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Yuan YY, Cao WD, Zhang XH, Du RX, Wang XQ, Li J, Chen J, Yang JZ, Chen JQ. Application of E-coach chronic disease management model in rehabilitation management of patients with arteriosclerosis obliterans. J Health Popul Nutr 2023; 42:115. [PMID: 37891631 PMCID: PMC10612356 DOI: 10.1186/s41043-023-00454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To explore the effect of a health (E)-coach chronic disease management model on the rehabilitation behaviour management of patients with arteriosclerosis obliterans (ASO). METHODS The E-coach chronic disease management model was constructed based on a literature review and expert interviews. The effect of the E-coach model on patients with ASO during hospitalisation was analysed by comparing the compliance rates of blood glucose control, blood pressure control, drug compliance, ankle-brachial index, 6-min walking test (6MWT) and pain-free walking distance (PFWD) scores between the E-coach and control groups. RESULTS In total, 212 patients with ASO were included in this study. After the intervention, the blood pressure compliance rate (44.8% vs. 65.7%) and blood glucose compliance rate (48.6% vs. 66.8%) were higher in the E-coach group than in the control group (p < 0.05). After intervention, compared with the control group, the patients in the E-coach group had better drug compliance (6.8 ± 1.9 vs. 7.9 ± 1.0), and the difference was statistically significant (p < 0.05). The scores for the 6MWT (329.19 ± 5.58 vs. 353.00 ± 9.76; 412.65 ± 12.59 vs. 499.16 ± 18.43) and PFWD (219.15 ± 11.96 vs. 225.36 ± 16.13; 331.62 ± 51.36 vs. 369.42 ± 75.71) tests were significantly higher in the E-coach group than in the control group at 1 and 6 months after intervention (p < 0.05). CONCLUSION The E-coach chronic disease management model can effectively improve the control rates of blood glucose and blood pressure and the behaviour management of patients with ASO and is thus worthy of clinical reference.
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Affiliation(s)
- You-Yuan Yuan
- Department of Interventional Therapy for Tumor and Vascular Disease, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Wen-Dong Cao
- Department of Interventional Therapy for Tumor and Vascular Disease, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Xiao-Hong Zhang
- Department of Nursing, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, China
| | - Rong-Xin Du
- Department of Urology Surgical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, China
| | - Xue-Qi Wang
- Department of Interventional Therapy for Tumor and Vascular Disease, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Jing Li
- Department of Interventional Therapy for Tumor and Vascular Disease, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Juan Chen
- Department of Interventional Therapy for Tumor and Vascular Disease, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Jun-Zi Yang
- Department of Interventional Therapy for Tumor and Vascular Disease, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Jia-Qi Chen
- Department of Interventional Therapy for Tumor and Vascular Disease, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China.
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Zhuang JM, Li TR, Li X, Luan JY, Wang CM, Feng QC, Han JT. [Application of Rotarex catheter system in femoropopliteal artery stenosis accompanied with thrombosis]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:328-332. [PMID: 37042145 PMCID: PMC10091259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of Rotarex catheter system in treating femoropopliteal artery stenosis accompanied with thrombosis. METHODS From Jun. 2017 to Dec. 2019, the clinical data of 32 femoropopliteal artery stenosis accompanied with thrombosis cases treated with Rotarex catheter system were retrospectively analyzed. There were 23 males and 9 females aged from 50 to 89 years and the mean age was (70.7±10.3) years. Six cases had acute course of disease (≤2 weeks), 17 cases had subacute course of disease (>2 weeks, ≤3 months), and 9 cases had chronic course of disease (>3 months). Mean lesion length was (23.4±13.7) cm, mean occlusion length was (19.9±13.3) cm, and in-stent occlusion 7 cases. The superficial femoral artery (SFA) was involved in 13 cases, the popliteal artery (PA) was involved in 8 cases, and both SFA and PA were involved in the other 11 cases. All the cases were treated with Rotarex catheter system. When necessary, suction with large lumen catheter was enabled. Residual stenosis was treated with percutaneous transluminal angioplasty (PTA). Drug-coated balloon (DCB) was only used in patients with financial status, and stent was used only when it was necessary. Heparin was used for 24 h after procedures, and after that, antiplatelet agents were used. Doppler ultrasonography was taken during the followed-up. RESULTS Technical success was 100%, and mean procedure time was (107.4±21.5) min. 8F (1F≈0.33 mm) and 6F Rotarex catheter were used in 27 and 5 cases respectively. In 27 cases, forward flow was obtained immediately after debulking with Rotarex catheter, and in the other 5 cases, suction with large lumen catheters were used. PTA was used in all 32 cases. DCB were used in 8 cases, of which 4 were used in in-stent stenosis. Twelve cases were implanted stents. There were no perioperative deaths. The only one procedure related complication was distal embolism. We took out the thrombus with guiding catheter. In all cases, mean hospital stay were (4.6±1.5) d. The ankle brachial index increased from 0.32±0.15 to 0.86±0.10 after treatment (t=-16.847, P < 0.001). The Rutherford stages decreased significantly (Z=-4.518, P < 0.001). All the patients were followed up for 6.0-36.0 months, and the median time was 16.0 months. 2 cases stopped antiplatelet agents, which resulted in acute thrombosis. Another percutaneous mechanical thrombectomy and PTA were taken in one of them. Two cases died of cardiovascular disease during the follow-up, and no amputation was observed. Target lesion restenosis occurred in 7 cases during the follow-up, and target lesion revascularization (TLR) was taken in two of them. CONCLUSION In treating femoropopliteal artery stenosis accompanied with thrombosis, Rotarex catheter can remove thrombus effectively, and that can expose underlying lesions and reduce stent use and complications rates. It is a safe and effective method.
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Affiliation(s)
- J M Zhuang
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - T R Li
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - X Li
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - J Y Luan
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - C M Wang
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Q C Feng
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - J T Han
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
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Shimabukuro M, Ishii N, Ko T, Matsuzaki K, Kishi K. A Case of Refractory Heel Ulcer Complicated by Moderate Osteomyelitis and Cellulitis Successfully Treated with Rheocarna. World J Plast Surg 2023; 12:106-110. [PMID: 38226196 PMCID: PMC10788112 DOI: 10.61186/wjps.12.3.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/19/2023] [Indexed: 01/17/2024] Open
Abstract
Revascularization surgery was first considered for the treatment of ulcers in patients with critical limb ischemia (CLI). However, it may not be indicated for patients with severe infections or peripheral vascular occlusions. Although blood purification therapy is adjuvant therapy for such patients, it is not yet widely used due to insurance coverage. We report a case of a refractory heel ulcer with moderate osteomyelitis and cellulitis that was not amenable to revascularization. Treatment with the adsorptive blood purifier rheocarna® (Kaneka Corporation; Osaka, Japan) resulted in complete epithelialization of the ulcer and control of inflammation. Although this case required careful follow-up, we believe rheocarna might be a promising treatment option for patients with CLI who do not respond to revascularization. Rheocarna could improve peripheral blood flow and control inflammation by improving antibiotic drug delivery.
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Affiliation(s)
- Makoto Shimabukuro
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Takanori Ko
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Kyoichi Matsuzaki
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
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Wu Y, Tian S, Li C, Zhang W, Xing Q, Chen G. Predictive Value of Contrast-Enhanced Ultrasound in Chemical Lumbar Sympathectomy for End-Stage Arteriosclerosis Obliterans of the Lower Extremities. Pain Ther 2022; 11:209-223. [PMID: 35034342 PMCID: PMC8861241 DOI: 10.1007/s40122-021-00347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction The therapeutic effect of chemical lumbar sympathectomy (CLS) on ischemic diseases of the lower limbs varies greatly among individuals. The time to peak (TTP) response in contrast-enhanced ultrasound (CEUS) can reflect the perfusion disorder of the calf skeletal muscle and the collateral circulation. In this study we evaluated the predictive value of CEUS in patients treated with CLS for end-stage atherosclerotic occlusive disease of the lower extremity (ASO-LE). Methods This was a prospective study that included patients with end-stage ASO-LE and moderate to severe pain who had undergone a CEUS examination and CLS procedure and who were observed for 12 months after surgery. The patients’ characteristics and prognostic factors, including lower limb pain score, skin temperature, walking distance, and ulcer and gangrene healing, were recorded. Results Fifty-eight patients with a mean age of 66.24 (range 58–78) years were included in the study, of whom 42 (71.41%) were men. Following the CLS procedure, the numerical rating scale (NRS)-measured pain decreased significantly, and the skin temperature of the affected limb increased significantly (P < 0.05). The satisfaction rate of lower limb pain relief 1 year after operation was 53.45%. Correlation analysis showed that preoperative TTP response was correlated with the NRS score and skin temperature of the affected limb at 6 months and 12 months post surgery (P < 0.05). The binary logistic regression analysis indicated that a longer preoperative TTP response was associated with a higher risk of poor pain relief after CLS (odds ratio 1.126, 95% confidence interval 1.058–1.205). The receiver operating characteristic curve showed that preoperative TTP response had a certain predictive value on CLS treatment effect, with a sensitivity and specificity of 81.5% and 83.9%, respectively. When the preoperative TTP response was > 77.5, the risk of poor response after CLS increased. Conclusions Preoperative TTP response was able to predict the therapeutic effect of CLS to a certain extent, and thus may aid physicians in determining the choice of CLS treatment for patients with ASO-LE. Trial Registration Chinese Clinical Trial Registry: ChicTR1900028424 (principal investigator: Yue Wu; date of registration: 21 December 2019). Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00347-9.
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Affiliation(s)
- Yue Wu
- Department of Anesthesiology, Sir Run Run Shaw Hospital affiliated with School of Medicine of Zhejang University, 3 Qingchun Road East, Shangcheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Suming Tian
- Department of Anesthesiology, Sir Run Run Shaw Hospital affiliated with School of Medicine of Zhejang University, 3 Qingchun Road East, Shangcheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Chunye Li
- Department of Pain, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, People's Republic of China
| | - Weibo Zhang
- Department of Anesthesiology, Sir Run Run Shaw Hospital affiliated with School of Medicine of Zhejang University, 3 Qingchun Road East, Shangcheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Qianqian Xing
- Department of Anesthesiology, Sir Run Run Shaw Hospital affiliated with School of Medicine of Zhejang University, 3 Qingchun Road East, Shangcheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Gang Chen
- Department of Anesthesiology, Sir Run Run Shaw Hospital affiliated with School of Medicine of Zhejang University, 3 Qingchun Road East, Shangcheng District, Hangzhou, 310016, Zhejiang, People's Republic of China.
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Kihara K, Horie H, Miyatani K, Endo M, Matsunaga T, Yamamoto M, Yata S, Tokuyasu N, Sakamoto T, Fujiwara Y. A rare case of sigmoid colon cancer in which the lower limbs received collateral blood flow from the inferior mesenteric artery owing to peripheral artery disease. Surg Case Rep 2021; 7:190. [PMID: 34417902 PMCID: PMC8380216 DOI: 10.1186/s40792-021-01274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Colorectal cancer and peripheral artery disease are common conditions in older adults and may coexist in this population. Lymph node dissection along the inferior mesenteric artery is a vital procedure in cases of left-sided colorectal cancer. However, the inferior mesenteric artery may show a collateral blood pathway in rare cases of peripheral artery disease. We report a case of advanced sigmoid colon cancer in which the lower limbs received inferior mesenteric artery flow owing to asymptomatic peripheral artery disease. The possibility of catastrophic lower-limb ischemia because of complete mesenteric excision with ligation of the inferior mesenteric artery was a matter of concern in this case. Case presentation A 73-year-old man with asymptomatic peripheral artery disease was diagnosed with stage IIIB advanced sigmoid colon cancer. Angiography using a balloon-occlusion catheter revealed that his lower limbs received prominent inferior mesenteric artery blood flow through a collateral pathway. Therefore, interventional radiologists and cardiovascular surgeons evaluated the indications for endovascular stents or bypass grafts. The patient also had dilated cardiomyopathy, so the cardiovascular physicians evaluated his tolerance in the worst-case scenario of a colorectal anastomotic leak. The patient underwent axillofemoral artery bypass and two-stage laparoscopic sigmoid colectomy without anastomosis. The postoperative course was uneventful, and he resumed his job within a month after the resection. Conclusions Although collateral flow from the inferior mesenteric artery is rare in patients with peripheral artery disease, a few case reports have described fatal lower-limb ischemia following anterior resection. The perioperative multidisciplinary evaluation enabled us to understand the patient’s condition and risks, and allowed successful cancer treatment without ischemia of the lower limbs.
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Affiliation(s)
- Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan.
| | - Hiromu Horie
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Masayuki Endo
- Division of Radiology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Shinsaku Yata
- Division of Radiology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
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Jia HY, Guo W, Xiong J. [Influence of deformation of femoropopliteal artery on choice of stents]. Zhonghua Wai Ke Za Zhi 2020; 58:826-30. [PMID: 33120443 DOI: 10.3760/cma.j.cn112139-20200605-00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, stent implantation has played an important role in solving femoropopliteal artery disease. Because part of the femoropopliteal artery is at the level of the knee joint, the deformation of this segment of the artery is greater when the lower limbs are bent, and the stent fracture rate is higher. Studies have showed that the deformation of the femoropopliteal artery mainly includes bending, twisting, axial compression and radial compression. The selection of stents with mechanical properties suitable for the deformation of artery in different sections can reduce the risk of fracture. The commonly used clinical stent designs (classic laser engraving stent, braided stent and covered stent) have large differences in mechanical properties. Braided stents with higher radial support are more suitable for treating popliteal artery disease, while covered stent has good compliance and can be used in all segments. Of course, the existing types of stents cannot meet all mechanical requirements. The design of the new stent needs to be studied, and its clinical results need to be confirmed by research.
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Yagyu T, Funabashi S, Yoneda S, Noguchi T, Yasuda S. Novel Evaluation Method for Lower Extremity Peripheral Artery Disease With Duplex Ultrasound - Usefulness of Acceleration Time. Circ J 2020; 84:1990-1998. [PMID: 32938899 DOI: 10.1253/circj.cj-20-0427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Duplex ultrasound scanning (DUS) plays a major role in less invasive diagnosis and assessment of lesion severity in lower extremity peripheral artery disease (PAD). In this study, we evaluated the efficacy of each DUS parameter measured in patients with PAD and established a simple method for PAD evaluation.Methods and Results:We retrospectively investigated 211 patients (270 limbs) who underwent assessment with both angiography and DUS. During DUS of the common femoral artery (CFA) and popliteal artery, we measured 3 parameters: acceleration time (AcT), peak systolic velocity (PSV), and waveform contour. We compared these parameters with the degree of angiographic stenosis. AcT at the CFA had a significantly higher value in prediction of aortoiliac artery lesions with >50% stenosis (c-index, 0.85; 95% confidence interval (CI), 0.79-0.91), with a sensitivity of 0.82 and specificity of 0.76 at the best cutoff point, compared with PSV and waveform contour (P<0.001, respectively). For femoropopliteal lesions, the ratio of AcT at the popliteal artery to AcT at the CFA is the most predictive parameter, with sensitivity of 0.86 and specificity of 0.92 at the best cutoff point (c-index, 0.93; 95% CI, 0.90-0.97), compared with others (P<0.001, respectively). CONCLUSIONS For the assessment of PAD with DUS, AcT and AcT ratio are simple and reliable parameters for evaluating aortoiliac and femoropopliteal artery disease.
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Affiliation(s)
- Takeshi Yagyu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Sayaka Funabashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Zhou B, She J, Wang Y, Ma X. Venous thrombosis and arteriosclerosis obliterans of lower extremities in a very severe patient with 2019 novel coronavirus disease: a case report. J Thromb Thrombolysis 2020; 50:229-32. [PMID: 32306290 DOI: 10.1007/s11239-020-02084-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The outbreak of 2019 novel coronavirus disease (COVID-19) began since early December 2019, and has been declared as a public health emergency by the World Health Organization. Due to the hypercoagulable state, blood stasis and endothelial injury, severe patients with COVID-19 are at high risk for thrombosis. We report a case of very severe COVID-19 complicated with venous thrombosis and arteriosclerosis obliterans of lower extremities. Risk stratification for deep vein thrombosis and peripheral arterial disease are of vital importance for the prognosis of COVID-19.
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Shoji K, Yanishi K, Shiraishi H, Yamabata S, Yukawa A, Teramukai S, Imai K, Ito-Ihara T, Tao M, Higashi Y, Ishigami T, Fukumoto Y, Kuwahara K, Matoba S. Establishment of optimal exercise therapy using near-infrared spectroscopy monitoring of tissue muscle oxygenation after therapeutic angiogenesis for patients with critical limb ischemia: A multicenter, randomized, controlled trial. Contemp Clin Trials Commun 2020; 17:100542. [PMID: 32072074 PMCID: PMC7015992 DOI: 10.1016/j.conctc.2020.100542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/20/2020] [Accepted: 02/02/2020] [Indexed: 01/14/2023] Open
Abstract
Critical limb ischemia (CLI) is a potentially life-threatening condition that involves severely reduced blood flow to the peripheral arteries due to arteriosclerosis obliterans (ASO) of the limbs or a similar condition. CLI patients must undergo revascularization to avoid amputation of the lower limbs and improve their survival prognosis. However, the outcomes of conventional surgical revascularization or endovascular therapy are inadequate; therefore, establishing further effective treatment methods is an urgent task. We perform therapeutic angiogenesis using autologous bone marrow-derived mononuclear cells in clinical practice and demonstrated its safety and efficacy for CLI patients for whom conventional treatments failed or are not indicated. Exercise therapies must be devised for CLI patients who have undergone therapeutic angiogenesis to save their limbs and improve survival. Because evidence regarding the efficacy and safety of exercise therapy for CLI patients is lacking, we plan to perform a prospective trial of the efficacy and safety of optimal exercise therapy following therapeutic angiogenesis for CLI patients. The trial will enroll 30 patients between 20 and 79 years with Rutherford category 4 or 5 CLI caused by ASO who will undergo therapeutic angiogenesis. Participants will be randomly allocated to receive either optimal exercise therapy or fixed exercise therapy. Those receiving optimal exercise therapy will undergo tissue muscle oxygen saturation monitoring using near-infrared spectroscopy while performing exercises and will be prescribed optimal exercise therapy. The optimal amount of exercise will be determined on day 8, 31, 61, 91 and 181 after therapeutic angiogenesis. Ethics and dissemination This protocol was approved by the Institutional Review Boards of Kyoto Prefectural University of Medicine. In accordance with the Helsinki Declaration, written informed consent has been obtained from all participants prior to enrollment. The results of this trial will be disseminated by publication in a peer-reviewed journal. Trial registration This trial is registered at http://www.umin.ac.jp/ctr/index.htm (identifier: UMIN000035288).
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Key Words
- ASO, arteriosclerosis obliterans
- Arteriosclerosis obliterans
- BM-MNC, bone marrow-derived mononuclear cells
- CLI, critical limb ischemia
- CT, computed tomography
- Critical limb ischemia
- NIRS, near-infrared spectroscopy
- NO, nitric oxide
- Near-infrared spectroscopy
- Optimal exercise therapy
- PAD, peripheral artery disease
- RHI, reactive hyperemia index
- SPP, skin perfusion pressure
- StO2, thenar tissue oxygen saturation
- TAO, thromboangiitis obliterans
- TOI, tissue oxygenation index
- TcPO2, transcutaneous oxygen pressure
- Therapeutic angiogenesis
- Tissue muscle oxygen saturation
- VAS, visual analogue scale
- WIQ, walking impairment questionnaire
- eNOS, endothelial nitric oxide synthase
- nTHI, normalized tissue hemoglobin index
- ΔHHb, change in deoxygenated hemoglobin concentration
- ΔO2Hb, change in oxygenated hemoglobin concentration
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Affiliation(s)
- Keisuke Shoji
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirokazu Shiraishi
- Rehabilitation Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shiho Yamabata
- Rehabilitation Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Arito Yukawa
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kojiro Imai
- Department for Medical Innovation and Translational Medical Science, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Toshiko Ito-Ihara
- The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masami Tao
- The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tomoaki Ishigami
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Lian W, Nie H, Yuan Y, Wang K, Chen W, Ding L. Clinical Significance of Endothelin-1 And C Reaction Protein in Restenosis After the Intervention of Lower Extremity Arteriosclerosis Obliterans. J INVEST SURG 2020; 34:765-770. [PMID: 31996054 DOI: 10.1080/08941939.2019.1690600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aims to investigate the role of endothelin-1 (ET-1) and C-reactive protein (CRP) in restenosis after intervention of lower extremity arteriosclerosis obliterans. METHODS The present prospective observational study included a total of 251 patients with arteriosclerosis obliterans in the lower extremity. All patients were treated with balloon dilatation, stent-assisted angioplasty or balloon dilatation, and stent-assisted angioplasty. Furthermore, these patients received a CTA examination at one and three months after surgery. The serum ET-1 and CRP levels were determined using a commercial enzyme-linked immunosorbent assay (ELISA). RESULTS In non-restenosis patients, both the CRP and ET-1 levels were significantly upregulated after surgery, reached a peak level at one week, and decreased at one month after surgery. However, for restenosis patients, the serum ET-1 and CRP levels did not decrease to the baseline at one and three months after surgery, but were remarkably higher than the levels for non-restenosis patients. Serum ET-1 levels were positively correlated with serum CRP levels at both one and three months after surgery. Both ET-1 and CRP levels after one week and one month, and CRP at three days, one week, one month and three months after surgery were risk factors for restenosis after intervention surgery of arteriosclerosis obliterans. CONCLUSION Both serum ET-1 and CRP levels were elevated after one and three months of intervention for lower extremity arteriosclerosis obliterans in patients with restenosis. These might be the risk factors for restenosis of lower extremity arteriosclerosis obliterans patients.
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Affiliation(s)
- Weishuai Lian
- Department of Interventional and Vascular Surgery, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Hongpeng Nie
- Department of General Surgery, Chongming Branch of Tenth People's Hospital of Tongji University, Shanghai, China
| | - Yifeng Yuan
- Department of Interventional and Vascular Surgery, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Kun Wang
- Department of Vascular Surgery, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Weiqian Chen
- Department of Interventional and Vascular Surgery, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Liangfu Ding
- Department of General Surgery, Chongming Branch of Tenth People's Hospital of Tongji University, Shanghai, China
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Eiki K, Otake T. Factors Affecting Intermittent Infusion Hemodiafiltration. Blood Purif 2019; 48 Suppl 1:17-21. [PMID: 31752001 DOI: 10.1159/000503876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intermittent infusion hemodiafiltration -(I-HDF) has been performed for a number of years since this mode of dialysis became available with dialyzers used in Japan. It has been effective in some cases and ineffective in others. In this study, we analyzed and clarified these differences. SUMMARY We conducted a retrospective study to determine the factors affecting the effectiveness of I-HDF treatment in some patients and ineffectiveness in others and classified the complex causes associated with volume load that were identified. Key Messages: Bolus dialysate infusion in I-HDF affects the volume load (preload), and repeated bolus dialysate infusion influences both preload and afterload in patients with valvular heart disease. In this study, I-HDF was effective when brain natriuretic peptide levels, cardiothoracic ratio, and ultrafiltration rate were well controlled and cardiac load was low. I-HDF was shown to be effective in patients who are prone to developing hypotension at the end of a dialysis session. There were several factors, including different types of load, involved in inefficiency of I-HDF.
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Affiliation(s)
- Kenji Eiki
- Department of Clinical Engineering, Tajirigaoka Hospital, Medical Cooperation Aiseikai, Hitachi, Japan,
| | - Takuya Otake
- Department of Clinical Engineering, Tajirigaoka Hospital, Medical Cooperation Aiseikai, Hitachi, Japan
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Wang K, Yu J, Wang B, Wang H, Shi Z, Li G. miR-29a Regulates the Proliferation and Migration of Human Arterial Smooth Muscle Cells in Arteriosclerosis Obliterans of the Lower Extremities. Kidney Blood Press Res 2019; 44:1219-1232. [PMID: 31614351 DOI: 10.1159/000502649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/10/2019] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The molecular mechanisms underlying the contribution of human arterial smooth muscle cells (HASMCs), one of the most important components of the arterial wall, to the pathogenesis of arteriosclerosis obliterans (ASO) remain elusive. METHODS The expression levels of miR-29a in arterial walls were analyzed via real-time-polymerase chain reaction. An ASO cell model was established to investigate the expression of miR-29a on HASMCs. The interaction between miR-29a and platelet-derived growth factor receptor B (PDGFRB) was detected by luciferase reporter assay, and the alteration of the expression of PDGFRB was determined in platelet-derived growth factor‑BB (PDGF-BB)-stimulated HASMCs transfected with miR-NC, miR-29a mimics, and miR-29a inhibitors. Further, HASMCs cell proliferation was investigated by cell counting kit-8 and EdU assays, and cell migrations were evaluated by Transwell and wound closure assays. RESULTS The expression of miR-29a was remarkably downregulated in the arterial walls of ASO patients compared with normal arterial walls. Furthermore, expression of miR-29a in HASMCs under PDGF-BB stimulation was lower than vehicle control. PDGFRB was identified as a target of miR-29a in HASMCs, and miR-29a inhibited the proliferation and migration in PDGF-BB-induced HASMCs, via regulating the expression of PDGFRB. CONCLUSION This study showed that miR-29a is downregulated in the arterial wall of ASO patients, as well as in the PDGF-BB-stimulated HASMCs. This alteration of miR-29a could upregulate target genes PDGFRB and inhibits the proliferation and migration of HASMCs. These findings discovered new mechanisms of ASO pathogenesis, and the miR-29a/PDGFRB axis could serve as potential therapy target of ASO.
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Affiliation(s)
- Kun Wang
- Department of Vascular Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Jian Yu
- Department of Vascular Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Bin Wang
- Department of Vascular Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Hui Wang
- Department of Vascular Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Zuolei Shi
- Department of Vascular Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Guangxin Li
- Department of Vascular Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China,
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Cui J, Lun Y, Sun JJ, Wang SY, Wang L, Xin SJ, Zhang J. [Clinical observation of drug-coated balloon in the treatment of lower extremity arterial long segment lesions]. Zhonghua Yi Xue Za Zhi 2019; 99:1787-1791. [PMID: 31207688 DOI: 10.3760/cma.j.issn.0376-2491.2019.23.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the efficacy of drug -coated balloon (DCB) in the treatment of long -segment arterial stenosis in lower extremity. Methods: Were retrospectively analyzed in February 2017 to January 2018,the First Hospital Affiliated to China Medical University of vascular surgical treated 80 patients with lower limb sclerosis of arterial congee appearance (lesion length>10 cm), accept the DCB and stents (BMS) treatment, compared two groups of patients with preoperative and postoperative issue patency rate of target lesion, ABI, Rutherford, amputation rate and the change of clinical symptoms and quality of life. Results: There were 60 cases in DCB group,20 cases in BMS group and 80 cases in BMS group. The patency rate of DCB group was 83.33% and 75.00% at 6 and 12 months after operation. The patency rate was 85.00% and 65.00% in the BMS group at 6 and 12 months after surgery. ABI, walking distance, Rutherford grade and clinical symptoms were significantly improved in the two groups compared with those before surgery. During the operation, 1 patient in the DCB group presented flow limiting interlayer and 1 patient still had>50% stenosis after predilation, and then underwent stent implantation for remediation. Conclusion: The treatment of lower limb arterial stenosis with DCB can obtain better near -and medium-term clinical efficacy.
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Affiliation(s)
- J Cui
- Department of Vascular Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
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Wang B, Liu W, Huo Y, Gong Z, Wang W, Hao R, Fang J, Zhang J, Jiang W. [Application of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting for lower extremity arteriosclerosis obliterans or combined with diabetic foot]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:1576-1580. [PMID: 30569686 PMCID: PMC8414223 DOI: 10.7507/1002-1892.201806124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/07/2018] [Indexed: 11/03/2022]
Abstract
Objective To discuss the effectiveness of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting in treatment of lower extremity arteriosclerosis obliterans (ASO) or combined with diabetic foot. Methods Between March 2014 and June 2016, 9 patients with lower extremity ASO or combined with diabetic feet were treated with femoral-femoral artery bypass grafting and transverse tibial bone transporting. All patients were male, aged from 63 to 82 years with an average of 74.2 years. The disease duration of ASO was 1.5-22.0 months (mean, 10.5 months). All cases were severe unilateral iliac arterial occlusion, including 5 cases of the left side and 4 cases of the right side. There were 7 cases with superficial femoral and/or infrapopliteal artery disease. There were 7 cases of ASO and 2 cases of ASO combined with diabetic foot (Wagner grade 4); all the ASO were grade Ⅳ according to Fontaine criteria. All patients had rest pain before operation, and the ankle brachial index was 0.24±0.12. In femoral-femoral artery bypass grafting operations, artificial blood vessels were used in 7 cases and autologous saphenous vein were used in the other 2 cases. The tibial bone transverse transporting began on the 8th day after operation by 1 mm per day and once per 6 hours; after transported for 2-3 weeks, it was moved back. The whole course of treatment was 10-14 weeks. Results The incision of tibial bone transverse transporting was necrotic in 1 case, and healed after dressing change. There was no obvious complication at the orifice of the needle. The other patients had no incision complication. The granulation tissue of foot wound was growing quickly after tibial bone transverse transporting, and the wound was reduced after 2-3 weeks. All the 9 patients were followed up 12-32 months (mean, 19 months). The ankle brachial index was 0.67±0.09 at 2 months postoperatively, which was significantly higher than that before operation ( t=17.510, P=0.032). All the feet ulcer wounds healed and the healing time was 6.7-9.4 weeks (mean, 7.7 weeks). During follow-up, color Doppler ultrasound or CT examination revealed grafted blood vessel patency. The external fixator was removed at 12-14 weeks after operation. One case died of sudden myocardial infarction at 14 months after operation, and there was no lymphatic leakage. The patency rate of femoral-femoral bypass was 100% at 1 year after operation. The tibial transverse bone grafting healed with tibia at 4-6 months after operation. At last follow-up, the effective rate was 100%. Conclusion Femoral-femoral artery bypass grafting combined with transverse tibial bone transporting is an effective method in the treatment of lower extremity ASO or combined with diabetic foot.
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Affiliation(s)
- Bin Wang
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000,
| | - Wei Liu
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Yongxin Huo
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Zhongping Gong
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Wei Wang
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Ruizheng Hao
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Jun Fang
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Jian Zhang
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Wenping Jiang
- Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
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Chen Z, Wang M, Huang K, He Q, Li H, Chang G. MicroRNA-125b Affects Vascular Smooth Muscle Cell Function by Targeting Serum Response Factor. Cell Physiol Biochem 2018; 46:1566-1580. [PMID: 29689557 DOI: 10.1159/000489203] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Increasing evidence links microRNAs to the pathogenesis of peripheral vascular disease. We recently found microRNA-125b (miR-125b) to be one of the most significantly down‑regulated microRNAs in human arteries with arteriosclerosis obliterans (ASO) of the lower extremities. However, its function in the process of ASO remains unclear. This study aimed to investigate the expression, regulatory mechanisms, and functions of miR-125b in the process of ASO. METHODS Using the tissue explants adherent method, vascular smooth muscle cells (VSMCs) were prepared for this study. A rat carotid artery balloon injury model was constructed to simulate the development of vascular neointima, and a lentiviral transduction system was used to overexpress serum response factor (SRF) or miR-125b. Quantitative real‑time PCR (qRT‑PCR) was used to detect the expression levels of miR‑125b and SRF mRNA. Western blotting was performed to determine the expression levels of SRF and Ki67. In situ hybridization analysis was used to analyze the location and expression levels of miR-125b. CCK-8 and EdU assays were used to assess cell proliferation, and transwell and wound closure assays were performed to measure cell migration. Flow cytometry was used to evaluate cell apoptosis, and a dual-luciferase reporter assay was conducted to examine the effects of miR‑125b on SRF. Immunohistochemistry and immunofluorescence analyses were performed to analyze the location and expression levels of SRF and Ki67. RESULTS miR-125b expression was decreased in ASO arteries and platelet-derived growth factor (PDGF)-BB-stimulated VSMCs. miR-125b suppressed VSMC proliferation and migration but promoted VSMC apoptosis. SRF was determined to be a direct target of miR-125b. Exogenous miR-125b expression modulated SRF expression and inhibited vascular neointimal formation in balloon-injured rat carotid arteries. CONCLUSIONS These findings demonstrate a specific role of the miR-125b/SRF pathway in regulating VSMC function and suggest that modulating miR-125b levels might be a novel approach for treating ASO.
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Affiliation(s)
- Zhibo Chen
- Division of Vascular Surgery, Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, Guangzhou, China.,Department of Vascular and Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mian Wang
- Division of Vascular Surgery, Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, Guangzhou, China
| | - Kai Huang
- Department of Vascular and Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiong He
- Division of Pathology, The First Affiliated Hospital, Sun Yat‑sen University, Guangzhou, China
| | - Honghao Li
- Department of Vascular and Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Division of Vascular Surgery, Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, Guangzhou, China
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Darinskas A, Paskevicius M, Apanavicius G, Vilkevicius G, Labanauskas L, Ichim TE, Rimdeika R. Stromal vascular fraction cells for the treatment of critical limb ischemia: a pilot study. J Transl Med 2017; 15:143. [PMID: 28629476 PMCID: PMC5477131 DOI: 10.1186/s12967-017-1243-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/13/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cell-based therapy is being explored as an alternative treatment option for critical limb ischemia (CLI), a disease associated with high amputation and mortality rates and poor quality of life. However, therapeutic potential of uncultured adipose-derived stromal vascular fraction (SVF) cells has not been evaluated as a possible treatment. In this pilot study, we investigated the efficacy of multiple injections of autologous uncultured adipose-derived SVF cells to treat patients with CLI. METHODS This study included 15 patients, from 35 to 77 years old, with rest pain and ulceration. SVF cells were injected once or twice in the ischemic limb along the arteries. Digital subtraction angiography was performed before and after cell therapy. The clinical follow up was carried out for the subsequent 12 months after the beginning of the treatment. RESULTS Multiple intramuscular SVF cell injections caused no complications during the follow-up period. Clinical improvement occurred in 86.7% of patients. Two patients required major amputation, and the amputation sites healed completely. The rest of patients achieved a complete ulcer healing, pain relief, improved ankle-brachial pressure index and claudication walking distance, and had ameliorated their quality of life. Digital subtraction angiography performed before and after SVF cell therapy showed formation of numerous vascular collateral networks across affected arteries. CONCLUSION Results of this pilot study demonstrate that the multiple intramuscular SVF cell injections stimulate regeneration of injured tissue and are effective alternative to achieve therapeutic angiogenesis in CLI patients who are not eligible for conventional treatment. Trial registration number at ISRCTN registry, ISRCTN13001382. Retrospectively registered at 26/04/2017.
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Affiliation(s)
- Adas Darinskas
- Laboratory of Immunology, National Cancer Institute, Santariskiu Str. 1, 08660 Vilnius, Lithuania
| | - Mindaugas Paskevicius
- Department of Vascular Surgery, Vilnius City Clinical Hospital, Antakalnio Str. 57, 10207 Vilnius, Lithuania
| | - Gintaras Apanavicius
- Department of Vascular Surgery, Vilnius City Clinical Hospital, Antakalnio Str. 57, 10207 Vilnius, Lithuania
| | - Gintaris Vilkevicius
- Northway Medical and Surgical Center, S.Zukausko Str. 19, 08234 Vilnius, Lithuania
- Clinics of Cardiovascular Diseases, Vilnius University, Santariskiu Str. 2, 08661 Vilnius, Lithuania
| | - Liutauras Labanauskas
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Medical Academy, University Clinics of Kaunas, Eiveniu Str. 2, 50009 Kaunas, Lithuania
| | | | - Rytis Rimdeika
- Department of Plastic and Reconstructive Surgery, Lithuanian University of Health Sciences, Medical Academy, University Clinics of Kaunas, Eiveniu Str. 2, 50009 Kaunas, Lithuania
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Hu W, Wang M, Yin H, Yao C, He Q, Yin L, Zhang C, Li W, Chang G, Wang S. MicroRNA-1298 is regulated by DNA methylation and affects vascular smooth muscle cell function by targeting connexin 43. Cardiovasc Res 2015; 107:534-45. [PMID: 26025955 DOI: 10.1093/cvr/cvv160] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 05/07/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Growing evidence links microRNA to the process of peripheral vascular disease. Recently, we have found that microRNA-1298(miR-1298) is one of the most significantly down-regulated microRNAs in human arteries with arteriosclerosis obliterans (ASO) of the lower extremities. However, little is known regarding its role in the process of ASO. The present study aimed to investigate the expression, regulatory mechanisms, and functions of miR-1298 in the process of ASO. METHODS AND RESULTS Using quantitative reverse-transcription PCR and in situ hybridization assays, miR-1298 was observed predominantly expressed in the vascular smooth muscle cells (VSMCs) and was significantly down-regulated in ASO compared with normal arteries. Pyrosequencing analysis revealed that the miR-1298 DNA upstream of CpG sites were hypermethylated in ASO compared with normal arteries. Next, the luciferase reporter assay revealed that miR-1298 down-regulation is related with upstream DNA CpG site hypermethylation. Introducing a miR-1298 mimic into cultured VSMCs significantly attenuated cell proliferation and migration. Connexin 43 (Cx43) was validated to be a functional target of miR-1298 that was involved in the miR-1298-mediated cellular effects. Finally, lentivirus-mediated delivery of miR-1298 and its target Cx43 into a rat carotid balloon injury model indicated that re-overexpression of miR-1298 significantly decreased neointimal formation by targeting connexin 43. CONCLUSION Our data demonstrate a specific role of the upstream DNA methylation/miR-1298/Cx43 pathway in regulating VSMC function and suggest that modulation of miR-1298 levels may offer a novel therapeutic approach for ASO.
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Affiliation(s)
- Wei Hu
- Division of Vascular Surgery, The Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The Vascular Surgical Disease Research Center of Guangdong Province, First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou, Guangdong 510080, China
| | - Mian Wang
- Division of Vascular Surgery, The Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The Vascular Surgical Disease Research Center of Guangdong Province, First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou, Guangdong 510080, China
| | - Henghui Yin
- Division of Vascular Surgery, The Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The Vascular Surgical Disease Research Center of Guangdong Province, First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou, Guangdong 510080, China
| | - Chen Yao
- Division of Vascular Surgery, The Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The Vascular Surgical Disease Research Center of Guangdong Province, First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou, Guangdong 510080, China
| | - Qiong He
- Department of Pathology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Leping Yin
- Division of Vascular Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Chunxiang Zhang
- Department of Pharmacology, Rush University Medical Center, Chicago, USA
| | - Wen Li
- Laboratory of General Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Division of Vascular Surgery, The Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The Vascular Surgical Disease Research Center of Guangdong Province, First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou, Guangdong 510080, China
| | - Shenming Wang
- Division of Vascular Surgery, The Guangdong Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, The Vascular Surgical Disease Research Center of Guangdong Province, First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou, Guangdong 510080, China
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Chen T, Chen D, Li F, Tan Z. Netrin-1 with stem cells promote angiogenesis in limb ischemic rats. J Surg Res 2014; 192:664-9. [PMID: 25240286 DOI: 10.1016/j.jss.2014.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/08/2014] [Accepted: 07/01/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Recent findings have elucidated that netrin-1 has ability of promoting angiogenesis besides the functions in nervous system. Autologous mesenchymal stem cells (MSCs) transplantation is now proved to be an effective method to treat peripheral arterial disease. However there are still many patients who cannot complete full treatments. Therefore it is necessary to improve the effectiveness. This study estimated the curative effects in chronic limb ischemia when MSCs allied with netrin-1. MATERIALS AND METHODS Thirty-six rats were made into chronic limb ischemia models. They were randomly assigned to four groups, netrin-1 + MSCs group (treated with netrin-1 and MSCs derived from peripheral blood), MSCs group (treated with MSCs individually), netrin-1 group (treated with netrin-1 individually), and control group (treated with saline). Measurements of murine behaviors, vascular endothelial growth factor expression, and capillary density in ischemia limb were performed on days 7, 14, and 28 after treatments; measurements of contraction force in ischemia limb was performed on day 28 after treatments to compare differences among the groups. RESULTS Netrin-1 allied with MSCs significantly increased Tarlov score, vascular endothelial growth factor expression, capillary density, and muscular strength in ischemia limb. CONCLUSIONS Netrin-1 allied with MSCs derived from peripheral blood significantly promoted angiogenesis in aged rats with chronic limb ischemia. It may be a promising method of treating peripheral arterial disease in the future.
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Affiliation(s)
- Tao Chen
- Department of Vascular Surgery, Zhongnan Hospital of Wuhan University, Zhongnan Hospital, Wuhan city, Hubei province, China; Department of Vascular Surgery, Affiliated Xiangyang Central Hospital of Hubei University of Arts and Science, Xiangyang Center Hospital, Xiangyang city, Hubei province, China
| | - Dejie Chen
- Department of Vascular Surgery, Affiliated Xiangyang Central Hospital of Hubei University of Arts and Science, Xiangyang Center Hospital, Xiangyang city, Hubei province, China
| | - Fangfang Li
- Department of Pharmacy, Affiliated Xiangyang Central Hospital of Hubei University of Arts and Science, Xiangyang Center Hospital, Xiangyang city, Hubei province, China
| | - Zui Tan
- Department of Vascular Surgery, Zhongnan Hospital of Wuhan University, Zhongnan Hospital, Wuhan city, Hubei province, China.
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Dang Y, Xia Y, Li Y, Yu DCW. Anemia and type 2 diabetes mellitus associated with peripheral arterial disease progression in Chinese male patients. Clin Biochem 2013; 46:1673-7. [PMID: 23892184 DOI: 10.1016/j.clinbiochem.2013.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Peripheral arterial disease (PAD) is a chronic occlusive disease mainly occurred in elderly adults. Arteriosclerosis obliterans (ASO) mainly occurring from small or medium sized arteries of the lower extremities is one of the most common causes of PAD. The gender-related differences of circulating risk factors in diabetic patients with ASO in China remain unknown. The aim of this study is to investigate the gender-related differences in the pattern of several potential risk factors between male and female patients with ASO and type 2 diabetes mellitus (T2D). DESIGN AND METHODS Clinical profiles and risk factors were analyzed in 323 Chinese patients with ASO and 112 patients were confirmed with T2D. Severities of limb ischemia were staged according to Fontaine classification. RESULTS The significant inverse correlation was seen between the increased age and hemoglobin. The significant positive correlation was seen between the increased age, urea and creatinine both in the non-diabetic and diabetic male patients. The expression levels of hemoglobin significantly correlate with the classification of Fontaine clinical symptoms in Chinese male patients with T2D/ASO. CONCLUSION The study is the first report indicating that the gender-related differences of circulating risk factors are associated with T2D patients with ASO in China. Anemia in Chinese male patients with T2D/ASO may play an important role in peripheral arterial disease progression.
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Affiliation(s)
- Yiping Dang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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