BACKGROUND:Intracranial and extracranial arterial stent implantation is the main therapy for cerebrovascular diseases, especialy for some patients who cannot tolerate surgical operation, but the postoperative rehabilitation and biocompatibility problems restrict the further development of the technology. OBJECTIVE:To explore the rehabilitation efficacy and biocompatibility of acupuncture after degradable cerebrovascular stent implantation. METHODS: A total of 70 patients with cerebral arterial stenosis aged 43-79 years were enroled, including 41 males and 29 females, who were al treated with drug-eluting stent implantation, carotid artery stent implantation in 31 cases, vertebral artery stent implantation in 21 cases, subclavian stent implantation in 5 cases, and middle cerebral artery stent implantation in 13 cases. After stent implantation, al the patients were randomly divided into two groups: control group with routine rehabilitation therapy and acupuncture group with routine rehabilitation therapy+electroacupuncture. After 3 months of treamtnet, neurologic impairment scores, Fugl-Meyer score for motor function, Barthel index, degree of stent stenosis, thromboxane A2, prostacyclin, thromboxane A2/ prostacyclin levels were detected. RESULTS AND CONCLUSION:At 3 months after treatment, the neurological impairment scores were significantly lower in the acupuncture group than the control group (P < 0.05), but the Fugl-Meyer score for motor function andBarthel index were higher in the control group (P < 0.05). After treatment, the thromboxane A2 and thromboxane A2/prostacyclin levels were significantly decreased in the two groups (P < 0.05), but the prostacyclin levels were increased than those before treatment (P < 0.05). In addition, there were no differences in the thromboxane A2, prostacyclin, thromboxane A2/prostacyclin levels between the two groups. Compared with the control group, the rate of restenosis was significantly lower in the acupuncture group (P < 0.05), and there were no significant difference in the reference vessel diameter, blood vessel stent diameter, decreased vessel diameter index, re-intervention rate between the two groups (P > 0.05). Taken together, acupuncture can promote the rehabilitation efficacy folowing degradable cerebrovascular stent implantation, reduce the incidence of restenosis, and show good biocompatibility.

Objective To observe the effects of multidisciplinary therapy on central pain of patients with spinal cord injury.Methods 32 cases of spinal cord injury with central pain were treated with accupuncture, massage and drugs, and the effects were assessed by McGill Pain Questionnaire (MPQ), Visual Analogous Score (VAS) and Barthel Index (BI).Results The scores of pain of all patients significantly decreased and the scores of BI highly increased after treatment (P<0.01).Conclusion Multidisciplinary therapy is effective on central pain in patients with spinal cord injury.

Objective To discuss the clinical value of transposition of the pedicled anterolateral femoral periosteal flap. Methods The blood supply of anterolateral femoral periosteum were dissected on 38 adult cadaveric lower limber specimens injected with red dye. The origins, distributions and anastomosis of periosteal breanches were observed and measured. Based on these anatomic investigations, the transposition of pedicled anterolateral femoral periosteal flap was designed to repair the bone nonunion and lesion of femur. Results Twenty-two cases were treated in the satisfactory results, and followed-up from 1 to 5 years. The size of the periosteal flap ranged from 8cm?4cm to 10cm?5cm. Conclusions The periosteal flap could be operated so conveniently and safely as to be spread easily, treatment of lesion and incision of periosteal flap can be finished in the same operative approach. The periosteal flap have been proved to be powerfully clinical value.

Objective To assess the effect of anti- Helicobacter pylori (Hp) treatment on patients with chronic idiopathic thrombocytopenic purpura (cITP). Methods Fifty-nine patients with cITP and positive-Hp were divided into two groups by random digits table:Hp eradication group (30 cases,given a standard anti-Hp treatment) and placebo controlled group (29 cases,received a placebo). The platelet response of two groups was compared after three months' follow-up. Result The platelet response in Hp eradication group (63.3%, 19/30) was significantly higher than that in placebo controlled group (27.6%,8/29 )(χ2 = 7.59, P ＜ 0.05 ), and the increasing level of platelet count in Hp eradication group [ (33.5 ± 21.6)× 109/L] was higher than that in placebo controlled group [(12.6 ± 19.5) × 109/L] (t = 5.52,P ＜0.05).Conclusion Hp eradication treatment can promote the platelet recovery in mild and moderate cITP patients with positive-Hp.

OBJECTIVE To summarize the use of intraoperative neuromonitoring system for monitoring and protection of recurrent laryngeal nerve during thyroid surgery. METHODS There were 21 cases in this study, included 5 cases with thyroid cancer, 9 cases with thyroid benign tumor and 7cases with hyperthyroidism. Intraoperative neuromonitoring system includes the host monitor, stimulus detection pin of recurrent laryngeal nerve, special EMG endotracheal intubation tube which contacts vocal cord, grounding conductive circuit electrode, and anti-jamming probe. Operation method: a "three-step method" was adopted. First we revealed the cervical vagus nerve trunk and tested our instruments, and then dissected and protected the recurrent laryngeal nerve, followed by removal of thyroid tissue. RESULTS In all 21 patients, operative side recurrent laryngeal nerve were exposed from lower thyroid blood vessels to the larynx. All patients were phonated as well as before operation, and without drinking cough. CONCLUSION The intraoperative neuromonitoring system can avoid damage of the recurrent laryngeal nerves when we exposed the recurrent laryngeal nerve before resection of the thyroid tissue and tumor.

Objective To investigate the value of creatine kinase and computed tomography(CT)angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism(SMAE).Methods The retrospective cross-sectional study was adopted.The clinical data of 26 patients with SMAE who were admitted to the first Affiliated Hospital of Wenzhou Medical University between January 2008 and October 2015 were collected.The patients received serologic examination and CT angiography firstly,and then medicinal conservative method and surgical method were respectively conducted according to the results of above examinations.Observation indices:(1)clinical features,(2)serum indicators results,(3)CT angiography results:①location(main stem and non-main stem)of SMAE and development of distal branches of superior mesenteric artery(SMA),②indirect signs,such as bowel wall thickening,bowel dilatation combined with effusion and air accumulation and pneumatosis intestinalis,(4)therapy and prognosis.Measurement data with normal distribution were presented as-x±s,comparisons among groups were analyzed by one-way ANOVA.Measurement data with skewed distribution were presented as M(range)and analyzed by the Kruskal-Wallis rank sum test,and pairwise comparison was done using the Nemenyi test.Results(1)Clinical features:of 26 patients with SMAE,6 patients had intestinal ischemia,8 patients had partial intestinal necrosis and 12 patients had long segmental intestinal necrosis(postoperative short bowel syndrome in 5 patients and total small intestinal necrosis and partial colonic necrosis in 7 patients).Duration of symptoms before diagnosis was(1.7±0.8)days in 6 patients with intestinal ischemia and(2.1±1.1)days in 8 patients with partial intestinal necrosis and(1.5±0.7)days in 12 patients with long segmental intestinal necrosis,with no statistically significant difference(F=1.27,P＞0.05).(2)Serum indicators results:levels of serum creatine kinase in patients with intestinal ischemia,partial intestinal necrosis and long segmental intestinal necrosis were 68 U/L(range,50-86 U/L),98 U/L(range,54-244 U/L)and 300 U/L(range,40-873 U/L),respectively,with a statistically significant difference among patients(H=7.32,P＜0.05)and between patients with intestinal ischemia and with long segmental intestinal necrosis(H=7.21,P＜0.05),and with no statistically significant difference between patients with partial intestinal necrosis and with intestinal ischemia or long segmental intestinal necrosis(H=1.53,2.07,P＞0.05).(3)CT angiography results:①developments of SMAE(main stem and non-main stem)and distal branches of SMA:main stem embolism of SMA in 13 patients demonstrated hypodense shadow,with non-contrast of distal branches of artery,including 1 with intestinal ischemia,1 with partial intestinal necrosis and 11 with long segmental intestinal necrosis.Main stem embolism of SMA in 8 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 3 with intestinal ischemia,4 with partial intestinal necrosis and 1 with long segmental intestinal necrosis.Main stem embolism of SMA in 2 patients demonstrated hypodense shadow,with non-contrast of distal branches of SMA,showing partial intestinal necrosis.Non-main stem embolism of SMA in 3 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 2 with intestinal ischemia and 1 with partial intestinal necrosis.②Indirect signs:5 patients had bowel wall thickening,including 3 with intestinal ischemia and 2 with long segmental intestinal necrosis.Seventeen patients had bowel dilatation combined with effusion and air accumulation,with gas fluid level in local intestinal canal,including 2 with intestinal ischemia,5 with partial intestinal necrosis and 10 with long segmental intestinal necrosis.Two patients had pneumatosis intestinalis,with bubble shadow of bowel wall,showing long segmental intestinal necrosis.(4)Therapy and prognosis:of 6 patients with intestinal ischemia,1 underwent embolectomy of SMA and 5 underwent low-molecular-weight heparin anticoagulation and vasodilator alprostadil therapy.Eight patients with partial intestinal necrosis received resection of necrotic intestine.Of 12 patients with long segmental intestinal necrosis,5 with postoperative short bowel syndrome received resection of necrotic intestine combined with postoperative parenteral hyperalimentation.The above-mentioned patients were improved and discharged from hospital after symptomatic treatment and surgery.Twelve patients with long segmental intestinal necrosis,7 with total small bowel necrosis and partial colonic necrosis underwent only exploratory laparotomy and then were dead in a short time.Conclusion Elevated creatine kinase and main stem embolism of SMA combined with non-contrast of distal branches using CT angiography maybe predict poor short-term prognosis of patients with SMAE.

ObjectiveTo discuss the clinical efficacy of distal medial arm perforator flaps.MethodsAccording to the basic anatomy of distal medial arm perforator flaps,the distal medial arm perforator flaps were designed for repairing skin defects around elbow joints and at upper part of forearms in 15 cases.ResultsAll flaps were survived and first intention of wounds was obtained.At 3-36 months of follow-up,flap shape and elbow joint function revealed satisfactory recovery.Conclusions With the constant anatomical position,good blood supply,safe surgical approaches and cryptic donor site,the distal medial arm perforator flap is an alternative to repair the skin defects around elbow joints and in proximal forearms.

Objective To discuss clinical application of descending genicular artery perforator flap.Methods According to the anatomic features of direction,branches and anastomosis of the descending genicular artery,the descending genicular genicular artery perforator flap at medial superior aspect of knee joint was designed to reconstruct the soft tissue defects at the anterior medial 1/3 of the calf and the anterior medial part and popliteal fossa of the knee,with the axis based on the anterior border of the Sartorius and with the pivot point on the site where the cutaneous branches from the superior medial genicular artery pierced out within the triangle concave surface bounded by the vastus medialis,the tendon of adductor magnus and the condylus medialis.Results All flaps survived well in five patients,with primary healing.After a follow-up of 1-12 months,all flaps turned out to be with good texture,near-normal color and good appearance.Conclusion With a constant anatomic location,excellent blood supply and easy surgical procedure,the descending genicular artery perforator flap is one of feasible ways for repair of soft tissue defects around the knee.

Objective To explore the clinical application of perforating branch flap of medial vastus muscle. Methods Perforating branch flap (muscle branch) of medial vastus muscle was designed by using the surface projection of the medial vastus muscle artery as flap anxial line and the given point of direct cutaneous artery as flap center to repair skin and soft tissue defects of the knee in seven patients.Results All flaps survived well with primary healing in all patients, with one stage healing. After a follow-up for 1-18 months, all flaps turned out to be with good texture and satisfactory appearance and function of the flaps. Conclusion The surgery of perforating branch flap of medial vastus muscle is simple,safe and easy handling and provides a new feasible surgical procedure to repair skin and soft tissue defects of medial femur and around the knee.

In this paper,adverse drug reaction(ADRs)of two groups using ionic contrast media(ICM)and nonionic contrast media(NICM)respectively for conventional an- giography(CA),DSA and contrast enhanced CT(CTE)were analysed and compared with the recent literature. The results of this study indicated that(1)using ICM for CA,DSA and CTE,the in- cidence of ADRs is higher than that of NICM because of its high osmolarity,the effect of electric charge and chemotoxicity;however,even in the at-risk patients the incidence of ADRs; can be significantly decreased by using NICM.(2)the incidence of ADRs in patients with rapidly intraarterial injection is higher than that of intravenous injection;(3)the patients with ADRs to ICM previously could be reexamined by using NICM without inducing the ADRs (4)using lower concentration or/and volume of NICM than that of ICM may obtain superior images than the equivalent ICM because of the little influence of NICM on the plasma volume and the concentration of intravascular contrast midia;and(5)though NICM is surely a safe and ideal contrast midia,it still must be careful to use in at-risk patients. Because of its high cost limiting its universal use,a selective use in at-risk patients for the intavenous examinations is proposed by us.Excluding the usual high risk factors describ- ed in literature,we suggested that if the patients with the following factors,NICM should be the preferred choice for the angiography and CTE:(1)the post-operative patients of biain disease;(2)the patients with coma or shock;(3)the patients with peripheral aterial of ve- nous thrombosis and(4)the patients for interventional procedures of cardioascutlar system (CVIR). In addition to,the authors pointed out that some new problems concerning with the con- trast media(CM)must be noticed in the procedures of CVIR:the overdose of CM,he ad- verse effects resulted from the mixing of CM with other pharmaceutical products injected and the evaporated hyperc oncentatian decomposition,or carbonization of the CM resulted from the interaction within high energy equipment or under high temperature.