Objective:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Objective:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Objective: To explore the predictive value of fractional lfow reserve (FFR) level for long-term prognosis in patients after coronary drug-eluting stent (DES) implantation, and to analyze the relevant factors affecting the level of post-operative FFR. Methods: A total of 135 patients who received DES implantation in our hospital from 2012-01 to 2013-07 with coronary intermediate lesion at (50-80) % were studied. The relevant factors for MACE occurrence were studied by multivariate logistic regression analysis, the post-stent FFR level for predicting the long term prognosis after DES implantation was ifnally analyzed by ROC curve. Results: All patients ifnished 1 year follow-up study including 104 male and 31 female with the mean age of (63 ± 9) years. The post-stent FFR level was lower in MACE group than that in Non-MACE group, (0.82 ± 0.07) vs (0.87 ± 0.06),P=0.004. Multivariate logistic regression analysis presented that the higher level of post-stent FFR was the protective factor for MACE occurrence (OR=0.212,P=0.039); the post-stent FFR level had certain predictive value for MACE occurrence at 1 year after DES implantation (AUC=0.706,P=0.006); Kaplan-Meier survival study showed that the patients with post-stent FFR<0.875 had the less MACE occurrence than those with FFR≥0.875,P=0.012. Multivariate logistic regression analysis also indicated that post-stent FFR≥0.875 was positively related to right coronary target vessel, higher pre-operative FFR level and larger stent diameter.Conclusion: Post-stent FFR level had certain predictive value for MACE occurrence in patients at 1 year after DES implantation, the patients with post-stent FFR≥0.875 had the lower MACE occurrence rate than those with FFR<0.875.

PurposeTo investigate the relationship between left atrial volume index (LAVI) and severity of coronary lesions in patients with stable angina pectoris, so as to provide information for the evaluation of the severity of coronary artery disease (CAD). Materials and MethodsAccording to the results of coronary angiography, 279 patients with stable angina pectoris and 92 healthy people were as control group, all subjects were divided into four groups: control group (n=92), single-vessel CAD group (n=116), double-vessel CAD group (n=93) and triple-vessel group (n=70). Each group was compared in the aspects of demographic characteristics, history of illness, liver and kidney functions and parameter's difference in echocardiogram; the correlation between LAVI and Gensini score was analyzed; and the receiver operating characteristic (ROC) curve was used to identify the predictive value of LAVI in severity of coronary lesions.ResultsCompared with the control group, the double-vessel and triple-vessel CAD groups had significantly larger left atrial diameter (P<0.05). In triple-vessel CAD group, the left atrial diameter was significantly larger than that in the single-vessel CAD group (P<0.05), and the left ventricular end-diastolic diameter was significantly larger than that in the control group and in the single-vessel CAD group (P<0.05), and the E/Em and LVMI were significantly higher than those in other groups (P<0.05). The LAVI was higher in patients with CAD compared with those in the control group and the LAVI in the triple-vessel CAD group was significantly higher than that in single-vessel CAD group and double-vessel CAD group (P<0.05); the LAVI was correlated positively with Gensini score (r=0.499,P<0.01). LAVI had certain value in predicting triple-vessel CAD (AUC=0.782,P<0.01). The results of multi-factor Logistic regression analysis showed that male patients with hypertension, mitral reflux, and multi-vessel CAD were more likely to had high LAVI.Conclusion The worsening LV diastolic function is associated with the increasing severity of coronary artery lesions, and LAVI may have predictive value for severity of CAD.

Objective To explore the value of left atrium volume index (LAVI) in the diagnosis of heart failure with preserved ejection fraction (HFPEF). Methods Seventy-seven patients with HFPEF and 33 patients without HFPEF who had been treated from May 2012 to September 2013 in Guangdong General Hospital were en-rolled. The clinical data and a series of ultrasound parameters were collected and analysed. The relationship between LAVI, LAV, and other indexes of diastolic function was determined by Pearson correlation analysis. The value of LAVI and LAV for diagnosing HFPEF was compared by the ROC curve. Results LAVI and LAV of were signifi-cantly greater in HFPEF group than in non-HFPEF group. LAV and LAVI were significantly associated wtih HEPEF. The area under the ROC curve (AUC) of LAVI increased significantly as compared with the AUC of LAV (0.832 vs. 0.799, P<0.05). With a cut-off value of 30 mL/m2, the specificity and sensitivity for diagnosing HEPEF were 64.9%and 84.8%, respectively. Conclusions LAVI may be valuable in the diagnosis of HFPEF.

Objective To explore the relationship between the apolipoprotein ApoA1-75 bp polymorphism and risk for dyslipidemia and coronary artery disease (CAD).Methods A total of 723 patients (mean age (62.4 ± 10.2) years old) admitted to Guangdong General Hospital from 2011 to 2013 were enrolled.They were subdivided into CAD group (n =444) and non-CAD (n =279) group according to the result of coronary angiography (CAG).Clinical data including the profiles of lipids,-75 bp gene polymorphisms and Gensini scores were analyzed to determine the correlation between-75 bp gene polymorphisms,lipid profile and CAD.Result Frequency of male gender,history of diabetes and smoking,TC,TG,LDL-C and ApoB level were significantly higher and HDL-C level was significantly lower in CAD group than in non-CAD group (all P ＜ 0.05).Frequency of A allele was significantly lower in CAD group than in non-CAD group (43.7％ (194/444) vs.56.6％ (158/279),P =0.003).The ApoA1-75 bp gene polymorphism was significantly correlated with CAD (P ＜ 0.005).Multivariate logistic regression analysis showed that-75 bp gene polymorphism mutation (OR =0.649,P =0.021) is an independent protective factor for coronary heart disease.Conclusion ApoA1-75 bp gene polymorphism is linked with risk of dyslipidemia and CAD.

Objective To observe the clinical effect of Ozagrel sodium with ultrasonic therapy in patients with acute cerebral infarction (ACI). Methods Eighty-three ACI patients were randomly divided into 2 groups: ultra-sortie therapy group(n=42) received Ozagrel sodium and ultrasonic therapy, whereas control group(n = 41) only ac-ecpted the Ozagrel sodium for injection. Both two groups were under conventional treatment. The level of laboratory in-dex and the neurological impairment were detected before and after treatment. And the clinical effect were detected in the end of the treatment. Results The neurological impairment and the clinical effect defected after therapy in both groups, had statistical difference(P < 0. 05), especially in the ultrasonic therapy group. Conclusion Ozagrel sodium with ultrasonic therapy in patients with ACI could promote recovery of the neurological function, thus increase clinical effect.