Objective:To report a single-center experience with the Cordis Incraft endograft with low-profile in abdominal aortic aneurysms (AAAs) with severe infrarenal neck.Methods:All patients underwent EVAR with Incraft stent grafts between September 2019 and September 2022, were prospectively enrolled, and retrospectively analyzed. Anatomical details of the proximal aortic neck were evaluated, divided into the severe infrarenal neck (SIN, 13 cases) and normal infrarenal neck (NIN, 50 cases) groups. Early endpoints were intraoperative unplanned cuff or coil embolism, technical success (TS), 30-day morbidity/mortality, and reinterventions. Follow-up endpoints were occurrence of endoleaks, endograft migration, branch stent/ iliac stent-graft stenosis or occlusion, reintervention. The postoperative endoleak, aneurysm sac shrinkage, patency of iliac stent-graft/branch stent, and freedom from reinterventions between the two groups were compared.Results:A total of sixty-three patients were enrolled in this trial, all of whom were successfully treated. There was no significant difference in patient and lesion characteristics, excluding aneurysm neck length, neck angle and maximum aneurysm sac diameter. Proximal aneurysm neck length was shorter in the SIN group [(9.9±8.3)mm vs. (29.6±12.3)mm, P<0.001] and the neck angle was more tortile in the SIN group [(39.1±30.4)°vs.(25.1±15.4)°, P=0.036], as well maximum sac diameter was larger in the SIN group [(57.5±13.4)mm vs. (45.5±12.4)mm, P=0.016]. Although the results showed no differences between the two groups regarding the oversize rate of the main body stent graft, endoleak in operative and perioperative period, as well the hospital stay, the operative time was significantly longer in the SIN group [(96.36±31.83)min vs. (63.58±26.68)min, P=0.001]. Over the 3 years of follow-up (median time, 18 months), there were significant differences between the two groups regarding the complication occurrence of endoleak, renal stent or iliac stent-graft stenosis/occlusion ( P=0.012), and reintervention ( P=0.044). Conclusion:Data from this trial demonstrated excellent early and mid-term outcomes of EVAR using Incraft stent grafts, including severe infrarenal neck, with acceptable safety and efficacy in the short and middle terms.

Objective:To evaluate the safety and effectiveness of ARAHKEY(arterial closure using an additional hemostatic device that is deeply compatible with an extravascular suturing device) technique during percutaneous transluminal repair of thoracic aortic disease(TEVAR).Methods:From January 2021 to January 2023, a total of 202 patients underwent TEVAR in our center.24 patients were treated with ARAHKEY technology, which involves using an additional 7F Exosel at the femoral artery puncture site to achieve hemostatic effect when two ProGlide embedded sutures cannot achieve hemostatic effect.Results:All patients achieved complete hemostasis.The mean time for compression hemostasis was(5.8±2.6)min.In this study cohort, no complications including recurrent bleeding, infection, and late acquired hematoma were observed.Conclusion:ARAHKEY technology is a safe method that can be considered as the primary choice when using ProGlide during TEAVR without achieving hemostatic effects.

Objective To compare the radiation dose of in vitro pre-fenestration and in situ fenestration thoracic endovascular aortic repair(TEVAR)in treatment of aortic disease.Methods Data of 51 patients with aortic diseases who received in vitro pre-fenestration(group A)and 21 cases who underwent in situ fenestration(group B)TEVAR were retrospectively analyzed.The fluoroscopy duration,total reference air kerma(AK),total dose area product(DAP)and TEVAR time were compared between groups.Results TEVAR was successfully completed in all 72 patients.Fluoroscopy duration([21.42±8.04]min vs.[34.57±9.07]min)and total DAP(44315.0[31157.0,56307.5]μGy·m2 vs.72153.0[45460.0,82354.0]μGy·m2)in group A were both significantly lower than those in group B(both P＜0.05),while total AK(2423[1638,3533]mGy vs.3600[1898,3921]mGy)and TEVAR time([83.41±22.89]min vs.[81.00±22.13]min)in group A were not significant different from those in group B(both P＞0.05).Conclusion Compared with in situ fenestration TEVAR,both the fluoroscopy time and total DAP of in vitro pre-fenestration TEVAR significantly reduced for treating aortic diseases.

Objective:To assess the clinical value of Gore C-TAG stent-graft segmented release mode combined with 'periscope’ technique in dealing with distal reentry tear of aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods:The clinical data of 5 patients of distal false lumen enlargement after thoracic endovascular aortic repair for Stanford type B aortic dissection (TBAD) from 2019 to 2020 was retrospectively analyzed.Results:All five patients were male. Combining Gore C-TAG stent-graft segmented release mode with 'periscope’ technique was used. All five patients successfully underwent secondary endovascular repair, no intraoperative thoracotomy or major postoperative complications during hospitalization occurred . Compared to aortic CTA imaging in pre- and post-secondary endovascular repair, the curative efficacy of this method in the treatment of distal reentry tear of aortic dissection was evaluated. It showed that distal reentry tears were covered completely without reperfusion of aortic false lumen, as well as branch stents with well-perfusion based on aortic CTA imaging during the first year following-up.Conclusions:Gore C-TAG stent-graft segmented release mode combined with 'periscope’ technique in dealing with distal reentry tear of aortic dissection is technically applicable and highly successful with satisfactory short-term results.

Neuropathic pain (NP) that contributes to the comorbidity between pain and depression is a clinical dilemma. Neuroinflammatory responses are known to have potentially important roles in the initiation of NP and depressive mood. In this study, we aimed to investigate the effects of paeoniflorin (PF) on NP-induced depression-like behaviors by targeting the hippocampal neuroinflammation through the toll-like receptor 4 (TLR4)uclear factor-kappa B (NF-kB) signaling pathway. We used a murine model of NP caused by unilateral sciatic nerve cuffing (Cuff ). PF was injected intraperitoneally once a day for a total of 14 days. Pain and depression-like behavior changes were evaluated via behavioral tests. Pathological changes in the hippocampus of mice were observed by H&E staining. The levels of proinflammatory cytokines in the hippocampus were detected using ELISA. Activated microglia were measured by immunohistochemical staining. The TLR4/NF-kB signaling pathwayassociated protein expression in the hippocampus was detected by western blotting. We found that the PF could significantly alleviate Cuff-induced hyperalgesia and depressive behaviors, lessen the pathological damage to the hippocampal cell, reduce proinflammatory cytokines levels, and inhibit microglial over-activation. Furthermore, PF downregulated the expression levels of TLR4/NF-kB signaling pathwayrelated proteins in the hippocampus. These results indicate that PF is an effective drug for improving the comorbidity between NP and depression.

Neuropathic pain (NP) that contributes to the comorbidity between pain and depression is a clinical dilemma. Neuroinflammatory responses are known to have potentially important roles in the initiation of NP and depressive mood. In this study, we aimed to investigate the effects of paeoniflorin (PF) on NP-induced depression-like behaviors by targeting the hippocampal neuroinflammation through the toll-like receptor 4 (TLR4)uclear factor-kappa B (NF-kB) signaling pathway. We used a murine model of NP caused by unilateral sciatic nerve cuffing (Cuff ). PF was injected intraperitoneally once a day for a total of 14 days. Pain and depression-like behavior changes were evaluated via behavioral tests. Pathological changes in the hippocampus of mice were observed by H&E staining. The levels of proinflammatory cytokines in the hippocampus were detected using ELISA. Activated microglia were measured by immunohistochemical staining. The TLR4/NF-kB signaling pathwayassociated protein expression in the hippocampus was detected by western blotting. We found that the PF could significantly alleviate Cuff-induced hyperalgesia and depressive behaviors, lessen the pathological damage to the hippocampal cell, reduce proinflammatory cytokines levels, and inhibit microglial over-activation. Furthermore, PF downregulated the expression levels of TLR4/NF-kB signaling pathwayrelated proteins in the hippocampus. These results indicate that PF is an effective drug for improving the comorbidity between NP and depression.

Objective:To analyze the association between high density lipoprotein cholesterol (HDL-C) and the risk of cardiovascular disease mortality.Methods:A total of 71 618 residents aged over 18 years with complete baseline data, who were filed on the health information big data platform of Yinzhou district, Ningbo city, Zhejiang Province from 2009 to 2014, were selected as the research population. The research population were divided into four groups according to the level of HDL-C: low-level group (HDL-C<1.0 mmol/L), intermediate-level group (1.0 mmol/L≤HDL-C<1.5 mmol/L), medium-high-level group (1.5 mmol/L≤HDL-C<2.0 mmol/L) and high-level group (HDL-C≥2.0 mmol/L). Cox proportional hazard model was used to calculate the risk ratio of cardiovascular diseases mortality in different groups.Results:The study population was followed up for a total of 427 989.4 person-years, follow-up time of (5.98±1.04)years. During the follow-up period, there were 799 deaths due to cardiovascular diseases. After adjusting for confounding factors, compared with the medium-high-level group as the reference group, the HR (95% CI) for cardiovascular diseases mortality was 1.43 (1.13-1.82) in the low-level group and 1.22 (1.02-1.46) in the high-level group. Conclusion:The low level of HDL-C (<1.5 mmol/L) is associated with a higher risk of cardiovascular disease deaths. The level of HDL-C can be used as a biological indicator to monitor the development of cardiovascular diseases and guide treatment.

Objective:To analyze the association between high density lipoprotein cholesterol (HDL-C) and the risk of cardiovascular disease mortality.Methods:A total of 71 618 residents aged over 18 years with complete baseline data, who were filed on the health information big data platform of Yinzhou district, Ningbo city, Zhejiang Province from 2009 to 2014, were selected as the research population. The research population were divided into four groups according to the level of HDL-C: low-level group (HDL-C<1.0 mmol/L), intermediate-level group (1.0 mmol/L≤HDL-C<1.5 mmol/L), medium-high-level group (1.5 mmol/L≤HDL-C<2.0 mmol/L) and high-level group (HDL-C≥2.0 mmol/L). Cox proportional hazard model was used to calculate the risk ratio of cardiovascular diseases mortality in different groups.Results:The study population was followed up for a total of 427 989.4 person-years, follow-up time of (5.98±1.04)years. During the follow-up period, there were 799 deaths due to cardiovascular diseases. After adjusting for confounding factors, compared with the medium-high-level group as the reference group, the HR (95% CI) for cardiovascular diseases mortality was 1.43 (1.13-1.82) in the low-level group and 1.22 (1.02-1.46) in the high-level group. Conclusion:The low level of HDL-C (<1.5 mmol/L) is associated with a higher risk of cardiovascular disease deaths. The level of HDL-C can be used as a biological indicator to monitor the development of cardiovascular diseases and guide treatment.

Objective:To evaluate the effect of dexmedetomidine on Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway in lung tissues in a rat model of cardiopulmonary bypass (CPB).Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, weighing 320-350 g, aged 12-16 weeks, were randomly divided into sham operation group (group S), CBP group, and dexmedetomidine group (group Dex), with 8 rats in each group.In group Dex, dexmedetomidine was intravenously infused in a dose of 5 μg/kg starting from 15 min before CPB followed by infusion of 5 μg·kg -1·h -1 during CPB.Blood samples were collected at 2 h after the end of CPB for blood gas analysis, and oxygenation index (OI) and respiratory index (RI) were calculated.Then the rats were sacrificed by bloodletting.The lung tissues were removed for microscopic examination of the pathological changes which were scored and for determination of wet/dry weight ratio (W/D ratio), contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)(by enzyme-linked immunosorbent assay), and expression of JAK2, STAT3, phosphorylated JAK2 (p-JAK2) and phosphorylated STAT3 (p-STAT3) (by Western blot). The p-JAK2/JAK2 and p-STAT3/STAT3 ratios were calculated. Results:Compared with group S, the lung injury score, W/D ratio and RI were significantly increased, OI was decreased, the contents of TNF-α and IL-6, p-JAK2/JAK2 ratio and p-STAT3/STAT3 ratio were increased in the other two groups ( P<0.05). Compared with group CPB, the lung injury score, W/D ratio and RI were significantly decreased, OI was increased, the contents of TNF-α and IL-6, p-JAK2/JAK2 ratio and p-STAT3/STAT3 ratio were decreased in group Dex ( P<0.05). Conclusion:The mechanism by which dexmedetomidine attenuates CPB-induced lung injury may be related to inhibiting JAK2/STAT3 signaling pathway and reducing inflammatory responses in lung tissues of rats.

Objective:To assess the value of AngioJet Ultra thrombectomy device in dealing with limb graft occlusion after endovascular repair for abdominal aortic aneurysm.Methods:The clinical data of 12 unilateral limb graft occlusion cases treated with percutaneous mechanical thrombectomy (PMT) after endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) from Dec 2014 to Nov 2019 was retrospectively analyzed.Results:All 12 patients were male, age ranging from (63±12) years old.Four cases had left iliac limb graft occlusion and eight cases had right iliac limb graft occlusion. All cases were treated with PMT and iliac branch angioplasty. Successful rate was 100%.Nine cases with bifurcated stent-graft were then implanted bare/covered stent. Postoperative intermittent claudication/ gluteus claudication disappeared. Hemoglobinuria occurred in 2 cases after operation, in which one suffered from mild renal impairment and recovered. Median following-up time was 18 months, there was no recurrence of lower limb ischemia.Conclusion:Application of AngioJet Ultra thrombectomy device in PMT treatment was safe, effective and less traumatic for iliac limb graft occlusion after endovascular anortic repair for abdominal aortic aneurysm.