A prospective study of super-thin anterolateral thigh flap harvesting assisted by high-frequency color Doppler ultrasound in detecting perforators in deep adipose layers / 中国修复重建外科杂志

OBJECTIVE@#To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF).@*METHODS@#Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured.@*RESULTS@#A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory.@*CONCLUSION@#Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.

Riluzole interferes with the activation of NLRP3 inflammasome in microglia of rats with spinal cord injury / 中国组织工程研究

BACKGROUND:Previous animal studies have shown that riluzole can inhibit neuroinflammatory response after spinal cord injury and promote functional recovery in injured rats,but the study on whether it can regulate the expression of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome in the acute stage is lacking. OBJECTIVE:To observe whether riluzole can reduce microglial pyroptosis and promote functional recovery after spinal cord injury by modulating NLRP3 inflammasome through animal experiments,histological experiments and molecular biology experiments. METHODS:Female SD rats were divided into sham operation,model and riluzole groups,with 12 rats in each group.In addition to the sham operation group,T10 spinal cord injury was conducted in rats.The model group was treated with intraperitoneal administration of riluzole with solvent cyclodextrin.The riluzole group was treated with a 4 mg/kg dose of riluzole injection.The effect of riluzole on motor function recovery was assessed using the BBB score and inclined plane test.The recovery of sensory-evoked potential and motor-evoked potential was measured by electrophysiology.Hematoxylin-eosin staining was used to evaluate spinal cord tissue repair.The regulatory effects of riluzole on NLRP3,Caspase-1 and gasdermin D protein expression in spinal cord tissues were detected by western blot assay.ELISA was utilized to detect the expression levels of inflammatory factors interleukin-1β and interleukin-18.The effects of riluzole on the expression of NLRP3,Caspase-1,gasdermin D and interleukin-1β in microglial cells of the injured spinal cord were determined by immunofluorescence staining. RESULTS AND CONCLUSION:(1)At 35 days after spinal cord injury,BBB score and inclined plane test score in the riluzole group were higher than those in the model group(P<0.05).(2)At 3 days after spinal cord injury,the protein expressions of NLRP3,cleaved Caspase-1,gasdermin D-N(N-terminal domain),interleukin-1β,and interleukin-18 in the spinal cord homogenate of the riluzole group were significantly lower than those of the model group(P<0.05).(3)At 3 days after spinal cord injury,the fluorescence intensity of NLRP3,Caspase-1,gasdermin D and interleukin-1β in the riluzole group was significantly lower than that in the model group(P<0.05).(4)At day 35 after spinal cord injury,hematoxylin-eosin staining showed that the area of spinal cord injury in the riluzole group was smaller than that in the model group.Electrophysiological tests showed that the latency periods of sensory-evoked potential and motor-evoked potential in the riluzole group were shorter than those in the model group,and the latency period of wave amplitude in the riluzole group was higher than that in the model group.(5)These results suggest that riluzole can promote the repair of injured spinal cord tissue,promote the repair of nerve conduction function,and further promote the recovery of motor function in rats with spinal cord injury,which may be achieved through the regulation of NLRP3 inflammasome and the reduction of microglial pyroptosis.

Circ0005512 promotes microglia/macrophage pyroptosis after spinal cord injury in female rats / 中国组织工程研究

BACKGROUND:Neuroinflammation is an important factor leading to secondary spinal cord injury,and microglia/macrophage pyroptosis is a significant part of post-spinal cord injury neuroinflammation.Studies have shown that microglia/macrophage undergoes pyroptosis after spinal cord injury,but the regulatory mechanism of circular RNA(circRNA)in microglia/macrophage pyroptosis after spinal cord injury remains unclear. OBJECTIVE:To investigate the role and mechanism of circRNA0005512 in regulating microglia/macrophage pyroptosis after spinal cord injury. METHODS:Female Wistar rats were divided into sham group and spinal cord injury group.Motor function was evaluated using the Basso,Beattie,and Bresnahan(BBB)scale.Cavity volume was assessed by hematoxylin-eosin staining.Differential expression of circRNA in spinal cord tissue was screened using RNA-sequencing and circ0005512 was validated by real-time PCR.Immunofluorescence,western blot assay,ELISA,and real-time PCR were performed to detect cell pyroptosis in the rats and lipopolysaccharide-induced microglial cell line HAPI cell models.Gene knockdown was used to confirm the regulatory role of circRNA0005512 in microglia/macrophage pyroptosis. RESULTS AND CONCLUSION:(1)Seven days after spinal cord injury,evident cavities were observed at the injury site.Immediately after spinal cord injury,the motor function of rats was completely lost.Over time,the motor function of rats in the spinal cord injury group gradually partially recovered,and there was a significant difference in BBB scores compared to the sham group.(2)Circ0005512 was significantly upregulated according to the results of the RNA-sequencing and confirmed in both the animal and cell models.(3)Immunofluorescence,western blot assay,real-time PCR,and ELISA confirmed the significant upregulation of cell pyroptosis markers(NLRP3,GSDMD,and caspase-1)in spinal cord injury tissue and lipopolysaccharide-induced HAPI cells.(4)In the cell model,knockdown of circ0005512 resulted in significantly decreased levels of cell pyroptosis marker-NLRP3.(5)The results above indicate that circ0005512 promotes pyroptosis in microglia/macrophages after spinal cord injury.

A prospective clinical controlled study of minimally invasive-locking block modified Krackow technique for repairing achilles tendon rupture / 中华骨科杂志

Objective:To investigate the clinical effect of minimally invasive-locking block modified Krackow (MI-LBMK) and open giftbox technique in the treatment of Achilles tendon rupture.Methods:Fifty-six patients with Achilles tendon rupture from January 2016 to December 2018 were collected, including 54 males and 2 females, aged 40.7±9.4 years (range 26 to 65 years). The MI group (30 patients) used two minimally invasive incisions without exposing the rupture site, and the LBMK technique was used to repair the Achilles tendon. The open group (26 patients) used a posteromedial longitudinal incision and the giftbox technique was used to repair the rupture tendon. The Achilles tendon was repaired with 6-strand sutures in both groups. Early rehabilitation programs were adopted for postoperative rehabilitation, and regular follow-up (6 weeks, 3, 6, 12 and 24 months after operation) was performed to record the Achilles tendon resting angle (ATRA), American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Achilles tendon total rupture score (ATRS). The rupture gap and cross-sectional area (CSA) were measured by MRI at 6 weeks and 3 months after surgery.Results:A total of 30 patients in the MI group and 26 in the open group were enrolled. The differences between the two groups in age, body mass index, interval from injury to operation, and tendon rupture site were not statistically significant ( P>0.05). All patients were followed up to 24 months after surgery. There were no wound complications in MI group, and 2 cases of superficial infection and 1 case of wound skin necrosis occurred in open group. There was no re-rupture in both groups. The relative ATRA of MI group was -6.32°±0.99°, -3.90°±1.05°, -2.38°±0.84°, -0.25°±1.37° at 3, 6, 12 and 24 months after operation, respectively. The relative ATRA of open group was -7.88°±3.71°, -6.16°±1.10°, -4.53°±0.95°, -3.01°±0.95° at 3, 6, 12 and 24 months after operation, respectively. The differences between the two groups were statistically significant ( P<0.05). The ATRS of minimally invasive group at 6 months and 12 months were 72.70±7.41 and 92.97±3.35 respectively, and the ATRS of open group at 6 months and 12 months were 68.08±6.64 and 90.85±4.27 respectively, and the differences were statistically significant ( P<0.05). The AOFAS of minimally invasive group at 6 months and 12 months were 88.60±2.76 and 93.83±1.98 respectively, and the AOFAS of open group at 6 months and 12 months were 85.77±3.20 and 92.08±2.64 respectively, and the differences were statistically significant ( P<0.05). The difference in the gap between the tendon rupture ends measured by MRI sagittal plane T2WI between the two groups was not statistically significant ( P>0.05). The cross-sectional area of Achilles tendon in the MI group was higher than that of the open group at 12 weeks ( P<0.05). Conclusion:The MI-LBMK technique may protect the peritendon tissue and has fewer complications, and can enable the patient to return to daily life faster, with lower postoperative Achilles tendon elongation and better recovery of Achilles tendon function.

Mechanical thrombus aspiration combined with superior mesenteric artery transcatheter thrombolysis in the treatment of portal vein thrombosis / 国际外科学杂志

Objective:To compare the effectiveness and safety of mechanical thrombus aspiration combined with superior mesenteric artery transcatheter thrombolysis with those of simple superior mesenteric artery transcatheter thrombolysis in the treatment of portal vein-superior mesenteric vein thrombosis.Methods:A retrospective case-control study was used to analyze the clinical data of 27 patients with portal vein thrombosis treated by interventional therapy in Beijing Friendship Hospital Affiliated to Capital Medical University from February 2020 to October 2022. According to different interventional procedures, they were divided into two groups: 13 cases were treated with mechanical thrombus aspiration combined with superior mesenteric artery catheterization thrombolysis (combined treatment group), and 14 cases were treated with superior mesenteric artery catheterization thrombolysis alone (catheterization thrombolysis group). The postoperative and preoperative portal vein thrombus grade, catheterization thrombolysis time, parenteral nutrition time and operation-related complications were observed and compared between the two methods, and the incidence of long-term intestinal necrosis was compared after postoperative follow-up. Measurement data of normal distribution were expressed as mean±standard deviation( ± s), t-test was used for comparison between groups. Counting data were expressed as cases and percentage(%), and comparison between groups was used Chi-square test or Fisher exact probability method. Results:There was significant difference in the grade of portal vein thrombosis between the combined treatment group and the catheterization thrombolysis group( P<0.05). The thrombolytic time of catheterization in the two groups was (2.38±0.74) d and (4.79±1.15) d, respectively, and the time of parenteral nutrition was (4.08±2.87) d and (8.50±3.16) d, respectively. The difference was statistically significant ( P<0.05). There was no significant difference in operation-related complications between the two groups ( P>0.05). There were no severe injury of liver and kidney function in both groups. One patient in each group underwent long-term enterectomy. Conclusions:Mechanical thrombus aspiration combined with superior mesenteric artery thrombolysis is safe and effective in the treatment of portal vein thrombosis. Compared with simple superior mesenteric artery thrombolysis, mechanical thrombus aspiration combined with superior mesenteric artery thrombolysis can increase the rate of thrombus clearance and reduce the time of thrombolysis and parenteral nutrition support.

Clinical application of G-iliac? iliac branch device in the treatment of common iliac artery aneurysm / 国际外科学杂志

Objective:To analyze the safety and efficacy of G-iliac? iliac branch device (IBD) in the treatment of common iliac artery aneurysm.Methods:The clinical data of 7 patients with common iliac artery aneurysm who were treated with G-iliac? IBD and internal iliac artery (IIA) preserved were retrospectively analyzed in the Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University from June 2021 to June 2022, and the surgical effects and related complications were analyzed.Results:All 7 patients were male, aged from 57 to 80 years, with an average age of 70.9 years. There were 6 cases of abdominal aortic aneurysm combined with common iliac artery aneurysm and 1 case of simple common iliac artery aneurysm, all of them were successfully applied with G-iliac? IBD to preserve IIA. Cardiogenic shock occurred in 1 patient after the operation. 7 patients were followed up for 3-15 months, with an average of 8 months. During the follow-up period, the iliac artery and IIA stents were all patency, and there was no IBD-related endoleak, stent displacement, buttock claudication, sexual dysfunction, or aortic-related death. The diameter of abdominal aortic aneurysm and common iliac artery aneurysm were stable.Conclusion:For patients with common iliac artery aneurysm, preservation of IIA with G-iliac? IBD is a safe and effective technique with a high technical success rate and IIA patency rate, and has a low complication rate, but the long-term effect still requires more data and longer follow-up data to support.

Analysis of influencing factors of therapeutic strategies for spontaneous isolated superior mesenteric artery dissection / 国际外科学杂志

Objective:To investigate the influencing factors and clinical effect analysis of the choice of treatment method for spontaneous isolated superior mesenteric artery dissection (SISMAD).Methods:The clinical data of 35 patients with SISMAD admitted to Beijing Friendship Hospital, Capital Medical University from December 2015 to November 2021 were retrospectively analyzed. They were divided into conservative group ( n=24) and surgical group (endoluminal stent group + open surgery group, n=11). The conservative group was treated with conservative methods, the endoluminal stent group ( n=10) was treated with endoluminal stent placement, and the open surgery group ( n=1) was treated with superior mesenteric artery endarterectomy + angioplasty + ileal resection. The white blood cell (WBC) count on admission, the time of abdominal pain, YOO classification, aorta mesenteric angle(AMA), and the length of hospital stay between the two groups were analyzed. All patients were followed up for more than 24 months, at the end of which the vascular remodeling rate of superior mesenteric artery (SMA) between the two groups was studied. In addition, the primary patency rate and secondary patency rate of intracavitary stents were analyzed. Measurement data that conform to normal distribution were expressed as mean ± standard deviation ( ± s), and independent samples t-test was used for comparison between groups; measurement data that do not conform to normal distribution were expressed as median (interquartile range) [ M( Q1,Q3)], the nonparametric test was used for comparison between groups. Enumeration data were compared between groups using the Chi-square test. Results:Univariate analysis showed that compared with the conservative group, the IVS type in YOO classificationin of surgical group was significantly more than the conservative group. There was no significant difference in WBC, duration of abdominal pain, or AMA at admission ( P>0.05). In addition, the length of hospital stay in the conservative group was significantly shorter than that in the surgical group. No intestinal necrosis occurred in endoluminal stent group. After 24 months of follow-up, the remodeling rate of SMA in the surgical group was higher than that in the conservative group; the primary patency rate of the endoluminal stent group was 87.5%, and the secondary patency rate was 100%. One patient in the conservative group developed SMA dissection aneurysm during 12 months of follow-up and received endovascular treatment. Conclusions:For the treatment of SISMAD, most patients can be cured by conservative treatment. However, for patients with consistent abdominal pain and IVS type in YOO classification, if there is no severe manifestation of peritonitis, it is recommended to perform endovascular stent placement as soon as possible to open the blood supply. Meanwhile, the SMA stenting has an ideal long-term patency rate and vascular remodeling rate.

Reconstruction of foot soft tissue defects by superthin anterolateral thigh flap harvested with retrograde dissection of the perforator in the interface plane between the superficial and deep layer of superficial fascia / 中华显微外科杂志

Objective:To investigate the clinical effect of superthin anterolateral thigh flap(ALTF) with retrograde dissection of perforator in the interface plane between the superficial and deep layer of superficial fascia for reconstruction of soft tissue defect in the foot.Methods:The study involved 24 Side of 23 patients with foot soft tissue defects in Department of Foot and Ankle Surgery in Wuxi Ninth People’s Hospital from August 2019 to July 2021. There were 15 males and 8 females with an average of 42(range, 22-59) years old, including 9 in left foot, 13 in right foot, and 1 in both feet. The size of soft tissue defects was 4 cm×4 cm-11 cm×17 cm. The dimension of the superthin ALTF was 4 cm×5 cm-12 cm×18 cm. CTA and high-frequency CDU were used to locate the perforator in the superficial fascia plane. The perforator was exposed and dissected retrograde in the adiposal layer. The superthin ALTF was harvested to repair the foot wound. The donor site was sutured directly. All patients enter follow-up reviews at outpatient clinic or by WeChat. The appearance of flaps were recorded.Results:The superthin ALTF survived in all patients. Two cases had partial epidermal necrosis at the distal part of the flap. The thickness of the flap averaged approximately 4(range 3-6) mm. During 8-16(mean 12) months of follow-up, all superthin ALTF were soft in texture without ulceration. Two flaps required secondary defatting procedures, others showed satisfactory appearance without bulky deformity. Only linear scars left in donor areas.Conclusion:The technique of harvesting superthin ALTF with retrograde dissection of perforator in the superficial fascia plane for repairing foot wounds is reliable and is able to achieve satisfactory functional and esthetic outcome.

The distribution of bone cement in the vertebral body after percutaneous vertebral augmentation for osteoporotic vertebral compression fractures / 中华骨科杂志

Percutaneous vertebral augmentation, including percutaneous vertebroplasty and percutaneous kyphoplasty, has been considered as an effective and safe option in treating osteoporotic vertebral compression fractures. The fractured vertebrae were strengthened by the bone cement injected, thus reducing the symptoms related to fracture. Bone cement injected intraoperatively can be divided into extraspinal (leakage) and intraspinal part, depending on its final location. The former may lead to pulmonary embolism, spinal cord or nerve injury, or some other sequelae; the latter may closely relate to the clinical outcome, radiological outcomes, surgical complications and biomechanical properties. To date, there were a large number of studies on term of the distribution type of bone cement. However, the classification criteria varied and there was lack of literature review on this issue. According to the literature reviewed, the distribution type of bone cement was a critical parameter in percutaneous vertebral augmentation; most classification systems were based on the postoperative X-ray, some based on the postoperative CT, and only a few based on postoperative MRI; in different classification systems, criteria on bone cement morphology tends to be consistent, however, criteria on bone cement range tends to be inconsistent, consistency, similarity and controversy all exited among conclusions between various studies on the morphology and range of bone cement; any single classification system can not describe the distribution of bone cement thoroughly. In this study, classification systems were reviewed, clinical significance and biomechanical conclusions of different classification systems were documented, and the reliability and limitations of classification systems were summarized, hence providing an insight for further research on classifications of the bone cement distribution.

Clinical analysis of Rotarex percutaneous mechanical thrombectomy for treatment of lower extremity artificial bypass occlusion / 国际外科学杂志

Objective:To evaluate the clinical efficacy of Rotarex percutaneous mechanical thrombectomy(PMT) for treatment of lower extremity arterial graft occlusion.Methods:The clinical data of 19 patients with lower extremity arterial bypass occlusion admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients were treated with Rotarex-based endovascular therapy. After 12 months follow-up, the clinical features, surgical outcomes and follow-up data were analyzed to identify effectiveness and safety of the therapy. Independent sample t test was used to analyze the measurement data of continuous normal distribution which were expressed as mean±standard deviation( ± s), enumeration data were expressed as number and percentage, and the comparison between groups were analyzed by chi-square test. Results:A technical success rate of 100% was demonstrated. Rotarex combined with catheter directed thrombolysis was performed in 2 cases, Rotarex combined with percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Rotarex combined with stent implantation was performed in 8 patients. The Ankle brachial index significantly increased (0.82±0.14 vs 0.47±0.11, P<0.05). Critical limb ischemia (Rutherford class 4 or higher) improved significantly (0 case vs 9 cases, P<0.05). Distal embolism occurred in 1 patient and acute myocardial infarction occurred in 1 patient. There was no vascular rupture, haemorrhage, infection, pseudoaneurysm, death and amputation. Kaplan-Meier survival analysis revealed 12-month primary patency rate and freedom from clinically driven target lesion revascularization was 78.9% and 89.5% respectively. Conclusion:Rotarex-based endovascular therapy is a safe and effective treatment for graft occlusion after lower extremity arterial prosthesis bypass with high patency rate and few complications.

Risk factors for cement leakage in percutaneous vertebroplasty for Kümmell disease / 中华骨科杂志

Objective:To identify risk factors for cement leakage in percutaneous vertebroplasty (PVP) for Kümmell disease.Methods:A total of 309 patients (351 levels) with Kümmell disease who underwent PVP between November 2015 and June 2019 were retrospectively reviewed. Age, gender, time of symptom onset, staging of Kümmell disease, fracture site(thoracic, lumbar), cortical disruption, type of fracture (wedge, biconcave, crush), fracture severity (mild, moderate, severe), intrusion of posterior wall, basivertebral foramen, puncture approach (unilateral, bilateral), cement distribution pattern (lumped, spongy), cement volume, cement leakage (yes, no) and cement leakage type were recorded. Cement leakage was classified into three types: through the basivertebral vein, through the cortical defect, and through the segmental vein. The data was analyzed by univariate and multivariate analysis to determine related factors of cement leakage in general and each type.Results:The rate of overall leakage was 65.8% (231/351). The leakage rate of basivertebral vein type, cortical defect type, and segmental vein type was 21.4% (75/351), 37.6% (132/351) and 22.8% (80/351), respectively. Multivariate analysis showed that three significant factors related to leakage in general were cortical disruption, basivertebral foramen and cement distribution pattern. Significant factors related to basivertebral vein type leakage were basivertebral foramen and cement distribution pattern. Significant factors related to cortical defect type leakage were cortical disruption and cement distribution pattern. Significant factors related to segmental vein type leakage were basivertebral foramen, cement distribution pattern, cement volume and fracture site.Conclusion:Risk factors of cement leakage in PVP for Kümmell disease include cortical disruption, basivertebral foramen and cement distribution pattern.

Rotarex debulking combined with paclitaxel drug-coated balloon in treatment of ischemia of lower limb artery / 中华普通外科杂志

Objective:To evaluate the effect of Rotarex debulking combined with paclitaxel drug-coated balloon in the treatment of ischemia of lower limb artery.Method:The clinical data of 34 patients who had lower extremity arterial ischemic disease treated by Rotarex debulking combined with paclitaxel drug-coated balloon from Nov 2016 to Sep 2018 was retrospectively analyzed.Results:There were male 25 cases, with an average age of (69±10) years, the lesion length was (216.7±110.0)mm, and the course of disease was(169.3±303.0) days. Fourteen (41.18%) had primary lesions, 8 (23.53%) had stent occlusion, 11 (32.35%) had primary+ stent occlusion, and 1 (2.94%) had primary+ artificial vascular thrombosis.The technical success rate was 97.06% (33/34), and 100% after catheter directed thrombolysis (CDT). Thirty patients (88.24%) received percutaneous transluminal angioplasty (PTA) and 6 patients (17.65%) received stent placement. The clinical success rate was 97.06% (33/34). There were 2 cases (5.88%) with distal vascular embolism during the operation, no bleeding or artery rupture. The ankle brachial index (ABI) (0.86±0.13) significantly increased (0.40±0.28) ( t=8.851, P<0.01). All patients were followed up for 12 months. The patency rate was 94.12% (32/34), 87.88% (29/33) and 75.76% (25/33) in 3, 6 and 12 months respectively. There was no death in perioperative period and no amputation above ankle in follow-up period. 93.94% of patients were free from clinical driven target lesions. Conclusion:Rotarex debulking combined with paclitaxel in the treatment of lower extremity arterial ischemic disease is safe and effective.

Percutaneous mechanical thrombectomy and angioplasty for femoropopliteal artery stent restenosis / 中华普通外科杂志

Objective To evaluate percutaneous mechanical thrombectomy and angioplasty in patients with femoropopliteal artery stent restenosis.Methods The clinical data of 41 cases with critical limb ischemia caused by femoropopliteal artery stent restenosis were analyzed retrospectively from Jun 2015 to May 2017,who were treated by percutaneous mechanical thrombectomy (PMT) + percutaneous angioplasty (PTA) simultaneously.Clinical status assessment,ankle brachial index (ABI) test and color duplex ultrasonography (CDU) were administered at 3rd,6th and 12th month during follow-up;and computed tomography angiography (CTA) or digital subtraction angiography (DSA) was performed at 6th and 12th month after discharged.Results Procedures were successful in all patients.27 cases were under PTA after PMT,other 14 cases were under PTA + stenting after PMT.The average ABI increased from 0.34 ± 0.28 to 0.84 ± 0.32 (P =0.00) immediately.There was no perioperative death and major limb amputation.36 cases (36/41,87.8％) were followed-up from 169 to 698 days (mean 426 days).During follow-up of 12 months,there were 18 cases with in-stent restenosis and/or thrombosis.PMT + PTA were performed again in 14 cases and 4 cases accepted medication;no case encountered major amputation.The primary patency and second patency were 82.9％ and 97.6％ respectively at 6th month;Which were 49.8％ and 88.8％ respectively at 12th month,and the ABI was 0.65 ± 0.10 (P =0.01).Conclusion Percutaneous mechanical thrombectomy and angioplasty is safe,miniinvasive and effective for femoropoplitealartery stent restenosis.

Analysis of future scientific research work planning of the tertiary from the perspective of subject declaration / 中华医学科研管理杂志

Objective From the perspective of the application of Beijing Tongzhou district science and technology project,we can grasp the present situation,existing problems and opportunities of the hospital.Methods Taking the information of the application declared by Beijing Luhe Hospital in 2017 as the research object,using the Excel,statistical analysis of the applicants'age,professional title,degree and departments distribution;summing up the common problems of the expert feedback.Results The study found that the 144 subjects participated in the declaration had been laying particular stress on each of the five areas,including:research category,applicants‘ age,professional title,degree and department.Conclusions Based on the data of the application,we have made a preliminary discussion about the overall planning and management measures of the future hospital scientific research.

Percutaneous mechanical thrombectomy and angioplasty for femoropopliteal artery stent restenosis / 中华普通外科杂志

Objective@#To evaluate percutaneous mechanical thrombectomy and angioplasty in patients with femoropopliteal artery stent restenosis.@*Methods@#The clinical data of 41 cases with critical limb ischemia caused by femoropopliteal artery stent restenosis were analyzed retrospectively from Jun 2015 to May 2017, who were treated by percutaneous mechanical thrombectomy(PMT)+ percutaneous angioplasty (PTA) simultaneously. Clinical status assessment, ankle brachial index (ABI) test and color duplex ultrasonography (CDU) were administered at 3rd, 6th and 12th month during follow-up; and computed tomography angiography (CTA) or digital subtraction angiography (DSA) was performed at 6th and 12th month after discharged.@*Results@#Procedures were successful in all patients. 27 cases were under PTA after PMT, other 14 cases were under PTA+ stenting after PMT. The average ABI increased from 0.34±0.28 to 0.84±0.32(P=0.00)immediately. There was no perioperative death and major limb amputation.36 cases (36/41, 87.8%) were followed-up from 169 to 698 days (mean 426 days). During follow-up of 12 months, there were 18 cases with in-stent restenosis and/or thrombosis. PMT+ PTA were performed again in 14 cases and 4 cases accepted medication; no case encountered major amputation. The primary patency and second patency were 82.9%and 97.6% respectively at 6th month; Which were 49.8% and 88.8% respectively at 12th month, and the ABI was 0.65±0.10 (P=0.01).@*Conclusion@#Percutaneous mechanical thrombectomy and angioplasty is safe, miniinvasive and effective for femoropopliteal artery stent restenosis.

Discussion on the regional medical scientific research alliance / 中华医学科研管理杂志

Objective Through analyzing and summarizing the experiences and reflections during the construction of regional medical scientific research alliance,to explore the ultimate goal and ideal model of such work.Methods Literature review,as well as working experience summary and analysis.Results The purpose of setting up regional medical scientific research alliance lies in shared regional medical scientific research data information,using the two-way transformation model of laboratory and clinical research to support the medical service of primary health care in local hospitals,at the same time,promoting the construction and development of regional medical alliance.The ideal model is to make good use of the regional clini cal scientific research data sharing platform and related information sharing platform to promote the collaborative development of regional medical scientific research.Conclusions The ultimate goal of collaborative development of scientific research is to establish "an information map of regional scientific research resources",the map can be used for scientific research project cooperation,resource allocation,integration of scientific research forces and training of talent echelon,thereby comprehensively improve the regional research capacity.

Spinal Cord Stimulation for Pain Treatment After Spinal Cord Injury / 神经科学通报·英文版

In addition to restoration of bladder, bowel, and motor functions, alleviating the accompanying debilitating pain is equally important for improving the quality of life of patients with spinal cord injury (SCI). Currently, however, the treatment of chronic pain after SCI remains a largely unmet need. Electrical spinal cord stimulation (SCS) has been used to manage a variety of chronic pain conditions that are refractory to pharmacotherapy. Yet, its efficacy, benefit profiles, and mechanisms of action in SCI pain remain elusive, due to limited research, methodological weaknesses in previous clinical studies, and a lack of mechanistic exploration of SCS for SCI pain control. We aim to review recent studies and outline the therapeutic potential of different SCS paradigms for traumatic SCI pain. We begin with an overview of its manifestations, classification, potential underlying etiology, and current challenges for its treatment. The clinical evidence for using SCS in SCI pain is then reviewed. Finally, future perspectives of pre-clinical research and clinical study of SCS for SCI pain treatment are discussed.

Acute Massive Pulmonary Thromboembolism Treated by Selective Catheter-Directed Thrombolysis.

BACKGROUND: To evaluate the safety and efficacy of selective catheter-directed thrombolysis (SCDT) in treating acute massive pulmonary thromboembolism (AMPTE). METHODS: Twenty-six AMPTE patients were enrolled between March 2010 and March 2013. A Uni*Fuse infusion system was inserted into the main pulmonary artery thrombus. The thrombolytic regimen included an intraoperative bolus injection of 250,000 IU urokinase, followed by continuous thrombolytic infusion of 5,000 IU/kg per (every) 24 hr urokinase for 72 hr postoperatively. Clinical symptoms, shock index (SI), systolic pulmonary artery pressure (sPAP), peripheral arterial partial pressure of oxygen (PaO2), and Miller index (MI) were assessed before and after treatment. RESULTS: The patients included 16 men and 10 women (49.9 ± 18.8 years old; time to onset of 50.2 ± 28.5 hr). After thrombolysis, dyspnea and cough were relieved to varying degrees; chest pain, hemoptysis, and syncope disappeared. Importantly, a clinical success rate of 100% was achieved. All objective indices were improved: SI decreased from 1.74 ± 0.38 before operation to 0.71 ± 0.09 postoperatively (P = 0.00); PaO2 increased from 52.78 ± 6.92 mm Hg to 85.98 ± 5.91 mm Hg (P = 0.00); sPAP was reduced from 65.19 ± 8.22 mm Hg to 34.42 ± 4.05 mm Hg (P = 0.00); MI dropped from 0.69 ± 0.09 to 0.33 ± 0.06 (P = 0.00). Mean total urokinase amounts were 1,298,000 IU for each patient. Postoperative complications included 2 cases of puncture-site hematoma (cured by pressure bandage) and 1 case of gastrointestinal hemorrhage (healed by conservative treatment without blood transfusion). CONCLUSIONS: SCDT may be considered a safe and efficacious treatment for AMPTE.

Quality control and safeguarding measures for the whole-process management of scientific research in tertiary hospitals / 中华医学科研管理杂志

Objective Sharing and exploring the efficient development of scientific research management with peers in large tertiary general hospital.Methods This article took the whole process management of scientific research in our hospital during the past five years as example,analyzed and elaborated the quality control and related safeguarding measures.Results According to the comparison between 2012 and 2016,the number of SCI papers published,the number of National Natural Science Funding and other important indicators all have been increased significantly in our hospital.Conclusions The implementation of the whole process quality control management and security measures of scientific research helps hospital to achieve initial and efficient development in research management.

Investigation and analysis on the NSFC application capacity and existing problems of a tertiary general hospital in Beijing / 中华医学科研管理杂志

Objective To achieve the hospital's scientific research objectives during the 13th five-year plan period,we designed to know about the potential NSFC application capacity and existed problems in our hospital.Methods Using "Questionnaire Star" network investigation platform to design questionnaire and conduct data analysis.Results Respondents are divided into two groups,one was who intend to apply in next three years while the other would not.it is found that there are obvious differences between the publication of SCI,as well as the previous research project application and conducting experiences.Conclusions In order to improve the rate of NSFC application,the hospital scientific management workers can consider doing the following:Improve the number of SCI papers published from the perspective of helping to encourage and forcing pressure.Strive for financial support from all parties and build a central experimental platform to create conditions for basic experiments for clinical medical workers.Regular and in time training for NSFC application.Some pressure when necessary to promote the extension of low-level study.Pay more attention to the incentives of research performance at the department level.