Objective:To explore the clinical feasibility and application method of speckle-tracking echocardiography (STE) in assessing left ventricular longitudinal strain in infants.Methods:One hundred and ten infants within one week of birth were randomly selected in the Third Affiliated Hospital of Guangzhou Medical University from June 2019 to February 2020, and the basic data were collected. STE was performed by two physicians with more than 5 years′ experience.Images of the same infant were analyzed by physicians with 5 years′ experience and 2 years′ experience, respectively, and the difference and correlation of the results between the two doctors were analyzed. The images of the same infant were analyzed twice by the doctor with 5 years′ experience, and the differences and correlations between the results were analyzed. The infants were divided into different groups according to weight to compare the correlations between inter-physicians and intra-physician. STE analysis indicators included global left ventricular longitudinal peak strain (Glps-avg), four-chamber left ventricular longitudinal strain (Glps-A4C), three-chamber left ventricular longitudinal strain (Glps-A3C), two-chamber left ventricular longitudinal strain(Glps-A2C), left ventricular anterior wall longitudinal strain (Glps-a), anterior interventricular septum longitudinal strain(Glps-ais), posterior interventricular septum longitudinal strain (Glps-pis), inferior wall of left ventricle longitudinal strain (Glps-i), posterior wall of left ventricle longitudinal strain (Glps-p), lateral wall of left ventricle longitudinal strain (Glps-l), left ventricular basal section longitudinal strain (Glps-bs), left ventricular middle section longitudinal strain (Glps-ms) and left ventricular apex section longitudinal strain (Glps-as), a total of 13 indicators. The differences were analyzed by paired t test, and the correlations were determined by intra-group correlation coefficient (ICC). Results:According to the inclusion and exclusion criteria, 95 patients were included. For the 13 STE indicators, inter-physicians comparison: the differences between the two physicians were statistically significant (all P<0.05) except for Glps-pis, and the ICC were 0.38-0.72 (all P<0.01). Intra-physician comparison: the differences of these indicators between two measurements were not statistically significant (all P>0.05) except for Glps-ais and Glps-I, ICC were 0.31-0.76 (all P<0.05). Among them, inter-physicians and Intra-physician ICC of Glps-avg, Glps-bs, Glps-ms were 0.68/0.75, 0.72/0.66 and 0.65/0.76 respectively. The group comparison by infants′ weight showed that: In very low weight infants group, the ICC of inter-physicians and intra-physician ranged 0.82-0.93(all P<0.05) and 0.80-0.95(all P<0.05). In low weight infants group, the ICC of inter-physicians and intra-physician ranged 0.65-0.94 (all P<0.05) and 0.69-0.93 (all P<0.01). In the normal weight infants group, ICC of inter-physicians ranged 0.06-0.68, with statistical significance except for Glps-A3C (all P<0.05); ICC of intra-physician ranged 0.36-0.59 (all P<0.05). In overweight infants group, there was no statistical significance in ICC of inter-physicians (all P>0.05), the ICC of intra-physician, Glps-bs and Glps-ms groups were 0.63 and 0.77 (all P<0.05), with no statistical significance in other indicators (all P>0.05). Conclusions:Left ventricular longitudinal strain by STE in infants has better repeatability, and the consistency of intra-physician is higher than inter-physicians, among which the Glps-avg consistency is the best, followed by Glps-bs and Glps-ms. STE is more reproducible in low and very low weight infants than in normal and overweight infants.

Objective To explore the anatomic basis of the thinning of the free posterior tibial artery perforator flaps and the clinical effect of repairing wound on hand or foot due to trauma.Methods From November,2016 to December,2017,10 cases of lower extremity cadaver specimens perfused with red ralex were dissected,which were perfused through the amputated femoral artery.Five of them were left and the rest were right.All cases were males.The number,diameter,branches and distribution of the perforator was observed.From September,2012 to September,2017,there were 13 cases of clinical application,which were 5 cases of hand wound and 8 cases of foot wound.The size of the wound was 3.0 cm × 2.0 cm to 6.0 cm × 4.0 cm,and the flap area was 3.5 cm × 2.2 cm to 6.5 cm × 4.5 cm.The repairing procedure was suitable for the wound associated with tendon,bone,joint capsule exposure.Results The number of posterior tibial artery perforating branches that more than 0.50 mm in diameter was 4 to 6,and the mean diameter was (0.87±0.26) mm.The perforating branch penetrated into the fat layer and was divided into 3 layers of vascular network:deep fat vascular network,superficial fat vascular network and subdermal vascular network.The perforating branch was located according to the positional relationship from deep to shallow,and vessel diameter become smaller step by step.The perforating branch trunk gave off branches to the deep vascular network,and the superficial vascular network had the same origin or shared with the deep blood vessels.The subdermal vascular network issued from the superficial vascular network or directly from the perforating branch trunk.There was no or few communicating branch between the deep vascular network and superficial ones,besides the vessel pedicle.So trimming deep fat layer will not affect the blood supply of superficial vascular network and neither will affect the flap blood supply.Most of the deep fat tissue was trimmed in 13 cases.The superficial and subdermal fat vascular network was preserved,and the same to the trunk and branches of the pedicle.All the flaps survived.Of which,1 appeared arterial crisis on the 2nd day after operation,and relieved by the local injection of papaverine.There was 1 case of venous crisis on the 3rd day,and improved by stitches,local release of congestion.Followed-up time was ranged from 2 to 12 months.All flaps were soft with good blood supply and good appearance,and did not need a second thinning surgery.Flaps restored the protective feeling 6 months later.Conclusion The microdissection of perforator flap of posterior tibial artery provides a theoretical basis for the perforator flap thinning,and the thinning of perforator flap is a good method to repair the appearance and function of the wound after foot and hand injuries.

From 1978 to 2019, the cause of neurosurgery in China has developed rapidly, and the surgical treatment of pituitary adenoma has achieved good results.. This article focuses on the surgical treatment of pituitary adenomas from imaging techniques, surgical techniques and anesthesia techniques, and looks forward to the future.