Risk factors of supplementary injection after foam sclerotherapy for varicose veins of lower extremities and its impact on blood coagulation function / 实用医学杂志

Objective To explore the risk factors of supplementary injection after foam sclerotherapy for varicose veins of lower extremities and its impact on blood coagulation function.Methods A total of 185 patients with varicose veins of lower limbs diagnosed in the First People's Hospital of Zunyi from January 2018 to December 2021 were selected.The corresponding pathological data were collected,and the D-dimer,thrombin time,and fibrinogen level of patients were detected 1 d before and 1 d after the surgery.The postoperative video phone follow-up lasted until 6 months after the surgery.The patients were divided into single treatment group and supple-mentary treatment group according to whether supplementary injection of foam sclerosing agent was needed during the follow-up.Propensity matching on the data between the two groups was conducted,and the correlation between disease course data,coagulation factors,and the occurrence of supplementary injection was analyzed.A time series model for the incidence of supplementary injection was established,and the therapeutic effect and complica-tions were observed.Results After propensity matching,there was still significant difference in the degree of lesion between the two groups(P<0.05).On the first day after surgery,there was significant difference in the D-dimer and fibrinogen groups between the two groups(P<0.05),and but no significant difference in thrombin time(P>0.05).The occurrence of supplementary injection was significantly correlated with D-dimer,fibrinogen,thrombin time,and first-time injection dose(P<0.05),and the incidence of supplementary injection was higher in patients who received first-time injection in January,August,September,and December.Both groups achieved successful treatment 6 months after surgery,and there was no significant difference in the incidence of compli-cations.Conclusion Patients with lower limb varicose veins of C3/C4 are more likely to require supplementary injection compared to patients with other levels.The level of D-dimer and fibrinogen at 1 d after surgery is positively correlated with the occurrence of supplementary injection,while the dose of the first injection is negatively corre-lated with the occurrence of supplementary injection.

Diagnosis and treatment of chronic exertional compartment syndrome of the lower extremities: a review / 中华创伤杂志

Chronic exertional compartment syndrome (CECS) of the lower extremities is a common clinical condition characterized by exercise-induced pain in the extremities, which is predominantly observed in people who take an active part in sports, such as athletes. It is mainly presented as post-exercise pain in the lower extremities, probably accompanied by numbness and limb weakness, etc., affecting the patients′ life and work. The symptoms of CECS in the lower limbs are usually present after physical activities of a certain intensity, making them difficult to be identified through routine outpatient physical examination, and likely to be misdiagnosed and underdiagnosed. Furthermore, the absence of universally accepted and unified treatment standards for CECS of the lower extremities complicates the decision-making process regarding the necessity of surgical intervention and choice of surgical approach in the clinical practice. For this purpose, recent developments in the diagnosis and treatment of CECS of the lower extremities were reviewed to provide reference for its standardized diagnosis and treatment.

Heberprot-P® en el tratamiento de trauma vascular distal / Heberprot-P® in the treatment of distal vascular trauma

Introducción: Los traumatismos constituyen causa frecuente de consulta. Entre sus localizaciones más comunes se encuentran las extremidades inferiores. El Heberprot-P® resulta un factor de crecimiento epidérmico que se ha utilizado durante más de una década para la cicatrización de las úlceras del pie diabético con excelentes resultados. Ampliar su utilización a otras patologías, incluso de etiología traumática, permitiría expandir las posibilidades terapéuticas para la cicatrización de las heridas. Objetivo: Exponer el resultado de la aplicación del Heberprot-P® en una amputación transtarsiana en un paciente portador de un trauma vascular distal. Presentación del caso: Paciente masculino de 23 años con antecedentes de salud. Luego de traumatismo por accidente de tránsito presentó fractura de huesos del metatarso y la sección total de la arteria pedia del pie izquierdo, lo cual provocó una gangrena húmeda de la extremidad. Por este motivo se realizó una amputación transtarsiana del pie. Se usó el Heberprot-P® como terapia para acortar el tiempo de cicatrización. Conclusiones: El Heberprot-P® resultó útil para la evolución de la herida como consecuencia de un trauma vascular, al evitar una amputación mayor, acelerar el proceso de cicatrización y conservar una extremidad funcional, lo que demostró que puede constituir una terapia eficaz para las heridas de difícil cicatrización, independientemente de su etiología(AU)

Introduction: Trauma is a frequent cause of consultation. Among its most common locations are the lower extremities. Heberprot-P® is an epidermal growth factor that has been used for more than a decade for the healing of diabetic foot ulcers with excellent results. Extending its use to other pathologies, including traumatic etiology ones, would expand the therapeutic possibilities for wound healing. Objective: To present the result of the application of Heberprot-P® in a Chopart´s amputation in a patient with distal vascular trauma. Case presentation: A 23-year-old male patient with a health history. After trauma from a traffic accident, he presented a fracture of the bones of the metatarsus and the whole section of the left foot´s pedis artery, which caused a wet gangrene of the extremity. For this reason, a Chopart´s amputation of the foot was performed. Heberprot-P® was used as therapy to shorten healing time. Conclusions: Heberprot-P® was useful for wound evolution as a result of vascular trauma, avoiding major amputation, accelerating the healing process and preserving a functional limb, which showed that it can be an effective therapy for wounds that are difficult to heal, regardless of their etiology(AU)

Combining transcranial magnetic stimulation with head-eye movement improves the lower limb movement and balance of hemiplegic stroke survivors / 中华物理医学与康复杂志

Objective:To observe any effect of supplementing head-eye movement with repeated transcranial magnetic stimulation (rTMS) on the lower limb movement and balance of hemiplegic stroke survivors.Methods:Forty stroke survivors with hemiplegia were divided at random into a control group and an observation group, each of 20. Both groups received conventional medication and head-eye movement rehabilitation training, while the observation group was additionally provided with rTMS daily for 20 days. The head-eye movement training involved one minute for each movement, twice a day, five days a week for 4 weeks. Before and after the treatments, both groups were assessed using the Fugl-Meyer Assessment Scale for the Lower Extremities (FMA-LE), the Berg Balance Scale (BBS), timed up and go tests (TUGs), and the Modified Barthel Index (MBI).Results:The treatment improved both groups′ average FMA-LE, BBS and MBI scores significantly, and significantly shortened their average TUG times. The observation group showed significantly greater improvement than the control group, on average.Conclusion:Combining rTMS with head-eye movement can significantly improve the lower limb movement and balance of hemiplegic stroke survivors.

Fatores prognósticos em traumatismos vasculares do segmento femoropoplíteo: decisões intraoperatórias são importantes / Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter

Resumo Contexto O trauma vascular acomete frequentemente os membros inferiores; entretanto, ainda há dúvidas sobre quais fatores levam a desfechos desfavoráveis. Objetivos Determinar o perfil das vítimas de traumatismo femoropoplíteo, o tratamento utilizado e fatores relacionados a desfechos desfavoráveis. Métodos Estudo retrospectivo, baseado em prontuários de pacientes operados entre 2017 e 2021. Foram analisados: sexo, idade, distância percorrida para atendimento, mecanismo de trauma, presença de choque hipovolêmico, lesões associadas, tratamento, realização de fasciotomia, decisões intraoperatórias inadequadas e índice de severidade de trauma. Necessidade de reintervenção, amputação e óbito foram considerados desfechos desfavoráveis. Foram utilizadas análises univariadas, bivariadas e regressão logística. Resultados Noventa e quatro pacientes foram selecionados, sendo 83% homens, com idade média de 30,8 anos. Lesões arteriais e venosas simultâneas ocorreram em 57,5% dos casos; vasos femorais superficiais foram mais acometidos (61,7%), e mecanismos penetrantes, mais prevalentes (80,9%). Lesões arteriais foram frequentemente tratadas com enxerto venoso (59,6%), e lesões venosas foram submetidas à ligadura (81,4%). Em 15% houve decisões cirúrgicas inadequadas, sendo o uso da safena magna ipsilateral para reconstrução arterial a mais comum. Ocorreram desfechos desfavoráveis em 44,7% dos casos; em 21,3%, foi necessária reintervenção; amputação em 25,5%; e ocorreu óbito em 9,5% dos pacientes. Conclusões As lesões acometeram principalmente homens jovens, vítimas de ferimento por arma de fogo. Vasos femorais superficiais foram os mais lesados, e traumatismos não vasculares concomitantes foram frequentes, principalmente fraturas. Decisões cirúrgicas inadequadas aumentaram em 34 vezes a necessidade de reintervenções. Necessidade de realização de fasciotomia, presença de fratura/luxação, mecanismo contuso de trauma e lesão de artéria poplítea aumentaram o risco de amputação.

Abstract Background Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes. Objectives To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes. Methods A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted. Results The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died. Conclusions These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.

Crecimiento guiado en extremidades inferiores / Guided growth in lower extremities

El crecimiento guiado es una opción quirúrgica de uso creciente para la corrección de las deformidades angulares de extremidades inferiores en pacientes esqueléticamente inmaduros. Es posible de realizar en múltiples planos o segmentos, con excelentes resultados. Su uso más frecuente es en deformidades del plano coronal alrededor de la rodilla. La epifisiodesis permanente se puede realizar en pacientes dentro de los dos años previos al término del crecimiento longitudinal del segmento a tratar, considerando la epifisiodesis temporal para los pacientes con más de 2 años de crecimiento restante.En casos leves a moderados las tasas de éxito llegan incluso al 100% en algunas series, en tanto, pacientes con enfermedad de Blount, obesidad, edad esquelética avanzada o deformidades severas, tienen menos posibilidades de lograr una corrección completa.Independientemente de la técnica quirúrgica, es necesario una adecuada planificación preoperatoria, educación familiar y un seguimiento estricto para así minimizar las complicaciones y permitir una excelente corrección de la deformidad con una morbilidad mínima.

Guided Growth is a surgical option of increasing use for the correction of angular deformities of the lower extremities in skeletally immature patients. It is possible to perform in multiple planes or segments, with excellent results. Its most frequent use is in deformities of the coronal plane around the knee. Permanent epiphysiodesis can be performed in patients within 2 years before the end of longitudinal growth of the segment to be treated, considering temporary epiphysiodesis for patients with more than 2 years of remaining growth.In mild to moderate cases, the success rates reach even 100% in some series, while patients with Blount's disease, obesity, advanced skeletal age or severe deformities are less likely to achieve a complete correction.Regardless of the surgical technique, adequate preoperative planning, family education and strict follow-up are necessary to minimize complications and allow excellent correction of the deformity with minimal morbidity

Effect of hydrogen on lung injury induced by extremity ischemia-reperfusion in elderly patients / 中华麻醉学杂志

Objective:To evaluate the effect of hydrogen on lung injury induced by extremity ischemia-reperfusion (I/R) in elderly patients.Methods:Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-75 yr, with height 155-180 cm, weighing 50-75 kg, undergoing lower limb surgery under spinal anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: hydrogen inhalation group (H group) and control group (C group). In H group, 67% hydrogen-33% oxygen was inhaled through the nasal catheter until the end of surgery starting from the completion of anesthesia.In group C, 33% oxygen was inhaled through the nasal catheter until the end of surgery after the completion of anesthesia.Blood samples from the radial artery were collected before anesthesia and at 60 min after tourniquet deflation.Blood gas analysis was performed to determine and record arterial oxygen partial pressure (PaO 2) and arterial carbon dioxide partial pressure (PaCO 2), and alveolar-arterial partial pressure of oxygen difference (A-aDO 2), oxygenation index (OI) and respiratory index (RI) were calculated.Pulmonary surfactant protein D (SP-D) and interleukin-6 (IL-6) concentrations in serum were measured by enzyme-linked immuno sorbent assay.ICU stay time and incidence of pulmonary complications within 7 days after operation were recorded. Results:Compared with group C, PaO 2 and OI were significantly increased, RI and A-aDO 2 were decreased, SP-D and IL-6 concentrations in serum were decreased at 60 min after tourniquet deflation, and ICU stay time was shortened ( P<0.05), and no significant change was found in the incidence of pulmonary complications within 7 days after surgery in group H ( P>0.05). Conclusion:Hydrogen can reduce the lung injury induced by extremity I/R, and the mechanism may be related to the reduction of inflammatory response in elderly patients.

Compliance and influencing factors of stretch sock pressure therapy with varicose veins of lower extremities / 中华全科医师杂志

A total of 280 patients with varicose veins of lower extremities who were prescribed stretch socks as pressure therapy in the outpatient clinic of Beijing Chaoyang Hospital from September 2019 to November 2019 were included in the study. Among 280 patients 208 were followed up for one year(74.3%), 139 cases (66.8%) gave up wearing stretch socks and 69 cases (33.2%) insisted to wear. The main reasons for giving up wearing were feeling too tight (23.1%), too much troubles (17.7%), symptom improvement (15.1%), poor effect (10.8%) and so on. The compliance of wearing stretch socks as pressure therapy in outpatients with varicose veins of lower extremities is poor with a variety of reasons, the data may provide a reference for improving clinical compliance in the future.

Combining scalp acupuncture with feedback can relieve post-stroke spasticity and paralysis of the lower extremities / 中华物理医学与康复杂志

Objective:To observe the effect of combining scalp acupuncture with feedback training on muscle tone, motor ability, plantar pressure distribution and joint range of motion of stroke survivors with lower limb spastic paralysis.Methods:A total of 212 stroke survivors were randomly divided into a combination group ( n=70), an exercise group ( n=70) and a scalp acupuncture group ( n=72) according to a random number table. All of the patients received routine medication and 120 minutes of rehabilitation training six days a week for 8 consecutive weeks. The rehabilitation training included guidance on good posture, posture change training, balance training and gait training. The scalp acupuncture and exercise groups were additionally provided with 40 minutes of scalp acupuncture and lower limb intelligent feedback training, while the combination group was given both. Muscle tension, balance and lower extremity movement were quantified before and after the training, and a gait evaluation system was used to detect the plantar pressure distribution on the affected side and the range of motion range of the lower limb joints during walking. Results:After the treatment, significant differences were observed in the average modified Ashworth scores, modified Berg scale scores, Fugl-Meyer lower extremity ratings and modified Barthel Index scores compared with before the treatment. The average scores of the combination group were then significantly better than those of the other two groups. The average load bearing ratios of the affected toes, metatarsal bones Ⅰ-V, medial arch, external arch, medial heel and external heel had improved significantly in all of the groups, with the improvement of the combination group again significantly greater than those of the other groups. The same pattern of improvement was observed in the groups′ average pelvic rotation angles, hip flexion angles, knee flexion angles and ankle dorsiflexion angles.Conclusion:Combining scalp acupuncture with intelligent feedback can significantly improve lower extremity functioning after a stroke. That should improve performance in the activities of daily living of stroke survivors.

Treatment of open fracture of lower limb in high altitude area / 中国骨伤

OBJECTIVE@#To explore the treatment methods and experience of open fracture of lower limb in high altitude area.@*METHODS@#From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard.@*RESULTS@#Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases.@*CONCLUSION@#It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.

A Case of Child Who Improved Difficulty in Walking Due to Lower Limb Pain by Traditional Chinese Medicine (Dankanzen-based Prescription) / 日本東洋医学雑誌

As for the clinical condition to be called “cold stagnating in the liver vessel” (寒滞肝脈kantaikanmyaku),cold invades a liver-­meridian (肝経絡) and causes pain. We report a case of 7-­year-­old boy that reached the difficulty in walking for agreed pain of lower extremities in a liver-­meridian by cold house environment after the diarrhea. There was no abnormality in a blood test and the MR imaging in Western medicine. The treat­ment principle was to warm the meridian and reduce the pain. We chose the infusion of “dankanzen­-based prescription” (暖肝煎加味方) to warm the meridian and to remove the pain. The symptom improved. And the bathing therapy to warm a body relieved pain too. The case report of children of kantaikanmyaku was not found as far as we examined it. However, we believe that such cases are latent in Japan where air conditioners are widely used.

Comparison of measurement methods of lower limb length in hip arthroplasty for femoral neck fracture / 中国骨伤

OBJECTIVE@#To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly, and to introduce a "shoulder to shoulder" anatomical location marking method for femur.@*METHODS@#From January 2017 to January 2019, 90 elderly patients with femoral neck fracture were treated with hip replacement, including 39 males and 51 females, aged 65 to 96(78.0±7.4) years, 56 cases of total hip and 34 cases of hemi hip. According to garden classification, there were 7 cases of typeⅡ, 63 cases of type Ⅲ and 20 cases of type Ⅳ. The patients were divided into three groups according to different measurement methods:contralateral contrast method (group A) of 19 cases, shuck test method (group B) of 28 cases, and "shoulder to shoulder" anatomical marker localization method (Group C) of 43 cases. The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging.@*RESULTS@#All patients completed the operation successfully. After total hip arthroplasty, the length of lower limbs in group A was(12.9±8.6) mm, and that in group B was(10.3±4.4) mm. After hemiarthroplasty, the length of lower limbs in group A was (13.2±7.2) mm, group B was (8.7±3.5) mm, and group C was (6.3±2.8) mm; the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1) mm in group A, (9.6±4.0) mm in group B and (6.6±2.6) mm in group C. The results of factorial analysis of variance showed that the differences among the three groups were statistically significant (@*CONCLUSION@#The "shoulder to shoulder" anatomic localization marking method can reduce the length of lower limbs simply, effectively and accurately in the elderly patients with femoral neck fracture hip replacement.

Effect of Whole Body Vibration on Abilities of Lower Extremities for Stroke Patients / 中国康复理论与实践

Objective:To explore the effect of whole body vibration (WBV) on lower extremities loading, balance and walking for stroke patients based on weight-bearing training. Methods:In 2017, 70 stroke inpatients were randomly divided into control group (n = 35) and experimental group (n = 35). They all accepted routine rehabilitation and weight-bearing training, while the experimental group accepted WBV in addition, for six weeks. They were assessed with weight-bearing time, gait length and speed, Berg Balance Scale (BBS) and Functional Ambulation Category (FAC) before and after treatment. Results:The weight-bearing time, gait length and speed, and the scores of BBS and FAC improved after treatment in both groups (t > 8.835, P < 0.001), and improved more in the experimental group than in the control group (F > 19.644, P < 0.001). Conclusion:WBV may further improve the abilities of lower extremities for stroke patients.

Replantation and functional reconstruction of an amputated lower extremity / 中华创伤骨科杂志

Objective To evaluate our replantation and functional reconstruction of amputated lower extremities.Methods From February 2013 to October 2017,13 patients with an amputated lower extremity were treated at Orthopaedic Department,The 960th Hospital of the PLA Joint Logistics Support Force.They were 10 males and 3 females,aged from 15 to 63 years (average,39 years).In all the patients,large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage.After desired extension was achieved,the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction.Postoperatively,functions of the knee and ankle joints,sensory recovery of the foot sole,length and appearance of the extremity were observed.Results All the 13 patients were followed up for 12 to 24 months (average,16 months).All the limb replants survived well.Of them,12 were satisfied with their weight-bearing walking and therapeutic outcomes.Conclusions For an amputated lower extremity,the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

Orthopaedic Replantation and functional reconstruction of an amputated lower extremity / 中华创伤骨科杂志

Objective@#To evaluate our replantation and functional reconstruction of amputated lower extremities.@*Methods@#From February 2013 to October 2017, 13 patients with an amputated lower extremity were treated at Orthopaedic Department, The 960th Hospital of the PLA Joint Logistics Support Force. They were 10 males and 3 females, aged from 15 to 63 years (average, 39 years). In all the patients, large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage. After desired extension was achieved, the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction. Postoperatively, functions of the knee and ankle joints, sensory recovery of the foot sole, length and appearance of the extremity were observed.@*Results@#All the 13 patients were followed up for 12 to 24 months (average, 16 months). All the limb replants survived well. Of them, 12 were satisfied with their weight-bearing walking and therapeutic outcomes.@*Conclusions@#For an amputated lower extremity, the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

Effect of individual exercise prescription on walking ability of patients with arteriosclerosis obliterans of lower limbs / 中国实用护理杂志

Objective To explore whether individualized exercise prescription can improve the walking ability of patients with lower extremity arteriosclerosis occlusion (ASO). Methods A total of 64 ASO patients with ankle brachial index (ABI) between 0.6 and 0.9 were randomly divided into the observation group (32 cases) and the control group (32 cases), Patients in the control group received routine nursing intervention, and patients in the observation group received nursing intervention based on individualized exercise prescription, ABI and walking impaired questionnaire (WIQ) scales were measured at admission and 12 weeks after intervention. Results There was no statistically significant difference in ABI values before and after the intervention of the control group (P>0.05), and ABI values before and after the intervention of the observation group were 0.72+0.15 and 0.77+0.13 respectively (t=2.254 , P<0.05). There was no statistically significant difference in walking distance and walking speed before intervention (P>0.05) in the two groups; the walking distance and walking speed after intervention in the observation group were (498.38 ± 77.11) m and (50.44 ± 11.27); the control group was (461.72 ± 64.64) m and (44.02 ± 9.86), and the differences were statistically significant (t=2.06, 2.43, P < 0.05). Conclusions Individualized exercise prescription can improve the degree of ischemia of the affected limb, improve the walking distance and walking speed of the patients, and it is convenient to implement and worthy of clinical promotion.

Case Analysis o f Clinical Pharmacists Participating in Warfarin Individualized Anticoagulation Therapy for a Patient with Lo- wer Extremity Venous Thrombosis Complicated with Pulmonary Arterial Thromboembolism / 中国药房

OBJECTIVE： To investigate the role of clinical pharmacists in the individual anticoagulation of warfarin for the patients with lower extremity venous thrombosis （LEVT） and pulmonary arterial thromboembolism （PATE）. METHODS： Clinical pharmacists participated in individual anticoagulation of warfarin for the patients with LEVT and PATE. It was suggested to detect the gene type of the patient. According to the results of gene test [cytochrome P450 （CYP）2C9*1*1 and vitamin K epoxide reductase complex subunit Ⅰ] and the dose recommended by FDA based on the patient’s gene， the initial dose of warfarin （3.125 mg，once a day） was determined according to the patient’s living habits， height and body mass. Then the maintenance dose of warfarin （the maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day） was calculated according to the warfarin maintenance dose prediction formula established by Warfarin Pharmaeogenetics Consortium. Pharmaceutical monitoring was conducted， such as INR， prothrombin time and bleeding event monitering. RESULTS： Physicians adopted the suggestion of clinical pharmacists. The maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day. It was suggested to give Flucloxacillin sodium injection which had less influence on warfarin. The patient recovered well and was discharged. CONCLUSIONS： Based on pharmacogenomics， clinical pharmacists participate in the formulation of individualized anticoagulant regimens for patients， which promote TNR ralue of patients， reduce the risk of early postoperative thromboembolism， and further ensure the safety of drug use in patients.

Effect of individual exercise prescription on walking ability of patients with arteriosclerosis obliterans of lower limbs / 中国实用护理杂志

Objective@#To explore whether individualized exercise prescription can improve the walking ability of patients with lower extremity arteriosclerosis occlusion (ASO).@*Methods@#A total of 64 ASO patients with ankle brachial index (ABI) between 0.6 and 0.9 were randomly divided into the observation group (32 cases) and the control group (32 cases), Patients in the control group received routine nursing intervention, and patients in the observation group received nursing intervention based on individualized exercise prescription, ABI and walking impaired questionnaire (WIQ) scales were measured at admission and 12 weeks after intervention.@*Results@#There was no statistically significant difference in ABI values before and after the intervention of the control group (P > 0.05), and ABI values before and after the intervention of the observation group were 0.72 + 0.15 and 0.77 + 0.13 respectively (t=2.254, P < 0.05). There was no statistically significant difference in walking distance and walking speed before intervention (P > 0.05) in the two groups; the walking distance and walking speed after intervention in the observation group were (498.38±77.11) m and (50.44±11.27); the control group was (461.72±64.64) m and (44.02±9.86), and the differences were statistically significant (t=2.06, 2.43, P < 0.05).@*Conclusions@#Individualized exercise prescription can improve the degree of ischemia of the affected limb, improve the walking distance and walking speed of the patients, and it is convenient to implement and worthy of clinical promotion.

A Case of Concomitant Extra-Anatomic Bypass to Both Femoral Arteries with Central Repair in a Patient with Aortic Dissection Complicated Ischemia in the Lower Extremities / 日本心臓血管外科学会雑誌

We report a case of aortic arch replacement and extraanatomic bypass from a branched graft to both bifemoral arteries in a patient with aortic dissection complicated by ischemia in the lower extremities. A 61-year-old woman was found to have thrombosed type II aortic dissection by enhanced computed tomography (CT). Because she had no clinical symptoms, we chose conservative pharmacotherapy. A year later, she suddenly felt severe back pain and dyspnea. CT demonstrated type IIIb aortic dissection. She developed lower extremity ischemia because the true lumen in the abdominal aorta was severely compressed by the false lumen. Two weeks after onset, we planned a bilateral axillo-femoral bypass because the right lower limb ischemia had worsened, with severe pain. However, CT showed ascending aortic dissection. Hence, emergency graft replacement of aortic arch was required. A T-shaped graft was anastomosed to the bilateral femoral arteries, and was used as a delivery line during cardiopulmonary bypass. Although distal anastomosis of the arch was constructed only to the true lumen, leg ischemia persisted. Therefore, the T-shaped graft was connected to the branched graft used for antegrade systemic perfusion. We used INVOS as an indicator of intraoperative lower limb ischemia, which was useful for judging whether or not revascularization of lower extremity was achieved. After the operation, the bypass graft was patent, and ischemia in the lower extremities disappeared.

Effects of mirror therapy on lower extremity motor function and activities of daily living after stroke: A me-ta-analysis / 中华物理医学与康复杂志

Objective To meta-analyze the effect of mirror therapy on the lower limb motor function and ac-tivities of daily living of stroke survivors so as to evaluate its clinical efficacy. Methods Medline, PubMed, OT seeker, the Cochrane library, the Wanfang database, the VIP database and the CNKI were searched for reports of randomized and controlled trials (RCTs) of the effect of mirror therapy on the lower limb motor function and activities of daily living of stroke survivors published between December 2008 and December 2018. Strict inclusion and exclu-sion criteria were applied, and the quality of the documents was comprehensively assessed according to version 5.1.0 of the Cochrane manual. The results were analyzed using version 5.2 of the RevMan software suite. Results Four-teen trials were included. Meta-analysis showed that mirror therapy had been shown to improve the patients'scores of Fugl-Meyer assessment ( FMA ), functional ambulance category ( FAC ) and modified Barthel index ( MBI ). Conclusion Mirror therapy can improve the motor function of the affected lower extremities of stroke survivors and their ability in the activities of daily living.