Internal Jugular Vein Graft after Inadvertent Severing of the Internal Carotid Artery during Carotid Endarterectomy and an Urgent Re-Exploration for Immediate Post-Operative Wound Site Bleeding: A Case Report

Carotid endarterectomy is a well-established treatment for preventing stroke in selected patients. Although there is debate over whether patch angioplasty or primary closure should be used to reconstruct the bifurcation after carotid endarterectomy, there is growing evidence in the literature in favor of patch angioplasty. When compared to primary closure, patch angioplasty during conventional carotid endarterectomy is suggested to lower the incidence of restenosis and recurrent ipsilateral stroke. Various materials have been used as a patch in this procedure, including the saphenous vein, synthetic patches, or less frequently, an internal jugular vein patch where extensive narrowing of the internal carotid artery is evident. In our case, we used an internal jugular vein graft after inadvertent severing the internal carotid artery (ICA) during carotid endarterectomy after the failure of reconstruction with a saphenous vein patch. We also encountered immediate postoperative reactionary hemorrhage following anesthetic reversal, necessitating an urgent re-exploration. The purpose of this case report is neither an attempt to suggest all patients need angioplasty nor to state that an internal jugular vein patch or graft is superior to synthetic material or saphenous veins;rather, it is an attempt to emphasize a potentially effective rescue way to reconstruct inadvertent extensive vascular injury during carotid endarterectomy.

A novel strategy of smart manipulation by micro-scale oscillatory networks of the reactionary zones for enhanced extreme thrust control of the next-generation solid propulsion systems

The main aim of this research is to get a better knowledge and understanding of the micro-scale oscillatory networks behavior in the solid propellants reactionary zones. Fundamental understanding of the micro-and nano-scale combustion mechanisms is essential to the development and further improvement of the next-generation technologies for extreme control of the solid propellant thrust. Both experiments and theory confirm that the micro-and nano-scale oscillatory networks excitation in the solid propellants reactionary zones is a rather universal phenomenon. In accordance with our concept,the micro-and nano-scale structures form both the fractal and self-organized wave patterns in the solid propellants reactionary zones. Control by the shape, the sizes and spacial orientation of the wave patterns allows manipulate by the energy exchange and release in the reactionary zones. A novel strategy for enhanced extreme thrust control in solid propulsion systems are based on manipulation by selforganization of the micro-and nano-scale oscillatory networks and self-organized patterns formation in the reactionary zones with use of the system of acoustic waves and electro-magnetic fields, generated by special kind of ring-shaped electric discharges along with resonance laser radiation. Application of special kind of the ring-shaped electric discharges demands the minimum expenses of energy and opens prospects for almost inertia-free control by combustion processes. Nano-sized additives will enhance self-organizing and self-synchronization of the micro-and nano-scale oscillatory networks on the nanometer scale. Suggested novel strategy opens the door for completely new ways for enhanced extreme thrust control of the solid propulsion systems.

OBSERVATIONS ON THE THERAPEUTIC EFFECT OF THE TREATMENT OF 100 SCAPULOHUMERAL PERIARTHRITIS CASES BY "HEGUCI" (MUSCLE NEEDLING) COMBINED WITH MASSAGE

Objective： To explore an effective method for managing middle and late stages of scapulohumeral periarthritis. Methods： A total of 182 cases of scapulohumeral periarthritis were randomized into treatment group （100 cases） and control group （ 82 cases）; those in treatment group were managed by “Heguci” （合谷刺 muscle needling） at the reactionary spot of focus （found out via palpation around the shoulder region） in combination with reinforcing needling manipulation of “Setting the Mountain on Fire” and topical massage; whereas, those in control group treated by conventional method of “selecting aoupoints E Jianqian （肩前 extra point）, Jianyu （肩髃 LI 15）, Jianliao （肩髎 TE 14）, etc] along the course of the affected meridians in combination with massage”. The treatment was given once daily, with 10 sessions being a therapeutic course, 20 sessions altogether. Results： Of the 100 cases and 82 cases in control and treatment groups, 36 （43.90%） and 69 （69.00%） were cured, 42 （51.21% ） and 26 （26.00%） improved, 4 （4.87%） and 5 （5.00%） failed, with the total effective rates being 95.13% and 95.00% respectively. The average treatment sessions of control and treatment groups were 16.32±4.24 and 9.66±8.44 separately. The curative rate of treatment group was significantly higher than that of control group and the rumber of the therapeutic sessions required of the former group was evidently fewer than that of the later group （ P 〈 0.01 ）. Conclusion： The therapeutic effect of “Heguci” combined with massage is significantly superior to that of conventional acupuncture plus massage in the treatment of middle and late stages of scapulohumeral periarthritis.