Predictors of post-operative mortality following treatment for non-ruptured abdominal aortic aneurysm

The aim of this prospective study of patients undergoing repair of non-ruptured abdominal aortic aneurysm between 1999 and 2003 was to evaluate and compare risk factors for mortality after surgery, to determine a complex of informative factors for lethal outcome, and to define patient risk groups. Logistic regression analysis revealed a complex of informative factors, including female gender, previous myocardial infarction, age greater than 75 years, and clinical course of abdominal aortic aneurysm as important indicators for lethal outcome. A risk score model identified low-, moderate- and high-risk groups with mortality rates of 2.9%, 8.0% and 44.4%, respectively.     

Flow dynamics in Models of Intracranial Terminal Aneurysms

Flow dynamics play an important role in the pathogenesis and treatment of intracranial aneurysms. The evaluation of the velocity field in the aneurysm dome and neck is important for the correct placement of endovascular coils, and the temporal and spatial variations of wall shear stress in the aneurysm are correlated with its growth and rupture. This numerical investigation describes the hemodynamic in two models of terminal aneurysm of the basilar artery. Aneurysm models with a aspect ratio of 1.0 and 1.67 were studied. Each model was subject to physiological representative waveform of inflow for a mean Reynolds number of 560. The effects of symmetric and asymmetric outflow conditions in the branches were studied.     

The vascular protective role of oestradiol: a focus on postmenopausal oestradiol deficiency and aneurysmal subarachnoid haemorrhage

The steroid hormone, oestradiol, has pleiotropic functions. The protective effects of oestradiol are attributed to its anti‐inflammatory, antioxidant, anti‐atherogenic, anti‐apoptotic, vasodilatory activities and regulation of micro RNA. Oestradiol upregulates endothelial nitric oxide synthase gene expression and increases the production of nitric oxide, an important vasodilator. It suppresses the renin–angiotensin system and monitors haemodynamic stress. The hormone maintains the integrity of blood vessels by reducing oxidative stress while upregulating the expression of antioxidant enzymes and prevents vascular inflammation by regulating pro‐ and anti‐inflammatory cytokines. Aneurysmal subarachnoid haemorrhage (aSAH) occurring as a consequence of the rupture of an intracranial aneurysm is a devastating cerebrovascular event, representing 5–7% of all strokes. Postmenopausal women are more susceptible to aSAH compared to men in the same age group. This gender disparity has been attributed to reduced levels of the vascular protective hormone oestradiol following menopause. This review is focused on the protective role of oestradiol on vasculature and how the drop in oestradiol levels after menopause dramatically increases the incidence of aSAH in women. During menopause, oestradiol deficiency may affect vascular integrity causing dysregulation of vascular homeostasis by affecting the renin–angiotensin–aldosterone system (RAAS) and inflammatory and apoptotic cascades, resulting in the weakening of the cerebral arterial wall and potentially to development of an aneurysm and its rupture. In view of the role of oestradiol in maintaining vascular integrity, treatments involving hormone replacement could be a promising approach in postmenopausal women who are at risk of developing or rupturing an intracranial aneurysm.     

瑞芬太尼复合七氟醚在颅内动脉瘤栓塞术中的临床观察

目的：探讨瑞芬太尼复合七氟醚在颅内动脉瘤栓塞术中的临床效果。方法：回顾性分析在我院行择期颅脑动脉瘤栓塞术的70例患者的临床资料,按照随机序号的方式将其分为观察组和对照组各35例,观察组患者采用瑞芬太尼复合七氟醚麻醉,对照组采用瑞芬太尼复合异丙酚麻醉,对两组麻醉诱导前1min（T1）、麻醉诱导后1min（T2）、插管时（T3）、手术开始后30min（T4）以及拔管时（T5）患者的血压、心率变化及清醒后拔管时间进行记录和分析。结果：两组患者在T2时收缩压（Systolic blood pressure,SBP）、舒张压（Diastolic blood pressure,DBP）和心率（HeartRate,HR）均较T1明显下降,比较差异均有统计学意义（P〈0．05）;观察组患者的清醒时间（5．1±1．5）min及拔管时间（15．5±7．5）min均明显短于对照组,两组比较差异有统计学意义（P〈0．05o结论：在进行颅内动脉瘤栓塞术时,选择使用瑞芬太尼复合七氟醚的麻醉方式,可使患者血流动力学较为稳定,术后苏醒较快,值得在临床推广应用。     

TGFBR1 mutations associated with Loeys-Dietz syndrome are inactivating

To assess the effect of Loeys-Dietz syndrome (LDS) mutations affecting TGFΒR1 a selection of seven disease-associated amino acid substitutions were introduced into wild type TGFβR1 and constitutively active TGFβR1^T204D. Receptor function was tested by co-transfection with a luciferase reporter or EGFP-tagged SMAD2 in HEK293 cells. All of the mutations were found to be inactivating for canonical TGF-β signaling. Differences in residual activity were not found to correlate with disease subtype. In co-transfection experiments with equal amounts wild-type receptor, the LDS mutations were found to confer a modest dominant negative effect. These results are discussed in relation to LDS and the related Marfan syndrome.     

自膨式支架辅助弹簧圈栓塞治疗颅内动脉瘤的疗效及安全性分析

摘要 目的：探讨自膨式支架辅助弹簧圈栓塞治疗颅内动脉瘤的疗效及安全性。方法：回顾性分析2014年1月-2019年1月我院采取自膨式支架辅助弹簧圈栓塞治疗颅内动脉瘤患者159例（A组）及采取单纯弹簧圈栓塞治疗颅内动脉瘤患者178例（B组）,比较两种手术方法治疗颅内动脉瘤的手术时间、术后住院时间、随访时间、手术相关并发症发生率并通过格拉斯哥（GOS）预后评分、Raymond分级比较2种治疗方法的安全性及有效性。结果：两组手术时间、术后住院时间、随访时间比较差异无统计学意义（P＞0.05）。两组术后出血及缺血事件发生率差异有统计学意义（P＜0.05）,脑积水、肺炎发生率、致死率及致残率差异无统计学意义（连续校正后P=1）。术后1月内及术后12个月随访GOS评分,A组评分高于B组,差异具有统计学意义（P＜0.05）;术后1月内及术后12个月随访Raymond分级,A组优于B组,差异具有统计学意义（P＜0.05）。结论：自膨式支架辅助弹簧圈栓塞治疗颅内动脉瘤栓塞效果明显且术后并发症少,对于颅内动脉瘤患者在弹簧圈栓塞基础上应用自膨式支架辅助可提高手术安全性及栓塞的疗效。     

不同时机行血管介入栓塞术治疗颅内动脉瘤的疗效及对患者预后、神经功能和血清炎性因子的影响

摘要 目的：探讨不同时机行血管介入栓塞术治疗颅内动脉瘤的疗效及对患者预后、神经功能和血清炎性因子的影响。方法：选择2019年3月到2020年12月期间我院收治的80例颅内动脉瘤患者,按手术时间的不同将其分为早期组、延期组,其中早期组36例,发病至手术时间≤72 h;延期组44例,发病至手术时间＞72 h,对比两组疗效、预后、神经功能、血清炎性因子及并发症发生率。结果：早期组的完全栓塞率高于延期组,基本栓塞率低于延期组（P<0.05）。两组术后3个月美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表评分均较术前下降,且早期组低于延期组（P<0.05）。早期组的预后良好率高于延期组（P<0.05）。两组术后3 d血清白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平下降,且早期组低于延期组（P<0.05）,白介素-10（IL-10）水平升高,且早期组高于延期组（P<0.05）。早期组的并发症发生率低于延期组（P<0.05）。结论：早期行血管介入栓塞术治疗颅内动脉瘤患者,可提高完全栓塞率,减轻神经功能损伤及炎性应激,降低并发症的发生风险,促进预后和生活质量改善。     

端粒生物学与胸主动脉瘤的研究进展

摘要：随着细胞生理性衰老,端粒（telomere）即染色体末端的重复性 DNA 序列会出现累积性损伤,而血管内皮细胞、平滑肌细胞衰老相关的端粒损伤和修复则被认为是退行性血管疾病发病的分子机制之一。胸主动脉瘤为老年人群中的重要致死性疾病之一,与衰老相关的退行性变在其中发挥着重要的作用。因此本文主要对端粒/端粒酶在胸主动脉瘤发病和进展中的作用做了概述,总结了血管病理学中端粒/端粒酶的调控机制。     

非编码RNA与胸主动脉瘤的研究进展

摘要：非编码RNA是一类缺乏编码蛋白能力的RNA,在机体发育和疾病发生发展过程中发挥着复杂而精确的调控功能。目前认为胸主动脉瘤（Thoracic aortic aneurysm, TAA）的发病涉及遗传因素、动脉内血流动力学变化、透壁炎症反应及细胞外基质降解和重构等。研究发现胸主动脉瘤病理进展过程中,易累及主动脉中膜平滑肌细胞,从而发生平滑肌细胞的丢失以及表型转化,而这些改变受到众多非编码RNA的调节。因此本文针对非编码RNA与胸主动脉瘤发病机制的密切关联做详细阐述。     

Finite element modeling of embolic coil deployment: Multifactor characterization of treatment effects on cerebral aneurysm hemodynamics

Endovascular coiling is the most common treatment for cerebral aneurysms. During the treatment, a sequence of embolic coils with different stiffness, shapes, sizes, and lengths is deployed to fill the aneurysmal sac. Although coil packing density has been clinically correlated with treatment success, many studies have also reported success at low packing densities, as well as recurrence at high packing densities. Such reports indicate that other factors may influence treatment success. In this study, we used a novel finite element approach and computational fluid dynamics (CFD) to investigate the effects of packing density, coil shape, aneurysmal neck size, and parent vessel flow rate on aneurysmal hemodynamics. The study examines a testbed of 80 unique CFD simulations of post-treatment flows in idealized basilar tip aneurysm models. Simulated coil deployments were validated against in vitro and in vivo deployments. Among the investigated factors, packing density had the largest effect on intra-aneurysmal velocities. However, multifactor analysis of variance showed that coil shape can also have considerable effects, depending on packing density and neck size. Further, linear regression analysis showed an inverse relationship between mean void diameter in the aneurysm and mean intra-aneurysmal velocities, which underscores the importance of coil distribution and thus coil shape. Our study suggests that while packing density plays a key role in determining post-treatment hemodynamics, other factors such as coil shape, aneurysmal geometry, and parent vessel flow may also be very important.