ObjectiveTo discuss the role of nuclear factor-kappa B in restenosis after angioplasty.MethodsRelated literatures of recent 5 years were reviewed.ResultsNuclear factor-kappa B could lead to hyperplasia of vascular intima which resulted from proliferation and decrease of apoptosis of vascular smooth muscle cells.ConclusionNuclear factor-kappa B plays an important role in restenosis after angioplasty.
Objective To discuss the cause and prevention of bacterial translocation after small bowel transplantation (SBT). MethodsMost of the existing literatures concerning bacterial translocation and SBT were reviewed. ResultsThe ischemia/reperfusion injury, graft rejection, graft versus host disease (GVHD) and administration of immunosuppressive drugs were associated with the gut barrier damage, intestinal mobility and transmit dysfunction and luminal potentially pathogenic bacterial overgrowth after SBT which caused the germs and toxin to translocate into recipient tissues, and posed a major threat on the development of sepsis. Conclusion The rate of bacterial translocation after SBT is higher than that of other types of solid organ transplantation,which is the main cause of recipient sepsis affecting the outcome of SBT. Improving the surgical techniques, shortening ischemia preservation time, selective bowel decontamination and improving the methods of nutritional support and immunosuppression would decrease the incidence of bacterial translocation and sepsis, and improve the outcome of SBT.
ObjectiveTo assess the effects of Radix Salviae Miltiorrhizae (RSM) on patency and proliferation lesion of autologous vein to artery grafts in the earlymiddle stage.MethodsAutologous jugular vein was grafted into abdominal artery in the rats. The rats were divided into two groups: RSM group and control group. The rats in RSM group were fed with RSM ［24 g/(kg·d )］,which began 1 day before operation and continued until harvesting. Vein grafts were harvested at 1,3 days, 1, 2, 4 and 8 weeks after surgery for examining the patency, thickness of intimamedia and expression of proliferating cell nuclear antigen (PCNA). ResultsNo significant differences existed in patency of vein grafts between the two groups (Pgt;0.05). The intimamedia thickness of the vein grafts in RSM group decreased 1/3 compared with control group at 2, 4 and 8 weeks (P＜0.01). The PCNA positive cells in RSM group reduced significantly as compared to the control group (P＜0.01). ConclusionRSM can inhibit proliferation lesion of vein grafts but has no influence on patency of vein grafts in the earlymiddle stage.
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.
Objective To understand the value of pre-coating in artificial vessel endothelialization. Methods Literature concerning precoating in artificial vessel endothelialization was extensively reviewed. Results Pre-coating included chemical coatings(collagen, fibronectin, laminin, poly-l-lysin, gelatin andextracellular matrix), pre-clotting(plasma, blood, serum and fibrin glue), chemical bonding (heparin, RGD and lectins) and surface modification. Most of them could enhance the adhesion of the endothelial cells. Conclusion Pre-coating couldimprove endothelialization, but further research is needed to search for the appropriate concentration and incubation time.
OBJECTIVE: To explore the possibility of repair of the extensive bile duct injuries with expanded polytetrafluoroethylene (ePTFE). METHODS: A total of 36 local healthy hybrid dogs were employed to establish bile duct injury models by means of partial removal of bile duct (group A, 14 dogs), excision of a segmental duct (group B, 10 dogs), and ligation of the lower part of common bile duct(group C, 5 dogs; group D, 7 dogs). Group A were patched with ePTFE mesh, group B replaced by ePTFE tube. Interposition of the grafts between gallbladder and duedenum or jejunum was performed on group C and group D. The animals’ postoperative performance status were evaluated. Cholangiography was used to define the patency of bile ducts. Tissues of bile ducts and liver were taken at 3 days, 2, 4, 8, 12 and 52 weeks for microscopic and ultrastructural examination to observe the healing process of bile duct and morphological changes in the liver. RESULTS: Group A with ePTFE patch covered by epithelium had a high patency rate of 75%(9/12) and pathological damages were not found in the liver. The patency rate of group B was merely 40%(4/10), to some extent, accompanying damages in the liver. The grafts of group C and group D were fully expelled, ultimately leading to cystic-duodenal or cystic-jejunal fistulas formation. CONCLUSION: The study suggests that application of ePTFE patch to repair bile duct defects is feasible.
Objective To study the advances in clinical application of hernioplasty by high molecular material. Methods The literature in the recent years on the advances of hernioplasty by high molecular material was reviewed. Results At present time many operative techniques of hernioplasty by high molecular material have been developed. The representative techniques were ①Rives-Stoppa′s mesh inlay hernioplasty; ②Lichtenstein′s tesion-free herniorrhaphy; ③mesh plug hernioplasty; ④Gilbert′s sutureless hernioplasty; ⑤laparoscopic inguinal hernioplasty. The reparing high molecular material was divided into absorbable and unabsorbable material, the former included polyglycolic-acid and polyglaction, the later consists of polypropylene polyester and expanded polytetrafluoroethylene.Conclusion The clinical application of henioplasty by high molecular material is increasing. According to the hernia type and patient condition, excellent outcome will be achieved by the application of proper repairing method and repair material.
ObjectiveTo review the research advances in molecular biology of vascular restenosis.MethodsThe literatures about molecular biology of vascular restenosis were reviewed.ResultsCurrent transgenic ways had some advantages and disadvantages. Gene therapy with HSV-tk, Rb,p21，p27,p53,c-myc, c-myb, vascular endothelial growth factor,bFGF,platelet derived growth facfor，nuclear factor-κB and so on inhibited vascular restenosis.ConclusionA better transgenic system and gene-combination therapy will be effective to treat vascular restenosis.
ObjectiveTo summarize the progress on the injury mechanism of vascular endothelial cells in atherosclerosis.MethodsThe latest progress was reviewed in recent literatures.ResultsAll kinds of etiological factors have activated NF-kappa B and cytokines in the development of atherosclerosis, which lead to expression of cell adhesive molecules and adhesion of monocytes to vascular endothelial cells.A variety of inflammatory mediums are released, which can directly damage endothelial cells.Besides, the inflammatory mediums make monocytes and neutrophils attach to endothelial cells by immune mechanisms, which injure the endothelial cells more severely. Meanwhile the damaged membrance structure leads to the production of AECA which activates the complementary system. Then the vascular endothelial cell injury is aggravated and the development of atherosclerosis accelerated. ConclusionIt is very important to recognize the injury mechanism of vascular endothelial cells in the development of atherosclerosis for prevention and treatment of atherosclerosis.
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.