Objective To compare the postoperative follow-up indexes of femoral popliteal artery bypass grafts and evaluate the sensitivity of vessel function test methods for the early detection of grafts restenosis.Methods 84 cases were followed-up after femoral popliteal graft bypass,using ankle brachial index (ABI),ABI decrease amplitude,and Duplex ultrasound to detect peak systolic velocity (PSV) and peak systolic velocity ratio (PSVR).All patients were divided into mild stenosis group (0-49％),moderate stenosis group (50％-74％) and severe stenosis group (75％-99％).Results ABI was 0.88 ±0.12,0.81 ± 0.10 and 0.52 ± 0.13;ABI decrease amplitude was 0.13 ± 0.06,0.12 ± 0.06 and 0.36±0.06;PSV(m/s) was 0.89 ±0.23,0.91 ±0.31 and 1.70 ±0.85,respectively.There was remarkable difference for ABI,ABI decrease amplitude and PSV between severe stenosis and mild to moderate stenosis group (P ＜0.05).PSVR was 1.00 ±0.08,2.14 ±0.31 and 3.58 ±0.31 respectively,in the three groups (P ＜ 0.05).Conclusion PSVR was more sensitive to detect grafts restenosis early than ABI,ABI decrease amplitude and PSV.

Objective To evaluate the incidence of asymptomatic carotid stenosis (ACS) in patients with peripheral arterial occlusive disease (PAOD) who was admitted for revascularization.Methods 229 PAOD patients were evaluated by carotid ultrasound preoperatively and divided into severe ACS group (ACS ≥ 70％) and non severe ACS group (ACS ＜ 70％).The clinical characteristics and associated risk factors of the two groups were analyzed.Results The incidence of severe ACS was 19.7％,age,blood pressure,total cholesterol and fibrinogen levels in severe ACS group were significantly higher than those in non-severe ACS group (P ＜ 0.05),the more severe the symptoms of PAOD are,the higher is the incidence of severe ACS.Age,hypertension and hypercholesterolemia were all predictors of severe ACS.Conclusions The severity of PAOD is positively correlated with the incidence of severe ACS.Age,hypertension and hypercholesterolemia are independent risk factors for severe ACS.

Objective To explore the clinical value of the duplex ultrasonography (duplex US) for evaluating the re-stenosis after peripheral arterial bypass grafting. Methods Eighty prosthetic grafts of sixty-three patients with femoral-pop-liteal arterial bypass grafting were follow-up regularly by duplex US. They were divided into non significant stenosis group (n=56), the significant stenosis group (n=15) and occlusion group (n=9) according to the tube diameter and arterial blood flow-ing parameters, which changed postoperatively. The diagnostic results were compared and analyzed between duplex US and digital subtraction angiography (DSA). The peak flow velocity of middle grafts (MG) to 40 cm/s was defined to evaluate risk of graft occlusion. Results The diagnostic coincidence rate of duplex US and DSA for grafts stenosis classification was 90%. The diagnostic sensitivity of duplex US to grafts stenosis was 91.7%, and the specificity was 92.9%. The positive pre-dictive value was 84.6%for grafts stenosis, and the negative predictive value was 96.3%, the false positive rate was 16.7%, and the false negative rate was 8.3%. The grafts occlusion rate was higher in MG<40 cm/s group than that of MG≥40 cm/s group. Conclusion There was a good consistency with Duplex US and DSA for the diagnosis of peripheral artery bypass graft restenosis. Duplex US showed characteristics of non-invasive, simple and easily accepted by patients.

Objective To understand the status quo of the illness situation and the implementation of prevention and control measures on Kashin-Beck disease( KBD ) in Shandong Province , and provide a scientific basis for assessment and acceptance of the work on eliminating KBD. Methods In accordance with the requirements of the national “Implementation Scheme for Endemic Disease Control in 2012” and the “Shandong Provincial Technical Scheme for KBD Control in 2012”. In four towns of Qingzhou, three epidemic villages were selected as the surveying villages in each town in order to understand the implementation of measures for prevention and control of KBD; information such as population of investigating villages, per capita income, farming, food and the implementation of control measures,etc were included. In each investigating village, 7 - 12 years old children were selected to receive clinical and X-ray examination. When fewer than 50 people in a investigating village , one additional endemic village was included near the investigating village , and all children aged 7 to 12 of the village were checked. The number of cases of clinical degree Ⅰ, Ⅱ, Ⅲand the detection rates, X-ray positive detection rate, the number of cases of metaphysis, epiphysis, distal end of phalanx, carpal bone, triad and the detection rates were calculated, respectively. Clinical and X-ray diagnosis were based on “The Diagnostic Criteria of Kaschin-Beck disease”(WS/T 207-2010). Results A total of 14 epidemic villages were selected to survey in four towns of Qingzhou. In the recent three years in the epidemic areas, measures of supplying Se had not been implemented;measures of resettlement and off-site education had not been implemented either. In the epidemic areas , the main crops were wheat and corn; the staple food was flour which accounted for more than 80%, and the foreign food bought accounted for only 11%. The areas of returning farmland to forest (grass) accounted for 0.32%(36/11 151) of the original arable land, and the areas of replanting economic crops accounted for 1.17%(131/11 151) of the original farmland. A total of 536 children aged 7 to 12 were examined by clinical and X-rays. Patient of KBD was not detected clinically. Six positive patients with metaphyseal changes of KBD were detected by X-rays, and the average X-ray detection rate was 1.12%(6/536). Patients with abnormal epiphysis, distal end of phalanx and carpal bone were not detected by X-rays. Conclusions KBD in Shandong Province has been effectively controlled. Since the cause of KBD is still unknown, it is necessary to build a sustainable long-term control mechanism of KBD;further improve the monitoring system and dynamic monitoring work still need to be strengthened.

Objective To evaluate the relationship between asymptomatic carotid stenosis (ACS)and lower limb arteriosclerosis obliterans (ASO).Methods 200 patients with lower extremities arteriosclerosis obliterans who were admitted in our hospital between Oct 2013 and Oct 2015 were retrospectively reviewed.Patients were divided into severe ACS (stenosis ≥ 70％)and moderate ACS (stenosis ＜ 70％).Results Compared with moderate ACS,the severe ACS patients were elder,heavier cigarette-smoker and alcohol drinker,higher hypertriglyceride and fibrinogen level (all P ＜ 0.05).The incidence rate of severe ACS increased as lower limb ASO gets more significant (x2 =28.2,P ＜ 0.05).It also increased with age (x2 =7.78,P ＜ 0.05).Multi-factor logistic regression showed advanced age (OR:1.079,95％ CI:1.055-1.104,P ＜ 0.05) and hypertriglyceride (OR:2.013,95％ CI:1.076-3.325,P ＜ 0.05) were risk factors for severe ACS.Conclusions The incidence of severe ACS increased with the increasing of age and severity of lower limb ASO.Advanced age and hypertriglyceride were potential risk factors for severe ACS.

Objective To explore the effects of lipoxin A4 ( LXA4 ) on lipopolysaccharide ( LPS)-induced oxidative stress in human umbilical veins endothelial cells(HUVEC) and the possible mechanism.Methods Neonatal umbilical cords were obtained from normal term pregnant women with cesarean section within 4 hours and then were used to isolate HUVEC for subculture.HUVEC were divided into four groups:control group; LPS group ( 10 μg/ml of LPS); LPS + LXA4 group ( 10 μg/ml of LPS and 100 nmol/L of LXA4); LXA4 group (100 nmol/L of LXA4) All expriments were performed after cells treated for 12 and 24 hours respectively.Immunofluorescence was used to detect the expression of Ⅷ foctor and nuclear translocation of nuclear factor-erythroid-2-related factor 2 ( Nrf2 ); the mRNA expression of Nrf2, heme oxygenase 1 (HO-1) and reduced form of nicotinamide-adenine dinucleotide quinone oxidoreductase-1(NQO1) were evaluated by reverse transcription-PCR .Results (1)The flavovirens fluorescence was observed in the cytoplasm under fluorescence microscope, which confirmed the existence of Ⅷ factor which specifically expressed in endothelial cells, especially in HUVEC.(2)Immunofluorescent results showed that in control group, Nrf2 protein expressed in the cytosol rather than in the nucleus.In LPS group, the expression of Nrf2 protein obviously increased in the nucleus while decreased in the cytosol after 12 hours.However, after LPS treatment for 24 hours, Nrf2 expression reduced in the cytosol and nucleus.In cotreatment with LPS and LXA4 group,the expression of Nrf2 protein was much higher than that in LPS group after 12 hours or 24 hours.Furthermore, Nrf2 protein also mostly expressed in the cytosol in LXA4 group.(3) After stimulation for 12 hours, compared with control group, the gene expression of Nrf2 and HO-1 were significantly enhanced in LPS group (0.581 ± 0.019 and 0.081 ±0.009, P ＜ 0.05 ) and in LPS + LXA4group(0.692 ±0.048 and 0.136 ± 0.018, P ＜ 0.05 ), the level of NQO1 mRNA in LPS group and LPS +LXA4 group were 0.381 ± 0.009 ( P ＞ 0.05 ) and 0.574 ± 0.034 ( P ＜ 0.05 ).After treatment for 24 hours,compared with control goup, the gene expressions of Nrf2 and NQO1 were down-regulated in LPS group (0.180±0.017 and 0.472 ±0.064, P＜0.05).But in LPS + LXA4 group the expression of Nrf2 and NQOI were upregulated (0.532 ± 0.051 and 0.830 ± 0.068, P ＜ 0.05, compared with treatment for LPS group).The mRNA expressions of Nrf2, HO-1 and NQO1 were increased in LPS + LXA4 group compared with LPS group ( P ＜ 0.05 ).In addition, there was no markedly difference in the expressions of Nrf2, HO1 and NQO1 between control and LXA4 group after 12 hours and 24 hours ( P ＞ 0.05 ) .Conclusion Through activating nuclear translocation of Nrf2 protein from cytoplasm, LXA4 upregulates the Nrf2downstream enzymes, such as NQO1 and HO-1 to protect HUVEC against the oxidative stress induced by LPS.

OBJECTIVETo summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.

METHODSTwenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012. The treatment protocols included interventional covered-stent placement (10 cases), spring coil embolization (2 cases), and surgical operation (8 cases). Surgical operations included pseudoaneurysm repair (2 cases), autologous-vein transplantation (1 case), and artificial-vessel bypass graft (5 cases).

RESULTSAll the patients were successfully treated without aggravating lower limb ischemia. Pseudoaneurysm disappeared after treatment. A surgical operation is suitable to most pseudoaneurysms, but its damage is relatively obvious and usually leads to more bleeding. It also requires a longer operating time. Compared to a surgical operation, interventional therapy is less traumatic and patients usually have a quicker recovery (P<0.05). All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination. There were no cases of pseudoaneurysm recurrence.

CONCLUSIONBoth surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.

Adult ; Aged ; Aneurysm, False ; diagnostic imaging ; etiology ; surgery ; Angiography, Digital Subtraction ; Embolization, Therapeutic ; Female ; Humans ; Leg Injuries ; complications ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Stents ; Treatment Outcome ; Ultrasonography, Doppler

Objective To explore whether lipoxin A4 (LXA4)could prevent lipopolysaccharide (LPS)-induced human umbilical vein endothelial cells (HUVEC) monolayer hyperpermeability and its possible mechanism. Methods Human umbilical cords were obtained from women with normal pregnancy immediately after delivery from Tongji Hospital Affiliated of Tongji Medical College. Primary HUVEC were isolated from umbilical veins and subcultured, then, HUVEC were divided into four groups:control group;LPS group (10 mg/L of LPS); LPS + LXA4 group(10 mg/L of LPS and 100 nmol/L of LXA4); LPS +LXA4 + BOC-2 group [10 μmol/L of BOC-2, an effective antagonist of formyl peptide receptor like 1 (FPRL-1)]. All expriments were performed after cells were treated for 24 hours. Endothelial permeability was measured by fluorescein isothiocyan-ate labelled bovine serum albumin (FITC-BSA) clearance across the monolayer; tumor necrosis factor α(TNF-o) mRNA and secretion were detected by reverse transcriplase (RT) -PCR and ELISA assay respectively, and nuclear factor κB(NF-κB) protein change was determined by western blot. Results (1) LPS induced a significant increase in the permeability [Pa value of LPS group was (183.1 ±1.7)%], while co-administrating with LXA4 obviously attenuated this LPS-induced hyperpermeability, Pa value of LPS + LXA4 group was (103.1 ±2.2)%, LPS + LXA4 + BOC-2 group was (162.2 ± 2.8)%, control group was 100%, the permeability of HUVEC monolayer was significantly increased by LPS which was (83.1 ± 1.7)% of control (P <0.01), however, it was notably inhibited by LXA4 (P<0.05); the blockade of FPRL-1 could attenuate the effect of LXA4, that is, there was no difference between the LPS + LXA4 + BOC-2 group and the LPS group. (2) After treatment with different concentration of LPS(0,0.1, 1,10 mg/L), the mRNA expressions of TNF-α were increased (1.11 ±0.11,1.27 ± 0.03, 1.60 ± 0.06, 1.82 ± 0. 04, respectively), compared with the control group, at the concentration of 1,10 mg/L LPS, the difference was statistically significant (P<0. 05). (3) The increased levels of NF-κB and inflammatory mediator TNF-α in the LPS group were both inhibited by LXA4. Levels of NF-κB protein and TNF-o mRNA secretion in LPS treated group (0.53 ±0.06 and 0.81 ±0.09 ,respectively)were both inhibited by LXA4 (0.19 ± 0.05 and 0.41 ± 0.07, respectively, and both had significant difference, P<0.05). (4) Levels of TNF-α in HUVEC culture medium of LPS group [(31.94 ±0.01)ng/L] was significantly higher than the control group [(18.17 ± 0.03) ng/L, P<0.05], LPS + LXA4 group [(15.72 ± 0.07) ng/L] was significantly lower than the LPS group (P<0.05). Conclusion Our findings demonstrated that LXA4 could prevent the endothelial cell hyperpermeability induced by LPS in HUVEC under which the possible mechanism was through inhibiting the expression of NF-κB and its related cytokines through receptor-dependent.