Objectives To assess the safety and efficacy of the combination of brachial artery (BA) cutdown with purse-string suture (PSS) for BA preclosure during fenestrated thoracic endovascular aortic repair (f-TEVAR).Methods We reviewed the consecutive data in our center from January 2022 to May 2023. Clinical data were analyzed retrospectively, including the baseline characteristics, procedural details, complications, and outcomes. Dichotomous data were summarized as absolute values and percentages. Continuous variables were presented as median values and interquartile ranges (IQRs). All patients underwent arterial cutdown with the PSS technique for BA preclosure. The technique was considered successful when complete hemostasis was achieved and confirmed by ultrasonography 24 h postoperatively. The patients were followed up 30 days postoperatively for access-related complications.Results Forty-eight patients who underwent f-TEVAR with 48 BA access sites were included [36 males and 12 females; median age: 62 (IQR: 30-78) years]. The median body mass index was 27.3 (IQR: 21.2-32.7) kg/m2. The median access establishing and closing times were 7.8 (IQR: 6-9.3) min and 3.7 (IQR: 2.5-5) min, respectively. The median operative time and length of stay were 75 (IQR: 63-87) min and 7 (IQR: 5-9) days, respectively. Although the success rate was 100%, partial numbness in the median nerve distribution was noted in 1 patient in the forearm. This resolved spontaneously and no permanent neurological problem was seen. No other access-related complications were noted, and the total complication rate was 2.1% (1/48).Conclusions BA preclosure with the PSS technique is safe and effective for left subclavian artery revascularization in Stanford B aortic dissection and can be another option for access closure during f-TEVAR.

Endothelial progenitor cells (EPCs) contribute to recanalization of deep vein thrombosis (DVT). MicroRNAs (miRNAs) play regulatory roles in functions of EPCs, which is becoming a promising therapeutic choice for thrombus resolution. The main purpose of this study was to explore the effect of miR-125a-5p on EPC functions in deep vein thrombosis (DVT). EPCs were isolated from the peripheral blood of patients with DVT. In DVT mouse models, DVT was induced by stenosis of the inferior vena cava (IVC). The levels of miR-125a-5p and myeloid cell leukemia sequence 1 (MCL-1) in EPCs and thrombi of DVT mice were detected by RT-qPCR. EPC migration, angiogenesis, and apoptosis were estimated by Transwell assay, tube formation assay, and flow cytometry analysis. Luciferase reporter assay was utilized for detecting the binding of miR-125a-5p and MCL-1. The phosphorylation of PI3K and AKT was estimated by western blot. DVT formation in vivo was observed through hematoxylin–eosin (H E) staining. The expression of thrombus resolution marker, CD34 molecule (CD34), in the thrombi was measured by immunofluorescence staining. MiR-125a-5p upregulation repressed EPC migration and angiogenesis and facilitated apoptosis. MiR-125a-5p downregulation showed the opposite effect. MCL-1 was targeted and negatively regulated by miR-125a-5p. Additionally, miR-125a-5p inhibited the PI3K/AKT pathway in EPCs. Inhibition of MCL-1 or PI3K/AKT pathway reversed the effect of miR-125a-5p knockdown on EPC functions. The in vivo experiments revealed that miR-125a-5p downregulation repressed thrombus formation and promoted the homing capability of EPCs to the thrombosis site, thereby alleviating DVT mice. Downregulation of miR-125a-5p promotes EPC migration and angiogenesis by upregulating MCL-1, thereby enhancing EPC homing to thrombi and facilitating thrombus resolution.

Objective:To evaluate the efficacy and safety of percutaneous multi-metal stent insertion in the treatment of hilar cholangiocarcinoma with Bismuth-Corlette typeⅡor above, and analyze the stent patency and overall survival.Methods:During the period from January 2019 to September 2021, the clinical data of patients with Bismuth Ⅱ or above hilar cholangiocarcinoma who treated with multi-metal stent insertion in Department of Vascular Surgery, Suzhou Municipal Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. The technical success, clinical success, complications, stent patency, and overall survival were evaluated.Results:108 patients were enrolled, aged from 38 to 92, and the average was (66.8 ± 10.6) years old. Technical success was 100%, and successful drainage was achieved in 91 of 108(84.3%) patients. After the procedure, the total bilirubin level decreased from (266.23 ± 108.87) μmol/L to (153.08 ± 98.63) μmol/L. Besides, the level of direct bilirubin, alanine transferase, aspartate aminotransferase and alkaline phosphatase were significantly decreased (P < 0.01), however there was no significant change in albumin level (P = 0.252). Incidence of complications was 12.0%, and no major complications occurred. The median stent patency was 122 days (range, 17~833 days), and the median survival time was 151 days (range, 17~915 days).Conclusions:Percutaneous multi-metal stent insertion may offer a safe and effective way for patients with BismuthⅡor above hilar cholangiocarcinoma to solve jaundice and recover liver function in a certion extent.

Objective To investigate the efficacy of AngioJet mechanical thrombus aspiration combined with catheter-directed thrombolysis（CDT） in the treatment of acute mixed deep venous thrombosis（DVT） of lower limbs.Methods A total of 60 patients with acute mixed lower extremity DVT admitted to Suzhou Municipal Hospital from June 2019 to February 2022 were selected as the research subjects, and the patients were divided into CDT group（n=32） and combined treatment group（n=28） according to the treatment method.The patients in the CDT group were treated with CDT,while the patients in the combined treatment group were treated with AngioJet mechanical thrombus aspiration and CDT.The DVT clearance, thrombolytic effect, complications, serum vascular cell adhesion molecule-1（VCAM-1） and platelet endothelial cell adhesion molecule-1（PECAM-1） levels, and plasma fibrinogen（FIB）,D-dimer（D-D） and hemoglobin（Hb） levels were compared between the two groups.Results The effective thrombus removal rate in the combined treatment group and CDT group was 96.73%（27/28） and 71.88%（23/32）,respectively.The effective thrombus removal rate in the combined treatment group was significantly higher than that in the CDT group（χ~2=4.835,P＜0.05）.There was no statistically significant difference in the circumference difference between the affected and healthy thighs, the circumference difference between the affected and healthy legs, and the venous patency score of patients between the two groups before operation（P＞0.05）.The circumference difference between the affected and healthy thighs, the circumference difference between the affected and healthy legs, and the venous patency score of patients after operation were significantly lower than those before operation in both groups（P＜0.05）.The circumference difference between the affected and healthy thighs, the circumference difference between the affected and healthy legs, and the venous patency score of patients in the combined treatment group were significantly lower than those in the CDT group after operation（P＜0.05）.The venous patency rate, thigh detumescence rate and leg detumescence rate of patients in the combined treatment group were significantly higher than those in the CDT group after operation（P＜0.05）.Compared with the CDT group, the urokinase dosage in the combined treatment group was significantly reduced, the thrombolysis time and hospitalization time were significantly shortened（P＜0.05）.There was no statistically significant difference in serum VCAM-1 and PECAM-1 levels of patients between the two groups before operation（P＞0.05）.The levels of serum VCAM-1 and PECAM-1 of patients after operation were significantly lower than those before operation in both groups（P＜0.05）.The levels of serum VCAM-1 and PECAM-1 of patients in the combination treatment group were significantly lower than those in the CDT group after operation（P＜0.05）.There was no statistically significant difference in the levels of plasma FIB,D-D and Hb of patients between the two groups before and after operation（P＞0.05）.The levels of plasma FIB,D-D and Hb of patients after operation were significantly lower than those before operation in both groups（P＜0.05）.The incidence of complications in the combined treatment group and the CDT group was 10.71%（3/28） and 9.38%（3/32）,respectively.There was no significant difference in the incidence of complications between the two groups（χ~2=0.067,P＞0.05）.Conclusion The combination of AngioJet mechanical thrombus aspiration and CDT in the treatment of acute mixed lower extremity DVT can significantly improve the effective thrombus clearance rate and thrombolytic effect, reduce the dosage of urokinase and the expression of serum cell adhesion molecules, and does not increase the incidence of complications.

BackgroundIt is well known that patients with systemic lupus erythematosus (SLE) had a high risk of venous thromboembolism (VTE). This study aimed to identify the crosstalk genes between SLE and VTE and explored their clinical value and molecular mechanism initially.MethodsWe downloaded microarray datasets of SLE and VTE from the Gene Expression Omnibus (GEO) dataset. Differential expression analysis was applied to identify the crosstalk genes (CGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed on the shared genes. The shared diagnostic biomarkers of the two diseases were further screened from CGs using least absolute shrinkage and selection operator (Lasso) regression. Two risk scores for SLE and VTE were constructed separately to predict the likelihood of illness according to the diagnostic biomarkers using a logical regression algorithm. The immune infiltration levels of SEL and VTE were estimated via the CIBERSORT algorithm and the relationship of CGs with immune cell infiltration was investigated. Finally, we explored potential phenotype subgroups in SLE and VTE based on the expression level of CGs through the consensus clustering method and studied immune cell infiltration in different subtypes.ResultA total of 171 CGs were obtained by the intersection of differentially expressed genes (DEGs) between SLE and VTE cohorts. The functional enrichment shown these CGs were mainly related to immune pathways. After screening by lasso regression, we found that three hub CGs (RSAD2, HSP90AB1, and FPR2) were the optimal shared diagnostic biomarkers for SLE and VTE. Based on the expression level of RSAD2 and HSP90AB1, two risk prediction models for SLE and VTE were built by multifactor logistic regression and systemically validated in internal and external validation datasets. The immune infiltration results revealed that CGs were highly correlated with multiple infiltrated immunocytes. Consensus clustering was used to respectively regroup SLE and VTE patients into C1 and C2 clusters based on the CGs expression profile. The levels of immune cell infiltration and immune activation were higher in C1 than in C2 subtypes.ConclusionIn our study, we further screen out diagnostic biomarkers from crosstalk genes SLE and VTE and built two risk scores. Our findings reveal a close relationship between CGs and the immune microenvironment of diseases. This provides clues for further exploring the common mechanism and interaction between the two diseases.

目的 探讨血管缝合器配合经皮穿刺技术在老年腹主动脉瘤(AAA)腔内修复术(EVAR)中的安全性与有效性.方法 回顾性分析2016年3月-2021年3月,南京医科大学附属苏州医院血管外科收治并行EVAR的老年AAA患者的临床资料.根据是否使用血管缝合器,将研究对象分为观察组(n=33)和对照组(n=30).其中观察组应用Proglide血管缝合器封堵穿刺口,对照组行双侧股动脉切开并于术后缝合.记录2组的手术时间、入路建立时间、伤口处理时间、术后制动时间和术后住院时间;比较2组的技术成功率和术后并发症发生率.结果 共纳入63例老年AAA患者,年龄71 ～90岁,平均(78.2±4.7)岁.2组的手术成功率和技术成功率均为100％.与对照组比较,观察组手术时间[(62.67±10.61) minvs(93.23±16.90) min]、入路建立时间[(10.18±2.69) min vs (33.70±3.29) min]、伤口处理时间[(6.33±0.72) minvs(27.24±3.34) min]、术后制动时间[(5.13±1.63)hvs(24.27±3.90)h]及术后住院时间[(3.97±1.16) dvs (9.70±2.20)d]减少,差异均有统计学意义(均P＜ 0.001).2组的并发症发生率差异无统计学意义(6.06％vs6.67％,P＞0.05).结论 血管缝合器配合经皮穿刺技术能够一定程度上缩短老年AAA患者的手术时间、入路建立时间、伤口处理时间、术后制动时间和术后住院时间,且术后并发症较少.

Background: Low lymphatic tumor burden is associated with a better prognosis. However, it is uncertain whether those patients diagnosed as cN0 found to be pN+ could be a favorable subgroup in stage III disease. Radical surgery alone might avoid overtreatment in those patients. Methods: Eligible patients diagnosed with colon cancer without metastasis were recruited from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016 using SEER*Stat 8.3.5 software (Surveillance Research Program, National Cancer Institute) and divided into two groups: surgery group (n = 3,081) and surgery followed by adjuvant chemotherapy group (n = 4,591). Overall survival (OS) and cause-specific survival (CSS) differences were assessed by Kaplan-Meier analysis, and survival differences were estimated with log-rank tests. Univariate and multivariate Cox proportional hazard regressions were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) for colon cancer patients. Results: A total of 7,672 pT1-3N1a colon cancer patients were recruited from 208,751 colon cancer patients. The 5-year CSS rates of patients without and with adjuvant chemotherapy were 80.0 and 90.7%, respectively. The receipt of adjuvant chemotherapy after the radical resection of the primary tumor was independently associated with 57.3% decreased risk of colon cancer-specific mortality compared with surgery alone (HR = 0.427, 95% CI = 0.370-0.492, P < 0.001, using surgery alone as the reference). Conclusions: Adjuvant chemotherapy was significantly associated with improved prognosis and radical surgery alone did not provide enough treatment for colon cancer with very low lymphatic tumor burden.