Medial Soft tissue and medial malleolus loss-the posterior tibial artery perforator technique combined with iliac crest autograft to Stabilize the ankle and cover Soft tissue defect: A case Series.

PURPOSE: The purpose of this study was to investigate clinical efficacy of posterior tibial artery perforator technique combined with iliac crest autograft in treatment of medial soft tissue and medial malleolus loss. METHODS: This study involved 11 cases of medial soft tissue and medial malleolus loss from October 2011 to March 2016. Patients were treated with posterior tibial artery perforator technique combined with iliac crest autograft, and given routine treatment, such as rehydration, anti-inflammation, anticoagulation and vasodilation. Ankle function of patients was evaluated according to the American Orthopedic foot and ankle Association (AOFAS) ankle-hind foot scoring system. RESULTS: All flaps survived without bone exposure, and the appearance of skin flaps was satisfactory. There was one case of arterial crisis, one case of venous crisis, one case of skin edge necrosis and one case of incision infection. Wounds of the above patients were healed. Skin flap was soft and elastic without secondary contracture. The two-point discrimination of skin flap was 5-11 mm. The ankle range of motion was 10-60°. X-Ray showed that grafts healed within 8.6 months. According to AOFAS evaluation, four cases were excellent, four cases were good, and three cases were poor. The excellent and good rate was 72.8%. CONCLUSIONS: In this study, posterior tibial artery perforator technique combined with iliac crest autograft was used to treat medial soft tissue and medial malleolus loss. The findings demonstrated that this treatment was reliable and efficacious.

Clinical application for DSA combined with a double-chamber Fogarty catheter in the treatment of venous crisis.

INTRODUCTION: Venous crisis, as a common vascular crisis post limb replantation, is usually treated with surgical exploration. AIM: To investigate effects of digital subtraction angiography (DSA) combined with double-chamber Fogarty balloon catheter on venous crisis post replantation of limbs. MATERIAL AND METHODS: Twelve patients suffering from severed limbs were involved in this study. Patients underwent DSA combining double-chamber Fogarty balloon catheter operation. Colour Doppler ultrasound was used to diagnose patients with venous crisis. Patients were treated with rehydration, anti-infection, anticoagulation, and vasodilation. Indexes, including total joint active activity, working condition, remaining symptoms, appearance, feeling, and muscle strength, were evaluated. RESULTS: During operation, the limb was shortened to 0-1 cm in 8 cases, to 1-2 cm in 2 cases, and to 2-2.5 cm in 2 cases. According to DSA findings, popliteal vein thrombosis was formed at 0.6-4.2 cm and was removed from the popliteal vein. After removal of the thrombosis, DSA images showed re-canalization of the popliteal vein. A typical case of a 16-year-old patient underwent limb replantation; however, venous crisis was formed post operation. Postoperative colour Doppler ultrasound findings indicated re-canalization of the popliteal vein. Tibia and fibula were reduced and internally fixed, while the limb was survived post-operation. The degree of swelling of limbs was improved, and skin temperature was normal or 0.6-1.5°C lower than affected limbs. Skin colour was normal and activity was improved. Patients demonstrated sensory recovery grade of S3+ and two-point discrimination of 4.5 mm. CONCLUSIONS: DSA combining double-chamber Fogarty balloon catheter, as a minimally invasive and fast approach, could accurately locate thrombi and improve pertinence of vein branches.

Dynamic sampling iterative phase retrieval for holographic data storage.

A dynamic sampling iterative phase retrieval method, which dynamically samples the Fourier intensity distribution of the reconstruction beam captured by the detector, is proposed to shorten the iterative number and decrease the phase error rate of phase retrieval in the phase-modulated holographic data storage. By the dynamic sampling method, that keeping relatively low frequency component of Fourier intensity spectrum at the beginning of iteration and gradually releasing more high frequency component at the subsequent iterations, we shortened the iterative number by 2 times and decreased the phase error rate to some extent because our method provided a better convergent path to the phase retrieval. We also believe the thought of our method can be used in more image retrieval fields.

Improved phase retrieval in holographic data storage based on a designed iterative embedded data.

Embedded data are used to retrieve phases quicker with high accuracy in phase-modulated holographic data storage (HDS). We propose a method to design an embedded data distribution using iterations to enhance the intensity of the high-frequency signal in the Fourier spectrum. The proposed method increases the antinoise performance and signal-to-noise ratio (SNR) of the Fourier spectrum distribution, realizing a more efficient phase retrieval. Experiments indicate that the bit error rate (BER) of this method can be reduced by a factor of one after 10 iterations.

Lnc-MEG3 acts as a potential biomarker for predicting increased disease risk, systemic inflammation, disease severity, and poor prognosis of sepsis via interacting with miR-21.

BACKGROUND: This study aimed to investigate the correlations of long non-coding RNA maternally expressed gene 3 (lnc-MEG3), microRNA (miR)-21, and lnc-MEG3/miR-21 axis with disease risk, inflammation, disease severity, and 28-day mortality of sepsis. METHODS: Totally, 219 sepsis patients and 219 health controls (HCs) were enrolled. Plasma samples were obtained from sepsis patients within 24 hours after admission and from HCs on enrollment to detect lnc-MEG3 and miR-21 expressions by real-time quantitative polymerase chain reaction. RESULTS: The lnc-MEG3 expression and lnc-MEG3/miR-21 axis were increased, while miR-21 expression was decreased in sepsis patients compared with HCs. Lnc-MEG3 (area under the curve (AUC): 0.887, 95% confidence interval (CI): 0.856-0.917) and lnc-MEG3/miR-21 axis (AUC: 0.934, 95% CI: 0.909-0.958) had good values for predicting elevated sepsis risk, while miR-21 (AUC: 0.801, 95% CI: 0.758-0.844) presented a good predictive value for reduced sepsis risk. Furthermore, lnc-MEG3 expression and lnc-MEG3/miR-21 axis positively correlated with, whereas miR-21 expression negatively correlated with acute pathologic and chronic health evaluation II, sequential organ failure assessment score, serum creatinine, C-reactive protein, tumor necrosis factor-α, interleukin (IL)-1ß, IL-6, and IL-17 in sepsis patients. Additionally, lnc-MEG3 (AUC: 0.704, 95% CI: 0.626-0.783) and lnc-MEG3/miR-21 axis (AUC: 0.669, 95% CI: 0.589-0.750) exhibited acceptable values in predicting higher 28-day mortality risk, while miR-21 (AUC: 0.588, 95% CI: 0.505-0.672) presented a poor predictive value for lower 28-day mortality risk in sepsis patients. CONCLUSION: Lnc-MEG3 might serve as a potential biomarker for the development, progression, and prognosis prediction of sepsis via interacting with miR-21.

[Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis].

Objective: To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Methods: Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. Results: No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases with an excellent and good rate of 83.3%. Conclusion: Ultrasound guided Fogarty balloon catheter treatment of posterior replantation of arterial crisis can accurately locate the thrombosis, get the thrombus fast and invasive minimally to avoid the blind and repeated thrombectomy, and obtain certain effectiveness.

The longitudinal epineural incision and complete nerve transection method for modeling sciatic nerve injury.

Injury severity, operative technique and nerve regeneration are important factors to consider when constructing a model of peripheral nerve injury. Here, we present a novel peripheral nerve injury model and compare it with the complete sciatic nerve transection method. In the experimental group, under a microscope, a 3-mm longitudinal incision was made in the epineurium of the sciatic nerve to reveal the nerve fibers, which were then transected. The small, longitudinal incision in the epineurium was then sutured closed, requiring no stump anastomosis. In the control group, the sciatic nerve was completely transected, and the epineurium was repaired by anastomosis. At 2 and 4 weeks after surgery, Wallerian degeneration was observed in both groups. In the experimental group, at 8 and 12 weeks after surgery, distinct medullary nerve fibers and axons were observed in the injured sciatic nerve. Regular, dense myelin sheaths were visible, as well as some scarring. By 12 weeks, the myelin sheaths were normal and intact, and a tight lamellar structure was observed. Functionally, limb movement and nerve conduction recovered in the injured region between 4 and 12 weeks. The present results demonstrate that longitudinal epineural incision with nerve transection can stably replicate a model of Sunderland grade IV peripheral nerve injury. Compared with the complete sciatic nerve transection model, our method reduced the difficulties of micromanipulation and surgery time, and resulted in good stump restoration, nerve regeneration, and functional recovery.