Portal vein arterialization in 25 liver transplant recipients:A Latin American single-center experience

BACKGROUND Portal vein arterialization(PVA)has been used in liver transplantation(LT)to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for complex portal vein thrombosis(PVT).The effect of PVA on portal perfusion and primary graft dysfunction(PGD)has not been assessed.All patients receiving PVA and LT at the Fundacion Santa Fe de Bogota between 2011 and 2022 were analyzed.To account for the time-sensitive effects of graft perfusion,patients were classified into two groups:prereperfusion(pre-PVA),if the arterioportal anastomosis was performed before graft revascularization,and postreperfusion(post-PVA),if PVA was performed afterward.The pre-PVA rationale contemplated poor portal hemodynamics,severe vascular steal,or PVT.Post-PVA was considered if graft hypoperfusion became evident.Conservative interventions were attempted before PVA.

A Comparative Analysis on Surgical Outcomes and Complications of Endoscopic and Open Vein Harvesting Techniques

Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein harvesting (EVH) is an alternative approach, utilizing specialized instruments and small incisions to harvest the vein. Methods: A retrospective analysis was conducted on a cohort of patients who underwent Coronary artery bypass graft (CABG) requiring great saphenous vein (GSV) harvesting which was done by EVH or OVH procedures. Demographic variables, including age and gender, were assessed for both groups. Intraoperative variables such as the number of grafts, cardiopulmonary bypass time, X clamp time, and type of procedure were analyzed. Postoperative variables, including infection and bleeding rates, were also evaluated. Results: The study included 30 patients each undergoing Coronary artery bypass graft (CABG) with need of great saphenous vein harvesting which was done by EVH and OVH. Demographic variables were well-matched between the two groups in terms of age, while a significant difference in gender distribution was observed. Obesity and smoking were more prevalent in the OVH group, and EVH was associated with a higher mean number of grafts compared to OVH. Conversion to an open technique occurred in a portion of the EVH cases, and infection rates did not significantly differ between the EVH and OVH groups. However, the incidence of postoperative bleeding was significantly higher in the EVH group. Conclusion: This study provides valuable insights into the demographic, intraoperative, and postoperative variables associated with EVH and OVH techniques. EVH demonstrated advantages in terms of reduced infection rates compared to OVH. However, the higher incidence of postoperative bleeding associated with EVH raises concerns about potential risks.

Evaluation of corporal fibrosis in cadaveric pericardium and vein grafts for tunica albuginea substitution in rats

<abstract>Abstract Aim: To evaluate the degree of corporal fibrosis in rats with cadaveric pericardium or vein as grafting materials for tunica albuginea substitution. Materials and methods: Thirty male Sprague-Dawley rats (300 g-325 g) were divided at random into 3 groups of 10 animals each: group 1 was the sham-operated controls and groups 2 and 3 underwent wedge excision of tunica albuginea and replacement with cadaveric pericardium and vein grafts, respectively. Four months later, rats were sacrificed and the penis removed to assess the degree of fibrosis using RT PCR technique for TGP-β1 mRNA expression. The tissues were fixed in 10 % formalin, paraffin-embedded and stained with Masson's trichrome and Verhoff's van Giesen for collagen and elastic fibers. Results: Four months after grafting, there was minimal fibrosis surrounding the patch in the vein graft rats and moderate fibrosis in the pericardial graft rats. The degree of penile fibrosis in the pericardial graft rats was significantly higher than that in the controls (P<0.01), but in the vein graft rats it was not significantly different from that of the controls (P>0.05). Conclusion: The degree of penile fibrosis of cadaveric pericardial graft was significantly higher than that of the control group, while in the vein graft group it was comparable to the latter. The authors believe that the vein graft may be a more ideal substance to be used as the tunica albuginea substitute than the pericardial graft in the surgical treatment of Peyronie's disease.

Retrograde percutaneous coronary intervention via critically degenerated saphenous vein grafts for chronic total occlusion in native coronary arteries

We report the case of a 78-year-old woman with saphenous vein graft (SVG) disease and chronic total occlusion (CTO) in three native coronary arteries [left anterior descending artery (LAD), left circumflex artery, and the right coronary artery], who was successfully treated by percutaneous coronary intervention (PCI) using the retrograde approach via the critically degenerated SVGs. The patient, a 78-year-old woman, presented with sudden chest pain and dyspnea. She had previously undergone coronary artery bypass surgery using SVGs for the three vessels and percutaneous coronary intervention with sirolimuseluting stent placement in the posterolateral branch 13 and 3 years ago, respectively. Electrocardiography revealed ST-segment elevation in leads V1-4, whereas emergent coronary angiography revealed total occlusion in her native coronary arteries. Primary PCI was scheduled. A channel dilator was advanced very smoothly and safely into the distal site of the CTO lesion in the LAD, which showed complete occlusion in the proximal region, via an SVG that was temporally occluded four days earlier. A reverse controlled antegrade and retrograde tracking technique was used to successfully perform percutaneous recanalization. Subsequently, the other two native CTO lesions protected by critically degenerated SVGs were treated with retrograde intervention via the SVGs. The retrograde approach via critically degenerated SVGs is safe, reliable, and fast. If an SVG bypassing the native CTO lesion is critically degenerated, percutaneous coronary intervention should be performed via the SVG.

Experimental Study of Tissue-type Plasminogen Activator Gene to Prevent Vein Grafts Stenosis

The effects of in vivo local expression of recombined human tissue-type plasminogen activator （t-PA） gene on the thrombosis and neointima formation of vein grafts were explored. Jugular vein-to-artery bypass grafting was performed on 72 New Zealand white rabbits. The rabbits were divided into 3 groups according to the different processing methods： transfected t-PA gene group （n = 24）, vector group （n= 24） and blank control group （n = 24）. Samples of vein grafts were harvested at different time points after surgery. The expression of t-PA gene in vein graft was detected by RT-PCR and the synthesis of t-PA protein by Western-Blot assay. The t-PA activity was measured by chromogenic substrate assay. The Cr51 labeled platelets accumulation in vein grafts was counted. The histopathological changes were compared in intima hyperplasia index among the three groups after operation. The results showed that at the 2^nd , 5^th , 14^th and 28^th day after operation, RT-PCR and Western-blot confirmed the expression of t-PA mRNA and protein at the site of gene transfer. The t-PA activity detected on the 2^nd, 5^th, 14^th and 28^th day in experimental group was 370. 63±59. 44, 344. 13±48. 47, 252.87±51.80 and 161.75±68. 94 U/g respectively, and disappeared on the 60^th day and undetected in the control groups. The number of platelets accumulated in the vein grafts in gene group, vector group and blank control group was （85. 04 ± 21.58） 10s, （225.87±85.13） 10^6 and （211.57±78.02） 10^6 respectively. The number of platelets accumulated in gene group was significantly fewer than that in the control groups. Morphometric analysis revealed that intimal hyperplasia was markedly reduced in the t-PA gene group as compared with that in the control groups. It was suggested that the local expression of t-PA gene in vein graft significantly inhibited the accumulation of platelets, thrombosis and concomitant intimal hyperplasia, by which stenosis of bypass graft could be prevented effectively.

Reducing intimal hyperplasia in vein grafts harvested by a no-touch harvesting technique

Objective To investigate the effect of no-touch harvesting technique in reducing vein graft intimal hyperplasia. Methods This longitudinal trial compared graft angiostenosis of two groups undergoing jugular vein to carotid artery interposition grafting in rabbit model. Conventional group:12 rabbits had their veins stripped,distended,and stored in heparinized saline solution. No-touch group:12 rabbits had veins removed with surrounding tissues,but were not distended,and stored in heparinized blood. The grafts were removed 4 weeks following grafting,and morphometry and immunohistochemistry assessment were performed. Results The intimal thickness,degree of angiostenosis and proliferation index of vascular smooth muscle cells of no-touch group were significantly reduced (P<0.01) compared with those of the conventional group. The proliferating cell nuclear antigen positive-staining cells were significantly increased (P<0.01) in the conventional group compared with whose in the no-touch group. Conclusion Harvesting the vein graft with no-touch harvesting technique could significantly reduce intimal hyperplasia of the vein graft.

SEM image analysis of endothelium of distended autogenous vein grafts

Femoral veins of 17 mongrel dogs were distended with 40 kpa, 80 kpa and 120 kpa respectively prior to grafting to colateral femoral arteries. The sections were harvested at intervals of immediatness, 1 week, 4 week and 16 week followed with scanning electron microscopy (SEM) examination. The endothelial cells of grafted veins were investigated by computerized imaging analysis system. The results showed that desquamation extent of intimal layer correlated positively with the pressure. 80 kpa and 120 kpa caused relatively severe damage to the endothelium, which was significantly different from that of control group (P<0. 05). We conclude that preimplantation distention shooed be employed with less than 80 kpa, and 120 kPa shoud be avoided due to its damage to the development of reendothelialization. Nevertheless, the distension makes little notable impact to graft Patency rate as demonstrated in this experiment.

Ligamentum teres hepatis as a graft for portal and/or superior mesenteric vein reconstruction:From bench to bedside

BACKGROUND Pancreaticoduodenectomy combined with portal vein(PV)and/or superior mesenteric vein(SMV)resection in patients with pancreaticobiliary malignancy has become a common surgical procedure.There are various grafts currently used for PV and/or SMV reconstruction,but each of these grafts have certain limitations.Therefore,it is necessary to explore novel grafts that have an extensive resource pool,are low cost with good clinical application,and are without immune response rejection or additional damage to patients.AIM To observe the anatomical and histological characteristics of the ligamentum teres hepatis(LTH)and evaluate PV/SMV reconstruction using an autologous LTH graft in pancreaticobiliary malignancy patients.METHODS In 107 patients,the post-dilated length and diameter in resected LTH specimens were measured.The general structure of the LTH specimens was observed by hematoxylin and eosin(HE)staining.Collagen fibers(CFs),elastic fibers(EFs),and smooth muscle(SM)were visualized by Verhoeff-Van Gieson staining,and the expression of CD34,factor VIII-related antigen(FVIIIAg),endothelial nitric oxide synthase(eNOS),and tissue type plasminogen activator(t-PA)were detected using immunohistochemistry in LTH and PV(control)endothelial cells.PV and/or SMV reconstruction using the autologous LTH was conducted in 26 patients with pancreaticobiliary malignancies,and the outcomes were retrospectively analyzed.RESULTS The post-dilated length of LTH was 9.67±1.43 cm,and the diameter at a pressure of 30 cm H2O was 12.82±1.32 mm at the cranial end and 7.06±1.88 mm at the caudal end.Residual cavities with smooth tunica intima covered by endothelial cells were found in HE-stained LTH specimens.The relative amounts of EFs,CFs and SM in the LTH were similar to those in the PV[EF(%):11.23±3.40 vs 11.57±2.80,P=0.62;CF(%):33.51±7.71 vs 32.11±4.82,P=0.33;SM(%):15.61±5.26 vs 16.74±4.83,P=0.32].CD34,FVIIIAg,eNOS,and t-PA were expressed in both LTH and PV endothelial cells.The PV and/or SMV reconstructions were successfully completed in all patients.The overall morbidity and mortality rates were 38.46%and 7.69%,respectively.There were no graft-related complications.The postoperative vein stenosis rates at 2 wk,1 mo,3 mo and 1 year were 7.69%,11.54%,15.38%and 19.23%,respectively.In all 5 patients affected,the degree of vascular stenosis was less than half of the reconstructed vein lumen diameter(mild stenosis),and the vessels remained patent.CONCLUSION The anatomical and histological characteristics of LTH were similar to the PV and SMV.As such,the LTH can be used as an autologous graft for PV and/or SMV reconstruction in pancreaticobiliary malignancy patients who require PV and/or SMV resection.

Changes of Ca^2+ activated potassium channels and cellular proliferation in autogenous vein grafts

Objective: To investigate changes of Ca2+ activated potassium channels (KCa) in autogenous vein grafts. Methods: Contraction of venous ring was measured by means of perfusion in vitro. The intimal rabbits proliferation of vascular and proliferation of cultured smooth muscle cells(vascular smooth muscle cells, VSMCs)were observed by the means of computerised image analysis and MTT method respectively. Furthermore, whole cell mode of patch clamp was used to record KCa of VSMCs isolated from autogenous vein grafts. Results: One week after transplantation there were no significant differences of contraction and intimal relative thickness between autogenous vein grafts and control. Contraction and intimal relative thickness of autogenous vein graft were significantly increased 2 weeks after transplantation (P<0.05, n=8 vs control), and they was more enhanced 4 weeks after vein transplantation (P<0.01, n=8 vs control).TEA(blocker of Ca2+ activated potassium channels)increased MTT A490 nm value of VSMCs from femoral vein in a dose dependent manner(P<0.05, n=8). KCa current density was significantly attenuated in VSMCs from autogenous vein grafts (1-4) week after transplantation(P<0.05, n=5).Conclusion: KCa is inhibited in autogenous vein graft, which account for vasospasm and intimal proliferation.

Radial Artery and Saphenous Vein Grafts in Coronary Artery Bypass Surgery Comparison in Terms of Patient Symptoms

Background: The aim of this study is to compare radial artery with saphenous vein grafts which are widely used for coronary bypass, from views of patients’ satisfaction and postoperative findings. Methods: 42 isolated coronary bypass (CABG) patients performed during November 2012-April 2013 are included in the study. 30 days after the operation, in patients who had both RA and SV removal made responses to a questionnaire form which included 6 questions about symptoms of extremity. Results: After analyzing the responses and physical examination, there was no difference in terms of quality of life and usefulness of the extremity for daily use between two grafts. 2 patients (2%) have wound infection on the saphenous vein incision and additional surgical procedure was performed and a scar tissue has occurred. There was no statistically significance between uncomfortable symptoms and demographic data. Conclusion: Our study suggested that RA graft using showed a bit more comfortable and suitable effect against SV in our patients. We think that radial arterial grafts should be used more widely in coronary surgery with selected patients.

Effects of 3,3',4',5,7-pentamethylquercetin on intimal hyprerplasia vein grafts

Objective Pentamethylquercetin (PMQ) has a role in cardiovascular protection.We investigate the effects of 3,3 ’,4 ’,5,7 pentamethylquercetin,a derivative of PMQ,on intimal hyperplasia of the vein grafts in rats both in vivo and in vitro. Methods The proliferation of vascular smooth muscle cells (VSMC) was induced with Ang Ⅱ (0.1 μmol/L,24 h) while PMQ was administrated at six different dosages (0.1,0.3,1,3,10 and 30 μmoL/L).

Internal Jugular Vein Graft after Inadvertent Severing of the Internal Carotid Artery during Carotid Endarterectomy and an Urgent Re-Exploration for Immediate Post-Operative Wound Site Bleeding: A Case Report

Carotid endarterectomy is a well-established treatment for preventing stroke in selected patients. Although there is debate over whether patch angioplasty or primary closure should be used to reconstruct the bifurcation after carotid endarterectomy, there is growing evidence in the literature in favor of patch angioplasty. When compared to primary closure, patch angioplasty during conventional carotid endarterectomy is suggested to lower the incidence of restenosis and recurrent ipsilateral stroke. Various materials have been used as a patch in this procedure, including the saphenous vein, synthetic patches, or less frequently, an internal jugular vein patch where extensive narrowing of the internal carotid artery is evident. In our case, we used an internal jugular vein graft after inadvertent severing the internal carotid artery (ICA) during carotid endarterectomy after the failure of reconstruction with a saphenous vein patch. We also encountered immediate postoperative reactionary hemorrhage following anesthetic reversal, necessitating an urgent re-exploration. The purpose of this case report is neither an attempt to suggest all patients need angioplasty nor to state that an internal jugular vein patch or graft is superior to synthetic material or saphenous veins;rather, it is an attempt to emphasize a potentially effective rescue way to reconstruct inadvertent extensive vascular injury during carotid endarterectomy.

经内窥镜大隐静脉获取术在冠状动脉旁路移植术中应用的学习曲线

【目的】探讨内窥镜获取大隐静脉在冠状动脉旁路移植术中的应用并探讨学习曲线,重点关注初学者易发生的问题及对早期临床结果的影响。【方法】回顾性分析2013年7月至2014年4月在郑州大学第一附属医院心外科接受不停跳冠状动脉旁路移植术并使用内窥镜技术获取大隐静脉的83例患者的临床资料,按照手术时间的先后顺序分为A组(初学组20例)、B组(熟悉组20例)、C组(进步组20例)、D组(成熟组23例),分析各组之间患者围术期及随访结果差异,明确学习曲线周期。【结果】该组患者年龄为(60.22±8.06)岁,体质量为(69.77±11.66)kg,其中合并高血压24例、糖尿病26例、亚急性脑梗14例。A组相对于后三组获取大隐静脉长度与时间比值明显较小(P<0.001),静脉主干损伤数量明显较多(P=0.006),并且随访1年时静脉桥通畅率较低,但差异无统计学意义。【结论】内窥镜获取大隐静脉之前技术操作培训是必要的,能有效规避初学者造成的血管损伤,实际获取的过程中大概需要亲自操作20例,并认真总结技术技巧就可以较为熟练地进行相关操作。

内窥镜采集大隐静脉对微创冠状动脉旁路移植术患者手术切口及生活质量的影响

目的 探讨内窥镜采集大隐静脉(EVH)在微创冠状动脉旁路移植术(MICABG)患者中对下肢手术切口及术后早期生活质量的影响。方法 分析2022年1月至12月我院及北京安贞医院单医疗组行微创冠状动脉旁路移植术患者共82例,内窥镜采集大隐静脉组(EVH)36例,开放采集大隐静脉组(OVH)46例。比较两组患者一般情况及术后下肢切口愈合不良、感染等方面的差异;应用SF-36生活质量量表比较两组患者术后早期生活质量的变化。结果 EVH组下肢手术切口愈合不良等并发症较少,在躯体疼痛、总体健康两个维度方面的改善率均优于OVH组(所有P<0.05)。结论 对于行微创冠状动脉旁路移植术的患者,内窥镜采集大隐静脉可减少下肢切口相关并发症,并能更好地提高患者术后早期的生活质量。

不接触获取大隐静脉技术应用于非体外循环冠状动脉旁路移植术的早期临床效果

目的:评价不接触获取技术与常规获取技术应用于非体外循环冠状动脉旁路移植术的早期临床效果。方法:回顾性分析南京医科大学第一附属医院心脏大血管外科2020年7月—2022年7月行非体外循环冠状动脉旁路移植术的120例患者的临床资料,其中50例采用不接触获取技术(No-touch组),70例采用常规获取技术(CVH组)。观察指标包括手术时间、静脉桥血管数量、静脉桥血管平均流量、机械通气时间、ICU监护时间和术后下肢切口愈合不良、术后急性肾损伤等并发症,以及随访1年后的心脏超声指标和冠状动脉CT血管成像结果。结果:两组患者手术时间、静脉桥血管数量、静脉桥血管平均流量、机械通气时间、ICU监护时间等比较差异均无统计学意义(P> 0.05)。No-touch组术后主动脉内球囊反搏(intra-aortic balloon pump,IABP)支持5例,下肢切口愈合不良2例,术后突发心血管事件1例。CVH组术后IABP支持2例,术后急性肾损伤1例。两组均无二次开胸探查和二次气管插管情况,且术后各并发症发生率比较差异无统计学意义(P> 0.05)。两组患者术后1年心脏超声指标差异无统计学意义(P> 0.05)。No-touch组术后1年静脉桥血管闭塞率低于CVH组(P <0.05)。结论:与常规获取技术相比,在非体外循环冠状动脉旁路移植手术中采用不接触技术获取大隐静脉不增加手术风险,术后1年桥血管通畅率较高。

采用RA和SVG分别联合LIMA实施CABG治疗的多支冠状动脉病变患者术后1年桥血管通畅情况

目的对比观察采用桡动脉(RA)和大隐静脉(SVG)分别联合左乳内动脉(LIMA)实施冠状动脉旁路移植术(CABG)的多支冠状动脉病变患者术后1年桥血管通畅情况。方法接受CABG治疗的多支冠状动脉病变患者67例,根据手术方式不同分为RA组、SVG组,其中RA组35例患者选用LIMA+RA作为桥血管进行CABG治疗,SVG组32例患者选用LIMA+SVG作为桥血管CABG治疗。两组患者均在体外循环下完成CABG。收集并比较两组患者术后住院时间、ICU监护时间、术后并发症(肺部感染、胸骨哆开、肾功能不全、二次探查止血)、术肢伤口长度及术肢伤口愈合情况等。术后1年行冠脉CTA与心脏彩超检查,评估患者桥血管早期通畅情况,收集并比较两组患者心脑血管事件(心绞痛、心肌梗死、脑梗死、二次血运重建)发生情况、术后生存情况、术肢并发症的发生情况。结果两组患者均顺利完成体外循环下CABG手术。RA组患者共涉及桥血管76支,其中LIMA桥血管35支、RA桥血管41支。SVG组共涉及桥血管97支,其中LIMA桥血管32支、SVG桥血管65支。RA组患者的术后住院时间、出现肺部感染的概率、术肢伤口长度、出现术肢伤口愈合不良的概率均低于SVG组(P均<0.05)。两组患者LIMA桥血管均通畅。RA组术后1年RA桥血管通畅率(85.4%)与SVG组SVG桥血管通畅率(87.6%)相比差异无统计学意义(P>0.05),但RA组RA桥血管与SVG组SVG桥血管相比更易出现“线样征”(P<0.05)。两组患者不良心脑血管事件发生情况、术后生存情况、术肢并发症的发生情况差异无统计学意义(P均>0.05)。结论RA桥血管、SVG桥血管在多支冠状动脉病变患者CABG术后1年的通畅率均较高,与SVG组患者相比,RA组患者的术后住院时间更短、肺部感染等术后并发症更少、更易出现“线样征”。

Management of the middle hepatic vein and its tributaries in right lobe living donor liver transplantation

BACKGROUND: Left liver graft from a small donor will not meet the metabolic demands of a larger adult recipient. To overcome the problem of graft size insufficiency, living donor liver transplantation (LDLT) using the right lobe has become a standard method for adult patients. As the drainage of the median sector (segments V, VIII and IV) is mainly by the middle hepatic vein (MHV), the issue of whether the MHV should or should not be taken with the graft or whether the MHV tributaries (V5, V8) should be reconstructed in the recipient remains to be settled. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1985-2006) on right lobe living donor liver transplantation, middle hepatic vein, vein graft, hepatic venoplasty and other related subjects. RESULTS: Some institutions had proposed their policy for the management of the MHV and its tributaries. Dominancy of the hepatic vein, graft-to-recipient weight ratio, and remnant liver volume as well as the donor-to-recipient body weight ratio, the volume of the donor's right lobe to the recipient's standard liver volume and the size of MHV tributaries are the major elements for the criteria of inclusion of the MHV, while for the policy of MHV tributaries reconstruction, the proportion of congestive area and the diameter of the tributaries are the critical elements. Optimal vein grafts such as recipient's portal vein and hepatic venoplasty technique have been used to obviate hepatic congestion and venous drainage disturbance. CONCLUSIONS: Taking right liver grafts with the MHV trunk (extended right lobe grafts) or performing the MHV tributaries reconstruction in modified right lobe grafts, according to the criteria proposed by the institutions with rich experience, can solve the congestion problem of the right paramedian sector and help to improve the outcomes of the patients. The additional use of optimal vein grafts and hepatic venoplasty also can guarantee excellent venous drainage.

Glabridin Relaxes Vascular Smooth Muscles by Activating BK_(Ca) Channels and Inhibiting Phosphodiesterase in Human Saphenous Vein

The aim of the current study was to investigate the pharmacological activity of glabridinon the isolated human saphenous vein (SV) and explore the underlying mechanisms. Samples of patients' SVs were removed during bypass surgery, and 4-mm lengths of the vessels were placedin Krebs solution at ±4℃ and hung in an isolated organ bath to assess their contraction/relaxationresponses. The contraction/relaxation responses were recorded to observe if the cyclic guanosinemonophosphate (cGMP)/protein kinase G (PKG) pathway mediates the relaxant effect of glabridinafter treatment with blockers like ODQ (a guanylate cyclase inhibitor), KT5823 (a PKG inhibitor),isobutylmethylxanthine [IBMX, a phosphodiesterase (PDE) inhibitor], and cantharidin [Cant,a myosin light-chain phosphatase (MLCP) inhibitor]. Moreover, nitric oxide (NO), cGMP, andPKG levels in SV tissues were determined by ELISA after incubation with glabridin, N(o)-nitro-L-arginine methyl ester (L-Name, a NO synthetase inhibitor), phenylephrine (PE), ODQ, IBMX,and KT5823. The results showed that glabridin relaxed the vascular smooth muscle of humanSV pretreated with PE in a dose-dependent manner, which was independent of the endothelium.The vasorelaxant effect of glabridin was only inhibited by iberiotoxin (IbTX), Cant, and KT5823.Glabridin increased cGMP and PKG levels in SV homogenates, whereas it did not alter the NOlevel. The enhancing efects of cGMP and PKG levels by glabridin were abolished by ODQ andKT5823. In conclusion, glabridin has a vasorelaxant effect, which is associated with the activationof BKc. channels and inhibition of PDE.

Autogenous inside-out versus standard vein and skeletal muscle-combined grafting for facial nerve repair

BACKGROUND： In the repair of nerve defects, collapse of the venous wall, as a result of vein grafting alone, could impede nerve regeneration. Therefore, vein lumens filled with muscle and nerve segments have been used to bridge nerve defects. OBJECTIVE： To compare the effects of autogenous, inside-out, vein-skeletal, muscle-combined grafting versus standard, vein-skeletal, muscle-combined grafting for the repair of facial nerve defects. DESIGN, TIME AND SETTING： A randomized, controlled, neuroanatomical, animal study was performed at the Animal Experimental Center and Laboratories of the Capital Medical University Xuanwu Hospital and the Peking Union Medical College Hospital from September 2007 to October 2008.MATERIALS： A total of 10 healthy, male, New Zealand rabbits, aged 6 months, were randomly assigned to inside-out, vein-skeletal, muscle-combined grafting and standard, vein-skeletal, muscle-combined grafting groups, with 5 rabbits in each group. METHODS： A 20-mm gap in the buccal branch of the right facial nerve was made in each animal, which was respectively repaired with inside-out, vein-skeletal, muscle-combined grafts or standard vein-skeletal muscle-combined grafts.MAIN OUTCOME MEASURES： At 6 months after implantation, evoked maximal compound muscle action potentials were recorded on bilateral facial nerves using electromyogram. Myelinated nerve fibers of the regenerating nerves were quantified using myelin sheath osmic acid staining. RESULTS： There was no significant difference between the groups in terms of ratios of bilateral amplitude and latency of compound muscle action potential （P 〉 0.05）. Moreover, morphology of regenerating nerves and quantity of myelinated nerve fibers were similar between the groups （P 〉 0.05）. CONCLUTION： Compared with standard vein grafting, the inside-out vein grafting did not significantly improve nerve regeneration. Therefore, it is not necessary to utilize inside-out vein grafting for the repair of nerve defects, in particular with the combined use of autogenous vein and skeletal muscle grafts.

Application of Endoscopic Vein Harvesting in Obese Patients Undergoing Coronary Artery Bypass Grafting

This study aims to evaluate the clinical outcomes of endoscopic vein harvesting （EVH） for coronary artery bypass grafting （CABG） in obese patients. Totally, 153 obese patients who underwent EVH （n=81） or standard bridging technique （SBT, n=72） in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups （P〉0.05）. There were no statistical differences in total operation time （226±28 min vs. 224±30 min, P〉0.05）, number of damaged vessels （0.12±0.05 vs. 0.16±0.06, P〉0.05） and short medium-term outcomes including revascularization rate （1.25% vs. 2.78%, P〉0.05）, vessel dysfunction rate （11.25% vs. 11.11%, P〉0.05） and mortality （0.00% vs. 0.00%, P〉0.05）. Use of EVH was associated with significant reduction of total harvesting time （41±6 min vs. 63±11 min, P〈0.05）, incision length （4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05） and postoperative lower extremity complications （P〈0.05）. EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.