Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion

ObjectivesThere are few long-term follow-up studies about the result of revascularization surgery for the treatment of popliteal artery entrapment syndrome (PAES). We performed this retrospective study to analyze the long-term result of revascularization surgery in patients with advanced PAES during the last 16 years.MethodsTwenty-two limbs in 18 consecutive patients with PAES were treated surgically at Seoul National University Hospital between January 1994 and December 2009. The preoperative diagnosis of PAES was made by duplex ultrasonography, three-dimensional computed tomography angiography, magnetic resonance imaging, or conventional angiography. The method of surgical approach was determined by the extent of arterial occlusion in preoperative images.ResultsThe mean age was 31 years old and the majority of patients were men (94%). The chief complaints were claudication in 18 limbs, ischemic rest pain in three limbs, and toe necrosis in one limb. All 22 limbs underwent revascularization for advanced PAES with segmental arterial occlusion. Fourteen limbs underwent musculotendinous section and popliteo-popliteal interposition graft (13 posterior approaches, one medial approach), five femoropopliteal (below-knee) bypasses, one femoro-posterior tibial bypass, and two popliteo-posterior tibial bypasses. All revascularization surgeries were performed with reversed saphenous veins. The overall primary graft patency rates at 1, 3, and 5 years were 80.9%, 74.6%, and 74.6%, respectively. Comparing 5-year graft patency according to the extent of arterial occlusion, patients with occlusion confined to the popliteal artery (n = 14) showed a better patency rate than patients with occlusion extended beyond the popliteal artery (n = 8) with no statistical significance (83.6% vs 53.6%; P = .053). Comparing 5-year graft patency according to the inflow artery, superficial femoral artery inflow (n = 6) showed a worse patency rate than popliteal artery inflow (n = 16) (30.0% vs 85.9%; P = .015).ConclusionIn advanced popliteal entrapment syndrome, longer bypass with superficial femoral artery inflow showed poor long-term graft patency rate. The graft patency rate was excellent in patients whose arterial occlusion was confined to the popliteal artery and treated by popliteal interposition graft with reversed saphenous vein. With these data, we suggest that longer bypass extending beyond the popliteal artery might only be indicated in patients with critical limb ischemia when the extent of disease does not allow short interposition graft

Non-thermal atmospheric pressure plasma-conditioned root dentin promotes attraction and attachment of primary human dental pulp stem cells in real-time Ex Vivo

This study investigated if non-thermal atmospheric pressure plasma (NTAPP) treatment of root dentin surfaces promotes human dental pulp stem cell (hDPSCs) adhesion. Freshly extracted human single-rooted teeth (n = 36) were decoronated and cut (first vertically, then horizontally) into root dentin slices (3 mm thick). Primary hDPSCs cultures were seeded onto slices randomly assigned to pretreatment groups (n = 9/group): NaOCl (1.5%), EDTA (17%) then NTAPP (Group I); NaOCl then NTAPP (Group II); NaOCl then EDTA (Group III); and NaOCl alone (Group IV). Cell viability and proliferation were measured using MTT assay with log-linear statistical analysis. Cell attachment and spreading morphologies on dentin slices (n = 3/group) were examined through scanning electron microscopy. Early cell adhesion events and subcellular activities were observed in real time by live-cell imaging through holotomographic microscopy. Cell viability and proliferation were significantly higher on NTAPP-treated dentin (p \u3c 0.05), without interactions with EDTA (p \u3e 0.05). The attachment, spreading, extensions and multiple layers of hDPSCs were heightened on NTAPP-treated dentin. Cell adhesion, spreading, and dentinal tubule penetration were hastened on NTAPP-treated dentin surfaces in real-time, with elevated subcellular activities and intracellular lipid droplet formation. NTAPP-treated root dentin surfaces support enhanced cellular responses, potentially promoting pulp-dentin regeneration

Outcomes after aortic aneurysm repair in patients with history of cancer: a nationwide dataset analysis

Synchronous cancer in patients with abdominal aortic aneurysm (AAA) increases morbidity and mortality after AAA repair. However, little is known about the impact of the history of cancer on mortality after AAA repair. Patients with intact AAA who were treated with endovascular aneurysm repair or open surgical repair were selected from the Health Insurance and Review Assessment data in South Korea between 2007 and 2016. Primary endpoints included the 30- and 90-day mortality and long-term mortality after AAA repair. The Cox proportional hazards models were constructed to evaluate independent predictors of mortality. A total of 1999 patients (17.0%, 1999/11785) were diagnosed with cancer prior to the AAA repair. History of cancer generally had no effect in short-term mortality at 30 and 90 days. However, short-term mortality rate of patients with a history of lung cancer was more than twice that of patients without it (3.07% vs. 1.06%, P = 0.0038, 6.14% vs. 2.69%, P = 0.0016). Furthermore, the mortality rate at the end of the study period was significantly higher in AAA patients with a history of cancer than in those without a history of cancer (21.21% vs. 17.08%, P < .0001, HR, 1.31, 95% CI, 1.17–1.46). The history of cancer in AAA patients increases long-term mortality but does not affect short-term mortality after AAA repair. However, AAA repair could increase both short- and long-term mortality in patients with lung cancer history, and those cases should be more carefully selected

Detection of Biomolecular Binding Through Enhancement of Localized Surface Plasmon Resonance (LSPR) by Gold Nanoparticles

To amplify the difference in localized surface plasmon resonance (LSPR) spectra of gold nano-islands due to intermolecular binding events, gold nanoparticles were used. LSPR-based optical biosensors consisting of gold nano-islands were readily made on glass substrates using evaporation and heat treatment. Streptavidin (STA) and biotinylated bovine serum albumin (Bio-BSA) were chosen as the model receptor and the model analyte, respectively, to demonstrate the effectiveness of this detection method. Using this model system, we were able to enhance the sensitivity in monitoring the binding of Bio-BSA to gold nano-island surfaces functionalized with STA through the addition of gold nanoparticle-STA conjugates. In addition, SU-8 well chips with gold nano-island surfaces were fabricated through a conventional UV patterning method and were then utilized for image detection using the attenuated total reflection mode. These results suggest that the gold nano-island well chip may have the potential to be used for multiple and simultaneous detection of various bio-substances

Repetitive Nerve Stimulation Test in Amyotrophic Lateral Sclerosis with Predominant Oropharyngeal Manifestations

BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis (ALS) patients display easy fatigability and abnormal decrements on repetitive nerve stimulation (RNS) test of clinically involved limb muscles, which can result in ALS being misdiagnosed as myasthenia gravis. We retrospectively analyzed the RNS tests of ten ALS patients with only or predominant oropharyngeal symptoms without ocular or facial weakness. METHODS: RNS tests were performed on the abductor digiti quinti, flexor carpi ulnaris, orbicularis oculi (OO), nasalis and trapezius muscles at low-rate stimulation frequencies of 3 and 5-Hz. Decrements greater than 10% of the compound muscle action potential amplitude on the fifth stimulation compared to the first was regarded as abnormal. RESULTS: Six patients complained of muscular fatigue or diurnal fluctuation. Among the ten patients, three exhibited abnormal decrements during low-rate stimulation in the facial muscles but not in the limb muscles, two exhibited abnormal decrements in the OO and nasalis muscles, and one exhibited abnormal decrements in the OO muscle. CONCLUSIONS: These findings show that the facial muscles may be involved in some early oropharyngeal forms of ALS, although facial weakness may not be clinically evident. We confirm herein that abnormal decrement of facial muscles to RNS test cannot make a definite diagnose for myasthenia gravis.ope

Bilateral iliac and popliteal arterial thrombosis in a child with focal segmental glomerulosclerosis

Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%–5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS