Objective:To study the influence of r-tPA and urokinase in curative effect and thrombolysis time on patients with acute and severe pulmonary embolism after interventional thrombectomy .Methods:After reviewing and analyzing the clinical data of 19 acute and severe pulmonary embolism patients , we classified them into two groups in accordance with the application of r-tPA and urokinase to compare the changes of their heart rate , blood pressure , pulmonary arterial pressure , arterial partial pressure of oxygen and hemachrome before and after thrombolysis , as well as the thrombolysis effect time the two groups took.Results: The heart rate, blood pressure, pulmonary arterial pressure , arterial partial pressure of oxygen of the patients in both groups gained remarkable improvement after operation ( P<0 .05 );the pulmonary arterial pressure of the r-tPA patient group dropped but not significantly compared with that before operation ( P>0.05); the pulmonary arterial pressure of the urokinase patient group dropped significantly compared with that study before operation ( P<0.05 ); the hemachrome of both patient groups did not significantly drop after operation ( P>0 .05 );the thrombolysis effect time by adop-ting r-tPA was remarkably shorter than that caused in thrombolysis by adopting urokinase ( P<0 .05 ) . Conclusion: Both r-tPA and urokinase are effective in interventional thrombolysis for acute and severe pulmonary embolism .However , r-tPA could significantly shorten the time caused in thrombolysis without increasing any bleeding risk.

Objective:To investigate the clinical value of digital technology in repair of soft tissue defect in hand by anterior tibial artery perforator flap.Methods:From January 2015 to February 2021, 9 patients with soft tissue defects in hand were repaired with anterior tibial artery perforator flap assisted by digital technology in flap design, including 6 males and 3 females aged from 19 to 63 years with a mean age of 33 years. The size of defects varied from 2.0 cm×1.5 cm to 4.0 cm×3.0 cm, with exposed bones or tendons. Preoperative CTA scan of lower limb was performed and three-dimensional image was reconstructed with Mimics 20.0. The anterior tibial artery perforator flap was designed according to the shape and size of the defect, then the resection of flap was digitally simulated. The flap based on the digital design was harvested and the defect was repaired in the operation. The size of flap was 2.5 cm×2.0 cm~4.5 cm×3.5 cm. Outpatient clinic follow-up was performed to evaluate the survival of flaps. Disability of Arm, Shoulder and Hand(DASH) was used for function evaluation.Results:All flaps were harvested successfully and all donor sites were closed directly. After surgery, 8 flaps survived completely. One flap developed venous occlusion that showed partial necrosis of the flap, and it was rescued after exploration and re-anastomosis. The follow-up period ranged from 6 to 21 months, with an average of 13 months. The DASH scores of the affected limb were 2 to 15 points at the last follow-up, with an average of 6.4 points. Mild scar hyperplasia occurred at donor site in 1 case without sensory abnormality.Conclusion:The digital technology is able to accurately locate the perforators by allowing an individualised design of the anterior tibial artery perforator flap. The flap is suitable for repair of small and medium-sized soft tissue defect in hand, and the digital technology has certain value in clinical application.