Objective To explore the efficacy of endovascular treatment for closed articular artery injuries.Methods The clinical data of 13 patients from Jan 2010 to Dec 2014 treated for closed articular artery injuries were analyzed retrospectively.The location,severity and extent of arterial injury were confirmed by intraoperative arteriography.The diameter and length of the injured arteries were measured.The guidewire was sent to the lesion site and working wire pathway was established.When the guidewire was difficult to pass through the lesion site,femoral and posterior tibial or radial artery may be used to establish working wire pathway.The stent or stent-graft was implanted through the contralateral femoral artery or distal end of ipsilateral artery.Results Intraoperative angiography confirmed intimal injury (n =2),partial transection (n =5),complete transection (n =5) and arteriovenous fistula (n =1).Eighteen stents or stent-grafts were implanted.Treatment was successful in all patients without peiropeartive death and procedure-related complications.All were followed up for 15 to 48 months and the mean follow-up was (30 ± 11) months.Three patients with stent lumen stenosis less than 50％ as showed by angiography.There was no stent fracture,displacement,or deformation.Conclusions Endovascular treatment for closed articular artery injuries is of less invasion,shorter operative time and quick postoperative recovery.

OBJECTIVETo investigate the feasibility of the composite transplantation of 1:3 meshed split-thickness autograft and acellular heterologous (porcine) dermal matrix.

METHODS9 inpatients with full thickness skin burn or hypertrophic scar were selected in this study. After the eschar or scar was excised, the wound was covered with acellular heterologous dermal matrix. Then the meshed (1:3) split-thickness autologous skin sheet was grafted on the dermal matrix. Before dressing up, the radiated pigskin was placed on the composite transplants.

RESULTSThe composite transplantation was successfully used in 9 cases. The meshed split-thickness autograft was expanded 3 times and covered the dermal matrix tightly. The clinical results of the composite transplantation were similar to that of intermediate split thickness skin graft or full thickness skin graft.

CONCLUSIONThe composite transplantation of meshed (1:3) split-thickness autograft and acellular heterologous (porcine) dermal matrix allowed the expansion of the autologous skin sheet to 3 times. The clinical results were similar to that of intermediate split thickness skin graft or full thickness skin graft.

Adolescent ; Adult ; Animals ; Burns ; pathology ; surgery ; Child ; Dermatologic Surgical Procedures ; Dermis ; transplantation ; Female ; Graft Survival ; physiology ; Humans ; Male ; Middle Aged ; Skin ; pathology ; Skin Transplantation ; methods ; Swine ; Transplantation, Autologous ; Transplantation, Heterologous ; Wound Healing ; physiology

OBJECTIVE To explore the CT and MRI appearances of otogenic sigmoid sinus thrombophlebitis(SST) and abscess. METHODS The HRCT, plain MRI, magnetic resonance venography(MRV), enhanced MRI findings in 11 patients with otogenic SST were retrospectively analyzed. RESULTS On CT, the bony wall of sigmoid sinus was eroded in 10 cases (10/11), and air bubbles were found in or around sigmoid sinus in 4 cases. On plain MRI, sigmoid sinus flow void effect disappeared in all 11 cases. SST manifested as high signal on T2W1 in all 11 cases, and as low signal on T1WI in 2 cases, isointense signal on T1WI in 6 cases, high signal on T1WI in 3 cases. Contrast enhancement MRI showed enhancement in wall of venous sinus, but venous sinus thrombosis did not enhanced, but showed as irregular filling defect or empty triangle. MRV showed that involved venous sinus was not visualized. CONCLUSION CT can show the erosion of the bony wall of sigmoid sinus which may indicate the SST; and if air bubbles are found around or in the sigmoid sinus, the abscess around or in the sigmoid sinus should be doubted. Conventional MRI combined with MRV are effective and noninvasive methods in the diagnosis of SST.

Objective:To evaluate the clinical value of neutrophil/lymphocyte ratio (NLR) in early prediction of the incidence of sepsis-induced organ dysfunction and 28-day mortality.Methods:A retrospective study was conducted in 815 adult patients with sepsis admitted to the department of critical care medicine of the First Affiliated Hospital of China Medical University from January 2017 to December 2019. The clinical data including age, gender and complication were collected, and the peripheral blood routine indexes at 24, 48 and 72 hours after the diagnosis of sepsis were collected, and the NLR was calculated. The primary endpoint of the study was the incidences of sepsis related acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and acute liver failure (ALF); the secondary endpoint was the 28-day in-hospital mortality in septic patients with organ dysfunction. Univariate and multivariate Logistic regression were used to analyze the risk factors of organ dysfunction and 28-day mortality in patients with sepsis, the receiver operating characteristic curve (ROC curve) was drawn and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of NLR for organ dysfunction and 28-day mortality in patients with sepsis.Results:A total of 714 patients with sepsis were enrolled for final statistical analysis. There was no significant difference in NLR at 24, 48 and 72 hours in patients with or without organ dysfunction (such as AKI, ARDS, DIC and ALF). Logistic regression analysis showed that there was no significant difference in NLR at 24 hours with 28-day in-hospital mortality [odds ratio ( OR) = 1.006, 95% confidence interval (95% CI) was 0.994-1.019, P = 0.323]. However, NLR at 48 hours and 72 hours had a significant difference with 28-day mortality (48 hours: OR = 1.026, 95% CI was 1.013-1.040, P = 0.000; 72 hours: OR = 1.021, 95% CI was 1.005-1.037, P = 0.010), which suggested that NLR at 48 hours and 72 hours after diagnosis were independent risks factor for 28-day mortality in patients with sepsis. ROC curve showed that the AUC of NLR at 48 hours was 0.598, 95% CI was 0.540-0.658, P = 0.02; when the cut-off value was 10.1, the sensitivity and specificity for predicting 28-day mortality was 75.2% and 58.0%, respectively; the AUC of NLR at 72 hours was 0.595, 95% CI was 0.536-0.655, P = 0.03; when the cut-off value was 9.24, the sensitivity and specificity for predicting 28-day mortality was 75.3% and 59.9%, respectively. Conclusions:NLR cannot predict the occurrence of AKI, ARDS, DIC and ALF in sepsis in early stage. NLR has a certain clinical value in predicting 28-day mortality in patients with sepsis, but its predictive efficiency is low.