Objective To summarize the recent progress in pathogenetic, diagnostic and therapeutic researches on the intestinal barrier dysfunction (IBD) of severe acute pancreatitis (SAP). MethodsThe advancement of IBD in SAP, which was published recently at home and abroad, was collected and reviewed. Results The pathogenesis of IBD in patients with SAP was complex. Ischemia-reperfusion injury, endotoxin, inflammatory mediators and gastrointestinal hormone played an important role in the process of IBD. There were many ways to detect IBD, and the ratio of lactulose and mannitol, plasma diamine oxidase were relatively ideal markers. Medical therapies, such as treatment of SAP and maintaining the perfusion of intestines, were essential to cure IBD. On this basis, the propulsives, nutritional support and traditional Chinese drugs should be administered reasonably. Conclusions IBD is a sophisticated process of pathophysiology. In recent years, abundant of animal experiments and clinical researches have provided new clue for prevention and cure of IBD, but further researches are still needed on the mechanism of the cells and molecules implicated.
ObjectiveTo review the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension as well as the inadequacy, and to reevaluate the clinical significance of the technology. MethodsDomestic and foreign literatures were collected to summary the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation in treatment of resistant hypertension. ResultsThe percutaneous radiofrequency catheter-based renal sympathetic denervation in the treatment of resistant hypertension had obtained some positive results recently, but the long-term outcomes and safety of the technology were still subjected to further evaluation. ConclusionThe effect of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension remains to be controversial, and both the equipment and technology of radiofrequency catheter-based ablation need to be improved.
ObjectiveTo summarize the research status and progress of interleukin-6 (IL-6) in Takayasu arteritis (TAK). MethodRecent literature published at home and abroad about the study of IL-6 in the TAK was reviewed and analyzed. ResultsIL-6 was a pro-inflammatory cytokine secreted by a variety of cells, which participated in a variety of inflammatory and immune reactions, and played an important role in the progress of TAK. The expression levels of IL-6 in the peripheral blood and vascular wall tissues of patients with TAK were increased. The gene polymorphism of IL-6 might be related to the occurrence of TAK. Tocilizumab, an IL-6 receptor antagonist, was effective and safe in the treatment of TAK. ConclusionsIL-6 can be used as one of the monitoring indicators for the active phase and recurrence of TAK. IL-6 receptor antagonist can be used as the treatment choice of TAK, but the application results in different stages of TAK are still worth expecting.
ObjectiveTo summarize the diagnosis and management of intravenous leiomyomatosis, and to compare effect of the one-stage surgery and two-stage surgery. MethodsClinicopathological data of 18 patients hospitalized in Peking Union Medical College Hospital who were diagnosed as intravenous leiomyomatosis with intracaval and intracardiac extension during Jan. 2002 to Sep. 2013 were collected, and some indexes of the one-stage surgery group and two-stage surgery group were compared, including blood loss, blood transfusion, operation time, period of stay in ICU, hospital stay, and hospitalization expense. ResultsAll the patients were diagnosed as intravenous leiomyomatosis pathologically after operation. Of the 18 patients, 6 (33.3%) patients underwent one-stage surgery and 12 (66.7%) patients underwent two-stage surgery. There were no significant difference on blood loss, blood transfusion, operation time, period of stay in ICU, hospital stay, and hospitalization expense (P > 0.05). There were some patients suffered from complication, including 1 case of pleural effusion, 1 case of recurrent laryngeal nerve injury, 1 case of pulmonary infection in one-stage surgery group; 1 cases of arrhythmia, 2 cases of intestinal obstruction, 2 cases of pleural effusion in two-stage surgery group. No significance had be found in incidence rate of complication between one-stage surgery group and two-stage surgery group (P=1.000). Tumors of 2 patients who underwent two-stage surgery had developed before the second surgery, increasing the difficulty and risk of the second surgery. Three cases of one-stage group were followed-up for 48-63 month (the median time was 62.0 months), 10 cases in two-stage group were followed-up for 1-43 month (the median time was 19.5 months). During the followed-up period, occurrence happened in 1 case of two-stage group, but without death in all cases. ConclusionsBoth one-stage surgery and two-stage surgery are effective and safe. Taking physical and psychological endurance of patients into consideration, one-stage surgery is highly recommended if the patient is in good status and can tolerate the strike brought by the surgery.
Objective To observe the influence of “liqitongxia decoction” on intestinal barrier dysfunction of acute pancreatitis (AP). Methods Forty AP patients were randomly divided into “liqitongxia decoction” group (n=20) and magnesium sulfate group (n=20). APACHE Ⅱ score and gastrointestinal functions score (GFS) on admission， at 24 h, 48 h, 72 h and on day 5 after admission were recorded. The ratio of urine lactulose to mannitol (L/M), plasma activity of diamine oxidase (DAO) and the levels of endotoxin, TNF-α and IL-6 on admission, at 72 h and on the day 5 after admission were detected. Results The ratio of severe AP was not significantly different between two groups (P＞0.05). On the day 5 after admission, APACHEⅡscore and GFS in two groups decreased. The ratio of L/M, the activity of DAO, the levels of endotoxin, TNF-α and IL-6 decreased in “liqitongxia decoction” group and elevated in magnesium sulfate group. The APACHE Ⅱ score was not significantly different between two groups on the day 5 of admission (P＞0.05), but the GFS, the ratio of L/M, the activity of DAO, levels of endotoxin, TNF-α and IL-6 were significantly different between two groups (P＜0.05, P＜0.01). Conclusion The “liqitongxia decoction” may ameliorate the intestinal barrier dysfunction of patients with acute pancreatitis.
ObjectiveTo evaluate the effects of nerve growth factor (NGF) on angiogenesis and skeletal muscle fiber remodeling in ischemic hindlimbs, and study the relationship of NGF and vascular endothelial growth factor (VEGF) to angiogenesis. MethodsEighteen mice were randomly allocated to normal control group (n=6), blank control group (n=6), and NGF gene transfection group (n=6). The left hindlimb ischemia model was established by ligating the femoral artery. NGF plasmid (125μg) was injected into the mouse ischemic gastrocnemius in the NGF gene transfection group. The same volume of normal saline (200μL) was injected into the mouse ischemic gastrocnemius in the blank control group. The gastrocnemius of left hindlimb was harvested under the condition of peritoneal cavity anesthesia on the 21th day after operation, and then the mice were sacrificed. The gastrocnemius of three groups were tested by hematoxylin-eosin staining, proliferating cell nuclear antigen (PCNA) and CD34 were determined by immunohistochemistry staining. Skeletal muscle fiber type was tested by myosin ATPase staining. NGF and VEGF protein expression were detected by enzyme linked immunosorbent assay. ResultsOn the 21th day after surgery, compared with the blank control group, the skeletal muscle atrophy degree was weaker, the functional assessment score was significantly lower (P < 0.05), the endothelial cell proliferation index, capillary density, the typeⅠskeletal muscle fiber proportion, NGF and VEGF expression were significantly higher (P < 0.05) in the NGF gene transfection group. ConclusionsNGF gene transfection could promote NGF and VEGF expression and angiogenesis in ischemic hindlimbs, and induce typeⅠskeletal muscle fibers formation in ischemic hindlimbs. The molecular regulation mechanism still needs to be further studied.
ObjectiveTo summarize the etiology and prevention measures of carotid artery pseudoaneurysms following carotid endarterectomy (CEA) and discuss the complications and prognosis of it performed surgery and endovascular treatment. MethodsThe process and experience of diagnosis and treatment of two patients with carotid pseudoaneurysm following CEA admitted in this hospital from January 2000 to March 2014 were analyzed retrospectively. The related English literatures concerning carotid artery pseudoaneurysm following CEA in PubMed, SpringerLink, ELSEVIER, and ScienceDirect database were searched and then made a conclusion. Results①The incidence of carotid artery pseudoaneurysms following CEA in this hospital was 0.31% (2/641). These two patients were treated with surgery and endovascular therapy respectively, and both recovered well after the treatment.②Thirty-nine related literatures totally were collected, including 187 patients with carotid artery pseudoaneurysm. One hundred and forty patients were treated with artificial patches during CEA, and 36 patients suffered secondary infection in the surgical sites. One hundred and fifty-two patients were treated with surgery, while 33 patients were treated with endovascular therapy, the residual two patients were accepted hybrid surgery. The overall incidence of cranial nerve injuries, the incidence of 30-day stroke, and the incidence of 30-day mortality were 6.4% (9/141), 7.4% (12/163), and 2.7% (5/182), respectively. ConclusionsSurgical site infection is one of the important reasons which lead to carotid artery pseudoaneurysm following CEA. Aneurysm resection and carotid artery reconstruction is still the main treatment of the carotid artery pseudoaneurysm; endovascular therapy could be used as a choice for a part of the patients. How to reduce the perioperative cranial nerve damage and the incidence of complications such as stroke still need further to be studied.
ObjectiveTo summarize the experience in treating the elderly patients (≥75 years old) with carotid artery stenosis, and to evaluate the efficacy and safety of the carotid endarterectomy (CEA). MethodsThe datum of 312 cases with carotid artery stenosis and underwent the CEA in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were retrospectively analized.The risk factors of the CEA in treating the elderly patients were analized, and the measures to prevent perioperative complications were discussed. ResultsThirty-nine cases were brought into the research.The mean follow-up was (22.18±8.71) months.Thirty-three cases (84.6%) were male and 6 cases (15.4%) were female.The median age was 77 years old (75-82 years old).Eleven cases (28.2%) were with bilateral lesions, and 7 cases (17.9%) were asymptomatic.A total of 39 CEA procedures were successfully performed, 22 artificial vascular patches (56.4%) and 16 shunts (41.0%) were used.The mean average hospital stay was (17.38±5.39) days.One case showed cerebral hyperperfusion syndrome in 2th day after operation, another 1 case was found ipsilateral restenosis in 15th month after operation. ConclusionCEA is a safe and effective measure in treating the elderly patients with carotid artery stenosis, if the the indications of surgery is performed strictly.
Objective To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood for postoperative complications of elective endovascular repair for abdominal aortic aneurysm (AAA). Methods From August 2016 to November 2021, the clinical data of patients with AAA who received endovascular isolation repair for the first time in the Department of Vascular Surgery of Beijing Hospital were retrospectively analyzed, including the basic information of the patients, comorbid diseases, and the largest diameter of AAA, preoperative blood labotry test, postoperative complications, long-term survival rate and other indicators. The optimal NLR in peripheral blood was determined, and the differences in postoperative complications and long-term survival rates between the high NLR group and the low NLR group were analysed. Results A total of 120 patients with AAA underwent endovascular isolation for the first time were included in this study, including 105 males and 15 females. The age ranged from 52 to 94 years, with an average of (73.3 ± 8.26) years. The largest diameter of abdominal aortic aneurysm was 35 to 100 mm, with an average of (58.5 ± 12.48) mm. The best cut-off value of NLR for predicting postoperative complications of AAA was 2.45 by using Yoden index screening. Those with NLR ≥2.45 were in the high NLR group (n=66), and those with NLR <2.45 were in the low NLR group (n=54). There was no statistically significant difference between the two groups in the incidence of overall complications and the incidence of sub-complications (P>0.05). The results of logistic regression analysis suggested that NLR was an independent risk factor for complications after endovascular repair of AAA (P<0.05). The median survival time of patients in the high NLR group and the low NLR group was 31.47 months and 35.28 months, respectively, and there was no statistically significant difference between the two groups (P>0.05). Conclusion NLR can be used as a reference predictor of complications after elective endovascular repair of AAA, but more research results are still needed to confirm.