Publications by authors named "Xinwu Lu"

83 Publications

A meta-analysis of randomized controlled trials on therapeutic efficacy and safety of autologous cell therapy for atherosclerosis obliterans.

J Vasc Surg 2021 Nov 14. Epub 2021 Nov 14.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.

Objective: Atherosclerosis obliterans (ASO) is a chronic occlusive arterial disease and the most common type of peripheral arterial disease. Current treatment options like medication and vascularization have limited effects for "no-option" patients, and stem cell therapy is considered a viable option, although its application and efficacy have not been standardized. The objective of this review was to assess the safety and efficacy of autologous stem cell therapy in patients with ASO.

Methods: We performed a literature search of published randomized controlled trials (RCTs) for patients with ASO receiving stem cell therapy without a revascularization option. PubMed, Embase, and the Cochrane Library were searched. This study was conducted by a pair of authors independently and audited by a third author. Data were synthesized with a random-effects model.

Results: A total of 630 patients in 12 RCTs were included. The results showed that cell therapy significantly improved total amputation (relative risk [RR], 0.64; 95% confidence interval [CI], 0.47-0.87; P = .004), major amputation (RR, 0.69; 95% CI, 0.50-0.94; P = .02), ankle-brachial index (mean difference [MD], 0.08; 95% CI, 0.02-0.13; P = .004), transcutaneous oxygen tension (MD, 11.52; 95% CI, 3.60-19.43; P = .004), and rest pain score (MD, -0.64; 95% CI, -1.10 to -0.17; P = .007) compared with placebo or standard care. However, current studies showed cell therapy was not superior to placebo or standard care in all-cause death (RR, 0.75; 95% CI, 0.41-1.36; P = .34) and ulcer size (MD, -8.85; 95% CI, -29.05 to 11.36; P = .39). The number of trials included was limited. Moreover, most trials were designed for "no-option" patients, and thus the results should be applied with caution to other patients with peripheral arterial disease.

Conclusion: Patients with ASO can benefit from autologous cell therapy in limb salvage, limb blood perfusion, and rest pain alleviation.
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http://dx.doi.org/10.1016/j.jvs.2021.10.051DOI Listing
November 2021

Twelve-Month Results From the First-in-China Prospective, Multi-Center, Randomized, Controlled Study of the FREEWAY Paclitaxel-Coated Balloon for Femoropopliteal Treatment.

Front Cardiovasc Med 2021 10;8:686267. Epub 2021 Sep 10.

Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.

Several paclitaxel-coated balloons have been proved to provide better efficacy results than uncoated balloons in femoropopliteal lesions. But the efficacy and safety of FREEWAY balloons have not been investigated in Chinese patients. This study aimed to evaluate the efficacy and safety performance of FREEWAY paclitaxel-coated balloons vs. uncoated balloons in Chinese femoropopliteal artery lesions. In this prospective multi-center randomized controlled FREEWAY-CHINA study, 311 patients with symptomatic lower limb ischemia (Rutherford category 2-5) and femoropopliteal lesions of 14 Chinese centers were randomly assigned in a 1:1 ratio to endovascular treatment with either FREEWAY paclitaxel-coated balloons or uncoated balloons (control). The primary endpoint was the 6-month clinically-driven target lesion revascularization (CD-TLR) rate. Secondary endpoints included the device and technical success rate, the ankle-brachial indexes (ABIs), Rutherford category change, the 6-month primary and secondary patency rates, severe adverse effects, and the 12-month CD-TLR rate. The two groups were comparable in terms of their demographic and lesion characteristics. Patients' mean age was 70 years, and 70% were men. The mean lesion length was 71 mm. The 6-month CD-TLR rate was 2.6% in the FREEWAY group and 11.7% in the control group ( = 0.001). The 12-month CD-TLR rate was 2.7% in the FREEWAY group and 13.2% in the control group ( = 0.0005). Other endpoints, including patency rates, major adverse events, and ABI or Rutherford change, did not differ between the two groups. The FREEWAY balloon resulted in an effective decrease in CD-TLR rates and had similar safety results compared to the uncoated balloon in Chinese femoropopliteal artery patients at the 12-month follow-up appointment.
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http://dx.doi.org/10.3389/fcvm.2021.686267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460758PMC
September 2021

Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal.

J Vasc Surg Venous Lymphat Disord 2021 Aug 3. Epub 2021 Aug 3.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine; Vascular Center of Shanghai JiaoTong University, Shanghai, China. Electronic address:

Objective: To evaluate the effectiveness of elastic compression stockings (ECS) in prevention of post-thrombotic syndrome (PTS) in patients suffering from proximal deep venous thrombosis (DVT) who did not undergo thrombus removal procedures.

Methods: In this randomized trial, patients with Iliofemoral venous thrombosis (IFDVT) and femoral-popliteal venous thrombosis who had not undergone thrombus removal procedures were screened at a single medical institution between December 2016 and June 2018. These patients were randomly assigned as an ECS group (wear ECS) and control group (not wear ECS). The primary end point was the incidence of PTS based on the Villalta scale at 24 months. The secondary end points included patient quality of life and symptom severity based on the VEINES-QoL/Sym questionnaire. Recurrent DVT in the same limb, compliance with ECS use, and other adverse events were also recorded. A logistic regression analysis was also performed to determine risk factors of PTS.

Results: Two hundred thirty-two patients were included in this study. One hundred thirteen patients were in the ECS group and 119 in the control group. The incidence of PTS was 42.0% in the ECS group and 57.8% in the control group at 24 months (risk ratio [RR], 0.726; 95% confidence interval [CI] 0.547-0.964; P = .024). The VEINES-QoL score was 63.7 ± 4.6 in the ECS group, which was higher than in the control group (60.6 ± 6.9; P < .001). Moreover, the VEINES-Sym scores revealed that patients in the ECS group reported better symptom relief than those in the control group (45.8 ± 5.1 vs 43.8 ± 6.1; P = .014). According to Logistic regression analysis of the entire cohort, IFDVT was a risk factor for PTS (RR, 2.253; 95% CI, 1.136-4.468) and high compliance with the use of ECS was protect factor (RR, 0.516; 95% CI, 0.277-0.961).

Conclusions: These results suggest that ECS can prevent PTS in patients with IFDVT and femoral popliteal venous thrombosis who do not undergo thrombus removal procedures.
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http://dx.doi.org/10.1016/j.jvsv.2021.06.023DOI Listing
August 2021

Exosomes derived from adipose-derived stem cells overexpressing glyoxalase-1 protect endothelial cells and enhance angiogenesis in type 2 diabetic mice with limb ischemia.

Stem Cell Res Ther 2021 07 15;12(1):403. Epub 2021 Jul 15.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.

Background: Diabetic limb ischemia is a clinical syndrome and refractory to therapy. Our previous study demonstrated that adipose-derived stem cells (ADSCs) overexpressing glyoxalase-1 (GLO-1) promoted the regeneration of ischemic lower limbs in diabetic mice, but low survival rate, difficulty in differentiation, and tumorigenicity of the transplanted cells restricted its application. Recent studies have found that exosomes secreted by the ADSCs have the advantages of containing parental beneficial factors and exhibiting non-immunogenic, non-tumorigenic, and strong stable characteristics.

Methods: ADSCs overexpressing GLO-1 (G-ADSCs) were established using lentivirus transfection, and exosomes secreted from ADSCs (G-ADSC-Exos) were isolated and characterized to coculture with human umbilical vein endothelial cells (HUVECs). Proliferation, apoptosis, migration, and tube formation of the HUVECs were detected under high-glucose conditions. The G-ADSC-Exos were injected into ischemic hindlimb muscles of type 2 diabetes mellitus (T2DM) mice, and the laser Doppler perfusion index, Masson's staining, immunofluorescence, and immunohistochemistry assays were adopted to assess the treatment efficiency. Moreover, the underlying regulatory mechanisms of the G-ADSC-Exos on the proliferation, migration, angiogenesis, and apoptosis of the HUVECs were explored.

Results: The G-ADSC-Exos enhanced the proliferation, migration, tube formation, and anti-apoptosis of the HUVECs in vitro under high-glucose conditions. After in vivo transplantation, the G-ADSC-Exo group showed significantly higher laser Doppler perfusion index, better muscle structural integrity, and higher microvessel's density than the ADSC-Exo and control groups by Masson's staining and immunofluorescence assays. The underlying mechanisms by which the G-ADSC-Exos protected endothelial cells both in vitro and in vivo might be via the activation of eNOS/AKT/ERK/P-38 signaling pathways, inhibition of AP-1/ROS/NLRP3/ASC/Caspase-1/IL-1β, as well as the increased secretion of VEGF, IGF-1, and FGF.

Conclusion: Exosomes derived from adipose-derived stem cells overexpressing GLO-1 protected the endothelial cells and promoted the angiogenesis in type 2 diabetic mice with limb ischemia, which will be a promising clinical treatment in diabetic lower limb ischemia.
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http://dx.doi.org/10.1186/s13287-021-02475-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281719PMC
July 2021

Meta-analysis suggests statins reduce mortality after abdominal aortic aneurysm repair.

J Vasc Surg 2022 Jan 28;75(1):356-362.e4. Epub 2021 Jun 28.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Center of Shanghai JiaoTong University, Shanghai, China. Electronic address:

Objective: The necessity and efficacy of statin treatment for abdominal aortic aneurysm (AAA) remains controversial. This systematic review and meta-analysis was conducted to investigate the effects of statin therapy on the outcomes of patients with AAA.

Methods: The Cochrane library, Embase, and MedLine were searched comprehensively to identify relevant cohort studies and randomized controlled trials. The primary outcomes included short- and long-term mortality after AAA repair, and secondary outcomes included the incidence of perioperative cardiovascular complications, sac shrinkage after endovascular aneurysm repair, and the growth rate of the aneurysms. Short-term mortality was defined as all-cause 30-day or in-hospital postoperative mortality. Long-term mortality was defined as the all-cause mortality at the end of follow-up period (≥1 year). A random effects model was used to combine the results of included studies. Forest plots were created to show the pooled results of each outcome.

Results: One post hoc analysis of a randomized trial and 36 cohort studies (n = 134,290 patients) were included in this systematic review. The average score of included studies by Newcastle-Ottawa Scale was 7.76. Patients taking or not taking statin therapy were all diagnosed with unruptured AAA, and 59.9% of these patients were given statin therapy. Compared with statin nonusers, patients in statin therapy had significantly lower long-term mortality (odds ratio, 0.67; 95% confidence interval, 0.59-0.75; P < .001; I = 71.7%), and short-term mortality after aneurysmal repair (odds ratio, 0.51; 95% confidence interval, 0.36-0.73; P < .001; I = 81.4%). No significant difference was found between patients taking or not taking statin treatment on perioperative cardiovascular complications or sac shrinkage after endovascular aneurysm repair or growth rate of AAA under surveillance.

Conclusions: These findings suggest that statin use is associated with a significant decrease in long- and short-term mortality in patients after AAA repair. Based on these results, statin therapy is worth being used in clinical practice for the management of AAA.
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http://dx.doi.org/10.1016/j.jvs.2021.06.033DOI Listing
January 2022

Atherectomy Combined with Balloon Angioplasty versus Balloon Angioplasty Alone for de Novo Femoropopliteal Arterial Diseases: A Systematic Review and Meta-analysis of Randomised Controlled Trials.

Eur J Vasc Endovasc Surg 2021 Jul 8;62(1):65-73. Epub 2021 Jun 8.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China. Electronic address:

Objective: The efficacy and cost effectiveness of atherectomy for femoropopliteal (FP) arterial diseases have not been determined yet. A systematic review and meta-analysis were performed to compare the efficacy and safety between atherectomy combined with balloon angioplasty (BA) and BA alone for patients with de novo FP steno-occlusive lesions.

Methods: The Cochrane Library, Medline, and Embase were used to search for studies evaluating outcomes of atherectomy combined with BA compared with BA alone in FP arterial diseases from inception to July 2020. The methodological quality of the included studies was evaluated with the Cochrane Risk of Bias Tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the level of evidence for each outcome. The fixed effects model was chosen to combine the data when I < 50%; otherwise, the random effects model was used. Subgroup and sensitivity analyses were performed to further analyse the results.

Results: Four RCTs were included. The meta-analysis showed that atherectomy combined with BA was associated with improved technical success rate (risk ratio [RR] 0.22, 95% confidence interval [CI] 0.13-0.38, p < .001; I = 0; high quality), reduced bailout stenting (RR 0.15, 95% CI 0.07-0.32, p < .001; I = 16%; high quality), and flow limiting dissection (RR 0.24, 95% CI 0.13-0.47, p < .001; I = 0; high quality). No statistically significant difference was found in target lesion revascularisation (TLR), primary patency, mortality, major adverse event (MAE), or ankle brachial index (ABI) after one year follow up.

Conclusion: Compared with BA alone, atherectomy combined with BA may not improve primary patency, TLR, mortality rate, or ABI, but may reduce the need for bailout stenting and the incidence of flow limiting dissection and increase the technical success rate in FP arterial diseases. More studies are warranted to further confirm the conclusion.
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http://dx.doi.org/10.1016/j.ejvs.2021.02.012DOI Listing
July 2021

A predictive model for postthrombotic syndrome in proximal deep vein thrombosis patients.

Ann Transl Med 2021 Apr;9(7):558

Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Postthrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT). Predictive models for PTS after hospitalized DVT patients, especially those with proximal DVT for whom preventative intervention decisions need to be made, are rare. We aimed to develop and externally validate a clinical predictive model for PTS in patients with proximal DVT.

Methods: This study was a retrospective, single-center, case-control study. The data used in our model were retrospectively collected from a prospective registry database in which 210 (derivation) and 90 (validation) consecutive patients were first diagnosed with proximal DVT. We developed a nomogram using the multivariate logistic regression model. External validation of our predictive model and previous predictive models in our validation set was assessed by discrimination, calibration, and clinical utility.

Results: Of the 30 candidate predictors, 5 were significantly associated with PTS in our final multivariable model, including the number of signs and symptoms (OR 1.33, 95% CI: 1.17 to 1.53, P<0.001), male sex (OR 1.79, 95% CI: 1.07 to 3.06, P=0.028), varicose vein history (OR 3.02, 95% CI: 1.04 to 7.60, P<0.001), BMI (OR 1.06, 95% CI: 1.00 to 1.12, P=0.052), and chronic DVT (OR 2.66, 95% CI: 1.49 to 4.79, P<0.001). The area under the curve was 0.724 in our predictive model, indicating suitable external performance.

Conclusions: A simple-to-use nomogram effectively predicts the risk of PTS in patients with proximal DVT. This predictive model may be considered for use in clinical care.
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http://dx.doi.org/10.21037/atm-20-3239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105809PMC
April 2021

Exosomes from Adipose Mesenchymal Stem Cells Overexpressing Stanniocalcin-1 Promote Reendothelialization After Carotid Endarterium Mechanical Injury.

Stem Cell Rev Rep 2021 May 12. Epub 2021 May 12.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.

Objective: Stanniocalcin-1 (STC-1) is a secreted glycoprotein that participates in the regulation of inflammation, apoptosis, and necrosis. We investigated the reendothelialization effect of exosomes from adipose stem cells (ADSC) overexpressing STC-1 on injured carotid endarterium.

Methods: ADSCs were transfected with lentivirus vectors containing pre-STC-1. PHK-26 as molecular probe was used to track the exosomes engulfed by mice arterial endothelial cells (MAEC). The role of STC-1-ADSC-Exosome (S-ADSC-Exo) in MAECs was verified through scratch test and tube forming. Expressions of STC-1 and NLRP3 inflammasome were detected by western blot and quantitative reverse transcription polymerase chain reaction. Reendothelialization effect was inhibited by the antagonist of siRNA targeting STC-1. Carotid endarterium mechanical injury was induced by insertion with a guidewire into the common carotid artery lumen. Carotid arteries were harvested for histological examination, immunofluorescence staining, and Evan's blue staining.

Results: Transfection of STC-1 significantly enhanced STC-1 levels in ADSCs, their exosomes, and MAECs. Compared with the control group and the ADSC-Exo group, STC-1 enriched exosomes markedly inhibited the expressions of NLRP3, Caspase-1, and IL-1β in MAECs, exhibited good lateral migration capacity, and promoted angiogenesis. Administration of siRNA targeting STC-1 completely abolished down-regulation of NLRP3, Caspase-1, and IL-1β by STC-1 and inhibited effects of S-ADSC-Exo on lateral migration and angiogenesis. In vivo administration of S-ADSC-Exo had reendothelialization effect on post-injury carotid endarterium as evidenced by thinner arterial wall, low-expressed NLRP3 inflammasome, and more living endothelial cells.

Conclusions: The reendothelialization effect of exosomes from ADSCs on post-injury carotid endarterium could be enhanced by genetic modification of the exosomes to contain elevated STC-1, possibly through suppression of NLRP3 inflammasome-mediated inflammation.
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http://dx.doi.org/10.1007/s12015-021-10180-4DOI Listing
May 2021

Outcomes of endovenous laser ablation with additional iliac vein stenting of nonthrombotic lesions in patients presenting with active venous ulcers.

J Vasc Surg Venous Lymphat Disord 2021 Nov 3;9(6):1517-1525. Epub 2021 May 3.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China. Electronic address:

Objective: We evaluated the clinical outcomes of superficial and perforator ablation and the effects on wound healing by adding iliac vein stenting of nonthrombotic iliac vein lesions (NIVLs) in patients presenting with active venous ulcers.

Methods: A retrospective analysis was performed of patients who had presented with venous ulcers and had a diagnosis of NIVLs from January 2017 to December 2019. Patients with a >50% diameter reduction in the iliac vein as determined by computed tomography venography had undergone transfemoral venography for further confirmation. Patients were divided into the endovenous laser ablation (EVLA) group and EVLA with stenting (EVLAS) group. The EVLA group had undergone endovascular laser treatment of superficial venous reflux, and the EVLAS group had undergone EVLA and stenting for NIVLs. The clinical outcomes were compared between the two groups. The primary end point was cumulative ulcer healing at 12 months. The secondary end points included complications, venous clinical severity score improvements, and pain scores during the follow-up period. Univariable and multivariable regression models were used to determine the refractory ulcer predictors.

Results: A total of 157 patients were included, 93 in the EVLAS group and 64 in the EVLA group. Of the 93 patients in the EVLAS group and patients in the EVLA group, 30 (32.26%) and 17 (26.56%) had presented with iliac venous occlusion, respectively (P = .48). The mean percentage of stenosis was 78.0% ± 13.6% in EVLAS group and 77.0% ± 14.0% in the EVLA group (P = .36). No significant differences in the general preoperative data were observed between the two groups. Cumulative ulcer healing at 1 year was 86.8% and 65.6% in the EVLAS and EVLA groups, respectively (P = .001). After a mean follow-up of 22 months (median, 24 months), the EVLAS group had a significantly improved venous clinical severity score compared with the EVLA group (EVLAS group, 8.3; EVLA group, 11.7; P = .01). Multivariable analysis of the entire cohort showed that obesity and employment that requires standing were predictive of refractory ulcers and that iliac venous stent placement was a protective factor for ulcer healing.

Conclusions: The results of the present study have suggested an association between improvement in the overall success of venous leg ulcer healing when including treatment of NIVLs with stents into a treatment plan that already includes saphenous and perforator vein ablation.
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http://dx.doi.org/10.1016/j.jvsv.2021.04.013DOI Listing
November 2021

Prescreening and treatment of aortic dissection through an analysis of infinite-dimension data.

BioData Min 2021 Apr 1;14(1):24. Epub 2021 Apr 1.

Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Aortic dissection (AD) is one of the most catastrophic aortic diseases associated with a high mortality rate. In contrast to the advances in most cardiovascular diseases, both the incidence and in-hospital mortality rate of AD have experienced deviant increases over the past 20 years, highlighting the need for fresh prospects on the prescreening and in-hospital treatment strategies.

Methods: Through two cross-sectional studies, we adopt image recognition techniques to identify pre-disease aortic morphology for prior diagnoses; assuming that AD has occurred, we employ functional data analysis to determine the optimal timing for BP and HR interventions to offer the highest possible survival rate.

Results: Compared with the healthy control group, the aortic centerline is significantly more slumped for the AD group. Further, controlling patients' blood pressure and heart rate according to the likelihood of adverse events can offer the highest possible survival probability.

Conclusions: The degree of slumpness is introduced to depict aortic morphological changes comprehensively. The morphology-based prediction model is associated with an improvement in the predictive accuracy of the prescreening of AD. The dynamic model reveals that blood pressure and heart rate variations have a strong predictive power for adverse events, confirming this model's ability to improve AD management.
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http://dx.doi.org/10.1186/s13040-021-00249-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015064PMC
April 2021

Outcomes of Drug-Coated Balloon Angioplasty for Isolated Chronic Occlusion of the Popliteal Artery: A Retrospective Single-Institution Study.

J Vasc Interv Radiol 2021 04 30;32(4):593-601. Epub 2021 Jan 30.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Vascular Center of Shanghai Jiaotong University, Shanghai, China, 200011. Electronic address:

Purpose: To assess the 12-month safety and effectiveness of paclitaxel drug-coated balloon (DCB) for the treatment of patients with isolated chronic occlusions in popliteal arteries and evaluate the risk factors of lesion reocclusion.

Materials And Methods: From January 2018 to December 2019, DCB angioplasty was performed in 54 limbs with isolated chronic popliteal artery occlusion of 48 patients (32 men) with a mean age of 71.5 ± 12.1 (range, 50-97) years, mean occlusive length of 6.3 ± 3.0 (range, 1-15) cm, and mean preoperative ankle-brachial index (ABI) of 0.42 ± 0.12 (range, 0.19-0.58). A total of 18.5% (10/54) of lesions were long-segment occlusions involving the entire popliteal artery from P1 to P3. Twenty seven of 54 limbs presented with critical limb ischemia (CLI) with a mean ABI of 0.33 ± 0.10 (range, 0.19-0.51). The primary endpoint was primary patency rate at 12 months. The secondary endpoints included technical success rate, 1-year secondary patency rate, limb salvage rate, and improvement in clinical symptoms. Univariate Cox regression analysis was used to determine the predictors of lesion reocclusion.

Results: The technical success rate was 85.2% (46/54), and bailout stenting was performed in 14.8% (8/54) of lesions. The 12-month primary and secondary patency rates by the Kaplan-Meier estimate were 72.6% and 88.3%, respectively. Two thirds of the reocclusions occurred within 6 months after intervention. No 30-day mortality was observed. The limb salvage rate was 100% during a mean follow-up period of 13 months, and all minor amputations occurred in the limbs presented with CLI. The mean ABI increased from 0.42 before the procedure to 0.73 after the procedure. Patients younger than 60 years and the lesions exhibiting long-segment occlusions present as trending risk factors for lesion reocclusion.

Conclusions: Paclitaxel DCB angioplasty is safe and effective in managing isolated chronic occlusion of popliteal arteries. Younger patients and long-segment occlusions of the popliteal artery are associated with a relatively higher reocclusion rate after the procedure.
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http://dx.doi.org/10.1016/j.jvir.2020.12.024DOI Listing
April 2021

Changes in aortic arch geometry and the risk for Stanford B dissection.

J Thorac Dis 2020 Dec;12(12):7193-7201

Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: The increase in aortic diameter is not closely associated with type B aortic dissection (TBAD); morphological risk factors other than aortic diameter may help to better identify patients at risk for TBAD. The purpose of this study was to investigate possible morphological factors associated with the occurrence of TBAD.

Methods: This study was a retrospective, multicenter, cross-sectional study. We collected 94 patients with TBAD as the TBAD group and 534 patients with healthy aortas as the healthy control group. Morphometric data were collected on three-dimensional models of the thoracic aorta. A propensity score matching (PSM) analysis was conducted to reduce the potential for confounding by baseline factors.

Results: The number of patients in the TBAD group was 75 after PSM. Longer lengths of the aortic arch (28.00±7.42 25.14±7.11 cm) were observed in patients with TBAD. The width (80.04±17.27 71.73±15.55 mm) and height (24.92±11.39 19.37±10.10 mm) of the aortic arch in patients with TBAD were both larger than those of healthy controls. The morphological changes associated with the occurrence of type B acute dissection were most pronounced in the geometry of the aortic arch.

Conclusions: This study demonstrates that TBAD was associated with longer lengths of aortic arch and with larger arch height and width.
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http://dx.doi.org/10.21037/jtd-20-1643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797824PMC
December 2020

Clinical Outcomes of Distal Tapered Restrictive Covered Stent Applied in Endovascular Treatment of Aortic Dissection Involving Zone 0.

Eur J Vasc Endovasc Surg 2021 03 7;61(3):413-421. Epub 2021 Jan 7.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Vascular Centre of Shanghai Jiao Tong University, Shanghai, China. Electronic address:

Objective: The safety and efficacy of a distal tapered restrictive covered stent (RCS) applied in the endovascular treatment of aortic dissection involving Zone 0 was evaluated.

Methods: This study retrospectively analysed 43 patients with acute aortic dissection involving Zone 0 who received in situ laser fenestrated thoracic endovascular aortic repair with distal tapered RCS from January 2015 to February 2019. The indication for the distal tapered RCS procedure was an inappropriate distal size of the main stent graft. Technical success, aortic remodelling, and clinical outcomes were evaluated.

Results: Technical success was achieved in all patients. The 30 day post-operative mortality rate was 0%. All patients had complete false lumen thrombosis in the stent coverage segment. True lumen volume increased significantly (p < .001) with an average change of 87.0% ± 34.3%, while false lumen volume decreased significantly (p < .001) with an average change of -71.0% ± 13.5% between baseline and 12 months. During the follow up period (mean 28.7 months, range 12-63 months), no distal stent graft induced new entry (SINE) was observed. The average distance between the distal end of the RCS and the coeliac trunk was 57.5 mm. Two (4.7%) patients had spinal cord ischaemia (SCI) and recovered without permanent paraplegia after undergoing conservative treatment.

Conclusion: The distal tapered RCS applied in the endovascular treatment of aortic dissection involving Zone 0 is considered to be a feasible and effective approach along with satisfactory aortic remodelling, a low risk of SINE, and SCI. The favourable results are partly explained by selection. No patients had an entry tear near the coronary artery, nor were the coronary arteries, pericardium, or aortic valve involved at the time of repair.
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http://dx.doi.org/10.1016/j.ejvs.2020.11.037DOI Listing
March 2021

Aligned Graphene Mesh-Supported Double Network Natural Hydrogel Conduit Loaded with Netrin-1 for Peripheral Nerve Regeneration.

ACS Appl Mater Interfaces 2021 Jan 4;13(1):112-122. Epub 2021 Jan 4.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.

The gold standard treatment for peripheral nerve injuries (PNIs) is the autologous graft, while it is associated with the shortage of donors and results in major complications. In the present study, we engineer a graphene mesh-supported double-network (DN) hydrogel scaffold, loaded with netrin-1. Natural alginate and gelatin-methacryloyl entangled hydrogel that is synthesized via fast exchange of ions and ultraviolet irradiation provide proper mechanical strength and excellent biocompatibility and can also serve as a reservoir for netrin-1. Meanwhile, the graphene mesh can promote the proliferation of Schwann cells and guide their alignments. This approach allows scaffolds to have an acceptable Young's modulus of 725.8 ± 46.52 kPa, matching with peripheral nerves, as well as a satisfactory electrical conductivity of 6.8 ± 0.85 S/m. In addition, netrin-1 plays a dual role in directing axon pathfinding and neuronal migration that optimizes the tube formation ability at a concentration of 100 ng/mL. This netrin-1-loaded graphene mesh tube/DN hydrogel nerve scaffold can significantly promote the regeneration of peripheral nerves and the restoration of denervated muscle, which is even superior to autologous grafts. Our findings may provide an effective therapeutic strategy for PNI patients that can replace the scarce autologous graft.
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http://dx.doi.org/10.1021/acsami.0c16391DOI Listing
January 2021

Comparing Safety and Efficacy of Rivaroxaban with Warfarin for Patients after Successful Stent Placement for Chronic Iliofemoral Occlusion: A Retrospective Single Institution Study.

Eur J Vasc Endovasc Surg 2021 03 31;61(3):484-489. Epub 2020 Dec 31.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China. Electronic address:

Objective: The aim was to compare the safety and effectiveness of rivaroxaban and warfarin as anticoagulants for treating patients with post-thrombotic syndrome (PTS) with chronic iliofemoral venous occlusion undergoing iliofemoral venous stenting.

Methods: This single institution retrospective study analysed patients with PTS with chronic iliofemoral venous occlusion who were prescribed rivaroxaban or warfarin for one year after successfully undergoing iliofemoral venous stenting. The primary safety and efficacy endpoints were bleeding complication rate and primary patency rate at one year. Secondary outcomes included Villalta score, symptom recurrence rate, ulcer healing rate, and clinically driven target lesion revascularisation (CD-TLR) rate during follow up.

Results: From January 2016 to December 2017, 154 legs from 154 patients were included in this study (69 in rivaroxaban group and 85 in warfarin group). The groups were well matched for patient demographics, clinical characteristics, and procedural details. There was no significant difference between the rivaroxaban group and warfarin group in bleeding complication rate (10% vs. 16%, p = .23, hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.25 - 1.37) at one year, as well as major bleeding complication rate (0% vs. 2%, p = .20, HR 0.16, 95% CI 0.01 - 2.61) and minor bleeding complication rate (10% vs. 14%, p = .40, HR 0.67, 95% CI 0.27 - 1.66). The primary patency rate was higher in the rivaroxaban group at one year (84% vs. 71%, p = .049, HR 0.50, 95% CI 0.26 - 0.96) and at two years (79% vs. 63%, p = .037, HR 0.52, 95% CI 0.29 - 0.93). At a mean follow up of 24 months (range 1 - 42 months), the rivaroxaban group had a significantly lower post-operative Villalta score (4.87 ± 3.51 vs. 6.88 ± 5.85, p = .010, t = 2.64, 95% CI 0.50 - 3.52), lower rate of symptom recurrence (4% vs. 32%, p < .001), lower CD-TLR rates (3% vs. 13%, p = .039), and higher ulcer healing rate (90% vs. 59%, p = .004) than the warfarin group.

Conclusion: For PTS patients with chronic iliofemoral venous occlusion undergoing iliofemoral venous stenting, rivaroxaban probably exhibited similar safety but superior efficacy to warfarin. However, further prospective control studies with large sample size are necessary to confirm the results.
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http://dx.doi.org/10.1016/j.ejvs.2020.11.050DOI Listing
March 2021

Laser fenestration of aortic arch stent grafts for endovascular treatment of retrograde type A dissection.

Int J Cardiol 2021 04 17;328:69-74. Epub 2020 Dec 17.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China; Vascular Center of Shanghai JiaoTong University, Shanghai, 200011, PR China. Electronic address:

Objectives: Retrograde type A dissection (RTAD) is a rare but life-threatening event following thoracic endovascular aortic repair (TEVAR), and its total endovascular treatment is a huge challenge. This research aimed to evaluate the safety, effectiveness, technical success, and medical outcomes of in situ laser fenestration of aortic arch stent grafts during TEVAR of RTAD.

Methods: We retrospectively reviewed the clinical data of 15 patients with RTAD who received in situ laser fenestration of aortic arch stent grafts during TEVAR between Mar 2016 and Dec 2019. All patients were subjected to intraoperative extracorporeal brain perfusion. The preoperative, intraoperative and postoperative medical data were collected and analyzed.

Results: The mean age of the 15 patients was 64 ± 8 years, 8 of whom were male. The immediate overall technical success rates, including aortic stent deployment were 100% and primary fenestration success was achieved in 13 (86.7%) patients. The mean postoperative length of stay was 10 ± 4 days. Stroke occurred in 1 case. No in-hospital/30-day death nor permanent paraplegia/paresis was observed. The mean follow-up time was 13 ± 5 months. Two type Ia endoleaks were found, but no late occlusion and migration of the supra-aortic branch arteries stents during the follow-up were observed.

Conclusions: The in situ laser fenestration of aortic arch stent grafts during TEVAR of RTAD is a potential total endovascular therapy of RTAD for patients unsuitable for direct surgical repair.
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http://dx.doi.org/10.1016/j.ijcard.2020.12.011DOI Listing
April 2021

Three-dimensional computed tomography venography reconstruction facilitates identification of atypical radiologic features of May-Thurner syndrome.

J Vasc Surg Venous Lymphat Disord 2021 07 25;9(4):946-953. Epub 2020 Nov 25.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, People's Republic of China; Vascular Center of Shanghai JiaoTong University, Shanghai, People's Republic of China. Electronic address:

Objective: May-Thurner syndrome (MTS) is typically characterized by compression of the left common iliac vein by the overlying right common iliac artery. The present study evaluated the occurrence of atypical imaging features of MTS using three-dimensional computed tomography venography reconstruction (3D-CTV) and analyzed their correlation with clinical features.

Methods: We analyzed the data from 268 patients with left lower extremity chronic venous disease (CVD) using 3D-CTV at a single institution from January to June 2019. An area stenosis percentage >50% was defined as significant venous compression. Of the 268 patients, 92 had at least one significant iliac and/or vena cava compression confirmed by 3D-CTV. Of the 92 patients, 89 underwent digital subtraction venography via the left common femoral vein, and the outcomes were compared with their 3D-CTV findings. Different types of venous compression were evaluated using 3D-CTV. The relationship among compression type, sex, age, and CVD symptoms was evaluated.

Results: A total of 106 venous compression sites were found in 92 patients. Atypical compression included inferior vena cava (IVC) compression and partial IVC compression (8.5% and 55.7%, respectively). Multiple compression sites were present in 13 patients (14.1%). The compression sites correlated significantly with clinical symptoms (P = .017) and were related to sex (P = .001). The number of patients with IVC and partial IVC compression but false-negative venography findings was four (33.3%) and six (50%), respectively.

Conclusions: 3D-CTV facilitates the detection of atypical venous compression in patients with MTS with notable chronic symptoms. Patients with multiple compression sites had more severe clinical symptoms and greater false-negative rates with venography. IVC compression was more likely to occur in female patients with MTS.
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http://dx.doi.org/10.1016/j.jvsv.2020.11.014DOI Listing
July 2021

Drug-Coated Balloon Angioplasty Compared With Uncoated Balloons in the Treatment of Infrapopliteal Artery Lesions (AcoArt II-BTK).

J Endovasc Ther 2021 04 29;28(2):215-221. Epub 2020 Oct 29.

Chinese PLA General Hospital, Beijing, China.

Purpose: To compare the safety and efficacy of drug-coated balloon (DCB) vs uncoated balloon angioplasty in the treatment of de novo and restenotic infrapopliteal lesions in patients with chronic limb-threatening ischemia (CLTI).

Materials And Methods: The prospective, multicenter, randomized study AcoArt II-BTK study ( identifier NCT02137577) enrolled 120 patients who were randomly assigned to angioplasty with either a DCB (n=61; mean age 70.7±7.4 years; 36 men) or a conventional balloon catheter (n=59; mean age 70.8±9.0 years; 36 men). There were no significant differences observed in baseline clinical or target lesion characteristics between the groups. The target lesion length was 169.95±86.35 mm in the DCB group vs 179.93±80.16 mm in the control group, and approximately three-quarters of the lesions were chronic occlusions. Primary patency was assessed by angiography at 6 months, and mortality and clinically-driven target lesion revascularization (CD-TLR) were evaluated at 12 months.

Results: Primary patency at 6 months was 75.0% in the DCB group and 28.3% in the control group (p<0.001), while late lumen loss was 0.43±0.62 mm for DCBs vs 0.99±0.55 mm for controls (p<0.001). Freedom from CD-TLR at 12 months was 91.5% in the DCB group vs 76.8% in the controls (p=0.03); there was no significant difference in mortality (1.7% DCB vs 3.6% controls; p=0.53).

Conclusion: This study demonstrated that the Litos/Tulip DCBs are safe and effective in treating infrapopliteal lesions, with improved angiographic and clinical outcomes vs plain balloon angioplasty. The DCBs demonstrated significantly higher primary patency with fewer CD-TLRs than conventional angioplasty. The safety of the DCBs was noninferior to that of the uncoated balloons after 1 year of follow-up.
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http://dx.doi.org/10.1177/1526602820969681DOI Listing
April 2021

In Situ Laser Stent Graft Fenestration of the Left Subclavian Artery during Thoracic Endovascular Repair of Type B Aortic Dissection with Limited Proximal Landing Zones: 5-Year Outcomes.

J Vasc Interv Radiol 2020 Aug 17;31(8):1321-1327. Epub 2020 Jul 17.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China; Vascular Center of Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, China. Electronic address:

Purpose: To assess safety and feasibility of in situ laser stent graft fenestration to revascularize the left subclavian artery (LSA) during thoracic endovascular repair (TEVAR) of type B aortic dissection (TBAD) with limited proximal landing zones with 5 years of follow-up.

Materials And Methods: In a single-center retrospective study, 130 patients with TBAD with limited proximal landing zones (≤ 1.5 cm) underwent in situ laser stent graft fenestration revascularizing the LSA during TEVAR from April 2014 to April 2019. Outcomes were assessed by CT angiography and clinic visits, including technical success rate, operative time, LSA patency, ischemic events, and late aorta-related complications during follow-up.

Results: Mean age of patients was 53 y (range, 33-73 y). Primary technical success rate was 96.9% (126/130). Three chimney stents were placed instead of fenestration, and 1 LSA fenestration was combined with a left common carotid artery (LCCA) chimney stent. Mean operative time was 53 min ± 28 with fluoroscopy time of 40 min ± 15. There were no neurologic complications and no deaths, with a mean duration of hospital stay of 9 d (range, 5-21 d). At a mean follow-up of 42 mo (range, 5-60 mo), there was a 97% primary LSA patency. Four patients had a type I endoleak, which disappeared during follow-up. One LCCA became occluded after 6 months. No type II or III endoleaks were found. Retrograde type A aortic dissection and stent graft-induced new distal entry were not found during follow-up.

Conclusions: In situ laser fenestration to revascularize the LSA during TEVAR of TBAD with limited proximal landing zones was efficient, safe, and feasible based on 5-year follow-up.
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http://dx.doi.org/10.1016/j.jvir.2020.02.025DOI Listing
August 2020

Allogeneic adipose-derived stem cells promote ischemic muscle repair by inducing M2 macrophage polarization via the HIF-1α/IL-10 pathway.

Stem Cells 2020 10 4;38(10):1307-1320. Epub 2020 Aug 4.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China.

Adipose-derived mesenchymal stem cells (ASCs) are multipotent stromal cells that possess considerable therapeutic potential for tissue remodeling. However, their protective mechanism in critical limb ischemia has not been fully defined. After the occlusion of blood vessels, hypoxia becomes a prominent feature of the ischemic limb. This study investigated the immunomodulatory effect of ASCs on ischemic muscle repair and explored the specific mechanism. We found that the ability of RAW264.7 cells to migrate was impaired in hypoxia, whereas coculturing with ASCs could enhance the migration capacity. In addition, under hypoxic conditions, the paracrine effect of ASCs was enhanced and ASCs could induce RAW264.7 macrophages toward the anti-inflammatory M2 phenotype. We further demonstrated that ASCs-derived interleukin 10 (IL-10), mediated by hypoxia inducible factor-1α (HIF-1α), played a crucial role in the induction of M2 macrophages by activating the signal transducer and activator of transcription 3 (STAT3)/Arginase (Arg-1) pathway. Our in vivo experiments revealed that transplanted ASCs exhibited an immunomodulatory effect by recruiting macrophages to ischemic muscle and increasing the density of M2 macrophages. The transplantation of ASCs into ischemic limbs induced increased blood flow reperfusion and limb salvage rate, whereas the depletion of tissue macrophages or transplanting HIF-1α-silenced ASCs inhibited the therapeutic effect. These findings elucidated the critical role of macrophages in ASCs-mediated ischemic muscle repair and proved that allogeneic ASCs could exert the protective effect by enhancing the recruitment of macrophages and inducing macrophages toward M2 phenotype through HIF-1α/IL-10 pathway.
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http://dx.doi.org/10.1002/stem.3250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590195PMC
October 2020

A new radiofrequency balloon angioplasty device for atherosclerosis treatment.

Biomed Eng Online 2020 Jun 10;19(1):44. Epub 2020 Jun 10.

School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.

Background: Restenosis remains a challenge in the treatment of atherosclerosis due to damage to the endothelial layer and induced proliferation of smooth muscle cells. A novel radiofrequency (RF) heating strategy was proposed to selectively ablate atherosclerosis plaque and to thermally inhibit the proliferation of smooth muscle cells while keeping the endothelial cells intact.

Methods: To realize the proposed strategy, a new radiofrequency balloon catheter, consisting of three ports, a three-channel tube, a balloon and an electrode patch, was designed. To evaluate the feasibility of this new design, a phantom experiment with thermocouples measuring temperatures with different voltages applied to the electrodes was conducted. A numerical model was established to obtain the 3D temperature distribution. The heating ability was also evaluated in ex vivo diseased artery samples.

Results: The experimental results showed that the highest temperature could be achieved in a distance from the surface of the balloon as designed. The temperature differences between the highest temperature at 0.78 mm and those of the surface reached 9.87 °C, 12.55 °C and 16.00 °C under applied 15 V, 17.5 V and 20 V heating, respectively. In the circumferential direction, the heating region (above 50 °C) spread from the middle of the two electrodes. The numerical results showed that the cooling effect counteracted the electrical energy deposition in the region close to the electrodes. The thermal lesion could be directed to cover the diseased media away from the catheter surface. The ex vivo heating experiment also confirmed the selective heating ability of the device. The temperature at the targeted site quickly reached the set value. The temperature of the external surface was higher than the inner wall surface temperature of the diseased artery lumen.

Conclusion: Both the experimental and numerical results demonstrated the feasibility of the newly designed RF balloon catheter. The proposed RF microelectrodes heating together with the cooling water convection can realize the desired heating in the deeper site of the blood vessel wall while sparing the thin layer of the endothelium.
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http://dx.doi.org/10.1186/s12938-020-00790-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288419PMC
June 2020

AgFeS nanoparticles as a novel photothermal platform for effective artery stenosis therapy.

Nanoscale 2020 May;12(20):11288-11296

College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, 518118, China.

Ternary I-III-VI2 semiconductors usually have narrow band gaps and large absorption coefficients arising from the unique characteristics of their outer-d valence electrons, which are intimately connected with the photothermal conversion properties. AgFeS2 is known as one such material that has the potential to absorb near-infrared light. In this work, we utilized density functional theory (DFT) calculations to evaluate the electronic structure and optical absorption properties of AgFeS2. Strong absorptions were predicted over a wide Vis-NIR region due to the localized 3d electron of Fe atoms, which agree quite well with the UV-Vis-NIR spectra measured by experiment. The as-prepared AgFeS2 nanoparticles were then modified with mPEG-DSPE, an efficient photothermal agent for artery stenosis therapy. Its photothermal conversion effect has been systematically studied, indicating the potential for causing the hyperthermia of macrophages, an essential part of the artery inflammation response. More importantly, both in vitro cell experiments and in vivo mouse-model studies show that the induction of hyperthermia in artery stenosis by using AgFeS2 nanoparticles is safe and effective when injected at a very low concentration. This study provides a novel photothermal platform derived from the inheritability of bandgap structure and also promotes the process of artery inflammation and stenosis therapy.
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http://dx.doi.org/10.1039/d0nr01587cDOI Listing
May 2020

Physicochemical Properties and In Vitro Biocompatibility of Three Bacterial Nanocellulose Conduits for Blood Vessel Applications.

Carbohydr Polym 2020 Jul 8;239:116246. Epub 2020 Apr 8.

Key Laboratory of Science & Technology of Eco-textile, Ministry of Education, Shanghai, 201620, China; Scientific Research Base of Bacterial Nanofiber Manufacturing and Composite Technology, China Textile Engineering Society, Shanghai, 201620, China. Electronic address:

A novel design of bioreactor G-BNC, in combination with two previously reported designs of bioreactor were used to fabricate three small caliber bacterial nanocellulose (BNC) conduits (G-BNC, S-BNC and D-BNC). They were compared systematically with a clinically-used ePTFE graft. S-BNC possessed a laminated structure, the lowest BNC content, roughest luminal surface and weakest mechanical properties, and so might not be sufficiently strong for use as an artificial blood vessel alone. The D-BNC conduit possessed an unstratified structure with a fiber network that was more dense and the greatest BNC content, providing the strongest mechanical properties. G-BNC possessed a looser network with the smoothest luminal surface and greater hemocompatibility. Following comprehensive evaluation of mechanical properties and performance, we judge that D-BNC and G-BNC should possess greater potential in application as small caliber vascular grafts, however the patency of the three BNC conduits need be further verified in animal studies in vivo.
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http://dx.doi.org/10.1016/j.carbpol.2020.116246DOI Listing
July 2020

A meta-analysis of combined proximal stent grafting with or without adjunctive distal bare stent for the management of aortic dissection.

J Vasc Surg 2020 09 15;72(3):1109-1120.e6. Epub 2020 Apr 15.

Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address:

Background: The efficacy and safety of placement of a proximal covered stent graft combined with a distal bare stent are controversial because of the lack of evidence. This systematic review and meta-analysis compared the outcomes of combined proximal covered stent grafting with distal bare stenting (BS group) and proximal covered stent grafting without distal bare stenting (non-BS group).

Methods: The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and key references were searched up to January 26, 2019. Predefined outcomes of interest were mortality, morbidity, and postoperative assessment of aortic remodeling. We pooled risk ratios (RRs) of the outcomes of interest using fixed effects model or random effects model.

Results: Overall, eight observational studies involving 914 patients were included. There were no significant differences in overall aorta-related mortality (RR, 0.54; confidence interval [CI], 0.24-1.24; P = .15), complete thoracic false lumen (FL) thrombosis rate (RR, 1.23; CI, 0.83-1.81; P = .30), or complete abdominal FL thrombosis rate (RR, 1.96; CI, 0.68-5.69; P = .21) between the BS group and the non-BS group. The BS group had a lower rate of partial thoracic FL thrombosis (RR, 0.40; CI, 0.25-0.65; P = .0002), a lower stent graft-induced new entry rate (RR, 0.08; CI, 0.02-0.41; P = .003), and a lower reintervention rate (RR, 0.42; CI, 0.26-0.69; P = .0005).

Conclusions: Combined proximal covered stent grafting with distal adjunctive bare stenting had the potential to reduce the partial thoracic FL thrombosis rate and the rates of stent graft-induced new entry and reintervention but was not associated with lower aorta-related mortality or the complete FL thrombosis rate. Further research with a stricter methodology is needed.
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http://dx.doi.org/10.1016/j.jvs.2020.02.052DOI Listing
September 2020

High-efficiency and safe sulfur-doped iron oxides for magnetic resonance imaging-guided photothermal/magnetic hyperthermia therapy.

Dalton Trans 2020 May 8;49(17):5493-5502. Epub 2020 Apr 8.

State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, China.

Heat therapy is a promising therapeutic modality for cancer treatment due to the minimum adverse effects of selective local hyperthermia; however, the low heating efficiency of heat therapy under safe conditions is an issue for its bioapplication. Here, we report the synthesis of water-dispersible sulfur doped iron oxides (SDIOs) with different phase structures and the exploration of the relationships between the different SDIOs and their induction heating capacities as a guideline to obtain a photo-magnetic hyperthermia agent. The agent exhibits good biocompatibility, excellent photothermal conversion efficiency (55.8%) and great T weighted magnetic resonance imaging (63.7 mM s). Significantly, the SDIOs effectively eliminate tumours in a biologically safe AC magnetic field range (H·f = 4.3 < 5.0 × 10 kA m s) and with 808 nm laser irradiation at a safe density of 0.33 W cm; also, they can be mostly metabolized from the body after one month. The work presented here adopts anion-doped iron oxides to dramatically improve photo-magnetic hyperthermia effects and may enable further exploration in thermotherapeutic research.
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http://dx.doi.org/10.1039/d0dt00297fDOI Listing
May 2020

A Dendrimer-Based Dual Radiodense Element-Containing Nanoplatform for Targeted Enhanced Tumor Computed Tomography Imaging.

Langmuir 2020 03 20;36(12):3096-3103. Epub 2020 Mar 20.

Key Laboratory of Science & Technology of Eco-Textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, People's Republic of China.

The exploration of original computed tomography (CT) imaging contrast agents with enhanced sensitivity and specificity is currently one of the major challenging tasks for precision medicine. Herein, we develop an innovative nanoprobe of dendrimer-stabilized gold nanoparticles (Au DSNs) linked with folic acid (FA) as a targeting ligand and diatrizoic acid (DTA) for specific enhanced tumor CT imaging. In current work, poly(amidoamine) (PAMAM) dendrimers of generation 5 (G5) with amine termini were adopted to entrap Au NPs through a stepwise complexation/reduction method to achieve a higher Au loading than the conventional one-step complexation/reduction method. The prepared [(Au)-G5.NH] NPs were sequentially functionalized with diatrizoic acid (DTA), a typical CT contrast agent based on iodine(I), FA through a poly(ethylene glycol) (PEG) spacer, and carboxylated PEG monomethyl ether (PEG-COOH), ended with complete acetylation of the leftover dendrimer amine termini. The generated Au DSNs-DTA-FA (Au core diameter = 5.9 nm) were thoroughly characterized. Our data reveal that the Au DSNs-DTA-FA containing Au and I dual radiodense elements are stable, display enhanced CT imaging performance, much higher than the single-radiodense elemental material solely based on Au or I, and possess a quite good cytocompatibility. With the demonstrated FA-rendered specific targeting, the developed Au DSNs-DTA-FA can be employed as a highly efficient nanoprobe for targeted enhanced CT imaging of cancer cells and a subcutaneous tumor model. Overall, the created Au DSNs-DTA-FA may be a powerful nanoprobe for specific enhanced CT imaging of various kinds of FA receptor-expressing tumors or biosystems.
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http://dx.doi.org/10.1021/acs.langmuir.0c00451DOI Listing
March 2020

Near-infrared -triggered release of tirofiban from nanocarriers for the inhibition of platelet integrin αIIbβ3 to decrease early-stage neointima formation.

Nanoscale 2020 Feb;12(7):4676-4685

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.

Platelets play an important role in the early stage of arterial remodeling after injury. Integrin GPIIb/IIIα (αIIbβ3) regulates platelet activation in the inside-out and outside-in signaling pathways. The use of tirofiban, an integrin αIIbβ3 inhibitor, in clinical therapy is limited by its short in vivo circulation time. Herein, a controlled drug-release system was formulated using [email protected] core-shell nanoparticles as near-infrared-triggered nanocarriers to release tirofiban on demand. The nanocarriers possessed good colloidal stability and very high loading efficiency for the integrin αIIbβ3 inhibitor (14.5 wt% for tirofiban). Local application of αIIbβ3 antagonist-tirofiban on an injured arterial wall inhibited platelet activation, which was accelerated by laser irradiation. Ex vivo platelet-promoted monocyte transmigration trans-well assays revealed decreased monocyte transmigration after platelet activation was inhibited by tirofiban. Two weeks after the wire-induced injury, the intimal area and cellular content were analyzed. The neointimal area was decreased in ApoE-/- mice with [email protected]/tirofiban and laser irradiation-promoted tirofiban release, which had limited the neointima formation. The lesions showed a decreased content of macrophages and smooth muscle cells compared with ApoE-/- mice without tirofiban inhibition. Therefore, the action of platelet-integrin αIIbβ3 in neointima formation after vascular injury was successfully inhibited in vivo through the controlled release of tirofiban using a near-infrared-triggered nanocarrier, leading to the decrease of early-stage neointima formation. This study also emphasizes the role of platelets in vascular remodeling and provides a new target, namely integrin αIIbβ3, for the inhibition of neointimal hyperplasia during vascular inflammation.
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http://dx.doi.org/10.1039/d0nr00555jDOI Listing
February 2020

Outcomes of emergency in situ laser fenestration-assisted thoracic endovascular aortic repair in patients with acute Stanford type A aortic dissection unfit for open surgery.

J Vasc Surg 2020 05 30;71(5):1472-1479.e1. Epub 2019 Oct 30.

Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, and Vascular Center of Shanghai Jiao Tong University, Shanghai, China. Electronic address:

Objective: This study investigated the outcomes of emergency in situ laser fenestration (ISLF)-assisted thoracic endovascular aortic repair (TEVAR) for patients with acute Stanford type A aortic dissection unfit for open surgery.

Methods: Twenty patients with acute Stanford type A aortic dissection who were found to be unfit for open surgery, underwent emergency ISLF-assisted TEVAR in our center between March 2016 and December 2018. Anatomic criteria for endovascular repair: coronary artery and aortic valve was not involved, proximal landing zone diameter of 45 mm or less, and proximal landing zone length of 20 mm or greater. Their clinical outcomes were reviewed retrospectively.

Results: Twenty patients achieved a procedural success of 100.0%. The 30-day mortality was 10%; two patients died, one of severe pneumonia and the other from cerebral hemorrhage after the operation. Rate of stroke at 30 days was 5%. The average follow-up time was 16 months (range, 3-26 months). One death owing to heart failure occurred at 23 months postoperatively. Kaplan-Meier curve analysis revealed that the 24-month survival rate was 77.1%. Two patients had type Ia endoleaks and one had a type II endoleak. There was no stent graft migration or fenestration-related endoleak and all patients had a thrombosed false lumen in the covered section of the stent grafts. No reintervention, myocardial infarction, transient ischemic attacks, cerebral infarction, or other complications occurred during the follow-up period.

Conclusions: Emergency ISLF-assisted TEVAR is a safe and effective alternative method for treating acute Stanford type A aortic dissection unfit for open surgery.
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http://dx.doi.org/10.1016/j.jvs.2019.08.233DOI Listing
May 2020

Janus Ag/AgS beads as efficient photothermal agents for the eradication of inflammation and artery stenosis.

Nanoscale 2019 Nov 23;11(42):20324-20332. Epub 2019 Oct 23.

State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, China. and College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, 518118, China.

Janus heterostructural materials as photothermal agents with enhanced optical conversion capability are promising for artery inflammation treatment by the hyperthermia of macrophages, a primordial part in the artery inflammation response that can deteriorate into atherosclerosis and even break the vessels. Herein, a synthesis route of Janus Ag/AgS beads with hydrophilic ligands has been developed with a precise control over concentration, time and surface functionalization. These Ag/AgS heterodimers show desirable sizes of around 90 nm in diameter, in which Ag nanocrystals have a diameter of around 25 nm, and they exhibit a photothermal conversion efficiency of up to 50.0% as well as relatively low biotoxicity and good biocompatibility. Importantly, the as-prepared Janus Ag/AgS beads with a high biological safety can be effectively swallowed by macrophages and have a remarkable benefit of eliminating these cells from the original state of artery inflammation through the excellent photothermal effect of this material, without causing any further damage to the arteries and major organs in vivo. This study further promotes the development of treatment for vascular inflammation by the photothermal melting of macrophage cells in intima environments.
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http://dx.doi.org/10.1039/c9nr04804aDOI Listing
November 2019

Differential Phagocytosis-Based Photothermal Ablation of Inflammatory Macrophages in Atherosclerotic Disease.

ACS Appl Mater Interfaces 2019 Nov 22;11(44):41009-41018. Epub 2019 Oct 22.

Christopher Ingold Laboratory, Department of Chemistry , University College London , London WC1E 7JE , U.K.

Inflammatory macrophage (Mφ)-mediated atherosclerosis is a leading cause of mortality and morbidity worldwide. Photothermal therapy (PTT) has been demonstrated as an efficient strategy in killing target cells, and its application in the treatment of inflammation in atherosclerosis is developing. However, the choice of nanomaterials, mechanisms, and side effects are seldom considered. In this study, semiconductor nanomaterials, that is, MoO nanoclusters, were synthesized and used for the first time in PTT for inflammatory Mφ-mediated atherosclerosis. Based on cell differential phagocytosis, the optimum amount of MoO and treatment time were selected to exert the maximum ablation effect on Mφ and minimal damage on endothelial cells without requiring additional target or selective groups. Moreover, MoO-based PTT shows an excellent therapeutic effect on atherosclerosis by eliminating Mφ in animal models, with no significant side effects observed. This study explores a new method of nanotechnology and pharmaceutical development by using and optimizing cost-effective metal oxide nanostructures in the treatment of atherosclerosis and motivates further research on minimizing the side effects of related materials.
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http://dx.doi.org/10.1021/acsami.9b12258DOI Listing
November 2019
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