Analysis of the Effect of Problem-Oriented Nursing Intervention on Patients with Lower Extremity Arteriosclerosis Obliterans in Vascular Surgery

Objective: To analyze the effect of problem-oriented nursing intervention on patients with lower extremity arteriosclerosis obliterans (ASO) in vascular surgery. Methods: The clinical data of 128 patients with lower extremity ASO in vascular surgery were selected and randomly divided into groups A and B, with 64 cases each. Group A is the control group, and Group B is the observation group. Group A received the routine nursing intervention, and Group B received the problem-oriented nursing intervention. The compliance, self-care ability, psychological state, quality of life, and nursing satisfaction of the two groups of patients were evaluated based on various indicators. Results: After the intervention, the evaluation of self-care ability (ESCA) score of the patients in Group B was higher than that of Group A, and the symptom checklist-90 (SCL-90) score was lower than that of Group A. The differences were significant (t = 10.019, t = 3.118, P < 0.01). After the intervention, the World Health Organization Quality of Life Brief (WHOQOL-BREF) index scores of the two groups increased and the increase in Group B was significantly higher than Group A (P < 0.001). The compliance rate of Group B (62/ 96.88%) was higher than that of Group A (52/ 81.25%), and the difference was extremely significant (χ2 = 8.020, P < 0.01). Conclusion: Problem-oriented nursing intervention for patients with lower extremity ASO in vascular surgery improved the patient’s self-care ability, and quality of life, reduced the patient’s negative emotions, and enhanced their overall satisfaction.

Clinical and prognostic features in asymptomatic and symptomatic patients with arteriosclerosis obliterans

Background: Patients with arteriosclerosis obliterans (ASO) often have co-existing atherosclerotic diseases. The purpose of this study was to examine the clinical features of patients with ASO, including the overlap of atherosclerotic risk factors, characteristics of car-diovascular events, and clinical prognosis. Method: We enrolled 205 consecutive patients who had ankle brachial index (ABI) of ?0.9 between January 2008 and December 2009. Fontaine (F) classification and clinical background were evaluated and clinical events including mortality and major adverse cardiocerebro-vascular events (MACCEs) were determined. Results: There was a high prevalence of each risk factor. Sixty- five percent of subjects had three or more of the four overlapping risk factors, including hypertension, dia- betes, dyslipidemia, and smoking. After a maximum follow-up of 800 days, the incidence of MACCEs and mortality was 46% and 10%, respectively. We divided the patients into two groups according to the presence of ASO symptoms (F1 and F2-4) and compared the incidence of events. The incidence of MACCEs and mortality in the F2-4 group was significantly higher than that in the F1 group (P = 0.048, P = 0.044, respectively). After excluding lower extremity revascularization, coronary artery disease was a common cause of MACCEs, and the mortality rates after MACCEs increased in a stepwise manner according to F classification severity (P = 0.028). Conclusion: Patients with ASO had overlapping coronary risk factors and a high incidence rate of cardiovascular events. The incidence of coronary events was common, especially in symptomatic patients, and the mortality rates after MACCEs were high in accordance with F classification severity.

Chronic lung allograft dysfunction post-lung transplantation:The era of bronchiolitis obliterans syndrome and restrictive allograft syndrome

Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.

Mechanism of Danggui Sini Decoction(当归四逆汤)for Atherosclerosis Obliterans Based on Network Pharmacology and Molecular Docking

Objective:Based on network pharmacology and molecular docking,we want to explore the pharmacological effects and mechanism of Danggui Sini Decoction in the treatment of lower extremity arteriosclerosis obliterans.Methods:Using TCMSP database to search the main active components of Danggui Sini Decoction(当归四逆汤,DSD)and their related targets,Cytoscape3.8.1 software was used to construct a"component-disease-target"interaction network.Meanwhile,DAVID database was used to enrich the key target genes with GO and KEGG functions.And we used Auto Dock Tools 1.5.6 for molecular docking.Results:A total of 45 candidate active molecules and 250 potential target proteins related to ASO were screened.Key genes such as TNF,IL6,VEGFA,MMP9,IL1B,CCL2,CXCL8,ICAM1,VCAM1,and IL10 are mainly through TNF signaling pathway,HIF-1 signaling pathway,cytokine-cytokine receptor interaction,Toll-like receptor signaling pathway,NF-kappa B signaling pathway,MAPK signaling pathway and other biological pathways exert their effects.The results of molecular docking showed that 5UUI-sesamin,5UUI-paeoniflorin,4XCT-sesamin,and 4XCT-sesamin have extremely strong binding ability.Conclusion:Danggui Sini Decoction(当归四逆汤,DSD)can synergistically exert pharmacological effects through multiple components,multiple targets,and multiple pathways.On the basis of regulating immunity and inhibiting smooth muscle proliferation,it can prevent the occurrence and development of ASO.

Association of the plasminogen activator inhibitor-1(PAI-1) gene 4G/5G promoter polymorphism in Buerger's disease (Tromboangiitis obliterans)

Thromboangiitis obliterans (TAO) is an unusual tobacco-associated vasculopathy that is a non- atherosclerotic inflammatory disorder of unkn- own etiology that affects small and medium- sized vessels of the extremities. The single guanosine nucleotide deletion/insertion polym- orphism (4G/5G) at -675 bp in promoter region of the PAI-1 gene is the major genetic determi- nant of PAI-1 expression. Plasma PAI-1 level is higher in people with the homozygous 4G genotype than in those with the 5G/5G genotype and renders higher transcription activity. The aim of this study was to determine the status and the role of PAI-1 gene 4G/5G promoter polymorphism in patients with Buerger's disease (Thromboangiitis obliterans—TAO). The current case-control study included 30 consecutive pat- ients with Buerger's disease (mean age 42.9 ± 14.3 years, 28 men and 2 women), and 30 healthy volunteers (mean age 40.9 ± 4.79 years, 27 men and 3 women) between January 2006 and September 2009. Patients and control cases were genotyped for the 4G/5G polymorphism using the multiplex PCR based stripassay reverse hybridisation technique. It was found that heterozygote PAI-1 gene polymorphisms (p < 0.05) was significantly more frequent in patients with TAO in the current results. There was a significant difference in genotype distribution between the two groups (P < 0.001). The 4G allele occurred more frequently in the patient group of heavy smokers (P = 0.05). The current study shows the higher prevalence of of 4G allele in TAO patients in Sivas population means gene may predispose to TAO.

Mechanism of Simiao Yongan decoction in the treatment of arteriosclerosis obliterans of lower extremity through JAK/STAT signaling pathway

Objective:To predict the effective components,potential targets and pathways of Simiao Yong’an Decoction in the treatment of lower extremity arteriosclerosis obliterans(ASO)based on the method of network pharmacology,and to explore the mechanism of Simiao Yong’an Decoction in treating ASO combined with cell experiment.Methods:TCMSP database was used to screen the active components and targets of Simiao Yong’an decoction,and Genecards and OMIM databases were used to obtain ASO related proteins;PPI network of drug disease target proteins was constructed by string platform;go function and KEGG pathway enrichment of Simiao Yong’an Decoction ASO target were analyzed by David database.The drug target pathway with high correlation with ASO was selected.The model of vascular smooth muscle cell injury(VSMCs)induced by ox LDL was used,and Simiao Yong’an decoction containing pharmaceutical Qing was given to verify the therapeutic effect of Simiao Yong’an Decoction on ox LDL induced VSMCs and its regulation on highly correlated target pathway.Results:A total of 126 active components of Simiao Yong'an Decoction were screened,40 targets of Simiao Yong’an Decoction ASO were selected,99 go biological processes and 48 related signal pathways were related to ASO;the experimental results showed that with the passage of time,Simiao Yongan decoction could significantly inhibit the proliferation of VSMCs(P<0.05);compared with the model group,the percentage of BrdU positive cells in each dose group of Simiao Yong’an decoction was significantly higher than that in the model group In addition,Simiao Yong’an decoction could significantly inhibit the proliferation of VSMCs(P<0.05);in addition,Simiao Yongan decoction could inhibit the levels of IL-6 and IL-1β(P<0.05);significantly inhibit the expression of PCNA,JAK2 and STAT3 mRNA(P<0.05);Conclusions:Simiao Yong’an decoction has the effect of"multi-component,multi-target and multi-channel"in the treatment of ASO.It can inhibit the activation of JAK/STAT signaling pathway,play an anti-inflammatory role and inhibit the proliferation of vascular smooth muscle cells.

Correlation of peripheral blood NF-κB expression with cytokines and endothelial injury in patients with thromboangiitis obliterans

Objective:To study the correlation of peripheral blood nuclear factorκB (NF-κB) expression with cytokines and endothelial injury in patients with thromboangiitis obliterans (TAO).Methods:Patients who were diagnosed as lower limb thromboangiitis obliterans in Jining No. 1 People's Hospital between March 2014 and October 2017 were selected as the TAO group of the research, and healthy subjects who received physical examination in Jining No. 1 People's Hospital during the same period and had the general information matching that of TAO group were selected as the control group. The NF-κB expression intensity in peripheral blood as well as the contents of cytokines and endothelial injury indexes in serum was determined.Results: NF-κB expression intensity in peripheral blood of TAO group was significantly higher than that of control group;serum ICAM-1, VCAM-1, E-selectin, TGF-β1, IL-10, TXB2, vWF, D-D, HIF-1 and VEGF levels of TAO group were significantly higher than those of control group whereas 6-Keto-PGF1 level was significantly lower than that of control group, and serum ICAM-1, VCAM-1, E-selectin, TGF-β1, IL-10, TXB2, vWF, D-D, HIF-1 and VEGF levels of TAO group of patients with high NF-κB expression were significantly higher than those of patients with low NF-κB expression whereas 6-Keto-PGF1 level was significantly lower than that of patients with low NF-κB expression.Conclusion: The high expression of NF-κB in the peripheral blood of patients with TAO can promote the excessive secretion of inflammatory and immune cytokines and aggravate the endothelial cell injury.

Application of Big Data Deep Learning in Auxiliary Diagnosis of Lower Extremity Arteriosclerosis Obliterans

At present,the incidence rate of arteriosclerosis obliterans(LEASO)of the lower extremities is significantly increased by aging and lifestyle changes.It is of great importance to predict the LEASO effectively and accurately by analyzing the imaging data of the lower extremities⑴.At this stage,China has entered the era of big data and artificial intelligence.Medical institutions at all levels can produce a large number of lower limb vascular image data every day.Using big data deep learning technology to intelligently analyze a large number of image data,and then carry out auxiliary diagnosis,so as to improve the diagnosis and treatment effect of LEASO is the focus of clinical research.

Si-Miao-Yong-An Decoction alleviates thromboangiitis obliterans by regulating miR-548j-5p/IL-17A signaling pathway

Thromboangiitis obliterans(TAO)is a rare,chronic,progressive,and segmental inflammatory disease characterized by a high rate of amputation,significantly compromising the quality of life of patients.Si-Miao-Yong-An decoction(SMYA),a tradition-al prescription,exhibits anti-inflammatory,anti-thrombotic,and various other pharmacological properties.Clinically,it was fully proved to be effective for TAO therapy,but the specific therapeutic effect of SMYA on TAO has been unknown.Thus,deep unveiling the mechanism of SMYA in TAO for identifying clinical therapeutic targets is extremely important.In this study,we observed elev-ated levels of IL-17A in the peripheral blood mononuclear cells(PBMCs)of TAO patients,whereas the expression of miR-548j-5p was significantly decreased.A negative correlation between the levels of miR-548j-5p and IL-17A was also demonstrated.In vitro ex-periments showed that overexpression of miR-548j-5p led to a decrease in IL-17A levels,whereas downregulation of miR-548j-5p showed the opposite effect.Using a dual luciferase assay,we confirmed that miR-548j-5p directly targets IL-17A.Furthermore,serum containing SMYA effectively decreased IL-17A levels by increasing the expression of miR-548j-5p.More importantly,the results of in vivo tests indicated that SMYA mitigated the development of TAO by inhibiting IL-17A through the upregulation of miR-548j-5p in vascular tissues.In conclusion,SMYA significantly enhances the expression of miR-548j-5p,thereby reducing the levels of the target gene IL-17A and alleviating TAO.Our research not only identifies novel targets and pathways for the clinical diagnosis and treatment of TAO but also advances the innovation in traditional Chinese medicine through the elucidation of the SMYA/miR-548j-5p/IL-17A regulatory axis in the pathogenesis of TAO.

Application of buried auricular point combined with Wenjing Sanhan prescription in arteriosclerosis obliterans patients with resting pain

BACKGROUND Research on the combined use of ear acupoint embedding beans and warming meridians with cold-dispersing formulas for alleviating resting pain in patients with arteriosclerosis obliterans(ASO)remains limited.AIM To explore the therapeutic efficacy of auricular point embedding beans combined with Wenjing Sanhan prescription in alleviating resting pain in patients with lower-limb ASO.METHODS A total of 100 patients with ASO experiencing resting pain who were treated at our hospital from January 2022 to January 2023 were enrolled.They were randomly allocated into two groups using a double-blind approach.The control group was treated using a warming meridian with a cold-dispersing formula,while the study group received additional treatment with ear acupoint embedding beans.The clinical efficacy,ankle-brachial artery pressure ratio,hemorheological indicators,and traditional Chinese medicine symptom scores were compared between the two groups.RESULTS The clinical efficacy rate in the study group was significantly higher(94.00%)than that in the control group(72.00%,P<0.05).Moreover,the ankle-brachial artery pressure ratio was significantly higher in the study group after treatment(P<0.05).Hemorheological parameters,including whole blood viscosity,plasma viscosity(1.83±0.11)mPa/s,fibrinogen levels(3.30±0.21)g/L,platelet adhesion rate(49.87%±10.51%),and erythrocyte aggregation index(1.79±0)were improved in the study group compared to the control group.In addition,the scores for decreased skin temperature(1.41±0.26),intermittent claudication(1.30±0.20),and resting pain(1.23±0.31)were significantly lower in the study group than those in the control group(all P<0.05).The level of oxidative stress in the study group also exhibited significant improvement(P<0.05),and the levels of inflammatory factors were considerably lower than those in the control group.CONCLUSION The combination of ear point embedding beans and Wenjing Sanhan prescription demonstrates promising clinical efficacy in alleviating resting pain associated with ASO.

Protective Effects and Potential Mechanism of Tongxinluo on Mice with Thromboangiitis Obliterans Induced by Sodium Laurate

Objective To investigate the effects of Tongxinluo(TXL)on thromboangiitis obliterans(TAO)and the underlying mechanisms.Methods Ninety male C57/BL6J mice were randomly divided into 6 groups according to a random number table:the sham group,TAO model group,Compound Danshen Tablet(CDT)group,and the high-,medium-,and low-dose TXL groups.All mice except the sham group were injected with sodium laurate(0.1 mL,5 mg/mL)in the femoral artery to establish TAO mouse model.After modeling,mice in the sham and TAO model groups were intragastrically administered 0.5%(w/v)sodium carboxymethylcellulose,mice in the CDT group were intragastrically administered 0.52 g/kg CDT,and mice in the TXL-H,TXL-M,and TXL-L groups were intragastrically administered 1.5,0.75,and 0.38 g/kg TXL,respectively.After 4 weeks of gavage,the recovery of blood flow in the lower limbs of mice was detected by Laser Doppler Imaging.The pathological changes and thrombosis of the femoral artery were observed by morphological examination.The expressions of tumor necrosis factorα(TNF-α)and inducible nitric oxide synthase(iNOS)in the femoral artery wall were detected by HE staining.Levels of thromboxane B2(TXB2),6-keto-prostaglandin F1α(6-keto-PGF1α),endothelin-1(ET-1),interleukin(IL)-1βand IL-6 were measured using enzyme-linked immunosorbent assay(ELISA).Levels of activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT)and fibrinogen(FIB)were detected by a fully automated biochemical analyzer.Results TXL promoted the restoration of blood flow in the lower limbs,reduced the area of thrombosis in the femoral artery,and alleviated the pathological changes in the femoral artery wall.Moreover,the levels of TXB2,ET-1,IL-6,IL-1β,TNF-αand iNOS were significantly lower in the TXL groups compared with the model group(P<0.05 or P<0.01),while the level of 6-keto-PGF1αwas significantly higher(P<0.01).In addition,APTT,PT,and TT were significantly prolonged in TXL groups compared with the model group(P<0.05 or P<0.01),and FIB levels were significantly decreased compared with the model group(P<0.01).Conclusions TXL had a protective effect on TAO mice,and the mechanism may involve inhibition of thrombosis and inflammatory responses.TXL may be a potential drug for the treatment of TAO.

Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment

Background Limited data are available in relation to the clinical features of PIBO undergoing prolonged nebulization treat-ment with budesonide, terbutaline and ipratropium bromide. This retrospective study aimed to outline the features of clini-cal, high-resolution computed tomography (HRCT) and pulmonary function test (PFT) of PIBO, undergoing maintenance therapy utilizing a triple nebulization treatment and to determine the factors associated with prognosis. Methods Children diagnosed with PIBO were followed up between April 2014 and March 2017. The clinical features after maintenance nebulization treatment for 12 months were thereafter summarized. Results Thirty patients, 21 boys and 9 girls, were enrolled in the study. The median age of patients was 17.4 months, with a range between 3.0 and 33 months. Persistent coughing and wheezing were detected whilst wheezing and crackles were the common manifestations presented. HRCT scans revealed patchy ground and glass opacity, while PFT showed fixed airway obstruction in all patients. Four patients were lost during follow-up. After treatment, the clinical symptoms were improved greatly in all patients (P<0.01). The mean increase in the percentage of TPEF%TE and VPEF%VE were improved greatly (P < 0.01). Images of the HRCT scan indicated marked improvements in 18 patients (81.8%) in comparison with scans obtained pre-treatment. Conclusions Our data suggest a potential role of long-term nebulization treatment of budesonide, terbutaline, ipratropium bromide on PIBO, due to its efficacy as indicated in the improved clinical symptoms, pulmonary functions and CT manifesta-tions identified in the children. New prospective and controlled studies are required to confirm this proposition.

3aired Capacity of Fibroblasts to Support Airway Epithelial Progenitors in Bronchiolitis Obliterans Syndrome

Background： Bronchiolitis obliterans syndrome （BOS） often develops in transplant patients and results in injury to the respiratory and terminal airway epithelium. Owing to its rising incidence, the pathogenesis of BOS is currently an area of intensive research. Studies have shown that injury to the respiratory epithelium results in dysregulation of epithelial repair. Airway epithelial regeneration is supported by stromal cells, including fibroblasts. This study aimed to investigate whether the supportive role of lung fibroblasts is altered in BOS. Methods： Suspensions of lung cells were prepared by enzyme digestion. Lung progenitor cells （LPCs） were separated by fluorescence-activated cell sorting. Lung fibroblasts from patients with BOS or healthy controls were mixed with sorted mouse LPCs to compare the colony-forming efficiency of LPCs by counting the number of colonies with a diameter of_〉50/.tln in each culture. Statistical analyses were pertbrmed using the SPSS 17.0 software （SPSS Inc., USA）. The paired Student＇s t-test was used to test tbr statistical significance. Results： LPCs were isolated with the surface phenotype ofCD31-CD34-CD45- EpCAMtSca- I . The colony-lbrming efficiency of LPCs was significantly reduced when co-cultured with fibroblasts isolated from patients with BOS. The addition ofSB431542 increased the colony-forming efficiency of LPCs to 1.8%; however, it was still significantly less than that in co-culture with healthy control fibroblasts （P 〈 0.05）. Conclusion： The epithelial-supportive capacity offibroblasts is impaired in the development of BOS and suggest that inefficient repair of airway epithelium could contribute to persistent airway inflammation in BOS.

Risk factors for bronchiolitis obliterans syndrome in allogeneic hematopoietic stem cell transplantation

Background The occurrence of bronchiolitis obliterans syndrome （BOS） after allogeneic hematopoietic stem cell transplantation （alIo-HSCT） is rare but severe. We examine the role of pre-HSCT chemotherapeutic exposure, pre-HSCT comorbidities, and transplant-related complications in the development of BOS after alIo-HSCT. Methods A nested case-control study was designed. Cases with BOS and controls matched for the year of alIo-HSCT and length of the follow-up were identified from a cohort of 1646 patients who underwent alIo-HSCT for treatment of hematologic malignancies between 2006 and 2011. Antithymocyte globulin was used in the partial matched related and unrelated matched donor HSCT, or patients with severe aplastic anemia. Results Thirty-six patients suffered from BOS; the mean age at the time of presentation was （32.7±2.4） years, and the mean time to presentation was （474±350） days post-HSCT. A pre-HSCT cyclophosphamide dose of 〉3.2 g/m2 （OR=8.74, P=0.025）, chronic graft-versus-host disease （moderate to severe） （OR=12.02, P=0.000）, and conditioning regimens without antithymocyte globulin （OR=2.79, P=0.031） were independently associated with BOS. Conclusions We found that higher pre-HSCT cyclophosphamide exposure, a conditioning regimen without antithymocyte globulin, and moderate to severe chronic graft-versus-host disease are significantly and independently associated with BOS. Based on these results, we can identify patients who are at a higher risk of developing BOS after alIo-HSCT, select a more appropriate therapeutic strategy, and improve the outcome of HSCT recipients.

Lung transplantation for bronchiolitis obliterans syndrome after allogenic hematopoietic stem cell transplantation

Bronchiolitis obliterans syndrome （BOS） after hematopoietic stem cell transplantation （HSCT） is a major cause of morbidity and mortality with limited treatment options. Lung transplantation （LTX） has been rarely reported as a treatment option for selected HSCT recipients with this problem. In the present study, we reported six patients who underwent LTX due to BOS after HSCT （two females, four males） from January 2012 to December 2014 in our center. The median time from HSCT to diagnosis of BOS was 2.5 years （ranging from 1 to 5 years）. At a median time of 4 years （ranging from 2 to 5 years） after diagnosis of BOS, four patients received bilateral sequential LTX, and two patients received single LTX. One of the recipients suffered from mild acute rejection after LTX, another suffered from primary lung graft dysfunction on post-operation day 2, and three experienced fungal infections. The median time for follow-up after LTX was 19.5 months （ranging from 12 to 39 months）. At present, all patients are alive with good functional capacity and no relapse of BOS and hematologic malignancy conditions. Patients who received bilateral LTX have better pulmonary functions than patients who received single LTX.

Loss of GRB2 associated binding protein 1 in arteriosclerosis obliterans promotes host autophagy

Background:Arteriosclerosis obliterans(ASO)is a major cause of adult limb loss worldwide.Autophagy of vascular endothelial cell(VEC)contributes to the ASO progression.However,the molecular mechanism that controls VEC autophagy remains unclear.In this study,we aimed to explore the role of the GRB2 associated binding protein 1(GAB1)in regulating VEC autophagy.Methods:In vivo and in vitro studies were applied to determine the loss of adapt protein GAB1 in association with ASO progression.Histological GAB1 expression was measured in sclerotic vascular intima and normal vascular intima.Gain-and loss-of-function of GAB1 were applied in VEC to determine the effect and potential downstream signaling of GAB1.Results:The autophagy repressor p62 was significantly downregulated in ASO intima as compared to that in healthy donor(0.80 vs.0.20,t=6.43,P<0.05).The expression level of GAB1 mRNA(1.00 vs.0.24,t=7.41,P<0.05)and protein(0.72 vs.0.21,t=5.97,P<0.05)was significantly decreased in ASO group as compared with the control group.Loss of GAB1 led to a remarkable decrease in LC3II(1.19 vs.0.68,t=5.99,P<0.05),whereas overexpression of GAB1 significantly led to a decrease in LC3II level(0.41 vs.0.93,t=7.12,P<0.05).Phosphorylation levels of JNK and p38 were significantly associated with gain-and loss-of-function of GAB1 protein.Conclusion:Loss of GAB1 promotes VEC autophagy which is associated with ASO.GAB1 and its downstream signaling might be potential therapeutic targets for ASO treatment.

Comparison of the Safety and Effectiveness of Lower Extremity Artery Bypass Grafting and Endovascular Angioplasty in the Treatment of Lower Extremity Arteriosclerosis Obliterans in the Elderly

Objective:To compare the safety and effectiveness of lower extremity artery bypass grafting and endovascular angioplasty in the treatment of lower extremity arteriosclerosis obliterans in the elderly.Methods:The data of 87 elderly patients with lower extremity arteriosclerosis obliterans treated in our hospital from August 2015 to August 2017 were analyzed retrospectively.According to the different treatment methods,they were divided into angioplasty group(n=45,intravascular angioplasty)and bypass grafting group(n=42,lower extremity artery bypass grafting).The success rate,hemodynamics of dorsalis pedis artery and nerve conduction of lower extremity were compared between the two groups Velocity,VAS score,late target vessel lumen loss(LLL),patency rate,restenosis rate,ankle brachial index(ABI)and clinical adverse events.Results:There was no significant difference between angioplasty group and bypass group(P>0.05).One month after operation,the hemodynamics of dorsalis pedis artery and nerve conduction velocity of lower limbs in the two groups were better than those before operation,the difference was statistically significant(P<0.05),but there was no significant difference between the two groups(P>0.05).The VAS score of the two groups was significantly lower than that of the preoperative group(P<0.05),but there was no significant difference between the two groups(P>0.05).The ABI of the two groups was significantly improved after operation,the difference was statistically significant(P<0.05),but there was no significant difference between the groups at each time point(P>0.05).There was no significant difference in LLL,patency rate and restenosis rate between the two groups(P>0.05).There was statistical difference in the incidence of complications between the two groups(P<0.05).During the follow-up period,no serious adverse events such as death or amputation occurred in both groups.Conclusion:Endovascular angioplasty and lower extremity artery bypass grafting have the same clinical effect in the treatment of elderly patients with lower extremity arteriosclerosis obliterans,which are safe and feasible.

Effect of Ligustrazine Injection on Vascular Endothelial Cell of The Patients with Arteriosclerosis Obliterans

Objective: To study the effect of ligustrazine injection (LI) on vascular endothelial cell of the patients with arteriosclerosis obliterans (ASO) and explore the new pathway of investigating effective vascular protective agents in Chinese medicinal herbs. Methods: Forty-six patients with ASO in the LI group treated by LI were observed, their circulating endothelial cells (CEC) were detected quantitatively before and after treatment. The results were compared with the CEC of 53 cases of healthy persons (control group) in the same period. Results: In the LI group, the immediate cure rate was 45.7% (21 cases), markedly effective rate 36.9% (17 cases) and the effective rate 17.4% (8 cases). The CEC of patients before treatment was 4.39±1.76/0.9μl, which was significantly higher than that of the healthy persons (1.53±0.42/0.9μl). It could be reduced after treatment, along with the improvement of symptoms and signs, to 2.43±0.87/0.9μl, P＜0.01. Conclusion: LI in treating ASO not only displays extraordinary effect, but also has good effect in curing the damage of endothelial cells.

Arteriosclerosis Obliterans Presenting as Multiple Leg Ulcers: A Case Report

Introduction Arteriosclerosis obliterans (ASO) is characterized by the ischemic symptoms of lower extremity,which are due to the stenosis and/or occlusion of artery based on the pathology of atherosclerotic change,mainly involving the large-and medium-sized arteries.Pain and ulcers of the leg are the main causes of patient seeking medical aid;however,a presentation of multiple ulcers is rare.Herein we report a case of ASO presenting as multiple leg ulcers.

Vacuum-compression therapy for ischemic disease of the extremities:experience with 40 patients

Objective To study the clinical effects of vacuum-compression therapy for ischemic disease of the extremities. Methods A total of 40 cases of peripheral arterial disorders,including 23 thromboangiitis obliterans (31 limbs) and 17 arteriosclerosis obliterans (23 limbs),were treated by a self-made vacuum-compression therapeutic apparatus. Results The effective rate in thromboangiitis obliterans and arteriosclerosis obliterans groups was 96.77% and 92.23%,respectively. The cuffs on the apparatus were improved to eliminate discomfort in the patients during treatment. "Rebound symptom" was observed during treatment,which had not been reported previously. Conclusion Vacuum-compression therapy has a good prospect for treating ischemia of the extremities.