Rui Feng

Second Military Medical University, Shanghai, Shanghai, Shanghai Shi, China

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Publications (25)68.67 Total impact

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    ABSTRACT: For our retrospective study, we chose patients who met the inclusion criteria for bipolar disorder (BD) according to the ICD-10. We conducted correlation analyses between scale scores and SSR and RRIV values before and after 1 year ±1 month of treatment. Our results suggest that the feet SSR latency and R% can be used as an indicator of clinical BD remission. The scales have high sensitivity and low specificity in assessing BD remission.
    No preview · Article · Jan 2016
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    ABSTRACT: Hypertension has been deemed as a pivotal risk factor for the development of aortic dissection; however, the importance and prognostic significance of blood pressure variability (BPV) in aortic dissection are always ignored. A total of 173 acute type B aortic dissection patients were enrolled in and retrospectively reviewed between January 2009 and November 2013. There were 74 patients with high BPV and 99 with low BPV stratified by preoperative mean BPV. Technical success was achieved in all patients. The proportions of hypertension and general anesthesia were significantly higher in the high BPV group (70.3% vs 55.6% and 77% vs 62.6%, P = 0.049 and 0.043, respectively). The risk of aorta-related death in the high BPV group was apparently higher than the low BPV group (28.4% vs 9.1%, P = 0.001). By performing multivariable logistic regression, we found history of hypertension was likely to be a risk factor of BPV (95% confidence interval [CI]: 1.010–3.911), and high BPV was an independent predictor of aorta-related death (95% CI: 1.671–9.587). The difference of aorta-related mortality was pronounced between high and low BPV subgroups regardless of the refractory hypertension (41.4% vs 14.3% and 20.0% vs 7.0%, P = 0.023 and 0.037, respectively). The thrombosis ratio of false lumen was significantly higher in the low BPV group at 3-month (72.4 ± 17.5% vs 51.8 ± 11.6%, P < 0.001) and 6-month (86.4 ± 9.1% vs 69.7 ± 7.9%, P < 0.001). High BPV is an independent risk factor for the prognosis of aortic dissection. Further studies on BPV might provide new preventive and therapeutic strategies for aortic dissection.
    Preview · Article · Sep 2015 · Medicine
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    ABSTRACT: There are disparities among the results of meta-analyses under different circumstances of carotid artery stenting (CAS) versus endarterectomy (CEA) for carotid stenosis. This study aimed to assess the efficacies of CAS and CEA for carotid stenosis at 5-year intervals and worldwide. Comparative studies simultaneously reporting CAS and CEA for carotid stenosis with at least 10 patients in each group were identified by searching PubMed and Embase in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles. The studies were stratified into different subgroups according to the publication year, location in which the study was mainly performed, and randomized and nonrandomized study designs. Thirty-five comparative studies encompassing 27,525 patients were identified. The risk ratios (RRs) of stroke/death when CAS was compared with CEA within 30 d of treatment were 1.51 (95% CI 1.32–1.74, P < 0.001) for overall, 1.50 (95% CI 1.14–1.98, P = 0.004) from 2011 to 2015, 1.61 (95% CI 1.35–1.91, P < 0.001) from 2006 to 2010, 1.59 (95% CI 1.27–1.99, P < 0.001) in North America, 1.50 (95% CI 1.24–1.81, P < 0.001) in Europe, 1.63 (95% CI 1.31–2.02, P < 0.001) for randomized, and 1.44 (95% CI 1.20–1.73, P < 0.001) for nonrandomized comparative studies. CEA decreased the risks of transient ischemic attack at 30 d (RR: 2.07, 95% CI 1.50–2.85, P < 0.001) and restenosis at 1-year (RR: 1.97, 95% CI 1.28–3.05, P = 0.002). Data from follow-up showed that the RRs of stroke/death were 0.74 (95% CI 0.55–0.99, P = 0.04) at 1 year, 1.24 (95% CI 1.04–1.46, P = 0.01) at 4 year, and 2.27 (95% CI 1.39–3.71, P = 0.001) at 10 year. This systematic review, compared with those of other meta-analyses, included all available comparative studies and analyzed them at 5-year intervals, in different continents, and under different study designs. Current evidence suggests that the efficacy of CEA is superior to CAS for freedom from stroke/death within 30 d, especially from 2006 to 2015, in North America and Europe. Meanwhile, the superiority was also observed for restenosis at 1-year, transient ischemic attack within 30 d, and stroke/death at 4- and 10-year follow-ups.
    Preview · Article · Jul 2015 · Medicine
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    ABSTRACT: Accumulating evidence suggests that early improvement after two-week antidepressant treatment is predictive of later outcomes of patients with major depressive disorder (MDD); however, whether this early improvement is associated with baseline neural architecture remains largely unknown. Utilizing resting-state functional MRI data and graph-based network approaches, this study calculated voxel-wise degree centrality maps for 24 MDD patients at baseline and linked them with changes in the Hamilton Rating Scale for Depression (HAMD) scores after two weeks of medication. Six clusters exhibited significant correlations of their baseline degree centrality with treatment-induced HAMD changes for the patients, which were mainly categorized into the posterior default-mode network (i.e., the left precuneus, supramarginal gyrus, middle temporal gyrus, and right angular gyrus) and frontal regions. Receiver operating characteristic curve and logistic regression analyses convergently revealed excellent performance of these regions in discriminating the early improvement status for the patients, especially the angular gyrus (sensitivity and specificity of 100%). Moreover, the angular gyrus was identified as the optimal regressor as determined by stepwise regression. Interestingly, these regions possessed higher centrality than others in the brain (P < 10(-3) ) although they were not the most highly connected hubs. Finally, we demonstrate a high reproducibility of our findings across several factors (e.g., threshold choice, anatomical distance, and temporal cutting) in our analyses. Together, these preliminary exploratory analyses demonstrate the potential of neuroimaging-based network analysis in predicting the early therapeutic improvement of MDD patients and have important implications in guiding earlier personalized therapeutic regimens for possible treatment-refractory depression. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Full-text · Article · Apr 2015 · Human Brain Mapping
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    ABSTRACT: This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period. Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results.
    Full-text · Article · Dec 2014 · Medicine
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    ABSTRACT: Objective: In this study we aimed to report on the midterm outcome of multiple overlapping uncovered stents in the treatment of peripheral and visceral aneurysms, and analyze the possible factors affecting the treatment efficacy. Methods: Data of patients who were regularly followed up over 24 months were retrospectively reviewed. Descriptive statistics were applied to present aneurysm thrombosis process and diameter change at each follow-up point, and a comparison with the baseline level was performed. Patients were divided into a totally thrombosed (TT) group and a residual perfusion (RP) group according to the sac thrombosis ratio (thrombus volume to sac volume ratio) at 3, 6, and 12 months of follow-up. Aneurysm shrinkage in the two groups was compared to explore the effect of the initial RP on the treatment outcome. Patients were also grouped based on their aneurysm morphology (saccular/fusiform). The aneurysm sac thrombosis speed (time to thrombosis) and diameter decrease (DD) ratio (percentage of DD) were compared between the two groups to understand the influence of aneurysm shape on the treatment efficacy. Results: Of the 64 patients treated, the initial 37 patients (25 male; average age, 55.5 ± 13.0 years) were enrolled into this study. Technical success rate was 100%. All patients were regularly followed up. At 24 months, 94.6% aneurysms (35/37) were TT, and the maximum aneurysm diameter decreased from 36.5 ± 9.7 mm preoperatively to 23.6 ± 7.7 mm (P < .001). Overall clinical success rate (complete thrombosis and shrinkage/stabilization of the aneurysm without aneurysm-related mortality) reached 94.6% in the study cohort. Most side branches (31/33) covered by the bare stent stayed patent during follow-up. Initial sac RP at 3, 6, and 12 months might not fully affect the final aneurysm DD ratio (TT group: 0.37 ± 0.09, 0.35 ± 0.09, and 0.35 ± 0.09; compared with the RP group: 0.33 ± 0.09, 0.36 ± 0.11, and 0.36 ± 0.13; P = .153, .964, and .418, respectively). At 3 and 6 months follow-up, saccular aneurysms (n = 29) seemed to have a faster thrombosis speed compared with fusiform aneurysms (78.1 ± 26.8% and 83.9 ± 21.8% vs 47.0 ± 24.4% and 63.9 ± 22.6%; P = .004 and .013, respectively), but there was no significant difference in aneurysm shrinkage ratio at 24 months between the two groups (0.36 ± 0.10 vs 0.33 ± 0.06; P = .357). Conclusions: Multiple overlapping uncovered stents could be a feasible option for the endovascular treatment of peripheral and visceral aneurysms. Neither the aneurysm shape nor the initial sac RP would affect the midterm treatment outcome. Further validation of this technique is required to substantiate these results.
    No preview · Article · Jul 2014 · Journal of Vascular Surgery
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    ABSTRACT: Objective: This study aims at evaluating the safety and efficacy of a porous stent system consisting of multiple overlapping uncovered stents in the treatment of complex aortic aneurysms with vital branches. Methods: Data of all patients with aortic aneurysms treated in our center with multiple overlapping uncovered stents between February 2010 and December 2011 were retrospectively reviewed. Preoperative characteristics, intraoperative details, and follow-up outcomes were documented. Technical success was defined as successful deployment of the stents to target locations without procedure-related complications. Clinical success was characterized by complete shrinkage or stabilization of the aneurysm, preservation of vital branches, and absence of major complications. Patients were grouped, according to rapidity of aneurysm thrombosis, into fast-thrombosis group (complete thrombosis of aneurysmal sac was achieved in ≤6 months) and a delayed-thrombosis group (>6 months required for complete thrombosis). Possible factors affecting the speed of thrombosis were analyzed statistically with the Fisher exact test and the t-test. Results: This porous stent system was used to treat 34 patients (23 men, 11 women; mean age, 65.7 years). Technical success was achieved in all patients (100%). Regular follow-up over 6 months was achieved in 29 patients (mean length of follow-up, 11.4 months). Complete thrombosis of the aneurysm sac within 12 months was observed in 24 patients (83%). Aneurysm shrinkage was documented in seven patients (24%) and stabilization in 21 (72%). All branch arteries covered by bare stents stayed patent during follow-up. The overall clinical success rate reached 97% in the follow-up group. Risk factors for delayed thrombosis included fewer stents implanted (P = .013), longer sac entrance (P = .043), and use of antiplatelet medication (P = .040). Conclusions: An alternative method of management of complicated aortic aneurysm appears to be feasible using overlapping bare stents, which may prevent aneurysm growth while preserving vital branches. The short-term outcome of our study seems encouraging but is not sufficient to draw a robust conclusion. Further hemodynamic and clinical studies are warranted to evaluate long-term efficacy.
    No preview · Article · May 2013 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
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    ABSTRACT: Background: Multilayer stent has become a new endovascular strategy for visceral artery aneurysm repair. However, its use was not allowed in some areas, such as China. This study evaluates an alternative method: multiple overlapping bare stents for repairing visceral artery aneurysms. Methods: Twenty-four patients with celiac artery aneurysm (n = 2), splenic artery aneurysm (n = 8), hepatic artery aneurysm (n = 3), superior mesenteric artery aneurysm (n = 6), and renal artery aneurysm (n = 5) were treated with 2 to 4 overlapping bare stents. Long-term results, including clinical achievement ratio and target artery patency, were followed up with computed tomographic angiography. Results: Insertion of overlapping bare stents was successful in all patients. Five aneurysms (21%) were totally excluded 3 months after operation, increasing to 12 (50%) and 20 (83%) aneurysms with total isolation at 6 and 12 months' follow-up, respectively. The clinical achievement ratios of multiple overlapping bare stents on splenic artery aneurysms, hepatic artery aneurysms, renal artery aneurysms, celiac artery aneurysms, and superior mesenteric artery aneurysms were 75%, 100%, 80%, 50%, and 100%, respectively. All cases combined had 100% target artery patency. Conclusions: Preliminary experience showed that repair using multiple overlapping bare stents seemed to be a potential alternative strategy for treating visceral artery aneurysm, resulting in target artery patency. However, the exact mechanism requires further study and more cases should be involved.
    No preview · Article · Mar 2013 · Annals of Vascular Surgery
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    ABSTRACT: OBJECTIVES: This paper sought to report the outcomes of patients who are considered unfit for urgent surgical repair of ascending aortic dissections who were treated using a novel endovascular repair strategy. BACKGROUND: Ascending aortic dissection is best treated by direct surgical repair. Patients who are unable to undergo this form of treatment have poor prognoses. Previously, clinical case reports related to endovascular repair of ascending aortic dissection have been controversial. METHODS: Between May 2009 and January 2011, 41 consecutive patients with ascending aortic dissection were treated in our institution. Fifteen patients were considered poor candidates for direct surgical repair and subsequently underwent the endovascular repair. RESULTS: The nature of the referral process to our tertiary care facility made the median time from aortic dissection onset to treatment 25.5 days (range: 6 to 353 days). Dissections in 5 patients (33.3%) were considered acute, and those in 10 patients (66.7%) were considered chronic. The rate of successful stent-graft deployment was 100%, and there were no major morbidities or deaths in the perioperative period. Median follow-up was 26 months (range: 16 to 35 months). One new dissection occurred in the aortic arch at 3 months and was treated with a branched endograft. Significant enlargements of true lumens and decreases of false lumens and overall thoracic aorta were noted after the procedures. CONCLUSIONS: Endovascular repair of ascending aortic dissection was an appropriate treatment option in patients who were considered poor candidates for traditional direct surgical repair by the clinical criteria used in our institution. A larger series of cases with longer follow-up is needed to substantiate these results.
    Preview · Article · Oct 2012 · Journal of the American College of Cardiology
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    ABSTRACT: To clarify the outcome of surgical reconstruction for renal artery in Takayasu arteritis-induced renal artery stenosis (TARAS). A retrospective chart review was conducted on 33 consecutive patients with TARAS, who underwent aortorenal bypass (ARB) with autologous saphenous vein graft. There were 9 male and 24 female patients, with a mean age of (25 ± 11) years. The effects on blood pressure and renal function were analyzed. Primary, primary assisted, and secondary patency rates were determined. The effects of various factors on primary patency rate were analyzed. All patients showed hypertension. The mean blood pressure was (175 ± 26)/(100 ± 19) mmHg (1 mmHg = 0.133 kPa). The mean antihypertensive dosage was (2.1 ± 0.6) defined daily dose (DDD). Seventeen patients showed intractable hypertension. Mean estimated glomerular filtration rate was (78 ± 5) ml/min. One patient was dialysis-dependent, and 3 patients were combined with congestive heart failure. ARB was performed for the 39 renal arteries, including 27 unilateral and 6 bilateral bypasses. Postoperative morbidity was 15.2%. All patients survived. During follow-up of mean (56 ± 18) months, two graft occlusions and four graft restenoses occurred. All graft restenoses were eliminated successfully with percutaneous angioplasty, but one patient experienced restenosis again six months later. At 1, 3, and 5 years of follow-up, primary patency was 92%, 89%, and 79%, respectively, primary assisted patency was 95%, 95%, and 91%, respectively, and secondary patency was 95%, 95%, and 91%, respectively. ARB resulted in a decrease in mean blood pressure to 139/85 mmHg (one month post-ARB, P = 0.000) and 136/80 mmHg (last follow-up, P = 0.000), and a reduction in mean antihypertensive dosage to 1.4 DDD (one month post-ARB, P = 0.084) and 0.6 DDD (last follow-up, P = 0.000). Mean estimated glomerular filtration rate increased to 82 ml/min (P = 0.458) one month post-ARB, and 91 ml/min (P = 0.044) at last follow-up, respectively. The dialysis-dependent patient no longer required hemodialysis, and left ventricular dysfunction resolved in all of the three patients. ARB using the autologous saphenous vein graft is safe, effective and durable for treating TARAS.
    No preview · Article · Nov 2011 · Zhonghua wai ke za zhi [Chinese journal of surgery]
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    ABSTRACT: Chronic venous disorder (CVD) of the lower extremities generally induces dermatologic complications in lower extremity skin, such as hyperpigmentation. If not treated effectively, the lesions may develop into severe outcomes, including dermal ulcer or necrosis. To evaluate the clinical efficacy of Mailuo Shutong Granule, a compound traditional Chinese herbal medicine, and Hirudoid cream (heparinoid), in treatment of patients with dermal hyperpigmentation of skin caused by CVD. Design, setting, participants and interventions: A total of 108 CVD outpatients with pigmentation from Department of Vascular Surgery, Shanghai Changhai Hospital were randomly divided into Mailuo Shutong group, Hirudoid group and combined therapy group, with 36 patients in each group. Patients in the Mailuo Shutong group and the Hirudoid group were treated with Mailuo Shutong Granule or Hirudoid cream, respectively, while those in the combined therapy group were treated with Mailuo Shutong Granule plus Hirudoid cream. They were all treated for 28 d. Main outcome measures: Before and after the 28-day treatment, area and average gray value of pigmentation lesions were measured and evaluated. Thirty-three cases in the Mailuo Shutong group, 34 cases in the Hirudoid group and 31 cases in the combined therapy group were included for analysis. After treatment, area of pigmentation decreased and average gray value of pigmentation declined in all the 3 groups (P<0.05). The reductions of area and average gray value in the combined therapy group were more significant than those in the Mailuo Shutong group and Hirudoid group (P<0.05). There were no differences in improvement of pigmentation between the Mailuo Shutong group and Hirudoid group (P>0.05). These data suggest that both Mailuo Shutong Granule and Hirudoid cream can improve CVD-induced hyperpigmentation, and combined treatment of the two drugs results in better clinical efficacy.
    No preview · Article · Aug 2011 · Journal of Chinese Integrative Medicine
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    Q Lu · Z Jing · Z Zhao · J Bao · X Feng · R Feng · Z Mei
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    ABSTRACT: To analyse our experience with endovascular stent graft repair of descending aorta dissections that require supraaortic branch vessel revascularisation. Retrospective study. From 2001 to 2009, 22 consecutive patients with the above dissections were retrospectively analysed. Inclusion requirement: aortic landing zone proximal to the left subclavian artery of less than 15 mm. Hybrid, scalloped or fenestrated endovascular stent grafts were selected based on dissection characteristics. Annual follow-up visits (median 27.1 months) included computed tomography angiography. End points include progressive pathology, complications and survival rates. Surgery was successful in all except for one operative complication. Two patients died within 30 days after surgery, one to cerebral infarction and the other to myocardial infarction. No postoperative complications occurred in the remaining patients. Thrombosis formed in the aortic false lumen of the graft exclusion segment in all patients. The maximum diameter of this segment decreased in 18 patients and was stable in two. In 19 patients, blood flow remained in the false lumen distal to the exclusion area not covered by stent. Patency was seen at mid- and long-term follow-up, without proximal endoleak, graft displacement or deaths. Endovascular stent graft methods show promise in endovascular stent graft repair of proximal descending aortic dissections involving the distal arch.
    Preview · Article · Jul 2011 · European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery
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    R Feng · X Wei · Z Zhao · J Bao · X Feng · L Qu · Q Lu · Z Jing
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    ABSTRACT: To clarify the outcome of aortorenal bypass (ARB) in Takayasu arteritis-induced renal artery stenosis (TARAS). A retrospective chart review was conducted on thirty-three consecutive patients (24 females; mean age, 25 years) with TARAS, who underwent ARB with autologous saphenous vein graft. The effects on blood pressure and renal function were analyzed. Primary, primary assisted, and secondary patency rates were counted. The effects of various factors on primary patency rate were analyzed. All patients showed severe hypertension (mean BP, 175 ± 26/100 ± 19 mm Hg; mean anti-hypertensive dosage, 2.1 ± 0.6 DDD). Mean estimated glomerular filtration rate was 78 ± 5.1 ml/min. One patient was dialysis-dependent, and three patients had congestive heart failure secondary to left-ventricular dysfunction. ARB was performed for the 39 renal arteries, including 27 unilateral and 6 bilateral bypasses. Postoperative morbidity was 15%. All patients survived. During follow-up (mean, 56 months), two graft occlusions and four graft restenosis occurred. All graft restenosis were eliminated successfully with percutaneous angioplasty, but one patient experienced restenosis again six months later. At 1, 3, and 5 years of follow-up, primary patency was 92%, 89%, and 79%, respectively; primary assisted patency was 95%, 95%, and 91%, respectively; and secondary patency was 95%, 95%, and 91%, respectively. ARB resulted in a decrease in mean BP to 139 ± 15/85 ± 13 mm Hg at one month (P < .05) and 136 ± 19/80 ± 8 mm Hg at last follow-up (P < .05). Mean anti-hypertensive dosage decreased to 1.4 ± 0.8 DDD at one month (P < .05) and 0.6 ± 0.8 DDD at last follow-up (P < .05). Mean estimated glomerular filtration rate increased to 82 ± 4.7 ml/min (P > .05) at one month and 91 ± 4.1 ml/min (P < .05) at last follow-up. The dialysis-dependent patient no longer required haemodialysis, and congestive heart failure resolved in all three patients. Our data suggest that ARB with autologous saphenous vein graft is safe, effective and durable in treating TARAS.
    Preview · Article · Apr 2011 · European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery
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    ABSTRACT: Endovascular repair continues to pose a formidable technical challenge in the cases of aneurysm, dissection, and proximal type I endoleak involving the aortic arch. During the process of covering the aortic arch by stent graft to achieve better sealing, maintaining blood flow to the vital supra-aortic branches is difficult. We present a case of successful endovascular treatment of secondary type I endoleak by a double-chimney technique in a 36-year-old woman who had previously undergone a complicated descending aortic dissection repair. This endovascular technology might offer a new option to simultaneously preserve the innominate artery and the left carotid artery for total reconstruction of the aortic arch.
    Preview · Article · Feb 2011 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
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    ABSTRACT: To investigate the potential role of four and a half Lin-11, Isl-1, and Mec-3 (FHL1) protein in the pathogenesis of thoracic aortic dissection (TAD). The expression levels and localization of FHL1 protein in aortic tissue of TAD were analyzed using Western blot and immunohistochemistry. Furthermore, small interfering ribonucleic acid was used to knock down the FHL1 gene in rat aortic smooth muscle cells (SMCs). After assessing knockdown efficiency and specificity by real-time polymerase chain reaction and Western blot, the effect of FHL1 knockdown on cell proliferation and apoptosis was evaluated by 3- (4,5-Dimethylthiazol-2-yl) -2,5-diphenyltetrazolium bromide assay and flow cytometry, respectively. Compared with normal aortic tissue, FHL1 protein expression in aortic tissue from TAD patients was significantly downregulated. Immunohistochemistry analysis showed that FHL1 was mainly localized in the cytoplasm of SMCs. In diseased aortic tissue, FHL1 immunoreactivity was lowest in SMCs in the split aortic media and adjacent area, but relatively high in SMCs in the aortic intima and adventitia. FHL1 knockdown significantly inhibited the proliferation of rat aortic SMCs but exerted no obvious effect on cell apoptosis. FHL1 protein expression is downregulated in TAD. Downregulation of FHL1 expression might contribute to the pathogenesis of TAD, perhaps by suppressing the proliferation of aortic SMCs and affecting aortic wall remodeling.
    No preview · Article · Feb 2011 · Annals of Vascular Surgery
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    ABSTRACT: But Etudier le rôle potentiel de quatre et demi Lin-11, Isl-1, et de la protéine Mec-3 (FHL1) dans la pathogénie de la dissection de l’aorte thoracique (DAT). Méthodes Les niveaux d’expression et la localisation de la protéine FHL1 dans le tissu aortique des DAT ont été analysés en employant un Western Blot et de l’immunohistochimie. En outre, un petit acide ribonuclétique d’interférence a été employé pour démanteler le gène FHL1 dans les cellules musculaires lisses aortiques de rat (CMLs). Après évaluation de l’efficacité et de la spécificité de la précipitation par amplification de réaction en chaîne en temps réel et par Western blot, l’effet de la précipitation de FHL1 sur la prolifération des cellules et l’apoptose ont été évalués par analyse du 3 - (4,5-Dimethylthiazol-2-yl) bromure de −2.5 diphenyltetrazolium et par cytometrie en flux, respectivement. Résultats Comparée au tissu aortique normal, l’expression de la protéine FHL1 dans le tissu aortique des patients avec DAT était significativement freinée. L’analyse en immunohistochimie a prouvé que FHL1 était principalement localisé dans le cytoplasme des CMLs. Dans le tissu aortique malade, l’immunoreactivité de FHL1 était inférieure dans les CMLs des médias aortiques fissurées et dans le secteur adjacent, mais relativement élevée dans les CMLs de l’intima et de l’adventice aortique. La précipitation FHL1 empêchait de manière significative la prolifération des CMLs aortiques chez le rat mais n’avait aucun effet évident sur l’apoptose cellulaire. Conclusion L’expression de la protéine FHL1 est freinée dans les DAT. Le frein de l’expression de FHL1 pourrait contribuer à la pathogénie de la DAT, peut-être en supprimant la prolifération de CMLs aortiques et en affectant le remodelage de la paroi aortique.
    No preview · Article · Feb 2011 · Annales de Chirurgie Vasculaire
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    ABSTRACT: To analyze a single-center experience of fibrin glue sac embolization to eliminate type I endoleaks after endovascular aneurysm repair (EVAR), assessing the feasibility and effectiveness of the technique in long-term follow-up. A retrospective study was conducted involving 783 EVAR patients treated between August 2002 and February 2009. Under a standardized protocol, 42 (5.4%) patients (37 men; mean age 73 ± 8 years) underwent intraoperative transcatheter fibrin glue sac embolization to resolve type I endoleak persisting after initial intraoperative maneuvers to close the leak or in necks too short or angulated for cuff placement. Intrasac pressure was measured before and after glue injection. Computed tomographic angiography was performed to assess the outcome after 3, 6, and 12 months and annually thereafter. In this type I endoleak cohort, 16 (38.1%) patients had proximal necks <10 mm long, and 5 (11.9%) patients had proximal neck angulation >60°; 22 additional devices (8 stents, 14 cuffs) had been placed in the initial attempts to resolve the endoleaks. After fibrin glue injection, 41 (97.6%) of the 42 endoleaks were resolved using a mean 15 ± 10 mL of glue. Intrasac pressure decreased significantly in successfully treated cases. The patient who failed embolotherapy was converted to open surgery (2.4%); he died 2 months later from multiorgan failure. Two (4.8%) patients died in the perioperative period from myocardial infarction. One (2.4%) patient developed right lower extremity ischemia unrelated to the fibrin glue treatment. There were no allergic reactions. Over a median follow-up of 39.9 months (range 10-88), 3 (7.1%) patients died (1 aneurysm-related). Cumulative survival was 90.5% at 1 year, 87.0% at 3 years, and 82.6% at 5 years. The mean maximal aneurysm diameter fell from the baseline 59.5 ± 14.7 mm to 49.0 ± 11.6 mm (p<0.001). Of the 4 patients with increased aneurysm diameter during follow-up, 1 was converted, 2 are being observed due to advanced age, and 1 died of renal failure. No recurrent type I endoleak or glue-related complications were observed in follow-up. Fibrin glue sac embolization to eliminate type I endoleak after EVAR yielded excellent results in our experience, effectively and durably resolving the leaks. Balloon occlusion of the proximal aorta must be done during glue injection to block proximal flow and facilitate formation of a structured fibrin clot.
    No preview · Article · Dec 2010 · Journal of Endovascular Therapy
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    H. Lu · R. Feng · Q. Lu · Z. Jing
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    ABSTRACT: A 63-year-old male presented with recurrent pyrexia, low back pain, and night sweats followed by knee pain and the inability to walk. Computed tomography revealed disintegration of the 4th and 5th lumbar vertebrae, and a laparotomy revealed a large aneurysm. A Medtronic aortic-united-iliac, PTFE-covered stent sealed the orifice of the aneurysm and combined with antituberculous treatment, relieved the patient of primary symptoms.
    Preview · Article · Sep 2009 · EJVES Extra
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    ABSTRACT: The aortic media lesion is a key pathologic feature in thoracic aortic dissection. To identify key proteins in aortic media lesions that may contribute to its pathogenesis, we performed proteomic studies to find differentially expressed proteins in the media from diseased and normal thoracic aorta. Ascending aortic segments were obtained from patients with thoracic aortic dissection (n = 8) and age-matched normal donors (n = 6). The differentially expressed proteins of their media tissues were analyzed by 2-dimensional electrophoresis and mass spectrometry, and verified by Western blotting. Oxidative stress was measured by functional assays in a larger sample size (15 patients and 10 controls). Image analysis of the protein profiles from 2-dimensional gels revealed 126 differentially expressed proteins, of which 26 were identified by mass spectrometry. Among them, extracellular superoxide dismutase, an enzyme involved in oxidative stress, was selected for further studies. Western blotting showed that extracellular superoxide dismutase expression was more than 50% lower in patient samples than in controls (P < .001). Superoxide dismutase activity was consistently decreased (P < .001) and lipid peroxidation was increased (P = .019) in patient media homogenates compared with that in controls. Our results indicate that protein expression profiles in the aortic media from thoracic aortic dissection differ significantly from that of controls, which may provide important insights into the disease mechanisms. This study also suggests that increased oxidative stress may play an important role in the disease.
    No preview · Article · Jul 2008 · The Journal of thoracic and cardiovascular surgery
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    ABSTRACT: To evaluate the effect of the diameter of abdominal aortic aneurysm (AAA) on endovascular exclusion (EVE) and its results. From March 1997 to June 2007, 429 AAA patients were treated with endovascular stent-graft exclusion. According to the maximal diameter of abdominal aortic aneurysm, the patients were divided into two groups: group A (diameter < 55 mm, n = 274) and group B (diameter > or = 55 mm, n = 155). The diameter of AAA, involvement of iliac artery, length, diameter and distortion of aneurismal neck in the two groups were recorded and compared retrospectively. Patients in group B were significantly older than group A (73.7 vs 71.1 years, P < 0.05). More patients in group B was complicated with coronary artery disease than those in group A (P < 0.05). The mean diameter of AAA in group A was (46.6 +/- 6.8) mm, and (66.8 +/- 11.2) mm in group B (P < 0.05). Proximal aneurysmal necks were shorter, wider and more tortuous in group B than those in group A (P < 0.05). Extraperitoneal approach, embolism of inner iliac artery and reconstruction of another inner iliac artery and stretch technique were more applied in group B. There were more endoleak during operation in group B and more stent-grafts were used. There was significant difference in morbidity rate between the two groups, while no statistic difference in mortality. And in group B, there were a high rate of endoleak and secondary intervention post operation. The diameter of AAA affects EVE and its results. In small aneurysms, EVE carries better outcome than in big aneurysms.
    No preview · Article · Apr 2008 · Zhonghua wai ke za zhi [Chinese journal of surgery]