have changed. However, many requirements must be in place for EVAR to be a viable alternative to open repair for patients with rAAAs. Such factors include available surgical expertise, available nursing expertise, and of course, available devices at all times in the operating room. It seems unlikely, unless an institution has large exposure to patients with rAAAs, that all of these things would come together with sufficient frequency that EVAR repair of rAAAs will exceed open repair of rAAAs in the near future. Effects of Extended-Release Metoprolol Succinate in PatientsUndergoing Non-Cardiac Surgery (POISE Trial): A Randomized Controlled Trial POISE Study Group. Lancet 2008;371:1839-47. Conclusion:The use of perioperative -blockade in patients undergoing noncardiac surgery results in a decrease in the composite end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal cardiac arrest, but results in an increased risk of death from all causes and stroke.Summary: Trials of routine use of -blockers in patients undergoing noncardiac surgery have reported conflicting results. The authors performed a randomized controlled trial in 190 hospitals in 23 countries to investigate the effects of perioperative -blockers. Initially, 9280 patients with, or at risk of, atherosclerotic disease and undergoing noncardiac surgery were randomized to receive extended-release metoprolol succinate or placebo. Unfortunately, it was determined that there were fraudulent data from six hospitals in Iran (752 participants) and three hospitals in Columbia (195 participants). These patients were excluded from the data, leaving 8351 patients from 190 hospitals in 23 countries for analysis.There were 4174 persons randomized to receive metoprolol and 4177 to receive placebo. Medication was administered 2 to 4 hours before surgery and continued for 30 days. Outcome adjudicators, data collectors, and health care providers for the individual patients were masked to treatment allocation. The primary end point was a composite end point of nonfatal myocardial infarction, nonfatal cardiac arrest, and cardiovascular death. Analysis was by intention to treat. The analysis included 8351 patients, and 8331 (99.8%) completed the 30-day follow-up.In the metoprolol group, 244 (5.8%) reached the primary end point vs 290 (6.9%) in the placebo group (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.70-0.99; P ϭ .0399). Fewer patients in the metoprolol group sustained myocardial infarction vs the placebo group (176 [4.2%] vs 239 [5.7%]; HR, 0.73; 95% CI, 0.60-0.89; P ϭ .0017). More overall deaths occurred in the metoprolol group than in the placebo group (129 [3.1%] vs 97 [2.3%]; HR, 1.33; 95% CI, 1.03-1.74; P ϭ .0317). More strokes occurred in the metoprolol group than the placebo group (41 [1.0%] vs 19 [0.5%]; HR, 2.17; 95% CI, 1.26-3.74; P ϭ .0053). Predetermined subgroup analyses for region, whether on-site monitoring occurred, and based on the presence of known atherosclerotic cardiovascular disease did not show subgroup effec...
WHAT THIS PAPER ADDS This comprehensive network meta-analysis used data from 28 randomised controlled trials of commonly used endovascular treatments for femoropopliteal lesions. It was found that drug eluting stents were significantly more effective than drug coated balloons for the treatment of short lesions. However, the overall analysis did not demonstrate any significant difference in the efficacy of drug eluting stents, covered stents, drug coated balloons, and bare metal stent. Percutaneous transluminal angioplasty alone does not constitute an effective choice. These outcomes may contribute to clinical decision making. Background/objective: Endovascular interventions for femoropopliteal (FP) arterial diseases are limited by the development of restenosis. Current drug coated devices are capable of preventing restenosis by releasing antiproliferative agents to the vessel wall. However, default strategies for the treatment of FP diseases remain controversial. The aim of this study was to investigate the efficacy differences between drug eluting stents (DES), covered stents (CS), and other commonly used endovascular treatments in FP lesions, including drug coated balloons (DCBs), bare metal stents (BMS), and percutaneous transluminal angioplasty (PTA). Methods: A comprehensive network meta-analysis was conducted using data from relevant randomised control trials published up to 16 December 2018. Primary patency and target lesion revascularisation (TLR) at 12 months were set as the primary and secondary end points, respectively. Results: Twenty-eight eligible trials including 4728 patients were selected. DES was ranked as the most effective treatment in the multidimensional analysis of primary patency; however, there was no significant difference in the efficacy of DES and that of CS, DCB, and BMS. However, in short lesions (<10 cm), DES was significantly more effective than DCB (odds ratio 0.35; 95% confidence interval 0.15e0.83). Primary patency at 12 months was significantly lower with PTA. In terms of preventing TLR, DCB was ranked first, followed by DES, CS, BMS, and PTA. TLR was significantly higher with PTA than with other treatment strategies. Conclusion: The findings of this network meta-analysis suggest that this is not the appropriate time to identify the best endovascular treatment strategy for the FP segment. DES is effective in maintaining mid-term patency, especially in short lesions, whereas DCB seems more suitable for clinical use.
increasing evidence suggests that T-cell immunoglobulin and mucin domain 3 (TiM-3) displays anti-atherosclerotic effects, but its role in vascular smooth muscle cells (VSMcs) has not been reported. The present study aimed to investigate the function of TiM-3 and its roles in human artery VSMcs (HaSMcs). a protein array was used to investigate the TIM-3 protein expression profile, which indicated that TiM-3 expression was increased in the serum of patients with lower extremity arteriosclerosis obliterans disease (leaod) compared with healthy individuals. immunohistochemistry and western blotting of arterial tissue further revealed that TiM-3 expression was increased in leaod artery tissue compared with normal artery tissue. additionally, platelet-derived growth factor-BB (PdGF-BB) displayed a positive correlation with TiM-3 expression in HaSMcs. TiM-3 decreased the migration and proliferation of PdGF-BB-induced HaSMcs, and anti-TiM-3 blocked the effects of TiM-3. The effect of TiM-3 on the proliferation and migration of HaSMcs was further investigated using lV-TiM-3-transduced cells. The results revealed that TiM-3 also inhibited PDGF-BB-induced expression of the inflammatory factors interleukin-6 and tumor necrosis factor-α by suppressing nF-κB activation. in summary, the present study revealed that TiM-3 displayed a regulatory role during the PDGF-BB-induced inflammatory reaction in HASMCs, which indicated that TiM-3 may display anti-atherosclerotic effects.
Background The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular-weight heparin (LMWH) during CDT for DVT. Methods The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage. Results A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) × 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) × 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (> 90%) and partial thrombolysis (50 ~ 90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant differences in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions Anticoagulation therapy using low molecular-weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.
Arteriosclerosis obliterans (ASO) is a limb manifestation of large vessel atherosclerosis. Phenotype switching of vascular smooth muscle cells (VSMCs) occurs in the course of the pathological process. The underlying mechanism of SMCs proliferation remains unclear. Several studies have demonstrated that the dysregulation of long non-coding RNA (lncRNAs) plays a pivotal part in the progression of ASO by exacerbating the proliferation of VSMCs. Based on the endogenous competitive RNA (ceRNA) hypothesis, the mechanism of lncRNAs involved in the pathology of VSMCs was exposed, while the entire map of the regulatory network remains to be elucidated. In the current study, genes and the lncRNAs modules that are relevant to the clinical trait were confirmed through weighted gene co-expression network analysis (WGCNA). In this study, we comprehensively constructed a specific lncRNAs-mediated ceRNA and RBP network. The three lncRNAs, HMGA1P4, C5orf66, and AC148477.2, influenced the proliferation of VSMCs and were found to be associated with the immune landscape, thus they were ultimately screened out. Further verification revealed that AC147488.2 was significantly down-regulated in both ASO arteries and all stages of proliferative VSMCs, which implied that AC147488.2 might have a significant impact on ASO. This finding would improve our understanding of the epigenetic regulation of ASO and unravel novel diagnostic and therapeutic targets.
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