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.

Adipose Stem Cell-Based Treatments for Wound Healing

      Wound healing is one of the most complex physiological regulation mechanisms of the human body. Stem cell technology has had a signifificant impact on regenerative medicine. Adipose stem cells (ASCs) have many advantages, including their ease of harvesting and high yield, rich content of cell components and cytokines, and strong practicability. They have rapidly become a favored tool in regenerative medicine. Here, we summarize the mechanism and clinical therapeutic potential of ASCs in wound repair.

Keywords: adipose stem cells, wound healing, regenerative medicine, skin regeneration, inflflammation

A machine learning algorithm for early detection of heel deep tissue injuries based on a daily history of sub-epidermal moisture measurements

Abstract：Sub-epidermal moisture is an established biophysical marker of pressure ulcer formation based on biocapacitance changes in affected soft tissues, which has been shown to facilitate early detection of these injuries. Artificial intelligence shows great promise in wound prevention and care, including in automated analyses of quantitative measures of tissue health such as sub-epidermal moisture readings acquired over time for effective, patient-specific, and anatomical-site-specific pressure ulcer prophylaxis.Here, we developed a novel machine learning algorithm for early detection of heel deep tissue injuries, which was trained using a database comprising six consecutive daily sub-epidermal moisture measurements recorded from 173 patients in acute and post-acute care settings. This algorithm was able to achieve strong predictive power in forecasting heel deep tissue injury events the next day, with sensitivity and specificity of 77% and 80%, respectively, revealing the clinical potential of artificial intelligence-powered technology for hospital-acquired pressure ulcer prevention. The current work forms the scientific basis for clinical implementation of machine learning algorithms that provide effective, early, and anatomy-specific preventive interventions to minimise the occurrence of hospital-acquired pressure ulcers based on routine tissue health status measurements.

KEYWORDS：artificial intelligence, predictive bioengineering modelling, pressure ulcer/injury prophylaxis, preventive interventions, SEM scanner

护理人员医疗器械相关压力性损伤认知 现状及其影响因素研究

摘要 目的：调查护理人员医疗器械相关压力性损伤（ＭＤＲＰＩ）认知现状，并分析其影响因素。方法：采用分层抽样法选取２０２０年５月—２０２０年７月清远市１０所医院的１０７４名护理人员为调查对象，采用自行设计的问卷对其进行问卷调查，采用多重逐步回归分析研究护理人员 ＭＤＲＰＩ认知的影响因素。结果：４２．３％的护理人员知晓压力性损伤的最新分期，ＭＤＲＰＩ知晓率为８６．８％。绝大部分护理人员在为病人护理时选择合适的器械，固定适宜。４８．０％的护理人员不会直接将器械放置在病人身上，大部分护理人员使用纱布／棉垫保护器械接触部位皮肤。约４３％的护理人员每天２次或３次评估医疗器械接触部位皮肤，５２．４％的护理人员每天２次清洁使用器械部位皮肤；气管插管被认为是最容易引起 ＭＤＲＰＩ的原因。多重线性回归分析结果显示，职称、医院级别、培训次数为护理人员 ＭＤＲＰＩ知识得分的影响因素（Ｐ＜０．０５）。结论：护理人员 ＭＤＲＰＩ知识和行为水平有待提高，需加强护理人员 ＭＤＲＰＩ相关知识的规范化培训，提高护理人员对 ＭＤＲＰＩ的认知和护理行为水平，以降低病人的 ＭＤＲＰＩ发生率。

关键词 医疗器械相关压力性损伤；护理人员；认知；影响因素