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Objective:To investigate the efficacy and prognostic factors of pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR) with chronic renal failure (CRF).Methods:A retrospective study. From January 2016 to June 2021, a total of 82 eyes of 58 patients diagnosed with PDR combined with CRF and treated with PPV in Department of Ophthalmology, The Second Hospital of Hebei Medical University were included in the study. There were 32 cases in males and 26 cases in females. The mean age was (48.45±10.41) years. The course of renal failure was (4.15±3.23) years, and the course of diabetes was (14.45±6.71) years. All patients undergo best-corrected visual acuity (BCVA). The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for recording. The mean number of logMAR BCVA was 2.04±0.82 (0.7-2.8). The duration of vitreous hemorrhage averaged (2.65±1.55) months. There were 38 eyes (46.3%, 38/82) with traction retinal detachment; 32 eyes had a history of panretinal photocoagulation (PRP) treatment (39.0%, 32/82). All eyes were treated with 25G PPV. Patients with traction retinal detachment were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) 3 days before surgery. Opacification of the lens affected the operation operator combined with phacoemulsification. Biochemical indexes such as hemoglobin, glycosylated hemoglobin, albumin, creatinine, uric acid, and alternative treatment (non-dialysis/hemodialysis/peritoneal dialysis) were collected. Postoperative follow-up time was ≥6 months. χ2 test or Fisher's exact test were used for comparison between groups. A logistic regression model was used for multivariate analysis, and Spearman correlation analysis was used to evaluate the correlations between variables. Results:At 6 months after surgery, the mean logMAR BCVA was 1.16±0.57. Compared with logMAR BCVA before surgery, the difference was statistically significant ( t=-0.837, P<0.001); 44 eyes had BCVA ≥0.1 and 38 eyes had BCVA <0.1. Postoperative vitreous hemorrhage (PVH) was observed in 17 eyes after surgery (20.7%, 17/82). PVH occurred in 15 (46.9%, 15/32), 1 (2.3%, 1/44), and 1 (16.7%, 1/6) eyes in patients without dialysis, hemodialysis and peritoneal dialysis, respectively. There was significant difference between those without dialysis and those on hemodialysis ( χ2=26.506, P<0.05). There was no significant difference between peritoneal dialysis patients and those without dialysis and hemodialysis patients ( χ2=2.694, 2.849; P>0.05). PVH occurred in 3 (10.0%, 3/30) and 14 (27.0%, 14/52) eyes of vitreous cavity filled with silicone oil and perfusion fluid, respectively. The difference was statistically significant ( χ2=3.315, P<0.05); 1 (33.3%, 1/3) and 10 (71.4%, 10/14) eyes were treated with PPV again, respectively, and the difference was statistically significant ( P<0.05). Neovascular glaucoma (NVG) occurred in 12 eyes (14.6%, 12/82). Logistic regression analysis showed that age [odds ratio ( OR) =0.911, P<0.05], diabetic retinopathy (DR) stage ( OR=7.229, P<0.05), renal failure duration ( OR=0.850, P<0.05), operation time ( OR=1.135, P<0.05) was an independent risk factor for poor vision prognosis. Diabetes duration ( OR=1.158, P<0.05), renal failure duration ( OR=1.172, P<0.05) and alternative therapy were independent factors affecting the occurrence of PVH. Diabetes duration ( OR=1.138, P<0.05) and renal failure duration ( OR=1.157, P<0.05) were independent risk factors for postoperative NVG. Spearman correlation analysis showed that PVH was strongly correlated with post-operative NVG ( r=0.469, P<0.01). There was no significant correlation between blood glucose, hemoglobin, creatinine and blood urea nitrogen and prognosis of postoperative vision, PVH and NVG occurrence ( P>0.05). Conclusions:In PDR patients with CRF, DR Stage, age, renal failure course and operation duration are correlated with vision prognosis. Compared with those who do not receive alternative therapy, hemodialysis treatment can reduce the occurrence of PVH and NVG after surgery.
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Objective:To observe the changes of the structure and visual function of the retina in patients with or without the ectopic inner foveal layers (EIFL) and to explore the factors influencing the recovery of visual function in patients with idiopathic epimacular membrane (IMEM).Methods:A retrospective clinical study. From March 2015 to June 2019, 90 patients with MEM who were diagnosed by Ophthalmic Center of the Second Hospital of Hebei Medical University were enrolled in the study. All patients were examined by best corrected visual acuity (BCVA) and frequency domain optical coherence scan. BCVA was recorded by Snellen vision table, and it was converted into the minimum resolution angle logarithm (logMAR) vision. Among 90 eyes, IMEM grade 2-4 was 68 (75.6%, 68/90), 18 (20.0%, 18/90), 4 (4.4%, 4/90), respectively. According to this, the grade 2 was set as group A, and the grade 3 and grade 4 were combined to group B. There was no significant difference in age ( t=0.015), sex composition ratio of patients between two groups ( χ2=0.060) and the average of central macular thickness (CMT) ( F=2.277) ( P=0.904, 0.809, 0.141). The difference of average logMAR and BCVA was statistically significant ( F=35.913, P=0.000). All patients underwent 25G pars plana three channel vitrectomy with simultaneous removal of epiretinal membrane and internal limiting membrane. BCVA, CMT and improvement of IMEM grading were observed at 1, 3, 6 and 12 months after operation. BCVA, EIFL thickness and CMT were compared before and after operation by single factor repeated variance analysis; Fisher exact probability method was used to compare the changes of the anatomical structure of the eyes in the two groups at 12 months after operation. Results:1, 3, 6, 12 months after operation, the average eyes of logMAR BCVA in group A were 0.50±0.13, 0.38±0.12, 0.27±0.12, 0.19±0.10. The patients in group B were 0.66±0.14, 0.60±0.13, 0.54±0.14, 0.52±0.14. CMT in group A were 364.82±81.29, 281.65±72.45, 228.55±55.34, 182.84±56.13 μm. The patients in group B were 455.88±69.60, 440.18±68.65, 383.76±65.38, 371.39±66.60 μm. The difference was statistically significant in the two groups (BCVA: F=37.913, 11.479, 24.250, 39.013; P=0.000, 0.002, 0.000, 0.000. CMT: F=10.987, 39.610, 55.789, 79.987; P=0.002, 0.000, 0.000, 0.000). In group A, IMEM was improved to 57 eyes of grade 1 on 12 months after operation. Among the 18 eyes in group B, IMEM was improved to 1 and 3 eyes in level 1 and level 2, respectively, and no improvement was found in 4 eyes in grade 4. The difference was statistically significant ( P=0.000) in the improvement of the number of eyes in the two groups. Conclusions:The patients with IMEM without EIFL have better visual prognosis and reversible anatomical changes. EIFL is an important factor affecting the visual function and anatomical structure recovery after operation.
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【Objective】 To explore the clinical efficacy of traditional Chinese medicine(TCM) therapy in patients with transfusion related iron overload diagnosed with chronic aplastic anemia (CAA). 【Methods】 A total of 115 patients with CAA and iron overload who had been admitted to Zhejiang Provincal Hospital of TCM from February 2015 to December 2016 were studied. They were assigned to treatment group(n=69), positive control group(n=16), and negative control group(n=30) according to different treatment plan designed in advance. Patients in the treatment group were treated with TCM of "Bushen Huoxue" recipe once a day, with the formula mixed with astragalus 40 g, rehmannia 12 g, cornus 12 g, deerhorn glue melting by heat 12 g, atractylodes 20 g, radix paeoniae alba 20 g, curculigo orchioides 10 g, herba epimedii 10 g, cistanche 12 g, cassia stem 10 g, dried orange peel 8 g, poria 10, gingembre 6 g, angelica sinensis 20 g, salvia miltiorrhiza 20 g, zedoary 9 g, leonurus 30 g, gromwell 15 g, and prepared liquorice root 6 g. Patients in positive control group were treated with desferrioxamine for more than 8 h per day, 5 to 7 days per week. Patients in negative control group were treated with basic treatment.The serum ferritin (SF) and cytokines of patients of the three groups before and 3 months after therapy were detected according to the blood-stasis of TCM symptom rating scale, and the correlation between the decrease of ferritin after treatment and the improvement of blood stasis syndrome score was analyzed. 【Results】 The level of SF of the treatment group, positive and negative control group before treatment were 1 881.63±1 386.81 vs 6 581.36±5 180.96 vs1 974.25±1 753.06, and were 2 040.14±1 484.27 vs 4 169.18±3 631.64(P<0.05)vs 2 699.80±2 352.34(P<0.05) 3 months after treatment. The treatment was effctive in 16 patients in treatment group, accounted for 23.19%(16/69). The score of blood stasis syndrome of the three groups before and after treatment were 4.26±1.45vs 6.88±1.31 vs 4.17±1.18 and 4.42±1.43 vs 5.00±0.89 vs 4.67±1.51(P<0.01), respectively. The effective rate of improving blood stasis syndrome score in the treatment group was up to 26.09%. The decrease of serum ferritin was positively correlated with the improvement of blood stasis score (P < 0.01). The levels of IL-6 and IL-10 in treatment group were 20.79±14.14 and 56.27±25.54 before treatment, 13.00±6.48 and 41.02±9.93(P<0.05)3 months after treatment, respectively. 【Conclusion】 "Bushen Huoxue" therapy can stabilize the the level of SF and improve the blood stasis syndrome in CAA patients with iron overload.
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Objective To investigate the risk factors associated with neovascular glaucoma (NVG) after pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR).Methods Retrospective study.One hundred and thirty-seven patients (137 eyes) with PDR who underwent PPV were recruited.There were 85 males and 52 females.The average age was (60.1 ± 8.8) years old.The duration of diabetes was (10.2 ± 3.6) years.There were 49 patients with ipsilateral carotid artery stenosis.Fifty-three eyes underwent intravitreal ranibizumab or conbercept injection before PPV.All eyes were treated with 23G standard three-port PPV.The average follow-up time after PPV was 11.5 months.Fundus fluorescein angiography (FFA) was conducted in postoperative 4-6 weeks to observe non-perfused retinal areas.Risk factors,such as ipsilateral carotid artery stenosis,the presence of non-perfusion in retina after PPV and the application of anti-vascular endothelial growth factor (VEGF) drugs before PPV,were identified by logistic regression.Results Twenty of 137 patients (14.6％) developed postoperative NVG after PPV.Ipsilateral carotid artery stenosis [odds ratio (OR) =5.048,95％ confidence interval (CI) 2.057-12.389,P=0.000] and the presence of non-perfusion in retina after PPV (OR=4.274,95％CI 1.426-12.809,P=0.009) were significant risk factors for postoperative NVG,while the application of anti-VEGF drugs was not (OR=1.426,95％CI 0.463-4.395,P=0.536).But the time from PPV to the onset of NVG varies significantly between the two groups of injection of anti-VEGF drugs or not (t=-4.370,P=0.000).Conclusions Risk factors associated with NVG after PPV in eyes with PDR included ipsilateral carotid artery stenosis and the presence of non-perfusion in retina after PPV.The application of anti-VEGF drugs before PPV can delay the onset of NVG in PDR eyes after vitrectomy.
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ObjectiveTo observe the clinical effects of biological artificial material (BAM)induced artificial bone in the repair of lower extremity bone defects. MethodsThe study involved 32 patients with lower extremity bone defects treated by BAM artificial bone grafting from January 2008 to December 2010.Their age was at a range of 21-77 years (mean,32.5 years).The volume of bone defects was 1.0 cm × 2.0 cm × 2.5 cm-3.0 cm × 3.5 cm × 5.0 cm ( mean,15.4 cm3 ).The main causes of bone defects were comminuted fracture,bone cyst,fibrous dysplasia,and chronic osteomyelitis.A followup was performed immediately after the surgery and at 1,2,3,5,7,9,12,18 months after surgery to observe the systemic and local reactions,changes of blood calcium/phosphorus,repair of bone defect and restoration of function of the affected extremity.ResultsAll patients were followed up for 9-18 months (mean,10.5 months).There were no local or systemic grafts rejection from the postoperative period to the last follow-up.Follow-up X-ray films showed fuzzy boundary of BAM artificial bone implantation area and bone tissues around bone defects three months postoperatively and new bone formation. Apparent bone ingrowth into the BAM artificial bone implantation area,integrated artificial bone materials and bone tissues,and basically repaired bone defects were founded six months postoperaively.The time for full weight-bearing of the affected extremity was on postoperative 2.5-4 months ( mean,3.2 months).ConclusionBAM artificial bone is characterized by good biocompatibility,osteogenesis effect and a certain stiffness and strength of inner structure and can he used to repair the lower extremity bone defects.
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Objective To investigate the clinical effects of transpedicular graft of biological artificial material (BAM) -induced artificial bone and posterior pedicle screw fixation in the treatment of osteoporotic thoracolumbar fractures.Methods A total of 72 patients with osteoporotic thoracolumbar fractures treated by transpedicular reduction by leverage,BMA-induced artificial bone grafting and posterior pedicle screw fixation from 2005 to 2010 were reviewed and followed up.The frontal and lateral X-ray radiograph of the spine was performed before and after operation and during the follow-up.The anterior and posterior height of the injured vertebrae,thoracolumbar kyphotic angle ( Cobb' s angle),ratio of anterior to posterior vertebral height were determined.Also,the America Spinal Injury Association (ASIA) scale was used to evaluate the neurological recovery and the visual analog scale (VAS) was applied to assess the back and waist pain.Results All patients were followed up for a mean period of 18.3 months,ranging from 12 to 28 months.Meanwhile,all the patients obtained bone union,with no rejection of artificial bone graft,breakage or loosening of screws,or obvious loss of both vertebrae height and deformity correction angle.Notable improvement of neurological function was achieved in all patients except for two patients with Frankel A nerve injury.The VAS score descended from pre-operative ( 8.4 ± 2.5 ) points to (2.2 ± 1.6 ) points at latest follow-up,which showed obvious alleviation of back and waist pain.Conclusions Transpedicular bone graft plus internal fixation is an effective,reasonable and easy method for managing osteoporotic thoracolumbar fractures.In addition,the implanted BAM-induced artificial bone is of good biological and mechanical properties.
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Objective To separate NK cells of mice from NK cell separation medium and study inhibitory effect of proliferated NK cell induced by low dose radiation on the leukemia model of K562 cells.Methods Flow cytometry and 3H-TdR methods were respectively used to measure proliferation index and activity of NK cells treated with low-dose radiation( which means exposure dose in 20 cGy low LET beam or 5 cGy high LET beam).CD13 + cells were measured by flow cytometry and TNF-α content in blood-serum was detected by ELISA.In vivo,peripheral blood leucocyte count,index of liver,indexes of spleen and kidney were observed in control group and experimental group.Results The purity of NK cell separation was (82.54 ± 0.18)%.The proliferation index of NK cells at 24 hours after 80 mGy irradiated was 36.31 ± 1.32% ,(t =24.69,P ＜0.05).Killing activity of NK cell induced by low dose radiation to K562 cell was (12.59±0.63)%(t=6.63,P＜0.05)and the inhibition ratio was 29.52%.Conclusion The injection of proliferated NK cell induced by low dose radiation demonstrated significant inhibitory effect on the growth of leukemia nude mouse.
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Objective To analyze indications,complications and outcomes of amputation.Methods A total of 15 patients undergone amputation in field or at tent hospital were collected for analy-zing injury severity,place where amputation was done,whether open or closed amputation and stitch re-moval time. Results There were 9 males and 6 females.at an average age of 32 years(11-51years).There were 16 amputations including Gustilo IIIB in 2 patients, Gustilo IIIC in 9 and Tscheme Ⅲin 5 according to Gustiln classification or Tscheme classification.Four patients who received amputation in field or at tent hospital developed infection and had to receive amputation again at a higher level on the limb and drainage of open wounds because of a higher infection rate due to the amputation location.Ten patients received first amputation at higher levels with open wound at station hospital but only 2 manifested infected incision.High level amputation with one stage closure was done in 1 patient who was infected and suppurated after operation and even developed bacteremia. Conclusions Infection rate following am-putation 4n field and tent clinics is rather higher,so secondary open amputations should be performed at a higher level as soon as possible.One-time and high-level open amputation plays an important role in treat-ment of severe lower limb injuries following earthquake.
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OBJECTIVE: To observe the revascularization and the opportunity of cross-finger flap. METHODS: An animal model was developed to permit daily monit oring of neovascularization of the flap with autoradiography, tissue transparent technique, gross observation and histological examination. RESULTS: The revascularization of the flap was chiefly raised f rom the surrounding tissues. The pedicles of 334 cross-finger flaps of the pati ents were successfully divided from 1 to 5 d after operations, averagely 3. 3 d. All of the cases showed satisfatory results according to a follow-up sur vey of 3 to 72 mon. The results further proved that the revascularization of the cross-finger flaps had accomplished within 3 d. CONCLUSIONS: It suggests that the division of a cross-finger f lap can be carried out between the 3rd and 5th day after operation with a high d egree of safety.
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OBJECTIVE: To provide a new method to estimate t he effectiveness of thoracolumbar vertebral finite element model. METHODS: A mechanical model of human thoracolumbar vertebrae mo tion segment was made using three-dimensional finite element method and the str ess distribution of vertically compressed thoracolumbar vertebrae was analyzed, meanwhile, 20 patients with burst fracture of thoracolumbar vertebrae were t ested by CT to calculated average CT value at ascertained different points of th oracolumbar vertebrae. The calculated results and effective stress at the same p osition were analyzed with straight line correlation. RESULTS: The stress level of different position of thoracolumba r vertebrae under vertical compressive force was positively correlated with the correlative CT value, and the regressive style, Y=214.028+45.268X, r=0.7386, P<0.05 (n=8) showed a statistical significance. CONCLUSIONS: To study mechanism of thoracolumbar vertebrae in juries under different forces has clinical significance.
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Objective To introduce the technique and efficacy of the treatment of avulsion fracture at tibial insertion of anterior cruciate ligament(ACL) in children through internal fixation by hollow cancellous bone screw under arthroscope.Methods December 2002 ～December 2007,internal fixation using percutaneous reduction by leverage was conducted in 68 children with avulsion fracture at tibial insertion of ACL in our hospital.In 68 children,there were 29 females and 39 males,aged 6～15 years(average age of 12 years),including 22 cases of typeⅡ(with limited knee extension)and 46 cases of type Ⅲ.The fracture was fixed by hollow titanium cancellous bone screw.Results Sixty eight cases were followed up for an average of 18 months(12～36 months).The muscle tension(mea sured by KT-2000) in injured side was recovered close to the uninjured side.Excellent reduction,solid inter nal fixation,complete healing,stable knee joint and negative Lachman and drawer tests were shown in this clinical setting.No swelling,pain and knee dysfunction were found.Impingement sign at intercondylar fossa disappeared.The patients were satisfied with their functional recovery.There was no abnormal angulation and shortness.Conclusion Treatment of avulsion fracture(type Ⅱ with limited knee extension or type Ⅲ) at tibial insertion of ACL by arthroscopic internal fixation with hollow titanium alloy cancellous bone screw could obtain accurate and reliable reduction,and avoide epiphysis injury with satisfactory functional recovery.