Against the backdrop of the Russia-Ukraine Conflict in 2022, this article reviews the characteristics of traumatic hemorrhage in modern warfare spanning the past century. It investigates several types of tourniquets used by the Russian and Ukrainian armed forces, including limb tourniquets and junctional tourniquets recommended by the Committee on Tactical Combat Casualty Care, tourniquets employed by the Armed Forces of the Russian Federation, and those used by the Armed Forces of Ukraine in the Russia-Ukraine Conflict. The analysis is conducted from perspectives, including the structure, usage methods, and limitations of different tourniquets. Additionally, the article synthesizes the research progress on tourniquets from 3 angles: battlefield adaptability, the impact of tourniquet application methods on patient outcomes, and training in tourniquet usage, offering insights from our team's perspective.
Tourniquets ; Humans ; Russia ; Hemorrhage/therapy* ; Ukraine ; Military Medicine/methods* ; Warfare ; Armed Conflicts

Objective: To explore a safe, effective and rapid rescue method and key points for the management of vascular surgical emergencies in an area under guaranting Covid-19 (corona virus disease 2019) . Methods: Under the guidance of COVID-19 diagnosis and treatment guidelines , 4 cases of vascular surgical emergency patients admitted to our department from Feb 1 to Feb 10, 2020 were screened for COVID-19 and given emergency vascular surgical treatment. Results: Two patients had acute thoracic aortic dissection, one patient had acute left foot ulcer with infection, one patient had severe carotid artery stenosis and frequent TIA. All patients were diagnosed quickly according to the three-level triage process. Endovascular repair (TEVAR) was performed in 2 cases, carotid stenting in 1 case, and left foot amputation in 1 case. Two patients running postoperative fever below 38℃ were safely excluded COVID-19 and cured. There were no other major morbidities nor mortality. Conclusions Under the COVID-19 prevention and control guidelines, the establishing of a comprehensive prevention and control system of patient-medicine-care-management helps to perform confine operation on vascular surgical emergency.

Objective:To investigate the clinical efficacy and mechanism of atorvastatin and Lipo-prostaglandin E1 (LipoPGE1) combined with hyperbaric oxygen (HBO) in the treatment of diabetic lower extremity vascular disease.Methods:A total of 194 patients with diabetic lower extremity ischemic disease received conservative treatment at the Department of Vascular Surgery of Longkou People’s Hospital from October 2016 to October 2019 were included into a retrospective analysis, who were divided into observation group ( n=102) and control group ( n=92) according to the treatment. The control group was treated with atorvastatin and LipoPGE1 on the basis of conventional symptomatic treatment, while the observation group was treated with HBO on the basis of that of the control group. The peak systolic velocity (Vmax), resistance index (RI), and ankle brachial index (ABI) of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery were measured before and after treatment by color Doppler ultrasound. The skin temperature and transcutaneous oxygen partial pressure (TcPO 2) were recorded before and after treatment. The levels of inflammatory factor interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum were detected by enzyme-linked immunosorbent assay (ELISA) and that of C-reactive protein (CRP) was detected by fluorescence method. The whole blood high, low, and medium shear rate, plasma viscosity, and fibrinogen (Fib) of the two groups were detected by digital noninvasive hemodynamic detector. Results:After 3 courses of treatment, the skin temperature, TcPO 2, and ABI of the two groups were significantly higher than those before treatment, and the skin temperature, TcPO 2, and ABI of the observation group were significantly higher than those of the control group ( P<0.05). The limb pain score and intermittent claudication score of the two groups were significantly lower than those before treatment; and after treatment, the limb pain score and intermittent claudication score of the observation group were significantly lower than those of the control group ( P < 0.05). The Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the two groups were significantly higher than those before treatment, and the RI was significantly lower than that before treatment; and after treatment, the Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the observation group were significantly higher than those of the control group, and the RI was significantly lower than that of the control group ( P<0.05). The levels of serum TNF- α, IL-6, and CRP of the two groups were significantly lower than those before treatment; and after treatment, the levels of TNF-α, IL-6, and CRP of the observation group were significantly lower than those of the control group ( P < 0.05). The whole blood high, low, and medium shear rate, plasma viscosity, and Fib of the two groups were significantly lower than those before treatment; and after treatment, those of the observation group were significantly lower than those of the control group, the differences were statistically significant ( P< 0.05). Conclusion:Atorvastatin and LipoPGE1 combined with HBO can significantly improve the clinical symptoms of the patients with diabetic lower extremity vascular disease and restore the damaged neurovascular function, which is mainly achieved by reducing the inflammatory factors and improving the level of hemorheology of the patients with diabetic lower extremity vascular disease.

Objective:To investigate the clinical efficacy and mechanism of atorvastatin and Lipo-prostaglandin E1 (LipoPGE1) combined with hyperbaric oxygen (HBO) in the treatment of diabetic lower extremity vascular disease.Methods:A total of 194 patients with diabetic lower extremity ischemic disease received conservative treatment at the Department of Vascular Surgery of Longkou People’s Hospital from October 2016 to October 2019 were included into a retrospective analysis, who were divided into observation group ( n=102) and control group ( n=92) according to the treatment. The control group was treated with atorvastatin and LipoPGE1 on the basis of conventional symptomatic treatment, while the observation group was treated with HBO on the basis of that of the control group. The peak systolic velocity (Vmax), resistance index (RI), and ankle brachial index (ABI) of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery were measured before and after treatment by color Doppler ultrasound. The skin temperature and transcutaneous oxygen partial pressure (TcPO 2) were recorded before and after treatment. The levels of inflammatory factor interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum were detected by enzyme-linked immunosorbent assay (ELISA) and that of C-reactive protein (CRP) was detected by fluorescence method. The whole blood high, low, and medium shear rate, plasma viscosity, and fibrinogen (Fib) of the two groups were detected by digital noninvasive hemodynamic detector. Results:After 3 courses of treatment, the skin temperature, TcPO 2, and ABI of the two groups were significantly higher than those before treatment, and the skin temperature, TcPO 2, and ABI of the observation group were significantly higher than those of the control group ( P<0.05). The limb pain score and intermittent claudication score of the two groups were significantly lower than those before treatment; and after treatment, the limb pain score and intermittent claudication score of the observation group were significantly lower than those of the control group ( P < 0.05). The Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the two groups were significantly higher than those before treatment, and the RI was significantly lower than that before treatment; and after treatment, the Vmax of popliteal artery, anterior and posterior tibial artery, and dorsalis pedis artery of the observation group were significantly higher than those of the control group, and the RI was significantly lower than that of the control group ( P<0.05). The levels of serum TNF- α, IL-6, and CRP of the two groups were significantly lower than those before treatment; and after treatment, the levels of TNF-α, IL-6, and CRP of the observation group were significantly lower than those of the control group ( P < 0.05). The whole blood high, low, and medium shear rate, plasma viscosity, and Fib of the two groups were significantly lower than those before treatment; and after treatment, those of the observation group were significantly lower than those of the control group, the differences were statistically significant ( P< 0.05). Conclusion:Atorvastatin and LipoPGE1 combined with HBO can significantly improve the clinical symptoms of the patients with diabetic lower extremity vascular disease and restore the damaged neurovascular function, which is mainly achieved by reducing the inflammatory factors and improving the level of hemorheology of the patients with diabetic lower extremity vascular disease.

Objective To evaluate the safety and efficacy of induced hypotension and hypotension in carotid endarterectomy (CEA).Methods Data of 1 486 patients who underwent CEA in multicenters from Aug 2012 to Aug 2018 were retrospectively analyzed.After screening,a total of 1 448 patients met the inclusion criteria.Induced hypertension and hypotension was used in all thees patients.Results 87.8％ of the patients were with severe carotid stenosis.The average operative time was (51.8 ± 6.1) min,and the internal carotid artery clamping time was (11.4 ± 3.1) min.After induced hypertension,the stump pressure were higher than that before,of which 1 438 (99.3％) were greater than 50 mmHg.Monitoring of EEG oxygen saturation showed that the value of ipsilateral rSO2 was significantly lower than that of the contralateral [(56％ ± 3％) vs.(64％ ± 4％),P ＜ 0.05] before induced hypertension.After induced hypertension and clamp removal,the value of ipsilateral rSO2 was lower than that of the contralateral,but there was not significant difference (all P ＞ 0.05).Perioperative cerebral infarction occurred in 2 cases,ipsilateral cerebral hemorrhage in 1 case,contralateral cerebral hemorrhage in 1 case and myocardial infarction in 2 cases.Connclusion The technique of induced hypotension and hypotension play a temporary role in brain protection for patients undergoing CEA.This study demonstrated the safety and effectiveness of induced hypertension and hypotension technique.

Objective To explore the feasibility and safety of carotid artery stenting (CAS) via right transradial approach (TRA).Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA.Patients were divided into the right carotid artery group (RCA),bovine left carotid artery group (B-LCA),nonbovine carotid artery group (NB-LCA) according to the lesion location.Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique(CLRET).Results CAS were successful in all cases (100％),the differences of the operation time and fluoroscopy time among RCA group,B-LCA group and NB-LCA group were not significant.In NB-LCA group,CLRET were applied in 10 cases (55.56％,10/18),includeing 8 cases with type Ⅲ aortic arch(100％,8/8)and 2 cases with type Ⅱ aortic arch (33.33％,2/6).The CLRET prolonged the operation time and fluoroscopy time [(39.45 ±7.27) min vs.(30.80±4.66) min;(11.84 ± 2.05) min vs.(9.91 ± 1.45) min,P ＜0.05).There was no cerebrovascular events and puncture point complications in perioperative period.Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible,especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.

YKL-40, a newly found inflammatory marker, is belonged to the mammals′chitinase family.It showed that YKL-40 can participate in a variety of inflammatory diseases such as airway inflammatory diseases, cardiovascular and neurological inflamma-tory diseases, and arthritis etc.It could be used to diagnose and evaluate these inflammatory diseases.Since its specific receptor has not been identified, the exact biological role of YKL-40 in inflammatory response still remains unclear.This article reviews the function of YKL-40 in inflammatory response and its related signaling pathways.

Cardiovascular Diseases ; Cell Proliferation ; Humans ; MicroRNAs ; Muscle, Smooth, Vascular

Objective To discuss the feasibility, safety and validity of the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral traumatic pseudoaneurysm (TPA). Methods During the period from June 2012 to April 2014, a total of 8 patients with peripheral TPA were admitted to the Department of Vascular and Endovascular Surgery of Shanghai Changzheng Hospital . The clinical data were retrospective analyzed. The lesions were located at the common carotid artery (n=4), vertebral artery (n=1), subclavian artery (n=1) and superficial femoral artery (n=2). On the basis of acute and chronic TPA classification and different therapeutic principles, endovascular repair with ViabahnTM self-expanding covered stent was employed in 8 patients. Intraoperative angiographic findings, the size and number of the implanted stent, and the immediate angiographic results after stent implantation were recorded. All the patients were followed up to evaluate the improvement of the symptoms, the effectiveness of the repair of TPA cavity, and the occurrence of endoleak or restenosis. Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 8 patients, with a technical success rate of 100%. Angiography performed immediately after stent implantation showed that complete repair of TPA cavity was obtained in all patients, the distal segment of the parent artery was patent, and no endoleak was observed. The sizes of the stent used in the patients were 8×50 mm (n=2) and 9×50 mm (n=2) in common carotid artery, 6×50 mm (n=1) in vertebral artery, 11×100 mm (n=1) in subclavian artery, and 8×100 mm (n=2) in superficial femoral artery. The patients were followed up for 6-30 months (mean of 14.3 months), and the clinical symptoms disappeared in all patients. CT angiography indicated that there was no endoleak or restenosis. Conclusion Based on the different therapeutic principles, the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral TPA is technically simple and micro-invasive, and clinically feasible with reliable effect and safety. Therefore, this technique can be employed as a first-line therapy option for peripheral TPA.

Objective To summarize the clinical characteristics of and therapeutic approaches to deep venous thrombosis(DVT)caused by pelvic tumors,in the fact that some patients with pelvic tumors may present DVT as the first sign of the tumor. Methods The clinical data of 36 patients admitted between January 1997 and April 2009 suffering from pelvic tumor induced DVT were analvzed retrospectively.Result In all of these 36 patients,the occurrence of limb sweUing wag chronic and progressive with insidious onset.Regular DVT treatment Was given to 25 cases yielding no effect before the cause Was revealed.Ultrasound and CT were used for detection of the pelvic tumor.and compression of the iliac vein by the tumor was detected in an the cases.Pelvic tumor resection with iliac vein ligation was done in 29 cases(5 cases had iliac artery reconstruction with prothesis graft),in the remaining cases the pelvictumors were left untreated. Elastic stocking compression and venotropie preparations. microcirculation-improving agents were routinely applied in all the pafients.All the cases got improvement with different degrees.Conclusion DVT Call be a precursor of pelvic tumors.A thorough consideration of this posibility Is important when limb swelling Was chronic and progressive,or no improvement was observed after regular DVT treatment.Surgical resection of the pelvic tumors and conservative therapy of the involved limb is the therapeutic principle.