�N�������˵���Ϻʹ���Ҫ��

??Key points for diagnosis and treatment of popliteal artery injury GUO Da-qiao??GUO Bao-lei.Department of Vascular Surgery??Zhongshan Hospital of Fudan University??Shanghai 200032??China
Corresponding author??GUO Da-qiao??E-mail??guo.daqiao@zs-hospital.sh.cn
Abstract Popliteal artery injury is common in the lower extremity trauma. For the features of sudden and occultness??the diagnosis and treatment of popliteal artery injury are sometimes difficult. A disaster would befall as an unreasonable management was decided. The surgeon should rebuild limb blood supply on the premise of maintaining stable vital signs. Six hours after trauma are the prime time to rebuild the blood supply. Surgeon should pay attention to the prevention and treatment of systemic and local complications after revascularization.     

�N���������ۺ�������Ϻ�����

??Diagnosis and treatment of popliteal artery entrapment syndromeJIANG Hong??zhou*,DING Kui,XIN Shi??jie,et al.*Division of Vascular and Thyroid Surgery,Department of General Surgery,the First Affiliated Hospital of China Medical University,Shenyang 110001,China. Corresponding author:XIN Shi??jie,E??mail:xinshijie1963@yahoo.com.cn AbstractObjectiveTo review the cases of popliteal artery entrapment syndrome (PAES) and explore the optimal diagnostic and therapeutic strategy.MethodsThe clinical manifestation,diagnostic and therapeutic methods and follow??up results of 8 cases of PAES admitted from January 2000 to January 2008 at First Hospital of China Medical University were analyzed retrospectively.ResultsAll the 8 cases underwent CT angiography (CTA) for early diagnosis,which was confirmed by pathology.The 8 cases underwent musculotendinous dissociation and/or autogenous vein graft arterial reconstruction.The surgical procedures were all successful and the follow??up results were all satisfactory.ConclusionCTA is a suitable diagnostic method for PAES.Surgical procedure is effective and is determined by symptoms,degree of popliteal arterial stenosis and thrombosis.     

��dz�����������N����֧�ܶ���Σ�����ط���

??Risk factors analysis of stent fracture after superficial femoral artery and proximal popliteal artery stenting DUAN Run-dan, XIE Hui, LÜ Lei,et al. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Corresponding author: ZHOU Zhao-xiong, E-mail: zhou_zhaoxiong@hotmail.com
Abstract Objective To study the risk factors of stent fracture??and determine the relationship between stent fracture and in-stent restenosis after superficial femoral artery and proximal popliteal artery stenting. Methods From March 2013 to March 2016??96 consecutive patients ??106 limbs?? who underwent endovascular stenting therapy in superficial femoral artery and proximal popliteal artery were followed up by the methods of Doppler ultrasound scanning??X-ray scanning?? computed tomographic angiography or digital subtraction angiography at Department of Vascular Surgery?? Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Statistical analysis was performed by using SPSS. Results Overall?? stent fractures were detected in 38 of 106 treated legs ??35.8%??. TransAtlantic Inter-Society Consensus(TASC) ??classification??P??0.001???? total stent length??P??0.001???? and increased overlap zone??P=0.01?? were statistically significant risk factors of stent fracture. The research also found that the highest incidence of fracture type was multi-struts fracture, and the highest incidence of the targeted arterial segment was the superficial femoral artery adductor canal segment. Conclusion TASC ??classification?? total stent length and increased overlap zone were risk factors of stent fracture.     

�N���������Բ���69�����Ʒ���

??Treatment of popliteal artery occlusion lesions??An analysis of 69 cases DIAO Yong-peng??GUO Li-long??SONG Xiao-jun??et al. Department of Vascular Surgery??Peking Union Medical College Hospital??Peking Union Medical College??Chinese Academy of Medical Science??Beijing 100730??China
Corresponding author??LI Yong-jun??E-mail??yongj_93@hotmail.com
Abstract Objective To summarize the treatment experience and effect of the popliteal artery occlusion lesions. Methods The clinical data of patients with popliteal artery occlusion (69 patients, 82 limbs) admitted from January 2010 to December 2012 in Peking Union Medical College Hospital were analyzed retrospectively. 26 patients had underwent operative therapy??and 43 patient had underwent endovascular therapy. Results The mean follow-up was (21.9±8.8) months. Operative therapy??symptoms of 25 limbs were relieved; restenosis occurred in 6 limbs??3 limbs were amputated??; primary patency rate was 80.6%; limb salvage rate was 90.3%; complication occurred in 2 cases??7.7%??. Endovascular therapy??symptoms of 42 limbs(82.4%) were relieved; restenosis occurred in 17 limbs??6 limbs were amputated among 9 limbs which had clinical symptoms??; primary patency rate was 66.7%; limb salvage rate was 88.2%; complication occurred in 5 cases??11.6%??. None died during perioperative period. Conclusion Endovascular therapy should be the preferred method if the popliteal artery occlusion is caused by atherosclerosis. Surgical treatment should be reserved in those endovascular treatment failed and the outflow tract without stenosis.     

不羁的N种方式

他在清晨的街头看着她迎面走来,然后,两人错肩而过。这一刻,他觉得过了很久。空旷的街,他是背着单薄行囊的过客,可是她,双手像翅膀一样张开,走路的姿势像放肆的舞步,没有背包,长短不齐的零乱碎发,赤脚。他知道对于这座城市,她其实与他一样是异乡人,是心灵的自由不羁使她成为不     

广义Green关系N、A与广义理想N(a)

定义了广义关系N和A以及主N理想N(a) ,并证明了N J A ,进而加细了Green关系 ,且给出了关系结构 :　　　　　　　　　　　　 　N　 　　　　B　　　　　　J A　　　　　　　 L　　　　 H　　 D 　　　　　　　 R     

禁而不止的N个理由

文刺一直以来是美容院的常规项目，不让美容院经营就等于砸了很多人的饭碗。两年前制度就出来了，但两年过去了，制度的制定者却无力进行后续的落实和监管，《办法》无疑也就成了一纸空文。     

Eine neue Nähmaschine für fortlaufende Nähte am Intestinaltrakt

Zusammenfassung Eine neuartige chirurgische Nähmaschine für fortlaufende, mit Nadel und Faden ausgeführte, gastrointestinale Nahtverbindungen wurde erstmals zur Herstellung einer laterolateralen Enterostomie (funktionelle End-zu-End-Anastomose) am Schweinedünndarm eingesetzt. Bei 10 Tieren traten während des Beobachtungszeitraums von 10 Tagen keine wesentlichen Komplikationen auf. Bei einem Tier fand sich eine Nahtinsuffizienz. In 5 Fällen belegte die Sektion eine Deckung der Anastomosenregion mit Dünndarmschlingen, ohne daß sich jedoch ein eindeutiger Anhalt fur eine gedeckte Insuffizienz ergab. Die Nähmaschine arbeitete im wesentlichen fehlerfrei. Ein klinischer Einsatz erscheint derzeit z. B. bei der Fertigung langstreckiger und bei Handnaht zeitaufwendiger Nahtverbindungen zwar denkbar, ist aber aufgrund technischer Probleme noch verfrüht. Ein deutlicher Nachteil besteht u. a. in der Größe der Maschine und der daraus resultierenden Beschränkung auf extraabdominelle Anwendungen. Dennoch ist das Prinzip einer fortlaufenden Naht mittels Nähmaschine weiter zu verfolgen.

---

A new sewing device for continuous sutures in the intestinal tract

A new surgical sewing device for continuous sutures of gastrointestinal anastomoses with needle and suture material was used for the first time to construct a latero-lateral enterostomy (functional end-to-end anastomosis) in the small intestine of pigs. In ten animals the course was mainly uneventful during the observation period of 10 days. One animal developed a postoperative anastomotic leakage. In five cases adhesions between the anastomotic region and the small intenstine were found on postmortem examination, but there was no evidence of any slight leakage. On the whole, the sewing device operated faultlessly. At present, clinical use seems possible for long sutures, which are time-consuming when sewn manually, but it is still premature. One major disadvantage of the device is its size, which restricts its application to extra-abdominal tasks. Nonetheless, the principle of a mechanical device for running sutures should be investigated further.

Förderung durch die Gesellschaft für Strahlen- und Umweltforschung Untersuchung über die Möglichkeit des Mechanisierens komplexer Verbindungstechniken im Bereich der operativen Medizin (Förderkennzeichen: 0702151)     

Distale Blockaden des N. ischiadicus

Background and objectives

The design of this study is related to an important current issue: should local anesthetics be intentionally injected into peripheral nerves? Answering this question is not possible without better knowledge regarding classical methods of nerve localization (e.g. cause of paresthesias and nerve stimulation technique). Have intraneural injections ever been avoided? This prospective, randomized comparison of distal sciatic nerve block with ultrasound guidance tested the hypothesis that intraneural injection of local anesthetics using the nerve stimulation technique is common and associated with a higher success rate.

Material and methods

In this study 250 adult patients were randomly allocated either to the nerve stimulation group (group NS, n?=?125) or to the ultrasound guidance group (group US, n?=?125). The sciatic nerve was anesthetized with 20 ml prilocaine 1% and 10 ml ropivacaine 0.75%. In the US group the goal was an intraepineural needle position. In the NS group progress of the block was observed by a second physician using ultrasound imaging but blinded for the investigator performing the nerve stimulation. The main outcome variables were time until readiness for surgery (performance time and onset time), success rate and frequency of paresthesias. In the NS group needle positions and corresponding stimulation thresholds were recorded.

Results

In both groups seven patients were excluded from further analysis because of protocol violation. In the NS group (n?=?118) the following needle positions were estimated: intraepineural (NS 1, n?=?51), extraparaneural (NS 2, n?=?33), needle tip dislocation from intraepineural to extraparaneural while injecting local anesthetic (NS 3, n?=?19) and other or not determined needle positions (n?=?15). Paresthesias indicated an intraneural needle position with an odds ratio of 27.4 (specificity 98.8%, sensitivity 45.9%). The success rate without supplementation was significantly higher in the US group (94.9% vs. 61.9%, p?<?0.001) and the time until readiness for surgery was significantly (p?<?0.001) shorter for successful blocks: 15.1 min (95% confidence interval CI 13.6–16.5 min) vs. 28 min (95% CI 24.9–31.1 min). In the NS subgroups the results were as follows (95% CI in brackets): NS1 88.2% and 22.7 min (19.5–25.9 min), NS2 24.2% and 43.3 min (35.5–51.1 min) and NS3 36.8% and 35.3 min (22.1–48.4 min).

Conclusions

For distal sciatic nerve blocks using the nerve stimulation technique, intraepineural injection of local anesthetics is common and associated with significant and clinically important higher success rates as well as shorter times until readiness for surgery. In both groups no block-related nerve damage was observed. The results indicate that for some blocks (e.g. sciatic, supraclavicular) perforation of the outer layers of connective tissue was always an important prerequisite for success using classical methods of nerve localization (cause of paresthesias and nerve stimulation technique). Additional nerve stimulation with an ultrasound-guided distal sciatic nerve block cannot make any additional contribution to the safety or success of the block. New insights concerning the architecture of the sciatic nerve are discussed and associated implications for the performance of distal ultrasound-guided sciatic nerve block are addressed.     

对促销的N种勾勒

新的一年来临．市场营销工作也将揭开新的一页。回首过去，其中况味有点像当红歌手了刀郎的“2802年的第一场雪，是乌鲁木齐难舍的情结。虽说“搞促销是找死，不促销是等死”不幸一语成谱。可多教企业还是被裹挟进促销洪流中载沉载浮。刚刚过去的2004年太多失意时间与市场变数，要做到逆风飞扬。唯一的策略就是顺势而动、周密部署。纵观2004年的促销，主要有以下几种形式：     

Präoperative Nüchternzeiten

BACKGROUND: In order to improve perioperative subjective quality of care it seems desirable to shorten preoperative fasting times as much as possible within acceptable safety limits. These efforts should result in a measurable reduction of preoperative thirst and hunger as well as in improvements of patient well-being. It is unknown to what extent preoperative patient comfort is limited by thirst and hunger from a patient point of view. The purpose of this study was to determine the impact of a traditional fasting regimen on preoperative patient discomfort. PATIENTS AND METHODS: We conducted a survey on preoperative thirst and hunger in 412 adult American Society of Anesthesiologists ASA I and II patients scheduled for minor elective surgery. RESULTS: Of the patients 33% complained of moderate to strong thirst, whereas 19% had moderate to strong hunger, 47% of the participants would have liked to have been able to drink and 72% would have appreciated a light breakfast before surgery. Mean preoperative fasting times were 12.8+/-3.4 h for fluids and 15.5+/-4.4 h for solids. "Thirst" was named by 3.3% and "hunger" by 0.8% of patients as the most important factor for preoperative discomfort but "long wait" (8.5%), "tenseness" (6.5%) and "anxiety" (4.8%) were the most frequently named factors. Answers were independent of the duration of preoperative fasting. CONCLUSION: Patient comfort is compromised by traditional fasting rules and liberalization of these policies is desired by patients. However, efforts to reduce preoperative anxiety and tenseness might have an additional, important potential to improve perioperative quality of care from a patient's perspective.     

Where is the boundary between N1 and N2 stations in lung cancer?

Background. The anatomical definition of N1 stations, its boundary to N2 stations, and its prognostic implication are yet to be defined in lung cancer. Metastasis in lymph nodes close to the pleural reflection has been classified differently as N1 or N2 according to the lymph node maps promulgated so far.

Methods. The pattern of lymphatic involvement and prognosis were retrospectively analyzed in 180 N1 patients who underwent at least lobectomy and complete hilar/mediastinal lymphadenectomy from 1987 through 1997. For comparison, the prognoses of 166 N2 patients were also analyzed.

Results. The overall 5-year survival of N1 and N2 patients was 67% and 37%, respectively, and the difference was statistically significant (p = 0.0000, log-rank test). The prognosis was compared between N1 without No. 10 involvement (N1⁻, N = 145), N1 with No. 10 involvement (N1⁺, N = 35), and N2 (n = 166). Their 5-year survival was 70%, 54%, and 37%, respectively. A significant difference was observed only between N1⁺ and N2 (p = 0.04), and not observed between N1⁻ and N1⁺. However, survival curves of single-node N2 (n = 66) and N1⁺ were superimposed.

Conclusions. In terms of prognosis, a pleural reflection does not seem an appropriate anatomical boundary between N1 and N2 stations in lung cancer.     

N次错误的陈奕池印象

陈奕池是影视圈里的新人，正在北京电影学院读二年级。平时除了拍戏，她涉足较深的是广告界，像吉百利、博士伦、松下电器、科健手机、李宁服饰等等。如此被广告商青睐，大都缘自她卓越的镜头感。     

新品拓市的N种错误

经销商对新品铺货不当，常常是导致产品“出师未捷身先死”的罪魁祸首。所以，面对新品的市场开发，经销商一定要小心谨慎，千万别让新品推广“夭折”在自己手中。