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BACKGROUND: The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications. It has been found that diabetic foot can be categorized into arterial stenosis and non-arterial stenosis, both of which have significant differences in hemodynamic characteristics. AIM: To evaluate the early hemodynamic changes in diabetic foot patients with nonarterial stenosis and arterial stenosis treated by tibial transverse transport (TTT) using high-frequency color Doppler ultrasonography (HFCDU) and a laser Doppler flowmeter. METHODS: Twenty-five patients with Wagner grades 3-5 diabetic foot ulcers were treated with TTT, and the wound healing time and rate were recorded. Patients were grouped according to the results of preoperative lower-extremity ultrasonography. Cases with ≥ 50% stenosis in any of the femoral, popliteal, posterior tibial, anterior tibial, and peroneal arteries of the affected limb were classified as the arterial stenosis group (n = 16); otherwise, they were classified as the nonarterial stenosis group (n = 9). Before and one month after surgery, HFCDU was used to evaluate the degree of lower limb artery lesions and hemodynamic changes in patients. The degree of femoral-popliteal atherosclerotic stenosis, the degree of vascular stenosis and occlusion of the lower-knee outflow tract, and the degree of medial arterial calcification were scored; the three scores were added together to obtain the total score of lower extremity arteriopathy. PeriScanPIM3, a laser Doppler flowmeter system, was used to detect alterations in plantar microcirculation before and 1 mo after surgery. Wound healing and hemodynamic indices were compared between the two groups. RESULTS: The wound healing time of the diabetic foot was significantly shorter in the nonarterial stenosis group than in the arterial stenosis group (47.8 ± 13 vs 85.8 ± 26, P < 0.05), and the wound healing rate of both groups was 100%. The preoperative total lower extremity arteriopathy scores were lower in the nonarterial stenosis group than those in the arterial stenosis group (18.89 ± 8.87 vs 24.63 ± 3.52, P < 0.05). The nonarterial stenosis group showed higher preoperative popliteal artery (POA) blood flow than the arterial stenosis group (204.89 ± 80.76 cc/min vs 76.75 ± 48.49 cc/min, P < 0.05). Compared with the baseline (before surgery), the postoperative POA blood flow of the affected limb in the nonarterial stenosis group decreased one month after surgery (134.11 ± 47.84 cc/min vs 204.89 ± 80.76 cc/min, P < 0.05), while that in the arterial stenosis group increased (98.44 ± 30.73 cc/min vs 61.69 ± 21.70 cc/min, P < 0.05). Although the POA blood flow in the arterial stenosis group was obviously improved one month after surgery, it was still lower than that in the nonarterial stenosis group (98.44 ± 30.73 cc/min vs 134.11 ± 47.84 cc/min, P < 0.05). The nonarterial stenosis group had higher preoperative plantar microcirculation than the arterial stenosis group (56.1 ± 9.2 vs 33.2 ± 7.5, P < 0.05); compared with the baseline, the plantar microcirculation in the arterial stenosis group was significantly improved one month after surgery (51.9 ± 7.2, P < 0.05), while that in the nonarterial stenosis group was reduced (35.9 ± 7.2, P < 0.05). CONCLUSION: Based on preoperative HFCDU findings, diabetic foot patients can be divided into two categories: Those with nonarterial stenosis and those with arterial stenosis, with obvious differences in hemodynamic changes in the early postoperative period between them. In the early stage after TTT, the blood flow volume and velocity and the plantar microcirculation perfusion of the affected limb of the diabetic foot with nonarterial stenosis decreased compared with the baseline, while those of the diabetic foot with arterial stenosis improved significantly compared with the baseline, although both had smoothly healed diabetic foot ulcers.
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A coumarin-appended rhodamine derivative was prepared by reacting rhodamine hydrazide and coumarin-3-carboxylic acid, which fluorescence sensing behavior toward Zn2+ against other metal ions was investigated in CH3CN. Significantly, the rodamine-coumarin derivative exhibited highly selective and sensitive recognition toward Zn2+ with a limit of detection (LOD) down to 10-9 M. Upon addition of Zn2+, remarkable fluorescent intensities enhanced and also clear color changed from colorless to pink. The Job's plot indicated the formation of 1:1 complex between the rhodamine-coumarin derivative and Zn2+. The presence of common coexisting alkali, alkaline earth, and transition metal ions showed small or no interference with the detection of Zn2+. The conjugate dye could be used for "naked-eye" detection of Zn2+.
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OBJECTIVE: To evaluate the efficacy and clinical value of the strategy of posterior simultaneous correction by bilateral corrective rod on the convex and concave sides in the treatment of adolescent idiopathic scoliosis (AIS). METHODS: From February 2006 to August 2008, posterior fusion was performed to 48 AIS patients. There were 16 males and 32 females, with an average age at the time of surgery of 17.1 years. Lenke Type I was found in 17 cases, Type II in 9, Type III in 14 and Type IV in 8. There were 27 patients used selective posterior fusion in thoracic, 21 cases without selective fusion. Observation index: the Cobb angle on coronal plane, translation and rotation of apical vertebrae, the coronal balance, the Cobb angle on sagittal plane, obliquity between lowest instrumented vertebrae (LIV) and the pelvis, intervertebral angle and rotation of the LIV. The patients were followed up at an average time of 15.1 months (12-27 months). RESULTS: In the 27 cases with selective fusion, thoracic coronal Cobb angle was (17 + or - 8) degrees after the operation, with an average correction rate of (76 + or - 11)% at final follow up. The lumbar Cobb angle was (13 + or - 7) degrees after the operation, with an average correction rate of (72 + or - 9)% at final follow up. In the 21 cases without selective fusion, the thoracic Cobb angle was (20 + or - 7) degrees after the operation, with an average correction rate of (74 + or - 15)% at final follow up. The lumbar Cobb angle was (16 + or - 8) degrees after the operation, with an average correction rate of (69 + or - 9)% at final follow up. The average number of vertebrae retained below LIV was 4.4. There was 1 case developing thoracolumbar kyphosis. During the follow up, there were no major complication of neurological injury, no pseudarthrosis and no spine decompensation. CONCLUSION: Posterior bilateral segmental pedicle screw simultaneous correction technique as a technique for correcting thoracic and lumbar curves scoliosis can improve the treatment of idiopathic scoliosis with fewer vertebral fusion and complications.