BACKGROUND:The oxygen free radicals and apoptosis play an important role in limb ischemia/reperfusion injury, so we can al eviate limb ischemia/reperfusion injury by inhibiting the production of oxygen free radicals and apoptosis.
OBJECTIVE:To discuss the application and effect of edaravone on limb ischemia/reperfusion injury in rats.
METHODS:Of the 30 female Sprague-Dawley rats, 20 rats were randomly selected to make models of limb ischemia/reperfusion injury by ligating the root of right lower limb with a self-made bal oon cuff at 40 kPa pressure to block blood flow for 4 hours and reperfusing. After success model establishment, they were randomly assigned to two groups. In the edaravone perfusion group, edaravone 3 mg/kg was injected via the left femoral vein at 5 minutes before reperfusion. In the model group and normal group (the remaining 10 rats), an equal volume of physiological saline was given at the same time point. At 24 hours after reperfusion, the right anterior tibial muscle of each group was removed and these ultrastructural changes were observed by transmission electron microscope. Bcl-2 mRNA and Bax mRNA of rat anterior tibial muscle of each group were semiquantitatively detected with the RT-PCR and the ratio of bcl-2/bax was calculated.
RESULTS AND CONCLUSION:(1)Electron microscope results:compared with the model group, the muscle fibers were neater;the M line and the N line were clearer;the swel ing of mitochondria was al eviated;the numbers of mitochondria and mitochondrial crista were also increased in the edaravone perfusion group. (2)RT-PCR results:At 24 hours after reperfusion, the relative expression of bcl-2 mRNA and the ratio of bcl-2 mRNA to bax mRNA in right anterior tibial muscle were lower in the model group compared with the edaravone perfusion group (P<0.05). However, relative expression of bax mRNA was greater in the model group than that in the edaravone perfusion group, which were both higher than the normal group (P<0.05). Results indicated that the free radical scavenger edaravone relieved limb ischemia/reperfusion injury by improving the mitochondrial ultrastructure and promoting expression of bcl-2 mRNA and inhibiting expression of bax mRNA, and could provide a new choice for the treatment of limb ischemia/reperfusion injury.

Objective To investigate the effect of constraint abstinence duration on regional homogeneity (ReHo) of heroin addicts in resting state.Methods Twenty heroin addicts abstinent for 6 months (PA6 group),sixteen heroin addicts abstinent for 11 months (PA11 group) and 30 demographically matched healthy controls (HC group) were enrolled.ReHo values were calculated and difference among three groups was analyzed.The relationship between ReHo values of differential brain regions and abstinent duration was performed with Pearson method.Results The results demonstrated statistically significant difference in ReHo values among three groups in the left parahippocampal gyrus,caudate,insula,cingulate gyrus,postcentral gyrus and right orbitofrontal cortex.Compared with the PA6 group,the PA11 group demonstrated lower ReHo value in left parahippocampal gyrus,caudate,insula,cingulate gyrus and postcentral gyrus,ReHos value were higher than PA6 and HC in right orbitofrontal cortex.Meanwhile,the ReHo values of left parahippocampal gyrus (r=0.53,P=0.000 8),caudate (r=0.54,P=0.000 6),insula (r=0.62,P＜0.000 1),cingulate gyrus (r=0.47,P=0.003 5) and postcentral gyrus (r=0.35,P 0.034 8) were negatively correlated with abstinence duration and ReHo value of right orbitofrontal cortex (r=0.66,P＜0.000 1) were positively correlated with abstinence duration.Conclusion During long-term abstinence,most of heroin addicts' damaged brain regions (mainly involved in craving,inhibitory control,learning and memory) tends to be normal,thus benefit reducing the risk of relapse,but motivation related brain region's (orbitofrontal cortex) neural activity increases abnormally,that may be one of the important reasons for relapse after abstinence.

Objective: To study the clinical effect of relaying peroneal artery perforator flap on anterior middle and lower tibia and donor-site defects repair. Methods: From July 2014 to June 2017, 12 patients were included. The anterior middle-lower tibia soft tissue defects and the primary donor-sites were repaired by relaying peroneal artery perforator flaps, and the second donor-sites were directly closed. The size of anterior middle-lower tibia defects ranged from 5 cm × 3 cm to 13 cm × 9 cm. The flaps repairing the wounds ranged from 6 cm × 4 cm to 14 cm × 10 cm in size. The flaps restoring the first donor-site ranged from 5 cm×4 cm to 10 cm×6 cm in size. The clinical effect was evaluated by observing the appearance of the recipient sites and the donor sites. Results: All the flaps survived uneventfully. All patients were followed up for 8-36 months (average 20 months). The flaps remained with good texture and color. The second donor-sites only left linear scar, which do not affect the overall appearance of limb. Conclusions The blood supply of relaying peroneal artery perforator is reliable without any disturbing of the main artery. The flap located on the lateral of the calf. The relaying peroneal artery perforator flap can repair the soft tissue defect at the anterior middle-lower tibia and improve the appearance of the first donor-site.

Objective: To explore the clinical effect of negative pressure wound therapy (NPWT) in emergency limb-salvage operation of destructive injury of limb. Methods: From July 2014 to December 2017, 43 patients with destructive injury of limb in one side conformed to the inclusion criteria were admitted to our hospital. The patients were divided to NPWT group of 24 patients [ 21 males and 3 females, aged (38±10) years] and routine dressing change group of 19 patients [ 17 males and 2 females, aged (37±10) years] according to their treatment methods. After the emergency debridement, fracture external fixation, neurovascular exploration, and microsurgical repair were performed, NPWT were applied on wounds of patients in NPWT group and routine dressing change treatment on wounds of patients in routine dressing change group. On 7 to 10 days after the emergency operation, incidence of arterial embolism of patients in the two groups were calculated, and condition of wound infection of patients in the two groups were observed. Complete wound healing time and survival condition of limb were recorded. Data were processed with independent sample t test or chi-square test. Results: Incidence of arterial embolism of patients in NPWT group on 7 to 10 days after the emergency operation was 6.67% (3/45), which was close to 5.56% (2/36) of patients in routine dressing change group (χ²=0.043, P>0.05). There was 1 patient with wound infection in NPWT group on 7 to 10 days after the emergency operation, obviously less than 6 patients in routine dressing change group (χ²=5.847, P<0.05). Complete wound healing time of patients in NPWT group was (30±4) d, significantly shorter than (36±8) d of patients in routine dressing change group (t=2.813, P<0.01). Limbs of 24 patients in NPWT group survived, which was close to 18 patients in routine dressing change group (χ²=1.293, P>0.05). Conclusions NPWT can significantly reduce tthe wound infection rate and shorten the time of wound healing of limb with destructive injury after emergency operation, which is worthy of popularization in clinic.

Objective Toinvestigatetheeffectofpressureandnon-pressureonthedirectimagingoflowerlimbdeepveinswith CTvenography(CTV).Methods 100patients(50malesand50females,aged30－80yearsold,mean (63.5±13.5yearsold)with suspectedlowerextremityvenousdiseasesfrom September2015to October2018 wereretrospectivelyanalyzed.50patientswere scannedafterpressingtheankle(controlgroup),andtheother50werescannedwithoutpressingtheankle(experimentalgroup).Results Therewerenosignificantdifferencesbetweenthecontrolandexperimentalgroupsintheauxiliaryveinscore (t＝－0.20,P＝0.82), femoralveinscore(t＝－0.1,P＝0.91),andtotaliliacveinscore(t＝－0.03,P＝0.97).Conclusion CTV withoutpressingtheankle demonstratescomparableefficacytodirectimagingoflowerlimbdeepveins,withgoodimagequality,reducedcomplicationsandeasy toapply,sothatitshouldbewidelyusedinclinicalpractice.

IDEAL framework and recommendations provide a scientific and integrated evaluation pathway for surgical innovations and other complex therapeutic interventions, and underline that the preliminary studies are needed to prepare for a successful randomized controlled trial. IDEAL framework provides a series of recommendations in terms of nature stages of surgical innovation. We have reported the introduction and reporting guidelines of the IDEAL framework and recommendations in our IDEAL series paper. This paper aimed to provide some empirical evidence, focusing specifically on stages 2a and 2b, to help surgeons and researchers to understand how to imply IDEAL framework and recommendations into their clinical practice.