Objective To investigate the feasibility of double low scanning technique using the gem spectrum CT coronary artery angiography among the patients at low heart rate≤ 65 beats per minute.Methods This prospective study was approved by the institutional re-view board with patient informed consent.Ninty patients (heart rate≤65 beats per minute)were randomly devided into 3 groups.Group A un-derwent spectral CCTA with iodixanol (Visipaque,270mg/mL)and low scanning technique,Group B conventional CCTA with iohexol (Omnipaque,370 mg/mL)and Group C conventional CCTA with iodixanol (Visipaque,270 mg/mL),Routine scan mode was used in Group B and Group C.Prospective ECG gating mode was used in all groups.120kVp polychromatic images with FBP algorithm (Group B and Group C)were reconstructed for conventional CCTA,60 keV monochromatic images with FBP algorithm (Group A) or with a fixed blending level (40%)of ASiR (Group A1 )were reconstructed for spectral CCTA.Compared the image quality of four groups and ED in three groups.Results The difference was ststistically significant between four groups with the CT value,im-age noise,SNR and CNR of coronary (each P<0.001.Group A1 has the highest SNR and CNR.Group C has the lowest image noise.There were no significant difference of coronary score between group A1 and group B(χ2=0.01,P=1.000)).There was significant difference of coronary score between group A and group B (χ2=22.428,P<0.001),group B and group C (χ2=39.005,P<0.001), group A1 and group A (χ2=21.854,P<0.001).Effective radiation dose in the group A(ED2.60±0.26 mSv)was lower than that of group B (ED3.02±0.36 mSv)(t=3.738,P=0.001)and group C (ED3.11±0.23)(t=3.725,P=0.001).Conclusion Double low scan-ning technique using the gem spectrum CT coronary artery angiography with 40% blending level of ASiR is able to provide better im-age quality than using conventional CCTA and to reduce the effective radiation dose and contrast dose.

Objective To discuss the indication , feasibility and curative effect of endovascular treatment for vascular injuries. Methods 7 patients with vascular injuries were treated by endovascular treatment, including 1 cases of pseudoaneurysm ,2 arteriovenous fistula , 3 closed arteriorrhexis and 1 arterial stenosis after vascular operation . All of the patients were treated by twelve stent - grafts and one introcoil stent. Results All cases were technically successful during follow - up for about 3 to 30 months. The blood flow was rebuild and the diseased region was removed effectively after stent operations. There was no extremity ischemia , hemorrhage , engorgement , stent shift ,fragmentation, angiostegnosis and reinjury appeared in these cases during follow - up. Conclusion Endovascular intervention is a new therapeutic approach with advantages of safety , efectiveness and minimal invasiveness. Its long - term eficacy needs to be further evaluated.

Objective To analysis the effect of stem cell transplantation on serum homocysteine ( Hcy ) , C reactive protein ( CRP ) and brain derived neurotrophic factor( BDNF) in patients with ischemic stroke.Methods 42 patients who were diagnosed with ischemic stroke in Yichang First People's Hospital were collected.All patients were randomly divided into experimental group and control group, 21 cases in each group.The control group was treated with conventional therapy, and the experimental group was treated with autologous bone marrow mesenchymal stem cell transplantation for treatment on the basis of conventional therapy, after treatment, the serum levels of serum homocysteine, CRP, BDNF and clinical curative effect were detected in all patients.Results After treatment, compared with control group, the serum Hcy level was lower in the experimental group(P<0.05);the serum CRP level was lower in the experimental group (P<0.05); the serum BDNF level was higher in the experimental group (P<0.05); the FIM, ADL and Fugl-Meyer score were higher in the experimental group(P <0.05).Conclusions The stem cell transplantation can significantly reduce the serum Hcy and CRP levels in patients with ischemic stroke, increase the content of BDNF in serum, improve the therapeutic effect, and have a guiding significance for clinical.

Objective To evaluate the role and mechanism of ifenprodil, which is the selective antagonist of N-methyl-D-aspartic acid subtype receptor NR2B, in soflurane-induced cognitive dysfunction in neonatal rats.Methods Twenty-eight 7-day-old Sprague Dawley rats, weighing 15-18 g, were randomly divided into 4 groups (n=7 each): control group (group C), ifenprodil group (group I), sevoflurane group (group S) and ifenprodil+sevoflurane group (group IS).Normal saline 0.2 ml was injected intraperitoneally in group C.Specific NR2B receptor antagonist ifenprodil 5 mg/kg was injected intraperitoneally at the corresponding time points in group I.Normal saline 0.2 ml was injected intraperitoneally and 2.0% sevoflurane was inhaled for 4 h in group S.Ifenprodil 5 mg/kg was injected intraperitoneally 2 h before sevoflurance inhalation, and 2.0% sevoflurance was inhaled for 4 h in group IS.The rats were then sacrificed 3 weeks after administration, their brains were immediately removed and hippocampal slices were prepared for electrophyisological experiments.The value of population spike amplitude (PSA) and long-term potentiation (LTP) were measured every 10 minutes.Induced LTP was recorded.Results Compared with group C, the values of PSA and rates of induced LTP were significantly decreased in group S (P＜0.01).The values of PSA and rates of induced LTP were significantly increased in group IS than those in group S (P＜0.01).Conclusion NR2B receptor is involved in sevoflurance-induced cognitive dysfunction in the neonatal rats.Pretreatment with ifenprodil 5.0 mg/kg can improve the neurotoxicity and protect the brain.

Objective To survey the prevalence of Hyperuricemia (HUA) in elder population of Changchun city,and to detect the correlation between cardiovascular risk factors and the HUA.Methods 900 residents older than 55 years were selected randomly for this questionnaire survey.Physical and laboratory examinations were performed.Results The HUA prevalence rate elder people in Xixin District of Changchun was 16.0％(144/900),while the rates were 13.7％(50/365),15.2％(47/309) and 20.8％(47/226) (P＜0.05) in the elder group (55-65 years),the aged group (66-75 years),and the advanced aged group (older than 76 years) respectively;there was no statistical significant difference in the prevalences between male and female (x2=0.023 5,P＞0.05).The HUA prevalence rate was significantly different between people who had different level of blood pressure,cholesterol,hypersensitive C-reactive protein (hs-CRP),body mass index (BMI),waisthip ratio (WHR).The level of uric acid (UA),total cholesterol (TC) and hs-CRP was significantly different in people with high uric acid when compared with those of normal patients (P＜0.05).There was positive correlation between UA level and TC,triglyceride (TG) level (r=0.364,P＜0.05;r=0.479,P＜0.05).Conclusion The HUA prevalence rate increases significantly as people getting older.There is positive correlation between the increase of uric acid level and the major cardiovascular risk factor.People with hypertension,hyperlipidemia,overweight and obese have high risk for HUA,so change life style and dietary habits may prevent or reduce the occurrence of HUA.

Objective To investigate the correlation between the insertion torque values and primary stability of dental implants using different insertion torque values ,and search for the best insertion torque values that can acquire good primary stability. Methods Six male pure beagles were selected, and the first molars and four premolars of bilateral mandibulars were extracted. Three months later, a total of 48 XIVE dental implants were inserted. All implants were divided into group A, group B, group C, and group D based on the insertion torque value (ITV): group A, 0 < ITV < 20Ncm; group B, 20 ≤ ITV < 40Ncm; group C,40Ncm ≤ ITV < 60Ncm;group D,ITV≥60Ncm The dental implant stability was measured by Resonance frequency analysis when implanrs were placed immediately. Results No complications occured.There was significant difference between group A and grop B (P=0.012), group A and grop C (P=0.037), group A and grop D (P=0.001). There are no ignificant difference among group B,group C and grop D(P>0.05). Conclusion With the limitations of the study, it was concluded the primary stability does not simply depend on the insertion torque;When the insertion torque value was no less than 20Ncm, the dental implant can acquire good primary stability.

Objective To observe the effects of ultrasound-guided laryngeal nerve block combined with intratracheal surface anesthesia on the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients.Methods Sixty elderly hypertensive patients,including 37 males and 23 females, with ASA physical statusⅡor Ⅲ,aged 65-85 years,scheduled for thoracic surgery under general anesthesia requiring one-lung ventilation,were equally and randomly divided into either laryngeal nerve block combined with intratracheal surface anesthesia group (group S)or general anesthesia group (group C).Internal jugular vein blood samples were taken to measure the plasma concentrations of epinephrine (E)and norepinephrine (NE) when patients entering the operating room (T0 ),before intubation (T1 ),immediately after intubation (T2 ),at 1 min (T3 ),3 min (T4 ),5 min (T5 )and 10 min (T6 )after intubation.Adverse e-vents,such us hypertension and tachycardia,were recorded during induction and intubation.Results Com-pared with T0 ,the plasma concentrations of E and NE were significantly increased at T2-T5 in group C (P<0.05 or P <0.01),while there were no such significant changes in group S.The plasma concentration of E and NE at T2-T5 in group S were significantly lower than that in group C (P <0.05 or P <0.01).The incidence of hypertension in group S was significantly lower than that in group C during induction of intuba-tion (0% vs 37%,P <0.01).There were no hypotension,tachycardia and bradycardia during induction and intubation in both groups.Conclusion Ultrasound-guided laryngeal nerve block combined with intratra-cheal surface anesthesia can effectively inhibit the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients,which is helpful for maintaining the hemodynamic stability during anesthesia induction.

Objective:To investigate the effects of anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata in repairing destructive wounds and rebuilding function of hands or feet.Methods:This study was a retrospective observational study. From January 2022 to March 2023, 16 patients with destructive wounds in hands or feet combined with extensor tendon defects who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital, including 12 males and 4 females, aged 3 to 63 years. The wounds were located on the hands in 12 cases and on the feet in 4 cases. The number of defective extensor tendon ranged one to five, and the length of the defect ranged from 2.5 to 6.0 cm. The wound area was 11.0 cm×5.5 cm to 29.0 cm×9.5 cm after debridement. The wounds were repaired with anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata, and the flap area was 12.0 cm×6.5 cm to 30.0 cm×11.0 cm. The fascia lata was used to repair the extensor tendon defects, and the harvesting area of fascia lata was 8.0 cm×3.0 cm to 12.0 cm×8.0 cm. The wounds in flap donor areas in 15 patients were sutured directly, and the wound in flap donor area in 1 patient was covered with medium-thickness skin graft from lower abdomen. The survival of flaps and the wound healing in donor and recipient areas of flaps were observed within 1 week after operation. The number of patients who underwent thinning and plastic surgery or tenolysis was recorded during postoperative follow-up. At the last follow-up, the recovery of sensory function of the transplanted flaps on hands or feet was evaluated, the efficacy of flap repair was evaluated according to the comprehensive flap evaluation scale, and the function of hands was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association. The following two indexes were compared, including the measured total active motion of the injured fingers and the foot function assessed using Maryland foot function scale between before surgery and at the last follow-up.Results:Arterial crisis occurred in flaps in 2 patients after operation, and the flaps survived after timely exploration; the flaps in the rest patients survived well after operation. No obvious scar hyperplasia or ulceration was observed in donor and recipient areas of flaps after operation. All patients were followed up for 8 to 16 months, of which 6 patients underwent flap thinning and plastic surgery 6 to 7 months after operation, and 4 patients underwent tenolysis 3 to 6 months after operation. At the last follow-up, the recovery of sensory function of flaps reached S1 level in 5 cases and S2 level in 11 cases, and the two-point discrimination only had 1 point. The efficacy of flap repair scored 80 to 91, which were evaluated as excellent in 5 cases, good in 9 cases, and acceptable in 2 cases. The hand function was evaluated as excellent in 5 cases, good in 5 cases, and acceptable in 2 cases. The active extension function of the injured finger/toe was reconstructed successfully, and the total active motion of the injured finger was (225±22)° at the last follow-up, which was significantly higher than (117±20)° before surgery ( t=119.59, P<0.05); the foot function score was 86±7 at the last follow-up, which was significantly higher than 29±7 before surgery ( t=222.68, P<0.05), and the foot function was evaluated as excellent in 2 cases, good in 1 case, and acceptable in 1 case. Conclusions:The operation of harvesting the anterolateral femoral perforator flap pedicled with oblique branch of lateral circumflex femoral artery is relatively simple. After the wounds on hands or feet being repaired with the flaps, the appearance and function are good, with no obvious scar hyperplasia in donor and recipient areas of flaps. The fascia lata carried by the flap can repair the extensor tendon defect at the same time and improve the movement of the finger/toe.

Objective To study the effect of levosimendan on cardiomyocyte apoptosis after coronary microembolization (CME) in swine,Methods Fifteen healthy swines were randomly divided into sham operation group,CME group and levosimendan treatment group (5 in each group).Their cardiac function was assessed by echocardiography,their cardiomyocyte apoptosis was assyed with TUNEL staining,and Caspase-3 expression was detected by Western blot at 12 h after operation.Results The LVEF was lower,the left ventricular minor axis was shorter and the cardiac output volume was smaller while the LVEDD was longer in CME group than sham operation group (P＜0.05).The cardiac function was significantly better in CME group than in sham operation group (P＜0.05).The cardiomyocyte apoptosis rate and Caspase-3 expression level were significantly higher in CME group than in sham operation group (P＜0.05).The cardiomyocyte apoptosis rate was significantly higher while the Caspase-3 expression level was significantly lower in levosimendan treatment group than in CME group (6.820％±-1.974 ％ vs 10.558％±2.425％,P＜0.05).Conclusion Pretreatment with levosimendan can effecively reduce the cardiomyocyte apoptosis and improve the cardiac function after CME by inhibiting the Caspase-3 expression in cardiomyocytes.

Objective:To investigate the clinical effect of three-dimensional(3D) flap model accurately designed before the operation in repairing irregular wounds of limbs with anterolateral thigh(ALT) perforator flap.Methods:The data of patients with ALT flaps designed with 3D printing technology to repair irregular soft tissue defects of limbs in Suzhou Ruihua Orthopedic Hospital from January to October 2022 were retrospectively analyzed. After the wound was scanned by 3D scanner before surgery, the wound model was printed. The ALT flap was precisely designed and harvested for covering the wound according to the body surface projection of the perforator vessel in the anterolateral femoral region located by color Doppler ultrasound before surgery. The survival of the flap, the healing of the donor and recipient sites and the occurrence of complications were observed and followed up after the operation. The effect of wound repair was evaluated by the comprehensive efficacy evaluation scale of the skin flap. The total score was 100 points, which was divided into excellent (90-100 points), good (75-89 points), fair (60-74 points) and poor (< 60 points).Results:A total of 34 patients were enrolled, including 26 males and 8 females, aged 18-75 years, with an average age of 45.5 years. Injury sites: wrist in 17 cases, foot in 10 cases, ankle in 7 cases. The operation time was 2.0-4.5 h (mean 3.3 h), and all donor sites were sutured directly. Vascular crisis occurred in 2 cases after skin flap transplantation. After surgical exploration, the transplanted skin flap survived, and the other skin flaps survived successfully. All 34 patients were followed up for 6 to 10 months, with an average of 8 months. All the donor sites of the skin flap healed primarily, and the wound healing time of the recipient site was 10-44 days, with an average of 20 days. At the last follow-up, the skin flap was good in color and texture, and the sensation returned to S1 and S2 grades. There were scars left in the donor site, no cicatricial contracture, pain and other discomfort, and no other serious complications. The results of flap evaluation were 80-91 points, with an average of 86 points. Among them, 25 cases were excellent, 6 cases were good, 3 cases were fair, and the excellent and good rate was 91%(31/34).Conclusion:The application of 3D printing technology assisted the design of ALT perforator flap to repair irregular wounds of limbs can significantly reduce the intraoperative design time of the flap, which is in line with the concept of precise design and incision of the flap, and has good clinical effect, and can effectively reduce the trauma and complications of the donor site.