Zinc Finger Protein-activating Transcription Factor Up-regulates Vascular Endothelial Growth Factor-A Expression in Vitro

Objective To construct the zinc finger protein-activating transcription factor (ZFP-ATF) plasmid and evaluate its efficacy in inducing vascular endothelial growth factor (VEGF) expression in EY.HY926 endothelial cells. Methods Firstly, we constructed the ZFP-ATF plasmid, then testified the quantity of VEGF protein in EY.HY926 endothelial cells after transfected with ZFP-ATP plasmid by Western blot, finally, we used the RT-PCR to testify whether the ZFP-ATF can stimulate expression of VEGF splice variants. Results The ZFP-ATF DNA sequences were located the multiclone sites of PVAX1 vector between the site of BamH Ⅰ and Xhol. Western blot result showed VEGF expression in EY.HY926 endothelial cells transfected with ZFP-ATF plasmid was significantly higher than that in cells transfected with VEGF165 (19.95±3.95 vs. 12.15±1.55 μg/μL, P<0.01). RT-PCR result showed VEGF-A mRNA expression level induced by ZFP-ATF was high than that induced by VEGF165. Conclusion ZFP-ATF can up-regulate the VEGF-A expression in comparison with VEGF165, which might have beneficial effects in angiogenesis process.

IMPAIRED ANGIOGENESIS FOLLOWING HIND-LIMB ISCHEMIA IN DIABETES MELLITUS MICE

Objective To investigate vascular endothelial growth factor(VEGF) and its signaling pathway spontaneous response in type 2 diabetes mellitus(T2DM) mice to surgery-induced hind-limb ischemia.Methods Sixty mice were randomly divided into two groups,one was fed with normal chow as control,and another was fed with high fat diet to induce T2DM.Fourteen weeks later,mice were surgically induced to hind-limb ischemia.Blood flow restoration was monitored with laser Doppler perfusion imaging.Tibialis anterior muscle was collected after 3 days of hind-limb ischemia.VEGF mRNA and protein expressions were analyzed using real-time PCR and ELISA;expressions of VEGF downstream signal molecules and receptors were analyzed using Western blotting and RT-PCR,respectively.Results Perfusion recovery 10,20,30 days after ischemia was significantly attenuated in T2DM compared with control group(P<0.05).T2DM impaired VEGF signaling pathway although VEGF levels increased in T2DM group.After ischemia,T2DM group had a comparable increase in VEGF expression compared with control group,but still had an impaired VEGF signaling pathway.Conclusion VEGF signaling pathway is abnormal in T2DM mice,although VEGF had a response to the ischemic stimulation.

Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn’s Disease

Objective To investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease (CD). Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively. Results All the cases were less than 50 years old and the most were females (8/9). Arterial occlusions occurred in either active (5/9) or inactive (4/9) stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings (4 had aortic plaques and 6 had iliac artery stenoses). Embolectomy or thromboendarterectomy were mostly performed. Four (44.4%) cases had recurrent lower limb ischemia. Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.

SURGICAL MANAGEMENT OF PSEUDOANEURYSM COMPLICATING ARTERIOVENOUS FISTULA FOR HEMODIALYSIS

Objective To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. Methods Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy. Results All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction. Conclusion Surgical repair is the best choice for PA of AVF for renal hemodialysis.

Different nutrient compositions in diet and taking hypoglycemic drugs can modulate gut microbial flora

The diet structure of diabetic patients is different from that of normal people.Diabetic patients also need to take hypoglycemic drugs to regulate blood sugar.Both dieting and drugs affect the gut microbiota of diabetic patients.In this letter,we discuss that different dietary patterns and the use of hypoglycemic agents may have an impact on changes in gut microbiota in diabetic patients.

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （CTA）, which is routine for follow-up, has side effects （e.g., radiation） and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound （CEUS） have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods： Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging （CDFI） and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDF1 was conducted using Fisher＇s exact test and clinical outcomes of all patients were followed up. Results： Sixteen patients were enrolled, and 12 （75%） had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFl-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically difl＇erent （P = 0,008）. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type Ⅲ endoleak had open surgery when endovascular repair failed. Conclusions： C EUS is a new, safe, and effective means for detection ofendoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

Electrochemical characterization of AlPO_(4) coated LiNi_(1/3)Co_(1/3)Mn_(1/3)O_(2) cathode materials for high temperature lithium battery application

Aluminum phosphate(AlPO_(4))was used to modify the surface of LiNi_(1/3)Co_(1/3)Mn_(1/3)O_(2)(NCM)cathode material.The surface structure and electrochemical properties of the coated materials were investigated by X-ray photoelectron spectroscopy(XPS)and electrochemical impedance spectroscopy(EIS).The results confirm the formation of aluminum-containing solid solution on the surface of NCM particles.An aluminum phosphate coating blocks the Li+insertion-extraction process in cells charged at high rates at room temperature,increasing surface film resistance and decreasing discharge capacity.However,an aluminum phosphate aids the formation of a stable solid electrolyte interface film on NCM surface and stabilizes the Rct of cell as samples electrochemically cycled at 55℃.The electrochemical studies suggest that the initial columbic efficiency is significantly enhanced.An NCM sample coated with 1.0 wt%AlPO_(4) delivers a higher discharge capacity and shows excellent capacity retention ability.

Outcomes of Chimney and/or Periscope Techniques in the Endovascular Management of Complex Aortic Pathologies

Background：The chimney/periscope technique has been used to address complex aortic pathologies.This study aimed to report the outcomes and experiences of chimney and/or periscope grafts （CPGs） used in the endovascular management of complex aortic pathologies.Methods：Twenty-two patients with complex aortic pathologies were retrospectively studied from January 2013 to August 2016 in two vascular centers of teaching hospitals.All patients were diagnosed using computed tomography angiography （CTA）.The patients were followed up at postoperative 1,3,6,and 12 months and yearly thereafter with X-ray,ultrasound,and/or CTA.Results：Twenty-two cases （17 males;mean age 60.7 ＆#177; 16.3 years） with complex aortic pathologies were analyzed.Nineteen patients underwent CPGs only,and the other three cases underwent the simultaneous implantation of chimney/periscope and fenestrated/scallop grafts.Twenty-six arteries were managed with forty CPGs during the procedures.Complete angiographies revealed two Type Ⅰ endoleaks,one Type Ⅲ endoleak,and one Type Ⅳ endoleak.Other intraoperative complications included brachial thrombosis,external iliac artery rupture,and left renal stenosis.The 30-day mortality was 0.The mean follow-up was 26.1 ＆#177; 10.1 months with a range of 2-39 months.During the follow-up,two Type Ⅰ endoleaks and one Type Ⅳ endoleak were observed.One right renal stent occlusion occurred in the 5th month and turned patent after reintervention.Three patients died during the follow-up,one due to an aneurysm rupture as a Type Ⅰ endoleak,and two due to myocardial infarction.The instant technical success was 96%.The primary and secondary patencies were 92%and 96%,respectively.The overall survival rates were 95%,84%,and 84% at 12,24,and 36 months,respectively.Stent migration was not observed in any patient.Conclusions：Chimney/periscope techniques could be used to tackle complex aortic pathologies,but the indications must be strictly controlled,and additional experiences are required.

Prospective Randomized Study of Sarpogrelate Versus Clopidogrel-based Dual Antiplatelet Therapies in Patients Undergoing Femoropopliteal Arterial Endovascular Interventions： Preliminary Results

Background：Sarpogrelate is a selective 5-hydroxytryptamine （5-HT） receptor subtype 2A antagonist which blocks 5-HT induced platelet aggregation and proliferation of vascular smooth muscle cells.We compared the efficacy of sarpogrelate-based dual antiplatelet therapies for the prevention of restenosis and target lesion revascularization （TLR） rates comparing with that of clopidogrel after percutaneous endovascular interventions （EVIs） of femoropopliteal （FP） arterial lesions.Methods：This prospective,multicenter,randomized clinical trial recruited a total of 120 patients with successful EVI of FP lesions at seven centers across China between January 2011 and June 2012.Patients were randomized to receive either sarpogrelate （100 mg trice daily for 6 months,n =63） or clopidogrel （75 mg once daily for 6 months,n =57）.All patients also received oral aspirin （100 mg once daily for 12 months）.Clinical follow-up was conducted up to 12 months postprocedure.Results：There was no significant difference between the two groups in basic demographic data.The restenosis rate was higher in the clopidogrel group （22.80%） than in sarpogrelate group （17.50%）,but there was no significant difference between these two groups （P =0.465）.The TLR rate,ipsilateral amputation rate,mortality in all-cause and bleeding rate were also similar in the two groups （P 〉 0.05）.Conclusions：Aspirin plus sarpogrelate is a comparable antithrombotic regimen to aspirin plus clopidogrel after EVI of FP arterial lesions.Dual antiplatelet therapies might play an important role in preventing restenosis after successful EVI of FP lesions.

Using a Surgeon-modified Iliac Branch Device to Preserve the Internal Iliac Artery during Endovascular Aneurysm Repair： Single-center Experiences and Early Results

Background：To evaluate the feasibility of a new surgeon-modified iliac branch device （IBD） technique to maintain pelvic perfusion in the management of common iliac artery （CIA） aneurysm during endovascular aneurysm repair （EVAR）.Methods：From January 2011 to December 2013,a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm.A stent-graft limb was initially deployed in vitro,anastomosed with vascular graft,creating a modified IBD reloaded into a larger sheath,with or without a guidewire preloaded into the side branch.The reloaded IBD was then placed in the iliac artery,with a covered stent bridging internal iliac artery and the branch.Finally,a bifurcated stent-graft was deployed,and a limb device was used to connect the main body and IBD.Results：Technical successes were obtained in all patients.The mean follow-up length was 24 months （range：6-38 months）.All grafts remained patent without any sign of endoleaks.There were no aneurysm ruptures,deaths,or other complications related to pelvic flow.Conclusions：Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.