Objectives: Distal stent graft-induced new entry (dSINE) can occur after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). In this study we aimed to compare the effectiveness of restrictive bare stent (RBS), tapered stent graft (TSG), and non-TSG in TEVAR in preventing dSINE after a midterm follow-up.Methods: This retrospective cohort study included patients with TBAD who under-went TEVAR (June 2010 to December 2018). The occurrence of dSINE during follow-up was examined. Predictors of dSINE were determined using Fine-Gray regression with death as the competing event. Survival was evaluated using Cox proportional hazards regression.Results: Finally, 364 patients were included: 111 with non-TSG TEVAR, 125 with TSG TEVAR, and 128 with TEVAR with RBS. After 54.5 months, incidences of dSINE in the 3 groups were 12.61%, 4.80%, and 1.56%, respectively (P = .002). On Fine-Gray regression adjusted for clinically relevant covariates, the expansion mismatch ratio (subdistribution hazard ratio, 1.09; 95% CI, 1.07-1.12; P < .001) and complete false lumen thrombosis (subdistribution hazard ratio, 0.35; 95% CI, 0.13-0.94; P = .037) were identified as predictors of dSINE. The Cox proportional hazards regression analysis revealed that dSINE was not only a risk factor for aortic -related mortality (hazard ratio, 17.90; 95% CI, 3.27-98.12; P = .001), but also a pre-dominant risk factor for all-cause mortality (hazard ratio, 4.91; 95% CI, 1.66-14.52; P = .004).Conclusions: dSINE can happen in TBAD patients who undergo TEVAR. Thus, long-term surveillance is crucial. TSG and RBS had lower expansion mismatch ratios, which might help prevent dSINE.

目的:研究主动脉腔内修复术(TEVAR)联合远端限制性支架(RS)治疗B型主动脉夹层的中、远期临床效果.方法:对2010年6月至2018年12月,哈尔滨医科大学附属第二医院血管外科接受TEVAR或TEVAR+RS治疗的B型主动脉夹层患者资料进行回顾性分析.结果:共239例患者纳入研究,男性185例,女性54例,年龄24～80岁,平均年龄(54.2±10.7)岁.TEVAR组111例,TEVAR+RBS组128例.手术成功率100％.TEVAR+RS组较TEVAR组支架远端新发破口(dSINE)发生率明显降低[14/111(12.6％)vs.2/128(1.6％),P=0.0007],同时主动脉假腔重构也明显优于TEVAR组.结论:应用胸主动脉腔内修复术联合RS治疗B型主动脉夹层,不仅能够有效地减少dSINE发生,并且有利于主动脉夹层假腔重构,具有良好的中-长期疗效.

Background Despite being one of the most common benign tumors, the prevalence and pathogenesis of hemangiomas (HAs) are poorly understood. We aimed to identify the biological role of the long non-coding RNA (lncRNA) CASC9 in the HA-derived endothelial cell (HDECs) phenotype as well as elucidate the mechanism involved. Methods The expression of CASC9 was identified by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). the effect of CASC9 on cell proliferation, migration and invasion of HDECs were examined by CCK8, wound healing, and transwell assay, respectively. Bioinformatics analysis and a luciferase reporter assay were utilized to investigated the mechanisms involved. The in vivo tumorigenesis capability of CASC9 on HA was also evaluated. Results The expression of CASC9 was significantly elevated in HA tissue compared to normal tissue. Down-regulation of CASC9 inhibited proliferation, migration, and invasion of HDECs. The translation of cyclinD1, N-cadherin, Twist, and MMP2 was also decreased by CASC9 knockdown treatment. Furthermore, CASC9 over-expression exerted the opposite effect of proliferation, migration, and invasion of HDECs. We also found that CASC9 interacts with miR-125a-3p/Nrg1 to regulate cellular functions. Interestingly, miR-125a-3p can reverse the effect of CASC9 on proliferation, migration, and invasion of HDECs. Together, the clinical data showed that CASC9 expression is negatively correlated with miR-125a-3p expression and positively correlated with Nrg1 expression. CASC9 also exerted anti-tumorigenesis capability in vivo. Conclusion Our study indicates that CASC9 accelerates cell growth and invasion of HDECs and provides new insights for the diagnosis and molecular therapy of HA.

To analyze the necessity of venous thromboembolism (VTE) prophylaxis for patients undergoing high ligation and stripping of the great saphenous vein (GSV) and to estimate the efficacy and safety of different anticoagulant protocols in a single-center randomized controlled trial with large sample size. A total of 2196 patients undergoing high ligation and stripping of the GSV were randomized to one of the following postoperative VTE prophylaxis protocols: group A, no VTE prophylaxis ( n=542); group B, subcutaneous low-dose unfractionated heparin (LDUH) hypodermic injection, 125 U/kg per day in three divided doses ( n=531); group C, low-molecular-weight heparin (LMWH) 6000 IU once a day ( n=573); and group D, LMWH 4000 IU twice daily ( n=550). Groups were compared for the incidence of VTE and major hemorrhage within 1 month following surgery. Varicose vein severity was classified by CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic elements) score. The clinical characteristics of the patients were equally matched between groups. Postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) were significantly higher in group A (DVT 5.17%, PE 1.48%) compared to groups B (0.56%, 0%), C (0.35%, 0%) and D (0.36%, 0%) ( p<0.01). The incidence of VTE did not differ between the three active chemoprophylaxis arms. Hemorrhagic complications were low for each group but higher in group B (0.75%) compared to the other groups (group A 0.18%; group C 0.17%; group D 0.18%, p<0.01). Hemorrhagic complications did not differ amongst groups A, C and D. In conclusion, postoperative VTE chemoprophylaxis following high ligation and GSV stripping effectively reduces the venous thrombosis complications of this procedure. Of the three active strategies tested, no difference in efficacy was noted; however, thrice daily LDUH did increase bleeding complications.

Objective In this research ,the effects of exogenous C 2-ceramide on the induction of apop-tosis of mesothelioma cells in vitro and related important proteins are investigated .Mtehods Mesothelioma cells were treated with various doses of C 2-ceramide for different duration .Cell viability were analyzed by cell count-ing kit-8 assay.Morphological changes of apoptosis of mesothelioma cells were observed by Diff Quik staining . Apoptosis of mesothelioma cells was also detected by Caspase -3 assay and lactate dehydrogenase(LDH)assay. Related important proteins involved in the signal transduction of apoptosis were detected by western blot .Results In vitro,C2-ceramide demonstrated a dose -and time-dependent inhibition of cell proliferation .Apoptotic bodies were observed by Diff Quik staining .The antiproliferative effect of 80 μm C2-ceramide was paralleled with an increase in Caspase -3 activity.LDH assay showed that C2-ceramide at a concentration of 80μm signifi-cantly promoted cells death .After treated by C2-ceramide,the expressions of Bax and the phosphorylated JNK in mesothelioma cells were increased , however , the expression of phosphorylated ERK 1/2 kinase was decreased . Conclusion Our results indicate that C 2-ceramide induced apoptosis of malignant mesothelioma cells in vitro . This anti-tumor affect is achieved by adjusting related important proteins .

Objective:The effects of exogenous C2 ceramide on the induction of apoptosis of mesothelioma cells in vitro and the cell growth of BALB/c (nu/nu)nude mice in vivo were investigated,in order to provide experimental data for the systemic treatment of this disease.Methods:In vitro,cell viability and apoptosis were analyzed by cell counting kit-8 assay,fluorescence activated cell sorter (FACS)analysis,DNA fragmentation analysis,Caspase -3 assay.In vivo,the BALB/c (nu/nu)nude mice models were developed,devided into four groups randomly and trea-ted with saline,vehicle (DMSO,1%),C2-ceramide direct injection and C2-ceramide intraperitoneal injection re-spectively.Tumor volume was calculated as length ×width2 ×0.5 with caliper.After the single tumor-bearing mouse was killed 21 days after treatment,samples of tissue were subjected to histological examination for the absence of mes-othelioma.Results:In vitro,C2 -ceramide demonstrated a dose -and time -dependent inhibition of cell prolifera-tion,induction of apoptosis,and cell-cycle arrest at G1/S phase in mesothelioma cells.The antiproliferative effect of 80μm C2-ceramide was paralleled by an increase in Caspase-3 activity in the two cell lines investigated.FACS a-nalysis showed that mesothelioma cells underwent apoptosis in a time-dependent manner.An increase in the portion of cells in the G0 -G1 phase and subG1 was observed in mesothelioma cells.The cells located in the subG1 portion were considered as being apoptotic.After cells transiently were transfected with C2 ceramide for 24h,C2 ceramide dramatically enhanced the level of DNA ladders in mesothelioma cells,whereas the DMSO resulted in undetectable laddering of the DNA.C2-ceramide reduced the volume of established tumors in mesothelioma xenograft mice.Con-clusion:Our results indicated that C2-ceramide induced apoptosis of malignant mesothelioma cells in vitro and re-duced growth of mesothelioma in vivo,the biological mechanism of mesothelioma cells were understood further.There-fore C2-ceramide might potentially provide clinical approach in the treatment of patients with mesothelioma.

Objective To reform enzymatic digestion and create a simple and effective primary culture methods for rat vascular smooth muscle cells(VSMC).Methods 0.1% collagenase Ⅱ was used to digest and isolate the thoracic aorta smooth muscle cells of rat and then cultured.The feature of vascular smooth muscle cells was observed by inverted phase contrast microscope and observed α-actin stained by indirect immunocytochemistry.Results The cultured cells exhibited the characteristic hills and valleys growth pattern as observed by phase contrast microscopy and cells that showed α-SM-actin positive staining were more than 98%.Conclusion Collagenase Ⅱ can digest and isolate vascular smooth muscle cells and also has advantages that make cells easy to live and short period for passaging.

Objective To establish a method for culture of rat vascular smooth muscle cell(VSMC) in vitro, then to investigate the effect of microRNA-21(miRNA-21) on the migration and invasion of VSMC. Methods 0.1% collagenase Ⅱ was used to digest and isolate the thoracic aorta VSMC of rat and then cultured. And expression of α-actin of cytoplasm of VSMC was analyzed with immunocytochemistry. Then VSMCs were grouped as follows: blank control grpup (only DEPC), transfection reagent group (lipofectamineTM2000), negative control group (transfection of negative control gene sequence) , up-regulation of miRNA-21 group (transfection of miRNA-21mimics),down-regulation of miRNA-21 group(transfection of check of miRNA-21 ), unrelated sequence group (transfection of unrelated sequence). Synthesized miRNA-21 was transfected with lipofectamineTM2000 into cultured rat aortic VSMC in vitro, and the expression of miRNA-21 of thses 6 groups was detected by real-time PCR, respectively. Migration ability of VSMC of thses 6 groups was measured by scratch wound model and invasion ability by Transwell chamber model in vitro. Results The cultured cells exhibited the characteristic "hills and valleys" growth pattern as observed by phase contrast microscopy and over 98%α-actin of cytoplasm stained. In up-regulation of miRNA-21 group, overexpression of miRNA-21in VSMCs increased cell migration and invasiveness(P<0.05), whereas in down-regulation of miRNA-21 group, inhibition of miRNA-21 in VSMCs reduced cell migration and invasiveness(P<0.05)compared with other control groups. Conclusion miRNA-21 can effectively promote the migration and invasion of the VSMC.

Objective To explore the clinical application of combining stenting and thrombectomy to treat long-segment iliac artery occlusive disease.Methods The clinical data of 26 patients with long-segment iliac artery occlusive disease performed by stenting and thrombectomy between July 2005 and October 2007 were analyzed retrospectively.Results Twenty-four patients were treated by stenting and thrombectomy successfully.Two patients failed and 3 patients were treated by stenting the opposite iliac artery simultaneously.The patients' symptoms were relieved obviously,even disappeared.The mean ankle brachial index(ABI) increased 0.52.They were followed-up for 4~30 months.There were 4 patients recurred in 25d,40d,12 and 21months respectively and symptoms were relieved by symptomatic treatment.Conclusion Combining stenting and thrombectomy can be a safe and effective method in treating long-segment iliac artery occlusive disease.But it will be necessary to control its indication and observe long-term therapeutic effect.

目的 探讨动脉取栓联合支架植入术治疗长段髂动脉闭塞的临床应用价值.方法 回顾性分析2005年7月至2007年10月动脉取栓联合支架植入术治疗长段髂动脉闭塞26例患者的临床资料.结果 24例患者成功行动脉取栓联合支架植入术,2例由于动脉管腔完全硬化闭塞而无法行介入手术,成功率为92.3%.有3例同时行对侧髂动脉支架植入术.术后患者症状均有明显改善或消失,围手术期无死亡.踝肱指数(ABI)平均增加0.52.随访时间4～30(平均22)个月.4例患者分别于术后25天、40天及12个月、21个月再次出现下肢缺血症状,给予对症治疗后症状改善.结论 动脉取栓联合支架植入术治疗长段髂动脉闭塞安全、疗效肯定,但应掌握其适应证,远期疗效需进一步观察.