脉复生联合杏芎氯化钠注射液治疗下肢动脉硬化闭塞症的 临床研究

【摘 要】 目的 观察脉复生联合杏芎氯化钠注射液治疗下肢动脉硬化闭塞症患者的临床疗效。方法 将 206 例下肢动脉硬化闭塞症患者随机分为治疗组和对照组各 103 例。两组均在常规治疗基础上给予杏芎氯化钠注射液

( 100 mL 静滴，qd) ，治疗组加服用脉复生( 30 mL，bid) ，治疗 15 d 后，观察治疗前后患者创面愈合率、疼痛程度 VAS 评分、血脂水平、血液流变学、患肢经皮氧负压( TcPO2 ) 、踝肱指数( ABI) 的变化。结果 治疗组总有效率为 96. 11% ，显著高于对照组的 77. 1% ( P ＜ 0. 05) ; 治疗组疼痛减轻程度大于对照组( P ＜ 0. 05) ，经皮氧负压高于对照组( P ＜ 0. 05) 。结论 脉复生联合杏芎氯化钠注射液治疗下肢动脉硬化闭塞症患者有显著疗效，有助于减轻患者溃疡疼痛、提高患肢经皮氧分压、促进患肢溃疡愈合。

【关键词】 下肢动脉硬化闭塞症; 脉复生; 杏芎氯化钠注射液; 下肢溃疡; 经皮氧分压 ABI

肠造口患者病耻感与出院准备度的关系肠造口患者病耻感与出院准备度的关系

【摘 要】目的: 调查肠造口患者病耻感与出院准备度现状，并探讨两者相关性。方法: 选取北京协和医院结直肠外科行肠造口术住院患者 124 例，采用出院准备度量表 ( RHDS) 评价出院准备度状况，用社会影响量表 ( SIS) 评价病耻感状况。结果: 居住在农村的患者 SIS 得分高于居住在城市的患者，家庭月均收入≤3000 元的患者 SIS 高于家庭月均收入 ＞ 3000 元的患者 ( 均 P ＜ 0. 05) 。患者 SIS 总分及各维度得分均与 RHDS 总分呈负相关 ( r = － 0. 35、 － 0. 31、 － 0. 26、 － 0. 32、 － 0. 36，均 P ＜ 0. 01) 。多重回归分析显示 SIS 的内在羞耻感维度得分与 RHDS 总分负向关联 ( β = － 3. 33，P ＜ 0. 05) 。结论: 肠造口患者病耻感与出院准备度密切相关。

【关键词】肠造口; 病耻感; 出院准备度

PFKP Activation Ameliorates Foot Process Fusion in Podocytes in Diabetic Kidney Disease

Background: Glycolysis dysfunction is an important pathogenesis of podocyte injury in diabetic kidney disease (DKD). Foot process fusion of podocytes and increased albuminuria are markers of early DKD. Moreover, cytoskeletal remodeling has been found to be involved in the foot process fusion of podocytes. However, the connections between cytoskeletal remodeling and alterations of glycolysis in podocytes in DKD have not been clarifified.

Methods: mRNA sequencing of glomeruli obtained from db/db and db/m mice with albuminuria was performed to analyze the expression profifiling of genes in glucose metabolism. Expressions of phosphofructokinase platelet type (PFKP) in the glomeruli of DKD patients were detected. Clotrimazole (CTZ) was used to explore the renal effects of PFKP inhibition in diabetic mice. Using Pfkp siRNA or recombinant plasmid to manipulate PFKP expression, the effects of PFKP on high glucose (HG) induced podocyte damage were assessed in vitro. The levels of fructose-1,6-bisphosphate (FBP) were measured. Targeted metabolomics was performed to observe the alterations of the metabolites in glucose metabolism after HG stimulation. Furthermore, aldolase type b (Aldob) siRNA or recombinant plasmid were applied to evaluate the inflfluence of FBP level alteration on podocytes. FBP was directly added to podocyte culture media. Db/db mice were treated with FBP to investigate its effects on their kidney.

Results: mRNA sequencing showed that glycolysis enzyme genes were altered, characterized by upregulation of upstream genes (Hk1, and Pfkp) and down-regulation of downstream genes of glycolysis (Pkm, and Ldha). Moreover, the expression of PFKP was increased in glomeruli of DKD patients. The CTZ group presented more severe renal damage In vitro, the Pfkp siRNA group and ALDOB overexpression group showed much more induced cytoskeletal remodeling in podocytes, while overexpression of PFKP and suppression of ALDOB in vitro rescued podocytes from cytoskeletal remodeling through regulation of FBP levels and inhibition of the RhoA/ROCK1 pathway. Furthermore, targeted metabolomics showed FBP level was signifificantly increased in HG group compared with the control group. Exogenous FBP addition reduced podocyte cytoskeletal remodeling and renal damage of db/db mice.

Conclusions: These fifindings provide evidence that PFKP may be a potential target for podocyte injury in DN and provide a rationale for applying podocyte glycolysis enhancing agents in patients with DKD.

Keywords: PFKP, diabetic kidney diseases, glycolysis, podocyte injury, cytoskeletal remodeling, FBP

Predictive Value of Contrast-Enhanced Ultrasound in Chemical Lumbar Sympathectomy for End-Stage Arteriosclerosis Obliterans of the Lower Extremities

ABSTRACT

Introduction: The therapeutic effect of chemical lumbar sympathectomy (CLS) on ischemic diseases of the lower limbs varies greatly among individuals. The time to peak (TTP) response in contrast-enhanced ultrasound (CEUS) can reflflect the perfusion disorder of the calf skeletal muscle and the collateral circulation. In this study we evaluated the predictive value of CEUS in patients treated with CLS for end-stage atherosclerotic occlusive disease of the lower extremity (ASO-LE).

Methods: This was a prospective study that included patients with end-stage ASO-LE and moderate to severe pain who had undergone a CEUS examination and CLS procedure and who were observed for 12 months after surgery. The patients’ characteristics and prognostic factors,including lower limb pain score, skin temperature, walking distance, and ulcer and gangrene healing, were recorded.

Results: Fifty-eight patients with a mean age of 66.24 (range 58–78) years were included in the study, of whom 42 (71.41%) were men. Following the CLS procedure, the numerical rating scale (NRS)-measured pain decreased signififi- cantly, and the skin temperature of the affected limb increased signifificantly (P \0.05). The satisfaction rate of lower limb pain relief 1 year after operation was 53.45%. Correlation analysis showed that preoperative TTP response was correlated with the NRS score and skin temperature of the affected limb at 6 months and 12 months post surgery (P \ 0.05). The binary logistic regression analysis indicated that a longer preoperative TTP response was associated with a higher risk of poor pain relief after CLS (odds ratio 1.126, 95% confifidence interval 1.058–1.205). The receiver operating characteristic curve showed that preoperative TTP response had a certain predictive value on CLS treatment effect, with a sensitivity and speci-fificity of 81.5% and 83.9%, respectively. When the preoperative TTP response was [ 77.5, the risk of poor response after CLS increased.

Conclusions: Preoperative TTP response was able to predict the therapeutic effect of CLS to a certain extent, and thus may aid physicians in determining the choice of CLS treatment for patients with ASO-LE.

Trial Registration: Chinese Clinical Trial Registry: ChicTR1900028424 (principal investigator: Yue Wu; date of registration: 21 December 2019).

Keywords: The time to peak; Peripheral arterial disease; Arteriosclerosis obliterans; Skeletal muscle; Collateral circulation

Research progress on negative pressure wound therapy with instillation in the treatment of orthopaedic wounds

Abstract:Negative pressure wound therapy with instillation (NPWTi) has the dual function of negative pressure sealing drainage and irrigation, which overcomes the disadvantages of NPWT, such as tube obstruction, inability to apply topical medicine, and poor anti-infection ability. NPWTi has been researched exten sively and widely used in various types of wounds, and certain effects have been achieved. A series of parameters for NPWTi have not been unified at present, including the flushing fluid option, flushing mode, and treatment period. This paper reviews the research progress of these parameters for NPWTi and their application in the treatment of orthopaedic wounds.

KEYWORDS:instillation, negative pressure wound therapy, orthopaedic wounds, treatment parameters

Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study

      Objective. To compare the clinical effffects of modifified above-knee and conventional surgery with the stripping of the greatsaphenous vein of varicose veins of the lower extremities. Methods. Clinical data of patients with a varicose vein of the lower extremity from May 2016 to May 2018 were collected. A retrospective study was conducted on the patients receiving modifified above-knee and conventional surgery with the great saphenous vein stripping. The baseline characteristics and long-term follow-up data were compared between the groups. Results. There were no signifificant difffferences in baseline characteristics between the two groups (P > 0:05). The surgeries were successfully performed by the same group of surgeons under local anesthesia and neuraxial anesthesia. The hospital stay, operation time, intraoperative blood loss, total length, and number of incisions in the above-knee group were comparable to those in the conventional surgery group (P > 0:05). The incidence of saphenous nerve injury and subcutaneous hematoma in the above-knee group was lower than that in the conventional surgery group (P < 0:05). There were no signifificant difffferences in recurrent varicose vein incidences (P > 0:05). After surgery, the venous clinical severity score (VCSS) and chronic venous insuffiffifficiency questionnaire (CIVIQ-14) scores of both groups were higher than those before operation (P < 0:05). There was no signifificant difffference in VCSS score or CIVIQ-14 scores between the two groups postoperation (P > 0:05). At 24 months after surgery, the above-knee group (71.8%) and conventional surgery group (73.2%) resulted in changes of at least two CEAP-C clinical classes lower than baseline, respectively. Conclusion. The modifified above-knee technique can ensure clinical outcomes, reduce intraoperative blood loss and complication incidences, and shorten the operative time. This gives evidence that the modifified above-knee technique is worthy of clinical application.