Objective:To investigate the efficacy of a modified intermittent horizontal mattress suture technique in arterial anastomosis with intimal dissection during free flap transplantation.Methods:A retrospective analysis was conducted on patients with limb wounds who underwent free flap transplantation with the modified intermittent horizontal mattress suture technique at the First People’s Hospital of Pingyuan County from September 2016 to November 2023. After debridement, free flap transplantation was performed. Under microscopic examination, recipient arteries with intimal dissection were identified, and proximal trimming failed to resolve the delamination. The modified intermittent horizontal mattress suture technique was applied to anastomose the dissected recipient arteries to donor arteries, while veins were conventionally horizontal mattress sutured. Postoperative flap viability, complications, and patient satisfaction were evaluated.Results:Fourteen patients were enrolled, including 8 males and 6 females, aged (51±14) years old (range: 18-71 years). Injuries involved the hand (5 cases) and foot (9 cases), with wound sizes ranging from 7 cm×8 cm to 22 cm×18 cm. Flaps included anterolateral thigh perforator flaps (11 cases) and groin flaps (3 cases), sized 8 cm×9 cm to 24 cm×20 cm. Seven patients had intimal dissection of the dorsalis pedis artery, with anastomoses performed to the descending branch of the lateral circumflex femoral artery (LCFA) in 5 cases, and to the superficial circumflex iliac artery in 2 cases. Intimal dissection of the medial plantar artery was identified in 2 cases, both of which were anastomosed to the descending branch of LCFA. And 5 cases had intimal dissection of the radial artery, with anastomoses performed to the LCFA in 3 cases, to the transverse branch of LCFA in one case, and to the superficial circumflex iliac artery in one case. The patients were followed up for (11.6±7.6) months (range: 3-30 months) after surgery. Eleven flaps survived completely, with partial flap margin necrosis in one case, in another case necrosis of one-third of the flap because of arterial insufficiency, both cases healed with dressing changes. The third patient resumed smoking and subsequently fell from the bed, resulting in necrosis of two-thirds of the flap five days post-discharge (12 days postoperatively). After debridement of the necrotic part of the flap, a split-thickness skin graft was applied for repair. Thirteen flaps exhibited no ulceration, with satisfactory texture and appearance, these patients expressed satisfaction. One patient with skin graft infection achieved scar healing.Conclusion:The modified intermittent horizontal mattress suture technique ensures reliable anastomosis of arteries with intimal dissection in free flap surgery, improving success rates and yielding favorable outcomes with high patient satisfaction.

Objective:To investigate the efficacy of a modified intermittent horizontal mattress suture technique in arterial anastomosis with intimal dissection during free flap transplantation.Methods:A retrospective analysis was conducted on patients with limb wounds who underwent free flap transplantation with the modified intermittent horizontal mattress suture technique at the First People’s Hospital of Pingyuan County from September 2016 to November 2023. After debridement, free flap transplantation was performed. Under microscopic examination, recipient arteries with intimal dissection were identified, and proximal trimming failed to resolve the delamination. The modified intermittent horizontal mattress suture technique was applied to anastomose the dissected recipient arteries to donor arteries, while veins were conventionally horizontal mattress sutured. Postoperative flap viability, complications, and patient satisfaction were evaluated.Results:Fourteen patients were enrolled, including 8 males and 6 females, aged (51±14) years old (range: 18-71 years). Injuries involved the hand (5 cases) and foot (9 cases), with wound sizes ranging from 7 cm×8 cm to 22 cm×18 cm. Flaps included anterolateral thigh perforator flaps (11 cases) and groin flaps (3 cases), sized 8 cm×9 cm to 24 cm×20 cm. Seven patients had intimal dissection of the dorsalis pedis artery, with anastomoses performed to the descending branch of the lateral circumflex femoral artery (LCFA) in 5 cases, and to the superficial circumflex iliac artery in 2 cases. Intimal dissection of the medial plantar artery was identified in 2 cases, both of which were anastomosed to the descending branch of LCFA. And 5 cases had intimal dissection of the radial artery, with anastomoses performed to the LCFA in 3 cases, to the transverse branch of LCFA in one case, and to the superficial circumflex iliac artery in one case. The patients were followed up for (11.6±7.6) months (range: 3-30 months) after surgery. Eleven flaps survived completely, with partial flap margin necrosis in one case, in another case necrosis of one-third of the flap because of arterial insufficiency, both cases healed with dressing changes. The third patient resumed smoking and subsequently fell from the bed, resulting in necrosis of two-thirds of the flap five days post-discharge (12 days postoperatively). After debridement of the necrotic part of the flap, a split-thickness skin graft was applied for repair. Thirteen flaps exhibited no ulceration, with satisfactory texture and appearance, these patients expressed satisfaction. One patient with skin graft infection achieved scar healing.Conclusion:The modified intermittent horizontal mattress suture technique ensures reliable anastomosis of arteries with intimal dissection in free flap surgery, improving success rates and yielding favorable outcomes with high patient satisfaction.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To evaluate the effectiveness of left ventricular assist device (LVAD)implantation via minimally invasive thoracotomy.Methods:From April 2022 to October 2023, we retrospectively collected and analyzed the perioperative data of 16 patients underwent LVAD via minimally invasive thoracotomy in our institute. 16 patients included 10 males and 6 females, the mean age was(58.6±7.6)(49-76)years old, BSA was (1.75±0.90)(1.35-2.01)m 2, 6 cases of dilated cardiomyopathy (DCM), 8 cases of ischemic cardiomyopathy (ICM) and 2 cases of end-stage valvular heart disease. LVAD type included 8 cases of CH-VAD, 7 cases of HeartCon and 1 case of Corheart-6. All the 16 patients underwent LVAD implantation were performed in condition of CPB, 13 patients on-beating heart, 3 patients with heart arrest. The outflow graft of 15 patients were place at ascending aorta, 1 patient was descending aorta. Results:The average surgical time was about 5.09 h, CPB time was(137±32)min, and the mechanical ventilation time was (20.8±13.6)h, stay in the ICU was(10.0±6.3)days, and the length of stay was(45.4±17.0)days. No case transition to sternotomy, no case in right ventricular failure, and no death case during 30 days.Conclusion:Minimally invasive thoracotomy approach is a safe and reliable method for left ventricular assist devices implantation, and can be used as a choice for LVAD implantation.

Objective:To analyze the causal relationship between lifestyle-based factors and the occurrence and development of hepatobiliary malignancies by Mendelian randomization study method,and to provide the potential clinical evidence for the prevention and treatment of hepatobiliary malignancies.Methods:The data from large-scale,independent genome-wide association studies(GWAS)were selected,and seven-step inclusion criteria for the instrumental variable screening were set up.The exposure lifestyles included the percentage of carbohydrate intake,percentage of fat intake,percentage of protein intake in the diet,coffee intake,weekly alcohol consumption times,leisure electronic screen exposure time,moderate to vigorous intensity physical activity(MVPA)during leisure time,sedentary behavior at work,age at first smoking,daily smoking quantity,current smoking status,and past smoking status,totaling 12 phenotypes.The primary analysis method used was the random effect model of the inverse variance weighted(IVW)method,and the heterogeneity was detected by Cochrane's Q test and the horizontal pleiotropy was detected by MR-Egger intercept method.Results:The current smoking status was significantly positively correlated with the increasing risk of extrahepatic cholangiocarcinoma(OR=1.607,95%CI:1.113-2.322,P=0.011).Higher coffee intake was causally linked to a higher risk of liver cancer and intrahepatic cholangiocarcinoma(OR=1.000,95%CI:0.999-1.000,P=0.012).In the physical activity,more MVPA was associated with the lower risk of liver cancer and intrahepatic cholangiocarcinoma(OR=0.998,95%CI:0.996-0.999,P=0.002).The Cochrane's Q test results showed that there was mild heterogeneity between MVPA and extrahepatic cholangiocarcinoma(Q=18.354,P=0.049)as well as the percentage of protein intake and intraphepatic cholangiocarainoma(Q=12.715,P=0.026),and the MR-Egger intercept method results showed there was no horizontal pleiotropy.Conclusion:There is a causal relationship between current smoking status and extrahepatic cholangiocarcinoma,and there is a causal relationship between more MVPA and the lower risk of liver cancer and intrahepatic cholangiocarcinoma.Education on smoking and physical activity for the patients may offer potential benefits for the prevention of hepatobiliary malignancies.

Objective To explore the relationship between preoperative coronary angiography and postoperative acute kidney injury (AKI) in cardiac surgery. Methods The clinical data of patients who underwent coronary angiography within 30 days before cardiac surgery in the First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to April 2019 were retrospectively analyzed. Univariate analysis and multivariate logistic regression analyses were used to explore the relationship between the interval from preoperative coronary angiography to cardiac surgery and postoperative AKI. Results Finally 1 112 patients were collected, including 700 males and 412 females, with a median age of 61 (55, 66) years. The incidence of postoperative AKI was 40.8% (454/1 112), of which grade 2-3 AKI accounted for 11.9%. Multivariate analysis showed that age (OR=1.049, 95%CI 1.022-1.077, P<0.001), body mass index (OR=1.065, 95%CI 1.010-1.123, P=0.020) and time interval between preoperative coronary angiography and cardiac surgery within 24 hours (OR=1.625, 95%CI 1.116-2.364, P=0.011) were independent predictors of postoperative AKI. Patients who underwent coronary angiography within 24 hours before surgery had a 10.6% higher incidence of postoperative AKI compared to those who underwent angiography ≥24 hours before surgery (P=0.004). Patients who underwent valve surgery with or without coronary artery bypass grafting (CABG) had a higher risk of AKI than those who only underwent CABG. The in-hospital stay of patients who developed AKI was 2 days longer than those without AKI. However, undergoing coronary angiography within 24 hours before cardiac surgery did not prolong the length of ICU stay or hospital stay, nor did it increase the risk of death or renal failure after the operation. Conclusion Undergoing coronary angiography within 24 hours before cardiac surgery increases the risk of postoperative AKI.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors not only have good lipid-lowering effects, but also have pleiotropic effects such as improving cardiovascular outcomes, relieving anti-inflammation, relieving oxidative stress and improving vascular endothelium. In recent years, the continuous development of PCSK9 inhibitors provides new ideas for the treatment of cardiovascular diseases. This article reviewed the pleiotropic mechanisms of PCSK9 inhibitors, especially on vascular endothelial function.

Objective:This study proposed a novel technique for aortic root reconstruction and evaluated its safety and effectiveness.Methods:Acute type A aortic dissection (ATAAD) patients who underwent Sun' s procedure from January 2020 to June 2022 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively enrolled. These patients were divided into three groups according to their surgical procedures of aortic root: aortic root reinforcement combined with vascular grafts built-in and intermittent anastomosis technique (XJ-procedure) group, continuous suture and pledgeted interrupted reinforcement group and Bentall group. The perioperative data and postoperative follow-up results of the three groups were compared to analyze the efficacy of XJ-procedure in the root treatment of ATAAD.Results:A total of 509 patients were enrolled in this study, including 288 patients in the XJ-procedure group, 132 patients in the continuous suture and pledgeted interrupted reinforcement group and 89 patients in the Bentall group. The 30-day mortality of all patients was 7.5% (38/509), and were 7.3%, 8.3% and 6.7% in the XJ-procedure group, continuous suture and pledgeted interrupted reinforcement group and Bentall group, respectively. The operation time of the XJ-procedure group [355 (320, 380) min] was significantly lower than the other two groups. The cardiopulmonary bypass time [154 (140, 169) min] and the aortic cross-clamping time [80 (72, 89) min] of XJ-procedure group were lower than the Bentall group [166 (147, 184) min and 86 (77, 96) min]. The aortic root bleeding that required secondary cardiopulmonary bypass did not occur in the XJ-procedure group. There was no significant difference in early postoperative complications among the three groups. The incidence of residual aortic root dissection before discharge, in 3 and 6 months after operation was lower in the XJ-procedure group compared to the continuous suture and pledgeted interrupted reinforcement group ( P<0.001). Conclusion:The XJ-procedure technique is a safe, simple and mastered method for the aortic root treatment of ATAAD, which shows an accurate early clinical effect.

Objective:This study proposed a novel technique for aortic root reconstruction and evaluated its safety and effectiveness.Methods:Acute type A aortic dissection (ATAAD) patients who underwent Sun' s procedure from January 2020 to June 2022 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively enrolled. These patients were divided into three groups according to their surgical procedures of aortic root: aortic root reinforcement combined with vascular grafts built-in and intermittent anastomosis technique (XJ-procedure) group, continuous suture and pledgeted interrupted reinforcement group and Bentall group. The perioperative data and postoperative follow-up results of the three groups were compared to analyze the efficacy of XJ-procedure in the root treatment of ATAAD.Results:A total of 509 patients were enrolled in this study, including 288 patients in the XJ-procedure group, 132 patients in the continuous suture and pledgeted interrupted reinforcement group and 89 patients in the Bentall group. The 30-day mortality of all patients was 7.5% (38/509), and were 7.3%, 8.3% and 6.7% in the XJ-procedure group, continuous suture and pledgeted interrupted reinforcement group and Bentall group, respectively. The operation time of the XJ-procedure group [355 (320, 380) min] was significantly lower than the other two groups. The cardiopulmonary bypass time [154 (140, 169) min] and the aortic cross-clamping time [80 (72, 89) min] of XJ-procedure group were lower than the Bentall group [166 (147, 184) min and 86 (77, 96) min]. The aortic root bleeding that required secondary cardiopulmonary bypass did not occur in the XJ-procedure group. There was no significant difference in early postoperative complications among the three groups. The incidence of residual aortic root dissection before discharge, in 3 and 6 months after operation was lower in the XJ-procedure group compared to the continuous suture and pledgeted interrupted reinforcement group ( P<0.001). Conclusion:The XJ-procedure technique is a safe, simple and mastered method for the aortic root treatment of ATAAD, which shows an accurate early clinical effect.

Five new terpenoids, including two vibsane-type diterpenoids (1, 2) and three iridoid allosides (3-5), together with eight known ones, were isolated from the leaves and twigs of Viburnum odoratissimum var.sessiliflorum. Their planar structures and relative configurations were determined by spectroscopic methods, especially 2D NMR techniques. The sugar moieties of the iridoids were confirmed as β-D-allose by GC analysis after acid hydrolysis and acetylation. The absolute configurations of neovibsanin Q (1) and dehydrovibsanol B (2) were determined by quantum chemical calculation of their theoretical electronic circular dichroism (ECD) spectra and Rh₂(OCOCF₃)₄-induced ECD analysis. The anti-inflammatory activities of compounds 1, 3, 4, and 5 were evaluated using an LPS-induced RAW264.7 cell model. Compounds 3suppressed the release of NO in a dose-dependent manner, with an IC₅₀ value of 55.64 μmol·L^-1. The cytotoxicities of compounds 1-5 on HCT-116 cells were assessed and the results showed that compounds 2 and 3 exhibited moderate inhibitory activities with IC₅₀ values of 13.8 and 12.3 μmol·L^-1, respectively.
Terpenes/pharmacology* ; Viburnum/chemistry* ; Molecular Structure ; Diterpenes/chemistry* ; Plant Leaves/chemistry*