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Traumatic injuries of the upper limbs can often result in serious and challenging wounds involving multiple compartments such as skin, bone, tendons and neurovascular structures. These type of injuries of the upper extremity pose several challenges to the plastic surgeon. The main difficulty is to provide a stable, long lasting and aesthetically acceptable coverage that enables joints excursion so that patient can return to work at the earliest. Here, we present a case of 45 years old gentlemen who sustained severe crush injury associated with avulsed radial and ulnar artery of left upper limb following road traffic accident. At presentation, there was no pin prick in his hand and hand was pale. At first surgery, hand was revascularized using a vein graft in radial artery and skin grafting was done over the forearm defect as a temporary cover. After 12 hours, when the viability of hand was reassured, the defect was covered with free supra thin anterolateral thigh (ALT) flap. Patient’s hand and flap both survived and he was discharged in a satisfactory condition.

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ObjectiveTo compare the effects and differences of Yiqi Liangxue Shengji Formula （益气凉血生肌方） and atorvastatin on the repair of vascular injury in rats from the perspective of metabolomics. MethodsTwenty-four male SD rats were randomly divided into sham-surgery， model， traditional Chinese medicine （TCM）， and ator-vastatin groups， with 6 rats in each group. The rat model was established by balloon-induced abdominal aorta injury. Gavage was started on the day after surgery in all groups of rats. The sham and model groups were given with deio-nized water， TCM group received Yiqi Liangxue Shengji Formula 6 g/（kg·d）， and the atorvastatin group treated with atorvastatin suspension 2 mg/（kg·d） for 4 weeks. HE staining was used to observe the pathological morphology of the injured segment of the abdominal aorta； ELISA detection was used to test serum nitric oxide （NO） and C-reactive protein （CRP） levels； UPLC MS/MS technology was used for widely targeted metabolomics detection in serum， and multivariate statistical analysis was used to screen metabolic markers and pathways of two drugs； finally， compare serum levels of key metabolic markers of the above two medications in rats of each group. ResultsCompared with the sham-surgery group， the neointima significantly thickened， the level of NO decreased significantly and the level of CRP increased in serum of the model group （P＜0.01）； compared with the model group， the degree of arterial intimal hyperplasia in TCM group and atorvastatin group reduced， with an increase in NO levels and a decrease in CRP levels （P＜ 0.05 or P＜0.01）. The results of serum metabolomics showed that TCM group obtained 49 metabolic markers and 6 metabolic pathways， while atorvastatin group obtained 41 metabolic markers and 4 metabolic pathways. The two medications jointly regulated 38 metabolites. Glycerophospholipid metabolism and arginine-related metabolism were common metabolic pathways for both medications. Lysophosphatidylcholine （16∶1/0∶0） ［LPC （16∶1/ 0∶0）］， phosphatidylcholine （15∶0/15∶0） ［PC （15∶0/15∶0）］ were the key metabolites of glycerophospholipid metabolic pathway； ornithine， spermidine were the key metabolites of arginine-related metabolic pathway. The tricarboxylic acid cycle and glutathione metabolism were the unique metabolic pathways of Yiqi Liangxue Shengji Formula. Compared with the sham-surgery group， LPC （16∶1/0∶0）， ornithine， and spermidine levels elevated and PC （15∶0/15∶0） levels decreased in the model group （P＜0.05 or P＜0.01）. Compared with the model group， LPC （16∶1/0∶0）， ornithine， and spermidine levels decreased， and PC （15∶0/15∶0） levels increased in both TCM group and atorvastatin group （P＜0.05 or P＜0.01）. The degree of LPC reduction （16∶1/0∶0） was more significant in atorvastatin group compared with that in the TCM group （P＜0.01）. ConclusionsBoth sham-surgery and atorvastatin could regulate lipid metabolism and arginine-related metabolism， exert the characteristics of lipid-lowering， anti-inflammatory， improve arginine/NO bioavailability， and improve endothelial dysfunction. Atorvastatin showed more advantages in lipid-lowering and anti-inflammatory， while Yiqi Liangxue Shengji Formula has unique characteristics in regulating energy metabolism and improving oxidative stress.

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OBJECTIVE To study the improvement effect of total flavonoids from Rosa multiflora root on vascular injury in rheumatoid arthritis （RA） model rats and its potential mechanism. METHODS Female Wistar rats were randomly divided into normal control group， model group， aspirin group （positive control， 30 mg/kg）， low-dose and high-dose groups of total flavonoids from R. multiflora root （4.15， 8.30 g/kg， by crude drug）， with 10 rats in each group. Except for the normal control group， the RA model was induced in other groups by collagen induction and high-fat diet. After 14 days of modeling， they were given corresponding drug solution/0.5% sodium carboxymethyl cellulose solution intragastrically， once a day， for 36 consecutive days. The total body score， arthritis index （AI） and swollen joint count （SJC） of the rats were evaluated regularly. After the last medication， serum levels of interleukin-6 （IL-6）， intercellular adhesion molecule-1 （ICAM-1） and vascular cell adhesion molecule- 1 （VCAM-1） were determined. The pathological morphological changes in the vascular tissue of thoracic aorta were observed； the protein expression of Toll-like receptor 4 （TLR4） and the protein phosphorylation levels of Janus kinase 2 （JAK2） and signal transduction and activator of transcription 3 （STAT3） in vascular tissue of thoracic aorta were measured. RESULTS Compared with the normal control group， serum levels of IL-6， ICAM-1 and VCAM-1， protein expression of TLR4， and the protein phosphorylation levels of JAK2 and STAT3 in vascular tissue of thoracic aorta were increased significantly in model group （P＜ 0.01）. The atherosclerotic plaque （atheroma）， cholesterol crystal， lymphocyte infiltration and a small number of unbroken foam cell aggregation could be seen in the vascular tissue of thoracic aorta. Compared with the model group， total body score （except for the low-dose group）， AI and SJC were decreased significantly in groups of total flavonoids from R. multiflora root on the 28th day （P＜0.05 or P＜0.01）； total body score，AI and SJC were decreased significantly in low-dose group of total flavonoids from R. multiflora root on the 49th day （P＜0.05 or P＜0.01）； the other quantitative indicators in serum and vascular tissue were significantly reversed in groups of total flavonoids from R. multiflora root （P＜0.05 or P＜0.01）， and pathological damage of vascular tissue was significantly relieved. CONCLUSIONS Total flavonoids from R. multiflora root can significantly improve vascular injury in RA model rats， and its mechanism may be related to reducing the protein expression of TLR4 in vascular tissue and inhibiting the activation of IL-6/JAK2/ STAT3 signaling pathway.

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Purpose: Pre-eclampsia (PE) is a pregnancy-related complication. Eucommia is effective in the treatment of hypertensive disorders in pregnancy, but the specific effects and possible mechanisms of Eucommia granules (EG) in PE remain unknown. The aim of this study was to investigate the effects and possible mechanisms of EG in PE rats. Methods: Pregnant Sprague Dawley rats were divided into five groups (n = 6): the control group, the model group, the low-dose group, the medium-dose group, and the high-dose group of EG. The PE model was established by subcutaneous injection of levonitroarginine methyl ester. Saline was given to the blank and model groups, and the Eucommia granules were given by gavage to the remaining groups. Blood pressure and urinary protein were detected. The body length and weight of the pups and the weight of the placenta were recorded. Superoxide dismutase (SOD) activity and levels of malondialdehyde (MDA), placental growth factor (PIGF), and soluble vascular endothelial growth factor receptor-1 (sFIt-1) were measured in the placenta. Pathological changes were observed by hematoxylin-eosin staining. Wnt/ß-catenin pathway-related protein expression was detected using Western blot. Results: Compared with the model group, the PE rats treated with EG had lower blood pressure and urinary protein. The length and weight of the pups and placental weight were increased. Inflammation and necrosis in the placental tissue was improved. SOD level increased, MDA content and sFIt-1/PIGF ratio decreased, and Wnt/ß-catenin pathway-related protein expression level increased. Moreover, the results of EG on PE rats increased with higher doses of EG. Conclusions: EG may activate the Wnt/ß-catenin pathway and inhibit oxidative stress, inflammation, and vascular endothelial injury in PE rats, thereby improving the perinatal prognosis of preeclamptic rats. EG may inhibit oxidative stress, inflammation, and vascular endothelial injury through activation of the Wnt/ß-catenin pathway in preeclampsia rats, thereby improving perinatal outcomes in PE rats.

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Introducción: Las fracturas supracondíleas del húmero en niños se asocian con complicaciones agudas como las vasculares que ponen en peligro la viabilidad del miembro afectado. Objetivo: Sistemtizar sobre las complicaciones vasculares agudas en pacientes con fractura supracondílea del húmero en niños. Método: La búsqueda y análisis de la información se realizó durante un período de 61 días (1 de diciembre de 2023 al 31 de enero de 2024) y se utilizaron las siguientes palabras: pediatricsupracondylar humeral fractures AND vascular lesion, pulseless hand AND pediatric supracondylar humeral fracture, complex fracture, compartment syndrome. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 186 artículos publicados en las bases de datos. Resultados: Se hace referencia al comportamiento de los artículos en la base de datos PubMed en los últimos 10 años. Se mencionan las principales características de las lesiones vasculares en cuanto a su exploración y formas de presentación. Se aborda el uso de la ecografía doppler y la arteriografía en estos pacientes, así como la conducta a seguir. En relación al síndrome compartimental se describe la incidencia, formas de presentación y conducta a seguir. Conclusiones: Las complicaciones vasculares agudas relacionadas con la fractura supracondílea en pacientes pediátricos constituyen un desafío para el personal médico. Sus variantes son múltiples con diferente interpretación y realización, la mayoría de los exámenes complementarios aportan elementos insuficientes en las etapas iniciales.(AU)

Introduction: Supracondylar fractures of the humerus in children are associated with acute complications such as vascular complications that endanger the viability of the affected limb. Objective: To systematize acute vascular complications in patients with supracondylar fracture of the humerus in children. Method: The search and analysis of the information was carried out over a period of 61 days (December 1, 2023 to January 31, 2024) and the following words were used: pediatric supracondylar humeral fractures AND vascular injury, pulseless hand AND pediatric supracondylar humeral fracture, complex fracture, compartment syndrome. Based on the information obtained, a bibliographic review of a total of 186 articles published in the databases was carried out. Results: Reference is made to the behavior of the articles in the PubMed database in the last 10 years. The main characteristics of vascular lesions are mentioned in terms of their exploration and forms of presentation. The use of Doppler ultrasound and arteriography in these patients is discussed, as well as the procedure to follow. In relation to compartment syndrome, the incidence, forms of presentation and behavior to follow are described. Conclusions: Acute vascular complications related to supracondylar fracture in pediatric patients constitute a challenge for medical personnel. Its variants are multiple with different interpretation and implementation, most of the complementary exams provide insufficient elements in the initial stages (AU)

Introdução: As fraturas supracondilianas do úmero em crianças estão associadas a complicações agudas, como complicações vasculares que colocam em risco a viabilidade do membro afetado. Objetivo: Sistematizar complicações vasculares agudas em pacientes com fratura supracondiliana de úmero em crianças. Método: A busca e análise das informações foram realizadas durante um período de 61 dias (1º de dezembro de 2023 a 31 de janeiro de 2024) e foram utilizadas as palavras: pediatricsupracondylar humeral fractures AND vascular lesion, pulseless hand AND pediatric supracondylar humeral fracture, complex fracture, compartment syndrome. Com base nas informações obtidas, foi realizada uma revisão bibliográfica de um total de 186 artigos publicados nas bases de dados. Resultados: Faz-se referência ao comportamento dos artigos na base de dados PubMed nos últimos 10 anos. São citadas as principais características das lesões vasculares quanto à sua exploração e formas de apresentação. Discute-se o uso da ultrassonografia Doppler e da arteriografia nesses pacientes, bem como o procedimento a seguir. Em relação à síndrome compartimental são descritas a incidência, formas de apresentação e comportamento a seguir. Conclusões: As complicações vasculares agudas relacionadas à fratura supracondiliana em pacientes pediátricos constituem um desafio para a equipe médica. As suas variantes são múltiplas com diferentes interpretações e implementações, a maioria dos exames complementares fornecem elementos insuficientes nas fases iniciais (AU)

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Background: Vascular trauma is a significant burden to the regional community due to the associated high morbidity and mortality from the complications of the injuries. This may be due to the complexity of the injuries and the issues with initial management at the regional hospitals. Vascular injury management training should improve the outcome of initial surgical management by the general surgical team in regional centres. The study aims to describe the epidemiology and management of vascular injury in regional hospitals in Queensland, Australia. Methods: A retrospective descriptive analysis was performed using the data of patients with traumatic vascular injuries between January 2017 and July 2021 presented to Hervey Bay hospital in Queensland, Australia. Results: Fifty-nine patients with vascular injuries were reviewed. The reported number of penetrating and blunt trauma cases were 43 (72.9%) and 16 (27.1%) respectively, and 42 (71.2%) were males. Most mechanisms of injury were cuts (n=32, 54.2%), followed by falls (n=16, 27.1%) and stabs (n=11, 18.7%). Fifty-one (86.4%) were initially surgically managed regionally, with 21 (35.6%) requiring transfer to a tertiary trauma centre. Outcomes of the incidents resulted in one (1.7%) patient requiring amputation, three (5.1%) needing a fasciotomy and the mortality of two (3.4%) patients. Conclusions: Vascular trauma causes a significant burden to Australian regional hospitals. Identifying injury patterns and common causes for vascular injury will help in early identification and prompt management. Vascular trauma management training should improve the quality of care from the general surgeons in the regional centres. AUTHOR BIOGRAPHIES Munasinghe Silva, Department of General Surgery, Hervey Bay Hospital, Queensland, Australia Registrar, Department of Surgery Aathavan Shanmuga Anandan, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia Medical Student

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Radiation therapy (RT), as a crucial part of current cancer treatment, has caused great concern since it brings therapeutic efficacy along with the risk of chronic complications. With an increase in age, patients treated with RT are subjected to a high incidence of vascular diseases in the neck and peripheral heart primarily due to the artery stenosis induced by radiation-caused vascular injury. To gain a deeper understanding of artery stenosis, its hazards, clinical presentation, pathogenesis, preventive recommendations, and treatment method was reviewed.

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【Objective】 To explore the causes and management of nephrostomy catheter following percutaneous nephrostolithotomy (PCNL) entering the inferior vena cava. 【Methods】 A retrospective analysis was performed on the management of two cases of nephrostomy catheter entering the inferior vena cava. The causes, changes of minimally invasive treatment and prevention plans were discussed. 【Results】 Two patients underwent digital subtraction angiography (DSA) to restore the nephrostomy tube to the renal pelvis collecting system. No renal vein rupture or bleeding occurred during the operation, and the patients’ vital signs were stable. Nephrostomy tube was removed successfully after operation. The wound healing was good, and there was no secondary hemorrhage such as perirenal hematoma. The prognosis was good. 【Conclusion】 Although intravenous nephrostomy tube misplacement is an uncommon PCNL complication, the consequences are serous. One-step retraction displacement of nephrostomy tube to the renal collecting system can effectively manage nephrostomy catheter entering the inferior vena cava.

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@#Genuine infrapopliteal aneurysms are quite rare, in contrast to pseudoaneurysms. The aetiology of pseudoaneurysms related to external fixation is attributed to various theories, including direct vascular damage due to misplaced pins or wires, overshooting or misguidance during osteotomy, distraction at the corticotomy site during an Ilizarov procedure, and continuous abrasion of the vessel caused by a wire inserted in close proximity to an artery. Arteriography proves valuable in documenting lesions and assessing deeper pseudoaneurysms, particularly when contemplating reconstruction; it plays a crucial role in guiding management decisions. For significant tears and symptomatic aneurysms, resection and reconstruction are the gold standard treatment.

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Abstract Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

Resumo O pseudoaneurisma do arco palmar é uma entidade rara, cujo diagnóstico depende de alta suspeição clínica. Apresentamos o caso de um paciente encaminhado ao pronto-socorro com história de traumatismo penetrante por vidro na face palmar, com massa pulsátil e sangramento em jato. A ultrassonografia com Doppler evidenciou pseudoaneurisma parcialmente trombosado, e a angiotomografia demonstrou formação sacular originada do arco palmar superficial. Uma abordagem cirúrgica convencional foi indicada. Para prosseguir com o diagnóstico correto, essa suspeita clínica deve ser aventada. Modalidades de imagem são necessárias para identificar o pseudoaneurisma e planejar o curso do tratamento. No entanto, a sequência diagnóstica é individual, pois uma avaliação mais aprofundada, com diferentes métodos de imagem, pode não alterar o racional da intervenção. Em nossa experiência, a remoção cirúrgica convencional é preferível, visto sua segurança e seus resultados bem estabelecidos.

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Introduction: Recent trends like pedicle screws and other instrumentation of cervical vertebra are on the rise. However, proximity of vertebral artery coursing in vertebral artery groove (VAG) on the superior surface of the posterior arch of atlas poses a unique challenge to surgeons performing these procedures. Such vascular injuries though rare, are not uncommon and may pose immediate to delayed complications. Radiological studies of atlas vertebra & VAG are being extensively done with CT and MR Angiography, but morphometric studies of VAG in atlas vertebra in South Indian population is lacking. Aims: To understand the morphology and dimensions of the vertebral artery groove and its variations if any, in dry atlas vertebra of South Indian population. Settings and Design: Descriptive observational study Methods and Material: 50 dried adult human atlas vertebra of unknown age & sex from the Anatomy Department, PSGIMS & R, Coimbatorewere studied. Intact cervical vertebrae without any degenerative or traumatic disorders were included. The morphometry of VAG and its distance from midline were evaluated through six linear measurements.The parameters were inner and outer lengths of the groove, width & thickness of the groove and the distance of its medial most and lateral most edges from the midline on both sides. Statistical analysis used: SPSS software Results: There is no statistically significant difference between mean values on right and left side for inner length, outer length, width and thickness of vertebral artery groove. The mean inner and outer distance of the vertebral artery groove from the midline on the right is higher than the left. Conclusions: The present study provides morphometric data of VAG & recommends a safe zone of 11.82 mm from midline for instrumentation in posterior spinal surgeries to minimize vertebral artery injuries.

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Radiation-induced brain injury (RBI) is one of the complications after radiotherapy for head and neck malignant tumors, which seriously affects the quality of life of patients. The pathophysiological mechanism of RBI is not completely clear. Current studies suggest that it is involved in a variety of cells in the central nervous system (CNS), whereas astrocyte, as the largest number of glial cells in the CNS, plays an important role in maintaining the CNS homeostasis and responding to CNS injury. In this article, the role of astrocytes in RBI was reviewed.

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Diabetes mellitus (DM) is a common and chronic metabolic disease, which disturbs the internal environment, and then causes series of acute or chronic complications. Chronic hyperglycemia induces macroangiopathy and microangiopathy, which is synergistically regulated by intricate molecular mechanisms, including inflammatory responses, intracellular stress, pyrotosis and ferroptosis. DM hinders the repair of blood-spinal cord barrier (BSCB) after spinal cord injury (SCI) and aggravates the neurological damage. Pericytes are the main component of neurovascular units, which regulates angiogenesis, capillary blood flow, and BSCB permeability. After SCI, the BSCB is destroyed, the coverage rate of pericytes is significantly reduced. Then, it greatly affects the normal function of blood vessels. Diabetes not only plays a role in regulating the contraction phenotype and signal transduction of pericytes, but also changes the secretion genome spectrum of pericytes, and then affects the normal function of pericytes. Moreover, it has also been shown that diabetes promotes the loss of pericytes after SCI. This review systematically describes the regulatory effect of diabetes on pericytes in the vascular system, and the effect of diabetes mediated-pericyte injury on BSCB after SCI.

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During gynecological tumor surgery, the incidence of iatrogenic vascular injury increases unabated due to the proximity of the operative area to important vessels in the pelvic and abdominal cavity, and the tumor growth is invasive and often adheres or oppresses the surrounding blood vessels. Intraoperative bleeding is related to many factors. Adequate preoperative evaluation, surgical field exposure, and skilled operation can effectively reduce intraoperative vascular injuries. Immediate recognition and prompt action at the occurrence of hemorrhage can significantly minimize life-threatening complications. This article reviews the common vascular injuries and treatment methods in gynecological tumor surgery.

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Background: Deep fascia is dense and well developed in limbs. In the upper limb the deep fascia is tightly adherent to the underlying muscles especially in the forearm, thereby, restricting the space available to muscular swelling causing painful compartment syndrome. Division of this inelastic fascia or fasciotomy is an emergency procedure to decrease the morbidity and mortality.Methods: 30 patients with acute compartment syndrome of the upper extremity of various aetiologies were studied. Adults with painful, swollen and tense upper extremities with progressive neurological dysfunction were studied. Compartment pressures before and after fasciotomy were measured by a standard Whiteside’s device. Various fasciotomies were carried out and associated skeletal and vascular injuries were also noted.Results: The majority of patients were males with average age being 29.33 years. 56.67% patients with upper limb compartment syndrome sustained road traffic injury, 20% were constrictive tight cast, 20% of patients sustained burn and 1 patient was shot by bullet. Of the 30 patients fractures of both ulna and radius (40%) were the most common. Fractures of the humerus, radius, ulna and small bone of metacarpals together account for 36.67% of the affected patients. 3 patients were found to have injury to major vessels. Compartment pressure was measured by Whiteside’s device and fasciotomy resulted in a drastic drop of the pressure from pre-fasciotomy pressure of 44.8±7.9 mmHg to post-fasciotomy pressure of 12.33±3.61 mmHg.Conclusions: The diagnosis of compartment syndrome should be confirmed swiftly and prompt fasciotomy is the treatment of choice. This offers the best chance at decreasing compartment pressure and preventing further damage.

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Abstract Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

Resumen Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

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Total Panax notoginseng saponin (TPNS) is the main bioactivity compound derived from the roots and rhizomes of Panax notoginseng (Burk.) F.H. Chen. The aim of this study was to investigate the effectiveness of TPNS in treating vascular neointimal hyperplasia in rats and its mechanisms. Male Sprague-Dawley rats were randomly divided into five groups, sham (control), injury, and low, medium, and high dose TPNS (5, 10, and 20 mg/kg). An in vivo 2F Fogarty balloon-induced carotid artery injury model was established in rats. TPNS significantly and dose-dependently reduced balloon injury-induced neointimal area (NIA) (P<0.001, for all doses) and NIA/media area (MA) (P<0.030, for all doses) in the carotid artery of rats, and PCNA expression (P<0.001, all). The mRNA expression of smooth muscle (SM) α-actin was significantly increased in all TPNS groups (P<0.005, for all doses) and the protein expression was significantly increased in the medium (P=0.006) and high dose TPNS (P=0.002) groups compared to the injury group. All the TPNS doses significantly decreased the mRNA expression of c-fos (P<0.001). The medium and high dose TPNS groups significantly suppressed the upregulation of pERK1/2 protein in the NIA (P<0.025) and MA (P<0.004). TPNS dose-dependently inhibited balloon injury-induced activation of pERK/p38MAPK signaling in the carotid artery. TPNS could be a promising agent in inhibiting cell proliferation following vascular injuries.

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BACKGROUND: Bone nonunion is a common complication after fracture, which brings great distress to patients. With the continuous development of exosomal technology, exosomes gradually show their advantages in the treatment of nonunion, which has become a new research direction in medical work. OBJECTIVE: To summarize the researches in and outside China and explore the role of exosomes in the treatment of nonunion. METHODS: The authors retrieved related Chinese articles published from 2003 to 2019 in Wanfang database, CNKI and VIP database with the key words of “exosomes, nonunion, bone remodeling, bone regeneration, vascular injury, osteoblasts, osteoclasts” and related English articles published from 2003 to 2019 in PubMed with the key words of “exosomes, nonunion, bone remodeling”. Totally 50 articles were selected based on inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) In recent years, more and more attention has been paid to the study of exosomes on bone nonunion. MiRNAs and proteins in exosomes can affect bone nonunion by affecting the differentiation of osteocytes. (2) Studies have found that exosomes can treat bone nonunion by regulating bone remodeling, promoting vascular repair, and improving systemic diseases. (3) However, the current research on exosomes is still in the experimental stage. The specific method of how to better apply it to clinical treatment needs further exploration.

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Betulinic acid is a natural pentacyclic pentane triterpenoid, usually isolated from the bark of Betula platyphylla, or in the form of free glycosides and glycosyl derivatives in various plants. A variety of derivatives can be obtained by modifying its chemical structure. Betulinic acid and its derivatives have certain regulatory effects in anti-tumor, antiviral, anti-inflammatory, analgesic, inhibition of cerebral nerve and vascular injury, and treatment of other common diseases. The category, pharmacological activities and related mechanisms of betulinic acid and its derivatives are reviewed in this paper, in order to provide a theoretical reference for the future application.

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BACKGROUND: Vascular injury is a common complication after balloon dilatation. The development of umbilical cord mesenchymal stem cells (UC-MSCs) provides a new method for treating vascular injury. OBJECTIVE: To investigate the mechanism underlying the repair of damaged blood vessels by human UC-MSCs (hUC-MSCs) transfected with interleukin-8RA/B (IL-8RA/B) adenovirus. METHODS: hUC-MSCs and human umbilical vein endothelial cells (hUVECs) were collected and transfected with adenovirus vectors containing human IL-8RA and/or IL-8RB cDNAs and green fluorescent protein. A rat model of carotid artery injury was established. Sprague-Dawley rats were randomly divided into four groups: IL-8RA/B-hUCMSCs group, Il-8ra/B-hUVECs group, Null-hUCMSCs group, and control group, followed by injection of 0.5×106 corresponding cells (500 μL) and same volume of normal saline via the tail vein respectively at 1, 3, and 5 hours post-surgery. After 30 minutes of injection, the carotid artery was taken and the expression of green fluorescent protein was observed. After 24 hours, the serum levels of inflammatory and anti-inflammatory factors were measured by ELISA; and the infiltration of neutrophil cells and mononuclear macrophages was observed by immunohistochemistry. After 14 days, Evans blue staining was used to observe vascular endothelialization and fibrosis. After 28 days, the neointimal hyperplasia was observed by hematoxylin-eosin staining. RESULTS AND CONCLUSION: (1) After 30 minutes of IL-8RA/B-hUC-MSCs infusion, the expression of green fluorescent protein was observed in the injured vascular intima, and the fluorescence expression was higher than that of the other three groups. (2) After 24 hours of IL-8RA/B-hUC-MSCs infusion, the expression of inflammatory factors in the serum was significantly lower than that of the other three groups, while the expression of anti-inflammatory factor interleukin-10 was higher than that of the other three groups (P < 0.05). In addition, inflammatory cell infiltration in the IL-8RA/B-hUC-MSCs group decreased significantly. (3) hUC-MSCs overexpressing interleukin-8 receptor promoted re-endothelialization of injured vessels and reduced vascular fibrosis after 14 days of infusion. (4) IL-8RA/B-hUC-MSCs reduced vascular neointimal hyperplasia after 28 days of infusion. (5) Interleukin-8 receptor enhances the targeted homing ability of hUC-MSCs, allowing MSCs to migrate to the site of vascular injury, inhibit inflammation, reduce neointimal hyperplasia, and promote vascular repair.