Objective To discuss the reason of skin flap necrosis caused by vascular crisis of reverse island flap of forearm posterior interosseous artery.Methods Eight-six patients who were underwent reverse island flap of forearm interosseous posterior artery for deep tissues and skin defect on the back of hand between March,2002 and April,2014 were analyzed in this study.Eleven patients had occurred skin flap necrosis,include 5 cases had completely flap necrosis caused by circulation crisis,and 6 cases had partial necrosis at the distal of the flap.Among the necrosis cases,5 cases were injured by the machine injury,4 cases by the heavy crush and 2 cases by the traffic accident.The cause of circulation crisis was analyzed.Results In the series,75 skin flaps survived completely and 11 cases had occurred necrosis,included completely necrosis with 5 cases.The reasons of flap crisis were as follows:for the completely necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with absence of posterior interosseous artery,1 case with vessel pedicel entrapment in subcutaneous tunnel,and 1 case with misconduct venous congestion caused by the reverse perfusion of superficial vein.The reason of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 3 of them with distortion of entrapment at pedicel and vein crisis.One case was cured through debridement,change of medical prescription and skin grafting;and 4 cases were cured with other flap repair technique.For the partial necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with excessively narrow entrapment at pedicel in subcutaneous tunnel,1 case with folding vessel pedicel entrapment of skin at the back of wrist,1 case with misconduct of superficial vein trunk and 1 case with intraoperative side-injury.The symptoms of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 4 of them with distortion of entrapment at pedicel and vein crisis.Four cases were cured through debridement and skin grafting,1 case was cured by the vacuum-sealing drainage (VSD) and 1 case with skin flap repair at pedicle of abdomen.Conclusion The anatomic variation of perforator vessel of reverse island flap of forearm posterior interosseous artery;narrow entrapment at pedicel in subcutaneous tunnel and distortion of entrapment at pedicel;venous congestion caused by the reverse perfusion of superficial vein;intraoperative side-injury of the pedicel of the flap;excessively folding vessel pedicel entrapment of skin at the back of wrist after surgery will cause the circulation crisis of reverse island flap of forearm posterior interosseous artery and induce the necrosis of the skin flap.

Objective To investigate whether simple visual assessment of FVERVOT(the right ventricular outflow tract Doppler flow velocity envelop) graphs aids in hemodynamic differentiation. Method The hemodynamics, echocardiography, and clinical data of 88 patients with pulmonary hypertension (PH) were reviewed. The FVERVOTgraphs were categorized into normal pattern (no notch; NN), late systolic notch pattern (LSN) or mid-systolic notch pattern (MSN). Results The pulmonary vascular resistance (PVR) was highest in the MSN pattern (9.2±3.5 WU; P＜0. 001), in comparison with LSN (5,7 ±3. 1 WU) and NN (3.3±2.4 WU) patterns. The ratio of stroke volume to pulse pressure (compliance) also varied with different patterns of FVERVOr graph (MSN = 1.2 ± 0. 5; LSN = 1.7 ± 0.8; NN = 2.6 ± 1. 7, P = 0.001 and 0.04 respectively compared with NN). The specificity and sensitivity of MSN were 96% and 71%, respectively in case of a PVR ＞ 5 WU (PPV 98%). In the patients with PH, any notching pattern of FVERVOT graph was highly associated with PVR ＞ 3 WU (OR = 22.3, 95 % CI: 5.2 ～ 96.4), whereas the NN pattern predicted a PVR ≤3 WU and pulmonary artery wedge pressure (PAWP) ＞ 15 mmHg (OR =30.2, 95%CI: 6.3 ～ 144.9). Conclusions Visual inspection of the shape of the FVERVOT graphs provides insight into the hemodynamic status of patients with PH.

OBJECTIVE: To conduct signature analysis for splenic trauma in canines during hemorrhagic shock and resuscitation by contrast enhanced ultrasonography (CEUS). METHODS: Forty grade III-IV traumatic splenic lesions were established in 15 mongrel dogs. Hemorrhagic shock was induced in these animals by using the modified Wiggers's method. Animals in shock were then resuscitated with 6% hydroxyethyl starch. The features of splenic trauma during hemorrhagic shock or resuscitation were assessed by CEUS, which were compared with the data collected by contrast-enhanced computed tomography (CECT). Acoustic quantification of CEUS was performed to assess splenic blood perfusion in different stages. RESULTS: There was no significant difference in detection rate between CEUS and CECT during hemorrhagic shock and resuscitation. Before hemorrhagic shock, there were 40 traumatic bleeding lesions and 85% of them were revealed by CEUS (34/40). With the progress in shock, CEUS revealed that the numbers of tiny branches of splenic arteries were decreased, which became thinner with no active bleeding. After fluid resuscitation, rebleeding was occurred in 30 traumatic lesions, and 28 (93.3%) of them were captured by CEUS. CEUS could also visualize the changes in splenic perfusion in different stages. During the shock, the arrival time (AT), time to peak intensity (TTP), peak intensity (PI) were significantly lower and the washout time (WT) were significantly higher than those at other stages (P<0.01). CONCLUSION CEUS not only can dynamically monitor the changes in spleen traumatic hemorrhage and recurrent hemorrhage, but also can quantitatively study the changes in spleen blood perfusion in different stages.
Animals ; Contrast Media ; Disease Models, Animal ; Dogs ; Fluid Therapy ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; therapeutic use ; Resuscitation ; Shock, Hemorrhagic ; pathology ; therapy ; Spleen ; diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography

Background and purpose:As one of the most fatal malignant tumors in China, the morbidity and mortality of lung cancer remain high. Early diagnosis and normative treatment is the key to improve the prognosis of lung cancer. The aim of this study was to explore the practice of early lung cancer screening with low-dose spiral computed tomography (CT) based on the current situation in community health service, with integration of superior resources of med-ical institutions at all levels in Shanghai.Methods:From Aug. 2013 to Aug. 2014, we screened high-risk population in selected communities of Minhang District, Shanghai, for early diagnosis of lung cancer with low-dose spiral CT combined with multidisciplinary comprehensive treatment models including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation and follow-up.Results:Screening population is 11 332 (male 7 144, female 4 188); Twenty-nine cases with pathological diagnosis of malignant tumor, including 27 cases of pri-mary lung cancer, 1 case of lung metastasis, 1 case of breast cancer. The morbidity of primary lung cancer is 238.26×10-5. There were 22 cases of Stage 0-Ⅰ lung cancer accounting for 81.48% of all diagnosed primary lung cancer.Conclusion:Based on community health service, screening with low-dose spiral CT could improve the early diagnosis rate of lung can-cer with feasibility and validity, which could be applicable in qualified eligible medical center and community in China.

Objective:To evaluate the efficacy and safety of limited pars plana vitrectomy(LPPV), pressure-controlled phacoemulsification(PCP), intraocular lens implantation(IOL), and posterior capsulotomy (PC) in treatment of nanophthalmic glaucoma eyes which intraocular pressure(IOP) were still out of control after peripheral iridectomy.Methods:All 24 patients(29 eyes) with nanophthalmic glaucoma whose IOP failed to be reduced after peripheral iridectomy and needed LPPV plus PCP plus IOL plus PC were recruited from July 2017 to April 2021. The age of these patients was(44.6±11.0) years old. Preoperative and postoperative IOP, best corrected visual acuity(BCVA), anterior chamber depth(ACD) and number of glaucoma medications were recorded by chart review and compared by using paired t-test or Wilcoxon signed rank-sum test. P<0.05 was considered as statistical significant. IOP could be controlled in normal range(≥5 mmHg and≤21 mmHg), without both of disease progression and serious complications were regarded as the success criteria of the operation. Surgical success rate was evaluated. Surgery-associated complications were recorded. Results:The average follow-up time was(11.52±12.44) months. After the microsurgery, IOP decreased from(33.12±9.25) mmHg to(14.23±3.44) mmHg( P<0.01); The ACD increased from(1.23±0.46) mm to(2.86±0.62) mm, and the median number of glaucoma medications dropped from 3(3,4) to 3(0,3) at final follow-up visit( P<0.05). There were no significant differences in BCVA( P=0.196) and the degrees of angle closure(AC) ( P=0.478) before and after operation. The total surgical success rate was 86.2%(25/29) at the final follow-up visit. Two eyes suffered from local choroidal detachment which recovered within 2 weeks with medical treatment. Conclusion:LPPV plus PCP plus IOL plus PC is a safe and effective novel surgical procedure in the treatment of nanophthalmic glaucoma patients with uncontrolled IOP after peripheral iridectomy. It could significantly decrease IOP, increase the depth of ACD, reduce the number of glaucoma medications and maintain BCVA. It can be considered as a first choice for the surgical management for patients with a such condition.

Objective To identify the sets of lymphocytes that could systematically evaluate immune function of colorectal cancer patients, based on the expression of colorectal cancer T cells, natural killer (NK) cells, and NKT cell surface protein receptors. Methods Peripheral blood samples from 144 patients with colorectal cancer and 87 healthy controls were collected, and the differences in surface receptors of lymphocyte subsets in peripheral blood of patients and healthy controls were analyzed by means of flow cytometry and cell culture. Results Compared with healthy control group, the percentage of peripheral blood total lymphocytes, CD16^brightCD56^dimNK cells and NKT cells decreased in patients with colorectal cancer. The percentage of T cells, CD16^brightCD56^dimNK cells and NKT cell surface inhibitory receptors T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitor motif domains (TIGIT) increased; T cells, NK cells, NKT cell surface chemokine receptor C-C motif chemokine receptor 7 (CCR7) slightly decreased. Conclusion There are differences in the proportion of NK cell subsets and the expression profile of surface receptors in peripheral blood of patients with colorectal cancer.
Humans ; Lymphocyte Subsets ; Killer Cells, Natural ; Lymphocyte Count ; Receptors, Chemokine ; Colorectal Neoplasms