Objective To evaluate medium-term results in critical limb ischemia (CLI) patients undergoing endovascularly revascularization based on concepts of angiosomes.Methods Clinical data were reviewed on 612 CLI patients who had isolated below-the-knee (BTK)lesions and were treated by endovascular technology from June 2006 to May 2012.Following the angiosome model of perfusion,286 patients (357 limbs)were treated by directly revascularizing the feeding artery.326 patients (455 limbs)were treated by revascularizing non-feeding artery to improve perfusion to ulcer indirectly.Primary endpoints included ulce-healing rate as of 3 months,amputation-free survival( AFS),freedom from major amputation (FFMA) and recurrence rate of CLI.Results During follow-up(mean,24 ± 18 months),ulce-healing rate during 3 months of direct treatment group was obviously higher than that of indirect group (82.4％ vs.66.4％,X2 =26.16,P ＜0.05).The fourth year AFS was 48％ ±5％ vs.37％ ±6％,t =3.44,P ＜0.05,and the fourth year FFMA was 73％ ±4％ vs.58％ ±3％,t =4.61,P ＜0.05.In recurrence rate of CLI,there wasn't significant difference between direct group and indirect group(42％ ±5％ vs.45％ ±6％,t =- 0.64,P ＞ 0.05 ).Conclusions Following the angiosome model of perfusion,direct revascularizing the feeding artery of CLI patients can obviously improve ulcer-healing rate during 3 months,medium-term AFS and FFMA.

Animals ; Corticosterone ; pharmacology ; Hippocampus ; drug effects ; physiology ; In Vitro Techniques ; Long-Term Potentiation ; drug effects ; physiology ; Male ; Rats ; Rats, Wistar

Objective The purpose is to report the clinical result of repairing defection in hand surgery by using both the vascular tissue flap and external fixators. Methods The vascular tissue flap including bone flap and joint flap to repair the complex defection (soft tissue, bones and joints) in hand and forearm were applied in 9 cases. At the same time in surgery,injured bones and joints were fixed by A-O and mini external fixators in order to keep the non-injured joint actively and accelerate the cure of bones. Result All 9 cases were applied successfully with the all transplanted tissue survived. Pulling about the external fixator about 10- 12 weeks after surgery showed bone union and the f unction of hand recovered satisfactorily' Conclusion it is a reliable method for repairing the complex tissue defection in hand and forearm by combining external fixation of traumarology and microsugery technique. And it is also characterized by a minor injury in transplanted bones,early exercise for joints,flap circulation observed conveniently,and nursing easily.

Objective To investigate the effect of end to side arterial anastomosis in the transplantations of free tissue flap Methods The end to side arterial anastomosis were used in 47 free flaps of 46 cases in this series The arterial stomas were respectively prepared into the cross section (13/47),the inclined plane angled at 45 degree (26/47) and fish mouth shaped plane (8/47) The interrupture anastomosis and continuous anastomosis following two fixed point sutures,and the continuous anastomosis following four fixed point sutures were respectively used in 28,10 and 9 arterial anastomotic stomas Results There were not postoperative embolism in all end to side anastomotic stomas in this series During the operations the embolisms of the cutaneous branch caused by a detached mini thrombus from the anastomotic stomas were occurred in 2 cases,and the arterial crisis were eliminated by reversely milking out the detached mini thrombus All flaps survived except one due to venous embolism Conclusions It is a effective and safe method that the end to side arterial anastomosis are used in the transplantation of free flap

Objective To analyze the clinicopathological features of bilateral primary breast cancer (BPBC) by molecular subtypes.Methods Clinical data of 145 BPBC patients were reviewed focusing on the clinicopathological features of different molecular subtype and the concordance of molecular subtype between first and second primary breast cancers.Results Of the first primary breast cancers ( FPBC),91 cases (62.8％ ) were Luminal A subtype,Luminal B subtype in 13 cases (9.0％ ),Human epidermal growth factor receptor 2 (HER-2) subtype in 14 cases (9.7％ ),triple negative breast cancer (TNBC) in 27 cases ( 18.6％ ).Of the second primary breast cancers ( SPBC ),Luminal A subtype was found in 93 (64.1％ ) cases,Luminal B subtype in 10(6.9％ ) cases,HER-2 subtype in 14(9.7％ ) cases and TNBC in 28( 19.3％ ) cases.Most TNBC patients were young ( age ≤ 50 ) with high frequency of grade Ⅲ in FPBC.Molecular subtypes do not vary with tumor size,clinical stage,lymph node status and pathological types ( P ＞ 0.05 ).Most FPBC of Luminal A and TNBC were concordant same subtypes in SPBC ( K ＞ 0.04 ),while Luminal B and HER-2 subtypes often had discordant phenotypes in SPBC ( K ＜ 0.04).BPBC were more likely to have concordant subtypes if the two tumors developed in short time interval.Conclusions The distribution and clinical leatures of each subtype in BPBC is similar to unilateral breast cancer.Patients whose FPBC are Luminal A or TNBC often have concordant phenotypes for their SPBC,a short time interval between two cancers also predicts concordance.

In this paper a brief history of the development of PACS in China is reviewed, the current status of PACS is presented, and its development in the future is discussed.
China ; Humans ; Image Processing, Computer-Assisted ; Medical Records Systems, Computerized ; Radiology Information Systems ; organization & administration ; trends ; Technology, Radiologic

Objective To establish a scientific and normative process for using physical restraint,and to increase the safety and efficiency of physical restraint.Methods On the basis of the previous studies,combined with the literature and clinical,we drafted a process framework of using physical restraint and then conducted consultation from 11 experts by using the Delphi technique.Results After 2 rounds of consulting,an evaluation form,consisted of 4 first-dimensions and 11 second-dimensions,and a process,consisted of 4 first-dimensions and 26 second-dimensions,were established.Kendall's W were 0.37 and 0.38 respectively,and expert authority coefficient was 0.84.Conclusions The results from the study is valid,feasible and reliable,however it still need to be further perfected.

Objective To evaluate a 5HT receptor antagonist sarpogrelate hydrochloride after percutaneous transluminal angioplasty (PTA) in infrapopliteal arteriosclerotic occlusive disease.Methods From June 2010 to June 2012,105 (116 limbs) patients of infrapopliteal arteriosclerosis obliterans treated by PTA were divided randomly into two groups:treatment group (58 cases,64 limbs)and control group(47 cases,52 limbs).All patients were treated with aspirin and clopidogrel for 3 months.Patients in treatment group were treated with additional sarpogrelate hydrochloride.Intermittent claudication,rest pain,amputation rate,ABI,vascular prosthesis obstructing degree were assessed.Results 95 patients were followed up for 6 months,the intermittent claudication rate in treatment group and control group were 3.8％ and 16.3％ (P ＜ 0.05); while there was not different on 1,3 months,in the intermittent claudication rate and 1,3,6 months,in rest pain rate,amputation rate,target artery patency rate and ABI between the two groups (P ＞ 0.05).There was one bleeding event in treatment group (1.7％).Conclusions 5HT receptor antagonist (sarpogrelate hydrochloride) significantly improves intermittent claudication after PTA in infrapopliteal arteriosclerotic occlusive disease,and its use is safe with aspirin and clopidogrel.

Aminoglycoside antibiotics, due to their strong antibacterial effects and broad antimicrobial spectra, have been very commonly used in clinical practice in the past half century. However, aminoglycoside antibiotics manifest severe ototoxicity and nephrotoxicity, and are one of top factors in hearing loss. In this study, three members of the aminoglycoside antibiotics family, gentamycin, neomycin and streptomycin, were chosen as the representatives to be investigated for their toxicity to the embryonic development and the larva hair cells in zebrafish, and also to their target genes associated with hearing-related genes. The results showed that: (1) the lethal effect of all three drugs demonstrated a significant dependence on concentration, and the severity order of the lethal effect was streptomycin > neomycin > gentamycin; (2) all the three drugs caused the larva trunk bending in resting state at 5 dpf (day past fertilization), probably due to their ototoxicity in the physical imbalance and postural abnormalities; (3) impairment and reducing of the hair cells were observed in all three cases of drug treatment; (4) four genes, eya1, val, otx2 and dlx6a, which play an important role in the development of hearing organs, showed differential and significant decrease of gene expression in a drug concentration-dependent manner. This study for the first time reports the relevance between the expression of hearing genes and the three ototoxic antibiotics and also proved the feasibility of establishing a simple, accurate, intuitive and fast model with zebrafish for the detection of drug ototoxicity.