Objective:To explore the predictors and reasons for restenosis in patients with Takayasu′s arteritis(TA) involved renal artery after plain old balloon angioplasty(POBA).Methods:The clinical data of 47 TA patients (47) with renal artery admitted to Xuanwu Hospital, Capital Medical University from January 2014 to December 2020 were analyzed, including 12 man and 35 female. The age ranged from 21 to 43 years old, with an average of (28.52±10.78) years old. All patient were diagnosed as TA and underwent POBA. The patients were divided into restenosis group ( n=18) and non-restenosis group ( n=29). The patients were followed up at 1, 3, and 6 months after surgery, and after 6 months, the patients were followed up every 6 months. All patients were followed up from 36 to 108 months.The basic clinical data of the two groups were compared, and the length of stent and residual stenosis were also compared. Measurement data were expressed as ( ± s), and t-test was used for comparison between groups. Counting data were expressed as the number of cases and percentage, and comparison between groups was analyzed using the chi-square test. Multivariate Logistic regression model was used to analyze the independent risk factors of restenosis after balloon dilation, and the OR value and 95% confidence interval were calculated. Logistic regression model was used to analyze the independent risk factors for restenosis after balloon dilation. Results:All patients received POBA and operation was successfully. Restenosis was found in 18 patients, and 29 patients remained normal during the follow-up. The primary patency rate was 61.7%. Multivariate Logistic regression analysis showed that HDL-C and lesion length were the influencing factors of restenosis after POBA in TA of renal artery. The serum HDL-C level was significantly lower and the lesion was significantly longer in restenosis group than in non-restenosis group ( P<0.05). The proportion of residual stenosis>20% was higher in restenosis group than in non-restenosis group ( P>0.05). Conclusion:Serum HDL-C level, lesion length may be may be independent influencing factors of restenosis after plain old balloon angioplasty in TA of the renal artery restenosis.

Objective:To explore the therapeutic effect of interventional treatment on Takayasu arteritis involved renal artery.Methods:A retrospective analysis was conducted on the clinical data of 26 patients (28 blood vessels) with Takayasu arteritis involved renal artery admitted to the Xuanwu Hospital, Capital University of Medical Sciences from January 2012 to July 2023. Balloon dilation or stent implantation were performed, and the t vascular patency rate, blood pressure changes, surgical effects, and complications were followed up and observed.Results:All patients underwent balloon dilation or stent implantation, and the surgery was successful, including 23 cases of balloon dilation (25 blood vessels) and 3 cases of stent implantation (3 blood vessels). During the follow-up period of 12-102 months, one case died of renal failure at 57 months post surgery (unilateral renal artery balloon dilation case), and one case was lost in the first year (unilateral renal artery balloon dilation case). The patency rates of balloon dilated blood vessels at 1 year, 3 years, and 5 years were 23/24(95.83%), 22/24(91.67%), and 20/23(86.96%), respectively. Patients with stent implantation had 2 diseased blood vessels unobstructed at 1 year of follow-up and 1 diseased blood vessel unobstructed at 3 years of follow-up. Some patients showed improvement in clinical symptoms, including 3 cases (3/26, 11.54%) of cured hypertension symptoms, 19 cases (19/26, 73.08%) of improved symptoms, and 4 cases (4/26, 15.38%) of ineffective symptoms. The systolic blood pressure decreased from preoperative (169.29±10.76)mmHg to (150.31±14.62)mmHg, with a statistically significant difference ( P<0.05). There was no statistically significant difference in blood creatinine levels between preoperative (78.42±21.38)μmol/L and postoperative (77.83±21.14)μmol/L ( P>0.05). Conclusions:Endovascular angioplasty is safe, feasible, and has a definite therapeutic effect on patients with Takayasu′s arteritis involved renal artery.

BACKGROUND: Knee osteoarthritis (KOA) is a prevalent chronic joint disease caused by various factors. Mesenchymal stem cells (MSCs) therapy is an increasingly promising therapeutic option for osteoarthritis. However, the chronic inflammation of knee joint can severely impede the therapeutic effects of transplanted cells. Gelatin microspheres (GMs) are degradable biomaterial that have various porosities for cell adhesion and cell–cell interaction. Excellent elasticity and deformability of GMs make it an excellent injectable vehicle for cell delivery. METHODS: We created Wharton’s jelly derived mesenchymal stem cells (WJMSCs)-GMs complexes and assessed the effects of GMs on cell activity, proliferation and chondrogenesis. Then, WJMSCs loaded in GMs were transplanted in the joint of osteoarthritis mice. After four weeks, joint tissue was collected for histological analysis. Overexpressing-luciferase WJMSCs were performed to explore cell retention in mice. RESULTS: In vitro experiments demonstrated that WJMSCs loaded with GMs maintained cell viability and proliferative potential. Moreover, GMs enhanced the chondrogenesis differentiation of WJMSCs while alleviated cell hypertrophy. In KOA mice model, transplantation of WJMSCs-GMs complexes promoted cartilage regeneration and cartilage matrix formation, contributing to the treatment of KOA. Compared with other groups, in WJMSCs+GMs group, there were fewer cartilage defects and with a more integrated tibia structure. Tracking results of stable-overexpressing luciferase WJMSCs demonstrated that GMs significantly extended the retention time of WJMSCs in knee joint cavity. CONCLUSION Our results indicated that GMs facilitate WJMSCs mediated knee osteoarthritis healing in mice by promoting cartilage regeneration and prolonging cell retention. It might potentially provide an optimal strategy for the biomaterial-stem cell based therapy for knee osteoarthritis.

Objective: To investigate the current situation of obesity and related metabolic abnormalities among preschool children, so as to provide theoretical support for future intervention. Methods: A cohort of 3 952 children, born in Tianjin and enrolled in the kindergarten from September 2017 to October 2018, were selected to conduct a baseline survey and a three-year follow-up (questionnaire survey, physical examination and laboratory testing). At the same time, a two-way cohort study was conducted to retrospectively collect maternal prenatal examination, delivery and regular physical examination information of children from birth to preschool age from Tianjin Maternal and Child Health Information System. Results: A total of 3 935, 3 654 and 2 739 children completed the follow up in the primary, middle and senior classes of kindergarten respectively. The height and weight of pre-school children increased with age, while the percentage of body fat decreased with age ( β-trend =-0.74, P <0.01). During three-year follow up, height, weight and body mass index of boys were higher than girls (P<0.05), while the percentage of body fat was lower than girls (primary class: 17.5%,18.5%; middle class: 16.4%,17.2%; senior class: 16.1%,17.1%, P <0.05). The detection rate of overweight (including obesity) and obesity increased with age( χ 2 trend were 15.51,38.72, P <0.05). The total detection rate of obesity increased from 5.4% at the baseline level to 9.6%. Laboratory test results showed that the detection rates of fasting blood glucose of boys were higher than that of girls in primary class, but blood lipid abnormalities were in the opposite (glucose: 7.7%, 4.8 %; lipid: 23.8% , 27.7%)( χ 2=12.01, 6.63, P <0.05). Conclusion The study has established a large growth cohort starting from the early embryonic stage, which will help to establish the strategies to promote children s health and prevent obesity and chronic diseases from multidimensional perspectives.

Objective: To explore the relationship between prepregnancy body mass index, weight gain during pregnancy with preschool obesity and body composition in offspring, so as to provide evidence for gestational weight gain and childhood obesity prevention. Methods: A total of 1 333 preschool children were recruited from 3 kindergartens in Tianjin from September to December 2020. Structured questionnaire was used to collect children s lifestyle information. Height, weight and body fat mass of children were assessed, and body fat percentage (FM%), fat mass index (FMI) and non fat mass index (FFMI) were calculated. Maternal medical records were collected and the mothers were grouped according to their prepregnancy weight status and weight gain during pregnancy. χ 2 test, t test, linear regression model and Logistic regression were used to analyze the differences of obesity and body composition among different groups. Results: The prevalence of overweight and obesity in preschoolers was 12.7% and 7.7%. After adjusting maternal age and delivery, gestational age, gender, age and lifestyle of children, the correlation between maternal pre pregnancy BMI,gestational weight gain with obesity and body composition indexes of children in preschool age was statistically significant ( P <0.05). For mothers with normal weight before pregnancy, excessive weight gain during pregnancy increased risk of high FM% and high FMI in offspring ( OR=1.81, 1.68, P <0.05). There was no significant correlation between maternal weight gain during pregnancy with offspring obesity and body composition among mothers with prepregnant overweight or obesity. Conclusion Maternal weight status before pregnancy and weight gain during pregnancy are correlated with obesity and body composition in the preschool age of offspring. It is suggested that mothers should maintain appropriate weight status before and during pregnancy.

Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.

Background: Esophageal cancer is one of the leading causes of cancer deaths worldwide. T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) has been shown to be implicated in the tumor immune escape, and associated with tumor progression and poor prognosis in a variety of malignancies. Aims: To investigate the expression of Tim-3 in esophageal tumorigenesis and its clinical significance. Methods: Paraffin-embedded tissues from 103 esophageal cancer, 21 high-grade esophageal intraepithelial neoplasia, 16 low-grade esophageal intraepithelial neoplasia, and 20 chronic esophagitis were collected in this study. Using immunohistochemistry, the expression level of Tim-3 was evaluated; and the correlation of Tim-3 expression in cancerous tissue with the clinicopathological parameters of esophageal cancer was analyzed. Results: Tim-3 expression was increased from chronic esophagitis, low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia to esophageal cancer (0.271±0.138, 0.368±0.198, 0.443±0.147, and 0.639±0.119, P<0.05). Moreover, Tim-3 expression was significantly correlated with depth of tumor invasion, regional lymph node metastasis and TNM staging of esophageal cancer (P<0.05), whereas no relationship was found between Tim-3 expression and gender, age and tumor location of esophageal cancer (P>0.05). Conclusions: Tim-3 expression is increased in esophageal tumorigenesis; overexpression of Tim-3 in esophageal cancer is closely correlated with tumor progression. Tim-3 might be served as a biomarker for development, progression and prognosis of esophageal cancer.

Objective: To investigate the effect of endovascular treatment of cerebral infarction with right aortic arch and Kommerell's diverticulum. Methods: Retrospective analysis was done to assess the treatment effect of a case from vascular surgery, Xuanwu Hospital of Capital Medical University. This case was diagnosed as cerebral infarction with right aortic arch and Kommerell's diverticulum. Results: One month after the treatment of cerebral infarction, we successfully used the thoracic aortic stent to isolate the Kommerell's diverticulum. There were no operative complications occurred. The stent had good shape and smooth blood flow was seen in the stent. Conclusions Endovascular treatment to cerebral infarction with right aortic arch and Kommerell's diverticulum is safe and feasible, and the clinical outcome requires further long-term follow-up.

Objective: To investigate the effect of anastomotic reinforcing sutures on the incidence of anastomotic leakage after laparoscopic radical resection of rectal cancer. Methods: In this study, 300 patients diagnosed with rectal cancer, scheduled to undergo laparoscopic anterior resection at the Department of Gastrointestinal Surgery of Anhui Provincial Hospital, between September 2014 and December 2016, were prospectively enrolled. Patients were randomly assigned to undergo laparoscopic rectal resection with (reinforcing group, n = 150) or without (control group, n = 150) anastomotic reinforcing sutures. The laparoscopic total mesorectal excision was followed for all patients. In the reinforcing group, 4-0 absorbable sutures were used to reinforce the 2-4 needles used for the 2 cross-cutting lines that formed the stapler. Concurrent obstructions; the need for hemorrhagic emergency surgery, preventive ileostomy, Hartmann operation, abdominoperineal resection, or open surgery; and the presence of unresectable cancer were all reasons for excluding patients from the study. Univariate and multivariate analyses were performed on the clinical data collected for the two groups. According to the multivariate analysis results, patients were further divided into high-risk (≥ 2 high risk factors) and low-risk (≤1 high risk factor) groups, and were stratified to analyze the relationship between reinforcing suture use and the incidence of anastomotic leakage. This trial, approved by the Ethics Committee of Anhui Provincial Hospital, was registered as NCT02830633. Results: A total of 291 patients were included in the study, namely 145 in the reinforcing group and 146 in the control group. There were no significant differences between the two groups with respect to their general data or intra-operative conditions (all P > 0.05) . The overall incidence of anastomotic leakage was 7.6% (22/291) ; 3.4% (5/145) in the reinforcing group and 11.6% (17/146) in the control group (χ² = 6.992, P = 0.008) . Multivariate analyses showed that the lack of reinforcing sutures was an independent risk factor for anastomotic leakage (OR = 2.75; 95%CI, 1.72-5.48; P = 0.014) . Other independent risk factors included NRS2002 score ≥ 3 points, tumor diameter ≥ 4 cm, and tumor to anal margin distance < 5 cm. There were 80 patients in the high-risk group and 211 in the low-risk group, based on the aforementioned 3 risk factors. The incidence of anastomotic leakage was 27.1% (13/48) among the control patients in the high-risk group, but only 6.2% (2/32) among high-risk patients receiving reinforcing anastomotic sutures (χ² = 5.470, P = 0.019) . In the low-risk group, the incidence of anastomotic leakage was 2.7% (3/113) among patients receiving reinforcing anastomotic sutures, and 4.1% (4/98) among those not receiving reinforcing sutures. No significant difference was observed (χ² = 0.333, P = 0.564) . Conclusion Anastomotic reinforcing sutures for the prevention of anastomotic leakage after laparoscopic radical resection of rectal cancer is convenient and effective, particularly for patients with multiple risk factors.

Endovascular aortic repair (EVAR) has been the main treatment means for abdominal aortic aneurysm.It has become an expert consensus that in the case of abdominal aortic aneurysm that is complicated by iliac aneurysm,the preservation of internal iliac artery is necessary because it can prevent the occurrence of gluteal muscle ischemnia,sigmoid ischemia,male sexual dysfunction and other complications.In recent years,with the continuous updating of the endovascular devices it has become possible to retain the internal iliac artery in the performance of EVAR.At present,the reconstruction of internal iliac artery in EVAR includes a variety of techniques,including intraluminal iliac branched device (IBD) technique,sandwich technique,common iliac artery covered-stent bell-bottom (BBT) technique,external iliac artery-internal iliac artery intraluminal shunt technique (reverse chimney technique),and spring coil embolism technique.This article aims to make a summary of all the above mentioned techniques.