Abstract:To investigate the risk factors for lower extremity atherosclerosis disease (LEAD) in the elderly people. Methods Included as case group were 98 elderly LEAD patients treated in the Vascular Surgery of People′s Hospital in Inner Mongolia Autonomous Region and the Vascular Surgery of Peking Union Medical College Hospital from May 1,3 to December 31,4. At the same time, 70 healthy elderly people were enrolled as the control group who received check-ups at the 2 institutions. The baseline data and clinical indices of the 2 groups were collected and compared. SPSS statistics 19.0 was used for statistical analysis, and independent samples t test or χ² test, depending on data type, was used for comparison. The independent variables with P<0.01 in univariate analysis were included in a multiple logistic regression model to investigate the risk factors for LEAD in the elderly patients. Results The proportion of the male patients, the proportion of the smokers, hypertension rate, and systolic pressure in the case group were significantly higher than those in the control group, but diastolic pressure and body mass index were significantly lower (P<0.05). Of the clinical indices, fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), insulin, creatinine and high sensitivity C-reactive protein (hs-CRP) were significantly higher in the case group than in the control group, but the high-density lipoprotein cholesterol (HDL-C) and ankle brachial index (ABI) were significantly lower (P<0.05). Multiple factor logistic regression showed that sex (OR=1.007,5%CI 0.201-1.232), smoking (OR=0.181,5%CI 0.044-1.119), systolic pressure (OR=0.153, 95%CI 0.135-0.198), FBG (OR=3.226,5%CI 1.589-5.103), HOMA-IR(OR=2.971,5%CI 1.456-4.716), insulin(OR=1.996,5%CI 1.309-3.311), HDL-C(OR=0.311, 95%CI -0.237-0.515), hs-CRP(OR=1.058,5%CI 0.313-1.157)and ABI(OR=-3.011, 95%CI -4.238--2.010)were independent risk factors for LEAD (P<0.05). Conclusion Screening for LEAD should be emphasized in the elderly men with hypertension or diabetes, and they should be advised to quit smoking, control blood pressure and glucose, and reduce lipid.

Abstract:Objective To investigate the changes in medical expenditures in the patients with diabetic foot ulcers treated during 2006 to 2015. Methods The medical records of those first diagnosed as diabetic foot in Chinese PLA Hospital No.306 from 2006 to 2015 were retrieved from a self-developed database for the analysis of their medical expenditures. Results A total of 1962 patients (1201 males and 761 females) with diabetic foot were treated in this 10-year period, with the median age falling from 70 to 61 years and the median hospitalization from 29 to 17 days. An annual increase was observed in the highest average daily medication cost (median=RMB ￥649.5), the highest average daily examination fee (median=RMB ￥345.5) and the highest average daily bed care cost (median=RMB ￥114.7) with a median of the highest daily average treatment cost being RMB ￥191.2, which had no significant change. The proportion of self-funded patients decreased yearly from 42.2%(35/83) to less than 10%, and the proportion of the patients covered by New Rural Cooperative Medical Care by 18.1%(27/149), and the total medical cost increased. Conclusion From 2006 to 2015, the patients with diabetic foot became younger, with shorter hospital stay, increased medical cost, yearly decrease in the proportion of self-funded patients, and yearly increase in the proportion covered by New Rural Cooperative Medical Care.

Abstract:Objective To evaluate the safety and efficacy of continuous intravascular heparin infusion for acute lower extremity ischemia (ALI) in the elderly patients. Methods Sixty-seven elderly patients with ALI were enrolled in the study, who received endovascular treatment from July 2015 to February 2017 in PLA Army General Hospital. They were divided into 2 groups, one treated with standard catheter-directed thrombolysis (control group, n=35) and the other with continuous intraventricular heparin perfusion (heparin group, n=32). In the former, urokinase 1 million IU/day was administered via continuous infusion and low molecular heparin with 100 IU/(kg·12 h) hypodermically. In the latter, a continuous infusion heparin was administered at 18 U/(kg·h). Patients were followed up for 30 d, 3 months, and 1 year. Data of the general information, severity of ischemia, ankle brachial index (ABI), duration of the treatment, number of clots dissolved by thrombolysis and complications were recorded, and comparison was made between the 2 groups. SPSS statistics 23.0 was used for data analysis, and t test or Chi-square test for comparison, depending on data type. Results No significant difference was observed in general information and ischemic severity between the 2 groups (P>0.05). Compared with the control group, heparin group had significantly longer duration of continuous treatment [(53.24±10.49) vs (35.67±9.25)min, P=0.010] and lower hemorrhage rate [0.0%(0/32) vs 11.4%(4/35), P=0.001]. There was no significant differences in total thrombolysis rate, improvement in ABI, incidence of cardiovascular events, rate of amputation and mortality within 30 days, and rate of free-amputation at 1 year of follow-up (P＞0.05). Conclusion Continuous intravascular heparin infusion can achieve good short-term effects with significantly reduced hemorrhage rate. It serves as a safe and effective minimally invasive treatment for ALI in the elderly patients with high risk of hemorrhage.

Abstract:Objective To investigate the relationship between diabetic peripheral neuropathy and clinical indicators of oxidative stress in the patients with type 2 diabetes mellitus. Methods General and clinical data were collected of patients hospitalized from 2016 to 2017 with type 2 diabetes mellitus in our hospital. The patients were divided into group A with peripheral neuropathy (n=97) and group B (n=115) without. The two groups were compared in general and clinical data using SPSS statistics 23.0, and logistic regression was employed to analyze the risk factors for diabetic peripheral neuropathy. The characteristics of diabetic peripheral neuropathy and its correlation with clinical indicators of oxidative stress were investigated. Results The age, disease duration, glycosylated hemoglobin A1c and total cholesterol were significantly higher in group A than in group B, while fasting C peptide, hemoglobin and total bilirubin was significantly lower in the former than in the latter (P<0.05). The univariate logistic regression model revealed that age, disease duration, glycosylated hemoglobin A1c, total bilirubin and hemoglobin might be associated with diabetic peripheral neuropathy. The multivariate logistic regression analysis showed that disease duration (OR=1.006,95%CI 1.003-1.010), glyco-sylated hemoglobin A1c (OR=1.403,95%CI 1.118-1.657), hemoglobin (OR=0.976,95%CI 0.958-0.994) were significant risk factors for diabetic peripheral neuropathy. Conclusion Patients with diabetic peripheral neuropathy have lower clinical indicators of oxidative stress (total bilirubin and hemoglobin) than those without, the former being more advanced in age, having long duration of diabetes, poorer blood glucose control, and poorer islet function.

Abstract:Objective To compare the efficacy of superficial femoral artery stenting (SFAS) and deep femoral artery profundoplasty (DFAP) in patients with atherosclerotic lesions of common femoral artery. Methods A retrospective study was made of 40 patients treated in Beijing Jishuitan Hospital from January 2012 to December 2016 with severe lower limb ischemia (Rutherford stages 3-5). The patients were divided into 2 groups with 20 in each:SFAS group and DFAP group. The changes of ankle brachial index (ABI) and Rutherford stages were assessed before and after operation. Comparison was made in the respects of the amputation rate at 2 years and patency rates at 1 year and 2 years. SPSS statistics 17.0 were used for data analysis, and t test or Chi-square test for comparison. Results No significant differences between 2 groups (P>0.05) was observed in age, gender, clinical symptoms, blood glucose, blood lipids, hypertension, coronary heart disease and damaged blood vessel ratio. The postoperative ABI in both groups was significantly improved [(0.98±0.09) vs (0.51±0.08), t=-18.450, P<0.001] in SFAS group and [(0.70±0.10) vs (0.47±0.07), t=-8.910,P＜0.001] in DFAP group, but compared with DFAP group, SFAP group had higher postoperative ABI[(0.98±0.09) vs (0.70±0.10)], higher Rutherford grade reduction rate [90%(18/20) vs 60%(12/20)], and lower patency rate at 1 year [70%(14/20) vs 95%(19/20)] and 2 years [55%(11/20) vs 90%(18/20)]. The differences were statistically significant (P<0.05). Conclusion Both DFAP and SFAS can relieve symptoms and increase blood supply to limbs in the patients with severe lower limb ischemia from atherosclerotic lesions at the bifurcation of the common femoral artery. The immediate symptom relieve by SFAS is better than by DFAP, and DFAP results in higher patency rate at 1 year and 2 years than SFAS.

Abstract:Objective To assess the efficacy and safety of drug-coated balloon (DCB) treatment for femoralpopliteal arteriosclerosis occlusion.Methods A retrospective analysis was conducted of 162 patients treated in our hospital from June 2016 to May 2017 with femoralpopliteal artery disease (Rutherford 2-4). The patients were classified as DCB group (n=102) treated with DCB and PTA group (n=60) with percutaneous transluminal angioplasty (PTA). The patients were followed up and evaluated at 30 days, 6 months and 12 months after operation. Basic information was collected, and efficacy endpoints and safety endpoints were analyzed for both groups. SPSS statistics 19.0 was used for data analysis, and independent samples t test, Chi-square test (Pearson Chi-square or four-fold contingency table) or Wilcoxon signed-rank test were used for comparison. Results No significant difference between the 2 groups was observed in the basic data, but the male and the smokers in both groups accounted for above 50%. There was no significant difference between the 2 groups (P>0.05) in the characteristics of lesion and operation-associated variables. At 12 months follow-up, DCB group had a significantly greater increase than the PTA group in the primary patency rate [76.5%(78/102) vs 56.7%(34/60),P=0.008] and ankle brachial index (ABI) [(0.89±0.14) vs (0.82±0.20), P=0.027] and a significantly greater decrease in the ratio of target lesion revascularization (TLR) [5.9%(6/102) vs 27.1%(16/60), P<0.001]. However, the DCB group did not differ significantly than the PTA group in improved walking impairment questionnaire (WIQ) score [22.3(8.0,9.4) vs 21.4(5.4,7.7),P=0.403] and success rate of operation [100%(102/102) vs 100%(60/60), P=1.000]. One man in DCB group died of severe chronic obstructive pulmonary disease with severe pulmonary infection after 6 months′ follow-up, and one diabetic patient in PTA group underwent lower knee amputation for severe infection following foot trauma also after 6 months′ follow-up, but there was no significant difference between 2 groups in the incidence of safety endpoints and main adverse events (P>0.05). Conclusion DCB shows superior outcomes over PTA in the treatment of de novo femoropopliteal arteriosclerosis occlusion with comparable safety.

Abstract:Objective To investigate the characteristics and prognosis of arteriosclerosis obliterans in the elderly women. Methods A retrospective analysis was performed of 106 elderly patients (54 males and 52 females) from March 2015 to March 2016 with arteriosclerosis obliterans. The 54 male patients were 60-89 (68.3±13.4) years old, and 52 female patients 59-90 (77.3±7.7) years old. All the patients received endovascular treatment of lower extremity arteries. The two gender groups were compared in terms of the general data and postoperative follow-up, and the female patients were analyzed for the prevalence factors and efficacy of endovascular treatment. SPSS statistics 22.0 was used for data analysis, and Chi-square test for comparison of enumeration data. Results All patients underwent endoluminal surgery and were followed up, with a success rate of 99.1% (failed recanalization in 1 male patient with multi-segment lesions) and a follow-up rate of 94.3%. The female group were significantly advanced in age (P<0.05), with fewer smokers (P<0.05), more complicated with hypertension (P<0.05), greater proportion with distant femoral lesions (P<0.05) and more severe lesions (P<0.05). Perioperative complications occurred in 4 serious patients (3.85%), 2 of whom were female and had myocardial infarction. During the follow-up, in-stent restenosis occurred in 17 patients (13 males and 4 females) and, 3 (2 males and 1 female) died, 5 (3 males and 2 females) amputated. Cardiovascular and cerebrovascular events were reported in 11 patients (2 males and 9 females). Conclusion Compared with the males, the elderly females have a higher average age of onset of lower extremity arteriosclerosis, a higher proportion of concomitant hypertension, a significant smaller number of smokers, and more severe lesions. The elderly females show a lower rate of re-embolism after endovascular treatment than the males, but the incidence of concurrent cardiovascular and cerebrovascular events is significantly higher.

Abstract:Objective This study aimed to compare the primary iliac reconstruction coupled with angioplasty of profunda femoris artery (PFA) and the primary iliac reconstruction coupled with angioplasty of superficial femoral artery (SFA) for the treatment of severe lower extremity ischemia in the elderly in the aspects of clinical data and efficacy. Methods The clinical data were reviewed of 64 elderly patients with severe lower extremity ischemia treated at Heilongjiang Provincial Hospital and First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from January 2016 to December 2016. They were divided into 2 groups:SFA group and PFA group with 32 patients each. The two groups were compared in ankle brachial index (ABI) before and after treatment, complication rate, mortality, operation time, hospitalization days and days of ulcer healing. SPSS statistics 17.0 was used for data analysis, and Student′s t test or Chi-square test for different data types. Results ABI indicated significant increases of revascularization in both groups after treatment (P<0.05), with SFA group being obviously greater than the PFA group (P<0.05). SFA group had fewer ulcer healing days than the PFA group (P<0.001). PFA group outperformed SFA group in complication rate (62.5% vs 12.5%), operation time [(189±41) vs(130±61)min] and hospitalization days [(18±4) vs(10±4)d, P<0.001]. No significant differences was observed in the numbers of patients with claudication of less than 100 m (50.0% vs 46.9%) and amputation (28.1% vs 25.0%) within 1 year after operation (P>0.05). Conclusion The primary iliac artery reconstruction coupled with PFA angioplasty can not only alleviate lower extremity ischemia but also significantly reduce the postoperative complications and amputation rate with increased survival rate and improved life quality of the patients.

Abstract:Objective To investigate the efficacy and safety of vascular intervention for the treatment of lower extremity atherosclerotic occlusive disease(LEAOD) in the elderly. Methods A retrospective analysis was made of the clinical and follow-up data from 120 patients (146 limbs) with LEAOD undergoing percutaneous transluminal angioplasty (PTA) at the Department of Vascular Surgery of Chifeng Municipal Hospital from July 2014 to December 2015, and the remission of clinical symptoms and the incidence of complications were recorded. Depending on data type, SPSS statistics 17.0 was used to perform the statistical analysis and t test or Chi-square test was employed for comparison. Results The success rate of intervention was 97.95%(143/146) , and no case died. A statistically significant rise was observed after the procedure in the internal diameter of the dorsal foot artery [(1.16±0.32)vs(1.34±0.33)mm], the blood flow [(0.52±0.12) vs (0.66±0.13) ml/(s·mm²)], ankle brachial index[(0.36±0.11) vs (0.65±0.08)], lame distance [(34.53±8.72) vs (633.78±32.56)m] and skin temperature [(30.03±0.91)℃ vs (33.56±3.45)℃]. The peak velocity of the blood flow [(51.31±7.85) vs (41.51±6.82) cm/s] and visual analogue scale [(7.12±1.95) vs (0.65±0.12) scores] were all significantly lowered after the procedure. All the differences were statistically significant (P＜0.05). The limb preservation rate was 100.0%(143/143) within 24 months after the procedure, and no case died. The incidence of restenosis or occlusion was 35.0%(50/143) in 48 patients, with 8 undergoing a second PTA. Conclusion Vascular interventional therapy is effective and safe for LEAOD in the elderly patients.

Abstract:The diagnosis and treatment of lower extremity ischemia rely on precise imaging assessment, which was conventionally performed mainly by biphasic ultrasound, intra-arterial digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). These modalities are all intended to assess the vascular anatomical structure in limb ischemic changes. In recent years, imaging technologies for assessment of blood perfusion imaging in the ischemic area have been used for diagnosis and treatment in peripheral arterial disease, which include laser Doppler flowmetry, hyperspectral imaging, indocyanine green angiography, and so on. The improved conventional imaging techniques and the emerging perfusion imaging modalities provide vital information for the diagnosis and treatment of lower extremity ischemia, and their combination has been found of great clinical significance.

Abstract:C-X-C chemokine receptor 2 (CXCR₂) is a member of chemokine family, and has been much sought after both in preclinical and clinical research because its activation by its ligands plays an important role in the pathophysiology of a range of cardiovascular diseases, including hypertension, cardiac remodeling, atherosclerosis, and abdominal aortic aneurysm. This review focuses on the progress made in the studies about roles of CXCR₂ in cardiovascular diseases.

Abstract:Intermittent claudication is a common complaint among the elderly. It is mostly caused by atherosclerosis but also by stenosis of lower limb arteries resulting from giant cell arteritis. Distinct characteristics can be observed of giant cell arteritis and atherosclerosis on such imaging modalities as sonography, computed tomography angiography and magnetic resonance angiography. The two conditions can be effectively distinguished by imaging findings and clinical features, providing guide for patient′s management. In this article, we reported the progress in the diagnosis and treatment of intermittent claudication of lower extremities by reviewing recent studies on the condition caused by large-vessel giant cell arteritis.

Abstract:Ubiquitin-proteasome system (UPS) is the primary non-lysosomal pathway of protein degradation in eukaryotic cells, whose proteolytic activities are closely associated with subunits β1, β2, β5. Subunits β1, β2, β5 can be replaced respectively by subunits β1i, β2i and low-molecular-mass proteasome 7 (LMP7 or β5i), with β5i being most active and the new structure being called immunoproteasome. β5i plays an important role in autoimmune diseases, cardiovascular and cerebrovascular diseases, obesity and metabolic diseases, and tumor. This article introduced the latest progress in β5i in relation to the above diseases in view of providing effective intervention targets for drug therapy and improving the prognosis of the diseases.

Abstract:In-stent restenosis (ISR) occurs in half of the patients treated with stenting of femoral and popliteal artery for lower extremity arteriosclerotic occlusive disease despite revolutionized treatment of lower extremity arteriosclerosis obliterans (LEASO) as a result of the continuous renewal of Ni-Ti alloy stent. ISR, occurring commonly at long and complicated lesions with complex causes and mechanisms, is treated non-surgically and with vascular recanalization. Non-surgical treatment includes quitting smoking, control of blood sugar, blood lipids and blood pressure, anticoagulation, and active exercise, and medication. Vascular recanalization consists of conventional open surgery, Forgart catheter thrombectomy, intraductal contact thrombolysis, percutaneous transluminal angioplasty (PTA), percutaneous transluminal angioplasty and stenting (PTAS), and percutaneous plaque resection, excimer laser atherectomy (ELA), and endovascular brachytherapy (EVBT). Combined therapy is mainly used clinically to obtain better medium- and long-term treatment outcomes and reduce the occurrences of reintervention. In this article, we reviewed the causes of ISR and research progress in vascular recanalization treatment.

Abstract:Recent years have witnessed an obvious rise in the incidence of cholelithiasis in China, placing an enormous burden on both the patients and society. Cholelithiasis, associated with a wide variety of factors, remains tremendously diverse in its prevalence and affecting factors in different regions and among different populations. Accordingly, this paper, with an epidemiologic perspective, elaborates the risk factors for gallstone disease in China, aiming to provide a theoretical basis for its prevention and control.