ObjectiveTo investigate the expression of extracellular signalregulated kinase (ERK) and p38 mitogenactivated protein kinase （p38 MAPK） in autogenous vein grafts during vascular remodeling.MethodsAn autogenous vein graft model was established by transplanting the right jugular vein to infrarenal abdominal aorta in 80 Wistar rats. Vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after surgery. Gene expression of ERK and p38 MAPK was measured by reverse transcriptionPCR. Western blot was used to detect the expression of protein products and phosphorylation protein products of ERK and p38 MAPK. Apoptosis of vascular smooth muscle cells (VSMCs) was determined by TUNEL. Proliferating cell nuclear antigen(PCNA) of VSMCs also was studied.ResultsThe expression of ERK1 mRNA and p38 MAPK mRNA increased considerably after surgery. ERK1 mRNA reached the peak on the 7th day 〔（33.2±14.2）%, P＜0.01〕, but p38 MAPK mRNA reached the peak on the second week after surgery 〔(58.8±26.2）%, P＜0.01〕. The expression of ERK1/2 detected by western blot reached the peak during 1 to 2 weeks and decreased gradually to normal level 6 weeks after surgery. The expression of p38 MAPK reached the peak during 2 to 4 weeks and decreased to 1/4 to 1/2fold 8 weeks after surgery. There was a positive relationship between ERK1 and PCNA(r=0.759 6，P＜0.01) and a positive relationship between p38 MAPK and apoptosis(r=0.892 2，P＜0.01). ConclusionActivation of MAPK system exists in autogenous vein grafts and it may become a new target for the therapy of stenosis after vein grafts.
ObjectiveTo study the cell apoptosis and the dynamic expression and significance of apoptosis-related genes in graft veins. MethodsA rat experimental model of autogenous graft vein was established by transplanting the right external jugular vein to infrarenal abdominal aorta in 100 Wistar rats. TUNEL and immunohistochemistry were used to detect the apoptosis, the expression of apoptosis-related genes bcl-2 and bax in vascular smooth muscle cells (VSMCs) of graft veins. ResultsWithin the 8 weeks after transplantation, the apoptotic VSMCs in the graft veins were much more than those in the control group with the apoptotic rate reaching the peak〔（28.5±16.6）%〕 on the 2nd week and dropping to （8.1±2.8）% during the 4th to 8th week. There was statistical difference compared to the control group 〔(0.5±0.2)%, P＜0.01〕. From 1 to 2 weeks, the positive rate of bcl-2 was (22.1±5.4)% which was higher than that of the control group and the 4-8 week group (P＜0.01); from 1 to 6 weeks, the expression of bax was higher than that of the control group 〔(5.5±2.3)%〕 and the postoperative 8th week group 〔(8.2±2.9)%, P＜0.01〕.Conclusionbcl-2 and bax protein may be involved in the regulation of apoptosis of VSMCs. Apoptosis of VSMCs may be an important factor in graft remodeling and graft vein stenosis.
The expression of T antigen in rectal cancer and mucosa remote from carcinoma by immunohistochemistry was investigated. Mucin protein was also examined by HID-AB staining. The results showed that the expression of T antigen in rectal cancer was much ber than those in 10cm mucosa remote from carcinoma and no significant difference as compared with 5cm mucosa. The sialomucin reactions in 5cm and 10cm mucosa remote from carcinoma were 45% and 20% respectively. The coincident sialomucin positive reaction and expression of T antigen were found in 40% 5cm remote mucosa .There is significant correlation between them (Ｐ＜0.05). The authors conclude that the expression of tumorrelated antigen and change of mucin protein in remote mucosa without malignant invasion may suggest the malignant potential of the mucosa. Further investigations should be performed into the effect of these changes on the local recurrence after redical resection of rectal cancer.
Objective To discuss the early diagnosis and surgery of intestinal necrosis caused by superior mesenteric venous thrombosis （SMVT）. Methords The clinical data of 32 patients with intestinal necrosis caused by SMVT were reviewed retrospectively and analyzed, which included 6 cases of primary SMVT, 26 cases of secondary SMVT, 9 cases with pylethrombosis, 24 patients had been dignosed definitely as SMVT by imageology examination before surgery. All the patients accepted surgery therapy, within which 9 patients accepted Fogarty catheter, and anticoagulation and thrombolytic therapy were administrated postoperatively. Results All patients had recovered except for one with short bowel syndromle and one died. Conclusions SMVT is a rarely ischemic intestinal disease, which has complicated pathogenesis and difficulty in early diagnosis. Intestinal necrosis often occurs as a result of delayed treatment and the effective way is to cut off necrotic intestines in time. Intra-and postoperative anticoagulation and thrombolytic therapy could reduce recurrency effectively.
目的 总结颈动脉体瘤的诊断和外科手术治疗的经验。 方法 分析我院1991年9月至2009年2月期间手术治疗的16例颈动脉体瘤患者的临床资料。 结果 术前均行彩色多普勒超声检查，9例行CT检查，6例行数字减影血管造影检查。3例首诊时误诊为其他疾病。11例行单纯瘤体切除； 5例采用大隐静脉行颈动脉重建。术后1例出现声音嘶哑，1例出现伸舌右偏，1例出现呼吸困难。10例获得7个月～15年（平均67个月）随访，未见复发和转移。 结论 临床医师应提高对颈动脉体瘤的认识,注意选择合适的检查方法以免误诊，外科手术切除是首选的治疗措施，大隐静脉重建颈动脉是一种较安全、有效的治疗方法。
目的 探讨肢体假性动脉瘤的病因、发病机理以及手术方式的选择，评价各种手术的治疗效果，以提高对假性动脉瘤的诊治水平。方法 30例假性动脉瘤患者（股动脉18例，腘动脉7例，肱动脉2例，桡动脉3例），其中8例为感染或破裂性假性动脉瘤，1例肢体坏死。30例患者均行外科手术治疗,其中11例行假性动脉瘤破口修补术，2例行股动脉结扎术，2例行血管端端吻合术，8例行自体大隐静脉移植术，6例行人工血管移植术，1例行截肢术。结果 30例患者术后恢复顺利，除1例行下肢截肢术外，其余29例术后效果良好。随访7个月～8年,平均(4.4±2.3）年； 行人工血管移植术者4例移植段发生血栓，经溶栓治疗后好转，其余血供状况良好。结论 外科手术治疗肢体假性动脉瘤是一种有效的方法。
Objective To explore the effect and evaluation criterion of the transplantation of autologous peripheral blood stem cells(PBSC)for blood flow remodeling in the critical limb ischemia (CLI).MethodsThirty six patients with 39 limbs suffered from CLI at Yunnan Provincial Center of Vascular Surgery and Department of Vascular Surgery of The First Affiliated Hospital of China Medical University from March 2003 to January 2007 were included in this study.These patients were divided into two groups. One groupconsisted of 20 cases in all 22 limbs used the transplantation of autologous PBSC,and another group included 16 cases in all 17 limbs were not use this technique.Multifunction monitoring device,dopplor ultrasound monitoring device,per cutem oxygen partial pressure monitoring device and digital subtraction angiography were used to measure effect degree of limbs regional blood flow from cutaneous covering,blood vessel and blood on the preoperative and postoperative days and the follow-up time was six months.ResultsThe effect indexes of limbs regional blood flow of the case by transplantation of autologous PBSC was as follows:skin temperature index(STI)was(1.5±0.3) ℃， per cutem oxygen partial pressure monitoring device(TcPO2)was(36.6±9.3)mm Hg,ankle-brachium index(ABI)was0.7±0.1,photoplethysmograpy index(PPGI) was0.8±0.1,saturation of blood oxygen(SaO2)was(78.3±15.9)%,digital subtraction angiography score was1.5±0.3,the rate of limbs salvage was 82%,the distance of intermittent claudication was(150.3±41.1)meters,and the change of index was consistent with ameliorative tendency of symptom(0.415＜r＜0.592, P＜0.05).ConclusionThe transplantation of autologous PBSC can promote blood flowremodeling in limbs ischemia,and the effect indexes of limbs regional blood flow can objectively reflect the degree of blood flow remodeling.
ObjectiveTo detect the inhibitory effect of early growth response gene-1 DNA enzyme (EDRz) on proliferation of vascular smooth muscle cell (VSMC) and intimal hyperplasia, and confirm the effect of gene therapy on stenosis and occlusion after vein transplantation. MethodsEDRz was constructed, and autogenous vein graft model was established with Wistar rats, transplanting the right jugular vein to infra renal abdominal aorta by microsurgical technique. EDRz was transfected to the graft veins and the vein graft samples were harvested at hour 1, 2, 6, 24 and on day 3, 7, 14, 28, 42 after grafting, 10 Wistar rats were randomly selected in every time. The expression of EDRz in transfected vein graft was detected by fluorescent microscope. Egr-1 mRNA was measured by reverse transcription-PCR (RT-PCR) and in situ hybridization, respectively. The protein expression of Egr-1 was detected by Western blot and immunohistochemistry, respectively. HE stained vein grafts were observed under microscope. Results① The results of EDRz transfected vein graft: At hour 1 after grafting, EDRz was mainly located in adventitia, tunica media, and partial endothelial cells of vein graft; At hour 2, 6, and 24, EDRz was located in tunica media of vein graft; and on day 7, it was mainly located in intima of vein graft. There wasn’t EDRz in vein grafts on day 14, 28, and 42. ② The results of expression of Egr-1 mRNA: Detection by RT-PCR: At hour 1 after transfecting, the expression of Egr-1 mRNA arrived at the peak, and declined at hour 2, 6, and 24. The expression was tenuity on day 3. Egr-1 mRNA expression was not found on day 7, 14, 28, and 42. The expression of Egr-1 mRNA at hour 1 was significantly higher than that of the other time point (Plt;0.01). The result of in situ hybridization was coincident with RT-PCR. ③ The results of expression of Egr-1 protein: The result of Western blot: There was no expression of Egr-1 protein in normal veins. At hour 2 after grafting, expression of Egr-1 protein was found, and declined at hour 6, 24, and on day 3. There was no expression of Egr-1 protein at hour 1, and on day 7, 14, 28, and 42. The expression of Egr-1 protein at hour 2 was significantly higher than that of the other time point (Plt;0.01). The result of immunohistochemistry was coincident with Western blot. ④The degree of VSMC hyperplasia and intimal thickness were lighter in EDRz transfected vein grafts than that in nottransfected vein grafts contemporarily. ConclusionsEDRz could reduce the expression of Egr-1 in autogenous vein graft, and could effectively restrain VSMC proliferation and intimal hyperplasia, and prevent vascular stenosis and occlusion after vein grafting.