The free thoracoumbilical flap for resurfacing large soft-tissue defects of the lower extremity

Both cadavers and living patients were studied regarding a method to resolve large skin defects with bone exposure in the leg, with long-distance thrombosis of the anterior tibial vessels or posterior tibial vessels resulting from traumatic lesions. Forty-six casting mold specimens of cadaveric legs were investigated. There were rich communication branches among the anterior tibial artery, posterior tibial artery, and fibular artery in the foot and ankle, which complemented each other well. Twenty-six patients with large skin defects with bone exposure in the proximal or middle segment of the leg were admitted to the authors' hospital. Among those patients, 19 demonstrated long-distance thrombosis of the anterior tibial vessels or posterior tibial vessels resulting from traumatic lesions. During treatment, a thoracoumbilical flap based on the inferior epigastric vessels was anastomosed to the distal stump of the anterior tibial vessels or the posterior tibial vessels, with reversed flow. All defects were successfully repaired, with good color and texture matches of the flaps. This method can be used for patients with normal anterior tibial vessels or posterior tibial vessels, normal distal stumps of the injured blood vessels, and good reversed flow. The method has the advantages of dissecting blood vessels in the recipient area during the débridement, not affecting the blood circulation of the injured leg, not sacrificing blood vessels of the opposite leg, and not fixing the patient in a forced posture. The muscles are less bulky in the distal one-third of the leg, and the blood vessels are shallow and can be dissected and anastomosed easily. When the flap is used for reconstruction in the proximal two-thirds of the leg, the blood vessel pedicle of the free flap is at a straight angle, without kinking.     

脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析

目的:探讨脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响,并分析患者术后门静脉血栓形成的危险因素。方法:选择2016年1月-2017年12月在我院进行脾切除及贲门周围血管离断术的96例肝硬化门静脉高压患者,于术前、术后1d、3d、7d采用彩色多普勒超声对患者的肝脏血流动力学指标进行动态监测。统计术后7d内患者门静脉血栓的发生率,并将患者分为血栓组(n=28)和无血栓组(n=68),对两组患者的一般资料、手术指标、彩色多普勒超声监测指标等进行单因素分析,并采用Logistic多因素回归分析门静脉血栓形成的危险因素。结果:患者在术前、术后1d、3d、7d时的门静脉内径、最大流速、血流量呈逐渐降低的趋势,肝动脉内径、最大流速、血流量呈逐渐升高的趋势,且各时间点间两两比较差异有统计学意义(P0.05)。术后7d内有28例患者出现门静脉血栓,发生率为29.17%。血栓组和无血栓组患者在性别、年龄、体质量指数、手术时间、术前门静脉流速比较差异无统计学意义(P0.05);血栓组患者Child-Pugh分级为B级比例、术中出血量、脾质量、腹水量、术前门静脉内径均高于无血栓组,术后门静脉内径、术后门静脉流速均低于无血栓组(P0.05)。经Logistic多因素回归分析显示,患者术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素(P0.05)。结论:行脾切除及贲门周围血管离断术的肝硬化门静脉高压患者术后进行肝脏血流动力学监测,有助于患者术后的疗效判断,且术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素。     

超声引导下动静脉内瘘球囊扩张术疗效及通畅率影响因素分析

摘要 目的：观察超声引导下动静脉内瘘球囊扩张术疗效及通畅率的影响因素。方法：选择2018年6月-2020年12月在安徽医科大学第二附属医院行超声引导下自体动静脉内瘘球囊扩张患者230例作为研究对象,根据患者术前血镁水平将患者为低镁血症组87例、正常及高镁血症组143例。分析患者一般人口学资料、术前实验室检查及超声记录指标,随访预后疗效。结果：手术技术成功率98.12 %,平均随访443±100天。两组术后3个月的血管内径与透析血流量高于术前,正常及高镁血症组高于低镁血症组（P<0.05）。术后3个月正常及高镁血症组的总有效率高于低镁血症组（P<0.05）。正常及高镁血症组术后3个月、6个月与1年的血管通畅率分别为90.9 %、77.62 %、67.83 %,明显高于低镁血症组的80.46 %、64.37 %、51.72 %（P<0.05）。COX多因素分析影响随访血管1年通畅率的因素主要为镁、血管内径、肱动脉血流量、年龄等（P<0.05）。结论：超声引导下动静脉内瘘球囊扩张术对自体动静脉内瘘狭窄或血栓具有很好的效果,低镁血症、血管内径、肱动脉血流量是影响血管通畅率的重要因素。     

椎动脉狭窄内血液两相流动数值模拟分析

目的:对应用三维重构得到的人体真实椎动脉进行血液两相流数值模拟,与经典单相流牛顿血液模型对比,分析动脉粥样硬化等病因与椎动脉狭窄处的血流动力学关系。方法:把考虑血细胞和血浆的两相流血液模型应用到逆向工程方法构建的基于人体生理解剖特征的椎动脉三维几何模型中去进行数值模拟,分析血细胞分布情况等血流动力学参数,并与单相流模型的模拟结果进行对比。结果:通过瞬态模拟计算,得到了椎动脉在心动周期内不同时刻的两相流和单相流模型的血流动力学参数。结论:通过对比单相流数值模拟结果,得出血管狭窄处血细胞出现聚集,血流更加复杂和低壁面切应力分布等与动脉粥样硬化及血栓的形成相关的结论。并且与两相流模型相比,单相流模型存在如无法获得如血细胞分布等不足,为进一步深入研究椎动脉等疾病的发病机理提供方法和理论支持。     

B-mode and color Doppler ultrasound of the forearm arteries in the preoperative screening prior to coronary artery bypass grafting

The objective of this paper was to establish the normal findings of B-mode and color Doppler ultrasound of the forearm arteries in candidates for coronary artery bypass grafting with radial artery graft. Examination of radial and ulnar arteries was performed in 127 patients. The vessel diameters and peak systolic velocities were measured and the presence of atherosclerotic changes, calcifications and anatomical variants was assessed. Radial artery proved to be dominant forearm artery with non-significant side-to-side asymmetry. The luminal changes were present in 30% of the patients. Ulnar arteries were more prone to these changes than radial arteries (28.4% vs. 24.4%). The anatomical variants found included ulnar artery hypoplasia in 3.9% of patients and high brachial artery bifurcation in 2.4% of patients. No cases of high-grade stenosis or occlusion were found. The results of the present study indicate that B-mode and color Doppler are valuable methods for preoperative screening as they enable morphological and functional evaluation of the forearm circulation.     

不同年龄女性急性ST段抬高型心肌梗死患者冠状动脉病变特点、PPCI治疗临床疗效的差异及院内死亡的危险因素分析

摘要 目的：分析不同年龄女性急性ST段抬高型心肌梗死（STEMI）患者冠状动脉病变特点、经急诊经皮冠状动脉介入（PPCI）治疗后的临床疗效差异及院内死亡的危险因素。方法：选取2018年1月~2022年3月期间在我院接受PPCI治疗的女性STEMI患者408例,根据患者不同的发病年龄将其分为A组（年龄≤65岁,n=161）与B组（年龄>65岁,n=247）。对比不同的发病年龄PPCI冠状动脉病变特点、治疗后的临床疗效差异及院内不良事件发生情况。单因素和多因素Logistic回归分析女性STEMI患者院内死亡的危险因素。结果：A组、B组的病变血管数量、钙化病变组间对比有统计学差异（P<0.05）。A组、B组的病变血管部位、术前TIMI血流分级、分叉病变组间对比无统计学差异（P>0.05）。两组主动脉内囊反搏术比例组间对比未见明显差异（P>0.05）,B组症状发生到血管开通时间（S-to-D）、门-球囊扩张时间（D-to-B）时间长于A组（P<0.05）。两组术中死亡、支架内血栓、BARC3~5级出血比例组间对比无统计学差异（P>0.05）。B组术后死亡的发生率低于A组（P<0.05）。根据患者不同的预后结局分为存活组（n=369）和死亡组（n=39）。单因素分析结果显示女性STEMI患者院内死亡与年龄、糖尿病、体质量指数（BMI）、Killip心功能分级、术前TIMI血流分级、术后TIMI血流分级、住院天数、S-to-D时间、D-to-B时间、收缩压（SBP）、舒张压（DBP）、白细胞计数（WBC）、中性粒细胞、血小板体积分布宽度（PDW）、左心室射血分数（LVEF）、肌酸激酶同工酶（CK-MB）有关（P<0.05）。多因素Logistic回归分析,结果显示年龄偏大、LVEF偏低、CK-MB偏高、术后TIMI血流分级0~I级、S-to-D时间偏长是女性STEMI患者院内死亡的危险因素（P<0.05）。结论：不同年龄女性STEMI患者冠状动脉病变特点、且PPCI 的治疗效果存在一定的差异。此外,年龄偏大、LVEF偏低、CK-MB偏高、术后TIMI血流分级0~I级、S-to-D时间偏长是女性STEMI患者院内死亡的危险因素。     

Can the modified Allen's test always detect sufficient collateral flow in the hand? A computational study

Blood flow in the largest arteries of the arm up to the digital arteries is numerically modelled using the one-dimensional equations of pressure and flow wave propagation in compliant vessels. The model can be applied to different anatomies of arterial networks and can simulate compression of arteries, these allowing us to simulate the modified Allen's test (MAT) and to assess its suitability for the detection of sufficient collateral flow in the hand if radial blood supply is interrupted. The test measures blood flow in the superficial palmar arch before and during compression of the radial artery. The absence of reversal flow in the palmar arch with the compression indicates insufficient collateral flow and is referred to as a positive MAT. This study shows that small calibres of the superficial palmar arch and insufficient compression of the radial artery can lead to false-positive results. Measurement of the drop in digital systolic pressures with compression of the radial artery has proved to be a more sensitive test to predict the presence of sufficient ulnar collateral flow in networks with small calibres of the superficial palmar arch. However, this study also shows that digital pressure measurements can fail in detecting enough collateral flow if the radial artery is insufficiently compressed.     

Aerobic endurance, anatomical factors and time properties of laser Doppler recorded skin postocclusive hyperaemia

Aerobic endurance capacity is partly dependent on blood supply to and metabolic capacity of the active muscles. Recordings of lower limb skin postocclusive hyperaemia with laser Doppler flowmetry can differentiate between patients with lower limb atherosclerosis and healthy controls. In this study, we investigated the relationship between aerobic endurance, calf volume, common femoral artery diameter and time properties of the postocclusive laser Doppler curve. A group of 16 healthy male subjects with values for aerobic endurance which varied from those of untrained men to elite endurance trained athletes were examined. Duration of laser Doppler recorded skin postocclusive hyperaemia was significantly correlated to both aerobic power and anaerobic threshold (P less than 0.01). Hyperaemia in subjects with large common femoral artery diameter was of shorter duration (P less than 0.05). The peak and mean body mass related blood flow during hyperaemia was correlated to anaerobic threshold (P less than 0.05). These results were in agreement with previous studies indicating an effect of endurance training on the blood supply to the muscles concerned.     

An unusual log-splitter injury leading to radial artery thrombosis, ulnar artery laceration, and scapholunate dissociation

A log splitter is a gasoline- or diesel-powered machine that uses a hydraulic-powered cutting wedge to do the work of an axe. Log-splitter injuries that do not result in amputation of digits or limbs are uncommon and not well described in the literature. We present a unique case of a patient who sustained a log-splitter injury that resulted in thrombosis of the radial artery and avulsion laceration of the ulnar artery leading to acute hand ischemia, in addition to scapholunate ligament disruption leading to a DISI deformity. In this case, thrombolytic therapy was contraindicated and surgical revascularization was the best possible treatment option. Our case illustrates the pitfalls of using this modality in a crush injury, since the use of thrombolytics in this instance would have resulted in severe hemorrhage. An important clinical caveat is the potentially misleading arteriographic diagnosis of thrombosis and/or spasm.     

Can the modified Allen's test always detect sufficient collateral flow in the hand? A computational study

Blood flow in the largest arteries of the arm up to the digital arteries is numerically modelled using the one-dimensional equations of pressure and flow wave propagation in compliant vessels. The model can be applied to different anatomies of arterial networks and can simulate compression of arteries, these allowing us to simulate the modified Allen's test (MAT) and to assess its suitability for the detection of sufficient collateral flow in the hand if radial blood supply is interrupted. The test measures blood flow in the superficial palmar arch before and during compression of the radial artery. The absence of reversal flow in the palmar arch with the compression indicates insufficient collateral flow and is referred to as a positive MAT. This study shows that small calibres of the superficial palmar arch and insufficient compression of the radial artery can lead to false-positive results. Measurement of the drop in digital systolic pressures with compression of the radial artery has proved to be a more sensitive test to predict the presence of sufficient ulnar collateral flow in networks with small calibres of the superficial palmar arch. However, this study also shows that digital pressure measurements can fail in detecting enough collateral flow if the radial artery is insufficiently compressed.     

同型半胱氨酸、子宫动脉血流参数与反复妊娠丢失患者胰岛素抵抗和妊娠结局的关系

摘要 目的：探讨同型半胱氨酸（Hcy）、子宫动脉血流参数与反复妊娠丢失（RPL）患者胰岛素抵抗和妊娠结局的关系。方法：选择2020年6月至2022年10月昆明市妇幼保健院收治的162例RPL患者作为RPL组和同期82例规律产检的健康孕妇作为对照组。按照妊娠结局将RPL患者分为活产组（85例）和流产组（77例）。检测血清Hcy水平,胰岛素抵抗指数（HOMA-IR）,超声检查子宫动脉血流参数,包括子宫动脉收缩期峰值/舒张末期流速（S/D）、搏动指数（PI）、血流阻力指数（RI）。Pearson相关性分析Hcy、子宫动脉血流参数与HOMA-IR的相关性。采用多因素Logistic回归分析RPL 患者妊娠结局的影响因素。采用受试者工作特征（ROC）曲线分析Hcy、子宫动脉血流参数对RPL 患者妊娠结局的预测价值。结果：RPL组血清Hcy水平,S/D、PI、RI以及HOMA-IR均高于对照组（P＜0.05）。RPL组血清Hcy,S/D、PI、RI与HOMA-IR均呈正相关（P＜0.05）。流产组血清Hcy水平,S/D、PI、RI以及HOMA-IR均高于活产组（P＜0.05）,多因素Logistic回归分析显示高HOMA-IR、高Hcy、高S/D、高RI、染色体异常是RPL患者流产的危险因素（P＜0.05）。ROC曲线分析显示联合Hcy、S/D、RI预测RPL患者流产的曲线下面积（AUC）为0.849,高于单独预测。结论：RPL患者子宫动脉血流参数S/D、RI、PI和血清Hcy水平均增高,高S/D、RI和Hcy与RPL患者胰岛素抵抗以及流产风险增加有关。联合S/D、RI和Hcy可提高RPL流产风险评估效能。     

Radionuclide evaluation of the degree of tissue ischemia in acute thrombosis of the main arteries of the lower extremities

The authors ascertained the value of three-phase scintigraphy using 99mTc pyrophotech (intravenously injected in a dose of 370-500 MBq, radiation exposure 2.1-2.85 mZv) in the diagnosis of disorders of great blood flow and soft tissue blood supply in patients with acute thrombosis of the main arteries, including acute thrombosis caused by injury. Examination of 68 patients with critical ischemia of the lower limbs identified 5 types of 99mTc pyrophotech incorporation into ischemic tissues in main artery thrombosis, embolism and atherosclerotic occlusions. The radionuclide technique in combination with ultrasonography and X-ray contrast angiography has shown it possible to choose adequate treatment policy and to specify the level of amputation and the scope of necrectomy when local muscle necrosis is developed.     

Reduction of superior mesenteric hemodynamic responsiveness to [Sar1, Thr8]-angiotensin II and bradykinin, but not sodium nitroprusside, in the presence of homocysteine infusion

Hyperhomocysteinemia (HHcy) has been shown to be an independent risk factor for cardiovascular diseases, superior mesenteric thrombosis and inflammatory bowel disease. Superior mesenteric artery (SMA) supplies the intestine and reduced SMA blood flow results in intestinal ischemia. Although in vitro studies have shown that endothelium-dependent vasorelaxation of SMA is reduced in the presence of homocysteine incubation, it is not confirmed with in vivo studies. In this work, we evaluated responsiveness of SMA to endothelium-dependent or -independent vasodilators and a vasoconstrictor in the absence and presence of acute HHcy in vivo to clarify effect of HHcy on superior mesenteric vascular function. Sodium nitroprusside (SNP), bradykinin (BK), and [Sar1,Thr8]angiotensin II ([Sar1,Thr8]-ANG II) were intravenously administrated in sequence in male Sprague-Dawley rats with or without D,L-homocysteine infusion (6 mg/kg/min) through femoral vein. Agonists-induced changes in carotid artery blood pressure, superior mesenteric blood flow and vascular resistance were measured in the present study. We found that acute HHcy infusion had little effects on SNP-induced hemodynamic changes; however, BK-induced changes in blood pressure, blood flow and vascular resistance were significantly reduced in the presence of HHcy infusion. Additionally, HHcy also markedly decreased [Sar1,Thr8]-ANG II-induced superior mesenteric hemodynamic changes. These results demonstrated that responsiveness of SMA to vasoconstrictor, endothelium-dependent, but not endothelium-independent vasodilator, was inhibited in the presence of Hcy infusion. This HHcy-associated vascular hyporesponsiveness to vasoconstrictors and endothelium-dependent vasodilators may partially contribute to circulatory dysfunctions.     

彩色多普勒超声测量椎动脉血流量对后循环缺血的诊断价值

目的：探讨彩色多普勒超声技术测量椎动脉血流量对后循环缺血（PCI）的诊断价值。方法：选取2012年1月至2013年1月在本院神经内科住院并接受治疗的PCI患者58例作为观察组,另选取同期住院并确诊为非后循环缺血症的患者50例作为对照组。所有患者均接受颈部血管超声检查,测量椎动脉内径及血流量,观察组患者需行头颅CTA检查,比较两组患者的椎动脉内径、血流量及颈动脉硬化斑块发生率等。结果：观察组患者的椎动脉内径及血流量明显低于对照组,两组比较差异有统计学意义（P〈0．01）;观察组颈动脉硬化斑块的发生率为77．5％（44例）,对照组颈动脉硬化斑块的发生率为42％（21例）,两组比较差异有统计学意义（P〈0．05）。无狭窄、轻度狭窄、重度狭窄及闭塞的椎动脉血流量的变化（此处所指的血流量是指小于200mL/min那部分患者）有明显差异（P〈0．05）。结论：与头颅CTA对比检查,彩色多普勒具有直接、准确、方便及可重复性等优点,可有效的诊断后循环缺血症状。     

舒血宁注射液联合倍他司汀对椎-基底动脉供血不足性眩晕症患者椎-基底动脉血流速度和氧化应激的影响

摘要 目的：观察舒血宁注射液联合倍他司汀对椎-基底动脉供血不足性眩晕症（VBIV）患者椎-基底动脉血流速度和氧化应激的影响。方法：纳入河北北方学院附属第一医院神经内科2019年5月~2021年3月期间收治的91例VBIV患者,根据信封抽签法将患者分为对照组和研究组,例数分别为45例和46例。对照组、研究组患者分别接受倍他司汀、舒血宁注射液联合倍他司汀治疗,两组均治疗1个月。观察两组疗效、椎-基底动脉血流速度、氧化应激、血液流变学及药物安全性。结果：对照组（68.89%）的临床总有效率明显低于研究组（91.30%）,差异有统计学意义（P<0.05）。研究组治疗1个月后椎动脉（左侧、右侧）和基底动脉的平均血流速度高于对照组（P<0.05）。研究组治疗1个月后谷胱甘肽过氧化物酶（GSH-Px）、过氧化物歧化酶（SOD）高于对照组（P<0.05）。研究组治疗1个月后全血高切黏度（HSV）、红细胞压积（HCT）、丙二醛（MDA）、红细胞沉降率（ESR）、全血低切黏度（LSV）低于对照组（P<0.05）。治疗期间,两组均未发生明显的不良反应情况。结论：VBIV患者采用舒血宁注射液联合倍他司汀治疗,可改善椎-基底动脉血流速度和血液流变学,减轻机体氧化应激,疗效可靠。     

彩色多普勒超声对青少年椎动脉型颈椎病的诊断价值

目的:探讨彩色多普勒超声对青少年椎动脉型颈椎病的诊断价值。方法:选择我院2012年2月-2016年1月收治的80例青少年椎动脉型颈椎病患者作为研究组,选择同期100例门诊体检同龄健康者作为对照组,使用Acuson Sequoia 512以及HDI5000彩色多普勒超声仪进行检查,观察两组椎动脉和颈外动脉血流指标,记录椎间段血流参数:包括舒张末流速(EVD)、收缩期峰值流速(PSV)、血流量(Q)和阻力指数(RI)。结果:实验组椎动脉内径、EDV、PSV和血流量(Q)比对照组低(P0.05),实验组阻力指数(RI)比对照组高(P0.05)。结论:彩色多普勒超声对青少年椎动脉型颈椎病患者的血流相关指数检查对该病的诊断具有明显作用,适合在临床上推广应用。     

Value of color-Doppler imaging in diagnosis of intrabulbar and intraorbital tumors

Patients with intrabulbar and intraorbital tumours have been investigated by colour Doppler imaging. In the first group there were 20 patients with malignant melanoma of the uvea and in the second group there were 19 patients with cavernous hemangioma. The third group was a control group represented by 20 healthy individuals. In the group of patients with uveal melanoma it has been established that every patient, except one, has a blood flow inside of tumour tissue. Internal blood flow of intraorbital hemangioma was slower than inside the melanoma and the resistance index was lower. Comparison of blood flow in all patients has shown that there is no statistically significant difference between ophthalmic artery, central retinal artery and posterior ciliary arteries except in maximal blood flow in central retinal artery and posterior ciliary arteries.     

The use of cryopreserved arteries as arterial vascular prostheses]

The aim of the study is investigation of possibility to bypass small and medium-size arteries with cryopreserved artery allografts, storing 7-10 days at -196 degrees C under the protection of 15% dimethylsulfoxide. In experiments on 40 rabbits were placed a region of the left renal artery by cryopreserved bioprosthesis. Graft patency was 80% after observation up to 6 months. By angiography it was 8 cases of graft thrombosis (all during the 1st week after implantation) and 5 cases of moderate graft dilation (in 4 of them it was accompanied with stenosis of distal anastomosis). In 20 dogs we replaced a region of the femoral artery by cryostoring bioprosthesis. It was only one case of graft thrombosis which occurred on month 2 after the implantation during 1-year follow-up. After 3 months in 3 cases there developed 3 cases of diffuse narrowing of graft lumen without decreasing of blood flow through the prosthesis. Later, the graft lumen did not change. Histological investigations have revealed a viability of cryopreserved vessels, its almost complete de-endothelialization at 3 days and total re-endothelialization 2 weeks after implantation. During the first 2 weeks there were morphological events of graft rejection, which disappeared after 3 months.