Effect of Tongnaoyin on Cerebral Hemodynamics in Patients with Acute Cerebral Infarction of Phlegm and Blood Stasis Syndrome Based on CTA/CTP / 中国实验方剂学杂志

ObjectiveTo investigate the changes in cerebral blood perfusion in patients with acute cerebral infarction after taking Tongnaoyin， a traditional Chinese medicine， based on head and neck computed tomography （CT） angiography （CTA） combined with brain CT perfusion imaging （CTP）. MethodA total of 240 patients with cerebral infarction of phlegm and blood stasis syndrome treated in Jiangsu Province Hospital of Traditional Chinese Medicine from March 2018 to September 2023 were randomly divided into a control group （99 cases） and a Tongnaoyin group （141 cases）. Based on the guidelines， the control group was treated with conventional treatment such as anti-aggregation， anticoagulation， lipid-lowering and plaque stabilization， brain protection， and supportive treatment. The Tongnaoyin group was treated with Tongnaoyin of 200 mL in warm conditions in the morning and evening on the basis of the control group. Both groups underwent CTA combined with CTP within 24 hours after admission， and they were reexamined by CTA and CTP in the sixth month after admission. The degree of intracranial artery stenosis was determined according to the North American Symptomatic Carotid Endarterectomy Trial （NASCET） method. The relative cerebral blood volume （rCBV）， relative cerebral blood flow （rCBF）， mean transit time （MTT）， and time to peak （TTP） of the lesion area before and after treatment were compared. The adverse outcomes of the two groups within six months after discharge were compared. ResultCompared with the group before treatment， the degree of vascular stenosis in the Tongnaoyin group was significantly reduced， and the difference was statistically significant （Z=105.369，P<0.05）. Compared with the control group after treatment， the improvement rate of vascular stenosis in the Tongnaoyin group was higher （χ2=84.179，P<0.01）， and the curative effect was better.After treatment， the rCBV and rCBF of patients in the Tongnaoyin group were significantly increased， and the difference was statistically significant （P<0.01）. MTT and TTP showed a trend of shortening， but the difference was not statistically significant. There was no statistically significant difference in rCBV， rCBF， MTT， and TTP in the control group. Compared with those in the control group after treatment， the rCBV and rCBF in the Tongnaoyin group were significantly increased， while MTT and TTP were significantly reduced （P<0.01）. After six months of discharge， the risk of poor prognosis in the Tongnaoyin group was significantly reduced compared with the control group （P<0.05）. ConclusionTongnaoyin has a good effect on improving cerebral blood perfusion in patients with acute cerebral infarction. It can be used as an effective supplement for the conventional treatment of ischemic stroke to improve clinical efficacy.

Value of Head and Neck 4D-CTA Combined with SDF-1a/CXCR4 Signaling Pathway in Assessing the Risk of Ruptured Intracranial Posterior Communicating Aneurysms / 昆明医科大学学报

Objective To investigate the value of 4D-CTA combined with SDF-1a/CXCR4 signaling pathway in evaluating the risk of intracranial aneurysm rupture.Methods Fifty patients with unruptured intracranial posterior communicating aneurysms and 50 patients with ruptured intracranial posterior communicating aneurysms were divided into unruptured group 1 and ruptured group 1.All patients underwent 4D-CTA examination and serumSDF-1alevel was detected.Non-ruptured group 1 was followed up for 12 months(After conservative treatment),on this basis,patients with ruptured posterior communicating aneurysms were included in ruptured group 2,and patients with unruptured posterior communicating aneurysms were included in non-ruptured group 2.Results The AUC values of Wn,AR,L,SR,SDF-1a and their combinations in diagnosing ruptured intracranial posterior communicating aneurysms were all greater than 0.70.The AUC values of Wn,AR,L,SR,SDF-1a and their combinations in predicting ruptured intracranial posterior communicating aneurysms in ruptured group 2 were all greater than 0.70.Conclusion 4D-CTA combined with SDF-1acan effectively distinguish ruptured intracranial posterior communicating aneurysms and predict the risk of rupture.

Correlation of 4D-CTA Imaging and Rupture Risk of Anterior Communicating Aneurysms / 昆明医科大学学报

Objective To explore the correlation between 4D-CTA imaging and the risk factors for the rupture of anterior communicating aneurysms.Methods A total of 100 patients with anterior communicating aneurysms in the Department of Radiology of Yan'an Hospital of Kunming City from June 2020 to March 2023 were selected as the study objects.The patients were divided into ruptured group and unruptured group based on whether the aneurysm had ruptured(with 50 cases in each group).The unruptured group(50 cases)received conservative treatment and follow-up observation for 1-12 months.The measurements included the aneurysm neck width(Wn),aneurysm height(H),average diameter of the carrying artery(DA),aneurysm length(L),aneurysm neck ratio(AR),the ratio of aneurysm height to carrying artery diameter(SR),aneurysm volume to aneurysm base area(VOR),and the search for the pulsation point of the aneurysm,analyzing the correlation between these measurements and aneurysm rupture.Results Wn,AR,L and SR in ruptured group 1 were higher than those in non-ruptured group 1(P<0.05).Wn,AR,L and SR in fracture group 2 were higher than those in non-fracture group 2(P<0.05).The CT values of internal carotid artery and middle cerebral artery,and the CT values and noise of brain parenchyma in 4D-CTA were higher than those in 3D-CTA(P<0.05).Conclusion The use of 4D-CTA imaging for quantitative analysis of anterior communicating aneurysms can not only predict the risk of rupture,but also provide better image quality compared to 3D imaging while reducing radiation dosage.4D-CTA imaging has a positive impact on the diagnosis and treatment of clinical aneurysms.

The value of coronary CTA based on dual source CT in the diagnosis and treatment of coronary heart disease / 中国现代医生

Objective To study the value of coronary commodity trading advisor(CTA)based on dual source CT in the diagnosis and treatment of coronary heart disease.Methods Totally 57 patients with coronary heart disease were selected from the Third People's Hospital of Huzhou City and the Huzhou Ming State Hospital from June 2019 to October 2022,Dual source CTA and digital subtraction angiography(DSA)were performed successively,and the results were compared and analyzed.Results The sensitivity,accuracy,specificity,positive predictive value and negative predictive value of dual source CTA were 90.63%,95.18%,98.48%,97.75%and 93.53%,respectively.There was no significant difference between the two results(P>0.05).Conclusion Dual-source coronary artery has high sensitivity,accuracy,specificity,positive predictive value and negative predictive value in the diagnosis of coronary artery stenosis,which is significantly consistent with gold standard DSA coronary angiography,the technique of non-invasive angiography can reduce the occurrence of many complications,which is simple,safe and reliable,and plays a guiding role in the prevention and treatment of coronary heart disease.Dual-source coronary CTA has high sensitivity and accuracy,and noninvasive angiography can reduce many complications.It is simple,safe,reliable and cheap,it plays a guiding role in the prevention and treatment of coronary heart disease.

Diagnostic criteria and research progress on pancreas allograft pathology / 器官移植

Pancreas transplantation and pancreas-kidney transplantation are the optimal treatment for renal failure caused by type 1 diabetes mellitus, partial type 2 diabetes mellitus and their complications. Pancreas transplantation mainly includes simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation after kidney transplantation (PAK) and pancreas transplantation alone (PTA). Among all types of pancreas transplantation, biopsy of pancreas allograft remains the best method for definitively diagnosing rejection and differentiate it from other complications. In this article, biopsy methods of pancreas allograft and related research progress, diagnostic criteria and research progress on rejection of pancreas allograft biopsy, and main complications and pathological manifestations of pancreas allograft were illustrated, aiming to provide reference for guiding the clinical diagnosis of the above mentioned complications and ensuring the long-term survival of pancreas allografts and recipients.

Diagnostic criteria and research progress on Banff classification of allograft pathology in composite tissue allotransplantation / 器官移植

Composite tissue allotransplantation (CTA) is a novel transplantation discipline to treat functional tissue or limb defects. Since a majority of CTA grafts were vascularized grafts, it is also known as vascularized composite allotransplantation (VCA). The grafts of CTA/VCA consist of two or more types of allogeneic skin, subcutaneous tissue, bone, muscle, nerve and vessel, etc. Most of CTA/VCA grafts contain skin tissues, which possess the highest antigenicity. Acute rejection after transplantation is the primary obstacle leading to CTA/VCA graft failure and primary graft dysfunction. Hence, histopathological characteristics of skin rejection in CTA/VCA grafts have become the primary hotspot. In this article, pathological features of CTA/VCA rejection, Banff classification in 2007 and related research progress were reviewed, aiming to provide reference for the diagnosis and treatment of rejection and other complications of CTA/VCA.

Clinical application value of contrast-enhanced ultrasound in hepatic artery thrombosis after pediatric liver transplantation / 器官移植

Objective To investigate the clinical application value of contrast-enhanced ultrasound (CEUS) in hepatic artery thrombosis (HAT) after pediatric liver transplantation. Methods Clinical data of 126 pediatric recipients undergoing liver transplantation were retrospectively analyzed. The incidence of HAT after pediatric liver transplantation was summarized. Color Doppler ultrasound and CEUS manifestations of HAT were compared. Results According to color Doppler ultrasound, 17 cases were highly suspected with HAT. Nine cases were highly suspected with HAT by CEUS, who were subsequently confirmed by CT angiography (CTA) or surgery. CEUS manifestations of HAT showed that hepatic artery was not seen surrounding the portal vein during the arterial phase or even portal venous phase. Hepatocyte necrosis occurred in 4 patients with HAT, and no perfusion of intrahepatic contrast agent was observed on CEUS. Conclusions CEUS yields high clinical application value in the diagnosis of HAT after pediatric liver transplantation. It has significant advantages compared with traditional CTA, which could be widely applied in clinical practice.

Value of aortic root CTA assessment in aortic valve surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the data of preoperative aortic root CT angiography (CTA), compare it with two-dimensional transthoracic echocardiography and investigate the correlation of the two measurements with the actual intraoperative measurement data. Methods    Clinical data of 53 patients with aortic valve diseases who underwent aortic valve repair in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 38 males and 15 females with an average age of 42.9±18.3 years ranging from 10 to 77 years. Preoperative two-dimensional transthoracic echocardiography (TTE) and aortic root CTA measurements were collected, including aortic valve annulus (AVA), aortic sinus (Sinus) and sino-tubular junction (STJ). In comparison with the intraoperative measurements during the aortic valve repair surgery, the consistency analysis was performed. Results    Both the preoperative echocardiography AVA measurements and the CT AVA measurements were positively correlated with the intraoperative AVA measurements (P<0.001). Compared with the echocardiography AVA data [correlation coefficient (ρ)=0.74, mean squared error (MSE)=12.78], the CT AVA data were more accurate and consistent with the intraoperative AVA measurements (ρ=0.95, MSE=2.72). CT AVA data had a higher correlation coefficient with the intraoperative measurements, compared to that of  the echocardiography AVA data (P<0.001). Conclusion    In comparison with two-dimensional transthoracic echocardiography, preoperative morphological evaluation of aortic root CTA is more consistent with the actual intraoperative measurements during aortic valve repair surgery.

Analysis of imaging and clinical features and prognostic factors in patients with cervical artery dissection / 中风与神经疾病杂志

@#Objective Combined with the imaging，clinical features and ultrasonic follow-up of patients with cervical artery dissection，the influencing factors of prognosis were analyzed comprehensively.Methods From January 2016 to December 2019，the clinical and imaging data of patients with ischemic stroke or transient ischemic attack（TIA） caused by CAD in our hospital were collected. After 3 months，the vascular condition was followed up by ultrasound，and the prognosis was evaluated by modified Rankin Scale score（MRS）.Results There were 48 patients with CAD，including 33 males（68.75%），15 females（31.25%），average age（48.1± 9.8），31 patients with internal carotid artery dissection（ICAD）（64.58%），17 patients with vertebral artery dissection（VAD）（35.41%）. The first symptoms were numbness and weakness of one side of limbs，34 cases（70.83%），head and neck pain 5 cases（10.42%），dizziness 6 cases（12.5%），head and neck trauma history and suspicious trauma history 3 cases（6.25%）.The most common type of cervical vascular ultrasound was intramural hematoma（25 cases，52.08%），followed by vascular occlusion in 14 cases（29.17%），double lumen structure and intimal flap in 4 cases（8.33%），and VaD in 5 cases（10.42%）. 48 cases underwent CTA：21 cases（43.75%） had double lumen sign，14 cases（29.17%） had occlusion，13 cases（27.08%） had Beaded stenosis. Digital subtraction angiography（DSA） was performed in 40 cases，most of which were double lumen sign（15 cases，37.5%），vascular occlusion in 14 cases（35%），and beaded stenosis in 10 cases（25%）. Evaluation of collateral circulation：14 cases（35%） had good collateral circulation，including 10 cases of ICAD（25%），4 cases of VAD（10%）.Evaluation of collateral circulation：14 cases（35%） had good collateral circulation，including 10 cases of ICAD（25%），4 cases of VAD（10%）.After 3 months，44 cases were followed up：9 cases（20.45%） were still occluded，28 cases（63.64%） were stenosis，7 cases（15.91%） were normal. The prognosis was good in 31 cases（70.45%） and poor in 13 cases（29.55%）. The proportion of vascular occlusion，NIHSS score，basal ganglia infarction，brainstem infarction and collateral circulation in the poor prognosis group were higher than those in the good prognosis group（P<0.05）.Conclusion The prognosis of CAD was related to vascular occlusion，NIHSS score，collateral circulation，basal ganglia and brainstem infarction，but not to the final vascular recovery.

Ações itinerantes do Centro de Testagem e Aconselhamento (CTA) em ambiente universitário / Itinerant actions of the Testing and Counseling Center in university environment / Acciones itinerantes del Centro de Consejería y Pruebas en el ámbito universitario

Este artigo é um relato de experiência de ações itinerantes de um Centro de Testagem e Aconselhamento (CTA) em ambiente universitário. Essas ações de aconselhamento e testagem foram possíveis a partir da interação entre a comunidade acadêmica e os profissionais de saúde do CTA, levando em consideração a noção de vulnerabilidade e suas categorias (individual, social e programática).

This article reports on experience of itinerant actions of a Testing and Counseling Center in a university environment. These counseling and testing actions were carried out through the interaction between an academic community and health professionals, taking into account the notion of vulnerability and its categories (individual, social and programmatic).

Este artículo es un relato de experiencia de acciones itinerantes de un Centro de Consejería y Pruebas en el ámbito universitario. Estas acciones de consejería y pruebas fueron posibles a partir de la interacción entre los profesionales de la salud y de la comunidad académica, teniendo en cuenta la noción de vulnerabilidad y sus categorías (individual, social y programática).

Anomalies of Arch of Aorta and Its Branches - Computed Tomography Angiography Study

Introduction: The arch of aorta is a curved structure between the ascending aorta and the descending aorta.Three branches arise from the superior aspect of the arch- Brachiocephalic trunk, Left common carotid artery and Left subclavian artery. The aortic arch and its branches are well known for their anomalies which are important causes of cardio-vascular morbidity and mortality. The present study contribute for awareness and alertness regarding their incidence and prevalence for radiologists, cardiologists and endo-thoracic surgeons and to prevent complications during therapeutic procedures. Subjects and Methods: 500 CTA images were studied retrospectively from the patients who underwent chest and neck CTA for different reasons. Results: Out of 500 patients 474 (94.8%) patients had the classical branching pattern with left sided aorta. Six types of anomalies of the aortic arch and its branches were found in 26 (5.2%) patients. The most common anatomical variant was a common trunk for Brachiocephalic trunk and Left Common Carotid artery (bovine arch) found in 9 (1.8%) patients. In five (1%) patients, Left Vertebral Artery arises directly from the arch of aorta between left common carotid artery and left subclavian artery. Five (1%) patients had Right sided arch of aorta. Aberrant Right subclavian artery was found in four (0.8%) patients. Double arch in 2 (0.4%) cases and in one (0.2%) patient, we observed five branches arising directly from the arch, they are Right Common Carotid artery, Left Common Carotid artery, Left Vertebral artery, Left Subclavian artery and Aberrant Right Subclavian artery. Conclusion: With the ever increasing day to day advancements in complex endovascular interventions for the aorta and other great vessels of head and neck regions, early identification of aortic arch variant anatomy is of clinical significance to the radiologists and endovascular surgeons.

3D-CTA assisted anterolateral thigh lobulated perforator flap in repairing soft tissue defect of limb:11 cases report / 中华显微外科杂志

Objective To investigate the effectiveness of preoperative 3D-CTA in assisting the preparation of free thinned anterolateral thigh lobulated perforator flap with nerve in repairing soft tissue defect of limb. Methods Between February, 2010 and May, 2018, free super-thin anterolateral thigh lobulated perforator flap with nerve was transferred to repair soft tissue defect of limbs in 11 cases. There were 8 males and 3 females with an average age of 35 (range, 22-56) years.The defect area was 8.0 cm×11.0 cm-9.0 cm×23.0 cm. Preoperation CT scan of the free flap donor site was performed to obtain 3D images of the region with arterial blood supply by digital 3D reconstruction CT, and to determine the origin, direction, classification, length, diameter and the position of pedicle perforator.Postopera鄄tive regular followed-up was carried according to the Upper Limb Function Evaluation Trial Standards of Chinese Medical Association of Hand Surgery and Enneking Evaluation System. Results All 11 flaps survived. No vascular crisis happened.All 11 cases were followed-up for 3 to 12 (average, 5) months.The flaps were supple and elastic with near normal color.There was no bulkiness.Sensory function was recovered well and two point discrimination was 3.0-6.0 mm. According to the Upper Limb Function Evaluation of Upper Limb of Chinese Medical Association of Hand Surgery, the results were excellent in 1 case, good in 3 cases and fair in 1 case.The Enneking system was used to as鄄sesse the lower limbs recovery.The average score was 21, an average of 70% of limb function restored. Conclusion The free super-thin anterolateral thigh lobulated perforator flap with nerve offers advantages to the traditional antero鄄lateral thigh flap. The survived flaps are ideal in terms of covering limb defects and restoring functions. Preoperative 3D-CTA in the anterolateral thigh perforator flap transplantation is an accurate and useful method.It helps a safer and successful operation with optimal outcome.

Repairing massive soft tissue defects of shank and foot with combined flaps with the help of 3D-CTA technique / 中华显微外科杂志

To explore the clinical value of repairing massive soft tissue defects of shank and foot with diverse combined flaps with the help of 3D-CTA technique. Methods From March, 2011 to May, 2018, 7 pa-tients with massive soft tissue defects (defect area:21 cm×14 cm-53 cm×16 cm) of shank and foot were treated with combined flaps, including free anterolateral thigh flaps(ALTP) combined with local transferred sural neurocuta-neous vascular flaps in 2 cases, free ALTP combined with local transferred supracondylar flap in 2 cases, free thora-co-umbilical flaps plus local transferred gastrocnemius muscular flaps in 1 case, and free ALTP plus free thoraco-um-bilical flap in 1 case.Free ALTP and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibial vessel from the healthy limb to form vascular pedicles in 1 case. All cases received 3D-CTA to observe the distribution and anastomosis of perforator vessel. Regular followed-up was made post-opera-tively. Results All patients had been followed-up for 6-18 months. Outpatient service combined with telephone follow-up was adopted. All flaps survived, and flap shape, colour and lustre, elasticity got good recover. At the last follow-up, thermann scale function assessment: 4 cases were excellent, 2 were good, and 1 was fair. Conclusion It is a feasible and effective method to repair massive soft tissue defects of shank and foot using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb func-tion and shorten the course of treatment.Preoperative 3D-CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the oper-ation time and improve the accuracy rate of vascular anastomosis.

3D-CTA assisted anterolateral thigh lobulated perforator flap in repairing soft tissue defect of limb: 11 cases report / 中华显微外科杂志

Objective@#To investigate the effectiveness of preoperative 3D-CTA in assisting the preparation of free thinned anterolateral thigh lobulated perforator flap with nerve in repairing soft tissue defect of limb.@*Methods@#Between February, 2010 and May, 2018, free super-thin anterolateral thigh lobulated perforator flap with nerve was transferred to repair soft tissue defect of limbs in 11 cases. There were 8 males and 3 females with an average age of 35 (range, 22-56) years. The defect area was 8.0 cm×11.0 cm-9.0 cm×23.0 cm. Preoperation CT scan of the free flap donor site was performed to obtain 3D images of the region with arterial blood supply by digital 3D reconstruction CT, and to determine the origin, direction, classification, length, diameter and the position of pedicle perforator. Postoperative regular followed-up was carried according to the Upper Limb Function Evaluation Trial Standards of Chinese Medical Association of Hand Surgery and Enneking Evaluation System.@*Results@#All 11 flaps survived. No vascular crisis happened. All 11 cases were followed-up for 3 to 12 (average, 5) months. The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination was 3.0-6.0 mm. According to the Upper Limb Function Evaluation of Upper Limb of Chinese Medical Association of Hand Surgery, the results were excellent in 1 case, good in 3 cases and fair in 1 case. The Enneking system was used to assesse the lower limbs recovery. The average score was 21, an average of 70% of limb function restored.@*Conclusion@#The free super-thin anterolateral thigh lobulated perforator flap with nerve offers advantages to the traditional anterolateral thigh flap. The survived flaps are ideal in terms of covering limb defects and restoring functions. Preoperative 3D-CTA in the anterolateral thigh perforator flap transplantation is an accurate and useful method. It helps a safer and successful operation with optimal outcome.

Total cerebral infarction caused by autologous fat injection in the forehead: a case report / 中华整形外科杂志

Cerebral artery embolism is a rare but serious complication of facial plastic surgery. This paper reports a case of severe total cerebral arterial fat embolism caused by facial autologous fat injection. The patient past away after 40 hours of treatment. The cause of this total cerebral artery embolism patient was analyzed by tracing relevant medical history and cephalic CTA examination. By studying this case, we hope to reduce the occurrence of similar situations in the future.

Correlation between intracranial carotid artery stenosis and ocular arterial blood flow and retinal vascular morphology / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the correlation between intracranial internal carotid artery stenosis and ocular arterial blood flow and retinal vascular morphology.<p>METHODS: Totally, 251 patients admitted to our hospital due to suspected cerebral ischemia from January 2017 to June 2018 were selected. According to the degree of internal carotid artery stenosis, the patients were divided into non-stenosis group(39 cases), mild stenosis group(80 cases), moderate stenosis group(83 cases), and severe stenosis group(49 cases). The ocular hemodynamic indexes and retinal vascular diameters of the four groups were compared. The correlation and diagnostic value were analyzed between eye blood flow parameters and severe intracranial internal carotid artery stenosis.<p>RESULTS: In the severe stenosis group, the peak systolic velocity(PSV)and diastolic peak velocity(EDV)of ophthalmic artery(OA), central retinal artery(CRA)and posterior ciliary artery(PCA)were significantly lower than those of the other three groups. In the blood flow parameters of OA, CRA and PCA, PSV and EDV were significantly negatively correlated with severe intracranial internal carotid artery stenosis. The optimal diagnostic thresholds of PCA PSV and PCA EDV for severe intracranial internal carotid artery stenosis were 11.26cm/s and 5.21cm/s, respectively.<p>CONCLUSION: Intracranial internal carotid artery stenosis was significantly negatively correlated with PSV and EDV in the ocular arteries. PCA PSV and PCA EDV were most sensitive to intracranial internal carotid artery stenosis under the same index.

Basic anatomical research of the fallopian tube and its correlation with the vascular supply of the ovary / 中国实用妇科与产科杂志

Fallopian-tubal diseases are not rare inclinical practise that not only damage the fertility offemale,but also are lethal under certain circumstances.Hence OBGYN doctors should gain an insight into theanatomy related to the fallopian tube.Here we discussthe current status of the anatomical research on fallo-pian tube and introduce its correlation with the vascular supply of the ovary.

Application of digital technique to assist in the reconstruction of thumb and fingers defect / 中华显微外科杂志

Objective To investigate the clinical significance of the reconstruction surgery using the toes to repair thumb and fingers defect with the help of the digital technology. Methods Between June, 2012 and May, 2017, 17 partial thumb and finger defects in 12 cases received 3D-CTA assisted finger reconstruction surgeries in us-ing the toe. Preoperative ipsilateral foot 3D-CTA were conducted and the 3D digital models were analyzed. It helped to know the parameters of the move direction and classification of the arteries and veins, etc.It was helpful for design-ing personalized surgical scheme that could match with the length of each finger defect and the defect area and shape in the recipient site of the specific case. Results All 17 toe-to-hand transplants in 12 cases survived. With 6-12 month's followed-up, the appearance of the reconstructed fingers was very closed to the normal fingers. The two-point discrimination was 6-10 mm. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 9 digits, good in 6 digits, fair in 1 digit and poor in l digit. Conclusion The digital technology can help to formulate the operation scheme of personalized and accurate reconstruction of thumb and fingers before the operation.It was helpful to reduce the opera-tion risk and improve the survival rate of fingers reconstruction.It has very good practical and clinical significance.

Comparison of collateral circulation scales by computed tomographic angiography / 中华神经医学杂志

Objective To compare the regional leptomeningeal (rLMC) scale scores,Miteff scale scores and Tan scale scores to provide the clinical basis for selecting collateral circulation evaluation methods.Methods One hundred and fifteen patients with acute ischemic stroke,admitted to our hospital from August 2013 to February 2017 were chosen in our study.The rLMC scale,Miteff scale,and Tan scale were used to evaluate the collateral circulations of each patient.The credibility and validity of these 3 scales were compared.Modified Rankin scale (mRS) scores at 3 months were followed by 0-2 for good prognosis and 3-6 for poor prognosis.Binary Logistic regression analysis was used to determine the independent prognostic factors of ischemic stroke.Receiver operating characteristic (ROC) curve was used to compare the predictive values of the 3 scales for prognoses of ischemic stroke.Results Intra-observer agreement of the 3 scales from the highest to the lowest was rLMC scale (Kappa=0.871),Tan scale (Kappa=0.842),and Miteff scale (Kappa=0.752).The test-retest reliability of the 3 scales from the highest to the lowest was rLMC scale (Kappa=0.879),Tan scale (Kappa=0.826),and Miteffscale (Kappa=0.775).The validity of the 3 scales from the highest to the lowest was rLMC scale (rs=0.690),Tan scale (rs=0.680),and Miteff scale (rs=0.650).Univariable and multivariable analyses showed that the results of collateral circulation defined by rLMC scale (OR=1.325,95％CI=1.048-1.675,P=0.019),Tan scale (OR=2.938,95％CI=1.115-7.744,P=0.029) and Miteff scale (OR=2.698,95％CI=1.050-6.931,P=0.039) were associated with prognoses of acute ischemic stroke.ROC curve showed that the area under the curve of rLMC scale,Tan scale,and Miteff scale was 0.848,0.799,and 0.759,respectively;there were significant differences among the 3 scoring methods in the area under the curve (P＜0.05),indicating the predictive values of the three to the prognoses:rLMC scale＞Tan scale＞Miteff scale.Conclusions As compared with Miteff scale and Tan scale,rLMC scale has high intra-observer agreement and validity,and is reliable but complicated.The results of collateral circulation defined by these 3 scoring methods are associated with the prognoses of acute ischemic stroke.

The reevaluation and surgical strategy of the superficial circumflex iliac artery perforator (SCIP) flap / 中华显微外科杂志

Objective To introduce the classification of the perforators of the superficial circumflex iliac artery(SCIA),and the superficial circumflex iliac artery perforator (SCIP) flaps based on different perforators have different characters and harvesting methods.To explore a set of coping strategy for the drawbacks of the SCIP flap.Methods Review 90 cases of SCIP flaps in August,2011 to June,2017.The pre-operative radiology navigation was conducted in all cases.Different surgical approaches were applied in flaps based on different perforators.The pedicle elongation method was adopted when necessary.The thickness of the flap,the length of the pedicle,the survival rate of the flap and the closure of the donor site were analyzed.Regular follow-up was performed after the operation.Results All flaps were followed-up for 6-15 months (average 8 months).Fifty-seven flaps were raised on the basis of the proximal perforators of the superficial branch of the SCIA,whereas 29 cases were based on the distal perforators from the deep branch,and in 4 cases,the pedicle was switched to the superficial inferior epigastric artery.In 8 cases,the arterial pedicle lengthen technique was applied with a maximum length of 10 cm.All donor sites were closed directly.Conclusion These surgical strategies simplified the intraoperative decision-making and conquered the shortcomings of the SCIP flap.It is believed that the SCIP flap can possibly become the new workhorse flap in the field of reconstructive surgery.