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Objective:To compare the clinical effectiveness of propeller flap and vascular chain flap based on dorsal cutaneous branch of proper palmar digital artery for repair of wounds of fingertip or finger-pulp.Methods:From April 2018 to May 2021, a total of 55 patients (55 fingers) with wounds of fingertip or finger-pulp in the 2nd-5th fingers were treated in emergency surgery in the Department of Hand Surgery, the Second Hospital of Tangshan. The patients were randomly divided into 2 groups by the method of drawing lots. The wounds of 29 patients (29 fingers) were repaired by propeller flaps based on dorsal cutaneous branch of proper palmar digital artery (propeller group) and that of 26 patients(26 fingers) were treated by vascular chain flaps based on dorsal cutaneous branch of proper palmar digital artery(vascular chain group). Survival of the flaps and the skin grafts at donor sites were observed between the 2 groups. The operation and follow-up time in both groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone reviews and WeChat video-clips. At final follow-up, the static TPD of the flaps, patient satisfaction with the appearance of flaps and donor sites and the Range of motion(ROM) of the injured fingers were recorded. The measurement and count data of both groups were compared by independent sample t-test, χ2 tests or Fisher's exact test, respectively. P<0.05 was considered a statistically significant. Results:All the flaps and skin grafts survived primarily in both groups. The operation time in propeller group was 57.55 minutes±4.35 minutes. It was less than what in the vascular chain group (61.12 minutes±4.58 minutes) and with statistically significant difference( P<0.05). The follow-up period was 14.55 months±2.89 months in propeller group and 15.15 months±3.78 months in the vascular chain group. There was no significant difference between the 2 groups( P>0.05). At final follow-up, the static TPD and patient satisfaction with the appearance of flaps in propeller group were 6.55 mm±1.24 mm and 4.59±0.50, which were better than 7.46 mm±1.27 mm and 4.31±0.47 in the vascular chain group with a statistically significant difference( P<0.05). The patient satisfaction with the appearance of donor sites and ROM of the injured digital joints in propeller group were 4.45±0.57 and 190.86°±8.56°, while what in the vascular chain group were 4.35±0.56 and 185.96°±10.58°. There was no significant difference between the 2 groups( P>0.05). Conclusion:The propeller flap and vascular chain flap are both based on dorsal cutaneous branch of proper palmar digital artery and are both suitable for repair of wounds of fingertip or finger-pulp. Compared with the vascular chain flap, the propeller flap has the advantages in shorter operation time, better flap sensation and appearance.
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Objective:To explore the risk factors of skin flap pigmentation after repairing skin and soft tissue defects of extremities using cutaneous neurovascular flap and to give some suggestions for prevention and treatment.Methods:From January 2013 to March 2020, 160 cases of extremities cutaneous nerve vascular flap with survival in Tangshan Second Hospital were retrospectively studied. According to the occurrence of pigmentation, they were divided into two groups: Group A (pigmentation group) and Group B (non-pigmentation group). The observation indexes included sex, age, injury cause, defect size, complete debridement, anastomosis of skin flap, sunscreen measures and postoperative infection. First, univariate analysis was carried out to screen the influencing factors of pigmentation in the cutaneous neurovascular flap, and then Logistic regression was used for multivariate analysis to screen the risk factors.Results:The postoperative follow-up time was 12 to 24 months, with an average of 17.9 months. A total of 29 patients (18.1%) had skin flap pigmentation. Univariate analysis showed that there was no significant difference in sex, age, cause of injury and defect area between the two groups ( P>0.05). Further multivariate analysis showed that incomplete debridement, lack of venous anastomosis, failure to take sunscreen measures and postoperative infection were the risk factors of pigmentation of cutaneous neurovascular flap ( OR=0.310, 0.335, 0.355、5.878, 95% CI=0.112-0.863, 0.115-0.975, 0.133-0.949, 2.069-16.697, P<0.05). Conclusions:Incomplete debridement, lack of venous anastomosis, failure to take sunscreen measures and postoperative infection are the risk factors resulting in pigmentation of neurovascular flap. It is important to perform prevention to reduce the incidence of pigmentation.
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Objective To observe the effects of Tocilizumab on white blood cell (WBC) after acute myocardial infarction (MI) and explore its potential to treat MI.Methods Rats were divided into 3 groups:control,MI,and MI treated.Serum from individual mouse was collected before and after subcutaneously Tocilizumab treatment.The level of interleukin-6 (IL-6),the number of WBC and the ratio of active hematopoietic stem cell (HSC)was tested by ELISA,flow cytometry and blood routine examination.The fibrosis of heart tissue was observed by immunohistochemistry.Results The IL-6 level and the number of the WBC were reduced after Tocilizumab treatment.It indicates the effect of inhibiting the activity of HSC and improving the situation of cardiocytes remodeling.Conclusion Tocilizumab could inhibit the generation of WBC and re-construct myocardium after MI.
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Objective: To explore the peri-operative application of GLP-1 analogue and insulin on myocardial perfusion and clinical prognosis in patients of acute ST segment elevation myocardial infarction (STEMI) with stress-induced hyperglycemia. Methods: Our research was a prospective single center randomized control study. A total of 114 consecutive STEMI patients received percutaneous coronary intervention (PCI) within 12h of onset were enrolled, the patients had no diabetes while blood glucose ≥11.1mmol/L at immediate admission. Based on random number table, the patients were divided into 2 groups: Observation group, the patients received GLP-1 analogue, n=59 and Control group, the patients received insulin, n=55. The post-operative myocardial perfusion, indicators of myocardial damage and cardiac function, myocardial infarct area (MIA) and myocardial salvage index (MSI) were compared between 2 groups. The patients were followed-up for 6 months to record the incidence of major adverse cardiovascular events (MACE). Results: At peri-operative period, compared with Control group, Observation group had decreased peak values of creatine kinase isoenzyme (CK-MB) and troponin T (cTnT), P<0.05. At 6 months post-operation, compared with Control group, Observation group showed increased myocardial perfusion and left ventricular ejection fraction (LVEF), P<0.05, reduced MIA (15±12) g vs (20±14) g, P<0.05 and 12% elevated MSI as (0.64±0.13) vs (0.56±0.12), P<0.001. The MACE incidence was similar between 2 groups, P=0.217. Conclusion: In STEMI patients with stress-induced hyperglycemia, peri-operative application of GLP-1 analogue may safely regulate blood glucose, improve cardiac perfusion and function, reduce MIA; while it had no influence on myocardial perfusion at peri-operative period and no impact on MACE occurrence at 6 months post-operation.
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<p><b>BACKGROUND</b>Balloon release pressure may increase the incidence of no reflow after direct percutaneous coronary intervention (PCI). This randomized controlled study was designed to analyze the correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction (AMI) undergoing direct PCI.</p><p><b>METHODS</b>There were 156 AMI patients who underwent PCI from January 1, 2010 to December 31, 2012, and were divided into two groups according to the stent inflation pressure: a conventional pressure group and a high pressure group. After PCI, angiography was conducted to assess the thrombolysis in myocardial infarction (TIMI) grade with related artery. Examinations were undertaken on all patients before and after the operation including cardiac enzymes, total cholesterol, low-density lipoprotein, blood glucose, homocysteine , β-thromboglobulin (β-TG), Hamilton depression scale (HAMD) and self-rating anxiety scale (SAS). After interventional therapy, the afore-mentioned parameters in both the conventional pressure group and high pressure group were again analyzed.</p><p><b>RESULTS</b>The results showed that CK-MB, HAMD, SAS were significantly different (P < 0.05) in all patients after PCI, especially the CK-MB in the high pressure group ((25.7 ± 7.6) U/L vs. (76.7 ± 11.8) U/L). CK-MB, HAMD, SAS, and β-TG were comparative before PCI but they were significantly changed (P < 0.05) after intervention. No-reflow phenomenon occurred in 13 patients in the high pressure group, which was significantly higher than in the conventional pressure group (17.11% vs. 6.25%, P < 0.05).</p><p><b>CONCLUSION</b>In stent implantation, using a pressure less than 1823.4 kPa balloon to release pressure may be the better choice to reduce the occurrence of no-reflow following direct PCI.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Blood Glucose , Metabolism , Cholesterol , Blood , Homocysteine , Metabolism , Myocardial Infarction , Blood , General Surgery , Percutaneous Coronary Intervention , MethodsABSTRACT
Objective To evaluate the method of establishment of a minipig model of ischemic heart failure(HF) with acute myocardial infarction(AMI) by coronary balloon occlusion and coadministration of injecting of microthrombi and plastic microspheres.Methods A total of eighteen minipigs were selected.After coronary angiography,angioplasty balloons were placed in the mid-distal of left anterior descending(LAD).The balloon was inflated intermittently to occlude the LAD 3 times and then to occlude it continuously for 120 minutes.After the balloon was taken out,4F Judkins-type angiogrphic catheter was superelectively engaged in LAD and 3 mL intermixture of mierothrombi and plastic microspheres were injected at 10 minites interval until TIMI myocardial perfusion was grade<2 and left ventfieular end-diastolic pressure was maintained from 15 to 18 mmHg.Electrocardiogram(ECG),hemodynamic perameters,ultrasonic cardiogram,cTnI and CK-MB were measured.Myocardial infarction area was evaluated by histopathology.Results Fourteen days later,fifteen minipigs survived and fourteen satisfied the criteria(pulmonary capillary wedge pressure.PCWP>18 mmHg and eardio output (CO) decreased beyond 30% ). The changes of ECG, hemodynamic perameters, CKMB, cTnI and cardiac pathologic examination were in accordance with AMI. Conclusion A stable experimental method of establishment of minipig model of ischemic heart failure (HF) with acute myocardial infarction (AMI) by coronary balloon occlusion and coadministration of injecting of microthrombi and plastic mierospheres is succeded. This method has advantages such as closed chest, higher success rate and stability compared with the drug induced, taehycardia-pacing induced, coronary artery ligation induced or microsphere injection alone methods.