Vascular Investigation and Therapy

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The aim of the study was to evaluate the efficacy and safety of increased doses of anticoagulants in comparison with standard doses in inpatients with COVID-19. A systematic review was carried out in October 2021 using the PubMed database. The analysis included only randomized clinical trials (RCTs) with ≥ 200 participants that reported the rate of death as the total number of cases or the percentage of patients. The primary outcome was all-cause mortality within the observational period. In addition, the risk of arterial and venous thrombotic events and major and clinically relevant nonmajor (CRNM) bleeding was assessed. Searching of Pubmed identified 8903 references. The final qualitative and quantitative analysis included the results of 6 RCTs that covered 5228 patients. Among all patients, 2660 received increased and 2568 standard doses of anticoagulants. The follow-up period varied from 21 to 30 days. The administration of increased doses did not affect the risk of death (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.73–1.25; I2 = 59.5%), was associated with a reduced risk of thrombotic events (OR, 0.56; 95% CI, 0.43–0.73; I2 = 20.6%), and increased risk of major bleeding (OR, 1.86; 95% CI, 1.23–2.80; I2 = 0%) or CRNM bleeding (OR, 3.65; 95% CI, 1.65–8.09; I2 = 0%). Within the sensitivity analysis, similar results were obtained in the subgroups of critically ill or stable patients and individuals with increased D-dimer. The maximal reduction in the risk of thrombotic events was found for the subgroup of patients with increased D-dimer (OR, 0.48; 95% CI, 0.32–0.70; I2 = 36.4%). The use of increased doses of anticoagulants in inpatients with COVID-19 does not reduce the risk of death. Still, it is associated with a decrease in the risk of thrombotic events and increased risk of major bleeding.

Arterial claudication is generally the revealing form of clinically symptomatic lower extremity artery disease. It is defined as a pain of limb muscles that occurs during exercise and is relieved within 10 min when exercise is lowered or stopped. Atherosclerosis is the first underlying cause of arterial intermittent claudication. As such, the occurrence of arterial claudication is a severe medical event sharing almost similar the long-term morbidity and mortality risk as other arterial events such as stroke or myocardial infarction. Comorbid (both vascular and nonvascular) affections must be actively searched. Surgery is generally indicated only when medical treatment and training have failed to improve symptoms. This paper shortly reviews the cause, presentation, diagnostic algorithm, and treatments of arterial claudication.

OBJECTIVES: Occlusion of intimal tear with occlusive devices is an alternative or adjuvant method for endovascular repair of Stanford type B aortic dissection (TBAD) with insufficient landing zones. This study aimed to evaluate the efficacy and safety of using occluders in highly selective TBAD patients inappropriate for conventional thoracic endovascular aortic repair (TEVAR). METHODS: All patients undergoing TEVAR between July 2009 and July 2015 were retrospectively reviewed and patients treated with only or adjuvant occlusive devices were included in the study. Demographic data, clinical characteristics, perioperative data, and follow-up were collected and analyzed. RESULTS: A total of 10 TBAD patients treated with occluders were included in the study. The mean age was 56.8 ± 12.7 years old and the majority of the patients were male (7/10). Only occluders were applied to seal the proximal tears in seven cases, while occluders combined with other endovascular techniques were used in three cases. No 30-day mortality operative reintervention was required in two cases. Eight patients were followed up for 10.0 ± 4.1 years and two cases were lost to follow-up. Three patients died during the follow-up period; one patient died of stroke, while the other two patients died due to noncardiovascular causes. One reintervention was performed due to endoleak 2 years after the surgery. CONCLUSIONS: The early and long-term outcomes of the 10 patients show that treating difficult aortic lesions unfit for traditional TEVAR with occluders is effective and safe. The technique may provide a treatment alternative in highly selective TBAD patients unfit for traditional TEVAR.

OBJECTIVE: The objective of this study was to investigate how receptor for advanced glycation end-products–mitogen-activated protein kinase–nuclear factor-kappa B (MAPK-NF-κB) pathway is involved in advanced glycation end-product (AGE)-induced human umbilical venous endothelial cell (HUVEC) dysfunction. MATERIALS AND METHODS: HUVECs were cultured with AGEs, anti-RAGE, inhibitors of MAPK or NF-κB respectively. Then we detected endothelial nitric oxide synthase (eNOS) activation, nitric oxide (NO) concentration, cell migration ability, and RAGE expression of HUVECs. RESULTS: AGEs depressed eNOS activation, decreased NO concentration, impaired endothelial cell (EC) migration, and upregulated RAGE expression, which could be recovered by p38 inhibitor and extracellular regulated protein kinases (ERK) inhibitor. However, these effects could not be recovered by NF-κB inhibitor. CONCLUSIONS: AGEs increase RAGE expression and decrease NO release and migration of HUVECs through RAGE-MAPK pathway, but not NF-κB pathway.

OBJECTIVE: The objective of this study was to investigate the safety and efficacy of hepatocyte growth factor (HGF) gene therapy in the patients with diabetic lower limb arteriosclerosis obliterans, provide theoretical support for better coordination of clinical operation and anesthesia, ensure medical safety, and improve the quality of nursing. MATERIALS AND METHODS: Twenty-one patients with Grade 4–6 (Rutherford classification) and limb ischemia who met the inclusion criteria were divided into four dose groups, including three cases in the 4 mg group, six cases in the 8 mg group, five cases in the 12 mg group, and seven cases in the 16 mg group. The dosage of each group was divided into equal doses, which were injected intramuscularly on the 1^st and 15^th days of treatment, respectively. The dosage of each injection point was 0.25 mg/0.5 ml. Adverse reactions, visual analog scale (VAS) scores for pain and ulcer healing were observed on the 1^st, 8^th, 15^th, 21^st, 28^th, 59^th, and 91^st days after the treatment. The ankle-brachial index (ABI) was measured on the 1^st, 28^th, 59^th, and 91^st days after the treatment. RESULTS: Complications, serious adverse reactions, and abnormal test results did not occur in the patients during the operation. After the operation, the pain had significantly reduced in 17 cases, the average VAS score of all cases decreased from 5.95 to 1.64 (P < 0.05), and the pain disappeared completely in four cases. The average ABI of all cases increased from 0.49 to 0.63 (P < 0.05), five cases had ulcer, and four cases had gangrene. After treatment, one case of ulcer and one case of gangrene healed completely, and three cases of ulcer and one case of gangrene improved significantly, and one case of ulcer and two cases of gangrene had no significant change. CONCLUSION: HGF gene therapy can effectively treat diabetic lower limb arteriosclerosis obliterans, relieve the clinical symptoms and improve the quality of life. The smooth operation is inseparable from the cooperation of nurses, including careful preoperative visit, strict aseptic operation during the operation, follow-up visit regularly after the operation, and mastering the changes in patients' condition in the whole process to provide high-quality nursing for patients.

Online since 23^rd January 2018.