Objective To observe the efficacy of Venovo venous stent for treating post-thrombotic syndrome(PTS)after lower extremity deep venous thrombosis(DVT).Methods A total of 61 patients with PTS after lower extremioty DVT who underwent iliac vein stent implantation were retrospectively enrolled,including 33 cases underwent Venovo stent(Venovo stent group)and 28 cases underwent conventional stent implantation(conventional stent group).The technical success rates and perioperative complications,Villalta score and venous clinical severity score(VCSS)before and 6 and 12 months after treatment,as well as the primary stent patency were compared within and between groups.Results The technical success rate was 100%in both groups,and no significant difference of the incidence of perioperative complications was found between groups(P=0.187).There was no significant difference of Villalta score nor VCSS between groups before treatment(both P＞0.05),while significant decrease of Villalta score was noticed before and 6 or 12 months after treatment within both groups(all P＜0.05).No significant difference of Villalta score nor VCSS was found 6 months after treatment between groups(both P＞0.05),while significant difference of Villalta score and VCSS were observed in Venovo stent group compared with those in conventional stent group 12 months after treatment(both P＜0.05).No significant difference of primary stent patency rate was found between groups 6 and 12 months after treatment(both P＞0.05).Conclusion Venovo venous stent could be used to effectively treat PTS after lower extremity DVT.

Objective:To compare the effects of erector spinae plane block at T 2 (T 2-ESPB) and nerve root block at C 5 (C 5-NRB) in patients undergoing arthroscopic shoulder surgery with general anesthesia. Methods:This was a randomized, controlled, non-inferiority study. Sixty American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 45-75 yr, with body mass index ≤35 kg/m 2, scheduled for elective arthroscopic shoulder surgery at Jining No. 1 People′s Hospital from April 2023 to February 2024, were included and divided into 2 groups ( n=30 each) using a random number table method: C 5-NRB group (group C) and T 2-ESPB group (group T). In group C, C 5-NRB was carried out by injecting 0.5% ropivacaine 5 ml. In group T, T 2-ESPB was performed by injecting 0.25% ropivacaine 30 ml. The efficacy of nerve block was assessed using a prick test at 30 min after administration, and then total intravenous anesthesia was performed in both groups. The time to first rescue analgesia (the non-inferiority boundary Δ =2 h), requirement for rescue analgesia within 24 h after operation and intraoperative consumption of anesthetics were recorded. The motor function of the affected limb during shoulder abduction, elbow flexion and elbow extension was assessed and scored using the modified Bromage scale (MBS) at 30 min and 4 and 12 h after nerve block. The diaphragmatic excursion was measured and recorded using M-mode ultrasound before nerve block and at 30 min after nerve block to evaluate the occurrence of diaphragmatic paralysis. Complications such as local anesthetic toxicity, recurrent laryngeal nerve block and pneumothorax were also recorded. Results:The mean difference (95% confidence interval) for the time to first rescue analgesia between the two groups was 5.551 (1.875-9.148) h, with the upper limit exceeding the non-inferiority boundary. Compared with group T, the intraoperative consumption of remifentanil was significantly reduced, the time to first rescue analgesia was prolonged, the consumption of morphine for rescue analgesia was decreased, MBS scores during shoulder abduction, elbow flexion and elbow extension were decreased at 30 min after block, and MBS scores during shoulder abduction and elbow flexion were decreased at 4 and 12 h after block in group C ( P<0.05). There was no significant difference in the diaphragmatic excursion, incidence of diaphragm paralysis and incidence of complications before and after block in the two groups ( P>0.05). Conclusions:C 5-NRB provides superior efficacy compared to T 2-ESPB when used for arthroscopic shoulder surgery under general anesthesia.

Microglial pyroptosis and neuroinflammation have been implicated in the pathogenesis of sepsis-associated encephalopathy (SAE). OGT-mediated O-GlcNAcylation is involved in neurodevelopment and injury. However, its regulatory function in microglial pyroptosis and involvement in SAE remains unclear. In this study, we demonstrated that OGT deficiency augmented microglial pyroptosis and exacerbated secondary neuronal injury. Furthermore, OGT inhibition impaired cognitive function in healthy mice and accelerated the progression in SAE mice. Mechanistically, OGT-mediated O-GlcNAcylation of ATF2 at Ser44 inhibited its phosphorylation and nuclear translocation, thereby amplifying NLRP3 inflammasome activation and promoting inflammatory cytokine production in microglia in response to LPS/Nigericin stimulation. In conclusion, this study uncovers the critical role of OGT-mediated O-GlcNAcylation in modulating microglial activity through the regulation of ATF2 and thus protects against SAE progression.
Animals ; Microglia/metabolism* ; Pyroptosis/physiology* ; Mice ; Sepsis-Associated Encephalopathy/prevention & control* ; Activating Transcription Factor 2/metabolism* ; N-Acetylglucosaminyltransferases/genetics* ; Mice, Inbred C57BL ; Male ; Mice, Knockout

Objective:To compare the effects of erector spinae plane block at T 2 (T 2-ESPB) and nerve root block at C 5 (C 5-NRB) in patients undergoing arthroscopic shoulder surgery with general anesthesia. Methods:This was a randomized, controlled, non-inferiority study. Sixty American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 45-75 yr, with body mass index ≤35 kg/m 2, scheduled for elective arthroscopic shoulder surgery at Jining No. 1 People′s Hospital from April 2023 to February 2024, were included and divided into 2 groups ( n=30 each) using a random number table method: C 5-NRB group (group C) and T 2-ESPB group (group T). In group C, C 5-NRB was carried out by injecting 0.5% ropivacaine 5 ml. In group T, T 2-ESPB was performed by injecting 0.25% ropivacaine 30 ml. The efficacy of nerve block was assessed using a prick test at 30 min after administration, and then total intravenous anesthesia was performed in both groups. The time to first rescue analgesia (the non-inferiority boundary Δ =2 h), requirement for rescue analgesia within 24 h after operation and intraoperative consumption of anesthetics were recorded. The motor function of the affected limb during shoulder abduction, elbow flexion and elbow extension was assessed and scored using the modified Bromage scale (MBS) at 30 min and 4 and 12 h after nerve block. The diaphragmatic excursion was measured and recorded using M-mode ultrasound before nerve block and at 30 min after nerve block to evaluate the occurrence of diaphragmatic paralysis. Complications such as local anesthetic toxicity, recurrent laryngeal nerve block and pneumothorax were also recorded. Results:The mean difference (95% confidence interval) for the time to first rescue analgesia between the two groups was 5.551 (1.875-9.148) h, with the upper limit exceeding the non-inferiority boundary. Compared with group T, the intraoperative consumption of remifentanil was significantly reduced, the time to first rescue analgesia was prolonged, the consumption of morphine for rescue analgesia was decreased, MBS scores during shoulder abduction, elbow flexion and elbow extension were decreased at 30 min after block, and MBS scores during shoulder abduction and elbow flexion were decreased at 4 and 12 h after block in group C ( P<0.05). There was no significant difference in the diaphragmatic excursion, incidence of diaphragm paralysis and incidence of complications before and after block in the two groups ( P>0.05). Conclusions:C 5-NRB provides superior efficacy compared to T 2-ESPB when used for arthroscopic shoulder surgery under general anesthesia.

In January 2023, a patient with soft tissue degloving defect of right index, middle, ring and little fingers was treated in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Seven free flaps from a leg were harvested to reconstruct the defected wound of fingers in primary surgery. Flap thinning and plastic surgery were performed in stage-II surgery. Over the 22 months of postoperative follow-up, the flaps in right index, middle, ring and little fingers survived well with the colour and texture close to proximal skin. There was no obvious swelling of the flaps and sensation of the flaps recovered to S 3. The donor sites healed well and the donor leg walked normally.

In January 2023, a patient with soft tissue degloving defect of right index, middle, ring and little fingers was treated in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Seven free flaps from a leg were harvested to reconstruct the defected wound of fingers in primary surgery. Flap thinning and plastic surgery were performed in stage-II surgery. Over the 22 months of postoperative follow-up, the flaps in right index, middle, ring and little fingers survived well with the colour and texture close to proximal skin. There was no obvious swelling of the flaps and sensation of the flaps recovered to S 3. The donor sites healed well and the donor leg walked normally.

Objective To observe the efficacy of Venovo venous stent for treating post-thrombotic syndrome(PTS)after lower extremity deep venous thrombosis(DVT).Methods A total of 61 patients with PTS after lower extremioty DVT who underwent iliac vein stent implantation were retrospectively enrolled,including 33 cases underwent Venovo stent(Venovo stent group)and 28 cases underwent conventional stent implantation(conventional stent group).The technical success rates and perioperative complications,Villalta score and venous clinical severity score(VCSS)before and 6 and 12 months after treatment,as well as the primary stent patency were compared within and between groups.Results The technical success rate was 100%in both groups,and no significant difference of the incidence of perioperative complications was found between groups(P=0.187).There was no significant difference of Villalta score nor VCSS between groups before treatment(both P＞0.05),while significant decrease of Villalta score was noticed before and 6 or 12 months after treatment within both groups(all P＜0.05).No significant difference of Villalta score nor VCSS was found 6 months after treatment between groups(both P＞0.05),while significant difference of Villalta score and VCSS were observed in Venovo stent group compared with those in conventional stent group 12 months after treatment(both P＜0.05).No significant difference of primary stent patency rate was found between groups 6 and 12 months after treatment(both P＞0.05).Conclusion Venovo venous stent could be used to effectively treat PTS after lower extremity DVT.

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 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.

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.