Diabetic foot ulcer (DFU) affects approximately 25% of diabetic patients and represents the leading cause of non-traumatic lower extremity amputation. Neutrophil extracellular traps (NETs) contribute to chronic inflammation; however, their mechanistic role in DFU healing failure remains incompletely characterized. This study integrated bulk RNA sequencing (GSE143735, n = 9) and single-cell RNA sequencing (scRNA-seq; GSE165816, n = 11) datasets to investigate NET-related transcriptional programs. Differential expression analysis identified 96 differentially expressed genes, with significant NET pathway enrichment in non-healers (normalized enrichment score = 4.35, false discovery rate q < 0.001). Analysis of 33,654 single cells revealed elevated NET activity scores in neutrophils from non-healing wounds (p = 4.73 × 10-159). Four neutrophil subpopulations were identified, with the NETs-high subset expanded in non-healers (43.1% versus 15.4%). Cell-cell communication analysis demonstrated enhanced S100A8/A9-RAGE and IL1B-IL1R signaling in the non-healing state. A six-gene signature (S100A8, S100A9, MPO, ELANE, NCF1, HMGB1) achieved an area under the receiver operating characteristic curve of 0.750 for healing prediction under leave-one-out cross-validation. These findings implicate NET pathway activation as a potential driver of DFU healing impairment and identify candidate prognostic biomarkers warranting prospective validation.

BACKGROUND:This study evaluated the association of estimated glomerular filtration rate (eGFR)-based renal function severity and drug-coated device use with 2-year clinically driven target lesion revascularization (CD-TLR) after femoropopliteal endovascular intervention. METHODS:Patients who underwent femoropopliteal endovascular intervention at 3 centers between January 2018 and June 2023 were retrospectively reviewed. Renal function was stratified into eGFR-based categories: stage I, eGFR ≥90 mL/min/1.73 m2; stage II, eGFR 60-89 mL/min/1.73 m2; stage III, eGFR 30-59 mL/min/1.73 m2; and stage IV/severe renal dysfunction, defined as eGFR <30 mL/min/1.73 m2 or dialysis dependence. Drug-coated devices included drug-coated balloons and drug-eluting stents. The primary end point was 2-year CD-TLR. Predictors of CD-TLR were assessed using Cox proportional hazards regression models. RESULTS:A total of 589 patients were included; 229 patients (38.9%) were treated with drug-coated devices and 360 patients (61.1%) with conventional devices. Severe renal dysfunction/stage IV was associated with a higher risk of 2-year CD-TLR compared with stage I (hazard ratio [HR], 5.43; 95% confidence interval [CI], 2.80-10.51; P < 0.001). Drug-coated device use was associated with a lower risk of 2-year CD-TLR compared with conventional-device treatment (HR, 0.56; 95% CI, 0.35-0.91; P = 0.020). In secondary outcome analysis, patients with severe renal dysfunction/stage IV had worse overall survival. CONCLUSION:More advanced renal dysfunction was associated with an increased risk of 2-year CD-TLR after femoropopliteal endovascular intervention. Drug-coated device use was associated with a lower risk of CD-TLR in the overall cohort. Findings in the severe renal dysfunction subgroup should be interpreted cautiously because of the retrospective design, small subgroup size, and potential treatment-selection bias.

Flush infrarenal aortic occlusion presents a significant revascularization challenge. This study evaluated five patients who were treated with direct covered stent implantation via a combined transbrachial and bilateral femoral approach. Technical success was achieved in all cases, with a mean operative time of 88 minutes, and no major perioperative complications occurred. During 3-36 months of follow-up, all patients remained asymptomatic, and imaging confirmed stent patency. Direct covered stent implantation offers a safe and effective one-step endovascular strategy for flush infrarenal aortic occlusion, particularly for patients unsuitable for prolonged thrombolysis or invasive open surgery.

PurposeThe aim of this study was to compare the postoperative effectiveness of different embolization techniques for splenic artery aneurysms(SAAs), i.e., sandwich technique and mushroom technique, by analyzing data from our single center.Materials and methodsBetween January 2019 and December 2023, a total of 220 patients with SAAs underwent embolization (sandwich technique n = 102, mushroom technique n = 118). Outcomes assessed included technical success, procedure time, length of hospital stay, total hospital costs, 30-day mortality, incidence of post-embolization syndrome(PES), splenic infarction rate, and aneurysm recanalization rate. Univariate and multivariate analyses were used to identify risk factors for PES in patients with splenic artery aneurysms after surgery. Normograms were used to predict the likelihood of developing PES after surgery.ResultsThe technical success rate of both embolization techniques was 100%, and the 30-day mortality, splenic infarction rate, and aneurysm recanalization rate were all 0. However, the mushroom technique was associated with less procedure time, length of hospital stay, total hospitalization costs, and incidence of PES than the sandwich technique. Univariate and multivariate analyses showed that the number of aneurysms as well as the embolization method were independent risk factors for PES.ConclusionThe mushroom technique achieves the same favorable short-term prognosis of the sandwich technique and results in a relative reduction in operative time, length of hospital stay, total hospital costs, and incidence of PES.

Purpose: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatoduodenectomy. Stent-graft implantation is an emerging treatment option for PPH. This study reports the outcome of PPH treated with stent-graft implantation. Methods: This was a single-center, retrospective study. Between April 2020 and December 2023, 1723 pancreatectomy cases were collected while we screened 12 cases of PPH after pancreatoduodenectomy treated with stent-graft implantation. Patients' medical and radiologic images were retrospectively reviewed. Technical and clinical success, complications, and stent-graft patency were evaluated. Continuous data are reported as means ± standard deviation when normally distributed or as median (Q1, Q3) when the data is non-normal distributed. Categorical data are reported as n (%). A p < 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients’ survival. Results: Pancreatic fistula was identified in 6 cases (50.0%), and pseudoaneurysm was identified in 3 cases (25.0%), including pancreatic fistula together with pseudoaneurysm in 1 case (8.3%). All pseudoaneurysm or contrast extravasation sites were successfully excluded with patent distal perfusion, thus technical success was achieved in all cases. The overall survival rate at 6 months and 1 year was 91.7% and 78.6%, respectively. One patient had herniation of the small intestine into the thoracic cavity, which caused a broad thoracic and abdominal infection and died during hospitalization. Rebleeding occurred at the gastroduodenal artery stump in 1 case after stent-graft implantation for the splenic artery and was successfully treated with another stent-graft implantation. Two cases of asymptomatic stent-graft occlusion were observed at 24.6 and 26.3 after the operation, respectively. Conclusions: With suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.

Background: This study aimed to assess the safety and efficacy of the transbrachial approach as a single or combined procedure for complex interventions in peripheral artery disease (PAD). Methods: Between March 2011 and April 2021, 169 patients with PAD underwent endovascular therapy via the transbrachial approach as a single or dual procedure. Univariate and multivariate analyses were performed to evaluate the predictors of adverse events at the brachial puncture site. All demographic, clinical, and perioperative data were acquired from electronic medical records and retrospectively analyzed. Results: Brachial artery access was used alone and in combination in 87 and 82 patients, respectively. Patients in the combined -approach group underwent more intraoperative stent implantations and had more vascular closure devices (VCD). Multivariate logistic regression analysis revealed that hypertension was an independent factor for higher rates of brachial puncture site adverse events (odds ratio, 4.76; 95% confidence interval, 1.33e16.97; P 1 / 4 0.016). Brachial artery access -site complications occurred in 26 patients, including 6 (23.1%) major and 20 (76.9%) minor entry -site complications. Entry -site complications were observed in 21 (16.8%) and 5 (11.4%) patients assigned to manual compression and VCD groups, respectively. There were no significant intergroup differences in the incidence of major or minor complications. Interestingly, patients assigned to the VCD group did not experience major entry -site complications. Conclusions: The transbrachial approach, as a single or combined procedure, is a safe alternative to complex interventions in patients with PAD. Complications of brachial access progressively decrease with improved blood pressure control.

Objective: There is a lack of consensus regarding the optimal strategy for evaluating the efficiency and safety of dual-pathway inhibition (DPI) in preventing femoropopliteal restenosis in patients undergoing repeated endovascular interventions. Despite several therapeutic interventions available for preventing femoropopliteal restenosis post repeated endovascular interventions, the ideal strategy, particularly evaluating the efficacy and safety of DPI, remains a matter of debate. Methods: From January 2015 to September 2021, patients who underwent repeated endovascular interventions for femoropopliteal restenosis were compared with those who underwent DPI or dual antiplatelet therapy (DAPT) after surgery using a propensity score -matched analysis. The primary outcome was clinically driven target lesion revascularization (CD-TLR). The principal safety outcome was a composite of major bleeding and clinically relevant non -major (CRNM) bleeding. To further enhance the rigor, Kaplan -Meier plots, Cox proportional hazards modeling, and sensitivity analyses, as well as subgroup analyses were employed, reducing potential confounders. Results: A total of 441 patients were included in our study, of whom 294 (66.7%) received DAPT and 147 (33.1%) received DPI, with 114 matched pairs (mean age, 72.21 years; 84.2% male). Cumulative probability of CD-TLR at 36 months in the DPI group (17%) trended lower than that in the DAPT group (32%) (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.26-0.78; P =.004). The cumulative probability of freedom from CD-TLR at 36 months in the DPI group was 83%. No significant difference was observed in the composite outcome of major or CRNM bleeding between the DPI and DAPT groups (HR, 1.26; 95% CI, 0.34 to 4.69; P = .730). The DPI group was associated with significantly lower rates of CD-TLR in the main subgroup analyses of diabetes (P = .001), previous smoking history (P = .008), longer lesion length (>10 cm) (P = .003), and treatment with debulking strategy (P = .003). Conclusions: In our investigation focused on CD-TLR, we found that DPI exhibited a significant reduction in the risk of reintervention compared with other treatment modalities. This underscores the potential of DPI as a viable therapeutic strategy in preventing reinterventions. Moreover, our assessment of safety outcomes revealed that the bleeding risks associated with DPI were on par with DAPT, thereby not compromising patient safety. These findings pave the way for potential broader clinical implications, emphasizing the effectiveness and safety of DPI in the context of reducing reintervention risks. (J Vasc 2024;79:623-31.)

BACKGROUND AND OBJECTIVES: Current treatment strategies for elderly patients with acute lower limb ischemia (ALLI) have no definitive effect, and studies have reported no definitive prognostic factors that reflect poor outcomes among patients with ALLI. Therefore, reliable clinical indicators that can accurately predict outcomes and guide the choice of treatment options are needed. This study aimed to identify prognostic factors among the elderly patients who underwent endovascular treatment for ALLI. DESIGN: Retrospective. MATERIALS AND METHODS: From January 2011 to December 2020, 270 patients (281 limbs; 124 males; mean age: 84.8 years [range, 80–102 years]) underwent endovascular therapy for ALLI, including acute limb arterial embolism (191 limbs) and acute exacerbation of chronic ischemia (90 limbs). Factors identified through univariate analysis (P < 0.1) and other variables considered likely to have important prognostic value were tested in a logistic regression model for symptom improvement, major amputation, and all-cause mortality. RESULTS: The mean age of the patients was 84.8 years, 54.1% were female, and hypertension (69.0%) was the most common coexisting disease. Patients in the acute group exhibited higher rates of atrial fibrillation (45.5% vs. 24.4%; P = 0.001) and chronic renal failure (15.2% vs. 6.7%; P = 0.044) than the acute-on-chronic group. The acute group exhibited significantly higher plasma D-dimer levels than the acute-on-chronic group (1.59 vs. 1.06; P < 0.001). In the acute group, 145 (75.9%) limbs had preacute Rutherford Classification (RC) of Grade I. In the acute-on-chronic group, 47 (52.2%) limbs had symptom duration of 7–14 days, and 84 (93.3%) limbs were diagnosed with arteriosclerosis obliterans. Most patients opted for antiplatelet therapy, particularly those in the acute-on-chronic group. Multivariate logistic regression analysis revealed that onset time, hypertension, white blood cell (WBC) count, and lesion nature were independent factors for postoperative symptom improvement, whereas hypertension, WBC count, and preacute RC grade were independent factors for amputation at 3 months postoperatively. CONCLUSIONS: WBC count was a major risk factor for postoperative symptom improvement and amputation within 3 months among elderly patients; the higher the WBC count, the higher the risk for amputation. In addition, among patients >80 years of age, early surgery could significantly improve the prognosis of ALLI, regardless of the procedure used to restore blood supply.

目的 比较经肱动脉入路和经股动脉入路治疗肠系膜上动脉病变的效果.方法 回顾性分析 2020 年 6 月至 2022 年 7 月海军军医大学第一附属医院 73 例接受肠系膜上动脉支架植入术和肠系膜上动脉取栓术的肠系膜上动脉病变患者临床资料,其中肱动脉组 16 例,股动脉组 57 例.比较两组间"超选"肠系膜上动脉的时间、术后卧床时间和术后并发症等指标.结果 当肠系膜上动脉与主动脉夹角＜90°时,肱动脉组"超选"肠系膜上动脉的时间比股动脉组更短(P=0.004),且术后卧床时间短(P＜0.001).当肠系膜上动脉与主动脉夹角≥90°时,肱动脉组术后卧床时间更短(P=0.045),"超选"肠系膜上动脉的时间差异无统计学意义(P=0.682).肱动脉组和股动脉组在术后并发症的发生率方面差异无统计学意义(P＞0.05).结论 经肱动脉入路治疗肠系膜上动脉病变能缩短术后卧床时间,且当肠系膜上动脉与主动脉夹角＜90°时,经肱动脉入路"超选"肠系膜上动脉所用时间更短.

Thoracic endovascular repair (TEVAR) is currently the recommended and most widely used treatment for type B aortic dissection. A major challenge is revascularization of the left subclavian artery in order to extend the landing zone to zone 2 (Ishimaru classification). Various strategies have been used for revascularization, including branched stent graft, fenestrated stent graft, the chimney technique, the parallel technique, and bypass surgery. Single-branched stent graft is one of the most promising strategies, and several products have recently been reported as potential candidates for use with this approach. The Castor single-branched stent graft is the only off-the-shelf product available; this product has been developed through collaboration between Chinese corporations and clinicians. In this Perspective article, clinical experience and data obtained from TEVAR with the Castor single-branched stent graft are summarized by experienced Chinese experts.

目的 探讨性别与重症糖尿病足患者(Wagner分级3～5级)的外周血管腔内治疗效果的关系.方法 纳入2019年1月至2022年1月海军军医大学第一附属医院收治的接受外周血管腔内治疗的重症糖尿病足患者168例,根据性别分为男性组(n=118)和女性组(n=50).比较两组患者下肢血管病变特点、术中处理方式,收集术后创面愈合率及截肢等资料.结果 在重症糖尿病足患者中,女性组术后3个月及6个月的创面愈合较男性组差(P=0.035,P=0.002),但两组患者截肢率差异无统计学意义.多因素回归分析结果显示,女性(OR=5.24,95％CI 1.227～22.382;P=0.025)和病变累及膝下动脉数量(OR=5.24,95％CI 1.213～14.709;P=0.024)与术后6个月创面愈合不良相关.在病变累及膝下动脉的人群中,女性患者的术后6个月创面愈合较差(P<0.001).结论 女性患者就诊时年龄大,合并症复杂,以膝下血管病变为主,且术中干预及术后创面愈合情况较差.女性糖尿病足患者应更早更积极地进行腔内治疗,这对改善女性患者的预后有积极意义.

目的 评估自主研发的Castor分支型主动脉覆膜支架（简称Castor支架）治疗累及左锁骨下动脉（LSA）的Stanford B型主动脉夹层的中期治疗效果。方法 选择2018年12月—2020年6月间在海军军医大学第一附属医院使用Castor支架行胸主动脉腔内修复术（TEVAR）的Stanford B型主动脉夹层患者70例，其中男64例、女6例，年龄为（60.02±13.03）岁。所有患者均于全身麻醉下行TEVAR。记录围手术期和随访期间主要观察指标和次要观察指标。主要观察指标为患者全因死亡及夹层逆撕、脑梗死等主动脉夹层相关不良事件。次要观察指标：术前测量主动脉夹层近端锚定区主动脉直径、LSA开口与主动脉夹层近端裂口距离、LSA开口与主动脉夹层近端边缘距离、LSA起始部直径、左颈总动脉（LCA）开口远端与LSA开口近端距离，手术完成情况、手术时间、术中对比剂使用量，住院时间、随访时间，内漏、支架闭塞等并发症情况，Castor支架主体近端及远端直径、分支支架直径，主动脉主体支架近端和远端放大率。结果 主要观察指标：围手术期3例患者发生主动脉夹层相关不良事件（夹层逆撕1例，脑梗死2例）,随访期间5例患者死亡（夹层逆撕破裂1例，呼吸衰竭1例，心力衰竭1例，脑出血2例）。次要观察指标：主动脉夹层近端锚定区主动脉直径为（31.63±3.16） mm, LSA开口与主动脉夹层近端裂口距离为（45.79±19.60）mm, LSA开口与主动脉夹层近端边缘距离为（8.14±14.37） mm, LSA起始部直径为（11.35±1.45） mm, LCA开口远端与LSA开口近端距离为（8.44±2.44） mm。所有患者均顺利完成手术。手术时间为（109.63±44.65） min,术中对比剂使用量为（200.79±35.11） mL,住院时间为（8.57±3.22） d,随访时间为（11.64±6.77）个月，6例患者失访。随访期间发生Ⅰb型内漏1例，分支支架闭塞1例。Castor支架主体近端直径为（32.43±3.45）mm、远端直径为（26.46±3.40）mm,分支支架直径为（10.92±4.08） mm。主动脉主体支架近端放大率为2.48%（0,3.45%）,主动脉主体支架远端放大率为0（-7.14%,4.35%）。结论 Castor分支型主动脉覆膜支架能够安全、有效地用于累及LSA的Stanford B型主动脉夹层的腔内治疗。

Background To assess the immediate effect and factors affecting the efficacy of rotational thrombectomy (RT) in patients with thrombus-containing lower-limb ischaemic lesions. Methods Patients were retrospectively divided into two groups: RT and RT+ CDT (Catheter-directed thrombolysis). The RT group included patients in whom intraoperative thrombus aspiration was successful, while the RT + CDT group included patients in whom intraoperative thrombus aspiration was less effective and remedial CDT treatment was used. The primary outcome was the immediate effect of RT on thrombus-containing lower-limb ischaemic lesions. Results From May 2015 to July 2021, 170 patients (113 men, 57 women; mean age, 74.0 years) with thrombus-containing lower-limb ischaemic lesions were treated in our centre. Of these patients, 113 received RT only, while 57 received RT + CDT. There were no significant intergroup differences in terms of age, disease duration, or comorbidities, but a higher proportion of male patients and higher preoperative plasma D-dimer levels (1.23 vs. 0.84; p = .017) was observed in the RT + CDT group. There were no significant intergroup differences in terms of diagnosis, lesion characteristics, lesion location, or lesion length. Multivariate logistic regression analysis revealed that male sex (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.098–6.410; p = .030) and poor distal runoff (OR, 2.94; 95% CI, 1.439–5.988; p = .003) were associated with higher rates of additional CDT. Male patients also had a significantly longer onset time, more thrombotic occlusions, and a greater frequency of in-stent restenosis. Conclusions RT alone or with CDT is a feasible primary treatment option for thrombus debulking. Sex significantly influences the effect of RT on thrombus-containing lower-limb ischaemic lesions.

Introduction The efficacy and safety of antithrombotic strategies remain uncertain in patients with atrial fibrillation undergoing lower-extremity revascularisation. Materials and methods Between January 2011 and November 2021, 319 patients with atrial fibrillation after lower-extremity revascularisation received rivaroxaban or warfarin treatment as anticoagulation regimens with different antiplatelet therapy strategies. The primary efficacy outcome was the composite of acute limb ischaemia, major amputation for vascular causes, myocardial infarction, ischaemic stroke, clinically driven target lesion revascularisation, and death from vascular causes. The safety outcomes were major bleeding events according to the International Society on Thrombosis and Haemostasis classification criteria. Results A total of 178 and 141 patients received rivaroxaban and warfarin treatments, respectively, after revascularisation with or without antiplatelet regimens. The incidence of the primary efficacy outcome at 36 months in the rivaroxaban group (44 patients, 24.7%) tended to be lower than that in the warfarin group (43 patients, 30.5%) (hazard ratio, 0.870; 95% confidence interval, 0.565–1.339; P = 0.527). The incidence of the secondary efficacy outcomes decreased in the rivaroxaban group (56 patients, 31.6%) compared with that in the warfarin group (61 patients, 43.2%). Major bleeding events occurred in three patients (1.7%) in the rivaroxaban group and five patients (3.5%) in the warfarin group; no significant difference in fatal or intracranial bleeding was observed between the groups. Conclusion This study describes practical experience regarding the use of rivaroxaban and warfarin in patients with peripheral arterial disease complicated by non-valvular atrial fibrillation following endovascular intervention. The efficacy and safety outcomes do not differ significantly between rivaroxaban and warfarin.

Background and Objective Neurotoxicity is a common side effect of oxaliplatin; the effect of current drugs such as methylcobalamin and gabapentine is not obvious. Astragaloside IV (AS-IV) is an important active ingredient of Astragali Radix, which can protect the nervous system and inhibit tumor growth to a certain extent. However, whether AS-IV can reduce oxaliplatin neurotoxicity and its molecular mechanism remain unclear. Methods The network pharmacology method was used to determine the collective targets of AS-IV and oxaliplatin neurotoxicity. The model of neurotoxicity was established by intraperitoneal injection of oxaliplatin in rats. Bodyweight, mechanical withdrawal threshold (MWT), cold allodynia, and nerve conduction velocity (NCV) were examined, pathological changes were observed by hematoxylin-eosin staining, number of Nissl bodies were assessed by Nissl staining, the key collective targets were measured by spectrophotometry and immunohistochemistry. Results Through network pharmacological analysis, 25 collective targets of AS-IV and oxaliplatin neurotoxicity were identified, mainly related to inflammation and oxidative stress. AS-IV could increase body weight, elevate MWT, and reduce cold allodynia of model rats, it also raised NCV. Neuropathology was improved and the number of Nissl bodies was increased by AS-IV administration. It reduced TNF-α, IL-6, and IL-1β in the spinal cord of model rats to inhibit inflammation; it also decreased MDA, raised SOD, CAT, and GSH-Px in the spinal cord of model rats to block oxidative stress. Conclusion AS-IV improves oxaliplatin neurotoxicity by regulating neuroinflammation and oxidative stress; the results can provide a new perspective for the potential treatment strategy of oxaliplatin neurotoxicity.

Objective: To investigate the effect of bare-metal stent related technique on distal aortic dissection involving abdominal visceral segment. Methods: A retrospective analysis was performed on clinical data of 33 patients with distal aortic dissection involved abdominal visceral segment, who hospitalized in the Vascular Surgery Department of Shanghai Changhai Hospital from July 2012 to September 2019. The effect of the treatment was evaluated according to the clinical and preoperative, intraoperative and follow-up imaging data derived from (aorta computed tomography angiography (CTA) and digital subtraction angiography (DSA)) as well as the changes of the maximal diameter of the aorta and the thrombosis of the false lumen of the dissection. The criteria were as follows: the maximum diameter change of aortic dissection<5 mm was defined as stable; the maximum diameter decrease of aortic dissection≥5 mm was defined as effective reduction; the maximum diameter increase of aortic dissection≥5 mm was defined as expansion; the definition of diameter change of false lumen was the same as above. The hospital complications, clinical symptoms and survival were recorded. Results: There were 28 male patients in this cohort, the mean age was (57.6±4.9) years old. Twenty-one patients were treated with bare-metal stent and coils technique, of which 8 patients were jointly treated with stent grafts. Twelve patients were treated with multi-layer bare-metal stent technique, of which 4 patients were jointly treated with stent grafts. Intraoperative DSA image results showed that the visceral arteries were patent during the treatment, and the blood flow velocity of the false lumen was reduced in all 33 patients. There were no adverse events such as distal outflow tract embolism and coil displacement during the operation. During the period of hospitalization, one patient developed intimal rupture of subrenal abdominal aortic dissection on the fourth day after operation and emergency endovascular graft exclusion was performed for abdominal aortic dissection, and the patient recovered well from the emergency operation. The follow-up time was (16.7±14.0) months. One patient died 1 year after surgery due to non-disease-related factors. Follow-up CTA imaging results showed that the maximum diameter of the aorta in abdominal visceral segment tended to be smaller ((39.1±13.4) mm vs. (41.3±11.9) mm, P=0.469), and the maximum diameter of the false lumen was significantly reduced ((16.2±12.9) mm vs. (23.5±10.7) mm, P=0.014). The maximum diameter of the aortic dissection was reduced in 12 cases, stable in 19 cases, expanded in 2 cases. The maximum diameter of the false lumen was effectively reduced in 22 cases, stable in 10 cases, and expanded in 1 case. Four patients developed small endoleak in the false lumen, one of them was nearby the renal artery stent, and the remaining patients experienced complete thrombosis of the false lumen. Conclusions: Endovascular treatment of distal aortic dissection involving abdominal visceral segment with bare-metal stents related technique could promote the shrink and the thrombosis of the false lumen, and slow down the blood flow from the tear into the false lumen in the setting of patency of visceral arteries.

Because China is becoming an aging society, the incidence of diabetes and diabetic foot have been increasing. Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates. Negative pressure wound therapy (NPWT) is one of the most effective techniques for the treatment of diabetic foot wounds and great progress, both in terms of research and its clinical application, has been made in the last 20 years of its development. However, due to the complex pathogenesis and management of diabetic foot, irregular application of NPWT often leads to complications, such as infection, bleeding and necrosis, that seriously affect its treatment outcomes. In 2020, under the leadership of Burns, Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association, the writing group for ‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’ was established with the participation of scholars from the specialized areas of burns, endocrinology, vascular surgery, orthopedics and wound repair. Drawing on evidence-based practice suggested by the latest clinical research, this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot. The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.

Zr modification induces porous microstructures, inhibits defect formation and ameliorates the surface hydrophilicity of SrNbO2N, resulting in good photocatalytic activity.

Objectives To determine the association of pre- and postinterventional serum levels of interleukin-6 and high-sensitivity C-reactive protein at the six-month evaluation of restenosis after stenting of the femoropopliteal artery. Methods Sixty-eight consecutive patients with steno-occlusive femoropopliteal artery disease of Rutherford category III or IV who underwent stent implantation were included. Six-month patency was evaluated with color-coded duplex ultrasound. The association of in-stent restenosis with interleukin-6 and high-sensitivity C-reactive protein levels at baseline, and 24-h postintervention was assessed with a multivariate logistic regression analysis. Results In-stent restenosis was found in 15 patients (22.1%) within six months. Interleukin-6 and high-sensitivity C-reactive protein levels were significantly increased at 24-h postintervention compared to their preintervention values (p < 0.001 and p = 0.002, respectively). Interleukin-6 values at baseline (odds ratio, 1.11; 95% confidence interval: 1.00, 1.23; p = 0.044) and 24-h postintervention (odds ratio, 1.04; 95% confidence interval: 1.02, 1.06; p < 0.001) were independently associated with six-month in-stent restenosis. Twenty-four-hour postinterventional high-sensitivity C-reactive protein levels were also found to be related to restenosis (odds ratio, 1.15; 95% confidence interval: 1.04, 1.26; p = 0.006), but high-sensitivity C-reactive protein levels at baseline did not show an independent association with in-stent restenosis (odds ratio, 0.57; 95% confidence interval: 0.35, 1.80; p = 0.667). Smoking, diabetes mellitus, and cumulative stent length were other parameters associated with an increased risk for in-stent restenosis. Conclusions Femoropopliteal artery angioplasty with stent placement induces an inflammatory response. Interleukin-6 is a powerful independent predictor of intermediate-term outcomes for stenting of the femoropopliteal artery, suggesting that its predictive value may be superior to that of high-sensitivity C-reactive protein.

Objective: PGC-1 alpha achieves the protective effect of TNF-alpha-induced injury to human umbilical vein endothelial cells by inhibiting the Ca2+/NFAT pathway.Methods: Human umbilical vein endothelial cells were treated with 20, 40, and 80 ng/mL TNF-alpha to create three models with different degrees of cell injury. The human umbilical vein endothelial cells were cultured in vitro and transfected by interfering with the PGC-1 alpha RNA lentivirus. The silencing of the PGC-1 alpha gene was divided into two groups: the control group and the down-regulation of the PGC-1 alpha gene group. The effects of different concentrations of TNF-alpha on apoptosis of human umbilical vein endothelial cells were determined by flow cytometry. The expression of intracellular genes was detected by real-time quantitative PCR, and the expression of intracellular protein was measured by western blot assay. The concentrations of mtROS and Ca2+ were measured.Results: After human vein endothelial cells were treated for 24 h with different concentrations of TNF-alpha, the apoptosis rate gradually increased with the increase of TNF-alpha concentration, and the difference was statistically significant compared with the control group (P<0.05). The expression of PGC-1 alpha mRNA in each group was significantly lower than that of the control group after human venous endothelial cells were treated for 24 h of with different concentrations of TNF-alpha (P<0.05). After treatment with different concentrations of TNF-alpha, the relative expression rate of PGC-1 alpha protein in each group was remarkably lower than that in the control group (P<0.05). The expression of NFAT1 mRNA in the TNF-alpha 40 and 80 ng/mL treatment groups was significantly higher than that in the control group (P<0.05), and the expression of NFAT2 mRNA in different concentrations of the TNF-alpha treatment groups was markedly higher than that in the control group (P<0.05). The expression of NFAT1 protein in the TNF-alpha 40 and 80 ng/mL treatment groups was significantly higher than that in the control group (P<0.05), and the expression level of NFAT2 protein in different concentrations of TNF-alpha treatment group was clearly higher than that in the control group (P<0.05). The intracellular mROS and Ca2+ concentrations were significantly higher than that in the control group after the down-regulation of the PGC-1 alpha gene expression (P<0.05). After down-regulating the expression of the PGC-1 alpha gene, the levels of NFAT1, NFAT2, mRNA, and protein in the cells were significantly higher than those in the control group (P<0.05).Conclusion: 20, 40, and 80 ng/mL of TNF-alpha can induce different degrees of human umbilical vein endothelial cell injury. PGC-1 alpha has a protective effect on this kind of cell injury, and its related mechanism may be to inhibit the Ca2+/NFAT signalling pathway by reducing the intracellular mtROS concentration, and thus to protect damaged cells.