Objective:To evaluate the clinical efficacy of the bridge pedicled transplantation of medial leg fascial flap combined with medial hemisoleus muscle flap for contralateral leg soft tissue defect.Methods:Between January of 2012 and January of 2018, 12 patients with soft tissue defect of the leg were treated with bridge pedicled transplantation of contralateral medial leg fascial flap combined with medial hemisoleus muscle flap by posterior tibial artery. There were 9 males and 3 female, aged from 19 to 53 years (mean, 35 years). The size of the soft-tissue defects ranged from 12 cm×8 cm to 18 cm×9 cm. The immediate coverage of the fascial and muscle flaps and vessel pedicle were repaired by a meshed split-thickness skin graft. The donor site was closed directly. After the transplantation of the one pedicle and two flaps survived, vascular pedicle was cut off.Results:All the fascial and muscle flaps survived completely. No clinical vascular deficiency was found on the fascial and muscle flaps postoperatively. One case developed distal muscle flap small skin graft necrosis, and spontaneous healed after 2 weeks of dressing change. Follow-up period ranged from 2.5 to 4.5 years (mean 3.8 years). A good contour was confirmed both at the recipient and donor sites. Satisfactory clinical results were obtained in this series.Conclusion:This method is suitable for the treatment of soft tissue defects of the leg with only one major blood vessel, which reduces the damage to the donor site.

Objective:To evaluate the efficacy of the repairing anterior tibial adjacent double wounds by transposition with single-pedicle two flaps of the medial head of gastrocnemius.Methods:Between January of 2012 and January of 2018, 10 patients with the anterior tibial adjacent double wounds (7 males and 3 female, aged from 21 to 45 years) were treated by transposition with single-pedicle two flaps of the medial head of gastrocnemius. The size of the soft-tissue defects ranged from 2.0 cm×2.5 cm to 4.5 cm×4.0 cm. The medial head of the gastrocnemius was divided into two flaps with a single pedicle to repair two adjacent wounds of the anterior tibial. The muscle flaps were immediately covered by a meshed split-thickness skin graft, and the wound in donor site was closed directly.Results:All the muscle flaps survived completely. No clinical vascular deficiency was found on the muscle flaps postoperatively. Small wound dehiscence was developed in one patient and spontaneously healed 2 weeks after dressing change. Patients were followed up for 2.0 to 4.5 years. A good contour was confirmed at the recipient and donor sites. Satisfactory clinical results were obtained in this series.Conclusion:This method is suitable for the repair of two adjacent small wounds of the anterior tibial which can reduce the damage to the donor site.

With the development of first aid and severe medical technology,more and more patients are turning from severe coma to chronic disorder of consciousness (DOC),and the incidence rate of children is high.The treatments and prognoses of DOC in children are important issues related to family and society.This article reviews the diagnoses and scales,the research status of clinical drug therapy and non-invasive,invasive nerve stimulation therapies and hyperbaric oxygen therapy of DOC in childem.

Treatment for disorders of consciousness (DOCs) is still a Gordian knot. Evidence-based guidelines on the treatment of DOC patients are not currently available, while neuromodulation techniques are seen as a potential treatment. Multiple neuromodulation therapies have been applied. This article reviews the most relevant studies in the literature in order to describe a clear picture of the current state of neuromodulation therapies that could be used to treat DOC patients. Both invasive and non-invasive brain stimulation is discussed. Significant behavioral improvements in prolonged DOCs under neuromodulation therapies are rare. The efficacy of various such therapies remains a matter of debate. Further clinical investigations of existing techniques in larger samples properly controlling for spontaneous recovery are needed, and new approaches are awaited.
Brain ; drug effects ; physiopathology ; surgery ; Consciousness ; physiology ; Consciousness Disorders ; therapy ; Humans ; Neurotransmitter Agents ; therapeutic use ; Transcranial Magnetic Stimulation ; methods ; Treatment Outcome

Objective To investigate the effectiveness of evoked potential in monitoring cerebral perfusion during carotid endarterectomy by a retrospective cohort study.Methods A retrospective cohort survey of clinical data of 59 patients,who underwent carotid endarterectomy in our hospital from September 2013 to December 2016,was performed.All patients were monitored by transcranial doppler ultrasonography (TCD) and somatosensory evoked potential (SEP),motor evoked potential (MEP) for changes of cerebral blood flow;the monitoring of TCD was defaulted as "gold standard",recording monitoring results at different time points.By drawing the four table,the sensitivity,specificity,positive predictive value,negative predictive value of SEP and MEP during cerebral hypoperfusion were calculated,and correlation analyses between SEP and TCD,and between MEP and TCD were performed.Through receiver operating characteristic (ROC) curve,SEP monitoring threshold of cerebral hypoperfusion was predicted.Results The sensitivity,specificity,positive predictive value,and negative predictive value of SEP in predicting intra-operative cerebral hypoperfusion were 60.00％,91.84％,60.00％,and 91.84％ when SEP amplitude declined beyond 50％;the sensitivity,specificity,positive predictive value and negative predictive value of SEP in predicting intra-operative cerebral hypoperfusion were 70.00％,93.88％,70.00％ and 93.88％ when SEP latency extended beyond 10％.The sensitivity,specificity,positive predictive value,and negative predictive value of MEP in predicting intra-operative cerebral hypoperfusion were 30.00％,97.96％,75.00％,and 87.27％ when MEP amplitude declined beyond 50％.Decline of SEP and MEP amplitudes and extension of SEP latency have positive correlations with TCD.ROC indicated that the amplitude of somatosensory evoked potentials could predict intraoperative hypoperfusion when it decreased by 51.0％ than the baseline monitoring value after carotid artery occlusion,with sensitivity of 100.0％,specificity of 89.8％ and area under the curve of 0.918 (95％CI:0.846～0.990,P=0.024).ROC also showed that the latent phase of somatosensory evoked potentials could predict intraoperative hypoperfusion when it was prolonged ＞9.8％ compared to the baseline monitoring value after carotid artery occlusion,with sensitivity of 100.0％,specificity of 92.9％and area under the curve of 0.941 (95％CI 0.878～0.995,P=0.014).Conclusion Evoked potentials can real-time monitor intra-operative cerebral hypoperfusion continuously in carotid endarterectomy,enjoying high sensitivity and specificity;in addition,decline of SEP amplitude and extension of SEP latency have higher sensitivity than MEP.

Objective To explore the association,consistency and complications prognostic value of thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in patients with acute ischemic stroke.Methods A retrospective cohort survey of 240 patients,admitted to our hospital from September 2012 to December 2017,was performed.All acute ischemic stroke patients accepted coagulation function monitoring 5 d after aspirin and clopidogrel and endovascular treatments by thromboelastography (R time,K time,α angle,maximum amplitude [MA]) and routine coagulation tests (prothrombin time [PT],activated partial thromboplastin time [APTT],fibrinogen [FIB],international normalized ratio [INR],blood platelet count).The association,consistency,and sensitivity,specificity,positive predictive value,negative predictive value of complications prognostic value of thromboelastography and conventional coagulation tests were analyzed.Results (1) R time and APTT,K time and APTT,α angle and FIB,and α angle and PLT were positively correlated;K time and FIB,R time and PLT,and α angle and APTT were negatively correlated.(2) R time and APTT (κ=0.266,P=0.000),K time and APTT (κ=0.134,P=0.024),and α angle and FIB (κ=0.162,P=0.007) had agreement in identifying hypercoagulability;R time and APTT (κ=0.211,P=0.001),K time and APTT (κ=0.198,P=0.002),and blood platelet count and K (κ=0.388,P=0.000),and α angle and PLT (κ=0.099,P=0.041) had agreement in identifying hypocoagulability.(3) The sensitivity of thromboelastography and routine coagulation tests in identifying early neurological deterioration was 17.65％ and 58.82％,and the sensitivity in identifying symptomatic hemorrhages by thromboelastography and routine coagulation tests was 73.68％ and 47.39％.Conclusions Some parameters has correlations in peroperative period,and has agreement in identifying hypercoagulability and hypocoagulability.Accordingly,routine coagulation tests might be superior in evaluating early neurological deterioration,and thromboelastography might be superior in evaluating symptomatic hemorrhages in patients with acute ischemic stroke.

OBJECTIVETo evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB device in recanalization of patients with acute ischemic stroke of posterior circulation.

METHODSThe clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People's Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years (ranging from 44 to 75 years). Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale (NIHSS) score, were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after treatment.

RESULTSFifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7.5 hours. The NIHSS score at 7 days was 11±10, which was significantly decreased compared to the admission NIHSS score 17±5 (t=2.949, P=0.009). No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died(mRS 6), one patient seriously disabled (mRS 5), two patients moderately seriously disabled (mRS 4), four patients resulted in moderate outcome (mRS 3) and the other 9 patients achieved good outcome (mRS 0 to 2). The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition (NIHSS >20) and prolonged time (onset to sheath time >6 hours).

CONCLUSIONMechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability of complication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; surgery ; Thrombectomy ; Treatment Outcome

Objective To review systematically the clinical curative effects and time window of hyperbaric oxygen treatment of persistent vegetative state (PVS).Methods All the clinical research articles about hyperbaric oxygen for PVS from January 1990 to December 2013 were retrieved from China national knowledge internet,Wanfang Database and Vip Database (the Chinese key words:vegetative state,the vegetable,or hyperbaric oxygen),and then,a Meta-analysis was conducted.Results Search terms yielded 165 pieces of articles and 19 were included in the final analysis for treatment efficacy;the treatment group included 939 patients and the control group included 659 patients.Totally,17 pieces of articles of time window were included;the patients with onset＜60 d group included 700 patients and the patients with onset＞ 60 d group included 330 patients.The Jadad scores of included articles were not high in general,and the highest scores were two points.Comparable baseline data were demonstrated in all of the articles.Data from articles were pooled and analyzed,and the results showed that the effective rate of treatment group and control group were 67.51％ and 34.45％,with significant difference (Z=12.16,P=0.000,odd ratio=0.25,95％ confidence interval=0.20-0.31).The effective rate of patients with onset＜60 d group and patients with onset≥60 d group was 22.73％ and 63.29％ (Z=9.72,P=0.000,odd ratio=5.21,95％ confidence interval=3.74-7.27) Conclusion Hyperbaric oxygen treatment enjoys better treatment efficacy than conventional treatment;patients with onset＜60 d have better prognosis than patients with onset≥ 60 d.

Objective To observe the influence of carotid endarterectomy in cognitive functions of patients with symptomatic carotid stenosis.Methods Forty-three patients admitted to our hospital and performed carotid endarterectomy from February 2013 to August 2014, were enrolled in the study.Cognitive functions of the patients were evaluated by Montreal cognitive function assessment (MoCA) and cerebral blood flow (CBF) by cerebral perfusion CT scan three days before and three months after operation, respectively.According to the MoCA scores after operation, the patients were divided into significant improvement group and non-significant improvement group, and their cerebral hemodynamics indexes were compared.Results (1) As compared with those before operation (24.1±2.2, 0.97±0.08), the MoCA scores (26.02±2.9) and relative cerebral blood volumes (rCBV, 1.00±0.08) three months after operation were significantly different (P＜0.05).(2) The postoperative relative CBF, rCBV and relative mean transmit time in the significant improvement group were significantly improved as compared with those preoperative indexes (P＜0.05);whereas, these values in the non-significant improvement group didn't show significant difference between preoperative and postoperative indexes(P＞0.05).Conclusion Carotid endarterectomy may help to improve the cognitive function in those patients with symtompatic carotid stenosis, and the effect might be associated with the improvement of cerebral perfusion.