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Clinical Study on the Pathogenesis of Chronic Venous Insufficiency in the Lower Extremities

ObjectiveTo explore the relationship among plasma cytokines’ level, adhesion molecules expression and skin damage in patients with chronic venous insufficiency (CVI) of lower extremities.MethodsIn 32 patients with CVI and 8 normal individuals as control, blood TNFα, IL1β and IL2R were assayed with ELISA method; serum endothelial cellintercellular adhesion molecule1(ECICAM1), polymorphonuclearCD18(PMNCD18) and polymorphonuclearCD11b(PMNCD11b) were assayed with immunohistochemical method; and ultrastructure of diseased veins was examined by electroscope.ResultsThe results showed that the level of plasma TNFα and IL1β increased remarkably in Class 2-3 compared with Class 1 and control (P＜0.05), IL2R had no difference in Class 1,2,3(Pgt;0.05). The index of ECICAM1 and PMNCD11b positively expression increased remarkably in Class 2-3 compared with that in Class 1 and control. The index of PMNCD18 expression in Class 2-3 and Class 1 was greatly higher than that in control (P＜0.05). The expression of ICAM1 was positively correlated with that of CD11b/CD18. Electron microcopy showed that the change in microvessel was mainly PMN adhesion with endothelial cells (ECs) and trapped in microvessels.ConclusionThe results suggest that activated monocyte may release TNFα and IL1β, upregulate ICAM1 and CD11b/CD18 expression, and mediate the PMN adhesion to ECs, thus causing ECs and tissue damage. It may be one of important mechanism of venous ulcer.

THE EFFECT OF CELLS APOPTOSIS WITH VARICOSITY IN THE LOWER EXTREMITIES

Objective To explore the effect of apoptosis and venous remodeling in the varicosity. MethodsBy using TUNEL, Van Gieson collagen staining, venous wall image and transmission electron microscope, 83 patients with varicosity and 10 controls were studied. ResultsApoptosis and apoptosis index of ECs and SMC in cystic dilatations were compared with those of non-cystic dilatations and controls with significant difference(P＜0.01). The collagen content in patients with cystic dilatations and non-cystic dilatations were higher than that of controls (P＜0.05, P＜0.01). The venous wall of cystic dilatations become more thinner(P＜0.01). The regression and correlation analysis showed that collagen contents and SMC apoptosis index had significant effect on venous wall (r=0.9777,P＜0.001 and r=-0.5432, P=0.003) respectively. Electron microscopy confirmed apoptosis of ECs and SMC in varicosity. Conclusion Increased collagen content, increased cell apoptosis and reduced cell component lead to venous remodeling, and it may be one of the mechanism of varicosity.

A STUDY ON HEMODYNAMIC AND MORPHOLOGIC CHANGES OF DERMAL NUTRIENT DISTURBANCE IN VENOUS DISEASE

By using noninvasive venous plethysmography, venography and skin morphology, 44 patients (57 limbs) with chronic venous insufficiency (CVI) in lower extremity were studied , and compared with 12 normal subjects (24 limbs). The results showed that dermal nutrient disturbance caused by deep venous insufficiency accounted for 68%, and followed by perforating venous insufficiency was 44%. Furthermore compared venous refill time (VRT), segmented venous capacitancy (SVC) and maximum venous outflow (MVO) of dermal nutrient disturbance with those of exterior normal skin and normal subjects; and compared VRT, SVC, MVO of deep vein 3-4 stage reflux with those of 1-2 stage reflux and normal subjects,the differences were very significant (Ｐ＜0.05). Compared the VRT of perforating incompetence with that of competence (Ｐ＜0.01). Dermal pathology and ultramicrostructure showed that leucocytes trapping in capillary was a cause of microangiopathy. These results suggest that deep vein 3-4 stage reflux followed by calf perforating insufficiency was a main cause for dermal nutrient disturbance; lower extremity VRT reduced obviously and SVC increased significantly were hemodynamic character, leucocytes trapping in capillary was pathology basis of skin damage.

光电容积描记检测对下肢静脉瓣膜功能不全的诊断价值

Irradiating Effect of Low Intensive Microwave on Restenosis of External Iliac Artery of Rabbit after Injury

【Abstract】Objective To investigate the irradiating effect of low intensive microwave (LIM) on pathological process of blood vessel restenosis(RS) and assess the probability of LIM irradiation to prevent was used RS.Methods Fortyfour male healthy New Zealand rabbits were randomly divided into 2 groups. Fogarty catheter traumatize to the tunica intima of iliac artery so as to establish RS models. Two thousand four hundred and fifty MHz microwave with different power of 2 ,5 and 10 mW/cm2 was used, locally to irradiate EIA in irradiating group (1 h/d). Specimens were obtained at different time of 3,7,14 and 28 d after operation. Morphological changes of tissues were observed with HE and EF staining and the area of tunica intima, tunica media and the rate of cavity stenosis were analyzed with image analysis system; apoptosis was detected with TUNEL; phenotype and microstructure of VSMC were observed with TEM. Results After microwave irradiating, inflammatory reaction in early period was suppressed, mural thrombus decreased, the proliferation and migration of VSMC depressed, the area of tunica intima and the rate of cavity stenosis obviously reduced comparing with the control group (P＜0.01). The rate of apoptosis cells showed that there were no obvious differences among each group on 3 d after operation (Pgt;0.05). At other different time, however, the rate of apoptosis cells in irradiating groups obviously increased than that of the control group (P＜0.01), particularly in the one with power of 5 mW/cm2 .The number of synthesis form VSMC in the control group occupied (93.50±3.45)% of the total number of VSMC on 14 d after operation. Most of VSMC appear contractile in irradiating group in which a lot of morphological changes of apoptosis in fibroblast and VSMC existed.Conclusion LIM irradiation could obviously prevented from pathologic procedure of RS. After LIM irradiating, inflammatory reaction in early period is suppressed, the proliferation and migration of VSMC depressed. LIM irradiation promotes cell apoptosis, effectively prohibites the occurring and development of RS. LIM irradiation has had relationship between quantity and effect, power span to effectively prohibit RS, particularly in the one with power of 5 mW/cm2.

Advances in Vascular Prosthesis in Which Lined with Genetically Modified Endothelial Cells

Objective To discuss the endothelial cell which was modified by exogenous anticoagulant genes contribute to the increase of antithrombosis activity of lined vascular prosthesis and the influence to other physiological functions of endothelial cells. Methods This summarized paper was made on literature review of recent years. Results The transfection of genes, including plasminogen activator (tPA, uPA, Urokinase), thrombomoduline (TM) and hirudin, etc, to endothelial cells resulted in not only the increase of antithrombosis activity of local vascular, but also the decrease of endothelial cell function in adherence and proliferation. Conclusion The increase of antithrombosis activity of lined vascular prosthesis has been done by exogenous genes. However, this technique ought to be studied, intensively.

Calf Muscle Pump and Chronic Venous Insufficiency in Lower Extremities

Objective To discuss the relationship between calf muscle pump function and chronic venous insufficiency(CVI).Methods This summarized paper was made on literature review. Results Calf muscle pump function was studied by air plethysmography,straingauge plethysmography，intramuscular pressure，calf muscle pump efficiency，foot mercury straingauge plethysmography，isotope plethysmography，and digitized photo plethysmography.The calf muscle pump function of patients with CVI decreased apparently and can be markedly improved after proper treatment. Conclusion The relationship between calf muscle pump function and CVI is apparent.

Surgical Treatment of Complicated Traumatic Arterial Aneurysm and Arteriovenous Fistula

目的探讨复杂的创伤性动脉瘤（TAA）和动静脉瘘（TAVF）的手术方法和疗效。方法对我院1963年6月至2000年12月经手术治疗的TAA和TAVF 121例进行回顾性分析。结果TAA ７１例含９１个动脉瘤，TAVF ５０例含５４个动静脉瘘。手术方式包括瘤体切除和端端吻合或血管移植或上下结扎，瘤体上下结扎加血管旁路移植，直接修补或补片。瘘管切除加四头结扎或动静脉移植或动静脉修补，介入栓塞治疗。死亡１例。TAA、TAVF随访率分别为６５.７%和６０.0%。远期效果好。结论不同部位复杂的TAA和TAVF应根据其不同分型采用不同的手术方式，对选择性病例可考虑做介入治疗。

Cloning of Coding Fragment of Human Thrombomodulin Gene and Expression in Eukaryotic Cells

【Abstract】Objective To provide experimental evidence for gene therapy of thrombophilia diseases by constructing eukaryotic expression plasmid of human thrombomodulin(hTM) gene and transfecting the plasmid into COS7 cell and human umbilical vein endothelial cells(HUVECs). Methods The coding fragment of hTM gene was amplified by PCR. Both hTM gene and pcDNA3.1(+)/neo empty vector were digested with HindⅢ and EcoRⅠ. Two digested fragments were combined into pcDNA3.1/hTM with T4DNA ligase. After identification, the pcDNA3.1/hTM was transfected into COS7 cell and HUVECs using cation liposome. The expression of hTM mRNA and protein on the COS7 cell and HUVECs was detected by RTPCR and immunohistochemistry respectively. Results The hTM recombinant plasmid was confirmed by double endonuclease digesting and sequencing. It was transfected into COS7 cell and HUVECs successfully with liposome.Conclusion The pcDNA3.1/hTM plasmid can be successfully constructed and highlevel hTM can be expressed in eukaryotic cells. All of this provides us experimental evidence for gene therapy and further study of TM anticoagulant mechanism.