构建叶酸修饰的乳腺癌靶向纳米超声造影微粒

BACKGROUND: Studies have testified that nano-ultrasound contrast agents have a strong permeability, making it possible to image the targeted tissues outside blood vessels and overcome the limitation that micron contrast agents are only available for the blood pool imaging. OBJECTIVE: To construct the folate-modified nanoparticles targeting breast cancer as ultrasound contrast agents, as well as to observe their ability to specifically bind to cells and imaging effect in vitro. METHODS: Both contrast agents, pegylated lactic acid-glycolic acid copolymer wrapping liquid fluorocarbon formed nanoparticles (mPP/PFOB) and folate modified pegylated lactic acid-glycolic acid wrapping liquid fluorocarbon formed nanoparticles (mPPF/PFOB), were constructed by phacoemulsification-evaporation method. (1)Biocompatibility detection: HFF-1 and MCF-7 cells in the logarithmic phase were cultivated with various concentrations (0, 0.005, 0.01, 0.02, 0.05, 0.1, 0.2 and 1 g/L) of mPP/PFOB or mPPF/PFOB for 24 hours respectively, and then the cell viability was measured. (2)Targeting ability detection in vitro: HFF-1 and MCF-7 cells in the logarithmic phase were divided into three groups. Cy5-labled mPP/PFOB and mPPF/PFOB were added into groups A and B, respectively; the cells in group C were pretreated with folate for 2 hours, and sequentially Cy5-labled mPPF/PFOB was added into group C. Fluorescence intensity was detected by flow cytometry after 0.5 hours of culture. The distribution of contrast agents in cells was observed using confocal microscopy after 20 minutes of culture. (3)Ultrasound imaging in vitro: there were three groups: saline was as group A; the suspension of saline and mPPF/PFOB nanoparticles was prepared as group B; MCF-7 cells were resuspended with the mixture of saline and mPPF/PFOB nanoparticles to prepare the suspension of nanoparticles and cells as group C. In each group, the suspension was added into latex gloves, that were then tightened and immersed in water. Finally, the ultrasound was use to detect the ultrasound imaging effect in vitro. RESULTS AND CONCLUSION: Neither nanoparticles were with significant cytotoxicity. The flow cytometry showed that the mean fluorescence intensity in MCF-7 cells of group B was significantly higher than that of groups A and C. But there were no significant differences in the mean fluorescence intensity in HFF-1 cells among the three groups. It was observed that mPPF/PFOB mainly gathered around the MCF-7 cell membrane, while mPP/PFOB randomly distributed in the cytoplasm. After mPPF/PFOB binding to MCF-7 cells, they could enhance ultrasound echo in vitro. These findings indicate that the targeted nanoparticles mPPF/PFOB have good biocompatibility and can specifically bind to breast cancer MCF-7 cells in vitro and enhance the imaging capability.     

The diffusion of carbon dioxide in erythrocytes and hemoglobin solutions

Summary The CO₂ diffusion constant (Krogh's diffusion constant) has been estimated from the CO₂ flux across layers with defined thickness under steady state conditions.At 22°C and in hemoglobin solutions with a concentration of 33 g% the diffusion constant for CO₂ was found to be 3.3×10^–4 cm² min^–1 atm^–1. This value is about 40% of the diffusion constant for CO₂ in water. The relationship between the diffusion constant and the hemoglobin concentration was approximately linear in a concentration range of 10–40 g%. The temperature coefficient of the diffusion constant was –0.5%/°C both in water and hemoglobin solutions. At 38°C and in a hemoglobin solution with a concentration of 33 g%, the diffusion constant for CO₂ was therefore 3.0×10^–4 cm² min^–1 atm^–1, the diffusion coefficient 11×10^–6 cm² s^–1.A general theory for the diffusion of CO₂ in hemoglobin solutions has been derived. According to this theory the diminution of the CO₂ diffusion in hemoglobin solutions in comparison to water can be explained quantitatively by a reduction of the water space by the hemoglobin molecules.The diffusion constant for CO₂ in layers of erythrocytes was insignificantly (0–3%) smaller than in hemoglobin solutions with the same hemoglobin concentration. It is concluded that the erythrocyte membrane does not offer a considerable resistance for the CO₂ diffusion.     

Horizontal rotating tonometers for the equilibration of blood or plasma with gasmixtures at constant temperatures

Summary The construction of a thermostatted tonometry unit allowing the simultaneous equilibration of six blood or plasma samples with different gas mixtures is described. The tonometers rotate along their horizontal axis, insuring a large equilibration surface, resulting in equilibration with CO₂ in the gasphase being reached within 10 min. Samples may be introduced into or withdrawn from the rotating tonometers at any time. The gas mixtures leaving the tonometer may also be analyzed at any moment.     

Mobilization of circulating endothelial progenitor cells after endovascular therapy for ruptured cerebral aneurysms

Emerging evidence shows that circulating endothelial progenitor cells (EPCs) promote regeneration of the endothelium at sites of vessel injury. This study was designed to test the hypothesis that EPCs are mobilized in patients who had ruptured cerebral aneurysm (CA) and underwent endovascular therapy. Fourteen patients with ruptured CAs were recruited and blood samples were analyzed after coil embolization surgery. Blood samples were also obtained from 18 healthy control subjects who had no evidence of CAs and did not undergo endovascular surgery. We measured the numbers of circulating EPCs, levels of plasma vascular endothelial growth factor (VEGF) and platelet counts. EPCs significantly increased in patients with ruptured CAs and underwent surgical coil embolization, reaching a peak level on day 14 post operation. The levels of plasma VEGF and platelet counts also significantly increased in parallel with the increase in EPCs, leading to significant positive correlations of circulating EPCs with VEGF in plasma (r = 0.636, P < 0.01) and platelet counts (r = 0.721, P < 0.001), respectively. The finding suggests that EPCs are mobilized upon surgery and may play a critical role in repairing injured vascular endothelium. Levels of EPCs in peripheral blood could also serve as a prognostic marker for the outcomes of ruptured cerebral aneurysms after surgical repair.     

腹主动脉瘤开放手术和腔内手术治疗的近期疗效分析

目的 对比分析腹主动脉瘤开放手术(OSR)与腔内修复手术(EVAR)的近期疗效。方法 回顾性研究。纳入2008年1月—2020年12月蚌埠医学院第一附属医院血管外科接受手术治疗的腹主动脉瘤患者118例,其中男102例、女16例,年龄(70.5±9.6)岁。根据手术治疗方式的不同,分为OSR组23例和EVAR组95例。观察指标:(1)比较两组患者的年龄、性别、不良生活习惯、合并症、瘤体最大径、复杂瘤颈形态等基线资料。(2)比较两组患者手术时间、术中出血量、术后禁饮食时间、术后卧床时间、住院时间,以及术后并发症和死亡发生情况。(3)术后定期复查CT血管成像(CTA),观察有无再干预、支架内血栓形成、支架内再狭窄、移植物感染、各型内漏等发生。结果 OSR组和EVAR组的基线资料比较差异均无统计学意义(P值均＞0.05)。患者均顺利完成手术。EVAR组的手术时间、术中出血量、术后禁饮食时间、术后卧床时间、住院时间均少于OSR组,分别为(141.15±22.97) min与(242.79±29.41) min、(34.32±16.08) mL与(443.93±109.58)mL、(14.26±3.34) h与(52.25±12.05)h、(4.07±0.63) d与(6.48±0.83)d、(21.88±1.78) d与(24.44±2.44)d,差异均有统计学意义(t=17.919、17.881、14.978、15.532、4.745,P值均＜0.05);两组患者围手术期并发症发生率及死亡率比较,差异均无统计学意义(P值均＞0.05)。患者均获随访1年,除EVAR组2例出现轻微Ⅱ型内漏外,均无严重并发症发生。结论 腹主动脉瘤的OSR和EVAR均能取得良好的近期治疗效果。与OSR相比较,EVAR手术时间更短,术中出血更少,术后禁饮食、卧床及住院时间更短,术后恢复更快。     

Suitability of endovascular repair with current stent grafts for abdominal aortic aneurysm in Korean patients

Suitability rate of endovascular aneurysm repair (EVAR) and the anatomic features causing unsuitability have not been well determined in Asian patients who have abdominal aortic aneurysm (AAA). In a single Korean center, a total of 191 patients with abdominal aortic aneurysm (maximal diameter ≥ 4 cm) were identified. Aortoiliac morphologic characteristics in contrast-enhanced computed tomography images were retrospectively reviewed to determine suitability for EVAR with four FDA-approved stent-grafts. AAA was considered ideally suitable for EVAR in 46.6% of patients. The most frequent causes for unsuitability were common iliac artery (CIA) aneurysm (61.8%) and excessive neck angulation (52.9%). Problems such as small and/or short neck and small access were found in minor incidences. If CIA aneurysm is dealt by overstenting with sacrifice of internal iliac artery, suitability rate can increase to 65%. Larger aneurysms were more frequently unsuitable for EVAR and had more chance of having multiple unfavorable features. In conclusion, the overall feasibility rate for EVAR in Korean patients was not different from that in Western patients. However, considering the difference in the major causes of unsuitability, more attention has to be paid to neck angulation and CIA aneurysm to provide EVAR for more Korean patients especially who have large aneurysm.     

Comparison of renal damage by iodinated contrast or gadolinium in an acute renal failure rat model based on serum creatinine levels and apoptosis degree

This study was undertaken to compare renal damage, as determined by serum creatinine and degree of apoptosis, caused by iodinated contrast or gadolinium in an acute renal failure (ARF) rat model. Rats were divided into three groups; controls (n=3), a CT contrast medium group (n=9), and an MR contrast medium group (n=9). The CT and MR groups were further subdivided into three groups, namely, low, standard, and high dose subgroups. Renal function was evaluated by determining serum creatinine levels; before ARF, and 48 hr after ARF and contrast administration. Apoptosis was assayed by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). No significant creatinine level differences were observed between the CT and MR groups (p=0.116). Degrees of apoptosis in the renal cortex and medulla were more severe in the CT contrast medium group than in the control or MR contrast medium group (p<0.05). The study shows that CT contrast medium did not aggravate renal function more so than MR contrast medium in this ARF rat model. However, apoptosis examination in the renal cortex and medulla indicated that CT contrast medium induced more severe apoptosis than MR contrast medium (p<0.05). We conclude that CT contrast medium can be used for renal imaging studies when subjects are well hydrated and preventive medication is administered.     

基于CTA的后循环ASPECT评分对急性椎基底动脉闭塞患者血管内治疗临床结局的预测作用

目的:探讨基于CT血管成像(CTA)源影像的后循环急性卒中预后早期CT(CTA pc-ASPECT)评分对急性椎基底动脉闭塞(AVBO)患者行血管内治疗后临床结局的预测作用。方法:回顾性研究。纳入南阳市中心医院2018年1月—2020年1月35例术前经CTA影像确诊的AVBO患者,其中男25例、女10例,年龄34～84...     

Comparison of costs of endovascular repair versus open surgical repair for abdominal aortic aneurysm in Korea

This study was designed to compare the hospital-related costs of elective abdominal aortic aneurysm (AAA) treatment and cost structure between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in Korean health care system. One hundred five primary elective AAA repairs (79 OSRs and 26 EVARs) performed in the Seoul National University Hospital from 2005 to 2009 were included. Patient characteristics were similar between two groups except for older age (P = 0.004) and more frequent history of malignancy (P = 0.031) in EVAR group. Thirty-day mortality rate was similar between two groups and there was no AAA-related mortality in both groups for 5 yr after repair. The total in-hospital costs for the index admission were significantly higher in EVAR patients (mean, KRW19,857,119) than OSR patients (mean KRW12,395,507) (P < 0.001). The reimbursement was also significantly higher in EVAR patients than OSR patients (mean, KRW14,071,081 vs KRW6,238,895, P < 0.001) while patients payments was comparable between two groups. EVAR patients showed higher follow-up cost up to 2 yr due to more frequent imaging studies and reinterventions for type II endoleaks (15.4%). In the perspective of cost-effectiveness, this study suggests that the determination of which method to be used in AAA treatment be more finely trimmed and be individualized.     

Cross-reactivity patterns of T cells specific for iodinated contrast media

BACKGROUND: Approximately 3% of patients exposed to iodinated contrast media develop delayed hypersensitivity reactions. OBJECTIVE: We wanted to better understand the molecular basis of contrast media cross-reactivity. METHODS: Cross-reactivity was assessed by skin testing and measurement of T-cell activation (CD69 upregulation) and proliferation ((3)H-thymidine uptake, 5,6-carboxyfluorescein diacetate succinimidyl ester staining) of PBMCs, T-cell lines, and T-cell clones of 2 patients with delayed hypersensitivity reactions to iohexol and iomeprol, respectively. Thirteen different contrast media and potassium iodide were compared. RESULTS: Skin testing and analyses of PBMCs, T-cell lines, and clones showed broad cross-reactivity in both patients. Broad as well as more restricted cross-reactivity patterns were found in iohexol-specific and iomeprol-specific CD4(+) T-cell clones, whereas 1 iomeprol-specific CD8(+) T-cell clone showed no cross-reactivity at all. The reactivity to equimolar concentrations of iohexol and its dimer iodixanol was very similar, suggesting that the dimer was not more stimulatory than its monomer. Consistently low reactivity to iobitridol was found in both patients, but never to iodide. A frequency analysis of contrast medium-specific peripheral T cells gave values between 0.6 % (iomeprol) and 0.05 % (iobitridol). CONCLUSION: Clinically observed cross-reactivity between different contrast media is a result of the presence of contrast media-specific T cells, some of which show a broad cross-reactivity pattern. Iodide ions, known to be present at low concentration in contrast media solutions, do not seem to be the causative moiety. CLINICAL IMPLICATIONS: Detailed in vitro analysis might help identify noncross-reactive contrast media.     

Embolic materials for endovascular treatment of cerebral lesions

Recently developed soft microcatheters can be maneuvered endovascularly into the brain, permitting treatment of lesions without conventional neurosurgery. Progress in biomaterial science has contributed significantly to the development of this new therapeutic modality termed intravascular neurosurgery or interventional neuroradiology. Although embolic materials play an important role, ideal materials have yet to be devised. Various embolic materials in clinical use are reviewed, such as cyanoacrylates, ethylene-vinyl alcohol copolymer mixtures, Ethibloc, ethanol, estrogen, poly(vinyl acetate), cellulose acetate polymer, poly(vinyl alcohol), gelatin sponges, microfibrillar collagen, surgical silk sutures, detachable balloons, and coils. The materials are reviewed in the context of treatment application for various brain lesions, such as arteriovenous malformations, cerebral aneurysms, and head and neck tumors. Further developments in biomaterial polymer science can bring about progress against brain diseases.     

Stent graft treatment for thoracic and thoracoabdominal aortic disease using a unibody Z-stent that adapts to flexure

Positioning a stent graft (SG) that adapts to the anatomical shape of the aorta is important to prevent complications after SG procedures to treat aortic disease. The Gianturco Z-stent has several benefits, but its rigid structure prevents adaptation to flexure. We improved this stent and studied its ability to adapt in the clinical environment. We positioned SGs and inspected their adaptability to flexure in an aortic arch model. We examined several gap lengths and strut directions, and determined the distance generated between the stent and the aortic wall. We found that adaptation was quite satisfactory with a gap of more than 10 mm or when the struts faced the major flexure or the side of the model aorta. Based on these findings and to facilitate placement, we manufactured the unibody Z-stent with 10-mm gaps. The unibody Z-stent was applied to treat thoracic and thoracoabdominal aortic disease in seven patients. The SG was positioned from the femoral or iliac artery in five patients and from an anastomosed graft to the ascending aorta after median sternotomy and bypass of the arch branches in two patients. A minor endoleak developed in one patient. None of the other six patients developed complications or died during the procedure, although one patient died in the hospital due to cerebral infarction. The unibody Z-stent was applied as a SG that adapts to flexure of the aorta and was easy to apply. The frequency of complications was apparently decreased after clinical application of the unibody Z-stent in SG treatment for thoracic and thoracoabdominal aortic disease.     

两种手术方式治疗膝下动脉闭塞性病变的临床疗效对比

目的探讨腔内血管成形术与下肢动脉旁路移植术治疗膝下动脉闭塞性病变的临床疗效。方法选取膝下动脉闭塞性病变患者343例作为研究对象,其中142例行下肢动脉旁路移植术(旁路移植组),201例行腔内血管成形术(血管成形组)。采用1∶1倾向性评分,以血管成形组为基准组进行匹配,共67例匹配成功。分析2组肢体挽救率、靶血管一期通畅率、踝肱指数(ABI)、Rutherford分级评分及并发症发生情况。结果2组肢体挽救率、靶血管一期通畅率比较,差异均无统计学意义(P>0.05)。2组术前ABI、Rutherford分级评分比较,差异无统计学意义(P>0.05);但重复测量结果显示,以时间因素为作用主效应差异有统计学意义(P<0.05);2组术后7 d、6个月ABI均高于术前(P<0.05),但同一时间点组间比较差异无统计学意义(P>0.05);2组术后7 d、6个月Rutherford分级评分均低于术前(P<0.05),但同一时间点组间比较差异无统计学意义(P>0.05)。血管成形组并发症发生率明显低于旁路移植组(P<0.05)。结论腔内血管成形术与下肢动脉旁路移植术治疗膝下动脉闭塞性病变,患者的肢体挽救率、靶血管一期通畅率相当,但腔内血管成形术并发症相对较少。     

脐血干细胞移植及血管成形治疗糖尿病下肢缺血性疾病

背景：近年来介入治疗因其成功率高、疗效好、创伤小已被广泛认可,但由介入治疗引起的血管内膜损伤尚无有效的治疗手段,致使术后远期发生严重再狭窄。干细胞移植技术的出现为促进受损血管内皮功能修复、再内皮化及辅助恢复缺血组织血供带来了新的曙光。 目的：总结近年来有关脐血干细胞移植技术及腔内血管成形术治疗糖尿病下肢缺血性病变的研究进展。 方法：使用计算机检索 2000年1月至2015年3 月PubMed、CNKI数据库中相关文章,检索词为“human umbilical cord blood stem cell transpltation,percutaneous transluminal angioplasty,diabetic lower limb ischemia, restenosis”及“人脐血干细胞移植、血管腔内成形术、糖尿病下肢缺血、再狭窄”。将符合研究目的的文献分类筛选并进行评价,初检获得216篇相关文献,最终纳入44篇文献进行分析。 结果与结论：通过对人脐血干细胞移植及血管成形术这两种治疗方式的疗效及远期预后分析比较,得出脐血干细胞移植联合血管成形术疗效优于单纯干细胞移植或单纯介入治疗,能够促进侧支循环建立、改善受损内皮功能及降低介入治疗后再狭窄发生。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Developing a new endograft for the treatment of juxtarenal aortic aneurysms: definition and experimentation

OBJECTIVES:To analyze angiotomographic parameters of juxtarenal aneurysms to assess the applicability of an endograft model to patients and to create in vitro and in vivo models to assess the new endograft.METHODS:A total of 49 patients with juxtarenal aneurysms were submitted to angiotomographic evaluation, and parameters such as the aortic diameter, the length of the neck, and the angulations of the celiac trunk, superior mesenteric artery and renal arteries; the distances between them; and anatomic variations were analyzed. Based on these parameters, an endograft model was developed and tested in a newly created in vitro model of juxtarenal aneurysm. An experimental model of juxtarenal aneurysm was then established in six pigs weighing 50–60 kg to assess the new endograft model.RESULTS:The angiotomographic parameters of juxtarenal aneurysm measured in this study were similar to those reported in the literature and allowed the development of an endograft based on the hourglass concept, which was applicable to 85.8% of the patients. The in vitro model of juxtarenal aneurysm evidenced good radiopacity and functionality and permitted adjustments in the new device and technical improvements in the procedures for treating these aneurysms. In addition, the porcine model of juxtarenal aneurysm was successfully created in all six animals using a bovine pericardial patch, and use of the new endograft in three pilot procedures evidenced its feasibility.CONCLUSIONS:The Hourglass endograft was rendered applicable to treatment of the majority of patients with juxtarenal aneurysms simply by changing its diameter. Moreover, the new in vitro and in vivo models were shown to be effective for assessing both the presented endograft and experiments assessing the endovascular treatment of juxtarenal aneurysms.     

氧化铅与碘帕醇造影剂在离体胎盘血管CT三维重建中的显影效果比较

目的 探讨氧化铅与碘帕醇造影剂在离体胎盘血管CT 3D重建中的显影效果。方法 选取2015年12月—2016年2月于安徽医科大学第二附属医院妇产科足月分娩、无妊娠合并症且产妇自愿放弃的离体胎盘20例进行前瞻性研究。采用简单随机化分组方法分为碘帕醇组和氧化铅组,每组10例。分别将氧化铅和碘帕醇造影剂混于自凝牙托材料进行胎盘动静脉血管灌注,然后行CT增强扫描及胎盘血管3D重建,对比观察两组胎盘血管3D重建显影效果,测量胎盘体积、血管容积及各级血管直径,组间采用独立样本t检验分析数据。结果 成功构建18例胎盘血管造影标本,两组各有1例失败。氧化铅组的胎盘一级和二级血管饱满,立体感强,血管周围无明显伪影;但其三级和四级血管显影模糊,微血管及胎盘小叶显影稀疏。碘帕醇组的胎盘一级和二级血管显影不如氧化铅组饱满;但其三级和四级血管灌注完全,血管周围伪影少、显影清晰、走行自然,微血管及胎盘小叶显影均匀。氧化铅组与碘帕醇组的胎盘体积和胎盘血管容积比较,差异均无统计学意义(P值均＞0.05);氧化铅组一、二级血管直径均大于碘帕醇组,而三、四级血管直径均小于碘帕醇组,差异均有统计学意义(P值均＜0.05)。结论 氧化铅造影剂适用于一、二级胎盘血管造影,碘帕醇造影剂适用于三、四级胎盘血管造影。胎盘血管CT 3D重建后的定量测量方法可作为胎盘血管研究量化的基础。     

Carbon monoxide-bound hemoglobin-vesicles for the treatment of bleomycin-induced pulmonary fibrosis

Carbon monoxide (CO) has potent anti-inflammatory and anti-oxidant effects. We report herein on the preparation of a nanotechnology-based CO donor, CO-bound hemoglobin-vesicles (CO-HbV). We hypothesized that CO-HbV could have a therapeutic effect on idiopathic pulmonary fibrosis (IPF), an incurable lung fibrosis, that is thought to involve inflammation and the production of reactive oxygen species (ROS). Pulmonary fibril formation and respiratory function were quantitatively evaluated by measuring hydroxyproline levels and forced vital capacity, respectively, using a bleomycin-induced pulmonary fibrosis mice model. CO-HbV suppressed the progression of pulmonary fibril formation and improved respiratory function compared to saline and HbV. The suppressive effect of CO-HbV on pulmonary fibrosis can be attributed to a decrease in ROS generation by inflammatory cells, NADPH oxidase 4 and the production of inflammatory cells, cytokines and transforming growth factor-β in the lung. This is the first demonstration of the inhibitory effect of CO-HbV on the progression of pulmonary fibrosis via the anti-oxidative and anti-inflammatory effects of CO in the bleomycin-induced pulmonary fibrosis mice model. CO-HbV has the potential for use in the treatment of, not only IPF, but also a variety of other ROS and inflammation-related disorders.     

Significance of ankle brachial index and collaterals for prediction of critical limb ischemia in infrainguinal peripheral arterial occlusive disease

PurposeChronic limb ischemia (CLI) is a clinical diagnosis, but should be approved by technical tests like the ankle-brachial index (ABI). Although the ABI is well established, less is known about the influence of collateralization on clinical stage.Material/MethodsMagnetic resonance angiographies (MRA) of 129 lower extremities were searched for morphological changes and for the number of collateral vessels according to Sorlie. Ankle pressures were recorded as higher (APmax) and lower (APmin) systolic blood pressures of the two ankle arteries with consecutive calculation of ABImax and ABImin.ResultsIn comparisons of ROC curves, APmax (AUC=0.749) did significantly better as a prognostic marker than APmin (AUC=0.642) (p=0.005) and ABImax (AUC=0.744) did significantly better than ABImin (AUC=0.650) (p=0.019). APmax showed a positive likelihood ratio (+LR) of 5.79 and a negative likelihood ratio (?LR) of 0.47 (cutoff ≤55 mmHg). For the number of collateral vessels a +LR 2.27 and a ?LR of 0.09 and in patients with an APmax ≤55 mmHg a +LR of 5.50 and a ?LR of 0.00 were calculated (cutoff ≤1 collateral vessel).ConclusionWhereas APmax is more eligible for verification of CLI, collateral count is better in exclusion of CLI. Both seem to be independent factors for validating the clinical diagnosis of CLI.