Objective: The efficacy and clinical outcomes of emergent rituximab-based desensitization therapy in ABO-incompatible liver transplantation (ABO-I LT) remain poorly characterized. In this study, we analyzed a single-center cohort of emergency ABO-I LT recipients to delineate key clinical features and identify independent predictors of post-transplant survival. Methods: Between January 1, 2015, and August 31, 2021, 1015 (90.2%) recipients received ABO-compatible (ABO-C) deceased donor liver transplantation (DDLT), and 110 (9.8%) received ABO-I DDLT with emergent rituximab-based desensitization. Results: The ABO-C and ABO-I DDLT groups were followed up for 49.6 and 43.6 months, respectively. Following 1:1 propensity score matching (n=110 per group), the ABO-I group exhibited lower survival rates compared to the ABO-C group at 1, 3, and 5 years (74.0%, 68.5%, and 65.5% vs 88.0%, 83.0%, and 80.7%; P = 0.024). Multivariate analysis identified age > 65 years, liver cancer pre-transplantation, intraoperative blood loss > 1000 mL, and diffuse intrahepatic biliary stricture (DIHBS) as independent risk factors for patient survival. Crucially, after excluding DIHBS, survival outcomes between the two groups were comparable (P = 0.336). Conclusion: Emergent ABO-I LT with an adjusted desensitization protocol is feasible but associated with inferior survival due to a higher incidence of DIHBS. This disparity underscores the need for refined strategies to mitigate DIHBS and improve ABO-I LT outcomes.

Background: While elevated thyroid-stimulating hormone (TSH) is a known risk factor for differentiated thyroid cancer (DTC), it remains unclear whether autoimmune thyroiditis (AT) modifies this association. Clarifying this interaction is critical for personalized risk assessment and TSH suppression therapy. Methods: This study performed a retrospective analysis including 2425 participants who underwent thyroidectomy for thyroid nodules. Participants were categorized based on histological AT diagnosis and thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels. Multivariable logistic regression models were used to assess the association between thyroid parameters and DTC risk, stratified by AT and autoantibody status. Results: The prevalence of histological diagnosed AT, TgAb-positivity, and TPOAb-positivity among DTC patients was 31.58%, 13.68%, and 18.76%, respectively. An increase in one standard deviation in TSH, thyrotrophic thyroxine resistance index (TT4RI), and TSH index (TSHI) was associated with an elevated risk of DTC in euthyroid individuals without AT or positive thyroid autoantibodies. A positive and nonlinear association between TSH and DTC risk in euthyroid patients without AT was identified, with inflection points at TSH levels of 1.32 mIU/L. In subgroups characterized by concurrent AT, TgAb-positivity, or TPOAb-positivity, these thyroid parameters showed no statistically significant correlation with DTC risk. Conclusions: The association between TSH and DTC risk varies according to autoimmune thyroiditis status. These findings highlight the importance of considering thyroid autoimmunity in thyroid cancer risk assessment and warrant prospective evaluation to determine its potential implications for TSH suppressive therapy.

The specification of intestinal stem cells (ISCs) during development is critical for maintaining intestinal homeostasis. However, the mechanisms underlying this process remain elusive. Here, by counting and tracing ISC in Drosophila pupal midgut, we show that ISCs are specified within a narrow 12-hour developmental window, with ~150 ISCs emerging from a pool of ~6000 intestinal epithelial cells. Single-cell sequencing revealed the involvement of Notch and Wnt signaling, with genetic experiments demonstrating that ISC specification requires both Notch suppression and Wnt activation. Furthermore, we showed that Wnt signaling is activated in discrete spatial domains, and Notch-mediated lateral inhibition specifies ISCs in these Wnt-active zones, achieving a ratio of ~1/40. Notably, Notch suppression also promoted the specification of Lgr5 + progenitors in the mouse embryonic intestine. Together, our data show that Wnt activation defines niches permissive for ISC fate, whereas Notch suppression licenses fate commitment, a spatiotemporal coordination conserved from insects to mammals.

LncRNA has been implicated in the regulation of diabetes. We identified a novel lncRNA that inhibits phosphorylation of acetyl-CoA carboxylase 1 to modulate the dysfunction of vascular endothelial cells under high glucose conditions. In vitro experiments were performed to investigate the effects of lnc RNA ZRANB2-AS2 on ACC1 phosphorylation, free fatty acid and triglyceride levels, angiogenesis, cell apoptosis, cell proliferation and migration rate. Further, in vivo experiments were designed to examine the effects of lnc RNA ZRANB2-AS2 on the level of ACC1, the limb ischemia and foot movement of mice, as well as on apoptosis, cell proliferation, and migration of vascular endothelial cells under conditions of high glucose.By RNA sequencing, we identified a lncRNA, ZRANB2-AS2, which is highly expressed in human umbilical vein endothelial cells (HUVECs) under high glucose condition. We demonstrated that it could promote apoptosis and inhibit angiogenesis, proliferation and migration of endothelial cells. Using RNA pull-down and RIP assays, the binding specificity of lncRNA ZRANB2-AS2 and acetyl-CoA carboxylase 1(ACC1) was determined. We further established the rescue assay by adding CMS-121, a specific ACC1 inhibitor. These findings suggested that CMS-121 could reverse the inhibition of lncRNA ZRANB2-AS2 on ACC1 phosphorylation, decrease intracellular free fatty acid and triglyceride levels. We conducted in vivo experiments to determine the inhibitory effect of lncRNA ZRANB2-AS2 in diabetic mice model. Lnc ZRANB2-AS2 inhibits cell proliferation, migration and angiogenesis while accelerates apoptosis of endothelial cells by regulating the phosphorylation of acetyl-CoA carboxylase 1 in diabetes.

Hormones within the hypothalamic-pituitary-thyroid (HPT) axis play a central role in acclimatization, dynamically responding to nutritional, thermal, and photoperiodic cues to coordinate metabolic, thermoregulatory, and reproductive functions. Abundant food elevates thyroid hormone (TH), driving energy storage and foraging behaviors, while scarcity reduces TH levels, inducing energy-saving states like hypometabolism or hibernation, in which TH-leptin crosstalk is important. Cold exposure upregulates TH to enhance mitochondrial thermogenesis, with TH acting as a pivotal mediator in the coordination between the hypothalamic thermoregulatory center and peripheral organs. The photoperiodic response converges evolutionarily on the TSH-DIO2-T3 axis, modulating seasonal GnRH release for seasonal reproductive activity. Humans display an annual rhythm of HPT-axis hormones, characterized by winter TSH elevation with TH variability, which affects thyroid dysfunction diagnosis and necessitates seasonally adjusted therapies. Extreme natural environmental stressors and modern environmental changes can profoundly disrupt this acclimatization to decompensate into a pathophysiological state. Meanwhile, thyroid diseases like hypo- and hyperthyroidism show seasonal patterns of disease onset and exacerbation, indicating that the environment impacts disease progression. Thus, cross-species analysis of seasonal dynamics of TH signaling can enhance our understanding of environmental impacts on thyroid function and inform therapeutic strategies aligned with endogenous annual rhythms to optimize the management of thyroid disorders.

OBJECTIVE:This study evaluated two year clinical outcomes of endovascular treatment for femoropopliteal artery disease with moderate to severe calcification in a Chinese cohort and identified predictors of prognosis. METHODS:This was a prospective, observational, multicentre cohort study of patients with moderate to severe calcified femoropopliteal peripheral artery disease prospectively enrolled in the Evolusion study from December 2020 to October 2023 (ClinicalTrials.gov ID: NCT04716361). Outcomes included clinically driven target limb revascularisation (CD-TLR), major adverse limb events (MALEs), major adverse cardiovascular events (MACEs), all cause mortality (ACM), Rutherford classification, and Vascular Quality of Life (VascuQoL) scores. RESULTS:A total of 944 patients (mean age 74.7 years; 67.7% male) were enrolled, with 51.9% diagnosed with chronic limb threatening ischaemia (CLTI) and a 2 year follow up rate of 80.9%. Cumulative CD-TLR rates at 1, 3, 6, 12, 18, and 24 months were 0.54%, 1.30%, 2.54%, 5.03%, 7.43%, and 9.27%, respectively. MALE rates were 0.97%, 1.84%, 3.08%, 6.27%, 9.39%, and 11.41%, and MACE rates were 0.76%, 1.63%, 3.23%, 4.58%, 7.51%, and 8.24%, respectively. Freedom from ACM was 98.60%, 97.39%, 95.06%, 90.09%, 84.35%, and 82.29%. Statistically significant improvements in Rutherford classification and VascuQoL scores were observed throughout follow up (p < .001). Previous target limb intervention (hazard ratio [HR] 3.81; p = .022) and severe calcification (HR 1.58; p = .029) independently predicted MALEs, whereas chronic kidney disease (HR 2.73; p < .001) and CLTI (HR 2.72; p < .001) were associated with a higher ACM. Post-operative lipid lowering therapy (HR 0.58; p = .003) was a potential independent protective factor against ACM events. CONCLUSION:This study reported two year outcomes of endovascular treatment for moderately to severely calcified femoropopliteal artery disease in a Chinese population and identified potential independent risk and protective factors to aid risk stratification and therapeutic decision making.

Purpose:Osteoporotic vertebral compression fractures (OVCFs) pose significant challenges in healthcare, and percutaneous kyphoplasty (PKP) has emerged as a key treatment option. This study aimed to identify and analyze research trends on PKP and OVCFs through a comprehensive bibliometric analysis. Patients and Methods:A literature search on PKP and OVCFs was conducted using the Web of Science Core Collection, finalized on March 21, 2025. The analysis employed bibliometric tools including VOSviewer, CiteSpace, and the R package "bibliometrix". Results:A total of 381 articles published from 2002 to 2025 were included in this study. These publications were authored by 1739 researchers affiliated with 486 institutions across 28 countries. The journals Spine and European Spine Journal were prominent in terms of citations. China emerged as the leading contributor, ranking first in both total publications (265) and citations (3599). Soochow University was identified as the most productive institution. Yang HL was the most influential author, ranking first in total publications (22) and accumulating the highest total citation count of 483. The keyword "bone cement" was a frequently occurring term. The keywords "bone cement distribution" (2022-2025) and "volume" (2023-2025) were observed to undergo significant bursts of activity. Conclusion:This bibliometric study highlighted the growing global interest in PKP and OVCFs research, with China as a leading contributor. The research focus has evolved to emphasize procedural safety, material optimization, and patient-centered outcomes. These findings provide valuable insights for guiding future research and informing evidence-based treatment strategies.

OBJECTIVE:This meta-analysis synthesizes preclinical evidence on the safety and efficacy of genetically modified pigs to nonhuman primates (NHPs) liver xenotransplantation. BACKGROUND:The outcomes of liver xenotransplantation from genetically modified pig-to-NHP remain suboptimal. METHODS:A systematic search of Embase, PubMed, and Scopus was conducted to identify and select relevant experimental studies. Data on survival rates and complications were extracted. Data on survival and complications were pooled using a random-effects model to generate summary effect sizes (ES) and 95% confidence intervals (CI). RESULTS:Eleven studies involving 59 pig-to-NHPs liver xenotransplantations were included. The pooled median survival time was 5 days [interquartile ranges (IQR): 1-9 days]. The 1-day, 3-day, 7-day, and 14-day pooled survival rates were 88.6% (95% CI: 0.682-0.999), 78.8% (95% CI: 0.526-0.976), 29.2% (95% CI: 0.133-0.473), and 4.2% (95% CI: 0.000-0.141), respectively. Coagulopathy was the leading cause of death (32.2%). The pooled incidence of acute rejection, coagulopathy, surgery-related complications, and infection-related complications was 0.034 (95% CI: 0.000-0.131), 0.522 (95% CI: 0.308-0.733), 0.134 (95% CI: 0.037-0.261), and 0.282 (95% CI: 0.111-0.482), respectively. Subgroup analysis revealed trends towards improved early survival with heterotopic transplantation over orthotopic, and immunosuppressive regimens including co-stimulation blockade were associated with significantly higher survival rates at day 7 ( P = 0.013) and day 14 ( P = 0.042) compared to blocker-free regimens. CONCLUSIONS:The results indicate that pig-to-NHP liver xenotransplantation has limited short-term survival, with coagulopathy being a major challenge. Further research is needed to optimize this procedure and facilitate its clinical translation.

Circular RNAs (circRNAs) are non-coding RNAs with covalently closed loop structures that participate in various biological processes. However, the functions of many circRNAs remain unclear. Endothelial cell dysfunction, which involves abnormal ferroptosis, a unique form of regulated cell death, is a characteristic of various diseases. However, the mechanisms governing ferroptosis in endothelial cells are not fully understood. Here, we investigated the impact of a novel circRNA, circ-DAPK1, on ferroptosis in human umbilical vein endothelial cells (HUVECs) under high-glucose conditions. Our data showed that high-glucose conditions upregulate circ-DAPK1 expression in HUVECs. Overexpression of circ-DAPK1 induced ferroptosis in HUVECs, whereas depletion of circ-DAPK1 mitigated the ferroptosis triggered by high-glucose treatment. Inhibition of ferroptosis reversed the decrease in cell viability induced by high glucose or circ-DAPK1 overexpression. Using RNA immunoprecipitation analyses, we identified several ferroptosis-regulating proteins, including NAD(P)H dehydrogenase [quinone] 1 (NQO1) and insulin-like growth factor 2 mRNA binding protein 2 (IGF2BP2). Mechanistically, circ-DAPK1 interacts with NQO1, enhancing its ubiquitination and accelerating its degradation. NQO1 overexpression partially rescues HUVECs from high-glucose-induced ferroptosis. We also found that IGF2BP2 binds to the m6A site on circ-DAPK1. Depletion of IGF2BP2 in HUVECs reduced circ-DAPK1 expression and inhibited high-glucose-induced ferroptosis. These findings reveal the effects of the IGF2BP2-circ-DAPK1 axis in regulating ferroptosis in HUVECs under high-glucose conditions and extend our understanding of the mechanisms controlling ferroptosis in endothelial cells.

Peri-operative respiratory virus (RV) infection is critical in paediatric liver transplantation. However, it has been inadequately studied, especially in terms of the clinical latency of infection (incubation period) and Omicron variant infection. Herein, we compared the infection profile of common RVs and Omicron variants in paediatric liver transplantation, aiming to identify the association of virus infection with outcomes. The Omicron cohort was designed prospectively, and the RV cohort was retrospective. Survival outcomes, medical resources, and major complications were compared. Risk factors associated with peri-operative mortality were investigated using regression analysis. We enrolled 649 paediatric liver transplantation patients, including 28 Omicron and 61 RV infections. The 1-y overall survival was 97.7 ± 0.6% for the non-infected group, and 93.4 ± 3.2% for the RV group (p = 0.092). No death occurred in the Omicron group. Mortality was higher in the clinical latency infection group compared with that in the non-infected group (13.8% vs. 1.4%, p = 0.002). Latent RV infection (hazard ratio (HR) = 6.323, 95% confidence interval (CI): 1.374-29.087), Multi‑drug resistance organism pneumonia (HR = 7.177, 95% CI: 1.817-28.350), infectious shock (HR = 4.284, 95% CI: 0.995-18.442) and blood loss (HR = 3.209, 95% CI: 1.166-8.833) were independent risk factors for peri-operative mortality. In conclusion, pre-transplant viral screening is fundamental to paediatric liver transplantation. Peri-operative Omicron infection might be controllable, while RV infection led to more complications compared with those in the non-infected group. Clinical latency infection is the key risk for paediatric liver transplantation mortality.

The molecular mechanisms underlying the neurodevelopmental disorders (NDDs) caused by DDX3X variants remain poorly understood. In this study, we validated that de novo DDX3X variants are enriched in female developmental delay (DD) patients and mainly affect the evolutionarily conserved amino acids based on a meta-analysis of 46,612 NDD trios. We generated a ddx3x deficient zebrafish allele, which exhibited reduced survival rate, DD, microcephaly, adaptation defects, anxiolytic behaviors, social interaction deficits, and impaired spatial recognitive memory. As revealed by single-nucleus RNA sequencing and biological validations, ddx3x deficiency leads to reduced neural stem cell pool, decreased total neuron number, and imbalanced differentiation of excitatory and inhibitory neurons, which are responsible for the behavioral defects. Indeed, the supplementation of L-glutamate or glutamate receptor agonist ly404039 could partly rescue the adaptation and social deficits. Mechanistically, we reveal that the ddx3x deficiency attenuates the stability of the crebbp mRNA, which in turn causes downregulation of Notch signaling and defects in neurogenesis. Our study sheds light on the molecular pathology underlying the abnormal neurodevelopment and behavior of NDD patients with DDX3X mutations, as well as providing potential therapeutic targets for the precision treatment.

Objective:To analyze real-world clinical data and efficacy on endovascular interventions for moderate to severe calcification in femoropopliteal arteriosclerosis obliterans based on the database VASCBASE.Methods:From January 2021 to December 2022, clinical data on patients enrolled in the Evolusion program (NCT04716361) at the Department of Vascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine were collected. All patients, baseline condition gathered, were followed through May 1, 2023. Observations included the rate of technical success, the freedom from clinically driven target lesion revascularization(CD-TLR), the patency rate of target lesion, and the improvement in quality of life.Results:A total of 281 patients were enrolled, with 194 (69%) being male and the age being (73.8±10.7) years. Among them, 216 cases were diagnosed with total occlusion. Of all participants, 6 cases were classified as Rutherford category 2; 148 cases were classified as category 3; 51 cases, category 4; 73 cases, category 5; and 3 cases, category 6. The ankle-brachial index (ABI) was 0.32 (0.07,0.52) with an average lesion length of (17.5±8.1) cm. Vascular-targeted therapy was applied for the treatment of mere superficial femoral artery (140 cases; 49.8%), popliteal artery together with superficial femoral artery (118 cases, 42.0%), and other arteries (23 cases, 8.2%). Full stent coverage, drug-coated balloon (DCB)dilation, and local stent implantation following DCB pre-dilation or conventional balloon dilation were the most frequently used surgical techniques, accounting for 37.4%(105/281), 29.5%(83/281), 9.6%(27/281), and 8.2%(23/281) of cases, respectively. The rate of technical success was 100% with one postoperative complication (hematoma at the puncture site). Following surgery, the patients were followed up via mobile phone and outpatient services. The follow-up rate via mobile phone was 89.0%, 89.0%, 87.9%, and 78.3% at 1, 3, 6, and 12 months, respectively. The follow-up rate via outpationt service was 87.5%, 81.8%,66.9% and 30.9% at 1,3,6 and 12 months,respectively.At 1, 3, 6, and 12 months, the Vasc-QOL score was 5.56±1.18, 5.89±0.8, 6.09±0.82 and 6.19±0.93, respectively and the EQ-5D-5L score was 20 (18, 20), 20 (19, 20), 20 (20, 20) and 20 (20, 20), respectively, the difference was statistically significant ( F=13.91, P=0.001; H=0.005, P=0.001). At 1, 3, 6, and 12 months, 96.4% (241/250), 92.8% (232/250), 91.9% (227/247), and 89.1% (196/220), respectively, of patients were exempted from CD-TLR. Meanwhile, the primary patency rates were 87.8% (216/246), 73.9% (170/230), 61.7% (116/188), and 44.8% (39/87), respectively. Conclusions:Moderate to severe calcification of the femoropopliteal occlusive sclerosis primarily affects elderly men; risk factors include diabetes, hypertension, obesity, and smoking. Interventional procedures for the lower limbs have a high rate of efficacy and few complications. At one year, the rate of freedom from CD-TLR was greater, whereas the rate of primary patency was lower.

For comprehensive studies of the brain structure and function, fluorescence imaging of the whole brain is essential. It requires large-scale volumetric imaging in cellular or molecular resolution, which could be quite challenging. Recent advances in tissue clearing technology (e.g. CLARITY, PACT) provide new solutions by homogenizing the refractive index of the samples to create transparency. However, it has been difficult to acquire high quality results through immunofluorescence (IF) staining on the cleared samples. To address this issue, we developed TSA-PACT, a method combining tyramide signal amplification (TSA) and PACT, to transform samples into hydrogel polymerization frameworks with covalent fluorescent biomarkers assembled. We show that TSA-PACT is able to reduce the opacity of the zebrafish brain by more than 90% with well-preserved structure. Compared to traditional method, TSA-PACT achieves approximately tenfold signal amplification and twofold improvement in signal-to-noise ratio (SNR). Moreover, both the structure and the fluorescent signal persist for at least 16 months with excellent signal retention ratio. Overall, this method improves immunofluorescence signal sensitivity, specificity and stability in the whole brain of juvenile and adult zebrafish, which is applicable for fine structural analysis, neural circuit mapping and three-dimensional cell counting.

Higher concentrations of ambient air pollutants are associated with increased outpatient visits for psoriasis in Wuhan, China. Among the well-known air pollutants (PM2 center dot 5, PM10, NO2, SO2, CO and O-3), NO2 had a notable significant and stable effect on these increased visits. Background Psoriasis can be provoked by both external and internal factors. The effects of environmental factors on psoriasis remain unclear. Objectives To investigate the effects of air pollution on outpatient visits for psoriasis. Methods A distributed lag nonlinear model following quasi-Poisson regression was used to evaluate the lag effects of air pollutants on psoriasis outpatient visits, adjusting for potential confounders. Stratified analyses were performed to identify potential effect modifications by sex, age and season. Results In total, 13 536 outpatient visits for psoriasis were recorded in Wuhan, China from 1 January 2015 to 31 December 2019. In the single-pollutant model, exposures to particulate matter (PM) smaller than 2.5 mu m (PM2.5), PM smaller than 10 mu m (PM10), NO2 and SO2 were found to be significantly associated with increased daily psoriasis outpatient visits. For the largest effects, a 10-mu g m(-3) increase in concentrations of PM2.5 (lag1), PM10 (lag1), NO2 (lag0) and SO2 (lag3) corresponded to 0.32% [95% confidence interval (CI) 0.01-0.63], 0.26% (95% CI 0.05-0.48), 0.98% (95% CI 0.01-1.96) and 2.73% (95% CI 1.01-4.47) increases in psoriasis outpatient visits, respectively. In the two-pollutant model, only NO2 showed significant and stable effects on the outpatient visits for psoriasis. Conclusions Ambient air pollution, especially NO2, appears to be significantly associated with an increased risk of outpatient visits for psoriasis in Wuhan, China. Air pollution control and exposure prevention could be effective measures to relieve the symptoms of psoriasis among these patients.

We analyzed the characteristics, risk factors, outcomes, and post-coronavirus disease 2019 (COVID-19) symptoms in liver transplant recipients in China's late 2022 COVID-19 wave. Recipients with COVID-19 were enrolled from December 1, 2022, to January 31, 2023, and followed up until May 31, 2023. Baseline and characteristic data were collected. A total of 930 recipients were included, with a vaccination rate (non-mRNA) of 40.0%. Among 726 (78.1%) recipients with COVID-19, 641 (88.3%) patients were treated at home, 81 (11.2%) patients required hospitalization in general wards, 4 (0.6%) patients required intensive care, and 1 (0.1%) patient died because of COVID-19. Severe acute respiratory syndrome coronavirus 2 infection was related to close contact with confirmed cases (P < .001) and the condition of end-stage kidney disease (P < .046). Older age, male sex, less vaccination, and hypertension were independent risk factors for hospitalization. Fatigue (36.9%) was the most common symptom post-COVID-19, followed by memory loss (35.7%) and sleep disturbance (23.9%). Two doses of vaccines had a protective effect against these post-COVID-19 symptoms (P < .05). During this Omicron outbreak, liver transplant recipients were susceptible to COVID-19, with frequent hospitalization but low mortality. Two doses of non-mRNA COVID-19 vaccines could protect against liver transplant recipient hospitalization and post-COVID-19 symptoms.

Since the identification of the first case of pneumonia of unknown cause in 2019, the COVID-19 pandemic has spread the globe for over 3 years. As the most populous country in the world, China's disease prevention policies and response plans concern the health of the country's 1.4 billion people and beyond. During the course of the pandemic, scientific research has been accumulated and given evidence-based support to the official guidance of COVID-19 management. The National Health Commission of China have compiled, published, and updated a total of 10 versions of the "Diagnosis and Treatment Protocol for COVID-19 Patients" to better inform clinical practitioners and staff to effectively screen, diagnose, manage, treat, and care for cases of severe acute respiratory syndrome coronavirus 2 infection. This paper compares and summarizes each version of the protocol in terms of etiology and epidemiology, clinical manifestation and diagnosis, treatment and nursing, disease control and management, presenting detailed changes, additions, deletions, and refinement of the protocols.

OBJECTIVE:Both bypass surgery and endovascular treatment are well-recognized interventions for the treatment of peripheral artery disease; however, the effect of failed endovascular treatment on subsequent surgeries remains controversial. A systematic review was conducted to compare the outcomes of primary bypass and bypass surgery after endovascular treatment. METHODS:Three academic databases (Embase, PubMed, and Scopus) were searched from their inception to August 2022. Two independent investigators searched for studies that reported the outcomes of primary bypass surgery and bypass surgery after endovascular treatment in patients with peripheral artery disease. Abstracts and full-text studies were screened independently using duplicate data abstraction. Dichotomous outcome measures were reported using a random-effects model to generate a summary odds ratio (OR) and 95% confidence interval (CI). The risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS:Seventeen retrospective observational studies were selected from 3911 articles and included 8064 patients, 6252 of whom underwent primary bypass surgery and 1812 underwent bypass surgery after endovascular treatment. The mean age was 69.0 years and 61.2% (n = 4938) were male. For perioperative outcomes, the 30-day results showed no difference in mortality (OR, 0.76; 95% CI, 0.53-1.10), or amputation (OR, 0.89; 95% CI, 0.67-1.20). For short- to mid-term outcomes, primary patency did not differ at 6 months (OR, 0.98; 95% CI, 0.81-1.19), 1 year (OR, 1.12; 95% CI, 0.97-1.30), or 2 years (OR, 1.17; 95% CI, 0.85-1.61) follow-up. Amputation-free survival did not differ at 6 months (OR, 1.03; 95% CI, 0.82-1.30), 1 year (OR, 1.09; 95% CI, 0.89-1.32), 2 years (OR, 1.18; 95% CI, 0.93-1.50), or 3 years (OR, 1.09; 95% CI, 0.84-1.40) of follow-up. No significant difference was found in overall survival or second patency. CONCLUSIONS:This meta-analysis of retrospective, nonrandomized, observational studies suggests that prior endovascular treatment of lower extremity arterial disease does not result in worse perioperative, short-term, or mid-term clinical outcomes of subsequent infrainguinal bypass surgery compared with patients without prior endovascular treatment.

BackgroundAbdominal penetrating aortic ulcer (aPAU) is defined as an ulceration of the aortic intima and media lamina, even with rupture of the internal elastic lamina. Recently, there have been an increasing number of publications on endovascular treatment for aPAU. This review aimed to assess the efficacy and safety of endovascular treatment and provide clinicians with the latest evidence-based medical data.Methods3 academic databases (Embase, PubMed, and Scopus) were systematically searched for literature reporting on aPAU from 1986 (the earliest appearance of the concept of aPAU) to September 1, 2021, and related data were collected and evaluated. A fixed/random effects model was used to construct the forest plots. Funnel plots and linear regression tests were used to assess the publication bias.Results6 articles including 121 patients were included in the analysis. The average age was 71.4 years, with 72.7% of males and 85.6% with hypertension. Saccular aneurysms (SA) were the most prevalent complication (35.5%). Endovascular treatment had a perioperative mortality rate of .24% (95% CI, .00-2.70). The technical success rate was 99.15% (95% CI, 96.49-100). The type-II endoleak rate was 5.69% (95% CI, .00-12.13). The 1-year survival rate was 95.69% (95% CI, 90.49-100). The revascularization rate was 7.20% (95% CI, .07-14.32). Endovascular treatments for aPAU would lead to a high rate of technical success, few complications, and satisfactory 1-year survival.ConclusionsaPAU are a common disease that mainly affects elderly males with hypertension and hyperlipidemia. Endovascular treatment is required when an ulcer progresses rapidly or manifests symptoms. Endovascular treatment is associated with high technical success, low complication, and satisfactory 1-year survival. Further investigation into the long-term results of endovascular treatment is necessary.