Objective: To examine the effect of excimer laser ablation (ELA) combining with drug-coated balloon (DCB) for atherosclerotic lesions in no-stenting zones (NSZ) of the lower extremity. Methods: From June 2019 to December 2021, 46 patients who underwent ELA combining with DCB in lesions of NSZ at Zhongshan Hospital, Fudan University and Jinshan Hospital, Fudan University were retrospectively enrolled, including 29 males and 17 females. The age was (72.5±11.7) years (range: 42 to 93 years). Among them, 44 lesions (95.7%, 44/46) were in popliteal artery and 2 lesions (4.3%, 2/46) were in common femoral artery. Chronic total occlusion (CTO) was observed in 31 patients (76.4%, 31/46), and stenotic lesions were observed in 15 patients (32.6%, 15/46). The length of lesions was (7.3±2.7) cm (range: 3.0 to 13.2 cm). Patients were followed at 6, 12 months after surgery and every year thereafter, and they underwent Doppler and CT angiography examination at each follow-up point. The primary endpoint was primary patency. The secondary endpoints included major amputation-free survival (MAFS) rate, technical success, bailout stent, ankle-brachial index (ABI), target lesion reintervention (TLR). Student t test was applied to compare the difference between ABI of 6 or 12 months after surgery and the baseline. Primary patency, freedom from TLR, and MAFS rate were calculated by Kaplan-Meier method. Results: The technical success rate was 91.3% (42/46). The rate of procedure-related complication was 6.5% (3/46), and all the complications were distal embolization. The rate of flow-limiting dissection was 8.7% (4/46). ABI was significantly increased at 6 and 12 months compared to preoperatively (0.90±0.10 vs. 0.42±0.10, t=-4.48, P<0.01; 0.87±0.12 vs. 0.42±0.10, t=-5.21, P<0.01). The follow-up time[M(IQR)] was 22.5 (8.8) months (range: 6 to 32 months). TLR was performed in 4 patients (4/46, 8.7%). The 2-year primary patency was 86.2% (95%CI: 71.8% to 93.5%). The 2-year freedom from TLR and MAFS rate were 90.7% (95%CI: 77.0% to 96.4%) and 97.8% (95%CI: 85.6% to 99.7%), respectively. Conclusion: ELA combining with DCB can be applied to treat atherosclerotic lesions in NSZ.
Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Arteries ; Laser Therapy

BACKGROUND: Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency. METHODS: Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis. RESULTS: A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47-28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92-31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79-36.90; P < 0.01) were independent risk factors for the loss of primary patency. CONCLUSION Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.
Arterial Occlusive Diseases/surgery* ; Endovascular Procedures/methods* ; Female ; Humans ; Iliac Artery/surgery* ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Stents ; Survival Rate ; Treatment Outcome ; Vascular Patency

A total of 27 endophytic fungal strains were isolated from Huperzia serrata,which were richly distributed in the stems and leaves while less distributed in roots. The 27 strains were identified by Internal Transcribed Spacer( ITS) r DNA molecular method and one of the strains belongs to Basidiomycota phylum,and other 26 stains belong to 26 species,9 general,6 families,5 orders,3 classes of Ascomycota Phylum. The dominant strains were Colletotrichum genus,belonging to Glomerellaceae family,Glomerellales order,Sordariomycetes class,Ascomycota Phylum,with the percentage of 48. 15%. The inhibitory activities of the crude extracts of 27 endophytic fungal strains against acetylcholinesterase( ACh E) and nitric oxide( NO) production were evaluated by Ellman's method and Griess method,respectively. Crude extracts of four fungi exhibited inhibitory activities against ACh E with an IC50 value of 42. 5-62. 4 mg·L~(-1),and some fungi's crude extracts were found to inhibit nitric oxide( NO) production in lipopolysaccharide( LPS)-activated RAW264. 7 macrophage cells with an IC50 value of 2. 2-51. 3 mg·L~(-1),which indicated that these fungi had potential anti-inflammatory activities.The chemical composition of the Et OAc extract of endophytic fungus HS21 was also analyzed by LCMS-IT-TOF. Seventeen compounds including six polyketides,four diphenyl ether derivatives and seven meroterpenoids were putatively identified.
Acetylcholinesterase ; Animals ; Anti-Inflammatory Agents ; isolation & purification ; pharmacology ; Ascomycota ; chemistry ; classification ; isolation & purification ; Cholinesterase Inhibitors ; isolation & purification ; metabolism ; Endophytes ; classification ; isolation & purification ; Huperzia ; microbiology ; Mice ; RAW 264.7 Cells

Objective To evaluate the safety and efficacy of retroperitoneal laparoscopic procedure for rad-ical nephrectomy. Methods The clinical data of 140 cases underwent retroperitoneal aparoscopic radical nephrec-tomy from August 2013 to December 2015 were retrospectively analyzed. Among them ,87 cases were controlled by procedure for radical nephrectomy ,53 cases were treated with Non-procedural for radical nephrectomy. The peri-operative information parameters of the two groups were compared and analyzed. Results All of the 140 cases were operated under laparoscopy. There was no significant difference between the two groups in the basic condition and tumor location(P>0.05). Retroperitoneal laparoscopic procedure in the operation time ,intraoperative bleed-ing,peritoneal rupture rate,blood transfusion,complete tumor resection and postoperative drainage were better than non-procedural for radical nephrectomy ,the differences were statistically significant(P<0.01). All patients were followed up for 1 to 3 years without recurrence and metastasis. Conclusion Retroperitoneal laparoscopic pro-cedure for radical nephrectomy is significant ,worthy of clinical application and promotion.

Two new oleanane-type triterpenoids, parvifolactone A (1) and rubuside P (2), together with 11 known triterpenoids, fupenzic acid (3), 18,19-seco,2α,3α-dihydroxyl-19-oxo-urs-11,13(18)-dien-28-oic acid (4), euscaphic acid (5), maslinic acid (6), 1β- hydroxyeuscaphic acid (7), 2α,3α,19α,23-tetrahydroxyolean-12-en-28-oic acid (8), 2α,3β,19α,23-tetrahydroxyurs-12-en-28-oic acid (9), glucosyl pinfaensate (10), rubuside J (11), 2α,3α,19α,23-tetrahydroxyurs-12-en-24,28-dioic acid (12), and 2α,3β,19α- trihydroxyurs-12-en-23,28-dioic acid (13), were isolated from the roots of Rubus parvifolius.
Molecular Structure ; Plant Extracts ; chemistry ; isolation & purification ; Plant Roots ; chemistry ; Rubus ; chemistry ; Terpenes ; chemistry ; isolation & purification

Aged ; Aortic Aneurysm, Abdominal ; diagnostic imaging ; therapy ; Aortic Aneurysm, Thoracic ; diagnostic imaging ; therapy ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Stents

OBJECTIVETo assess the safety and efficacy of transcatheter intervention for critical pulmonary stenosis (CPS) and pulmonary atresia with intact ventricular septum (PA/IVS) in neonates.

METHODFrom June 2006 to September 2011, 27 neonates including CPS in 19 patients and PA/IVS in 8 patients underwent transcatheter intervention. All patients had membranous stenosis or atresia without severe Ebstein's anomaly and severe right ventricle and pulmonary valve hypoplasia, without right ventricle-dependent coronary circulation in PA/IVS. The mean age was (16.8 ± 9.9) d. The mean weight was (3.3 ± 0.5) kg. Two of them were premature neonates, the weight was 2.3 kg and 2.5 kg, respectively. The procedural success, early outcome, complication rates, midterm results and pulmonary regurgitation were retrospectively studied.

RESULTTwenty-six patients were successfully treated with transcatheter intervention. Right ventricular pressure fell from (112.0 ± 21.0) mm Hg (1 mm Hg = 0.133 kPa) to (50.4 ± 15.9) mm Hg (P < 0.001). The ratio of right ventricular pressure and aortic pressure fell from 1.7 ± 0.1 to 0.7 ± 0.3 (P < 0.001). One patient died early of PA/IVS. Complication occurred in 5 patients. Hemopericardium occurred in 3 patients, tachyarrhythmia in 2 patients. Five patients needed prolonged prostaglandin E(1) infusion for 3 to 14 days because of desaturation after the procedure. No patient needed surgery in neonatal period. At a mean follow-up of (33.5 ± 18.3) months (from 6 months to 5 years), 21 patients had no further transcatheter or surgical intervention. Four patients with CPS had moderate to severe residual pulmonary stenosis after the procedure, 3 of them underwent a second balloon dilation at 3 months of follow-up, the other one was waiting for the second balloon dilation. One patient with PA/IVS was waiting for a bidirectional Glenn procedure because of chronic right ventricular failure. Mild pulmonary regurgitation occurred in 18 patients (69.2%), and moderate pulmonary regurgitation in 8 patients (30.8%).

CONCLUSIONTranscatheter intervention for CPS and PA/IVS in neonates is safe and effective. It can avoid neonatal surgery. Some patients may require repeat balloon valvuloplasty in infant period. In most patients surgical or transcatheter intervention could be avoided and mild pulmonary regurgitation was the common finding in midterm follow-up.

Catheterization ; instrumentation ; methods ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; surgery ; Humans ; Infant, Newborn ; Male ; Pulmonary Atresia ; surgery ; Pulmonary Valve ; surgery ; Pulmonary Valve Stenosis ; surgery ; Reoperation ; Retrospective Studies ; Treatment Outcome

Objective To investigate the distribution of hepatitis delta virus (HDV) marker among hepatitis B virus (HBV) infected patients and to reveal its clinical significance.Method To collect the clinical data and sera samples of HBV infected patients and to detect HDAg,Anti-HDV as well as HBV infection markers by means of enzyme-linked immunosorbnent assay.These data combined with clinical diagnostic results and biochemical index were then analyzed.Result 462 samples of HBV infected patients were collected including 210 HBV carriers without symptom,175 chronic HBV infections,35 acute HBV infections and 42 liver fibrosis.The HDV infection rate was 4.8％ overall.The highest infection rate of 9.5％ was found in the group of liver fibrosis whereas the lower rate of 6.9％ was found in HBV chronic carriers.HDV infection rate was 7.8％ among the population of 40-60 years old,obviously higher than any other age groups.Conclusion HDV infection was significantly higher in the chronic HBV patients and liver fibrosis patients.Because HDV infection was highly associated with the progress of liver disease,we suggest the screen of HDV markers among hepatitis patients and discriminate whether the patient was co-infected with HDV.

BACKGROUNDAortic root replacement with pulmonary autograft (Ross procedure) has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease.

METHODSFrom October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28 +/- 15 years (range, 5-56 years). Congenital heart disease (CHD) with aortic valve stenosis (AS) and/or aortic valve insufficiency (AI) in 40 cases including one associated with ventricular septal defect (VSD), degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis (SBE) with AI in 1 were studied. The diagnosis was made by ultracardiography (UCG) in all patients. The mean aortic valve annulus diameter (AVD) was (2.45 +/- 0.31) cm and pulmonary valve annulus diameter (MPVD) was (2.34 +/- 0.21) cm. All patients had normal pulmonary valves. The New York Heart Association (NYHA) function class was II in 36 cases and III in 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass (CPB) with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft.

RESULTSThere was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was (6.11 +/- 0.12) mmHg. The left ventricular diastole diameter (LVDD) decreased significantly from (62 +/- 5) mm to (56 +/- 3) mm (P < 0.001). The mean postoperative left ventricular ejective fraction (LVEF) was 0.49 +/- 0.23. All patients were in NYHA class I-II. Follow-up was completed in 38 cases for a mean period of 3.2 years (range 1-10 years). All survivors were in NYHA class I with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year after the Ross procedure. The cause of death was uncontrolled bleeding. Another patient suffered from cardiogenic shock and was on extracorporeal membrane oxygenation (ECMO) for 10 days postoperatively. This patient was subsequently self-discharged from hospital due to financial issues and he was excluded from follow-up.

CONCLUSIONThe Ross procedure is an excellent technique to treat aortic valve disease. Our data show that it can be performed safely with good early and mid-term clinical outcomes.

Adolescent ; Adult ; Aortic Valve Insufficiency ; surgery ; Aortic Valve Stenosis ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Valve ; transplantation ; Transplantation, Autologous

OBJECTIVEThis study attempted to explore the value of combining serum hepatic fibrosis-related markers and ultrasound parameters together on diagnosis of hepatic fibrosis.

METHODSSix serum markers and 8 ultrasound parameters were measured from 100 patients with chronic hepatitis B or cirrhosis. The results of the serum hepatic fibrosis-related markers and ultrasound in disease group were analyzed and compared with the findings of hepatic pathology.

RESULTSBy filtrating,the group of platelet derived growth factor-BB (PDGF-BB) plus hyaluronic acid (HA) plus echo characteristics of liver parenchyma (LPEC) plus length of spleen (SL) had the highest Se and Spe, which were 90.7% and 85.4% respectively.

CONCLUSIONThe advantageous combination of serum markers and ultrasound parameters can significantly improve Se and Spe, which is superior to any single serum index or ultrasound parameter. And it was a better non-invasive method for diagnosing hepatic fibrosis.

Adolescent ; Adult ; Aged ; Alanine Transaminase ; blood ; Biomarkers ; blood ; Collagen Type III ; blood ; Female ; Hepatitis B, Chronic ; blood ; diagnosis ; diagnostic imaging ; Humans ; Hyaluronic Acid ; blood ; Liver Cirrhosis ; blood ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Platelet-Derived Growth Factor ; analysis ; Proto-Oncogene Proteins c-sis ; Reproducibility of Results ; Sensitivity and Specificity ; Tissue Inhibitor of Metalloproteinase-1 ; blood ; Transforming Growth Factor beta ; blood ; Ultrasonography, Doppler, Color ; methods ; Young Adult