ObjectiveTo compare two treatment methods for acute iliofemoral vein thrombosis:c atheter-directed pharmacomechanical thrombolysis (CDPT,47 cases) and intervention combined surgicaltherapy( IST,14 cases).MethodsThis study includes 61 patients of acute iliofemoral vein thrombosis treated by CDPT or IST.All discharged cases were followed up by telephone for a period of 14 -37 months.ResultsAmong the 61 patients (64 extremities),47 (forty-seven extremities) treated by CDPT,and 14 cases (seventeen extremities) treated by IST.The IST group included three patients of bilateral iliofemoral vein thrombosis,five patients on postoperative status within one month,and three patients in which the iliofemoral vein was not accessible.When discharged from hospital,the effective rate of edema relief is 93.6％ in CDPT group while that is 94.1％ in IST group; Melena occurred in one patient of CDPT group and incision hematoma occurred in one patient of IST group.According to the results of 14 -37 months follow-up,the effective rate of edema relief is 85.0％ in CDPT group while that is 85.7％ in IST group ( x2 =0.004 and the P =0.948).Calf pigmentation occurred in only one patient of CDPT group.The patency rate of vein by BUS examination is 52.6％ in CDPT group while that is 84.6％ in IST group x2 =4.157,P =0.041 ).ConclusionsComparing with CDPT group,IST group has the similar effective rate of edema relief,but has higher patency rate of iliofemoral vein.In case of bilateral acute iliofemoral vein thrombosis,in patients in whom thrombolysis is contraindicated,or when the iliofemoral vein is not accessible,IST is the treatment of choice for acute iliofemoral vein thrombosis.

Objective To study the clinical characteristics and treatment strategy for isolated dissection of the superior mesenteric artery (SMA).Methods Clinical data of 19 consecutive patients with IDSMA were retrospectively analyzed.There were 15 men and 4 women.The mean age was 56 ± 12 (41-84) years old.Fifteen patients presented with abdominal pain and 4 patients had no symptom.The dissections were diagnosed by contrast-enhanced computed tomography in 18 patients and ultrasonography in 1 patient.Results The dissections were located at the anterior wall of the curvature part of the SMA in all 19 patients.Asymptomatic patients underwent conservative management.One asymptomatic patient with aneurysmal dilation was managed by stent and the 15 symptomatic patients underwent endovascular management.During the mean 7-46 (21 ± 10) months follow-up period,all patients were asymptomatic with patency of SMA.Conclusions The dissection was located at the anterior wall of the curvature part of the SMA.Conservative management can be applied to the asymptomatic patients.For symptomatic patients without intestinal necrosis or artery rupture,stent implantation is recommended,and the curvature of SMA should be covered completely.Endovascular spasmolysis is helpful in relieving pain.

Objective To retrospectively analyze the one-year outcomes of modified single-armed suture technique for microsurgical vasoepididymostomy in men with epididymal obstructive azoospermia (EOA).Methods From February,2012 to November,2013,microsurgical longitudinal intussusception vasoepididymostomies using a modified single-armed suture technique in 51 men with EOA was performed.The followed-up period was designed as 1 year.The correlations between the sperm motility in epididymal fluid,unilateral or bilateral procedure,anastomotic site,and the female partner age and the patency or pregnancy rate were analyzed.Results Followups were carried out for 39 (76.5％) men.The patency was noted in 24 (61.5％) men and pregnancy was reported in 15 (38.5％) female partners,including 1 received in vitro fertilization using fresh ejaculated sperm.Motile sperms in epididymal fluid were observed intraoperatively in 14 (58.3％) patent men and 3 (20.0％) nonpatent men,respectively (P ＜ 0.05).In patent cohort,the mean ages of the pregnant and non-pregnant female partners were 26.5 and 32.7 years(P ＜ 0.05),respectively.Conclusion The modified single-armed suture technique showed favourable patency and pregnancy rates in this study.It's a practical alternative in the areas without the specialized double armed suture.

Objective]To explore the diagnostic value of magnetic resonance imaging(MRI)combined transrectal ultrasound (TRUS)to guide prostate cancer detection at different serum prostate-specific antigen(PSA)levels.[Methods]Totally 278 patients who underwent a systematic biopsy were collected in our hospital from November 2014 to June 2016. Preoperative tests of PSA , MRI,TRUS were performed in all the included patients. According to the PSA level of 4~10 ng/mL,10~20 ng/mL,over 20 ng/mL, 278 cases were divided into three group of A ,B ,C. Retrospective analysis was performed within the three groups of diagnostic accuracy.[Results]In Group A,the areas under ROC for MRI+TRUS and TRUS were 0.73 and 0.59,respectively(P = 0.02). In Group B ,the areas under ROC for MRI+TRUS and TRUS were 0.68 and 0.56 ,respectively (P < 0.001). In Group C ,the area under ROC for MRI+TRUS and TRUS were 0.74 and 0.63,respectively(P < 0.001). There is more significant statistical difference in Group B and C.[Conclusion]MRI combined TRUS has higher diagnostic value in cancer detection than TRUS before biopsy between different PSA levels ,which Indicates that MRI combined TRUS is an effective method for the improvement of prostate cancer detection.

Objective:To evaluate the effect of mechanical debulking in treating arteriosclerosis occlusive disease of lower extremity.Methods:The clinical data of 52 arteriosclerosis occlusive disease of lower extremity cases treated with Rotarex mechanical debulking system from June 2017 to June 2020 at Department of Intervention Vascular Surgery,Peking University Third Hospital were retrospectively analyzed. There were 37 males and 15 females,aged(69.4±10.1)years(range:47 to 89 years).Lesion length was (21.6±12.9)cm(range: 4 to 45 cm),occlusion length was (18.5±11.8)cm(range:4 to 45 cm).The lesion was located in iliac artery(IA) in 6 cases,femoral-popliteal artery(FPA) in 42 cases,and both IA and FPA in 4 cases. All the cases were treated with Rotarex mechanical debulking system. Residual stenosis more than 50% were treated with percutaneous transluminal angioplasty(PTA).Drug coated balloon was used in part of them,and stent was used only when it was necessary. The patient′s operation, complications, postoperative target vessel restenosis and reoperation were collected. The paired sample t test and rank sum test was used for data comparison and the postoperative target vessel patency rate was analyzed by Kaplan-Meier survival curve. Results:All the 52 cases obtained technical success. Percutaneous transluminal angioplasty was used in all cases,and drug coated balloon were used in 11 cases. Twenty-six stents were implanted in 24 cases (2 cases implanted 2 stents).Nine stents were implanted in IA and 15 in FPA. The length of stents was (11.3±3.3)cm(range:6 to 23 cm).There were 3 procedure related complications: one of them was acute occlusion in an iliac lesion,and thrombectomy was applied urgently,and the result was good. And the other two were distal embolism. The thrombus were took out with guiding catheter. The hospital stay was (4.8±1.9)days. The ankle brachial index increased from 0.34±0.16 to 0.81±0.16 after treatment ( t=-25.160, P<0.01).The Rutherford stages decreased from ( M(IQR)) 3(1) to 1(1)( Z=-6.825, P<0.01).The median followed up time was 19 months(range:6 to 42 months).Two cases stopped antiplatelet agents during follow-up and which result in acute thrombosis 2 weeks and 2 months later respectively. One of them was treated with percutaneous mechanical thrombectomy and the other one was not for gastrointestinal hemorrhage. Four cases died during follow-up,one case died of lung cancer,one died of abdominal infection,and the other 2 cases died of cardiovascular disease,and no amputation was observed. Target lesion restenosis(TLR) more than 50% occurred in 13 cases during the follow-up. All TLR were observed in FPA,and target lesion revascularization was taken in 3 of them. According to Kaplan-Meier survival curve analysis,half-year,1-year and 2-year cumulative patency rates of target vessels in this group was 94.2%,87.4% and 51.4%, respectively. And half-year and 1-year cumulative patency rates just in FPA cases was 92.9% and 84.3%, respectively. Conclusions:Percutaneous mechanical debulking using Rotarex catheter combining PTA can reduce the use of stents in femoral-popliteal artery. It is safe and effective in treating with arteriosclerosis obliterans of lower extremity.

Objective:To evaluate the effect of mechanical debulking in treating arteriosclerosis occlusive disease of lower extremity.Methods:The clinical data of 52 arteriosclerosis occlusive disease of lower extremity cases treated with Rotarex mechanical debulking system from June 2017 to June 2020 at Department of Intervention Vascular Surgery,Peking University Third Hospital were retrospectively analyzed. There were 37 males and 15 females,aged(69.4±10.1)years(range:47 to 89 years).Lesion length was (21.6±12.9)cm(range: 4 to 45 cm),occlusion length was (18.5±11.8)cm(range:4 to 45 cm).The lesion was located in iliac artery(IA) in 6 cases,femoral-popliteal artery(FPA) in 42 cases,and both IA and FPA in 4 cases. All the cases were treated with Rotarex mechanical debulking system. Residual stenosis more than 50% were treated with percutaneous transluminal angioplasty(PTA).Drug coated balloon was used in part of them,and stent was used only when it was necessary. The patient′s operation, complications, postoperative target vessel restenosis and reoperation were collected. The paired sample t test and rank sum test was used for data comparison and the postoperative target vessel patency rate was analyzed by Kaplan-Meier survival curve. Results:All the 52 cases obtained technical success. Percutaneous transluminal angioplasty was used in all cases,and drug coated balloon were used in 11 cases. Twenty-six stents were implanted in 24 cases (2 cases implanted 2 stents).Nine stents were implanted in IA and 15 in FPA. The length of stents was (11.3±3.3)cm(range:6 to 23 cm).There were 3 procedure related complications: one of them was acute occlusion in an iliac lesion,and thrombectomy was applied urgently,and the result was good. And the other two were distal embolism. The thrombus were took out with guiding catheter. The hospital stay was (4.8±1.9)days. The ankle brachial index increased from 0.34±0.16 to 0.81±0.16 after treatment ( t=-25.160, P<0.01).The Rutherford stages decreased from ( M(IQR)) 3(1) to 1(1)( Z=-6.825, P<0.01).The median followed up time was 19 months(range:6 to 42 months).Two cases stopped antiplatelet agents during follow-up and which result in acute thrombosis 2 weeks and 2 months later respectively. One of them was treated with percutaneous mechanical thrombectomy and the other one was not for gastrointestinal hemorrhage. Four cases died during follow-up,one case died of lung cancer,one died of abdominal infection,and the other 2 cases died of cardiovascular disease,and no amputation was observed. Target lesion restenosis(TLR) more than 50% occurred in 13 cases during the follow-up. All TLR were observed in FPA,and target lesion revascularization was taken in 3 of them. According to Kaplan-Meier survival curve analysis,half-year,1-year and 2-year cumulative patency rates of target vessels in this group was 94.2%,87.4% and 51.4%, respectively. And half-year and 1-year cumulative patency rates just in FPA cases was 92.9% and 84.3%, respectively. Conclusions:Percutaneous mechanical debulking using Rotarex catheter combining PTA can reduce the use of stents in femoral-popliteal artery. It is safe and effective in treating with arteriosclerosis obliterans of lower extremity.

Objective To investigate effect of remote ischemic preconditioning(RIPC)com-bined with transcutaneous vagus nerve stimulation(tVNS)on reperfusion injury in ST-segment eleva-tion myocardial infarction(STEMI).Methods A total of 132 STEMI patients were selected,and were randomly divided into control group,tVNS group and combined group(RIPC combined with tVNS)before percutaneous coronary intervention(PCI).A total of 9 of the 132 patients were exclu-ded,including 42 in the control group,40 in the tVNS group,and 41 in the combination group.The area under the curve(AUC)of creatine kinase isoenzyme(CK-MB)within 72 h and the ventricular arrhythmia(VAs)within 24 h after reperfusion were compared among the three groups.The levels of interleukin-6(IL-6),high mobility group protein B1(HMGB1),tumor necrosis factor-α(TNF-α)and left ventricular ejection fraction(LVEF)of the three groups were compared at admission and 24 h after reperfusion.Results The AUC of CK-MB in the combination group was significantly lower than that in the control group within 72 h(P＜0.05).The total number of premature ventricular beats and the number of ventricular tachycardia in the tVNS group and combined group were significantly lower than those in the control group within 24 h after reperfusion(P＜0.05).The levels of IL-6,HMGB1 and TNF-α in the combination group were significantly lower than those in the control group 24 h after reperfusion(P＜0.05).LVEF in the combination group was significantly higher than that in the light group at 7 days after reperfusion(P＜0.05).Conclusion The tVNS significantly reducs the incidence of VAs after PCI in STEMI patients,but has little effect on the level of reperfusion inflam-matory markers,myocardial infarction size,and acute left ventricular systolic function.The tVNS com-bined with RICP can produce significant benefits in the above indexes.

Objective To observe the influence of functional ankle instability(FAI)on balance and lower limb explosive power. Methods A total of 26 male FAI participants,13 bilateral(bilateral group)and 13 left(left group),who regularly en-gaged in high-intensity exercise,were recruited at Harbin Sport University in May,2024.Meanwhile,13 unin-jured male participants who engaged in high-intensity exercise were recruited as control group.They were mea-sured the moving area of the left foot,right foot and body center of gravity standing on feet with the eyes opened and closed;as well as the sway angle,confidence ellipse diameter(maximum and minimum)to circle area ratio,sway ratio and confidence ellipse standing on single foot,with Gaitview plantar pressure analysis system.They were also tested with Y-balance test(YBT),and were measured flight time and center of gravity height during jumps single leg left/right drift,stiffness and counter movement jump using Opto-jump Optical Measurement of Motor Quality. Results There were significant differences among the groups in swing angle,confidence ellipse diameter(maximum and minimum)to circle area ratio,swing ratio and confidence ellipse as left-leg stance with eyes closed(F>3.300,P<0.05),which was the least in the control group(P<0.05).Swing angle,swing ratio and confidence ellipse were also different among the groups as right-leg stance with eyes closed(F>4.404,P<0.05),and they were less in the control group than in the bilateral group(P<0.05),and less in the left group than in the bilateral group(P<0.05),except swing angle.There was a significant difference in YBT results(F>3.649,P<0.05),which was the least in the bilateral group(P<0.05).There were significant differences in the flight time and center of gravity height during counter movement jump(F>7.458,P<0.01),which was the least in the bilateral group(P<0.05). Conclusion FAI may impair the static balance as single-leg stance with eyes closed,dynamic balance and lower limb ex-plosive power.

Objective To investigate effect of remote ischemic preconditioning(RIPC)com-bined with transcutaneous vagus nerve stimulation(tVNS)on reperfusion injury in ST-segment eleva-tion myocardial infarction(STEMI).Methods A total of 132 STEMI patients were selected,and were randomly divided into control group,tVNS group and combined group(RIPC combined with tVNS)before percutaneous coronary intervention(PCI).A total of 9 of the 132 patients were exclu-ded,including 42 in the control group,40 in the tVNS group,and 41 in the combination group.The area under the curve(AUC)of creatine kinase isoenzyme(CK-MB)within 72 h and the ventricular arrhythmia(VAs)within 24 h after reperfusion were compared among the three groups.The levels of interleukin-6(IL-6),high mobility group protein B1(HMGB1),tumor necrosis factor-α(TNF-α)and left ventricular ejection fraction(LVEF)of the three groups were compared at admission and 24 h after reperfusion.Results The AUC of CK-MB in the combination group was significantly lower than that in the control group within 72 h(P＜0.05).The total number of premature ventricular beats and the number of ventricular tachycardia in the tVNS group and combined group were significantly lower than those in the control group within 24 h after reperfusion(P＜0.05).The levels of IL-6,HMGB1 and TNF-α in the combination group were significantly lower than those in the control group 24 h after reperfusion(P＜0.05).LVEF in the combination group was significantly higher than that in the light group at 7 days after reperfusion(P＜0.05).Conclusion The tVNS significantly reducs the incidence of VAs after PCI in STEMI patients,but has little effect on the level of reperfusion inflam-matory markers,myocardial infarction size,and acute left ventricular systolic function.The tVNS com-bined with RICP can produce significant benefits in the above indexes.

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.