Combined iliac artery stenting and open femoral endarterectomy in the treatment of multi-level iliac and common femoral occlusive disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of hybrid procedure for the treatment of multi-level iliac and common femoral occlusive disease.</p><p><b>METHODS</b>From January 2008 to June 2011, 36 lower limbs with sever iliac and common femoral occlusive diseases were treated by iliac artery stenting combined with open femoral endarterectomy. The mean age of the whole study population was 65 years (range 49 to 87 years) with a male predominance (26 males, 72.2%). The early clinical results were determined by ankle brachial index and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analysis were used to assess the influence of various risk factors on primary patency.</p><p><b>RESULTS</b>All lower limbs underwent successful hybrid surgical and endovascular therapy. Clinical improvement was seen in 94.4% of patients. The mean duration of follow-up was 24.2 months, overall, the primary patency rates, primary assisted patency rates and second patency rates were 72.2%, 83.3% and 94.4% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P = 0.041, 0.012). Cox regression analysis did not reveal any independent predictor of primary patency.</p><p><b>CONCLUSION</b>Hybrid procedures provided an effective treatment management of multilevel iliac-femoral arterial occlusive disease.</p>

Pilon fractures: a new classification and therapeutic strategies / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result.</p><p><b>METHODS</b>One hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved.</p><p><b>RESULTS</b>One hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley's Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system.</p><p><b>CONCLUSION</b>As a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.</p>

Tanshinone IIA attenuates the development of elastase-induced abdominal aortic aneurysm of rat / 中华外科杂志

<p><b>OBJECTIVE</b>To determine if tanshinone IIA (Tan IIA) can influence the development of elastase-induced experimental abdominal aortic aneurysms (AAAs).</p><p><b>METHODS</b>Totally 36 male Sprague-Dawley rats were randomly distributed into three groups (12 in each group): Tan IIA group, control group, and sham group. Rats of Tan IIA and control groups underwent intra-aortic elastase perfusion to induce AAAs, while rats of sham-group were perfused with saline. Rats of Tan IIA-group received Tan IIA treatment (2 mg/d). The luminal diameter of the aneurysm at the segment with maximum diameter were measured pre-perfusion and on the 4 time point after perfusion. Systolic blood pressure was measured by tail-cuff technique. Aortic tissue samples were obtained on 24 days after perfusion and evaluated by RT-PCR, Western blot, immunohistochemistry and Miller's elastin-Van Gieson's (EVG) staining.</p><p><b>RESULTS</b>Twenty-four days after perfusion, Tan IIA significantly reduced increased aortic size compared to control group ((0.210 ± 0.002) cm vs. (0.304 ± 0.004) cm, t = 78.858, P = 0.000) without affecting blood pressure (t = -1.237 to -1.221, P > 0.05). The over-expression of matrix metalloproteinases (MMP)-2/9 (t = 25.943, P = 0.000; t = 42.815, P = 0.000), monocyte chemotactic protein-1 (MCP-1) (t = 4.518, P = 0.000), inducible nitric oxide synthase (iNOS) (t = 17.685, P = 0.000) and the destruction of elastic fibers in aortic tissue of control group were significantly less than Tan IIA group (0.469 ± 0.040 vs. 0.230 ± 0.024, t = 17.944, P = 0.000).</p><p><b>CONCLUSION</b>Tanshinone IIA attenuates the development of elastase-induced experimental AAAs possibly by down-regulating MMP-2/9, MCP-1 and iNOS expression.</p>

Treatment of thoracoabdominal aortic diseases through hybrid operation / 中华外科杂志

<p><b>OBJECTIVES</b>To review the experience with the hybrid operations for patients with thoracoabdominal aortic diseases, as well as to evaluate and discuss the outcomes.</p><p><b>METHODS</b>Between June 2008 and September 2011, 11 patients (9 male and 2 female, mean age 52 years) were treated by hybrid operation. Hybrid operation includes debranching of the visceral arteries, followed by endovascular repair of the diseases (include aneurysmal disease, aortic dissection, or Takayasu's arteritis).</p><p><b>RESULTS</b>All the operations were successful. The mean operating time was 8.5 hours for patients done in one stage and 8.1 hours for the first stage of patient related in two stages. The endovascular stage took on average 2.0 hours. Overall mortality rate was 1/11 and morbidity was 4/11. No aneurysm-related death occurred. Two patients developed endoleak. Permanent paraplegia and renal failure rate was 0. Mean follow-up was 13.5 months.</p><p><b>CONCLUSION</b>Hybrid operation is a mini invasive and safe method for thoracoabdominal aortic diseases with acceptable morbidity and mortality.</p>

Hybrid surgical and endovascular therapy in TASC type D atherosclerotic occlusive disease: a retrospective analysis of 48 cases / 中华外科杂志

<p><b>OBJECTIVE</b>to retrospectively analyze 4-year results after hybrid (combined surgical-endovascular) therapy in patients with complex peripheral TASC type D atherosclerotic occlusive disease.</p><p><b>METHODS</b>from January 2006 to December 2009, 48 lower limbs in 46 patients with TASC type D atherosclerotic occlusive disease were treated by hybrid surgical and endovascular therapy. There were 32 male and 16 female, age ranged from 54 to 85 years with an average of 67 years. The early clinical results were determined by ankle brachial index (ABI) and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analyses were used to assess the influence of various risk factors on primary patency.</p><p><b>RESULTS</b>all lower limbs underwent successful hybrid surgical and endovascular therapy. The average ABI before and after hybrid therapy were 0.63 ± 0.18 and 0.24 ± 0.13 (P < 0.05). The average intermittent claudication distance significantly increased from (87 ± 48) m to (247 ± 62) m (P < 0.05). The mean duration of follow-up was 21.7 months (ranging 1 to 46 months). Over all, the primary patency rates, primary assisted patency rates and second patency rates were 79.2%, 83.3% and 95.8% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P < 0.05). Primary patency rates were lower in patients who underwent open surgery with both proximal and distal endoluminal procedures when compared with endovascular reconstruction proximal or distal to the site of open reconstruction (P < 0.05). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency rate (P = 0.013 and P = 0.008, respectively).</p><p><b>CONCLUSIONS</b>Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease.</p>

New strategy for decision making of Pilon fracture / 中华外科杂志

<p><b>OBJECTIVE</b>To study the guidance of four column theory in decision making of Pilon fractures and its result.</p><p><b>METHODS</b>Ninety-one cases of Pilon fractures classified by four column method and treated by open reduction internal fixation (ORIF) were reviewed from March 2005 to June 2009. Four column classification:lateral column of 67 cases were involved, posterior column of 34 cases were involved, medial column of 34 cases were involved and anterior column of 34 cases were involved. Among all the 94 fractures, single column of 20 fractures were involved, 2 columns of 49 fractures were involved, 3 columns of 15 fractures were involved and all of 4 columns of 10 fractures were involved.</p><p><b>RESULTS</b>Eighty-nine cases had been followed up. The average follow-up time was 16.2 months ranging between 6.0 and 39.0 months. The average healing time was 3.7 months ranging from 3.0 to 5.0 months. Reduction of 91% reviewed Pilon cases were good or acceptable according to Burwell and Charley's radiology evaluation system. Ankle function of 87.6% cases were excellent or good according to AOFAS evaluation system.</p><p><b>CONCLUSION</b>As a simple and comprehensive classification, four column classification can contribute to reasonable operating decision making and good prognosis of Pilon fracture.</p>

The treatment of complications of endovascular repair of aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the experience with special consideration for the occurrence and management of complications after thoracic aortic stent-graft treatment (EVAR).</p><p><b>METHODS</b>Retrospectively review the 33 cases with complications following EVAR from July 2002 to March 2008. There were 21 male patients and 12 female patients with a mean age of 46.3 years and mean postoperative period of 12.3 d. There were 5 cases with left carotid artery covered, 5 cases with proximal or distal endoleak, 4 cases with limbs artery injuries, 3 cases with entire stent in false lumen, 3 cases with retrogression dissections, and 2 cases with Stanford A type dissection. In addition, there were 1 case of acute cerebral infarction during the procedure, 1 case of cerebral haemorrhage 2 d after endovascular repair and 1 case of pseudoaneurysm of the left brachial artery. The procedures for the complications included second stent grafts placement in 13 cases, right-left carotid and left carotid-subclavian bypass in 7 cases, iliac-femoral artery repair or graft implantation in 4 cases, abdominal aortic dissection windowing in 2 cases, one artery thrombectomy and one Beutall's procedure.</p><p><b>RESULTS</b>Follow-up consisted of a CTA, MRI and office visit at 1, 6, 12 months and yearly thereafter. All the endoleak and retrogression dissections disappeared after secondary endovascular procedure. The ischemic complication of limbs, central nervous system and intestinal were cured after artery bypass. One case died of cardiac tamponade due to Stanford A aortic dissection and another case died of cerebral hemorrhage.</p><p><b>CONCLUSIONS</b>The complication should be corrected as soon as possible and it might get more success to combine the endovascular approach and open surgery. Meanwhile, enhanced follow-up would help to find correlative complications in time.</p>

Application of Code-switching in the Microbiology Bilingual Teaching / 微生物学通报

It is a trend that innovate the traditional bilingual education model and select a new teaching model.Code-switching is a lingual phenomenon when a passages or articles are expressed with two or more language.To guarantee effect of bilingual education and improve education quality,penetration bilingual education was applied during microbiology teaching.Professional English vocabulary,words,passages or articles were introduced to students timely and by measure by the way of language code-switching.The results showed that bilingual teaching mode with language code-switching inspire study emotion and self-confidence of English expression from students.

Reforming Experiment Teaching Mode to Cultivate Applied Capability of Bioengineering Students / 微生物学通报

To cultivate applied capability of bioengineering students, five aspects should be done: optimization of experiment teaching system, reformation of experiment teaching mode, intensifying management of experiment teaching, increase of new experiments related tightly to scientific research, and training students’ self-study capability.

Eversion carotid endarterectomy for carotid stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the effect of using eversion carotid endarterectomy (eCEA) for carotid stenosis.</p><p><b>METHODS</b>Twenty four patients with carotid stenosis (stenosis grade 65% approximately 95%), of which 18 were symptomatic and 6 were asymptomatic, were treated by eCEA under regional anesthesia. All patients underwent preoperative cervical duplex and DSA, CT or MRA scanning examination. The eversion technique involved an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque.</p><p><b>RESULTS</b>There was no perioperative mortality and stroke. Transient ischemic attacks (TIA) disappeared, cerebral ischemia symptom improved in our patients. But there were mini chronic symptom of cerebral ischemia in 4 patients with both carotid arterial stenosis.</p><p><b>CONCLUSION</b>Carotid eversion endarterectomy appears to be a universally applicable, safe, and durable operative technique.</p>