Lu Tian

Endovascular stenting for treatment of Nutcracker syndrome: report of 61 cases with long-term followup.

PURPOSE We report the efficacy and safety of endovascular stenting for nutcracker syndrome at long-term followup. MATERIALS AND METHODS We retrospectively evaluated the endovascular stenting experience with 61 patients with a median age of 26 years. Symptoms were hematuria, proteinuria or flank pain. Median followup was 66 months. RESULTS Peak velocity in the aortomesenteric portion, and the anteroposterior diameter ratio of the renal hilum and the aortomesenteric portion of the left renal vein on Duplex ultrasound after stenting was significantly decreased compared to that on Duplex ultrasound before stenting (p<0.05). However, peak velocity in the hilar portion did not statistically differ (p>0.05). Symptoms resolved or improved in 15, 24 and 20 of the 61 patients within 1 week, and 1 and 6 months, respectively, after endovascular stenting. Symptoms remained unchanged in 2 patients and recurred in 1. A perioperative complication was noted in 1 patient, that is a stent that was mistakenly moved and poorly deployed in a left renal vein collateral required operative intervention. Postoperative complications included stent migration into the right atrium, stent protrusion into the inferior vena cava and stent migration into the hilar left renal vein in 1 case each. CONCLUSIONS Based on our long-term followup endovascular stenting is a safe, effective procedure in select adults. We recommend endovascular stenting as primary option for nutcracker syndrome.

Nutcracker Syndrome—How Well Do We Know It?

Nutcracker syndrome (NCS), which is caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, leads to a series of clinical symptoms including hematuria, proteinuria, flank pain, and varicocele. The diagnosis of NCS is difficult due to variations in normal anatomy. Treatment, which ranges from observation to nephrectomy, remains controversial. We conducted a review based on the related literature and our experience with hundreds of cases. We summarize the characteristics of NCS, the different measurements used in diagnosis, and the current treatment options. We present our diagnostic criteria and recommend endovascular stenting as the primary option for NCS.

Acute Type B Aortic Intramural Hematoma: Treatment Strategy and the Role of Endovascular Repair

Purpose: To report a prospective study that explored the therapeutic strategies in the treatment of type B aortic intramural hematoma (IMH) and evaluated the role of endovascular repair. Methods: Between January 2001 and December 2009, 56 consecutive patients were enrolled in a prospective study to evaluate stent-graft repair versus medical therapy for acute type B IMH (patients with type A IMH excluded). Patients who had penetrating atherosclerotic ulcers, maximum aortic diameter >45 mm, hematoma thickness >10 mm, or sustained chest or back pain despite maximal medical therapy received endovascular stent-grafts (n=33; mean age 60 years, range 33–86), while other patients (n=23; mean age 56 years, range 29–83) received conservative therapy. Results: Stent-grafts were implanted successfully as scheduled in 33 patients as elective procedures; there were no complications related to the procedure. The mean follow-up up was 28±15 months (range 3–108). In the medically treated patients, there were 6 (26%) cases of IMH progression (4 treated with stent-grafts) and 2 (9%) deaths versus no IMH progression or death in the stent-graft patients. The thickness of the hematoma was reduced in all 37 patients receiving stent-grafts, and the maximum aortic diameter decreased in 19 of these patients. The 17 surviving patients in the medical group also showed regression of the hematoma in follow-up. Conclusion: Type B IMH is a potentially lethal disease, and the application of endovascular stent-grafts achieved an encouraging result in this study. Therefore, a more optimistic strategy, including endovascular repair, should be considered and evaluated in the future.

Cyclic RNA hsa‑circ‑000595 regulates apoptosis of aortic smooth muscle cells

Aortic aneurysm is a cardiovascular condition with a serious risk of mortality and the dismal prognosis of any type of major cardiovascular disease. The present study found that tissues from aortic aneurysm patients and hypoxic aortic smooth muscle cells showed aberrant high expression of the cyclic RNA hsa-circ-000595, as demonstrated by polymerase chain reaction array screening. Knockdown of hsa-circ-000595 resulted in a decreased apoptotic rate of human aortic smooth muscle cells. Furthermore, it was determined that miR-19a is a target of hsa-circ-000595. The results of the present study laid an epigenetic foundation for exploring the underlying mechanisms of the development of aortic aneurysm.

Stent migration after endovascular stenting in patients with nutcracker syndrome

OBJECTIVE In this study, we sought to investigate the incidence of stent migration after endovascular stenting (EVS) in patients with nutcracker syndrome (NCS) and to discuss the related factors. METHODS We retrospectively evaluated the data of all patients with NCS who were treated by EVS at our single center between January 2004 and October 2014. Data collection included details on clinical findings, radiologic evaluation, laboratory values, EVS procedure, stent size, and morbidity of stent migration. Sex, size of stents, interval (between EVS and stent migration), and preoperative parameters of the left renal vein (LRV) on duplex ultrasound (anteroposterior diameter in aortomesenteric portion and renal hilum of LRV, peak velocity in aortomesenteric portion and renal hilum of LRV) were analyzed. RESULTS A total of 75 patients (49 men) with a median age of 27 years (range, 16-43 years) underwent EVS for NCS. During a mean 55 months (range, 6-126 months) of follow-up, stent migration occurred in five patients (6.7%), and all of them were male. The stent migrated into the right ventricle in one patient, right atrium in one patient, inferior vena cava in two patients, and left side of the LRV in one patient. There were no significant differences in preoperative anteroposterior diameter and peak velocity of the aortomesenteric portion and renal hilum of the LRV on duplex ultrasound between patients with and without stent migration. There were also no significant differences in these parameters between patients with deployment of 12-mm and 14-mm-diameter stents. CONCLUSIONS Stent migration after EVS in patients with NCS is not as rare as we originally thought. Preoperative anatomic parameters of the LRV need to be more accurately measured. Stent choice for the individual patient and accurate stent deployment are important to avoid stent migration. Closer follow-up and early detection and treatment can reduce the number of stent migrations into the heart.

Endovascular Management of Nutcracker Syndrome After Migration of a Laparoscopically Placed Extravascular Stent

Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery and the aorta, leading to symptoms of hematuria and left flank pain. Management options include endovascular or laparoscopic extravascular stent placement, which is very appealing given the minimally invasive nature of these procedures. We report a case of migration of a laparoscopically placed extravascular stent for nutcracker syndrome that was treated successfully by endovascular stent placement.

Extravascular stent management for migration of left renal vein endovascular stent in nutcracker syndrome

BackgroundNutcracker syndrome is an entity resulting from left renal vein compression by the aorta and the superior mesenteric artery, which leads to symptoms of hematuria or left flank pain. The alternative option of endovascular or extravascular stenting is very appealing because of the minimal invasive procedures. Stents in the renal vein can cause fibromuscular hyperplasia, proximal migration or embolization.Case presentationA 30-year-old female was diagnosed with nutcracker syndrome for severe left flank pain. After failed conservative approach, she underwent endovascular stenting and subsequently developed recurrent symptom for stent migration one month postoperatively. She underwent successful extravascular stenting with complete symptom resolution.ConclusionThe extravascular stenting is an alternative option after migration of left renal vein endovascular stenting. The computed tomographic imaging was closely correlated to therapeutic interventions and stent migration.

Identification of key genes associated with the human abdominal aortic aneurysm based on the gene expression profile

The present study was aimed at screening the key genes associated with abdominal aortic aneurysm (AAA) in the neck, and to investigate the molecular mechanism underlying the development of AAA. The gene expression profile, GSE47472, including 14 AAA neck samples and eight donor controls, was downloaded from the Gene Expression Omnibus database. The total AAA samples were grouped into two types to avoid bias. Differentially expressed genes (DEGs) were screened in patients with AAA and subsequently compared with donor controls using linear models for microarray data, or the Limma package in R, followed by gene ontology enrichment analysis. Furthermore, a protein-protein interaction (PPI) network based on the DEGs was constructed to detect highly connected regions using a Cytoscape plugin. In total, 388 DEGs in the AAA samples were identified. These DEGs were predominantly associated with limb development, including embryonic limb development and appendage development. Nuclear receptor co-repressor 1 (NCOR1), histone 4 (H4), E2F transcription factor 4 (E2F4) and hepatocyte nuclear factor 4α (HNF4A) were the four transcription factors associated with AAA. Furthermore, HNF4A indirectly interacted with the other three transcription factors. Additionally, six clusters were selected from the PPI network. The DEG screening process and the construction of an interaction network enabled an understanding of the mechanism of AAA to be gleaned. HNF4A may exert an important role in AAA development through its interactions with the three other transcription factors (E2F4, NCOR1 and H4), and the mechanism of this coordinated regulation of the transcription factors in AAA may provide a suitable target for the development of therapeutic intervention strategies.

Surgical shunts compared with endoscopic sclerotherapy for the treatment of variceal bleeding in adults with portal hypertension: a systematic review and meta-analysis

Aim Portal hypertension is a common complication of chronic liver disease and can cause variceal bleeding which is associated with high mortality. Choices for the treatment of variceal bleeding include surgical shunts and endoscopic sclerotherapy. The aim of this study was to compare the efficacy of surgical shunts and endoscopic sclerotherapy in treating variceal bleeding due to portal hypertension. Design Systematic review and meta-analysis. Setting Medline, PubMed, Cochrane and Google Scholar databases were searched until 12 February 2015, for relevant randomised control trials. Twenty studies with a total of 1540 participants were included. Patients Patients with variceal bleeding due to portal hypertension. Interventions Surgical shunts compared to endoscopic sclerotherapy. Main outcome measures Rates of rebleeding, survival and hepatoencephalopathy, and length of hospital stay. Results Pooled data for 17 studies showed that the rate of rebleeding was significantly more frequent with sclerotherapy compared with surgical shunt therapy (OR 3.99, 95% CI 2.98 to 5.33, p<0.001). The sclerotherapy patient group compared with the shunt group was less likely to develop hepatoencephalopathy (15 studies: pooled OR 0.53, 95% CI 0.31 to 0.91, p=0.021) and had shorter hospital stays (pooled mean difference−4.32, 95% CI− 7.97 to −0.66, p=0.021). No significant difference in the survival rate was observed between the two groups (seven studies: OR 1.01, 95% CI 0.63 to 1.62, p=0.964). Conclusion This analysis indicated that the two types of treatment have similar mortality rates but differed with respect to rebleeding rate, incidence of hepatoencephalopathy and length of hospital stay.

Comprehensive analysis of differentially expressed profiles of lncRNAs and mRNAs reveals ceRNA networks in the transformation of diffuse large B‑cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is one of the malignancies with a high mortality rate. The molecular mechanisms involved in transformation of DLBCL remain unclear. Therefore, it is critically important to investigate the biological mechanisms of DLBCL. Accumulating evidence indicates that long non-coding RNAs (lncRNAs) serve key functions in tumorigenesis, cancer progression and metastasis. Compared with follicular lymphoma (FL), a total of 123 upregulated lncRNAs and 192 downregulated lncRNAs in DLBCL were identified. Subsequently, a specific DLBCL-associated competing endogenous RNA (ceRNA) network and a specific FL-associated ceRNA network was constructed. Gene Oncology and Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that differentially expressed lncRNAs served key functions in regulating signal transduction, transcription, cell adhesion, development and protein amino acid phosphorylation. Furthermore, the molecular functions of PRKCQ antisense RNA 1, HLA complex P5, OIP5 antisense RNA 1, growth arrest specific 5 and taurine upregulated 1 were investigated, and it was revealed that these lncRNAs served important functions in regulating a series of biological processes, including anti-apoptosis, cell cycle, DNA repair, response to oxidative stress and transcription. The present study may provide a potential novel therapeutic and prognostic target for the treatment of DLBCL.