Objective To investigate the CT perfusion imaging and the pathological features on the disturbance of regional cerebral microcirculation in a pre-infarction period, and to evaluate the relationship between the astrocytes and regional cerebral microcirculation. Methods Dynamic CT perfusion imaging of the models with regional cerebral hypoperfusion and astrocytic swelling in rats was performed to assess the presence or absence of the disturbance of regional cerebral microcirculation. Then, the histopathologic examination was made for both models, respectively. The ratios of side-to-side were measured at hypoperfusion areas in the models of regional cerebral ischemia. Results Regional hypoperfusion was revealed by regional cerebral blood flow (rCBF) and mean transit time (MTT) maps in the group of hypoperfusion for 6 hours. Regional cerebral blood volume (rCBV) and time-to-peak (TTP) maps were normal in that group. The ratios of rCBF, rCBV, MTT and TTP were 0 39-0 55, 0 92-1 00, 1 20-1 50 and 1 00-1 00 respectively. Astrocytic swelling pressing the capillary wall was obvious and subtle neuronal reversible degeneration was occasionally found. TTC stain was normal. In the tACPD group of astrocytic swelling, the abnormal hemodynamic regions on rCBF and MTT maps were found. The rCBV maps of 3 rats in the tACPD group showed the area of reduced rCBV. In 2 rats of tACPD group, the areas of delayed TTP were also found. The ratios of rCBF, rCBV, MTT and TTP were 0 25-0 44, 0 70-1 01, 1 20-2 00 and 1 02-1 45 respectively. TTC stain was negative. Electron microscope study revealed remarkable swelling of astrocytes, especially endfoot processes of astrocytes around capillaries. The abnormal hemodynamic region on rCBF and MTT maps matched with abnormal extent on histopathologic examination. The rCBV and TTP maps appeared normal. Conclusion The astrocytes can react in a way faster than the neurons in the pre-infarction period, viz. astrocytic swelling. The swelling of astrocytic foot, which pressed capillary vessel, induced the disturbance of regional cerebral microcirculation, and then aggravated hypoxic ischemic state in regional brain parenchyma. Perfusion CT and its parameters' analysis may play an increasing role to delineate the reversible hypoperfusion areas in pre-infarction period. Analyzing the relationship of rCBF and rCBV is very helpful to know the status of the capillary vessels in regional cerebral hypoperfusion area.

Objective To establish a stable and controllable model of acute regional cerebral ischemia in rats, and to evaluate it by CT perfusion imaging and histological study. Methods Twenty eight male Wistar rats were randomly divided into 4 groups, and there were 7 rats in each group. The sham operation rats were defined as the first group, rats suffered from cerebral ischemia for 15 minutes were classified as the second group, rats suffered from cerebral ischemia for 30 minutes and then reperfusion for 1 hour as the third group, and rats suffered from hypo perfusion for 6 hours as the fourth group. Cerebral ischemia or hypo perfusion were induced by inserting a nylon thread of different diameter into right middle cerebral artery (MCA) of rats under the monitoring of regional cerebral blood flow (rCBF) by the Laser Doppler Blood Perfusion Monitor (BPM). rCBF was also examined by dynamic CT perfusion imaging. At the end of the observation time, rats were decapitated, and three rats of each group were performed 2,3,5 triphenyltetrazolium chloride (TTC) staining and four rats were performed histological study. Results In the second group, rCBF was controlled within 5% to 22% under the monitoring by BMP and CT perfusion imaging showed the decreased rCBF in 7 rats, but TTC staining showed red appearance indicating no infarction focus formed. Electronic microscopic study revealed astrocytic swelling and a few of neuronal degeneration. In the third group, rCBF was controlled within 4% to 23% under the monitoring by BMP. There were more severe astrocytic swelling and a lot of neuronal degeneration. The abnormal areas in CT perfusion images were the same as TTC staining. In the fourth group, in accordance with less decrease ment of rCBF (from 38% to 55%) in 7 rats, there were obvious astrocytic swelling and subtle neuronal degeneration. TTC stain did not show ischemia area. All these abnormal changes were not observed in the sham operation rats. Conclusion The controllable acute regional cerebral ischemic model in rats is very stable and repeatable. It can be simulated into the ischemic state of different perfusion level. This model is suitable for the research of acute cerebral infarction and regional cerebral ischemia. The facts that parallel changes existed among BMP measurement, CT perfusion imaging, and brain histology indicated that CT perfusion imaging is accurate and sensitive in evaluating acute regional ischemia.

Objective To sum up our preliminary experience for the treatment of abdominal aortic aneurysm ( AAA) using unibody bifurcation stent-graft ( UBST). Methods This study included 42 cases, among them there were 39 AAA cases, one case of abdominal aortic pseudoanrurysm (AAPA) , one case of type C dissecting aortic aneurysm, one descending aortic aneurysm (DAA) with AAA. Five stent-grafts were deployed for the case with DAA and AAA including 4 stent-grafts were used for DAA and one UBST for AAA. For the case of type C dissecting aortic aneurysm, one straight stent-graft was used for sealing the proximal intimal tear, one UBST was deployed for sealing the distal intimal tear. A graft bypass was required in the case with AAPA through extraperitoneal incision occlusion of external iliac artery of one side, then an UBST was deployed for sealing the rupture of abdominal aorta. Results The average operative time was 50 minutes. One patient died. One more proximal cuff was required in 8 cases. One more distal cuff was required in one case, one more proximal and distal cuff respectively were required in one case. Postoperative transient slight leakage was present in 8 cases. Both internal iliac arteries were sealed in 5 cases; unilateral internal iliac artery was sealed in 20 cases. Success was reached in two cases with an angle of 90 degress between aneurismal neck and body. Conclusion The exclusion of AAA using UBST is successful and safe.

Objective To explore the relationship between the membranous tissue(MT)and organized thrombus(OT)in membranous obstruction of the inferior vena cava(MOVC),we investigated the related cytokines expression in the membranous tissues in MOVC as well as venous organized thrombi. Methods Using immunohistochemical method the expression of TGFβR,PDGFR,ET-1,FⅧ-rAg, ferritin and α1-antitrypsin were observed in the membranous tissues in 11 cases with MOVC and organized thrombi in 8 cases with deep venous thrombosis(DVT). Results Expression rates of TGFβR,PDGFR,ET-1,FⅧ-rAg, and ferritin in membranous tissues in 11 cases with MOVC and organized thrombi in 8 cases with DVT were as follows: TGFβR:MT 72.3%,OT 50%(P＞0.05);PDGFR:MT 45.5%,OT 100%(P＜0.05＝;ET-1:MT 100%,OT 0(P＜0.05＝;FⅧ-rAg: MT 90.9%,OT 12.5%(P＜0.05＝;ferritin: MT 72.3%,OT 100%(P＞0.05).α1-antitrypasin was not detected in either membranous tissues of MOVC or organized thrombi of DVT. Conclusions ThrovIgh the investigation of the related cytokines expression, it is possible that membranous tissue formation in MOVC is related to the organized thrombus.

ObjectiveTo summarize our preliminary result of the management of aneurysm using stent-graft. Method Different types of aneurysm were treated by stent-grafting in 71 cases including dissecting aortic aneurysm in 48 cases,infrarenal abdominal aortic aneurysm in 13 cases,pseudoaneurysm in descending aorta or left subclavian artery or infrarenal abdominal aorta and suprarenal abdominal aorta in 4,1,2 and 1 case(s) respectively,left or right iliac aneurysm in 2 cases respectively. The proximal intimal entry for dissecting aortic aneurysm and rupture site for pseudoaneurysm were sealed. Abdominal aortic aneurysm or iliac aneurysm was excluded using bifurcated or aorto-uni-iliac or straight stent-graft. Results The technique was successful in all cases. Two patients died perioperatively. Slight leakage in the proximal end of the dissecting aortic aneurysm was found in 5 cases,the leakage sealed off in 4 cases half year later. The reflux from distal entry was present in 9 cases. Initial leakage found in 6 cases of the abdominal aortic aneurysm,underwent spontaneous healing in 5 cases when followed-up at 3 months. Conclusion The treatment of dissecting aortic aneurysm,pseudoaneurysm and abdominal aortic aneurysm using stent-graft is mini-invasive and safe,though the long-term efficacy remains to be clarified.

Objective:To compare the toxicity and prognosis of patients with stage Ⅲ cervical cancer treated using different regimens.Methods:A retrospective analysis was carried out for 194 patients with stage Ⅲ cervical cancer determined according to the revised 2018 International Federation of Gynecology and Obstetrics staging system (16 cases of stage Ⅲ A, 23 cases of stage Ⅲ B, 136 cases of stage Ⅲ C1, and 19 cases of stage Ⅲ C2) admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2020. They were divided into a radical radiotherapy±chemotherapy group (81 cases) and a radical hysterectomy + radiotherapy±chemotherapy group (113 cases) according to different treatment method. The difference in toxicity between the two groups was determined using the χ2 test. The survival curves and progression-free survival curves were plotted using the Kaplan-Meier method, and the Log rank test was also performed. The differences in toxicity and prognosis were further analyzed in 136 patients with stage Ⅲ C1 cervical cancer result patients in the radical radiotherapy±chemotherapy group were more likely to have hemoglobin decline ( χ2=10.68, P=0.004), rectal mucositis ( χ2=14.41, P=0.001), and vaginal fistula ( χ2=7.16, P=0.012) of grades 3 and 4. Patients in the radical hysterectomy+ radiotherapy±chemotherapy group were more likely to have increased aspartate aminotransferase ( χ2=10.96, P=0.002) and alanine aminotransferase ( χ2=8.49, P=0.010). The differences were statistically significant. The 5-year progression-free survival rate of the radical radiotherapy±chemotherapy group was 58.3%, which was lower than that of the radical hysterectomy + radiotherapy±chemotherapy group (74.5%; χ2=5.33, P=0.021). Among the 136 patients with stage Ⅲ C1 cervical cancer, the ones in the radical radiotherapy±chemotherapy group (34 cases) were more likely to develop rectal mucositis ( χ2=13.25, P=0.003), while the ones in the radical hysterectomy + radiotherapy±chemotherapy group (102 cases) were more likely to have elevated aspartate aminotransferase ( χ2=6.18, P=0.046). The differences were statistically significant. The 5-year survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy+ radiotherapy±chemotherapy group were 85.5% and 86.3%, respectively. The difference was not statistically significant ( P=0.893). The 5-year progression-free survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy + radiotherapy±chemotherapy group were 65.6% and 77.1%, respectively. The difference was not statistically significant ( P=0.244). Conclusions:For patients with stage Ⅲ cervical cancer, the ones in the radical radiotherapy±chemotherapy group were more likely to progress and have a poorer prognosis compared with the ones in the radical hysterectomy+ radiotherapy±chemotherapy group. For patients with stage Ⅲ C1 cervical cancer, there was no significant difference in the prognosis of patients between the groups. The two treatment method lead to different toxicity, with no obvious advantages and disadvantages. Considering the risks and economic burdens caused by surgery, radical radiotherapy and chemotherapy is recommended for patients with stage Ⅲ C1 cervical cancer.

At present, the clinical judgment of cervical cancer prognosis is mainly based on common pathological factors, such as tumor size, lymph node metastasis, and the depth of interstitial invasion. In recent years, with the advancement of technology, many biomarkers have been proved to be closely related to the diagnosis and prognosis of cervical cancer. Hematological parameters and other medical diseases also affect the survival of cervical cancer patients to some extent.

Objective:To compare the differences in distribution and prognosis of cervical cancer patients in the 2009 and 2018 editions of International Federation of Gynecology and Obstetrics (FIGO) staging, and to analyze the prognostic factors of cervical cancer patients.Methods:The clinical data of 524 cervical cancer patients admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2018 were retrospectively analyzed. The cases were staged according to the 2009 and 2018 FIGO staging, and the Kendall τb coefficient was calculated to compare the consistency of the distribution of the two stages. Kaplan-Meier was used for survival analysis, and log-rank test was used to test the difference of prognosis in each stage. Cox-regression was used to analyze the prognostic factors of cervical cancer patients.Results:In the 2009 FIGO edition of staging, 1 case of stage ⅠB1 was reduced to stage ⅠA1 due to the microscopic infiltration depth <5 mm, 51 cases of stage ⅠB1 were raised to stage ⅠB2 due to 2 cm4 cm. A total of 119 cases raised to stage ⅢC1 due to pelvic lymph node metastasis, and 11 cases raised to stage ⅢC2 due to para-aortic lymph node metastasis. The distribution of cases in the two stages was consistent (τb=0.61, P<0.001). There were statistically significant differences in overall survival (OS) ( χ2=107.13, P<0.001; χ2=93.02, P<0.001; χ2=92.74, P<0.001) and progression-free survival (PFS) ( χ2=91.95, P<0.001; χ2=77.69, P<0.001; χ2=73.27, P<0.001) among patients with different stages of FIGO in 2018 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, ⅢC1, ⅢC2, Ⅳ) and 2009 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, Ⅳ) and patients with different T stages (T 1, T 2, T 3, T 4). There were statistically significant differences in OS ( χ2=20.71, P<0.001) and PFS ( χ2=24.25, P<0.001) in 2018 FIGOⅠB and ⅢC stages, and there was a statistically significant difference in OS between stage ⅢC1 and stage ⅠB2 ( χ2=6.18, P=0.013). Multivariate analysis showed that age ( HR=1.88, 95% CI: 1.08-3.28, P=0.026), pathological type ( HR=2.11, 95% CI: 1.04-4.27, P=0.038), lymph node metastasis ( HR=2.18, 95% CI: 1.34-3.56, P=0.002), parametrial spread ( HR=2.56, 95% CI: 1.52-4.29, P<0.001), maximum tumor diameter ( HR=1.98, 95% CI: 1.18-3.30, P=0.009), squamous cell carcinoma antigen (SCCA) positive after treatment ( HR=4.49, 95% CI: 2.09-9.68, P<0.001) and Hemoglobin (HB) level before treatment ( HR=0.58, 95% CI: 0.35-0.96, P=0.035) were independent risk factors for OS in patients with cervical cancer. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅠB1, ⅠB2, ⅠB3 were 100%, 97.1% and 87.9% respectively, with a statistically significant difference ( χ2=7.79, P=0.020), and there was a statistically significant difference between stage ⅠB1 and ⅠB3 ( χ2=5.55, P=0.019). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅠB1 and ⅠB2 were 95.7% and 84.3% respectively, with a statistically significant difference ( χ2=9.08, P=0.003). For patients with 2018 FIGO stage ⅠB, SCCA positive after treatment ( HR=1 172.50, 95% CI: 10.37-132 554.51, P=0.003) was an independent risk factor for OS, and differentiation degree ( HR=0.09, 95% CI: 0.01-0.81, P=0.032), treatment method ( HR=0.17, 95% CI: 0.04-0.71, P=0.015) and SCCA positive after treatment ( HR=190.68, 95% CI: 14.27-2 547.67, P<0.001) were independent risk factors for PFS. For patients with 2018 FIGO stage ⅠB, stage ( HR=9.56, 95% CI: 2.38-38.32, P=0.001), SCCA positive after treatment ( HR=126.32, 95% CI: 12.36-1 290.60, P<0.001) and lymph node metastasis ( HR=20.07, 95% CI: 3.63-111.11, P=0.001) were independent risk factors for OS, and differentiation degree ( HR=0.11, 95% CI: 0.02-0.63, P=0.013), treatment method ( HR=0.22, 95% CI: 0.06-0.75, P=0.015) and SCCA positive after treatment ( HR=43.83, 95% CI: 7.94-241.84, P<0.001) were independent risk factors for PFS. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 95.7% and 75.6% respectively, with a statistically significant difference ( χ2=13.96, P<0.001). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 83.1% and 67.1% respectively, with a statistically significant difference ( χ2=7.61, P=0.006). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 90.9% and 75.0% respectively, with a statistically significant difference ( χ2=8.85, P=0.003). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 75.7% and 66.7% respectively, with a statistically significant difference ( χ2=4.07, P=0.044). For patients with 2018 FIGO stage Ⅱ, pathological type ( HR=20.28, 95% CI: 2.93-140.32, P=0.002) and stage ( HR=4.35, 95% CI: 1.02-18.55, P=0.047) were independent risks factors for OS. For patients with 2009 FIGO stage Ⅱ, pathological type ( HR=5.82, 95% CI: 1.62-20.94, P=0.007) was an independent risk factor for OS, and pathological type ( HR=3.09, 95% CI: 1.22-7.85, P=0.017) and lymph node metastasis ( HR=2.07, 95% CI: 1.22-3.51, P=0.007) were independent risk factors for PFS. For patients with 2018 FIGO stage Ⅲ, maximum tumor diameter ( HR=3.31, 95% CI: 1.45-7.56, P=0.005) and SCCA positive after treatment ( HR=4.67, 95% CI: 1.22-17.86, P=0.024) were independent risk factors for OS, and pathological type ( HR=4.15, 95% CI: 1.47-11.77, P=0.007) and SCCA positive after treatment ( HR=3.96, 95% CI: 1.45-10.86, P=0.007) were independent risk factors for PFS. Conclusion:The 2018 and 2009 FIGO staging have a good distribution consistency in the cervical cancer patients, and the 2018 FIGO stage ⅠB has more advantages in judging the prognosis, but stage ⅢC cannot accurately judge the prognosis. Lymph node metastasis and maximum tumor diameter are more important prognostic factors.

Objective:To investigate the precautions and clinical effects of minimally invasive lateral bone transfer of tibia in the treatment of diabetic foot.Methods:A retrospective analysis was performed on 82 patients with diabetic foot admitted to the Trauma Department of Changzhou First People's Hospital from January 2019 to December 2022. According to the Wagner grade of diabetic foot, there were 12 cases of grade 2, 50 cases of grade 3, and 20 cases of grade 4. According to the surgical method, 45 patients were divided into bone transfer group. There were 29 males and 16 females, with an average age of 65.27±10.74 years (ranging from 44-87 years), who underwent minimally invasive bone transfer of tibia combined with local debridement treatment. In the non-bone transfer group, there were 37 cases (26 males and 11 females) with an average age of 66.05±11.08 years (ranging from 44 to 86 years), who were treated with local debridement. Gender, age, Wagner grade, surface temperature difference of the affected limb, visual analogue scale (VAS) score of the affected limb before and 1 month after surgery, wound healing rate 1 month after surgery, and recurrence rate of the affected foot 1 year after surgery were compared between the two groups. Outcomes of the cases of different Wagner grades were compared.Result:All 82 patients were followed up for 14.23±1.20 months. There was no significant difference in gender, age, Wagner grade and preoperative VAS between the two groups ( P>0.05). The skin temperature of the affected limb before and after surgery in the bone transfer group was significantly higher than that in the non-bone transfer group 1.93±0.31 ℃ ( P<0.05), and the VAS of the bone transfer group was 2.18±0.58 points 1 month after surgery, which was lower than that in the non-bone transfer group of 5.41±0.93. The VAS difference before and after surgery in the bone transfer group was 4.80±1.24 points, which was greater than that in the non-bone transfer group of 1.62±1.48 points with significant difference ( P<0.05). The wound healing rate was over 98.78%±2.17% in the bone transfer group and 52.57%±6.41% in the non-bone transfer group one month after surgery. No recurrence or recurrence was found in the bone transfer group one year after surgery, and the recurrence rate was 86% (32/37) in the non-bone transfer group with significant difference ( P<0.05). There was no difference in preoperative VAS for different grades of diabetic foot (grades 2, 3, and 4). There were significant differences in VAS, VAS decrease, postoperative limb surface temperature increase, local wound healing rate at 1 month, and lower limb ulcer recurrence or recurrence rate at 12 months in the bone transfer groups of Wagner grade 2, 3, and 4 ( P<0.05). Conclusion:Minimally invasive lateral bone transfer of tibia combined with local precision debridement could significantly increase the healing rate of diabetic foot ulcer, improve the peripheral microcirculation of the affected limb, reduce the pain of the affected limb, and decrease the recurrence rate of diabetic foot ulcer.

Objective The existing evidence of exercise rehabilitation in patients undergoing surgery for valvular heart disease was analyzed,described and evaluated by using evidence mapping methods.Methods Systematic reviews and randomized controlled trials on exercise rehabilitation of patients undergoing valvular heart disease surgery were searched from CNKI,Wanfang Data,VIP,CBM,Embase,PubMed,Cochrane Library,Web of Science,Ovid,CINAHL and other databases,and the search period was established until April 23,2024.The quality of the included literature was evaluated,and the feature information of the included literature was visualized in the form of bubble map and table.Results Fifty-one literatures(including 44 randomized controlled trials and 7 systematic evaluations)were finally included.Among the 44 randomized controlled trials,the types of exercise were mainly related to anaerobic exercise(3 literatures),aerobic exercise(11 literatures),flexibility training(8 literatures),and multisport exercise(22 literatures);postoperative inpatient rehabilitation accounted for a relatively high proportion(16 literatures),followed by overall postoperative rehabilitation(13 literatures)and pre-operative prehabilitation(7 literatures).Twenty-seven conclusions were categorized as"beneficial",15 as"possibly beneficial,"and one ach as"unclear"and"no effect".Seven systematic evaluations were subjected to Meta-analysis,and in terms of the design of the included studies,there were only 3 systematic reviews that included randomized controlled trials.Of the study conclusions,three were"beneficial",three were"possibly beneficial"and one was"unclear".Conclusion The evidence mapping shows that exercise rehabilitation is generally beneficial or potentially beneficial in the rehabilitation of valvular heart disease surgery,mainly in the postoperative inpatient rehabilitation phase.High-quality studies are needed to further investigate the effectiveness of exercise programs with different intensities,frequencies,and durations,as well as different valve types,adverse effects of exercise,and other outcome indicators.