Objective To observe the value of chocolate balloon(controlled dilatation technique)for vascular preparation of endovascular treatments for lower extremity arteriosclerosis obliterans(ASO).Methods Data of 110 patients with lower extremity ASO who underwent vascular preparation with chocolate balloon were retrospectively analyzed.The type of ASO,with calcification or not and so on were recorded,and the success rate of vascular preparation with chocolate balloon and the therapeutic effect of endovascular treatments for ASO were evaluated.Results Among 110 patients,unilateral lower extremity ASO were found in 100 cases,while bilateral lower extremities ASO were noticed in 10 cases,including 100(100/120,83.33%)chronic occlusive lesions,8(8/120,6.67%)stenotic lesions and 12(12/120,10.00%)thrombotic lesions.Calcification with grade 3-4 were observed in 50 lesions(50/120,41.67%).The technical success rate of vascular preparation with chocolate balloon was 92.50%(111/120),while 7(7/120,5.83%)lesions developed flow-limiting dissection after chocolate balloon dilatation and 2(2/120,1.67%)lesions had significant residual stenosis that did not meet the technical success criteria,which underwent stent implantation without drug-coated balloon(DCB).Besides,flow-limiting dissection were noticed in 15 lesions after DCB,hence salvage stents were implanted.The success rate of endovascular treatments of ASO was 100%.Conclusion Chocolate balloon(controlled dilation technique)was valuable for vascular preparation of endovascular treatments for lower extremity ASO.

Objective:To investigate the therapeutic efficiency of various types of Flow-through flap in the reconstruction of soft tissue defect with defect of proper palmar digital artery.Methods:Retrospective analysis was carried out on 22 patients who were treated with perforator flap of posterior interosseous artery, venous flap, the superficial palmar branch of radial artery flap, and "C" shaped flap of the great toe for soft tissue defects of hands with defects of palmar proper digital artery in the Department of Hand Surgery of Xuzhou Renci Hospital from January 2019 to January 2023. The patients were 15 males and 7 females with an average age of 39.5 (21-61) years old. The injured digits were 1 thumb, 6 index fingers, 8 middle fingers, 5 ring fingers and 2 little fingers. Ten injuries were of left hand and 12 of right hand. The wound size was 1.5 cm × 1.5 cm-4.5 cm × 3.0 cm, and the flap size was 2.0 cm × 1.5 cm-5.0 cm × 4.0 cm. The donor site wound were directly sutured and closed or treated by dressing changes to heal. Postoperative follow-ups were arranged at 1, 2, 3, 6 and 12 months after surgery at outpatient clinic, through telephone or WeChat interviews. The flap survival, postoperative complications at donor and recipient sites, patient satisfaction and range of motion of interphalangeal joint were observed and recorded.Results:Twenty flaps survived uneventfully. Tension vesicles appeared on the 2 arterialised venous flaps and healed after dressing changes. All donor sites healed uneventfully. All patients were included in the postoperative follow-up for an average of 10.3 (6-24) months. Appearance of the perforator flaps of posterior interosseous artery was bloated and the movement of interphalangeal joint was limited in 1 digit, however the patient refused a further flap thinning surgery. Scar dissection was performed on 1 of the venous flaps in stage II surgery. The rest of 20 patients were satisfied with the appearance of flaps hence no further thinning surgery was performed. According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 12 cases were evaluated as excellent, 9 cases as good, and 1 case as poor at the last follow-up. The mean static TPD was found at 6.9 (5-11) mm, and the average Semmes-Weinstein monofilament (SWM) test was found at 4.47 (3.61-6.65).Conclusion:The 4 types of perforator flap can be employed in the reconstruction of digital defect with defect of palmar proper digital artery in a one-stage surgery with satisfactory outcomes. Surgeons can accordingly make individualised surgical plans as required for the patients.

Objective To study the rheological properties of terbinafine hydrochloride cream,and provide a research basis for the consistency of this product.Methods The Kinexus rheometer was used to determine the dynamic and steady rheological parameters of terbinafine hydrochloride cream.Comparative studies on the rheological curves,yield stress,viscosity measurement,linear viscoelasticity and creep recovery of original and generic terbinafine hydrochloride cream were carried out.Results The original and generic terbinafine hydrochloride cream were both non-Newtonian fluid with shear thinning.The yield stress of three generic were similar to the original.The linear viscoelastic region of three generic were similar to the original,and the ranges of linear viscoelastic were both 0.01％-1％,the elastic moduli were all greater than the viscosity moduli and were viscoelastic materials.It could be seen from the creep recovery curve that the creep behavior of three generic were basically the same with the original.Conclusion Among the six terbinafine hydrochloride creams measured experimentally,the rheological properties of most generic drugs are basically the same as the original.

Objective To observe the value of susceptibility weighted imaging(SWI)based on 5.0T MRI for diagnosing hepatocellular carcinoma(HCC)complicated with vein tumor thrombi.Methods Totally 63 HCC patients were retrospectively enrolled,among them 17 complicated with vein tumor thrombi.The efficacy of 5.0T SWI for detecting vein tumor thrombus was observed,and the image quality were compared between 5.0T and 3.0T.Results 5.0T SWI displayed vein tumor thrombi in 16 cases,except for 1 case with vein tumor thrombi in the upper segment of the left lateral lobe of the left portal vein.The liver edge score,overall image quality score,signal-to-noise ratio and contrast-to-noise ratio of portal venous phase and hepatobiliary phase in 5.0T enhanced MRI were all higher than those in 3.0T(all P＜0.05).Conclusion 5.0T SWI was helpful for diagnosing HCC complicated with vein tumor thrombi.

Objective:To investigate the risk factors for refracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective cohort study was conducted on the clinical data of 149 OVCF patients who were admitted to the First Affiliated Hospital of Soochow University from June 2019 to June 2022, including 21 males and 128 females, aged 56-97 years [(73.2±8.7)years]. Initial surgical segments included T 7 in 1 patient, T 8 in 10, T 9 in 6, T 10 in 6, T 11 in 19, T 12 in 28, L 1 in 38, L 2 in 18, L 3 in 11, L 4 in 7 and L 5 in 5. Patients were divided into refracture group ( n=32) and non-refracture group ( n=117) according to whether they had postoperative refracture after PKP. Refractured surgical segments included T 8 in 2 patients, T 9 in 2, T 11 in 4, T 12 in 5, L 1 in 7, L 2 in 4, L 3 in 6, and L 5 in 2. The age, gender, underlying diseases (hypertension, diabetes), body mass index (BMI), preoperative bone mineral density (BMD), smoking history, drinking history, follow-up time, preoperative visual analogue scale (VAS), and preoperative Oswestry dysfunction index (ODI) of the two groups were recorded. Preoperative paravertebral muscle-related parameters of the two groups were calculated including cross-sectional area of bilateral psoas, bilateral erector spinae, bilateral multifidus, and vertebral bodies, paravertebral muscle mass, and vertebral bone quality (VBQ) score. Univariate analysis was performed to evaluate the correlation between the fore-mentioned indicators and postoperative refracture after PKP in OVCF patients. Multivariate logistic regression analysis was employed to identify the independent risk factors for postoperative refracture after PKP in OVCF patients. Results:Univariate analysis revealed that there was certain correlation of BMI, preoperative BMD, cross-sectional area of bilateral psoas, bilateral erector spinae, bilateral multifidus, paravertebral muscle mass and VBQ score with postoperative refracture after PKP in OVCF patients ( P<0.01), while no correlation was found between age, gender, hypertension, diabetes, smoking history, drinking history, follow-up time, preoperative VAS, preoperative ODI, or cross-sectional area of vertebral bodies and postoperative refracture after PKP in OVCF patients ( P>0.05). Multivariate logistic regression analysis showed that preoperative BMD ≤-3.4 SD ( OR=0.27, 95% CI 0.09, 0.80, P<0.05), paravertebral muscle mass ≤281.2% ( OR=0.98, 95% CI 0.97, 0.99, P<0.01) and VBQ score ≥4.8 points ( OR=4.41, 95% CI 1.18, 16.44, P<0.05) were significantly correlated with postoperative refracture after PKP in OVCF patients. Conclusion:Preoperative BMD ≤-3.4 SD, paravertebral muscle mass ≤281.2%, and VBQ score ≥4.8 points are the independent risk factors for refracture after PKP in OVCF patients.

Objective:To propose a novel refined subtyping of Neer type Ⅵ proximal humerus fracture-dislocation and explore its clinical application.Methods:A retrospective study was conducted to analyze the data of 36 patients who had been admitted to Department of Orthopaedics, Beijing Friendship Hospital between January 2018 and December 2022 for surgical treatment with proximal humeral internal locking system (PHILOS) for Neer type Ⅵ proximal humerus fracture-dislocation. There were 25 males and 11 females with an age of (46.1±4.7) years. According to the fracture-dislocation and the separation between the humeral head and the stem, the patients with Neer type Ⅵ proximal humerus fracture-dislocation were further subdivided into 3 subtype groups (known as STAB subtypes): subtype-T group (dislocation of the shoulder joint with macro-capitellar fracture, n=14), subtype-A group (proximal humerus fracture-dislocation without separation of the humeral head from the humeral stem, n=12), and subtype-B group (dislocation of the proximal humerus fracture with separation of the humeral head from the humeral stem, n=10). STAB subtyping was performed on the same imaging data from all the patients at admission and 2 weeks later by 4 surgeons with different qualifications. Interobserver and intraobserver agreements of the STAB typing were verified. The operation time, fracture healing time, visual analogue scale (VAS) pain score, Constant-Murley score, and complications were recorded for patients in the 3 subtype groups. Results:The differences in the preoperative general data were not statistically significant between the 3 subtype groups, indicating comparability ( P>0.05). All patients were followed up for (11.2±4.2) months. The inter-observer and intra-observer Kappa values for STAB subtyping were 0.94 and 0.95, respectively. For subtype-T group, subtype-A group, and subtype-B group, respectively, the operation time was (68.9±5.6) min, (90.0±5.2) min, and (113.0±9.2) min; the fracture healing time was (9.0±0.8) weeks, (10.3±1.2) weeks, and (11.8±0.9) weeks; the VAS scores at the last follow-up were 1.0(1.0, 2.0) points, 2.0(1.0, 2.0) points, 2.0(2.0, 3.0) points; the Constant-Murley scores at the last follow-up were (83.6±2.8) points, (74.5±3.0) points, and (62.7±5.5) points. The differences between the 3 subtype groups in the above items were statistically significant ( P<0.05). The overall success rate of closed reduction was 61.1% (22/36). In subtype-T, subtype-A, and subtype-B groups, respectively, the number of patients with successful closed reduction was 13, 7, and 2, while complications occurred in 2, 3, and 6 patients. The differences in closed reduction and complications among the 3 groups were statistically significant ( P<0.05). Conclusions:The STAB subtyping proposed in this study demonstrates strong intra- and inter-group consistency. Because the refined STAB subtyping can reveal differences among all the Neer type Ⅵ proximal humeral fractures and dislocations, it may provide more precise guidance for personalized clinical decision-making.

Objective To investigate the effects of remimazolam and propofol on postoperative nausea and vomiting(PONV)in patients undergoing painless prostate biopsy,so as to optimize the anesthesia protocols.Methods A retrospective analysis was conducted on the clinical data of 1217 patients who underwent painless prostate biopsy in our hospital during Jan.2023 and Jun.2024.Among them,1093 patients met the inclusion criteria and were divided into two groups:the remimazolam group(n=294)and the propofol group(n=799).After 1∶1 propensity score matching,with 267 patients in either group,a comparison was conducted regarding the incidence of PONV and anesthesia recovery time.Results Before propensity score matching,the remimazolam group had older age[66(53,83)years vs.63(49,78)years],higher body mass index(BMI)[25.30(21.83,29.23)vs.24.46(20.79,28.91)],larger intraoperative use of sufentanil[9(8,10)μg vs.7(6,9)μg],higher intraoperative use rate of ondansetron(55.4％vs.47.6％),and longer surgical duration[16(14,20)min vs.15(13,17)min],with statistically significant differences(P＜0.05).There were no statistically significant differences in the aforementioned factors between the two groups after propensity score matching(P＞0.05).Before propensity score matching,the incidence of PONV was higher in the remimazolam group than in the propofol group(17.7％vs.11.5％,P=0.007),while after propensity score matching,the incidence of PONV did not differ significantly between the two groups(12.7％vs.17.2％,P=0.146).Before and after propensity score matching,the anesthesia recovery time was significantly shorter in the remimazolam group than in the propofol group[3(2,4)min vs.7(4,10)min,P＜0.001].Conclusion Compared with propofol,remimazolam does not increase the incidence of PONV in patients undergoing painless prostate biopsy but can shorten anesthesia recovery time.

With the aging population, the increasing incidence of adult spinal deformity (ASD) associated with osteoporosis (OP) presents new challenges for evaluation and management. Although reasonable and standardized non-surgical treatment remains the first choice in the early stages of this disease, surgical treatment is necessary for patients with severe deformities and significant symptoms to achieve further improvement. Proximal junctional kyphosis/failure (PJK/PJF) is one of the most serious postoperative complications of ASD. Careful and comprehensive preoperative evaluation of bone quality and body sagittal alignment is crucial for the successful implementation of the operation. The Hounsfield unit (HU) based on CT imaging and the vertebral bone quality (VBQ) score based on MRI have proven to be reliable, effective, simple, and widely used in evaluating local vertebral bone quality in recent years. For the evaluation and prediction of PJF after ASD, the bone quality of the upper instrumented vertebra (UIV) can be assessed using HU values to identify high-risk patients and implement preventive measures. The VBQ score is predictive of the incidence of PJK/PJF in patients undergoing ASD surgery, with a high VBQ score being one of the risk factors for PJK/PJF after ASD correction. Patients with high VBQ scores can delay surgery and use anti-osteoporosis drugs before surgery to reduce the occurrence of PJK/PJF. Meanwhile, reasonable and personalized recovery parameters of ASD patients' sagittal sequence can help balance the benefits of efficacy and complications, maximizing the overall benefits. The prevention of PJK/PJF is challenging due to the stress gap between the internal fixation area and the original unfixed tissue area in the postoperative proximal junctional area, which is increasingly significant in OP patients. It is necessary to improve the fixation strength and bone riveting strength of the proximal junction area properly and to gradually decrease the fixed strength in the proximal junctional area to achieve a smooth transition of stress and avoid stress concentration resulting in failure. Relevant strategies include: 1. Enhanced proximal junction fixation, such as vertebral cement-enhanced pedicle screw fixation. 2. Strategies to cushion the stress in the proximal junction, such as Topping-off technology, which includes laminar/transverse hooks, dynamic rods, multi-segment stabilization screws, and multiple ligament-binding straps. 3. Minimally invasive technology can better protect the soft tissues such as the posterior ligament complex and muscles, reduce iatrogenic injury, and thus reduce the incidence of PJK/PJF. Currently, there are many controversies about the optimal treatment for ASD with OP, but the goal is to achieve maximum efficacy while minimizing complications. Additionally, attention should be paid to reasonable and standard anti-osteoporosis treatment in the perioperative period. This paper summarizes the relevant studies used to evaluate PJK/PJF after ASD in patients with OP and reviews the research progress on PJK/PJF prevention strategies, providing reference and ideas for reducing postoperative proximal junctional complications in adult spinal deformity patients with osteoporosis.

Astragalosides are the main active constituents of traditional Chinese medicine Huang-Qi, of which cycloastragenol-type glycosides are the most typical and major bioactive compounds. This kind of compounds exhibit various biological functions including cardiovascular protective, neuroprotective, etc. Owing to the limitations of natural sources and the difficulties encountered in chemical synthesis, re-engineering of biosynthetic machinery will offer an alternative and promising approach to producing astragalosides. However, the biosynthetic pathway for astragalosides remains elusive due to their complex structures and numerous reaction types and steps. Herein, guided by transcriptome and phylogenetic analyses, a cycloartenol synthase and four glycosyltransferases catalyzing the committed steps in the biosynthesis of such bioactive astragalosides were functionally characterized from Astragalus membranaceus. AmCAS1, the first reported cycloartenol synthase from Astragalus genus, is capable of catalyzing the formation of cycloartenol; AmUGT15, AmUGT14, AmUGT13, and AmUGT7 are four glycosyltransferases biochemically characterized to catalyze 3-O-xylosylation, 3-O-glucosylation, 25-O-glucosylation/O-xylosylation and 2'-O-glucosylation of cycloastragenol glycosides, respectively. These findings not only clarified the crucial enzymes for the biosynthesis and the molecular basis for the structural diversity of astragalosides in Astragalus plants, also paved the way for further completely deciphering the biosynthetic pathway and constructing an artificial pathway for their efficient production.

Objective:To analyze the risk factors for residual pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral fractures (OVF).Methods:Retrospectively analyzed were the patients with OVC who had been treated at Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University by single level PKP from January 2020 to December 2021. They were 40 men and 181 women, with an age of (69.6±8.2) years. By the pain score of visual analogue scale (VAS) on the postoperative day 3, they were assigned into 2 groups: a residual pain group (VAS≥4) and a control group (VAS<4). The general demographics, radiographic and surgical related data of the 2 groups were analyzed by single factor analysis, including their gender, age, bone mineral density, body mass index, glucocorticoid usage, follow-up time, duration of symptoms, fracture location, severity of fracture compression, intravertebral cleft, middle column involvement, thoracolumbar fascia injury, anesthesia method, puncture method, volume of bone cement injected, cement-endplates contact, pattern of cement distribution, cement leakage, vertebral height restoration, preoperative cobb angle and correction of cobb angle. The P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables. Results:In the present study, 19 patients were assigned into the residual pain group and 202 patients the control group. The univariate analysis showed that body mass index ( P=0.059), intravertebral cleft ( P=0.049) and thoracolumbar fascia injury ( P< 0.001) increased the risk for residual pain. The multivariate logistic regression analysis showed that thora-columbar fascia injury was an independent risk factor for residual pain ( OR=6.127, 95% CI: 2.240 to 16.755, P<0.001). Conclusion:Thoracolumbar fascia injury is an independent risk factor for residual pain after PKP for OVF.