Objective To discuss the therapeutic effect in the treatment of the acute limb arterial critical ischemia.Methods Collect thirty-nine cases of acute limb arterial critical ischemia in Renji Hospital from Janary 2014 to July 2016.According to the patients' manifestation,these operations were porfermed including thrombectomy,cathetery-directed thrombolysis,mechanical suction bolt,percutaneous angioplasty and stenting.The effect and complications were observed.Results The eighteen patients in 39 cases (46.2％) were dead,including 5 cases without operation,13 operation.The eight cases were amputated during 34 cases of operations.In the 21 out-patients safely,2 cases were not followed up.The time of follow-up was from 3 to 27 months,on average 14.3 months.During the 21 patients,5 cases died from heart cerebrovascular or tumor diseases,3 cases with footdrop,2 cases with toe amputations,3 cases with distal leg and foot anesthesias.Conclusions The patiens with acute limb arteries critical ischemia must be treated as early as,and reinforced the management of multiple organ function,which may improve the diseases' therapeutic effect.

Objective To summarize clinical experience of one-station therapy for infected seriouslyischemic diabetic foot.Methods The clinical data of 15 patients (15 diseased limbs in total) with infected seriously-ischemic diabetic foot,who were admitted to authors' hospital during the period from June 2015 to April 2016 to receive treatment,were retrospectively analyzed.For all patients,one-station sequential therapy was carried out,which included endovascular revascularization (EVR) to open occluded vessel,surgical debridement and closed negative pressure wound drainage and antiseptic moisturizing wound dressing.The healing rate of infected wound and the limb salvage rate were evaluated.Results The 15 patients included 10 males and 5 females,with a median age of 77 years old.Lower extremity angiography showed that multiple segmental lesions of lower limb were detected in 13 patients and simple leg lesions in 2 patients.According to TASC Ⅱ update classification,leg artery disease of grade D was observed in 13 patients and artery disease of grade C in 2 patients.After EVR therapy,at least one branch of leg arteries was reopened in 14 limbs.Intact arterial arch of pedal-plantar loop (PPL) was seen in 6 patients,semi-arterial arch in 7 patients,and absent of arterial arch in 2 patients.After surgical debridement,the wound was washed by using negative pressure wound therapy (NPWT) device as well as serf-made washing equipment.The time to control wound infection was (7.85±2.84) days.After discharge,the patients were followed up every 3-4 days,at the same time wound dressing exchange with antibacterial moisturizing sulfadiazine silver lipid hydrogel was conducted.Wound healing was achieved in 12 patients,and the mean healing time was (3.70±0.87) months.The wound failed to heal in 3 patients,among them below knee amputation had to be performed in 2 patients (13.3％,both patients showed absent of arterial arch of PPL),and the remaining one patient died of cardiovascular event.Statistically significant difference in PPL pathological changes existed between wound healing group and wound un-healing group (P=0.006 7).Conclusion The treatment of infected seriouslyischemic diabetic foot is rather complicated.Being one-station therapy,the sequential managements,which include EVR,NPWT device together with washing equipment and use of antibacterial moisturizing wound dressing,can effectively increase the blood supply to the affected limb,shorten the time to control infection and lower amputation rate.Therefore,one-station therapy should be regarded as the preferred method for infected seriously-ischemic diabetic foot.

Objective To explore the value of wound blush in predicting patients' ulcer healing whom with critical limb ischemia after revascularization.Methods Retrospectively analyze the clinical data of 173 cases of critical limb ischemia with ischemic ulcers under thetreatment of endovascular therapy followed the concept of angiosome.According to the condition of wound blush after endovascular therapy,by compared the difference of limb salvage rate and ulcer healing time,and try to analyze the value of wound blush in predicting ulcer healing in patients.Results Included in the study with a total of 173 cases (173 limbs),group wound blush(+) 109 patients,group wound blush (-) 64 cases,the age,proportion of male patients,smoking history,diabetes,coronary heart disease,chronic renal insufficiency,pre and post operative ankle brachial index,were no statistical difference between the two groups.The ulcer healing time of group wound blush (+) was significantly shorter than that of group wound blush(-) (P ＜ 0.05).The rate of ulcer healing in group wound blush(+) was significantly higher than that in group wound blush(-) (P ＜ 0.05).In group wound blush(+),the cumulative rate of limb salvage was statisticallyhigher than group wound blush (-) (P ＜ 0.05).By logistic regression analysis,wound blush(-) (OR =4.5,P ＜ 0.05),IRc revascularization (OR =2.6,P ＜ 0.05) were independent risk factors of ulcer healing.Conclusions The resoult of wound blush(+) shows a good distal perfusion of foot.It can be used as a predictive factor for critical limb ischemia ischemic ulcer healing,and wound blush (-) was an independent risk factor for ulcer nonhealing.

Objective:To observe the effect of radiofrequency thermocoagulation (RFTC) combined with pulsed radiofrequency (PRF) therapy on lumbar disc herniation (LDH) and the impacts on serum interleukin-8 (IL-8), CXC chemokine ligand 10 (CXCL10).Methods:From July 2014 to May 2017, 60 patients with LDH were randomly divided into two groups according to the random digital table method, with 30 patients in each group.The combination group was given RFTC combined with PRF therapy, while the PRF group was given single foraminal nerve PRF therapy.The visual analogue scale (VAS), the curative effect score of Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) were assessed in the two groups before treatment, 7 days after treatment and 3 months after treatment.The serum levels of IL-8, CXCL10 were determined simultaneously.Results:After treatment, the VAS score and ODI in the two groups were decreased(VAS score: t=12.14, 27.85, all P<0.05; ODI: PRF group t=4.932, 7.414, all P<0.05; combination group t=4.235, 9.706, all P<0.05), and the JOA scores increased(PRF group: t=5.329, 7.576, all P<0.05; combination group: t=5.980, 9.526, all P<0.05). There were statistically significant differences in VAS score, JOA score and ODI between the two groups at 3 months after treatment( t=7.329, 5.719, 2.255, all P<0.05), which of the combination group after treatmentwere superior to the PRF group (all P<0.05). The serum levels of IL-8 in the two groups after treatment were decreased (PRF group: t=3.621, 4.631, all P<0.05; combination group: t=3.393, 5.370, all P<0.05), and the CXCL10 levels in the two groups after treatment were increased(PRF group: t=2.251, 3.559, all P<0.05; combination group: t=3.393, 5.370, all P<0.05). There were statistically significant differences in IL-8, CXCL10 levels between the two groups at 3 months after treatment, and the regulation of IL-8 and CXCL10 levels in the combination group was significantly better than those in the PRF group ( t=20258, 2.237, all P<0.05). Conclusion:RFTC combined with PRF is effective in the treatment of LDH, which can significantly relieve the clinical symptoms, reduce the inflammatory response and has a lasting efficacy.