The formation of an arteriovenous fistual for dialysis by routine interrupted sutures anastomosing the vein and artery is difficult to perform and time-consuming. A new method, telescopic adhesive anastomosis was studied and applied in 10 hemodialysis patients, who were in need of an arteriovenous fistula. The external diameter of the vessels anastomosed was 2.40 +/- 0.20 mm (radial artery) or 2.40 +/- 0.35 mm (cephalic vein). After thorough debridement of the vascular ends, the arterial end was put in the venous lumen. In order to fix the telescopic vessels, two stitches were applied 180 degrees apart from each other and tied. Each stitch was inserted from vein (penetrating the whole wall) to artery (just through the adventitia and partial thickness of the media vasorum). The distance from the stitch to the edge of the vein was 0.5 mm, and that of the artery was approximated to the external diameter of the vessle. The medical adhesive was then applied for sealing the anastomotic adventitia. Ten seconds were given for the solidification of the adhesive. The patients were followed up for 8 months. The patency rate was 100%, and the rate of blood flow was more than 300 ml/min (measured by ultrasonography). It was shown that this method could be managed easily and quickly, and the so-formed fistula would fulfill the need of hemodialysis.
OBJECTIVE To investigate the clinical result in repair of soft tissue defect with combined skin flap vascularized by pedicle on the one end and vascular anastomosis on the other end. METHODS From October 1990 to August 1995, 5 cases with soft tissue defect at the extremities and 1 cases with sacral bed sore were repaired by the combined skin flaps transfer, ranged from 15 cm x 30 cm to 16 cm x 70 cm in defect, among them, 5 cases with myocutaneous flap and 1 case with skin flap, and the size of the combined skin flaps was 15 cm x 40 cm to 12 cm x 80 cm. RESULTS All the flaps were survived with satisfactory effect. Followed up 3 to 6 years, there was no obvious complication. CONCLUSION Transfer of combined skin flaps vascularized by pedicle and vascular anastomosis is suitable to repair the soft tissue defect, especially in large area defect.
Objective To explore the correlations of serum levels of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), and their ratios, with the severity of white matter hyperintensities (WMH) in patients with cerebral small vessel disease (CSVD). Methods This prospective study included patients with CSVD who were treated at Zhongshan Hospital, Xiamen University between January 2022 and February 2024. Qualitative and quantitative analyses of WMH were performed using the Fazekas scale and lesion prediction algorithm. Biomarkers such as MMP-2, MMP-9, and TIMP-1 were measured to explore their correlations with the severity of WMH. Results A total of 144 patients with CSVD were included in this study, comprising 63 males and 81 females, with an average age of (67.60±8.73) years. There were 83 (57.6%), 41 (28.5%), and 20 (13.9%) patients were categorized as Fazekas grade 1, 2, and 3 for WMH, respectively, with an median total WMH volume of 4.31 mL. Multinomial logistic regression analysis for Fazekas grade (grade 1 as the reference level) showed that MMP-2 [grade 2: odds ratio (OR)=1.059, 95% confidence interval (CI) (1.016, 1.105); grade 3: OR=1.463, 95%CI (1.124, 1.905)], TIMP-1 [grade 2: OR=1.019, 95%CI (1.006, 1.032); grade 3: OR=1.048, 95%CI (1.008, 1.090)], and MMP-9/TIMP-1 [grade 3: OR=2.650, 95%CI (1.393, 5.039)] were independently associated with Fazekas grade (P<0.05). Multinomial logistic regression analysis for the quartile group of total WMH volume (group Q1 as the reference level) showed that MMP-2 [group Q2: OR=1.160, 95%CI (1.021, 1.318); group Q3: OR=1.238, 95%CI (1.086, 1.412); group Q4: OR=1.313, 95%CI (1.140, 1.512)] and TIMP-1 [group Q2: OR=1.095, 95%CI (1.054, 1.138); group Q3: OR=1.084, 95%CI (1.045, 1.125); group Q4: OR=1.102, 95%CI (1.057, 1.149)] were independently associated with the quartile group of total WMH volume (P<0.05). Conclusions Serum levels of MMP-2 and TIMP-1 demonstrate significant independent associations with both the Fazekas grade and the total volume of WMH in patients with CSVD. These correlations underscore the potential utility of MMP-2 and TIMP-1 as critical biomarkers for assessing the severity of WMH in CSVD, highlighting their prospective roles in clinical diagnostics and therapeutic monitoring.
Objective To investigate the clinical characteristics and risk factors of immature hematomas in patients with primary intracerebral hemorrhage. Methods Patients with primary intracerebral hemorrhage who admitted in West China Hospital of Sichuan University between March 2012 and January 2021 were retrospectively analyzed. Brain CT scan was used to evaluate the presence of immature hematomas, as well as hematoma volume and the morphological features such as the number of hematoma projections or satellite foci, and finger-like projections. Imaging markers of cerebral small vessel disease such as lacunes, microbleeds, white matter hyperintensities (WMH), and enlarged perivascular space were evaluated on MRI. Mature hematomas were defined when the hematomas were completely homogeneous, without any irregularity or hypodensity, otherwise the hematomas were regarded as immature. Patients were divided into two groups: mature hematomas and immature hematomas. Multivariate Logistic regression was used to analyze the risk factors of immature hematomas. Results A total of 170 patients were included. Among them, there were 121 males (71.2%). The average age was (60.9±13.3) years old, and 129 cases (75.9%) had immature hematomas. The comparison between the mature hematomas group and the immature hematomas group showed that higher admission National Institutes of Health Stroke Scale score, larger hematoma volume, hematoma volume >30 mL, more hematoma projections or satellite foci, lower incidence of round or oval hematomas, cerebral small vessel disease score, lower WMH burden, and lower burden of cerebral small vessel disease were associated with the occurrence of immature hematomas. The results of multiple logistic regression analysis showed that lower incidence of round or oval hematomas, lower incidence of WMH, and lower periventricular WMH scores were associated with the occurrence of immature hematomas after adjusting for age, gender, hypertension, diabetes, smoking, alcohol consumption, admission National Institutes of Health Stroke Scale score, and hematoma volume. Conclusion Lower incidence of round or oval hematomas and lower periventricular WMH burden are associated with immature hematomas.
OBJECTIVE: To explore an ideal way of small vessel anastomosis for microsurgery. METHODS: Anastomosis of both carotid arteries were performed in 20 rabbits. One side of the arteries were anastomosed with anastomotic clips, the other side of the arteries, as comparison, were anastomosed with suture. The vessels were harvested at first and 14th day after operation and were evaluated using operating microscope, light microscope and electronic microscope. RESULTS: The average anastomotic time for suture was about 15 minutes, while for the clips was 2 to 5 minutes. There were no difference in patency between the two techniques. Endothelialization at the anastomotic sites were both completed 14 days postoperatively. However, for the anastomotic clips, there were no endothelia damage and foreign bodies formation inside the vessels. CONCLUSION: This experiment has confirmed that the anastomotic clip’s procedure provides a very safe and easy way to perform anastomosis and reduce the incidence of thromboses.
Cerebral small vessel disease is a common neurological disease, including acute and non-acute categories. With the development of neuroimaging, cerebral small vessel disease has attracted substantial attention in recent years. However, the categories and concepts of cerebral small vessel disease and the related imaging markers usually confuse people. The purpose of this study was to discuss the relationships among acute and non-acute cerebral small vessel disease and the imaging markers, so as to improve the understanding of cerebral small vessel disease, and to shed light on clinical practice and research.
Ischemic lesions, lacunar infarcts and leukoaraiosis on head CT or MRI are commonly detected in patients with non-specific symptoms such as dizziness and headache or people undergoing healthy physical examinations. Although these imaging findings are mostly related to vascular disease, especially cerebral small vessel disease, it does not mean that long-term use of antiplatelet drugs and statins are required. On the basis of literature review and clinical experiences, the article points out that the treatment methods for such manifestations include determining whether these lesions are vascular lesions, searching for risk factors or causes such as aging, hypertension, diabetes mellitus, vascular stenosis, and psychological factors, and taking strategies for the corresponding prevention and management, provides a reference for the appropriate diagnosis and treatment of these imaging manifestations in clinical practice.
Objective To investigate the correlation of red blood cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) with total imaging load of cerebral small vessel disease (CSVD), and the clinical diagnostic value of RDW, NLR and their combined indicators for high load of CSVD imaging. Methods The medical records of CSVD patients hospitalized in the Department of Neurology of Baotou Central Hospital between October 2018 and October 2022 were retrospective collected. The total imaging load of CSVD was obtained by evaluating the cranial MRI and divided into a low load group and a high load group. The general clinical data, past medical history, and blood biochemical indicators were compared between the two groups. The correlation analysis method was used to analyze the relationship between the relevant indicators and the total imaging load. Logistic regression analysis was used to analyze the risk factors of the total imaging load of CSVD. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the detection indicators for clinical diagnosis. Results A total of 320 patients were included. Among them, there were 201 cases (62.81%) in the low load imaging group and 119 cases (37.19%) in the high load imaging group. Excepted for age, gender, history of hypertension, RDW, and NLR (P<0.05), there was no statistically significant difference in the comparison of other indicators between the two groups (P>0.05). Spearman correlation analysis showed that RDW (r=0.445, P<0.001) and NLR (r=0.309, P<0.001) were positively correlated with the total imaging load of CSVD. The results of multivariate logistic regression analysis showed that age, male gender, RDW, and NLR were risk factors for high imaging load of CSVD. The areas under the ROC curve of RDW, NLR, and their combined indicators were 0.733, 0.644, and 0.792, respectively.Conclusions In patients with CSVD, the levels of RDW and NLR are related to the total imaging load of CSVD, which are independent risk factors for high imaging load of CSVD. The levels of RDW and NLR have clinical diagnostic value in predicting CSVD high load.
Cerebral small vessel disease refers to a series of clinical, imaging, and pathological syndromes caused by various factors affecting small blood vessels in the brain. Cognitive impairment is one of the most common complications of cerebral small vessel disease. Current researches have found that cognitive impairment is related to various factors such as hypoxia. Hyperbaric oxygen therapy can achieve certain therapeutic effects by improving hypoxia. This article reviews the pathogenesis of cerebral small vessel disease, biomarkers of cerebral small vessel disease, research progress on hyperbaric oxygen therapy for cognitive impairment, and focuses on the research progress of hyperbaric oxygen therapy for mild cognitive impairment and dementia, providing more references for clinical treatment.