Volume 87  ·   Issue 09  ·  2007

Posterior orthopedics has always been the standard surgical procedure for juvenile idiopathic thoracic scoliosis, but the anterior orthopedics technique, which has gradually become familiar to everyone, has its unique advantages. Firstly, anterior surgery can better correct coronal deformity, reestablish balance and reduce horizontal rotation of vertebral body by directly acting on lateral displacement and rotation of vertebral body by orthopedic force. In addition, correction of scoliosis deformity by compression of vertebral body screw can effectively restore the normal kyphosis of thoracic vertebra, and correct scoliosis by shortening rather than lengthening the spine. Therefore, the possibility of nerve injury caused by spinal cord pulling is reduced. These characteristics make anterior orthopedics also become one of the standard approaches for thoracic scoliosis. In recent years, the application of thoracoscopic orthopedics has made spinal orthopedics enter the minimally invasive era, and the orthopedics of juvenile idiopathic thoracic scoliosis has an open and minimally invasive choice [1-4].

Objective to investigate the value of arthroscopic technique in the selection of indications for unicondylar replacement. Methods 24 patients with unicondylar replacement of knee osteoarthritis were examined and cleared by arthroscopy, aged 49-74 years, with an average of 63 years, 9 cases of left knee and 15 cases of right knee. Due to the severity of cartilage injury in the lateral and patellofemoral compartments, 8 cases were changed to other surgical procedures, and 16 cases were selected for unicondylar replacement. All patients underwent arthroscopic synovial debridement. In the unicondylar replacement group, the free body was removed under microscope in 4 cases, the meniscus injury was repaired in the lateral compartment in 4 cases, and the synovial fold was resected in 3 cases. Results 16 cases were followed up after unicondylar replacement for an average of 14 months. The average preoperative Lysholm score was 67.5, and the average postoperative score was 94. The functional evaluation was excellent in 12 cases, good in 2 cases, and acceptable in 2 cases. There was no pain in the knee joint after operation, the extension and flexion mobility were normal, and the walking and quality of life were improved significantly. Conclusion Arthroscopic examination is beneficial to strictly screening the surgical indications for patients with unicondylar replacement for knee osteoarthritis.

Objective to investigate the clinical feasibility and safety of percutaneous cannulated screw fixation in the treatment of vertically unstable pelvic fractures. Methods The optimal nail insertion point and nail insertion angle of 40 adults aged 18-68 years were measured in 1CT horizontal scanning images of the sacrum, and the conclusions were drawn for clinical reference. 14 cases, 9 males and 5 females, aged 19-68 years, were vertically unstable pelvic fractures, 11 cases were type C1, 2 cases were type C2, and 1 case was type C3. All of them were corrected and displaced by heavy traction before operation, and the pelvic ring was percutaneously fixed in supine position, and then the sacroiliac joint was percutaneously fixed with cannulated nails in prone position. Results The average distance from the standard needle insertion point to the midline of the trunk was 10.78 cm (9.80-12.00 cm), and the standard needle insertion angle was 61.24 ° (52.18-68.20 °). After 6~24 months follow-up, 14 cases recovered their original work after fracture healing.Conclusion Percutaneous cannulated screw for the treatment of vertically unstable pelvic fractures has the advantages of simple operation, firm fixation, less trauma, small incision, less bleeding, etc. It is worthy of application and popularization

Objective to investigate the efficacy and safety of one-stage percutaneous single balloon multiple expansion percutaneous kyphoplasty (PKP) in the treatment of osteoporotic spinal compression fracture and vertebral body tumors.Methods Eighteen cases with 45 vertebrae with multiple painful vertebral lesions were treated with single balloon multiple expansion PKP, with an average age of 68.77 years. Among them, 11 cases with 29 vertebrae with osteoporotic spinal compression fracture, 2 cases with 4 vertebrae with vertebral body metastasis, and 5 cases with 12 vertebrae with multiple myeloma. The vital signs of the patients were monitored during the operation, and the postoperative pain relief, daily life function recovery and satisfaction with the operation were analyzed. The vertebral body height and kyphosis angle (Cobb angle) were compared before and after the operation. Results All patients completed the operation safely. The operation time was 55~127 min, with an average of 29.3 min/vertebra.The intraoperative balloon pressure was 87~210Psi, with an average of 165Psi; The expansion volume was 1.5~4 ml, with an average of 3.25 ml; The number of dilatations ranged from 2 to 5 times, with an average of 2.94 times. The balloon ruptured in one case at the fifth dilatation, and the balloon ruptured in one case at the third dilatation. The amount of bone cement injected was 2 to 8.5ml, with an average of 3.95ml/vertebra. The ODI score decreased from 72.8% to 29.5% before operation. The height of anterior edge and midline of vertebral body recovered significantly, and the Cobb angle improved. After 6~18 months of follow-up, the average was 12.3 months. The pain relief effect of the prevented patients was maintained steadily, the ability of daily living was improved, and there was no recollapse of vertebral body or fracture of vertebral body near operation. Conclusion One-stage percutaneous puncture single balloon multiple expansion percutaneous kyphoplasty is economical, safe and effective for the treatment of multiple osteoporotic spinal compression fractures and multiple vertebral tumors.

Objective to analyze the sleep structure of patients with narcolepsy and to understand their sleep disturbance at night.Methods the sleep structure of 38 patients with narcolepsy was compared with 44 normal controls with matched age and body mass index (BMI) and no complaints of sleep disturbance.The two groups were examined by international standard questionnaire, nighttime multi-channel physiological recorder sleep breath monitoring (PSG) and multiple nap sleep latency test (MSLT), and the sleep structure was analyzed according to international standard method.Results All 38 patients complained of fast falling asleep and no difficulty in falling asleep, and the average sleep incubation period at night was 5.6 min. However, 30 cases (79%) complained that they were easy to wake up at night or difficult to fall asleep for a long time after waking up. PSG monitoring showed that the sleep efficiency of narcolepsy patients was significantly lower than that of normal controls (81.7%±12.5%, 87.1%±7.9%, P =0.029), the sleep in NREM stage Ⅰ was significantly longer than that of normal controls (21.5±12.2, 10.3±6.3, P =0.000), the incubation period of REM sleep was shorter (55.4min±60.2, 120.1min±66.6, P =0.000) and the frequency increased (7.8±4.8, 4.0±1.5, P =0.000), but the percentage of REM in total sleep time was not high (17.7%±6.9%, 18.9%±5.5%, P =0.23), which was related to the interruption of REM sleep caused by frequent awakening from REM sleep. The percentage of long waking time in total sleep time after falling asleep was significantly longer (18.2%±15.5%, 9.3%±9.2%, P =0.004). Although the percentage of short waking time in total sleep time was only 2.2%±4.7%, but It may be related to the abnormality of the mechanism of sleep maintenance in the disease itself.

Objective to investigate the relationship between the A→G polymorphism of the second intron of cholesterol 24S-hydroxylase (CYP46) gene and the G→A (R219K) polymorphism of the sixth exon of adenosine triphosphate binding cassette transporter A1 (ABCA1) gene and the susceptibility to sporadic Alzheimer's disease (SAD). Methods the polymorphism of CYP46 and ABCA1 gene in 168 patients with SAD and 215 normal controls was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and the relationship between different genotypes and the risk of Alzheimer's disease (AD) was compared. Results the allele frequency and genotype distribution of the A→G polymorphism of the second intron of CYP46 gene were not significantly different between SAD group and normal control group. The genotype distribution of the G→A polymorphism of the sixth exon of ABCA1 gene was significantly different between the two groups (x2=8.230, P =0.016). However, AA homozygotes had 60% lower risk of AD than those carrying GG genotype (adjusted OR =0.40, 95% CI =0.21-0.77, P =0.006). Conclusion A→G polymorphism of CYP46 second intron may not be related to the onset of AD; G→A polymorphism in exon 6 of ABCA1 gene is associated with SAD, and carrying A allele or AA genotype may have a certain protective effect on the pathogenesis of SAD.

Objective to evaluate the intracranial collateral circulation before and during carotid endarterectomy (CEA) in patients with severe carotid artery stenosis. Methods 15 patients with carotid artery stenosis were examined by transcranial Doppler (TCD) to evaluate the opening of anterior communicating artery (ACoA), posterior communicating artery (PCoA) and ophthalmic artery (OA). The stump reflux pressure (SP) was measured after the carotid artery was occluded during the operation. Meanwhile, the mean blood flow velocity (mvMCA) of middle cerebral artery was monitored by TCD. Results ACoA was opened in 3 cases (20%), PCoA was opened in 5 cases (33.3%), ACoA and/or PCoA were opened in 6 cases, of which OA was also compensated in 3 cases, OA was opened in 6 cases (40%), and no collateral branch was opened in 7 cases SP ≥50 mm Hg (1 mm Hg =0.133 kPa) in 8 cases, SP<50 mm Hg in 7 cases. mvMCA The decrease was less than 30% in 111 cases, and mvMCA decreased>30% in 4 cases. To judge whether the compensation was adequate or not, the judgment of preoperative TCD was consistent with intraoperative SP in 9 cases, accounting for 60%, and the decrease of intraoperative mvMCA was consistent with the judgment of SP in 12 cases, accounting for 80%. All ACoA and OA collaterals were closed after operation. Conclusion Preoperative TCD is helpful in judging collateral compensation, but intraoperative monitoring is more instructive.

Objective to design the supratentorial and inferior anterior sigmoid sinus through partial labyrinthine keyhole approach with the assistance of neuronavigation, and to explore the feasibility of accurately abrasing the bone structure related to the approach, so as to provide the basis for clinical application. Methods Eight adult cadavers fixed with 40% formaldehyde and intracranial arteriovenous latex were used to establish the intraoperative navigation data before the experiment. The extent of important structures was marked with different colors in the navigation system. The posterior auricular 7 cm "C" incision of posterior labyrinthine keyhole approach was used, and the skin flap and myofascial flap were opened in layers, and the posterior auricular bone window was made about 3.5 cm ×3 cm. With the assistance of neuronavigation, the sigmoid sinus, bone semicircular canal and facial nerve canal were contoured, and part of the labyrinthine and petrous apex were abrased. The differences of exposed structures before and after the abrasion of partial labyrinthine and petrous apex were observed, and the extent of surgical field and the maximum angle of surgical field of anterior sigmoid space were measured. Results (1) The incision of posterior labyrinthine keyhole approach completely met the requirements of transpartial labyrinthine keyhole approach. (2) Neuro navigation can assist in accurately abrasing the bone related to the approach, Reduce the accidental injury of important structures caused by blind abrasion. (3) The approach can widely expose important structures in petrous oblique area, cerebellopontine angle, anterior pontin area and posterior cavernous sinus. (4) The horizontal visual field after partial labyrinth and petrous tip abrasion is: left side (18.8±1.6) mm, right side (17.7±1.2) mm; The maximum angle of the surgical field was left (59.3±9.2) ° and right (57.0±11.0) °. The increased value of the vertical surgical field was left (10.0±1.0) mm and right (10.0±0.8) mm. The difference of the increased value of the bilateral surgical field range and the maximum angle of the surgical field was statistically significant (all P<0.01). Conclusion the anterior partial labyrinth keyhole approach of supratentorial and inferior sigmoid sinus is feasible; Removing part of labyrinth and rock tip can significantly increase the range and angle of surgical field.

Methods Six cadavers were fixed with formalin, the abdominal aorta, inferior vena cava and surrounding adipose tissue were removed, and the course and distribution of lumbar sympathetic trunk, communicating branch and sinus vertebral nerves were observed under anatomical microscope. Results According to the relationship between communicating branch of sympathetic nerve and psoas major muscle, the communicating branch of sympathetic nerve was divided into superficial oblique branch and deep transverse branch, which was located between psoas major muscle and lateral vertebral body and showed non-segmental distribution; The deep transverse branches are located transversely in the lateral side of the lumbar vertebral body, accompanied by the lumbar segmental arteries and veins, and are segmentally distributed. The anterior side of the vertebral body and intervertebral disc are innervated by sympathetic trunk branches and visceral nerves, the lateral and posterolateral side of the vertebral body are co-innervated by sympathetic trunk branches, deep communicating branches and spinal nerve branches, and the upper lumbar also receives non-segmental innervation by superficial oblique branches of sympathetic nerves. The posterior part of the vertebral body, intervertebral disc and posterior longitudinal ligament are innervated by sinus vertebral nerves from deep transverse branches. Conclusion There are two types of innervation in lumbar vertebra: segmental innervation from spinal nerve and non-segmental innervation distributed through sympathetic nervous system. The lumbar sympathetic nervous system participates in the innervation of lumbar vertebra and intervertebral disc, which may be related to the pain transmission process of discogenic low back pain.

Objective to investigate the surgical treatment strategies and the selection of fusion segments for juvenile idiopathic scoliosis with single thoracic curvature. Methods 72 cases of juvenile idiopathic scoliosis with single thoracic curvature (50 cases of Lenke IA, 8 cases of Lenke IB, 14 cases of Lenke IC) were treated with an average age of 14.3 years, 13 males and 59 females, all of which were treated with posterior selective thoracic fusion. The lower fusion vertebrae was determined by the relationship between the lower end vertebrae, the lower rotating neutral vertebrae and the stable vertebrae, and the neutral vertebrae, one vertebral body above the neutral vertebra or one vertebral body above the stable vertebrae were taken. The anterior-posterior and lateral positions of the standing spine were examined before operation, and the left and right lateral flexion radiographs of the standing spine were examined after operation and follow-up. The coronal Cobb angle, apical vertebra deviation, apical vertebra rotation and trunk deviation were measured to observe the scoliosis correction and trunk balance. The average fusion of 7.3 segments (4~10 segments) was performed, and the average follow-up was 15.9 months (12~39 months). Results The coronal Cobb angle of thoracic curvature before and after operation was (56.7±14.5) ° (40~98 °) and (18.5±8.3) ° (3~40 °), respectively; The coronal Cobb angles of lumbar curvature were (33.9±10.4) ° (25-69 °) and (11.1±6.4) ° (0-30 °) respectively, and the spontaneous correction rate was (66.9±16) % (44-100) %. The trunk deviation was corrected from (16.1±10.2) mm (4-43) mm to (8.2±6.1) mm (0-25 mm). Two patients had mild trunk imbalance after operation, but there was no further progress after two years follow-up.Conclusion Combining the upper and lower vertebrae, neutral vertebra and stable vertebra in standing position to determine the fusion range can achieve good corrective effect in the treatment of idiopathic scoliosis in adolescents with single thoracic curvature.

Objective to investigate the role of leptin in the abnormal growth and development of female children with adolescent idiopathic scoliosis (AIS). Methods the leptin concentration in peripheral venous blood of 120 female children with AIS and 80 healthy girls was measured. The differences of plasma leptin concentration, anthropomorphometric indexes and growth and development status between girls in AIS group and control group were compared, and the correlation between plasma leptin concentration and body growth and development status of female children with AIS was analyzed. Results Compared with the control group, female children with AIS not only had lower body weight, BMI and higher corrected height (44.3 kg vs 53.6 kg, 17.5 kg/m2 vs 20.9 kg/m2 and 162.7 cm vs 160.2 cm, respectively), but also had lower plasma leptin concentration (8.6 μ g/L vs 14.9 μ g/L, respectively). However, there were significant positive correlations between leptin concentration and age, menstrual status, corrected height, weight, body mass index and Risser sign (r =0.234-0.506, P<0.01). Conclusion The plasma leptin concentration of female children with AIS was significantly lower than that of the same age control group, and it was significantly correlated with growth and development related indexes. This low leptin level may play an important role in causing low body weight and BMI in female children with AIS.

Objective to investigate the relationship between the changes of proteasome activity in rat cortical neurons and delayed neuronal death after ischemia-reperfusion. Methods A 20-min global cerebral ischemia rat model was used. Fifty Wistar rats were divided into 5 groups according to the reperfusion time: sham operation group, 0.5 h recovery group, 4 h recovery group, 24 h recovery group and 72 h recovery group, 10 rats in each group. The death of neurons after ischemia-reperfusion was observed by HE staining under light microscope. Immunohistochemistry combined with laser scanning confocal microscope was used to observe the distribution of proteasome in cells after ischemia-reperfusion. Results the proteasome activity [absorbance (A) value] was 54 602 ± 1602 in sham operation group and 42 036 ± 1465 after 0.5 h of ischemia-reperfusion (P<0.01). Although the activity recovered to 47 536 ± 2532 after 4 h (P<0.05), it decreased to 45 450 ± 649 after 24 h (P<0.01), and 43 108 ± 995 after 72 h of reperfusion (P<0.01). HE staining showed that partial death of cortical neurons was observed after 72 h of ischemia-reperfusion. Laser confocal scanning microscope showed that the proteasome in the nucleus and cytoplasm of cortical neurons decreased after 24 h of ischemia-reperfusion. After 72 h, the proteasome in the nucleus of dead neurons almost disappeared, and only a small amount of protease in the surrounding cytoplasm

Objective to investigate the effect of low molecular weight heparin on pulmonary surfactants in acute pulmonary embolism rats.Methods Twenty-four male SD rats were randomly divided into control group, pulmonary embolism group and low molecular weight heparin treatment group (treatment group) by random number table method, 8 rats in each group.The pulmonary embolism model was made by injecting gelatin sponge solution through the jugular vein; In the treatment group, subcutaneous injection of subbilin, 0.01 ml/kg, once every 12 h immediately after embolization; In the control group, the same volume of normal saline was injected into the jugular vein without intervention treatment. The experimental rats were sacrificed at 2 weeks, and the pulmonary artery pressure was measured by right heart catheter method, and blood was collected from the carotid artery for arterial blood gas analysis; The pathological changes of lung tissues were observed under HE staining light microscope, and the mRNA and protein levels of pulmonary surfactant-associated protein A (SPA) were determined by RT-PCR and Western blot. Results the mean pulmonary artery pressure of rats in the control group, embolization group and treatment group were (14.2±4.1) mm Hg, (29.0±8.2) mm Hg and (25.5±2.7) mm Hg, respectively (F value was 3.01, P<0.05); Arterial oxygen partial pressures were (94.1±8.8) mm Hg, (73.4±14.3) mm Hg, (82.9±3.7) mm Hg, respectively (F value was 1.31, P<0.05); SPA mRNA levels in lung tissue were 1.43±0.51, 0.87±0.35 and 1.07±0.20, respectively (F value was 2.87, P<0.05); The protein levels were 1.00±0.00,0.52±0.32,0.90±0.22 respectively (F value was 2.96,P<0.05); Light microscopy examination of pathological sections of lung tissues of experimental rats showed congestion, edema, inflammatory cell infiltration and thickening of alveolar septum in the lung tissues of the embolized group, but the above changes were alleviated in the treatment group. Conclusion the SPA level of acute pulmonary embolism rats was significantly reduced, and low molecular weight heparin treatment could significantly increase the SPA level of lung tissues.

Objective to investigate the inhibition of cyclin A2 gene expression by siRNA in osteosarcoma MG-63 cell line and normal fibroblasts and its effect on cell proliferation. Methods the siRNA targeting cyclin A2 gene was designed and chemically synthesized, and transfected into osteosarcoma MG-63 cell line and normal human fibroblasts (HSF) with oligofectamine. Nonsense siRNA transfection was used as negative control, and phosphate buffer (PBS) was used as blank control. The silencing effect of cyclin A2 gene was detected by real-time-polymerase chain reaction (PCR) and Western blot. The growth status of cyclin A2 gene expression was evaluated by MTT, RT-PCR, flow cytometry and plate cloning culture, and the changes of PCNA and cyclin B1 gene expression were also detected. Results cyclin A2-siRNA at concentrations of 1, 10, 50 and 100 nmol/L decreased the expression of cyclin A2 gene by 9.4%, 56.4%, 79.2% and 84.3%, respectively The expression levels of proliferating cell nuclear antigen (PCNA) and cyclinB1 mRNA in normal fibroblasts were significantly decreased. For HSF in normal fibroblasts, 50 nmol/L cyclinA2-siRNA could inhibit the expression of cyclinA2 gene and protein by 58.1%, which resulted in slight changes in cell cycle, but the cell proliferation and plate cloning ability were not affected. Conclusion cyclinA2 is a key gene dependent on tumor cell proliferation, and the siRNA targeting cyclinA2 gene can effectively reduce the expression of cyclinA2 mRNA and protein in cells, and it can inhibit the growth of osteosarcoma cells but has little effect on the proliferation of normal cells.

Objective to prepare an animal model of cervical intervertebral degeneration in rats with two hindlegs and to study the origin and regularity of chondroid cells in the nucleus pulposus during the natural aging and degeneration of cervical intervertebral disc. Methods Seventy-six SD rats aged 4 weeks were randomly divided into two groups. Thirty-six rats in the control group were divided into four groups (9 rats in each group) at 4, 8, 12 and 16 months after the start of the experiment. After sacrifice, the rats in each group were sacrificed, and the anterior and lateral cervical vertebral X-ray films were taken, and the histological sections of the middle sagittal plane of the intervertebral discs of C4~5, C5~6 and C6~7 were prepared. HE and safranin-O staining were performed to observe the degeneration of cervical intervertebral disc and the migration of endplate chondrocytes to the nucleus pulposus. Results After amputation of both forelimbs, all the rats of both hindlimbs survived. Typical signs of cervical intervertebral disc degeneration were found in the imaging and histological examination of the rats in the experimental group at 9 and 12 months after operation. In the central region of the nucleus pulposus, the chondrocytes migrated to the nucleus pulposus parallel or perpendicular to the endplate, and the chordal nucleus pulposus shrank centripetally and was finally completely replaced by the fibrocartilaginous nucleus pulposus.This process was completed faster and earlier in the process of cervical intervertebral disc degeneration.Conclusion the cervical intervertebral disc degeneration model of double hindfoot rats did not damage the normal anatomical structure of animal target organs, with high success rate and good repeatability, which conforms to the law of human cervical intervertebral disc degeneration; The chondrocytes in the nucleus pulposus migrated from endplate chondrocytes, and displayed different migration patterns in different parts of the nucleus pulposus and in different stages of aging and degeneration of intervertebral disc.

A 68-year-old male was admitted to the hospital on November 26, 2005 due to "anorexia accompanied by dull pain and discomfort in the upper abdomen for 15 months and intermittent jaundice for 11 months". Fifteen months ago, he developed loss of appetite, accompanied by dull pain and discomfort in the right upper abdomen, and the discomfort was paroxysmal, and the treatment according to gastropathy was ineffective. Eleven months ago, he developed yellow staining of the skin and sclera, itching of the skin, dark yellow urine, without cold or heat. After local symptomatic treatment for about 2 weeks, the symptoms resolved and discharged from the hospital. After that, the symptoms onset intermittently. One month ago, the symptoms recurred, occasionally with white clay-like stool changes, and the treatment was ineffective. CT examination in the local hospital found pancreatic head enlargement and extrahepatic bile duct dilation, and the diagnosis of "pancreatic cancer and obstructive jaundice" was recommended. After the onset of the disease, he felt fatigue and lost 5 kg in weight. He had no history of drinking, and the diagnosis of "coronary heart disease" was 2 years. 　　

A 58-year-old male was admitted to the hospital due to tenderness in the right face with hearing loss in the right ear for 2 years. The area of distribution of the second branch of the trigeminal nerve was the main area with aggravation of irregular dull pain in the right occipital region. Have a history of myocarditis; Physical examination: mild hearing loss (neuropathic) in the right ear, normal symmetrical corneal reflex, strong bilateral masticatory muscle without atrophy, symmetrical superficial sensation of the face, no facial paralysis, no dysphagia, sensitive pharyngeal reflex, soft palate and uvula centered, no ataxia. CT of the head showed a round, high density lesion of 2 cm ×3 cm ×3 cm in the right cerebellopontine angle, CT value 56 Hu.

CRP is a common inflammatory factor. It was determined by Abernethy and Avery in 1941 that it is a kind of protein, which can form a complex with C polysaccharide in pneumococcal capsule, that is, CRP. CRP is composed of five identical non-covalently bound subunits, and the half-life of molecular metabolism is only 5~7 h. It plays a part antibody but is not an antibody. CRP is synthesized by hepatocytes and released into the blood. It is an acute phase substance that can react rapidly during infection, tissue damage and necrosis. The level of CRP in serum will increase or decrease rapidly with the changes of injury, inflammation or various diseases. Not only is the reaction speed fast and the change range large, it can correlate with disease activity, and it is less affected by age, immune status, drugs and other factors, so it can be used to predict the risk degree of disease, track the course of disease, judge the treatment effect and prognosis. Its role in the diagnosis and treatment of respiratory diseases has been paid more and more attention.

Smoking is an important cause of cardiovascular disease, but the association between smoking (including secondhand smoke) and non-smoking and acute myocardial infarction (AMI) is still unclear. Recently, a large case-control STUDY (INTERHEART STUDY) on smoking and risk of myocardial infarction was published in the American journal Lancet (2006, 368: 647-658).

severe carotid-artery stenosis is one of the risk factors causing ischemic stroke and vascular dementia, especially for patients with symptomatic carotid-artery stenosis, it is necessary to solve the stenosis in time and restore brain tissue perfusion. endarterectomy is the standard scheme for the treatment of severe symptomatic carotid-artery stenosis at present. endarterectomy requires general anesthesia, incision of the neck leads to nerve damage, in addition to traumatic complications and other adverse effects. Compared with endarterectomy, stenting is less invasive, does not need general anesthesia, and can shorten the hospital stay.

Case 1: A 43-year-old female was admitted to the vascular surgery ward on February 16, 2000 due to swelling and pain of her right lower limb for more than 20 days after a fall. The examination showed thrombosis of the upper end of the right popliteal vein and iliac vein. At 6:45 on March 20, 2000, the patient suddenly felt chest pain and dyspnea, with a heart rate of 120 beats/min and a blood pressure of 75/50 mm Hg (1 mm Hg =0.133 kPa). Emergency spiral CT showed thrombosis of the right pulmonary artery trunk and left lower pulmonary artery, and was diagnosed as acute pulmonary embolism. Emergency surgery was performed at 9:20 on March 20, 2000. The right pulmonary artery trunk was longitudinally incised 2 cm, and a large number of old thrombi were removed. The thrombi at the distal ends of each branch of the right pulmonary artery were removed with 7F Fogarty catheter, and the right pulmonary artery incision was closed after repeated irrigation with liquid containing heparin. The main trunk of the left pulmonary artery was incised to the bifurcation, and the left pulmonary artery was nearly completely occluded, and there were thrombosis in the upper and lower branches of the left pulmonary artery. The thrombosis of the left pulmonary artery was treated in the same manner. The operation lasted for 3.5 h. The inferior vena cava filter (Simon nitinol filter) was placed under digital subtraction angiography (DSA) 2 weeks after the operation. The oral anticoagulant was administered for a long time after the operation.