Wound outcomes and factors associated with wound healing after first-time femoropopliteal artery intervention in patients with ischemic tissue loss

Background/objectiveThis study’s goal is to describe wound outcomes at 2 years following intervention for atherosclerotic femoropopliteal lesions in patients with ischemic tissue loss.MethodsA retrospective review of 135 first-time endovascular procedures for chronic femoropopliteal atherosclerotic lesions related to ischemic tissue loss was performed. The final wound outcomes were categorized according to the initial wound healing, recurrence and the need of major/minor amputation.ResultsAt 2-years of follow up, 76 limbs (56.3%) showed complete wound healing without recurrence, however, wound development occurred at other sites on the same foot following complete primary healing in 11 limbs (8.1%). Tolerable wounds persisted or wounds recurred at the same site in 30 limbs (22.2%), and 18 limbs (13.3%) needed major amputations. Independent factors that prevented wound healing without recurrence at 2 years were renal insufficiency (HR = 0.225, 95% C.I. = 0.091–0.556, p = 0.001), ankle pressure < 50 mmHg or flat forefoot PVR (HR = 0.328, 95% C.I. = 0.124–0.867, p = 0.025) and functional performance < 4 metabolic equivalents (MET) (HR = 0.150, 95% C.I. = 0.063–0.360, p < 0.001).ConclusionWound outcome classifications showed detailed information regarding clinical outcomes in patients with ischemic tissue loss. Renal insufficiency, ischemia grade 3 and poor functional performance were independent risk factors that prevented wound healing.     

Range of motion of foot joints following total ankle replacement and subtalar fusion

BackgroundIn severe cases of ankle and subtalar arthritis, arthrodesis of the subtalar joint is performed in combination with ankle arthroplasty. In these special cases gait analysis reveals real motion at the replaced tibiotalar joint.MethodsTwenty-three patients affected by ankle and subtalar arthritis, treated either with a 3-component or a 2-component prosthesis in combination with subtalar arthrodesis, were clinically evaluated preoperatively and at a minimum of 1-year follow-up. Gait analysis was performed postoperatively using a multi-segment foot protocol. Foot kinematics were compared to corresponding data from a healthy control group.ResultsClinical scores significantly improved from preoperative to follow-up. The clinically measured passive ankle dorsiflexion/plantarflexion significantly improved at the follow-up. Patients’ normalized walking speed and stride length were significantly lower than those in control. With exception of the ankle frontal-plane motion, sagittal-plane mobility of foot joints was about 50% than that in healthy joints.ConclusionsImprovement in clinical scores was found for both prostheses. Normal spatio-temporal parameters were not restored. In these patients, fusion of the subtalar joint appeared to be compensated by larger frontal-plane motion at the tibiotalar joint.Level of evidenceLevel III- retrospective comparative study.The study was approved by the local Ethics Committee as protocol MAT (protocol registration at clinicaltrials.gov NCT03356951).     

负压封闭引流促进糖尿病足溃疡的愈合

目的分析负压封闭引流(vacuum sealing drainage,VSD)能否促进糖尿病足溃疡的愈合。方法回顾分析自2015年1月至2019年12月,北部战区总医院烧伤整形科收治的糖尿病足溃疡患者60例,并根据患者的治疗方式分为常规治疗组(30例)和VSD治疗组(30例)。统计对比分析两组患者的平均换药次数、平均愈合时间、疼痛程度及满意度。搜集治疗前和治疗14 d后的肉芽组织进行HE染色和VEGF免疫组化染色,分析创面愈合情况以及VEGF的表达情况。结果VSD治疗组换药次数[(5.40±0.28)次]显著少于常规治疗组[(31.41±1.11)次],组间比较P<0.05;VSD治疗组平均愈合时间(29.38±0.63)d显著短于常规治疗组(50.81±2.15)d,组间比较P<0.05;VSD治疗组患者的痛苦程度明显轻于常规治疗组,满意度显著优于常规治疗组,组间比较P<0.05。结论VSD治疗能够促进创面成纤维细胞的增殖、减少炎性细胞的浸润、促进VEGF的表达及创面的愈合。     

2011-2018年中国手足口病发病的时空特征及影响因素研究

目的 分析我国手足口病的时空特征,探讨社会、经济、人口和卫生服务等因素对我国手足口病发病的影响,为手足口病疫情防控提供参考依据。方法 采用贝叶斯时空模型对手足口病数据进行拟合,评估手足口病的时空变化,并识别手足口病发病风险与社会、经济、人口和卫生服务等因素的潜在关联。结果 2011-2018年,我国共报告手足口病例17 118 050例,死亡2 283例,2011-2014年报告发病率呈波动上升趋势,2014-2018年报告发病率呈波动下降趋势,报告死亡率一直呈波动下降趋势。手足口病的发病具有空间聚集性,报告发病率最高的地区为华南地区且为热点区域及高风险区域,报告发病率最低的为西北地区,冷点区域及低风险区域也集中在其部分区域。手足口病发病风险与人均地区生产总值（RR=3.54）、每万人规模以上工业企业单位数（RR=1.61）、城市化率（RR=3.00）、人口出生率（RR=2.36）、每万人医疗机构床位数（RR=3.40）和人均公园绿地面积（RR=0.57）有关。结论 2011-2018年我国手足口病防控重点区域为东南沿海地区,在加快城市化进程的同时需考虑增加人均公园绿地面积,以降低手足口病的发病率。     

205例手足口病合并惊厥患儿的病原学及临床特征

目的探讨手足口病(HFMD)合并惊厥患儿的病原学及临床特征。方法选择西安市儿童医院2019年1月至12月收治的手足口病合并惊厥的患儿为研究对象,收集患儿的年龄、性别、个人史、症状、体征与临床转归等临床资料,采集其肛拭子,应用逆转录聚合酶链式反应PCR(RTPCR)对患儿标本进行病毒检测。结果2019年本院共收治手足口病合并惊厥的患儿205例,其中重症病例34例,普通病例171例(包括热性惊厥单纯型134例、复杂型30例、癫痫7例)。肛拭子病原学核酸检测肠道病毒核酸阳性195例(95.1%),其中血清学分型CA6患儿124例(60.5%),EV71分型患儿7例(3.4%),CA16分型患儿7例(3.4%),CA10分型患儿5例(2.4%),其他肠道病毒感染患儿52例(25.4%)。34例重症患儿中,CA6感染23例(67.6%),EV71感染2例(5.9%,其中1例放弃治疗后死亡),CA10感染2例(5.9%),CA16感染1例(2.9%),其他肠道病毒感染4例(11.8%),肠道病毒阴性2例(5.9%)。CA6分型患儿皮疹形态以大疱样皮疹为主,恢复期可出现脱皮、脱甲,EV71病例皮疹表现为小、厚、硬、少;入组病例经镇静止惊及对症支持治疗后仅1例因放弃治疗后死亡,余患儿均临床治愈出院。结论2019年本院手足口病合并惊厥患儿病原以CA6为主,其所致手足口病皮疹以大疱表现为主,恢复期可出现脱皮、脱甲;死亡病例仍为EV71所致。