Background The development of regenerative therapies using derivatives of embryonic stem （ES） cells would be facilitated by a non-invasive method to monitor transplanted cells in vivo, for example, magnetic resonanc...Background The development of regenerative therapies using derivatives of embryonic stem （ES） cells would be facilitated by a non-invasive method to monitor transplanted cells in vivo, for example, magnetic resonance imaging of cells labeled with superparamagnetic iron oxide （SPIO） nanoparticles. Although ES cells have been labeled with SPIO particles, the potential adverse effects of the label have not been fully examined. The objective of this study was to determine whether SPIO labeling affects routine ES cell viability, proliferation, or ability to differentiate into functional endothelial cells （ECs）. Methods Cross-linked iron oxide （CLIO, an SPIO） was conjugated with human immunodeficiency virus transactivator of transcription （HIV-Tat） peptides, and murine ES cells were labeled with either CLIO-Tat, CLIO, or HIV-Tat. After labeling ES cells were cultured for 4 days and FIk-1^＋ ES cells identified and sorted by immunocytochemistry and fluorescence activated cell sorting （FACS）. FIk-1^＋ cells were replated on fibronectin-coated dishes, and ECs were obtained by culturing these for 4 weeks in endothelial cell growth medium supplemented with vascular endothelial growth factor （VEGF）. ES cell viability was determined using trypan blue exclusion, and the proportion of SPIO^＋ cells was evaluated using Prussian blue staining and transmission electron microscopy. After differentiation, the behavior and phenotype of ECs were analyzed by reverse transcription-polymerase chain reaction, flow cytometry, immunocytochemistry, Dil-labeled acetylated low-density lipoprotein （AcLDL） uptake, and Matrigel tube formation assay. Results CLIO-Tat was a highly effective label for ES cells, with 〉96% of cells incorporating the particles, and it did not alter the viability of the labeled cells. ECs derived from CLIO-Tat^＋ ES cells were very similar to murine aortic ECs in their morphology, expression of endothelial cell markers, ability to form vascular-like channels, and scavenging of AcLDL from the culture medium. Conclusions CLIO-Tat is a highly effective label for ES cells and does not adversely affect cell viability, differentiation, or behavior. CLIO-Tat could be a useful marker for the non-invasive monitoring of transplanted stem cells.展开更多
Stanford B型主动脉夹层(type B aortic dissection,TBAD)是一种严重危害生命健康的血管疾病,有较高的病死率,多数TBAD具有起病急、发展快的特点。自1996年首例TBAD腔内修复术成功实施以来,TBAD的治疗由巨创转为微创,围手术期病死率和...Stanford B型主动脉夹层(type B aortic dissection,TBAD)是一种严重危害生命健康的血管疾病,有较高的病死率,多数TBAD具有起病急、发展快的特点。自1996年首例TBAD腔内修复术成功实施以来,TBAD的治疗由巨创转为微创,围手术期病死率和并发症发生率均显著降低[1]。2008年,中华医学会外科学分会血管外科学组发布了《主动脉夹层腔内治疗指南》,对TBAD的病因、诊断和腔内治疗作出了相应的推荐[2]。经过十余年的发展,新的腔内技术和腔内器具逐渐广泛应用于临床实践,并产生了新的循证医学证据[3-4]。鉴于此,中华医学会外科学分会血管外科学组组织国内血管外科领域部分专家,参考最新临床研究尤其是基于我国病例的研究结果,结合临床实践,围绕TBAD的诊断和治疗讨论并制订本共识,旨在为其诊疗提供原则性指导和依据,协助临床医生决策。展开更多
Background Acute kidney injury （AKI） is considered as a common and significant complication following abdominal aortic aneurysm （AAA） repair. This study aimed to assess the associated risk factors of AKI in the cr...Background Acute kidney injury （AKI） is considered as a common and significant complication following abdominal aortic aneurysm （AAA） repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population. Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage （RIFLE） kidney disease criteria. The goal-directed hemodynamic optimization （maintenance of optimal hemodynamics and neutral or negative fluid balance） and renal outcomes were also reviewed. Results Of the 71 patients enrolled, 32 （45.1%） developed AKI, with 30 （93.8%） cases diagnosed on admission to surgical intensive care unit （SICU）. Risk factors for AKI were ruptured AAA （odds ratio （OR）=5.846, 95% confidence interval （CI）： 1.346-25.390）, intraoperative hypotension （OR=6.008, 95% CI： 1.176 to 30.683）, and perioperative blood transfusion （OR=4.611, 95% CI： 1.307-16.276）. Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay （（136.9±24.5） hours vs. （70.4±11.3） hours） in Surgical Intensive Care Unit. Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.展开更多
Once the ascending aorta gets involved and however farther the dissection extends, it is named type Adissection （TAD）, in which the entry tear usually locates in the ascending aorta. But there exists a small subset ...Once the ascending aorta gets involved and however farther the dissection extends, it is named type Adissection （TAD）, in which the entry tear usually locates in the ascending aorta. But there exists a small subset with primary entry tear in the descending aorta and the dissection process extends back into the ascending aorta, which here we name primary retrograde type A dissection （PRTAD）. Operative procedures are far more difficult and extensive for PRTAD and usually result in poor prognosis in the aspects of surgical mortality and survival rate during follow-up.1-3 Kato et al4 and Chang et al5 showed successful method of endovascular repair for PRTAD and recommended it as an alternative to the operative treatment. During March 2008 to August 2010, five continuous patients with PRTAD were admitted into our institution. We here introduce our preliminary experience with medical therapy and thoracic endovascular aortic repair （TEVAR） for treating PRTAD.展开更多
Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very us...Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients （group A） and another group of 42 patients （group B） was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B （X2=0.80,P ＞0.05）,and age difference was not statistically significant （F=2.55,homogeneity of variance,t=-1.46,P ＞0.05）.A significant difference was found between the conventional and the MPR approaches for spin angle （t=9.17） as well as tilt angle （t=-2.07）,P ＜0.05.Percentage of proximal distributed markers （5.0％） of group A was significantly lower than that of group B （42.9％）,X2=15.92,P ＜0.05;and incidence of complications （5.0％） of group A was also significant lower than that of group B （21.4％）,X2=4.76,P ＜0.05.Conclusions Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA.It is feasible in endovascular treatment of type B aortic dissection,and can effectively and safely guide surgical operations.展开更多
With improvements in the technology of clinical diagnosis of aortic diseases, more and more cases have been found on such vascular lesions as aortic dissection and abdominal aortic aneurysm, which lead to aortic biome...With improvements in the technology of clinical diagnosis of aortic diseases, more and more cases have been found on such vascular lesions as aortic dissection and abdominal aortic aneurysm, which lead to aortic biomechanical changes. Aortic biomechanics research will become a hot spot in the near future. At the same time, stent grafts （SGs） are widely used in the endovascular treatment of vascular diseases. The biomechanical properties of SGs will also become a focus of research. Understanding the relation between the aorta and SGs will better cater to clinical services by improving the success rate of surgery for aortic diseases and reducing intraoperative and postoperative complications. This article reviews researches on the biomechanics of the aorta and SGs.展开更多
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 30571821）.
文摘Background The development of regenerative therapies using derivatives of embryonic stem （ES） cells would be facilitated by a non-invasive method to monitor transplanted cells in vivo, for example, magnetic resonance imaging of cells labeled with superparamagnetic iron oxide （SPIO） nanoparticles. Although ES cells have been labeled with SPIO particles, the potential adverse effects of the label have not been fully examined. The objective of this study was to determine whether SPIO labeling affects routine ES cell viability, proliferation, or ability to differentiate into functional endothelial cells （ECs）. Methods Cross-linked iron oxide （CLIO, an SPIO） was conjugated with human immunodeficiency virus transactivator of transcription （HIV-Tat） peptides, and murine ES cells were labeled with either CLIO-Tat, CLIO, or HIV-Tat. After labeling ES cells were cultured for 4 days and FIk-1^＋ ES cells identified and sorted by immunocytochemistry and fluorescence activated cell sorting （FACS）. FIk-1^＋ cells were replated on fibronectin-coated dishes, and ECs were obtained by culturing these for 4 weeks in endothelial cell growth medium supplemented with vascular endothelial growth factor （VEGF）. ES cell viability was determined using trypan blue exclusion, and the proportion of SPIO^＋ cells was evaluated using Prussian blue staining and transmission electron microscopy. After differentiation, the behavior and phenotype of ECs were analyzed by reverse transcription-polymerase chain reaction, flow cytometry, immunocytochemistry, Dil-labeled acetylated low-density lipoprotein （AcLDL） uptake, and Matrigel tube formation assay. Results CLIO-Tat was a highly effective label for ES cells, with 〉96% of cells incorporating the particles, and it did not alter the viability of the labeled cells. ECs derived from CLIO-Tat^＋ ES cells were very similar to murine aortic ECs in their morphology, expression of endothelial cell markers, ability to form vascular-like channels, and scavenging of AcLDL from the culture medium. Conclusions CLIO-Tat is a highly effective label for ES cells and does not adversely affect cell viability, differentiation, or behavior. CLIO-Tat could be a useful marker for the non-invasive monitoring of transplanted stem cells.
文摘Stanford B型主动脉夹层(type B aortic dissection,TBAD)是一种严重危害生命健康的血管疾病,有较高的病死率,多数TBAD具有起病急、发展快的特点。自1996年首例TBAD腔内修复术成功实施以来,TBAD的治疗由巨创转为微创,围手术期病死率和并发症发生率均显著降低[1]。2008年,中华医学会外科学分会血管外科学组发布了《主动脉夹层腔内治疗指南》,对TBAD的病因、诊断和腔内治疗作出了相应的推荐[2]。经过十余年的发展,新的腔内技术和腔内器具逐渐广泛应用于临床实践,并产生了新的循证医学证据[3-4]。鉴于此,中华医学会外科学分会血管外科学组组织国内血管外科领域部分专家,参考最新临床研究尤其是基于我国病例的研究结果,结合临床实践,围绕TBAD的诊断和治疗讨论并制订本共识,旨在为其诊疗提供原则性指导和依据,协助临床医生决策。
文摘Background Acute kidney injury （AKI） is considered as a common and significant complication following abdominal aortic aneurysm （AAA） repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population. Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage （RIFLE） kidney disease criteria. The goal-directed hemodynamic optimization （maintenance of optimal hemodynamics and neutral or negative fluid balance） and renal outcomes were also reviewed. Results Of the 71 patients enrolled, 32 （45.1%） developed AKI, with 30 （93.8%） cases diagnosed on admission to surgical intensive care unit （SICU）. Risk factors for AKI were ruptured AAA （odds ratio （OR）=5.846, 95% confidence interval （CI）： 1.346-25.390）, intraoperative hypotension （OR=6.008, 95% CI： 1.176 to 30.683）, and perioperative blood transfusion （OR=4.611, 95% CI： 1.307-16.276）. Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay （（136.9±24.5） hours vs. （70.4±11.3） hours） in Surgical Intensive Care Unit. Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.
文摘Once the ascending aorta gets involved and however farther the dissection extends, it is named type Adissection （TAD）, in which the entry tear usually locates in the ascending aorta. But there exists a small subset with primary entry tear in the descending aorta and the dissection process extends back into the ascending aorta, which here we name primary retrograde type A dissection （PRTAD）. Operative procedures are far more difficult and extensive for PRTAD and usually result in poor prognosis in the aspects of surgical mortality and survival rate during follow-up.1-3 Kato et al4 and Chang et al5 showed successful method of endovascular repair for PRTAD and recommended it as an alternative to the operative treatment. During March 2008 to August 2010, five continuous patients with PRTAD were admitted into our institution. We here introduce our preliminary experience with medical therapy and thoracic endovascular aortic repair （TEVAR） for treating PRTAD.
文摘Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients （group A） and another group of 42 patients （group B） was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B （X2=0.80,P ＞0.05）,and age difference was not statistically significant （F=2.55,homogeneity of variance,t=-1.46,P ＞0.05）.A significant difference was found between the conventional and the MPR approaches for spin angle （t=9.17） as well as tilt angle （t=-2.07）,P ＜0.05.Percentage of proximal distributed markers （5.0％） of group A was significantly lower than that of group B （42.9％）,X2=15.92,P ＜0.05;and incidence of complications （5.0％） of group A was also significant lower than that of group B （21.4％）,X2=4.76,P ＜0.05.Conclusions Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA.It is feasible in endovascular treatment of type B aortic dissection,and can effectively and safely guide surgical operations.
文摘With improvements in the technology of clinical diagnosis of aortic diseases, more and more cases have been found on such vascular lesions as aortic dissection and abdominal aortic aneurysm, which lead to aortic biomechanical changes. Aortic biomechanics research will become a hot spot in the near future. At the same time, stent grafts （SGs） are widely used in the endovascular treatment of vascular diseases. The biomechanical properties of SGs will also become a focus of research. Understanding the relation between the aorta and SGs will better cater to clinical services by improving the success rate of surgery for aortic diseases and reducing intraoperative and postoperative complications. This article reviews researches on the biomechanics of the aorta and SGs.
