OBJECTIVES: Pauwels III fracture is a kind of femoral neck fractures, in which the angle of the fracture line in the coronal plane and the upper edge of the acetabulum is more than 50°. Internal fixation for the treatment of femoral neck fractures is largely performed by cannulated compression screw (CCS), dynamic hip screw, or locking plate. This study aims to compare the biomechanical properties of parallel CCS combined with medial buttress plate fixation and F-type CCS fixation in the treatment of Pauwels III femoral neck fracture by finite element modeling and to determinate the most suitable procedure for such fractures. METHODS: A 52-year-old male volunteer, 176 cm in height and 72 kg in weight, with no history of hip joint, was selected. X-ray and CT examination confirmed that the morphology and bone condition of the right hip of the volunteer were normal. A simulation model of Pauwels III femoral neck fracture was established from the collected CT data of the right proximal femur of the volunteer by the finite element method. Four internal fixations were developed to treat the finite element model: Three CCSs in an inverted triangular parallel configuration combined with medial buttress plate model served as Group A, 2 CCSs in a vertical parallel configuration combined with medial buttress plate model served as Group B, 2 CCSs in a horizontal parallel configuration combined with medial buttress model served as Group C, and the "F" shaped CCS model served as Group D. The distribution of stress, the peak stress, the distribution and maximum of displacement of internal fixations and fracture ends in different models were evaluated. RESULTS: For Groups A, B, C, and D, the peak stresses on the internal fixation were 362.74, 586.84, 558.25, and 208.66 mPa, respectively, all of which occurred near the fractures and the stress distribution in Group D was the most uniform. The maximum displacements of internal fixations in Groups A, B, C, and D were 0.39, 0.45, 0.44, and 0.41 mm, respectively; the peak stresses on the fracture ends were 70.62, 98.48, 55.84, and 65.39 mPa, respectively, all of which were concentrated on the base of femoral neck and lateral cortex of the femoral shaft, and the stresses of Groups C and D were more evenly distributed than those of Groups A and B. The maximum displacements of fracture ends in Groups A, B, C, and D were 0.44, 0.52, 0.50, and 0.44 mm, respectively. CONCLUSIONS The biomechanical stability of F-type CCS fixation is similar to that of 3 CCSs in an inverted triangular parallel configuration combined with medial buttress plate, with a better dispersion of stress. F-type CCS fixation may be a well option for the treatment of femoral neck fracture of Pauwels III.
Bone Plates ; Bone Screws ; Femoral Neck Fractures/surgery* ; Finite Element Analysis ; Fracture Fixation, Internal/methods* ; Humans ; Male ; Middle Aged

Objective    To investigate the early clinical results of MitraClip system in domestic patients. Methods     We retrospectively analyzed the clinical data of 36 patients who underwent transcatheter edge-to-edge repair procedure using MitraClip system in Beijing Fuwai Hospital, Shenzhen Fuwai Hospital and Fuwai Yunnan Cardiovascular Hospital between January and June 2021. There were 24 males and 12 females, with a median age of 70 (47-86) years. Ten (27.8%) patients had 3+ mitral regurgitation (MR) and 26 (72.2%) patients had 4+ MR preoperatively. Results    All procedures were successfully performed. The reduction in MR was 2+ at least immediately after surgery, and 91.7% of patients had MR≤2+ at 3 days postoperatively. There was no statistical difference in left ventricular ejection fraction change postoperatively. Forward velocity and peak gradient of mitral valve were increased after the procedure. Mean gradient of mitral valve were increased at 3 days postoperatively than immediately after surgery (P<0.001). Two patients had acute pericardial effusion intraoperatively, and received pericardial puncture and drainage immediately. Conclusion    MitraClip system has been applied well in domestic patients and can significantly improve MR. This sutdy has a good consistency with foreign studies, and the early results are satisfactory.

Objective:To investigate the clinical characteristics and surgical treatment experience of carotid body tumor (CBT).Methods:The clinical data of 12 patients with CBT admitted to the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University from March 2013 to August 2020 were analyzed retrospectively. Among them, there were 6 males and 6 females, aged 31-83 years, with a median age of 57 years. Among the 12 patients, 2 patients were not treated surgically. The body mass index (BMI), tumor side, maximum diameter of tumor, and tumor classification, operation time, intraoperative bleeding volume, postoperative drainage volume and time, postoperative hospital stay and postoperative complications of patients undergoing surgery were recorded.Results:BMI of the 12 patients was 17.19-29.07 kg/m 2, with an average of (24.05±3.95) kg/m 2. Among the 12 patients, there were 4 tumors on the left side, 6 tumors on the right side and 2 patients had bilateral tumors. The maximum diameter of the tumor was 1.7-8.7 cm, with an average of (4.05 ± 1.89) cm. Among the 2 patients with bilateral tumors, 1 patient underwent staged resection within 9 months and 1 patient only removed the larger tumor. A total of 10 patients underwent surgical resection. All excised tumors were confirmed histopathologically to be paraganglioma. The average operation time and the amount of bleeding was(164.73 ± 74.39)min and 341.82 mL respectively. The drainage time was 1-3 d, with an average of (1.73 ± 0.65) d. The cumulative drainage volume was 22-237 mL, with an average of (77.18 ± 57.47) mL. Classification of 11 surgically resected tumors: 3 patients (3/11, 27.3%) were Shamblin Ⅰ, 7 patients (7/11, 63.6%) were Shamblin Ⅱ and 1 patient (1/11, 9.1%) were Shamblin Ⅲ. There were 1 patient of hematoma and 1 patient of acute cerebral infarction after operation. One patient with decrease in muscle strength of right limb, other surgical patients complained no complications such as stroke and cranial nerve injury when discharged. Patients undergoing surgery were hospitalized for 8-20 days, with an average of (13.36 ± 3.61) d. Conclusions:CBT is a rare paraganglioma in clinic. Surgical resection is an effective method to treat CBT. Careful operation should be carried out to avoid serious complications such as wound hematoma, cranial nerve injury and ischemic stroke.

Objective:To compare the efficacy and safety of Changsulin ? with Lantus ? in treating patients with type 2 diabetes mellitus (T2DM). Methods:This was a phase Ⅲ, multicenter, randomized, open-label, parallel-group, active-controlled clinical trial. A total of 578 participants with T2DM inadequately controlled on oral hypoglycemic agents were randomized 3∶1 to Changsulin ? or Lantus ? treatment for 24 weeks. The efficacy measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), 8-point self-monitoring of blood glucose (SMBG) profiles from baseline, and proportions of subjects achieving targets of HbA1c and FPG. The safety outcomes included rates of hypoglycemia, adverse events (AEs) and anti-insulin glargine antibody. Results:After 24 weeks of treatment, mean HbAlc decreased 1.16% and 1.25%, FPG decreased 3.05 mmol/L and 2.90 mmol/L, 2hPG decreased 2.49 mmol/L and 2.38 mmol/L in Changsulin ? and in Lantus ?, respectively. No significant differences could be viewed in above parameters between the two groups (all P>0.05). There were also no significant differences between Changsulin ? and Lantus ? in 8-point SMBG profiles from baseline and proportions of subjects achieving the targets of HbA1c and FPG (all P>0.05). The rates of total hypoglycemia (38.00% and 39.01% for Changsulin ? and Lantus ?, respectively) and nocturnal hypoglycemia (17.25% and 16.31% for Changsulin ? and Lantus ?, respectively) were similar between the two groups (all P>0.05). Most of the hypoglycemia events were asymptomatic, and no severe hypoglycemia were found in both groups. No differences were observed in rates of AEs (61.77% vs.52.48%) and anti-insulin glargine antibody (after 24 weeks of treatment, 6.91% vs.3.65%) between the two groups (all P>0.05). Conclusions:Changsulin ? shows similar efficacy and safety profiles compared with Lantus ? and Changsulin ? treatment was well tolerated in patients with T2DM.

About 25%-40% of ischemic stroke is in the posterior circulation, in which 20% of posterior circulation stroke is caused by vertebral artery stenosis. Patients with symptomatic vertebral artery stenosis have a high risk of recurrent stroke. At present, the treatments of vertebral artery stenosis include medication, open surgery and interventional therapy. In this paper, the endovascular treatment of vertebral artery stenosis is reviewed, especially the progress of endovascular treatment is expounded, in order to promote the development of its treatment.

OBJECTIVE: To investigate the metabolic profiles of urine from mice with early-stage Alzheimer's disease (AD). METHODS: Urine samples were collected from 13 mice of 16 weeks and 15 wild-type mice. H-NMR spectroscopy was acquired with a one-dimensional NOESY pulse sequence, and the integral values were imported to SIMCA-P+12.0 software for analysis. RESULTS: The metabonomic analysis showed that the metabolic profiles of the mice were significantly different from that of age-matched wild-type mice. The levels of 3-hydroxybutyrate, 2-hydroxybutyrate, succinic acid, 2-ketoglutaric acid, citric acid, cis-aconitic acid, fumaric acid decreased, and those of acetic acid, trimethylamine, taurine, creatinine, hippuric acid, formic acid, trigonelline, urea increased (all <0.05). CONCLUSIONS Metabolic pathways including glucose metabolism and methylamine metabolism may be involved in the pathogenesis of early AD.
Alzheimer Disease ; urine ; Animals ; Disease Models, Animal ; Magnetic Resonance Spectroscopy ; Metabolome ; Metabolomics ; Mice ; Mice, Inbred C57BL

Objective To explore the clinical effectiveness and safety of selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropo-pliteal artery disease. Methods From Jan 2014 to December 2015, 45 femoropopliteal artery atherosclerot-ic patients were treated with SilverHawk atherectomy and selective embolic protection device (EPD). The indication for EPD was instent restenosis, highly calcified lesion, suspicious of thrombosis, ulcerated le-sion, and single below-the-knee runoff. All cases who met the indication were treated with atherectomy and EPD, and those who did not meet the indication were treated with or without EPD according to the patient's choice. The embolic related complications were analyzed. Results Twenty three out of 45 patients who met the EPD indication were all treated with SilverHawk atherectomy under EPD protection, filter captured deb-ris in 17 patients (73. 9％) of the patients. The other 22 patients who did not meet the indication were di-vided into 2 groups according to the patient's choice of EPD usage, 11 were treated by atherectomy with EPD and 11 without EPD. One case out of 11 unindicated patients without EPD suffered a tibioperoneal trunk embolization and restored with catheter aspiration. For 1/11 (9. 1％) unindicated cases with EPD protec-tion, the filter captured embolization. There was a significant difference of distal embolization rate between the indicated and unindicated patients (χ2 =19. 368,P =0. 000). All filters were retrieved successfully without any distal embolization and any complications except arterial spasm occurred in 2 patients and re-stored well with nitroglycerin. Conclusions It is safe and effective for selective usage of embolic protection device to prevent distal embolization during SilverHawk atherectomy for atherosclerotic femoropopliteal artery disease.

Objective o investigate the clinical efficacy of atherectomy in the treatment of Tosaka class Ⅲ in-stent restenosis in the femoropopliteal artery. Methods From June 2013 to December 2015, 33 restenotic lesions after femoropopliteal artery stenting were retrospectively analyzed by clinical information including technical success rate, incidence of complications, improvement of postoperative symptoms and objective indicators, and target vessel patency. Results To January 2016, twenty-eight cases were followed up. The average follow-up time was 17. 9 months. Five cases were lost. The follow-up rate was 84. 9％. The technical success rate was 100％. The patency rate was 79. 9％ at 6 months and 65. 8％ at 1 year after surgery. Conclusions Atherectomy is safe and effective for treatment of Tosaka classⅢin-stent restenosis in femoropopliteal artery with good short-term and medium-term efficacy.

Endovascular aortic repair (EVAR) has been the main treatment means for abdominal aortic aneurysm.It has become an expert consensus that in the case of abdominal aortic aneurysm that is complicated by iliac aneurysm,the preservation of internal iliac artery is necessary because it can prevent the occurrence of gluteal muscle ischemnia,sigmoid ischemia,male sexual dysfunction and other complications.In recent years,with the continuous updating of the endovascular devices it has become possible to retain the internal iliac artery in the performance of EVAR.At present,the reconstruction of internal iliac artery in EVAR includes a variety of techniques,including intraluminal iliac branched device (IBD) technique,sandwich technique,common iliac artery covered-stent bell-bottom (BBT) technique,external iliac artery-internal iliac artery intraluminal shunt technique (reverse chimney technique),and spring coil embolism technique.This article aims to make a summary of all the above mentioned techniques.

Objective To evaluate the feasibility of endovascular aortic repair (EVAR) under local anesthesia without using any contrast agent for abdominal aortic aneurysm in patients with high allergic risk to contrast agent.Methods Under local anesthesia and with no use of any contrast,percutaneous EVAR was performed in a patient with abdominal aortic aneurysm who carried high allergic risk to contrast agent.Results Percutaneous EVAR was successfully accomplished.Postoperative follow-up MRI examination showed that the abdominal aortic aneurysm was completely isolated with no endoleak.The blood flow was unobstructed in the covered stent,and bilateral renal arteries were well visualized.Conclusion For the treatment of abdominal aortic aneurysm in patients who are highly allergic to contrast agent and who have contraindications to general anesthesia,percutaneous EVAR performed under local anesthesia and using no contrast agent is safe and effective.Strict observation of indications and sufficient preoperative evaluation of clinical conditions is the key to ensure a successful operation.