Background: Diabetic foot ulcer (DFU), characterized by delayed wound healing, is a severe complication of diabetes mellitus. A report using single-cell sequencing technology revealed increased chitinase 3 like 1 (CHI3L1)-overexpressing fibroblasts in DFU patients with wound healing. Therefore, this study aimed to elucidate the role and mechanism of CHI3L1 in wound-healing Methods: DFU model rats were constructed with streptozotocin injection and scald wound formation. Subsequently, the rats were administered with adeno associated virus to overexpress signal transducer and activator of transcription 3 (STAT3). Human dermal fibroblasts (HDFs) were transfected with recombinant constructs as needed. Moreover, the binding of STAT3 to CHI3L1 was determined through bioinformatics analysis and dual-luciferase reporter assay. The trauma area, pathological changes, cell viability, migration, and protein levels of hypoxia-inducible factor-1 (HIF-1 alpha), vascular endothelial growth factor (VEGF), and STAT3/CHI3L1/mitogen-activated protein kinase (MAPK) axis were assessed. Results: STAT3 overexpression significantly reduced trauma area and increased levels of HIF-1 alpha and VEGF and the number of new vessels in DFU rats (p < 0.001). Moreover, overexpression of STAT3 enhanced proliferation, migration, VEGF secretion, and the expression levels of HIF-1 alpha, VEGF, STAT3, CHI3L1, and phosphorylated p38 MAPK (p-p38) in DFU rats and HDFs (p < 0.001). STAT3 might bind with CHI3L1 in HDFs. The effect of CHI3L1 silencing on HDFs was opposite to that of STAT3 overexpression (p < 0.05). However, CHI3L1 silencing reversed the role of STAT3 overexpression (p < 0.001). Conclusion: STAT3 upregulation accelerates wound healing by promoting the proliferation and migration of fibroblasts by activating the CHI3L1/MAPK axis. These findings provide new drug targets for DFU treatment and unveil the underlying mechanism of delayed wound healing in DFU.

Abstract Background: Venous thromboembolism (VTE) poses a significant risk to patients with severe and critical pneumonia, contributing to increased mortality rates. Early detection of VTE in these patients is crucial for implementing timely interventions and improving outcomes. Method: We conducted a single-centered, retrospective, observational study involving 32 adult patients with severe and critical pneumonia admitted to the intensive care unit of Beijing Chaoyang Hospital, China, between January 1, 2020, and February 20, 2023. All patients underwent bilateral lower extremity venous ultrasound and D-dimer testing upon admission. Logistic regression analysis was performed to assess the relationship between patient mortality and VTE, considering gender, age, time to ultrasound examination, site of thrombus, and D-dimer levels. Results: Among the 32 patients, 21 (65.6%) developed acute venous thrombosis in both lower extremities, with varying degrees of involvement. Notably, 11 (52.3%) of these patients died during the study period. The logistic regression analysis identified standard deviation for D-dimer levels as a significant predictor of patient mortality (P = 0.05), indicating a strong association between elevated D-dimer levels and increased risk of death. Conclusions: Our findings underscore the importance of early detection and management of VTE in severe and critical pneumonia patients. Elevated D-dimer levels, indicative of a hypercoagulable state, were significantly associated with mortality risk in this population. Prompt initiation of anticoagulant therapy upon VTE diagnosis may help mitigate this risk and improve patient outcomes. These results emphasize the need for vigilant monitoring and proactive measures to prevent VTE-related complications in critically ill pneumonia patients. Trial Registration: Retrospectively registered

目的 探讨不同病因急性肢体缺血的临床特点及误诊原因.方法 对2011 年1 月—2022 年1 月收治的病因诊断错误的急性肢体缺血12 例的临床资料进行回顾性分析.结果 12 例因急性肢体缺血就诊,均存在我院门急诊及首诊医院病因诊断错误.首诊均诊断为急性肢体动脉栓塞.误诊时间 8～48 h.拟急诊行肢体动脉探查Forgarty导管取栓术.经相关检查等诊断腘动脉瘤合并血栓形成8 例,上肢动脉瘤血栓形成2 例,主动脉夹层1 例,髂股动脉夹层1 例.术前及术中修正手术方案,保肢成功.结论 对于急性肢体缺血诊治需要加强对病因诊断的认知.重视病史、临床查体及术前影像学检查结果判读是减少其误诊误治的关键.

目的 评估机械血栓清除装置联合药物涂层球囊(DCB)导管治疗股腘动脉支架内再狭窄(FP-ISR)的安全性及中远期疗效.方法 收集2016年6月至2017年7月首都医科大学附属北京朝阳医院收治的32例接受机械血栓清除装置联合DCB导管治疗的FP-ISR患者的临床资料,对患者的5年随访数据进行分析.分析患者的术后3、5年原发通畅率和免于临床驱动的靶病变血运重建(CD-TLR)率、手术治疗情况、不同Rutherford分级患者的治疗情况、不良事件发生率、截肢情况、死亡情况及步行障碍调查问卷(WIQ)评分.结果 32例FP-ISR患者的技术成功率和治疗成功率均为100％(32/32),其中,26例患者完成了5年随访.术后5年的WIQ评分为(49.28±24.62)分,踝肱指数(ABI)为(0.77±0.12),分别高于术前的(30.45±21.14)分、(0.45±0.14),差异均有统计学意义(P﹤0.05).术后3年,原发通畅率为81.5％(22/27),免于CD-TLR率为85.2％(23/27).术后5年,原发通畅率为76.9％(20/26),免于CD-TLR为80.8％(21/26).结论 机械血栓清除装置联合DCB导管治疗FP-ISR具有良好的中远期效果,安全性较高.

In recent years, there has been an increasing focus on the application of hydrogels in tissue engineering. The integration of 3D bioprinting technology has expanded the potential applications of hydrogels. However, few commercially available hydrogels used for 3D biological printing exhibit both excellent biocompatibility and mechanical properties. Gelatin methacrylate (GelMA) has good biocompatibility and is widely used in 3D bioprinting. However, its low mechanical properties limit its use as a standalone bioink for 3D bioprinting. In this work, we designed a biomaterial ink composed of GelMA and chitin nanocrystal (ChiNC). We explored fundamental printing properties of composite bioinks, including rheological properties, porosity, equilibrium swelling rate, mechanical properties, biocompatibility, effects on the secretion of angiogenic factors and fidelity of 3D bioprinting. The results showed that adding 1% (w/v) ChiNC to 10% (w/v) GelMA improved the mechanical properties and printability of the GelMA hydrogels, promoted cell adhesion, proliferation and vascularization and enabled the printing of complex 3D scaffolds. This strategy of incorporating ChiNC to enhance the performance of GelMA biomaterials could potentially be applied to other biomaterials, thereby expanding the range of materials available for use. Furthermore, in combination with 3D bioprinting technology, this approach could be leveraged to bioprint scaffolds with complex structures, further broadening the potential applications in tissue engineering.

Glioblastoma (GBM) recurrence after surgical excision has grown to be a formidable obstacle to conquer. In this research, biodegradable thermosensitive triblock copolymer, poly(D, L–lactic acid–co–glycolic acid)–b–poly(ethylene glycol)–b–poly(D, L–lactic acid–co–glycolic acid (PLGA–PEG–PLGA) was utilized as the drug delivery system, loading with micronized temozolomide(micro-TMZ) to form an in situ drug–gel depot inside the resection cavity. The rheology studies revealed the viscoelastic profile of hydrogel under various conditions. To examine the molecular characteristics that affect gelation temperature, 1H–NMR, inverse gated decoupling 13C–NMR, and GPC were utilized. Cryo-SEM and XRD were intended to disclose the appearance of the hydrogel and the micro-TMZ existence state. We worked out how to blend polymers to modify the gelation point (Tgel) and fit the correlation between Tgel and other dependent variables using linear regression. To simulate hydrogel dissolution in cerebrospinal fluid, a membraneless dissolution approach was used. In vitro, micro-TMZ@PLGA–PEG–PLGA hydrogel exhibited Korsmeyer–Peppas and zero–order release kinetics in response to varying drug loading, and in vivo, it suppressed GBM recurrence at an astoundingly high rate. Micro-TMZ@PLGA–PEG–PLGA demonstrates a safer and more effective form of chemotherapy than intraperitoneal TMZ injection, resulting in a spectacular survival rate (40%, n = 10) that is much more than intraperitoneal TMZ injection (22%, n = 9). By proving the viability and efficacy of micro-TMZ@PLGA–PEG–PLGA hydrogel, our research established a novel chemotherapeutic strategy for treating GBM recurrence.

Thermosensitive hydrogels, having unique sol–gel transition properties, have recently received special research attention. These hydrogels exhibit a phase transition near body temperature. This feature is the key to their applications in human medicine. In addition, hydrogels can quickly gel at the application site with simple temperature stimulation and without additional organic solvents, cross-linking agents, or external equipment, and the loaded drugs can be retained locally to improve the local drug concentration and avoid unexpected toxicity or side effects caused by systemic administration. All of these features have led to thermosensitive hydrogels being some of the most promising and practical drug delivery systems. In this paper, we review thermosensitive hydrogel materials with biomedical application potential, including natural and synthetic materials. We describe their structural characteristics and gelation mechanism and briefly summarize the mechanism of drug release from thermosensitive hydrogels. Our focus in this review was to summarize the application of thermosensitive hydrogels in disease treatment, including the postoperative recurrence of tumors, the delivery of vaccines, the prevention of postoperative adhesions, the treatment of nervous system diseases via nasal brain targeting, wound healing, and osteoarthritis treatment.

PURPOSE:To assess the efficacy and safety of the Orchid drug-coated balloon (coated with paclitaxel) for the treatment of femoropopliteal artery disease versus percutaneous transluminal angioplasty in Chinese population.METHODS:This is a prospective, single center, single-blinded, randomized controlled trial that randomized (1:1) 60 patients (38 men; mean age 68.7 ± 8.8) to drug-coated balloon group (n = 30) or percutaneous transluminal angioplasty group (n = 30). The primary efficacy endpoint was primary patency of the target lesion and clinically driven target lesion revascularization (CD-TLR) at 12 months. The primary safety end point was freedom from perioperative death at 30 days and freedom from limb-related death and major amputation at 12 months.RESULTS:Baseline characteristics were similar between the two groups. Drug-coated balloon group resulted in higher primary patency (82.8% vs. 48.3%, p = 0.005) and lower CD-TLR rates (3.5% vs. 27.6%; p = 0.001) versus percutaneous transluminal angioplasty group at 12 months. The ABI was significantly higher in drug-coated balloon group than percutaneous transluminal angioplasty group (0.86 ± 0.13 vs. 0.72 ± 0.18, p = 0.025). There were no perioperative death at 30 days, no limb-related death and no major amputation at 12 months in either group.CONCLUSIONS:The randomized controlled trial showed superior treatment effect with drug-coated balloon versus percutaneous transluminal angioplasty, with remarkably higher patency and lower CD-TLR rates. The result is consistent with other study and demonstrates the safety and efficacy of the Orchid drug-coated balloon for the treatment of femoropopliteal artery disease.

The recurrence of cancer after local surgery has been a difficult problem in the clinic for a long time. In recent years, local treatment via drug-loaded thermosensitive hydrogels have become a promising strategy to prevent cancer recurrence. Thus, a thermosensitive hydrogel based on poloxamer 407, poloxamer 188 and the bioadhesive excipient carbomer 974P was designed to locally release paclitaxel and prevent local tumour recurrence after direct smearing of the hydrogel at the site of injury in the surgical cavity. To improve the local drug concentration, paclitaxel was prepared into nanocrystals via a wet mill process. A series of studies were performed on this paclitaxel nanocrystal thermosensitive hydrogel (PTX-NCS-gel), including examination of its rheological properties and in vitro release and dissolution studies. Moreover, a postoperative tumour recurrence mouse model was established to evaluate the antitumour effects of this thermosensitive hydrogel. The results showed that PTX-NCS-gel had a clear, regular network structure with excellent temperature sensitivity and could be gelated within minutes at 33.1 °C. Additionally, the rheological property investigation indicated that the hydrogel has proper viscoelasticity and self-recovery ability. In vivo imaging showed that PTX-NCS-gel inhibited both local tumour recurrence and distant metastasis. Moreover, PTX-NCS-gel has the following advantages: it is more convenient to administer, avoids strong allergic responses, and has fewer side effects on the liver and spleen. This hydrogel has the potential to serve as a powerful auxiliary medication to prevent postoperative local tumour recurrence.

Meloxicam (MLX) is a non-steroidal anti-inflammatory drug used to treat rheumatoid arthritis and osteoarthritis. However, its poor water solubility limits the dissolution process and influences absorption. In order to solve this problem and improve its bioavailability, we prepared it in nanocrystals with three different particle sizes to improve solubility and compare the differences between various particle sizes. The nanocrystal particle sizes were studied through dynamic light scattering (DLS) and laser scattering (LS). Transmission electron microscopy (TEM) was used to characterize the morphology of nanocrystals. The sizes of meloxicam-nanocrystals-A (MLX-NCs-A), meloxicam-nanocrystals-B (MLX-NCs-B), and meloxicam-nanocrystals-C (MLX-NCs-C) were 3.262 ± 0.016 μm, 460.2 ± 9.5 nm, and 204.9 ± 2.8 nm, respectively. Molecular simulation was used to explore the distribution and interaction energy of MLX molecules and stabilizer molecules in water. The results of differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD) proved that the crystalline state did not change in the preparation process. Transport studies of the Caco-2 cell model indicated that the cumulative degree of transport would increase as the particle size decreased. Additionally, plasma concentration–time curves showed that the AUC0–∞ of MLX-NCs-C were 3.58- and 2.92-fold greater than those of MLX-NCs-A and MLX-NCs-B, respectively. These results indicate that preparing MLX in nanocrystals can effectively improve the bioavailability, and the particle size of nanocrystals is an important factor in transmission and absorption.

Background May-Thurner syndrome is a kind of disease caused by the compression of the left common iliac vein. It is one of the causes of incomplete venous valves and superficial varicose veins in lower limbs, and is also a potential factor of acute deep vein thrombosis (DVT). Method Here 3 cases are diagnosed as May-Thurner syndrome at different ages. Case presentations 1. A 35-year-old female patient was hospitalized with swelling of the left lower limb for 1 week. Computed tomography (CT) showed compression of the left common iliac vein with thrombosis. May-Thurner syndrome was diagnosed and catheter-directed thrombolysis was performed. 2. A 37-year-old male patient came to our hospital due to sudden swelling of the right lower extremity and pain for 3 days. Computed tomography showed compression of the left common iliac vein and deep venous thrombosis (DVT) of the right iliac vein. May-Thurner syndrome was diagnosed. The patient was performed with inferior vena cava (IVC) filter implantation, catheter-directed thrombolysis and balloon angioplasty for right iliac vein. And the patient recovered well; 3. A 55-year-old female patient came to our hospital with swelling and discomfort in the left lower extremity for 3 days. Computed tomography showed stenosis of the left common iliac vein with deep vein thrombosis. May-Thurner syndrome was diagnosed, balloon dilation and stent implantation were performed. During 3 years of follow-up, there was no swelling or new thrombosis in her lower limbs. Conclusion When encountering unexplained deep vein thrombosis, iliac vein compression syndrome should be considered and treated in time to prevent the recurrence of thrombosis. Catheter-directed thrombolysis can relieve symptoms and stenting placement is the optimal way to relieve stenosis, supplemented by long-term anticoagulation therapy and graduated compression stockings.

目的 评估Rotarex血栓清除术联合药物涂层球囊(drug-coated balloon,DCB)治疗股腘动脉支架内再狭窄(femoropopliteal artery in-stent restenosis,FP-ISR)的有效性和安全性.方法 对2016年6月至2017年7月间,接受Rotarex血栓清除术联合DCB治疗的32例FP-ISR患者,进行3年随访.研究的主要终点为术后3年的原发通畅率,免于临床驱动的靶病变再干预率(clinically-driven target lesion revascularization,CD-TLR).次要终点包括不良事件发生率、截肢率及病死率.患者的术后功能恢复情况由步行障碍调查问卷(Walking Impairment Questionnaire,WIQ)评估.结果 所有32例患者均获得了技术成功和手术成功,其中27例(84.4％)患者完成了3年的随访.术前平均踝肱指数(ankle brachial index,ABI)为0.45±0.14,3年时为0.81±0.10(P<0.05);术前WIQ评分为30.45±21.14,3年时为51.32±27.92(P<0.05).Kaplan-Meier生存曲线结果显示,随访3年,原发通畅率为81.5％,免于CD-TLR为85.2％.结论 Rotarex血栓清除术联合DCB治疗FP-ISR是安全有效的,其中长期结果令人满意.

Abstract Objective We investigated whether endothelial progenitor cells (EPCs) derived exosomes (EPC-exo) could improve angiogenesis in a rat hindlimb ischemia model to evaluate whether the EPC-exo may represent a potential therapeutic strategy for lower limb ischemia (LLI).MethodsEPCs were obtained from SD rats using the method of density gradient centrifugation, and identified by DIL-AC-LDL and FITC-UEA-l uptake test and flow cytometry. EPC-exo was isolated and purified from EPCs using ultracentrifugation method, and identified by transmission electron microscopy and western blot analysis. Rat chronic hindlimb ischemia model were divided randomly into three groups, the experimental group (n=5) was intramuscularly injected with 30ul EPC-exo through four points in ischemic hindlimb, while the EPC group (n=5) was injected with 30ul EPCs, and the control group (n=5) was injected with 30ul PBS. Laser doppler perfusion imaging (LDPI) was used to assessment blood flow perfusion of rat hindlimb at baseline, 7 day, 28 day after intramuscularly injection. Capillary density of muscle tissue was evaluated by immunofluorescence analysis at 28 day. Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) was used to detect the expression change of vascular related genes in endothelial cells (ECs) induced by EPC-exo. ResultsDIL-AC-LDL and FITC-UEA-l uptake test showed that more than 90% of the EPCs were double-positive. Flow cytometry showed that in our cultured EPCs, the positive rates of CD31, CD34, CD133 and VEGFR-2 were 97.8%, 85.3%, 83.2% and 91.3%, respectively, but the positive rate of CD45 was only 1.3%. EPC-exo with a size ranging from 30 to 100 nm and western blot analysis confirmed the presence of exosomes markers, including CD9, CD63 and CD81. Compared with non ischemic limbs, EPC-exo group recovered about 80% of the blood perfusion after 28 days, while the EPC group had a recovery rate of about 60%, and the control group had a recovery rate of about 40% only. Capillary density of muscle tissue in EPC-exo group increased significantly than EPC group and control group. qRT-PCR detected the expression of vascular related genes (VEGFA, VEGFR2, HIF-1a, eNOS, ANG1, ANG2, CXCL-16) increased significantly in EPC-exo group than control group.ConclusionThe study results suggest that transplantation of EPC-exo could significantly improve angiogenesis in a rat hindlimb ischemia model, which may be a potential therapeutic strategy for LLI.

Objective: The objective of this study was to evaluate the efficacy and safety of radiofrequency-induced thermotherapy (RFiTT) combined with transilluminated powered phlebectomy (TIPP) in the treatment of lower limb varicose veins (VVs) in comparison with high ligation and stripping (HLS) combined with TIPP. Methods: The patients with lower limb Ws were randomly assigned to RFiTT combined with TIPP or HLS combined with TIPP. The primary end point was total closure rate of the great saphenous vein at 12 months. Secondary end points included Venous Clinical Severity Score and 14-item Chronic Venous Insufficiency Questionnaire score changes at 12 months and perioperative complications. Results: The total closure rate of the great saphenous vein at 12 months was slightly lower in the RFiTTg roup (90.9% [90/99]) than in the HLS group (97.0% [98/101]) but not statistically significant (chi(2) = 0.068; P= .08). Operation time, intraoperative blood loss, duration in hospital, duration in bed, and resumption of activities were statistically significantly better with RFiTT than with H LS. There were no significant differences between the groups in deep venous thrombosis, phlebitis, hematomas, pain, and infection. However, skin pigmentation and paresthesia were statistically significantly better with RFiTT than with H LS. At 12 months, both groups showed similar improvement from baseline in Venous Clinical Severity Score (1.28 +/- 0.57 in the RFiTT group vs 1.33 +/- 0.61 in the H LS group) and 14-item Chronic Venous I nsufficiencyQuestionnaire score (67.32 +/- 1.29 in the RFiTT group vs 67.45 +/- 1.32 in the HLS group); however, neither group was superior to the other. Conclusions: RFiTT combined with TIPP is an effective treatment method for lower limb VVs and had a more satisfactory clinical outcome in surgical data, skin pigmentation, and paresthesia than HLS at the 12-month follow-up.

Background: The optimal treatment method for femoropopliteal (FP) artery in-stent restenosis (ISR) remains controversial. We assess the efficacy and safety of combination of Rotarex thrombectomy and drug-coated balloon (DCB) for the treatment of FP ISR. Methods: From June 2016 to July 2017, 32 patients with FP ISR who underwent combination of Rotarex thrombectomy and DCB angioplasty were included in a prospective registry. The primary end point was primary patency of the target lesion defined as a peak systolic velocity ratio <2.4 documented by duplex ultrasound at 12 months without clinically driven target lesion revascularization (CD-TLR). The secondary outcome measure was the rate of major adverse limb events. The primary functional end point was assessed using the Walking Impairment Questionnaire (WIQ). Results: Twenty-nine (90.6%) patients completed 12-month follow-up. Mean ankle-brachial index was 0.45 +/- 0.14 at baseline and 0.84 +/- 0.12 at 12 months (P < 0.05). The WIQ score was 30.45 +/- 21.14 at baseline and 52.68 +/- 29.75 at 12 months (P < 0.05). The Kaplan-Meier estimate of the primary patency rate at 12 months was 86.2% (25/29), and freedom from CD-TLR rate at 12 months was 89.7% (26/29). Conclusions: The data suggest that combination of Rotarex thrombectomy and DCB for treatment of FP ISR is safe and effective with satisfying primary patency rate and freedom from CD-TLR rate at 12-month follow-up.

As the preferred method for treatment of type B dissection, thoracic endovascular aortic repair (TEVAR) has been recognized by clinicians for its efficacy compared with open surgery. However, some serious complications still occur after TEVAR, such as progression of anterograde tear of the dissection, formation of new intimal rupture, rupture of the dissection aneurysm, and retrograde type A dissection (RTAD). Although the incidence rate of these complications is not high, the consequence is serious and should cause the clinician's attention. A retrospective analysis was performed of 53 patients with type B aortic dissection treated with TEVAR from January 2009 to December 2018. Complications occurred in six cases after TEVAR, with an incidence of 11.3%. RTAD occurred in two cases, and one patient died 2 hours after TEVAR. Another one was found by computed tomography angiography re-examination 2 weeks after TEVAR, and this patient's condition was stable after conservative treatment, such as blood pressure control. Two patients suffered from ruptured dissecting aneurysm of the descending arch, and one died within 1 hour after TEVAR; this patient was diagnosed with Marfan syndrome preoperatively. In the other patient, ruptured dissecting aneurysm occurred 5 hours after TEVAR; the patient survived with first-aid measures, including 1200-mL blood transfusion, and finally recovered by thoracic closed drainage and thoracoscopic hematoma removal. Two patients presented with progressive anterograde intimal tearing, and their condition was stable after conservative treatment. Some factors of postoperative complications of TEVAR are related to the patient's condition, such as Marfan syndrome. Uncontrolled severe hypertension was significantly associated with continued progress of the dissection or rupture of the dissected aneurysm. The occurrence of RTAD is related to the anchorage area near the proximal portion of the stent. The progression of anterograde intimal tear is related to the lesion of the endarterium at the distal end of the stent, such as significant narrowing of the true lumen. Materials and design of the stent also have an impact on the occurrence of complications after TEVAR. In addition, it is important to avoid iatrogenic injury during the endovascular procedure.

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Background: To assess the efficacy and safety of Orchid drug-coated balloon (DCB) for treatment of femoropopliteal (FP) artery in-stent restenosis (ISR) in Chinese patients. Methods: The study is a prospective, single center, single-blinded, randomized controlled trial (RCT) that randomized (1:1) 74 patients to DCB group (N.=38) and PTA group (N.=36). The primary efficacy endpoint was primary patency of the target lesion at 12 months. Second efficacy endpoint included clinically-driven target-lesion revascularization (CD-TLR) and ABI change at 12 months. The primary safety endpoint included peri-operative death at 30 days, all-cause death, major amputation, and other major adverse events (MAEs) at 12 months. The primary functional endpoint included Walking Impairment Questionnaire (WIQ), quality-of-life measures (EQ-5D) and 6-minute walking test (6MWT). Results: The DCB group had higher primary patency (87.9% vs. 51.6%; P=0.001) and lower rates of CD-TLR (6. I% vs. 35.5%; P=0.003) than the PTA group at 12 months. There were no peri-operative deaths, and no major amputations at 12 months in two groups. There were 1(2.6%) in the DCB group and 2 (5.6%) in the PTA group of all-cause deaths (P=0.524). Conclusions: Results from the study showed superior treatment effect with Orchid DCB versus PTA for the treatment of FP ISR, and without an apparent difference in safety.

Objective To investigate clinical features of chronic superior mesenteric artery ( SMA) stenosis or occlu-sion in order to avoid misdiagnosis and mistreatment. Methods Clinical data of 14 misdiagnosed patients with chronic SMA stenosis or occlusion admitted during August 2006 and November 2015 was retrospectively analyzed. Results All the 14 pa-tients visited doctors for different degrees of upper abdomen discomfort or pain, and were ever misdiagnosed as having chronic cholecystitis, upper gastrointestinal ulcer and malignant tumors. SMA stenosis or occlusion was confirmed by abdominal vascu-lar ultrasonography, CT angiography and magnetic resonance angiography (MRA). Interventional or operative therapy and postoperative anti-platelet aggregation treatments were given for all the patients, and the patients were discharged after condi-tions had improved. During 6-35 months of follow-up, all the patients had significant relief of symptoms and signs, and diet gradually returned to normal, But 1 patient died of myocardial infarction 32 months after operation, and the patient had no ab-dominal pain during his survival period. Conclusion Patients with postprandial upper abdomen discomfort and loss of weight, which are inconsistent with signs of abdominal symptoms, the SMA stenosis or occlusion should be taken into account. Related examinations should be performed as quickly as possible in order to avoid or decrease misdiagnosis.

1.病例资料?患者男性，61岁，因“间歇性跛行5年，加重伴下肢凉麻不适1个月”于2014年11月4日入院。既往史：高血压、冠心病、陈旧心梗、2型糖尿病及肺气肿病史。查体：双足皮肤颜色略苍白，皮温偏低，双足末梢充盈时间延长，双股动脉、双腘动脉、双足背及胫后动脉搏动未触及，跛行距离约50 m。下肢动脉CT血管造影（CTA）检查示：腹主动脉末端、双髂总及髂外动脉闭塞，右股浅动脉中段闭塞，左下肢动脉多发轻度狭窄(图1A、1B)。下肢动脉多普勒检查示：踝肱指数（ABI）左0.38，右0.31；腘肱比左0.34，右0.31；股肱比左0.56，右0.46。因患者发病过程中有急性进行性加重，且下肢动脉C TA见腹主动脉末端和双髂动脉均广泛闭塞，CT断层扫描见闭塞段有低密度影，考虑动脉硬化闭塞基础上伴血栓形成的可能性大，于是行动脉造影准备溶栓介入治疗。局麻下左肱动脉逆行穿刺置管，长鞘经左锁骨下动脉及降主动脉置于腹主动脉，造影见腹主动脉末端和双髂动脉均广泛闭塞(图2)，符合下肢动脉CTA结果，术中以多功能导管配合导丝试行开通闭塞段动脉未成功，于是在腹主动脉末端置入一根猪尾导管，经该导管持续泵入尿激酶约50万U/24 h。术后第2天，右足皮肤恢复温暖，右股动脉搏动可明显触及，左下肢皮肤温度及颜色也较术前改善。术后第4天造影见：腹主动脉末端、双髂总及右髂外动脉闭塞段血栓大部分溶解(图3)，左髂外动脉闭塞，右髂总及髂外动脉残余狭窄。以导丝导管配合通过了左髂外动脉闭塞段后植入2枚自膨式支架(8 mm×100 mm及8 mm×120 mm)，造影见左髂动脉血流通畅，无狭窄(图4A)；右髂动脉残余狭窄处植入2枚自膨式支架(8 mm×40 mm及8 mm×120 mm)，造影见右髂动脉血流通畅，无狭窄(图4B)。双下肢皮肤温度及颜色正常，双股动脉搏动（+++），左侧足背动脉搏动（++）。患者下肢凉麻不适症状完全消失，左下肢间歇性跛行症状消失，右下肢跛行距离延长至约500 m。复查下肢动脉多普勒超声见：ABI左0.92，右0.68。术后给予阿斯匹林100 mg/次+氯吡格雷75 mg/次，均1次/d，进行抗血小板聚集治疗，并控制血压、血糖及降血脂治疗。目前已门诊随访12个月，期间复查彩超见髂动脉支架通畅，下肢血循环良好，无明显不适。