The use angiogenesis stimulators for the treatment of chronic ischemia of lower extremities

We present the results of treatment of chronic ischemia of the lower extremities (distal form) with angiogenesis stimulators, autologous endothelioblast precursors (CD133+) and gene preparation of vascular endothelial growth factor VEGF₁₆₅ (angiostimulin). Good clinical effect was attained in all patients, which was confirmed instrumentally 1, 3, and 6 months after administration of the stimulant: transcutaneous oxygen tension on the foot, index of malleolar pressure, and walking duration increased, parameters of microcirculation improved, the number of newly formed collateral arteries increased (angiography findings), quality of life improved (SF 36 questionnaire), and parameters of coagulogram also improved. The maximum positive dynamics was observed by month 3 of the study. __________ Translated from Kletochnye Tehnologii v Biologii i Medicine, No. 3, pp. 159–164, July, 2007     

Impact of wound microbiology on limb preservation in patients with diabetic foot infection

Aims/Introduction:To investigate the association between specific bacterial pathogens and treatment outcome in patients with limb‐threatening diabetic foot infection (LT‐DFI).Materials and Methods:Consecutive patients treated for LT‐DFI in a major diabetic foot center in Taiwan were analyzed between the years 2014 and 2017. Patients with positive wound culture results at first aid were enrolled. Clinical factors, laboratory data, and wound culture results were compared. Lower‐extremity amputations and in‐hospital mortality were defined as a poor outcome.Results:Among the 558 patients, 272 (48.7%) patients had lower extremity amputation and 22 (3.9%) patients had in‐hospital mortality. Gram‐negative bacterial (GNB) infection was the independent factor following factors adjustment. When all the 31 microorganisms were analyzed, only E. coli (adjusted odds ratio [aOR], 3.01; 95% CI, 1.60–5.65), Proteus spp. (aOR, 2.99; 95% CI, 1.69–5.29), and Pseudomonas aeruginosa (aOR, 2.00; 95% CI 1.20–3.32) were associated with poor outcome. The analysis of specific GNB species in association with major‐ or minor‐ amputation have been reported. No specific pathogen was associated with cause of death in patients with mortality within 30 days. The antimicrobial‐resistant strains were not associated with a poor treatment outcome.Conclusions:The presence of GNB was associated with limb amputations. This study provides insight into more timely and appropriate management of the diabetic foot infection.     

Cycle-to-cycle control of swing phase of paraplegic gait induced by surface electrical stimulation

Parameterised swing phase of gait in paraplegics was obtained using surface electrical stimulation of the hip flexors, hamstrings and quadriceps; the hip flexors were stimulated to obtain a desired hip angle range, the hamstrings to provide foot clearance in the forward swing, and the quadriceps to acquire knee extension at the end of the swing phase. We report on two main aspects; optimisation of the initial stimulation parameters, and parameter adaption (control). The initial stimulation patterns were experimentally optimised in two paraplegic subjects using a controlled stand device, resulting in an initial satisfactory swinging motion in both subjects. Intersubject differences appeared in the mechanical output (torque joint) per muscle group. During a prolonged open-loop controlled trial with the optimised but unregulated stimulation onsets and burst duration for the three muscle groups, the hip angle range per cycle initially increased above the desired value and subsequently decreased below it. The mechanical performance of the hamstrings and quadriceps remained relatively unaffected. A cycle-to-cycle controller was then designed, operating on the basis of the hip angle ranges obtained in previous swings. This controller successfully adapted the burst duration of the hip flexors to maintain the desired hip angle range.     

下肢动脉硬化闭塞症治疗趋势与思考

随着对下肢动脉硬化闭塞症的不断深入研究和治疗技术的不断更新发展,介入治疗已经逐步取代了传统的外科治疗,成为治疗该疾病的主要方法。近年来,随着药物支架和长球囊广泛的应用于临床,治疗效果显著提高,内膜下成形术以及多种新的技术和器械问世并应用,明显提高了长段闭塞性病变开通率。本文就对该疾病临床特征、临床检查方法、TASCⅡ分型、介入治疗技术以及治疗的策略等方面进行细致的阐述,为临床治疗该疾病提供相关的参考依据。     

Lower Extremity Injury While Undergoing Urology Procedures in the Trendelenburg with Lithotomy Position: Three Case Reports

PurposeTo report and discuss the incidence of severe lower extremity injuries associated with robotic procedures in Trendelenburg with lithotomy position.Design and MethodsA case study method was used to describe three cases of patients who underwent robotically assisted urological procedures in Trendelenburg with lithotomy position and developed serious lower extremities injuries resulting in fasciotomies. Furthermore, a literature review was conducted to evaluate risk factors and possible interventions for the prevention of similar injuries.FindingsCase analysis revealed multifactorial causes, including patient comorbidities, long surgical procedures, and blood pressure decreases below the baseline for more than 30 minutes. The severity of lower extremity injury associated with lithotomy position may be underestimated. The etiology of peripheral nerve injury can be attributed to patient comorbidities, positioning, and surgical conditions. Injury prevention should include careful patient and procedural risk assessment, staff education, and communication strategies.ConclusionsExtreme Trendelenburg with lithotomy position for longer periods can lead to serious lower extremities injuries. Preanesthetic screening and multidisciplinary team discussions for additional precautions for high-risk patients are crucial interventions to decrease incidence and severity of lower extremities injuries.     

生长板材料属性对6岁儿童乘员膝关节损伤影响分析

目的构建较高仿真度的6岁儿童乘员下肢有限元模型,验证6岁儿童乘员膝关节的有效性;分析在前碰撞载荷下生长板对儿童膝关节的生物力学响应及损伤机制。方法基于儿童生理结构及CT影像构建包含生长板的6岁儿童乘员下肢有限元模型,赋予相应的材料属性;参照Kerrigan等及Haut等的生物力学实验,验证模型的有效性,分析不同生长板材料属性对膝关节损伤的影响。结果通过模型仿真实验与生物力学实验曲线对比验证了模型的有效性;在膝关节区域,生长板的存在可以改变儿童乘员下肢骨折的损伤模式;不同生长板的材料属性,可以影响股骨轴向损伤力的阈值及达到损伤阈值而发生骨折的相对位置。结论所建模型得到有效验证,可用于6儿童乘员膝关节损伤生物力学响应及损伤机制的相关研究及应用。     

长骨节段性缺损修复重建的理论及应用进展

背景：长骨节段性骨缺损修复重建方法众多,各有优缺点,限制了其广泛应用,仍是一个未完美解决的骨科难题。 目的：综述近年国内外长骨节段性缺损的修复重建进展研究。 方法：第一作者应用计算机检索1990年1月至2012年12月PubMed数据库、中国期刊全文数据库、维普数据库有关长骨节段性缺损修复重建的文章,英文检索词“bone defect, long bone reconstruction, tissue engineering of bone,scaffolds,bone reconstruction,bone graft,bone tumor; tumor resection,musculoskeletal tumors,regeneration,autografts”;中文检索词“大段,骨缺损,骨肿瘤,软组织肿瘤,瘤段切除,组织工程,骨移植”。共检索到104篇相关文献,纳入52篇文献进一步研究。 结果与结论：传统长骨节段性骨缺损的修复方法包括自体骨移植、异体骨移植、骨延长、人工假体置换等。研制适用于儿童保肢需要,符合儿童生长发育特点的假体成为儿童保肢的一个挑战课题。为了解决这一问题,人们研制出可以不断延长的假体,用于儿童骨肿瘤的保肢重建。随着医疗技术的进步,各种人工骨,尤其是骨组织工程和基因治疗在骨缺损修复中的逐步应用将进一步提高骨缺损的修复效果,是未来的研究方向。     

DIOMED激光治疗下肢静脉曲张的初步报告

目的:初步评价DIOMED激光治疗下肢静脉曲张的临床应用。方法:20例病人共26条患肢均行激光或激光结合手术治疗,主要应用4种手术治疗方式:①单纯激光治疗;②激光治疗加高位大隐静脉结扎术;③激光治疗加合股浅静脉瓣膜包窄术和大隐静脉高位结扎术;④激光治疗加大隐静脉高位结扎和交通支结扎术。结果:经随访2～14个月,所有病人都恢复正常生活自理或工作,无局部复发表现,疗效满意。结论:静脉内激光治疗是一种安全、有效、微创、不遗留手术疤痕、操作简便和疗效好的新治疗方法,还可联合手术治疗。     

乌司他丁预先给药对双下肢缺血再灌注损伤后血浆细胞因子的影响

 

目的 探讨乌司他丁预先给药对双下肢缺血再灌注损伤后血浆细胞因子的影响。方法 30例择期双下肢需上止血带(>150 min)手术的患者,随机分为:对照组(NC组,n=10)、乌司他丁预先给药组(UP1组,n=10)和乌司他丁治疗组(UP2组,n=10)。UP1组于首次上止血带前15 min静脉滴注乌司他丁按6000 U/kg,末次松止血带前15 min再次静脉滴注6000 U/kg;UP2组末次松止血带前15 min给予乌司他丁静脉滴注12 000 U/kg;NC组:末次开放止血带前15 min静脉滴注等容积生理盐水(均10 min内滴完)。3组患者首次上止血带前20 min(缺血前)、末次松止血带后30 min(再灌注后30 min)及术后(再灌注后)1 d、3 d和7 d ,取外周血检测血浆C反应蛋白(CRP)、白介素-6(IL-6)、和肿瘤坏死因子(TNF-α)水平。结果 与缺血前比较,再灌注后30 min、1 d及3 d,3组患者血浆CRP、IL-6、TNF-α水平均显著升高(P<0.05),但UP1组、UP2组与NC组相比明显低于后者[CRP:1 d(11.15±2.32)、(10.48±2.08) mg/l比NC(15.83±4.56)mg/l,3 d (4.29±1.89)、(3.89±1.34) mg/l比NC(6.78±2.95)mg/l;TNF-α:1 d(31.24±8.66)、(29.72 ±8.77) ng/l比NC(44.802 ±11.70)ng/l,3 d (13.75±5.11)、(15.73±4.16)ng/l比NC(20.787±8.05)ng/l;IL-6:1 d(160.80±46.95)、(179.72±35.77)ng/l比NC(329.50±95.34)ng/l,3 d (45.32 ±16.53)、(53.35±17.62)ng/l比NC(79.33±24.93)ng/l,P<0.05],UP2组与UP1组间比较差异均无统计学意义;再灌注后7 d 3组患者血浆细胞因子均恢复正常。结论 乌司他丁预先给药可有效地减轻双下肢缺血再灌注所引起的全身炎性反应,使血浆CRP、IL-6、TNF-α上升幅度明显受抑,从而可有效地阻抑炎性因子介导的组织器官损伤。

     

肥胖患者四肢骨折的治疗方案选择

目的:探讨肥胖患者骨折的临床治疗特点。方法:自2006年8月~2008年8月对收治的体重指数(BMI)≥25 kg/m2闭合性四肢长管骨骨折患者72例。年龄8~71岁。男性53例,女性19例。结果:3例发生骨延迟愈合,余均正常愈合。结论:对体重指数(BMI)≥25 kg/m2的骨折患者其治疗方法及实施方式有其特殊性,应充分考虑肥胖对骨折愈合的不利因素及患者的具体情况,尽可能选择对骨折端血运干扰小且牢固可靠的治疗方案。