Surgery and endovascular techniques are the most important methods in treating lower limb atherosclerosis occlusion.Different strategies should be adopted according to the features of lesion in lower limb.This article reviews the latest clinical outcomes in treating lower limb atheroselerosis occlusion with surgery and endovascular techniques.

Objective The purpose of this study is to determine whether the TransAtlantic InterSociety Consensus (TASC) criteria (Ⅱ-2007 versions), the Society of Vascular Surgery (SVS) runoff score or risk factors for peripheral arterial disease were correlated with postoperative outcome of superficial femoral artery occlusive disease. Methods From January 2006 to September 2009, patients who suffered from lower extremity atherosclerosis occlusion disease and underwent endovascular or surgical therapy in superficial femoral artery segment were reviewed retrospectively at Beijing Tongren Hospital. Femoralpopliteal artery lesions were graded according to the TASC Ⅱ criteria. Runoff scores were determined in infrapopliteal artery segment lesions. All patients were followed up. Kaplan-Meier method was applied to calculate primary patency rate, and COX regression analysis was used to determine if TASC Ⅱ classification,runoff score, or factors for peripheral arterial disease affected primary patency rate. Results 142 patients (197 limbs) were followed up after treatment at 1 month, 3 months, 6 months, and every 6 months thereafter. Median follow-up time was 13 months. By Cox regression analysis, TASC Ⅱ classification(RR =1.471,P = 0. 012 ), runoff score ( RR = 1.190, P = 0. 004 ), and type 2 diabetic mellitus ( RR = 2. 320, P =0.019) significantly affected primary patency. Conclusions Postoperative poor patency rates are associated with higher degree of the TASC Ⅱ lesions, poor initial runoff score, and type 2 diabetic mellitus in patients of superfical femoral artery occlusive disease.

Objective:To discuss the appropriate thyroid operation for the treatment of bilateral multinodular goiter.Methods: 328 bilateral multinodular goiter patients undergoing surgery in the department of general surgery of Capital Medical University Beijing Tongren Hospital from June 2012 to June 2016. were retrospectively analyzed. Of these patients, 85 underwent hemithyroidectomy combined with contralateral nodule resection or subtotal resection and 243 underwent bilateral subtotal thyroidectomy. The rate of postoperative complications and recurrence between hemithyroidectomy combined with contralateral nodule resection or subtotal resection and bilateral subtotal thyroidectomy were compared.Results: The follow-up time was 1 month to 48 months after operations. In hemithyroidectomy combined with contralateral nodule resection or subtotal resection group 1 patient developed recurrent laryngeal nerve palsy, 2 patients had transient hypoparathyroidism and 1 patient had hematoma in the operative cavity. In bilateral subtotal thyroidectomy group, 2 patients developed recurrent laryngeal nerve palsy and 2 patients had subcutaneous hematoma. The rate of recurrent disease was 2.35%(2 patients) in hemithyroidectomy combined with contralateral nodule resection or subtotal resection group and 7%(17 patients) in bilateral subtotal thyroidectomy group. There was no patient in both groups needed reoperation.Conclusions:Hemithyroidectomy combined with contralateral nodule resection or subtotal resection had similar complication rate compared with bilateral subtotal thyroidectomy, but it had a significantly lower risk of recurrence than bilateral subtotal thyroidectomy, Furthermore, the rest one lobe could be resected for many times which would not cause severe complications. Hemithyroidectomy combined with contralateral nodule resection or subtotal resection is worthed to be recommended.

Objective:To evaluate the clinical outcomes of implant-retained overdentures.Methods:57 patients treated by implant-retained overdentures were included.Parameters for peri-implant tissue conditions (e.g.peri-implant probing depth,plaque index,bleeding on probing,mucosal hyperplasia,peri-implant marginal bone loss) and prosthetic complications were examined and recorded.The precentage of satisfaction of the patients was assessed using the visual analog scale (VAS).Results:After an average follow-up of (48±11.3) months,the survival rate of the implants was 98.1%,the marginal bone loss was (1.38±0.74) mm.There was no statistically difference among the different attachment groups(bar,magnet and ball) regarding the peri-implant marginal bone loss or bleeding on probing(P>0.05).The peri-implant probing depth and plaque index in patients with magnet and ball attachments were lower than those in patients with bar attachments(P<0.05).The major complications were the upper abutment fracture,prostheses fracture and screw loosening.Most patients were satisfied with their prostheses and there was no statistically significant difference between the attachment types(P>0.05),except that magnet and ball attachments were much easier to clean compared with bar attachments(P<0.05).Conclusion:Implant-retained overdenture is a successful and satisfactory treatment option for patients with edentulous jaw.The patients should been given regular clinical examinations to keep peri-implant tissue health and reduce the complications,especially those with bar attachments.

Objective:To evaluate the effect of epigallocatechin-3-gallate (EGCG) and epigallocatechin-3-O-(3-O-methyl)-gallate (EGCG-3Me) on the anti-bacterial effect and the stability of intraradicular dentin-adhesive interface.Methods:EGCG and EGCG3Me with the concentration of 400 μg/ml were incorporated into Single Bond 2 (SB2) respectively to obtain 2 modified adhesives E-SB2 and E3-SB2.Confocal laser scanning microscopy(CLSM) and ultraviolet spectrophotometry were used to evaluate the anti-bacterial effect of the modified adhesives.Micro-Raman spectrum was used to test the degree of conversion (DC) of the adhesives.Push-out bond strength test was conducted to examine the immediate bond strength and the bond strength after themocycling.Results:E-SB2 and E3-SB2 both showed inhibiting effect on the proliferation of E.faecalis,while E3-SB2 performed stronger inhibiting effect.DC and the immediate push-out bond strength of SB2 were not decreased with the incorporation of EGCG or EGCG-3Me(P ＞ 0.05).E-SB2 and E3-SB2 showed significantly higher push-out bond strengths than that of SB2 (P ＜ 0.05) after themocycling.Conclusion:EGCG and EGCG-3Me modified adhesives have anti-bacterial effect and can enhance the stability of bonding between intraradicular dentin and adhesive,EGCG-3Me may have stronger anti-bacterial effect.

Objective To evaluate perioperative management of MEN 2A patients with medullary thyroid carcinoma after bilateral pheochromocytomas removal.Methods Seven cases of MEN 2A from three families were diagnosed as medullary thyroid carcinoma and adrenal pheochromocytoma by biochemical tests and imaging examinations.All had histories of operations due to medullary thyroid carcinoma and contralateral adrenal pheochromocytoma.Direct sequencing of entire exons was performed in all patients.Firstly they underwent laparoscopic surgery for pheochromocytoma, then after stetoids replacement they underwent total thyroidectomy and bilateral cervical lymph nodes dissection.Results One family had the combined C634Y/D707E mutations of RET mutation.The other two families had C634Y mutation and C634R mutation separately.All patients had histories of adrenal insufficiency because of bilateral laparoscopic adrenal pheochromocytomas removal.They suffered from medullary thyroid carcinoma at the same time and needed to do total thyroidectomy and bilateral cervical lymph node dissection.Under perioperative steroids treatment and closely monitoring, they successfully went through the surgery.No adrenal crisis or related complications happened.Conclusions MEN 2A patients in this study had RET mutations and D707E mutation is a newly discovered mutation.Patients of adrenal insufficiency face the risk of adrenal crisis after a major operation.Correct perioperative monitoring and management can avoid complications.

Objective To investigate the correlation between the proportion of peripheral blood follicular T helper cells(Tfh cells)and intracellular interleukin-21(IL-21)content with blue light retinal injury.Methods Brown Norway(BN)rats were randomly divided into 4 groups and were exposed to blue light for 3 hours a day to establish retinal light damage model.According to the duration of illumination,the rats was divided into 0 days(control group),3 days(3 d group),7 days(7 d group)and 14 days(14 d group).The proportion of Tfh cells and content of IL-21 in Tfh cells in peripheral blood of each group was detected by flow cytometry and ELISA sepa-rately after illumination.Electroretinogram(ERG)was used to evaluate retinal function.The changes of fundus in rats were observed by fundus photography.The thickness of outer nuclear layer of retina was analyzed by HE staining.Results After retinal blue light injury,with the extension of illumination time,the proportion of Tfh cells in peripheral blood and intracellular IL-21 content both increased(P<0.05).ERG showed that retinal function decreased after light damage and aggravated with the extension of illumination time,the latency and ampli-tudes of A-wave and B-wave increased and decreased respectively(P<0.05).The retinal fundus of rats showed depigmentation in 3 d,and the retinal vessels became thinner and exudate with the extension of illumination time.HE staining showed that the outer nuclear layer of retina(ONL)became thinner(P<0.05).Correlation analy-sis indicated that the proportion of Tfh cells in peripheral blood and the intracellular IL-21 content could jointly reflect the degree of injury(P<0.000 1),and the proportion of Tfh cells in peripheral blood was negatively corre-lated with ONL thickness and the amplitude of a and b waves,positively correlated with the peak time of a and b waves,(P<0.0001).Conclusion The proportion of Tfh cells in peripheral blood and the intracellular IL-21 content were increased after blue light damage to retina,and were significantly increased with the extension of light time with a certain correlation.