULTSThe measured stress values and the fitting curves showed that the stress stimuli from the Luo-Ye pump were enhanced by adding an air pump to the output of the bioreactor. Histological analysis revealed improved VSMC density, collagen content and α-SMA expression in the TEBVs constructed with the improved method as compared with those in the control and static groups.

CONCLUSIONAdding an air pump to the Luo-Ye pump significantly enhances the stress stimulation in the TEBV 3-D culture system to promote the secretion function of VSMCs.

Bioreactors ; Blood Vessel Prosthesis ; Cells, Cultured ; Collagen ; metabolism ; Humans ; Myocytes, Smooth Muscle ; cytology ; Polyglycolic Acid ; Tissue Engineering ; methods