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Objective: To investigate the safety and efficacy of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction. Methods: It was a randomized controlled trial. A total of 180 patients with great saphenous vein dysfunction were enrolled prospectively, and scheduled for surgical treatment in 9 hospitals, including the Second Affiliated Hospital of Naval Medical University, Shanghai Oriental Hospital Affiliated to Tongji University, Xuanwu Hospital Capital Medical University, the First Hospital of Hebei Medical University, Ganzhou People's Hospital, Shanxi Bethune Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, and Zhongshan Hospital Affiliated to Xiamen University, from June to October 2022. Using a random number table method, the subjects were divided into an experimental group and a control group, with 90 cases in each group. The patients of experimental group received treatment with varicose vein sealant kit, while the patients of control group received radiofrequency ablation. The main outcome measure was the complete closure rate of the great saphenous vein in both groups of patients 3 months after surgery. The secondary outcome measures were the complete closure rate of the great saphenous vein in both groups of patients immediately after surgery and 6 months after surgery, the operation time for closing the main trunk of the great saphenous vein, pain score, venous clinical severity score (VCSS), Aberdeen varicose veins questionnaire (AVVQ) at different times before and after surgery, and the incidence of complications in both groups of patients. The non inferiority threshold for the two treatment methods is set at "-10.00%". Results: A total of 177 patients were ultimately enrolled. There were 89 cases in the experimental group, including 38 males and 51 females, with a median age [M (Q1, Q3)] of 59.7(49.6, 66.7) years, and 88 cases in the control group, including 30 males and 58 females, with a median age of 57.2(46.9, 65.9) years. A total of 174 patients completed a 3-month follow-up, and 167 patients completed a 6-month follow-up. The closure time of the main saphenous vein in the experimental group was (22.1±11.1) min, which was longer than the control group, which was (18.7±9.8) min (P=0.031). The complete closure rate of the great saphenous vein immediately after surgery in both the experimental group and the control group was 100%. The complete closure rates of the great saphenous vein at 3 months after surgery were 98.8% (85/86) and 98.9% (87/88), respectively. The lower limit of the 95%CI for the difference between the two groups was -3.19%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The complete closure rates of the great saphenous vein at 6 months after surgery were 97.6% (81/83) and 100% (84/84), the lower limit of the 95%CI for the difference between the two groups was -5.71%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The immediate pain scores after complete anesthesia awakening of the experimental group and the control group were both 1.0 (0, 2.0), with no statistically significant difference (P=0.365). The incidence of bruising in the experimental group and the control group one week after surgery was 61.2% (52/85) and 67.1% (57/85), respectively, with no statistically significant difference (P=0.181). There was no statistically significant difference in VCSS and AVVQ scores between groups before surgery and at 1, 3, and 6 months after surgery (all P>0.05). There was no statistically significant difference in the incidence of complications such as deep vein thrombosis, phlebitis, pain, and subcutaneous hematoma in the lower limbs 3 months after surgery (all P>0.05). Conclusion: The varicose vein sealant kit is safe and effective in treating great saphenous vein dysfunction, and can achieve a complete closure rate of great saphenous vein that is not inferior to traditional radiofrequency ablation.
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Vena Safena , Várices , Insuficiencia Venosa , Humanos , Vena Safena/cirugía , Várices/cirugía , Insuficiencia Venosa/cirugía , Resultado del Tratamiento , Estudios Prospectivos , Masculino , Femenino , Persona de Mediana Edad , Ablación por Catéter/métodosRESUMEN
Objective: To evaluate the value of color Doppler ultrasound and digital subtraction angiography (DSA) in evaluating the level of carotid bifurcation and the morphology of extracranial internal carotid artery in patients with atherosclerotic carotid stenosis. Methods: The carotid artery examination data of 186 patients with atherosclerotic carotid stenosis who underwent carotid DSA and color Doppler ultrasound in Shanghai Changzheng Hospital from July 2017 to June 2019 were retrospectively analyzed, including 154 males and 32 females, with ages ranging from 36 to 84 (66±8) years old. The correlation between the position of carotid bifurcation and the level of cervical spine, the distance from the position of carotid bifurcation to mandibular angle, the correlation of the level of bifurcation with the length of neck, and the incidence of carotid distortion were analyzed. Results: DSA showed that the most common position of carotid bifurcation was at C3 level on the left [37.3% (56/150)], and at C3-C4 level on the right [33.6% (42/125)], and the highest position was at C2 level on the left, and at C2-C3 levels on the right, while the lowest level on both sides was at C5 level. The incidence of high bifurcation of left carotid artery (C3 and above) was 46% (69/150), which was higher than that of right carotid artery [21.6% (27/125), P<0.001]. The incidence of high carotid bifurcation in men and women was 33.2% (76/229) and 43.5% (20/46), respectively, with no significant difference (P = 0.182). Carotid ultrasound showed that the distance between the left carotid bifurcation and the mandibular angle was (3.0±1.3) cm, which was shorter than that on the right [(3.4±1.2) cm] (P<0.001). The distance between carotid bifurcation and mandibular angle in men and women was (3.2±1.2) cm and (3.3±1.0) cm, respectively, with no significant difference (P = 0.093). There was no significant correlation between carotid bifurcation level and carotid length (right: r = 0.02, P = 0.091; left: r = 0.01, P = 0.927). The incidence of carotid artery distortion was 28.1% (9/32) in women and 15.6% (24/154) in men, with no significant difference (P = 0.091). The incidence of right carotid artery distortion in high bifurcation group was 59.3% (16/27), which was higher than that in non-high bifurcation group [3.1% (3/98)] (P<0.001). Likewise, the incidence of left carotid artery distortion in high bifurcation group was 30.4% (21/69), which was higher than that in non-high bifurcation group [2.5% (2/81)] (P<0.001). Conclusions: The bifurcation position of left carotid artery in patients with atherosclerotic carotid stenosis is higher than that of the right. Patients with high bifurcation of carotid artery are more likely to be complicated with carotid distortion. Preoperative color doppler ultrasound combined with DSA can evaluate the distortion of extracranial carotid artery, thereby providing reference for the selection of surgical methods.
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Estenosis Carotídea , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Interna , Estenosis Carotídea/diagnóstico , Vértebras Cervicales , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ultrasonografía Doppler en ColorRESUMEN
Objective: To explore a modified method for constructing a mouse model of instable carotid plaque and provide the mouse model for simulating the development of human instable carotid plaque. Methods: Twenty-four low density lipoprotein receptor deficiency (LDLr-/-), C57BL/6, male mice were randomized into two groups according to computer-generated table, tandem constriction of carotid artery+ high cholesterol diet (tandem surgery group, n=12); sham surgery+ high cholesterol diet(sham surgery group, n=12). After 12 weeks of consecutive feeding, murine carotid artery were collected and analyzed by carotid ultrasound, pathological examination to assess the formation and stability of atherosclerotic plaque. Results: No statistical difference in body weight and blood lipid level between the two groups was observed (all P>0.05). After surgery, through ultrasound biomicroscopy, obvious stenosis at the two sites of tandem constriction and atherosclerotic plaque between the two sites were observed in tandem surgery group. By pathological examination, no plaque was formed in carotid artery in sham surgery group. The lipid area in the stable plaque of innominate artery in sham surgery group and the plaque of carotid artery in tandem surgery group were (4.8±0.6) ×10(4),(10.2±1.1)×10(4) µm(2), respectively. The difference was statistically significant between the two groups (t=12.023,P<0.001). In addition, the thickness of fibrous cap in the above groups were (122.4±17.8), (41.3±20.2) µm, respectively. The difference was statistically significant either (t=9.224, P<0.001). The region of necrotic core were (3.3±0.4)×10(4),(8.1±0.9)×10(4) µm(2).The difference was statistically significant as well (t=13.456, P<0.001). The percentage of macrophages in innominate artery of sham surgery group and in carotid artery of tandem surgery group were (20.8±5.2)%, (38.6±6.4)%, respectively.The percentage of vascular smooth muscle cells were (32.5±7.3)%,(21.2±5.1)%, respectively (t=6.114,3.585, all P<0.05). The results indicated that the plaque in tandem surgery group had severer inflammatory response. Conclusion: Through tandem constriction surgery upon carotid artery in LDL-/-mouse, instable carotid atherosclerotic plaque can be induced, which is less time-consuming, replicable and effective.
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Arterias Carótidas , Placa Aterosclerótica , Animales , Estenosis Carotídea , Modelos Animales de Enfermedad , Masculino , Ratones , Ratones Endogámicos C57BL , Miocitos del Músculo LisoRESUMEN
OBJECTIVE: Our previous study found that high miR-150 expression was positively correlated with prostate tumor recurrence or metastasis. In this work, we investigated the expression of miR-150 in prostate cancer stem cells (CSCs) and explored its regulation over p27 in the development of CSCs. MATERIALS AND METHODS: MiR-150 expression in CD144 or CD44 positive primary prostate cells and in DU145 cell line was measured. It regulation over CSCs was measured using tumor sphere assay and qRT-PCR analysis of CSC related Oct4, Nestin and Nanog genes. The direct binding between miR-150 and 3'UTR of p27 mRNA was verified using dual luciferase, qRT-PCR and western blot assay. The influence of miR-150-p27 axis on prostate CSC properties was further investigated. RESULTS: Findings of this study found miR-150 expression was significantly upregulated in CD44+ or CD133+ subgroups of prostate cancer cells. MiR-150 could directly target 3'UTR of p27 and decrease its expression, through which it increased the number and volume of tumor sphere formed by DU145 cells, as well as the expression of CSC related Oct4, Nestin and Nanog genes. CONCLUSIONS: Increased miR-150 expression might participate in the development and progression of human prostate CSC by suppressing p27. This supported our previous study which found miR-150 was positively correlated with prostate tumor recurrence or metastasis.
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Biomarcadores de Tumor/biosíntesis , Inhibidor p27 de las Quinasas Dependientes de la Ciclina/antagonistas & inhibidores , Inhibidor p27 de las Quinasas Dependientes de la Ciclina/biosíntesis , MicroARNs/biosíntesis , Células Madre Neoplásicas/metabolismo , Neoplasias de la Próstata/metabolismo , Línea Celular Tumoral , Células HEK293 , Humanos , Masculino , Células Madre Neoplásicas/patología , Neoplasias de la Próstata/patologíaRESUMEN
BACKGROUND: This study was designed to investigate the effect of a novel surgical method on cardia sphincter function and complication rates after Heller's cardiomyotomy for patients with achalasia. METHODS: Forty-eight patients (19 males, mean age 34.0 +/- 10.5 years, range, 12-58) were included in this study. A spindle diaphragm valve was used in the surgery to rebuild the cardiac sphincter function. The efficacy of the surgery was determined by clinical assessment of symptoms and lower esophageal sphincter pressure (LESP) measurements. Barium meal examination was also used to evaluate the efficacy. RESULTS: The mean LESP before surgery was 41.3 +/- 11.6 mmHg. It was reduced to 16.8 +/- 3.7 mmHg and 17.5 +/- 2.5 mmHg 3 and 12 months after surgery (P < 0.01). All patients were free of symptoms such as swallow difficulties or acid reflux during the follow up. However, barium swallow examination showed that 1 patient had mild reflux after the surgery. Clinical symptom scores on swallow difficulties/obstruction was reduced from 2.5 +/- 0.65 before surgery to 0.06 +/- 0.24 12 months after the surgery (P < 0.01). CONCLUSION: A spindle diaphragm valve used with Heller's cardiomyotomy was associated with a very low incidence of post-surgical complications, such as gastroesophageal reflux. This technique may be used in treating all patients with achalasia.