BackgroundPeripheral artery disease (PAD) is a major global health problem with marked regional disparities. Updated estimates are needed to better characterize these differences and inform priority-setting in prevention and management.MethodsUsing GBD 2021 data, we estimated PAD prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) in High-income North America (HINA), the Caribbean, and Sub-Saharan Africa (SSA). Outcomes were reported as counts, crude rates, and age-standardized rates (ASRs), with stratification by sex, socio-demographic index (SDI), and age. Temporal trends from 1990 to 2021 and risk factor-attributable DALYs were also assessed.ResultsFrom 1990 to 2021, PAD cases increased by 72% in HINA, 127% in the Caribbean, and 137% in SSA, while DALYs increased by 84%, 168%, and 203%, respectively. Prevalence and DALY ASRs declined slightly in HINA, increased moderately in the Caribbean, and rose more markedly in SSA. Women showed higher prevalence and YLD burden, whereas men had higher YLL and mortality. Tobacco use and high fasting plasma glucose contributed more prominently to the attributable burden in HINA and the Caribbean, whereas high systolic blood pressure and kidney dysfunction were more prominent in SSA. PAD burden increased substantially after age 60 and peaked in the oldest age groups.ConclusionPAD burden continues to rise, with SSA showing the least favorable age-standardized trends. These findings highlight substantial regional heterogeneity and may help identify priorities for earlier detection, risk-factor control, and long-term PAD management, particularly in lower-resource settings.

Previous systematic reviews of stem cell-based therapies for lower limb ulcers have largely focused on arterial, diabetic or mixed-aetiology ulcers, while evidence in strictly defined pure venous ulcers remains scarce. This systematic review evaluated the efficacy and safety of stem cell-based and stem cell-related regenerative therapies for pure venous ulcers. PubMed, Embase, Web of Science and the Cochrane Library were searched up to February 2026 for comparative clinical studies. Studies involving arterial, diabetic, mixed or non-venous ulcers, non-comparative designs or insufficiently extractable data were excluded. Three studies involving 43 patients were included, comprising two randomised controlled trials and one non-randomised comparative study. Interventions included autologous bone marrow-derived mesenchymal stem cells in fibrin spray, hair follicle-containing punch grafts and antlerogenic stem cell extract. In one randomised double-blind pilot trial, mesenchymal stem cells in fibrin spray accelerated linear healing by approximately 10-fold compared with saline spray and fibrin spray alone (p < 0.01). Another randomised trial found greater ulcer area reduction at 18 weeks in hair follicle-treated areas than in control areas (75.15% [SD 23.03] vs. 33.07% [SD 46.17], p = 0.002). The non-randomised study reported significant improvements in wound area, circumference and healing-related indices, although Ki-67 expression did not differ significantly. No major treatment-related safety concerns were reported, although adverse-event data were limited. Current evidence suggests potential benefit, but findings remain preliminary because of small samples, heterogeneous interventions and variable outcome definitions. Larger standardised studies are needed. Trial Registration: CRD420261304878.

BACKGROUND:Severe chronic lower extremity venous insufficiency caused by post-thrombotic syndrome (PTS) remains a challenging clinical condition. Femoral venous valve reconstruction offers potential therapeutic options, yet comparative data on different surgical approaches are limited. This study investigated the efficacy and safety of asymmetric femoral venous valve reconstruction in patients with severe chronic lower extremity venous insufficiency caused by PTS. METHODS:This study was a historical cohort study. Patients with PTS at the Clinical-Etiological-Anatomical-Pathophysiological classification C4 or higher were enrolled consecutively. All patients underwent femoral vein exploration for asymmetric valve reconstruction; if reconstruction was impossible or failed, valve transplantation or transposition was performed instead. Patients were grouped according to their final surgical procedure. The primary outcome was the Venous Clinical Severity Score (VCSS) during the 3-year follow-up period, and secondary outcomes were operative time, intraoperative pressure injury risk, ulcer healing status, and venous reflux. RESULTS:The asymmetric valve reconstruction group consisted of 11 individuals, while the venous valve transplantation/transposition group comprised 10. Compared with valve transplantation/transposition, from month 3 to month 24 after surgery, asymmetric valve reconstruction was associated with higher VCSS compared to the other group (P < 0.05), while after 30 months, there were no significant differences between the 2 groups (P > 0.05). Asymmetric valve reconstruction was associated with a shorter operative time (P < 0.001) and a lower intraoperative pressure injury (Stage I in the sacrococcygeal region) risk (P = 0.035). All venous ulcers healed (mean healing time: 5.1 months asymmetric reconstruction group versus 3.6 months transplantation/transposition group; Log-rank test, P = 0.068). Eight (72.7%) in the asymmetric reconstruction group and four (40%) in the transplantation/transposition group experienced recurrence of severe femoral venous reflux in the first 12 months (mean time free from severe reflux: 8.7 months vs. 10.8 months; Log-rank test, P = 0.097). CONCLUSION:For severe PTS patients failing nonsurgical therapy, femoral vein exploration with attempted asymmetric valve reconstruction may be prioritized over valve transplantation/transposition, offering comparable outcomes and better perioperative safety.

This study explores the risk factors for pulmonary embolism in patients with acute left lower extremity deep vein thrombosis and investigates the dual role of left iliac vein compression in the occurrence of pulmonary embolism. In a single-center retrospective study, patients diagnosed with left iliac vein compression combined with acute left lower extremity deep vein thrombosis who completed pulmonary artery CT imaging examinations were consecutively enrolled from 2013 to 2023. The demographic characteristics, risk factors, comorbidities, onset time, degree of left iliac vein compression, and the relationship with the occurrence of pulmonary embolism were collected and analyzed. Logistic regression analysis was used to evaluate the odds ratios and 95

A considerable number of patients with deep vein thrombosis of the lower extremities will develop post-thrombotic syndrome even after receiving standardized anticoagulation therapy. Damage to the femoral vein valves caused by post-thrombotic syndrome can lead to severe chronic lower limb venous insufficiency and currently there is a lack of effective treatment. We present a patient with pigmentation and itching due to post-thrombotic syndrome, where the anterior leaflet of the first set of valves in the superficial femoral vein was completely destroyed, while the posterior leaflet, although structurally intact, was adhered to the vessel wall. By reconstructing the posterior leaflet of the femoral vein valve and simultaneously narrowing the lumen where the anterior leaflet was located through suture ligation, we restored the valve’s function to prevent venous reflux. During a 12-month follow-up period, the patient’s quality of life significantly improved. Single-leaflet reconstruction surgery may serve as a potential treatment option for patients with post-thrombotic syndrome.

BACKGROUND:Micronized purified flavonoid fraction (MPFF) is a widely prescribed and extensively investigated venoactive drug (VAD). The standard dosage for MPFF is 500 mg administered twice daily. However, a new daily dose of 1000 mg has just been introduced. OBJECTIVE:This study investigated whether a daily dose of 1000 mg MPFF could be implemented and embraced by the public and still has the same therapeutic effects as conventional pharmaceuticals. METHODS:For this meta-analysis, we searched MEDLINE, Embase, Science of Web, Cochrane, and PubMed databases and forward and backward citations for studies published between database inception and March 2023. Three randomized controlled trials (RCTs) of comparison of different dosages of MPFF to evaluate whether there is a significant difference between them were included, without language or date restrictions. Due to the small sample size of the study included, we conducted a simple sensitivity test using a one-by-one exclusion method, and the results showed that the study did not affect the final consolidation conclusion. The quality of the evidence was assessed using the Cochrane risk-of-bias tool. RESULTS:Out of 232 studies, 99 were eligible and 39 RCTs had data, all with low to moderate bias. Overall, 1924 patients (experimental group: 967, control group: 957) in 3 RCTs met the criteria. There is no significant difference in patient compliance, efficacy, clinical adverse events, and quality of life scores between MPFF 1000 mg once daily and MPFF 500 mg twice daily (standardized mean difference [SMD]: 0.049 [0.048, 0.145], p=0.321, risk ratio [RR]: 0.981 [0.855, 1.125], p=0.904, and SMD: 0.063 [0.034, 0.160], p=0.203). INTERPRETATION:In symptomatic chronic venous disease patients, MPFF 1000 mg once daily and MPFF 500 mg twice daily improve patient compliance, lower limb discomfort, clinical adverse events, and quality of life scores similarly. Regular medical care should recommend MPFF 1000 mg daily more often.Clinical ImpactMicronized purified flavonoid fraction (MPFF) is a popular venoactive medication (VAD) in modern medicine.MPFF is effective in treating lower extremity venous problems.Currently, besides conventional 500 mg tablets, there exist alternative dosage forms such as solutions, chewable tablets, and other novel formulations for MPFF.The excessive frequency and amount of medication may have a negative impact on patient adherence.

BACKGROUND:Subclavian aneurysms are rare in clinic; right subclavian artery aneurysms (SAAs) are more common than left SAAs in clinical practice. Although the causes and methods of treating subclavian aneurysms have been studied, it is still unknown how they form naturally. OBJECTIVE:While describing the uncommon subclavian aneurysm, examine the pertinent literature to discuss its etiology and treatment outcomes, and offer some recommendations for this patient's treatment plan. METHODS:In this case report, we describe a man patient who had a right subclavian proximal aneurysm that was discovered by accident. No clear clinical symptoms or signs were present in the patient. Upon admittance, an examination revealed an aneurysm in the vertebral artery but no peripheral embolization or compression symptoms. The patient refused operation, so we opted for follow-up instead. RESULT:The patient took an ultrasound examination at our first follow-up appointment 3 months after discharge, and the results showed no thrombosis or appreciable aneurysm enlargement. Follow-up appointments for 6 months and a year have begun. CONCLUSION:Follow-up is a good method to monitor the course of subclavian aneurysms without a clear indication for surgery when there is a clear operation mode and risk.

深静脉瓣膜功能不全导致反流是下肢慢性静脉疾病的重要原因.技术难度、患者个体情况等原因限制了开放手术直接纠正瓣膜功能的应用,静脉瓣膜的置换成了更有潜力的治疗方式.目前,天然材料、合成材料、组织工程瓣膜各有其利弊,在瓣膜制作的发展过程中展示了多种可能性,尤其是组织工程为瓣膜制造提供了新途径.本文通过总结国内外瓣膜替代物的相关文献,对下肢深静脉瓣膜替代物进行综述,以期促进下肢慢性静脉疾病治疗的发展.

现代医院管理制度下,医院文化建设对促进医院整体发展的作用越来越重要.通过加强医院文化建设,促进医院核心竞争力提升是医院发展的方向之一.中华传统文化承载着中华民族千年传承的智慧,形成了自身的特质.某三级医院将医院传统文化与医院文化建设相融合,经过几年实践,确立自己特有的"以人为本"的宗旨和"家文化"体系,取得了良好效果,提升了医务人员幸福感和医疗服务质量,为其他医院提供了可供借鉴的经验和参考.

Objective: Peripheral artery disease (PAD) affects more than 200 million people worldwide, among whom more than two-thirds reside in low- and middle-income countries. China, as the largest low- and middle-income country, faces a challenge from the burden of PAD as the country undergoes economic expansion. We compared the patterns of PAD between China and Western countries to determine if there are differences in risk factors, awareness, or treatment of PAD. Methods: Literature searches were performed both in English databases and Chinese databases covering January 1, 1995, to March 1, 2020. Both landmark and high-quality articles were evaluated. Results: The prevalence of PAD in high-income countries increases linearly with age, whereas PAD increases slowly until the middle 60s and exponentially thereafter in China. In contrast with Western countries, the prevalence of PAD in China is reported to be higher in women than in men. There is a higher prevalence of risk factors in China, but the rates of awareness and treatment of these risk factors are low. Conclusions: The lack of awareness and lower rates of treatment and control of PAD and its risk factors in China may be underlying the higher prevalence of PAD in women than in men as well as the steep increase in PAD after the middle 60s. In all countries, more attention should be paid to the planning and implementation of preventative strategies and clinical services. The societal and economic effects of PAD are considerable and ongoing studies are needed to help curtail the burden of this disease.

OBJECTIVE: This study investigated the psychological effect of the coronavirus disease 2019 (COVID-19) outbreak on medical students in China. METHODS: In February 2020, an online survey was performed using a WeChat app with an online survey program to collect and analyze the effects of the COVID-19 outbreak on the mental health of medical students across China. RESULTS: Overall, 757 medical students responded to the survey. About 2.24% reported middle and high levels of anxiety since the COVID-19 outbreak began, and 14.40% reported middle and high levels of depression. Bachelor's students and those whose residence registration was located in a rural area were more likely to have anxiety and depression, compared with postgraduates and students whose residence registration location was an urban area, respectively. CONCLUSIONS: The COVID-19 epidemic is associated with a low but real rate of psychological trauma in the medical students of China, and protective programs are needed to lessen this adverse effect.

Stem cell therapy is emerging as an exciting new strategy for the treatment of chronic wounds representing a promising approach of regenerative medicine. Induced pluripotent stem cells (iPSC) represent an innovative, adult-derived, stem cell source with enhanced therapeutic and translational potential. iPSC are pluripotent stem cells derived from somatic donor cells, harvested via noninvasive techniques from a limitless donor pool. The use of iPSC technologies allows for generation of autologous pluripotent stem cell populations with enhanced in vivo survival while obviating ethical issues surrounding destruction of embryos. Because of their ability to differentiate into and repopulate all cell types found in the skin, iPSC have the potential to enhance each phase of wound healing via paracrine and direct cellular effects. Current methods that generate iPSC are often inefficient, predispose cells to mutagenesis, and yield impure cellular populations. Because undifferentiated cells carry tumorigenic potential, selection of terminally differentiated cells and use of cell-free extracellular vesicles may improve iPSC safety profile. While the ideal delivery platform for improving cell function and survival is yet to be designed, advances in bioengineered materials to create next-generation delivery scaffolds have shown promising results. Thus, despite tremendous advantages and promise for tissue regeneration, further studies to improve iPSC safety profile and generation methods are urgently needed prior to widespread clinical adoption.

颈动脉支架植入术(CAS)临床应用逐年增多,术后可能发生心脑血管事件甚至死亡,术后管理尤为重要.该文通过查阅近年来国内外文献并进行整理、分类、比较和分析,就CAS术后低血压控制目标与治疗管理,术后高血压和脑过度灌注综合征(CHS)处理,抗血小板药物、他汀类药物应用管理作一综述.术后密切监测,个体化维持血流动力学稳定,有效的抗血小板药物治疗和他汀类药物治疗是减少并发症发生的手段.

Diabetic foot is one of the long-term and serious complications of diabetes. It is characterized by complex etiology, great difficulty in treatment, rapid development of the disease, and has high disability and mortality. When patients with foot ulcers are not treated in time and effectively, local wound infection is easy to occur. Once myofascia space infection occurs and tension reduction and drainage is not timely, the infection will spread and spread rapidly, causing foot swelling or gangrene, and even systemic infection endangering life. Therefore, this article reviews the debridement drainage methods of the open debridement, vacuum sealing drainage and small incision counterpart drainage technology, elaborates the specific technical points, technical advantages and technical focus of the three debridement and drainage methods for preserving limbs in patients with diabetic foot with myofascial space infection, to provide a reference for diabetic foot multidisciplinary team to formulate a scientific and appropriate treatment plan, in order to promote the early recovery of diabetic foot ulcer patients and ensure the effectiveness of the overall treatment.

自2019年12月以来,国内各省市陆续发现新型冠状病毒肺炎患者.该病作为急性呼吸道传染病已经被列入《中华人民共和国传染病防治法》规定的乙类传染病,按甲类传染病管理.首都医科大学宣武医院作为一所综合医院,在疫情防控工作中,依法依规,科学有序,快速反应,做到早发现、早报告、早隔离、早转运,早治疗.门诊是医院防控疫情的第一道关口,把好第一关,是有效防控疫情的重要保障.同时,此次新型冠状病毒肺炎防控工作对综合医院门诊产生巨大影响,甚至会转变今后的诊疗模式,包括完善发热门诊设施设备、实行非急诊全面预约、推进互联网诊疗服务等.

实际工作发现,突发传染病疫情的首例确诊病例、以及后续确诊或疑似病例的报告主要来自综合医院.综合医院发热门诊承担发热患者的筛查、诊断和治疗,对筛查出的传染病疑似患者或确诊患者采取隔离救治措施.实践证明,提高发热门诊对传染病筛查的敏感性、准确性、及时性和衔接性,完善综合医院传染病防控体系建设,提升传染病防控能力,更好地发挥发热门诊的"哨点"作用,实现对传染病的早发现、早报告、早隔离、早诊断、早治疗.

目的 探讨开放性瓣膜修复术治疗下肢原发性深静脉瓣膜功能不全(PDVVI)的疗效.方法 收集2018年5月至2020年12月首都医科大学宣武医院17例行开放性瓣膜修复术治疗PDVVI的患者临床资料.患者按股浅静脉瓣膜损伤情况采取相应的开放性瓣膜修复术,9例采用股浅静脉切开瓣膜修复联合静脉壁外戴戒术;5例采用单纯股浅静脉戴戒术;3例采用自体腋静脉瓣膜股浅静脉移植术.术后随访,根据患肢基本临床表现恢复情况及静脉病变临床严重程度评分(VCSS)结果判断疗效.结果 术后6个月临床治疗有效率为94.1％,与术后12个月的90.0％比较,差异无统计学意义(P>0.05).术后6个月VCSS评分为(4.3±1.3)分,与术后12个月的(4.5±1.6)分比较,差异无统计学意义(P>0.05).术后6、12个月VCSS评分均低于术前的(20.9±4.7)分,差异有统计学意义(P<0.01).结论 开放性下肢深静脉瓣膜修复术安全有效,根据瓣膜损伤情况采取相应的术式及规范的操作是手术成功的保证.其长期疗效尚待大样本临床研究进行评估.

新冠肺炎疫情是新中国成立以来,传播速度最快、感染范围最广、防控难度最大的重大突发公共卫生事件.自北京市2020年1月23日启动重大突发公共卫生事件一级响应以来,首都医科大学宣武医院以战时状态,坚决按照党和政府的战斗部署,担当抗疫一线工作,进行这场没有硝烟的战争.医院门诊工作一方面要向患者提供必须、及时的医疗服务,另一方面要坚决、毫不放松地实行相应的防控举措,守住抗疫战线的第一道关口.笔者从医院新冠肺炎疫情防控举措入手,正视非常状态下门诊运行和管理中暴露出的问题,总结重大公共卫生应急状态下医院门诊工作的宝贵经验,提高应对传染病疫情举措的实操性和有效性.

Objective To investigate the effect of small incision counterpart drainage and dressing change technique on foot function in patients with diabetic foot muscle fascial space infection.Methods From January 2018 to July 2018,60 patients with diabetic foot fascial space infectioniabetic foot were treated in the Wound Care Center of Xuanwu Hospital Capital Medical University.The patients were randomly divided into two groups according to the random number table method,observation group and control group,30 cases in each group.The observation group underwent counterpart drainage and dressing with small incision to normal tissues.Necrotic tissue was gradually cleared away and the lipid hydrocolloid dressing was used for drainage after debridement.If inflammation spread,debridement continued.When the redness and swelling of the affected foot began to recede,the removal of the drainage strip was taken into consideration.Finally,the incision between sole and back of the foot was closed and covered with wet and closed dressing.The control group underwent thorough debridement through a large incision.In the later stage,sterile scissors or surgical blades were repeatedly used to debridement the necrotic tissue to control the infection.The affected foot was rinsed with 0.9％ sodium chloride solution and dried with sterile gauze.Functional dressings such as silver ion dressings were used to cover it.The pain score,incision healing time,patient satisfaction,and the health status of the patients in the two groups,including the physiological field (physical functions,physiological functions,physical pain and general health) and the psychological field (energy,social function,emotion functional and mental health) were calculated and surveyed.Data were compared by t test.Results The observation group's pain score,incision healing time,and patient satisfaction were (3.76 ± 1.94) points,(39.09 ± 10.55) d and (94.21 ±6.77) points,and the control group were [(5.31 ± 2.48) points,(47.11 ± 7.13) d and (82.09 ± 7.26) points],the differences were statistically significant (t =2.70,3.45,6.69;with P values below 0.05).In addition,the scores of the physiological field (physical functions,physiological functions,physical pain and general health) scores of the observation group were (79.99 ± 14.12),(71.33 ± 10.21),(77.47 ± 12.78) and (81.15 ± 12.77) points,respectively and those in the control group were [(72.54 ± 12.01),(63.03 ± 11.67),(67.19 ± 11.12),(73.08 ± 10.54) points],the differences were statistically significant (t =2.20,2.93,3.32,2.67;with P values below 0.05);the scores of various indicators in the psychological field (energy,social function,emotion functional and mental health) of the observation group were (83.64 ± 10.88),(92.55 ±11.32),(92.67 ±25.55) and (86.34 ±9.77) points,and those in the control group were [(76.11 ± 15.02),(70.31 ± 16.23),(73.34 ±21.21) and (78.98 ± 11.01) points],the differences were statistically significant (t =2.22,6.16,3.19,2.74;with P values below 0.05).Conclusions Counterpart drainage and dressing change with small incision is of less damage and bleeding,safer,more reliable,and much better than conventional dressing change.Moreover,the appearance and function of the diabetic foot can be preserved,and the quality of life and health of the patients can be significantly improved.