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Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.
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Objective:To investigate the effect of flap combined with 3D printed microporous titanium(tantalum)prosthesis in the treatment of lower extremity soft tissue defect with large bone defect.Methods:From January 2019 to December 2020, 2 patients with large soft tissue defects on dorsal foot together with large metatarsal bone defect and 4 patients with soft tissue defects of calf with large tibial bone defect were treated. The areas of soft tissue defect were 5.0 cm×8.0 cm-15.0 cm×10.0 cm. The length of the bone defect were 3.8 cm to 7.0 cm, 5.75 cm in average. In the first stage, metatarsal bone defect or tibial bone defect was filled with vancomycin blended bone cement, meanwhile, soft tissue defect was repaired with anterolateral femoral flap(ALTF) with vascular anastomosis in 2 cases of feet, and local fascia flap was trans-positioned in 4 cases of lower extremity defects. The sizes of repairing flap were 6.0 cm×8.5 cm-16.0 cm×11.0 cm. Two to 7 months after the initial surgery, the customer designed microporous titanium prostheses were used(5 cases with microporous titanium and 1 with microporous tantalum) to repair the bone defects. The wound healing, the integration of metatarsal and tibial fractures with 3D printed microporous titanium(tantalum) prostheses, and the walking condition were observed after surgery. The follow-up lasted from 6 to 25 months, with an average of 12.7 months.Results:The wound healing in 5 patients was good. The patients stood on the foot in 2 months after surgery, started to walk with the assistance of crutch in 3 months after surgery, and took walk without assistance in 5-6 months after surgery. Good osseous integration were achieved. One diabetic patient had infection of foot wound 3 months after surgery. After removal of microporous titanium prosthesis and replacement of vancomycin blended interstitial substance of bone cement, the wound healed and the patient resumed walking.Conclusion:It is an effective method to encourage the patients to take early ambulation after the surgery for lower extremity soft tissue defect with large bone defect that was repaired by a flap and 3D printed microporous titanium(tantalum)prosthesis. Further observations are required to investigate the long-term efficacy, and the reduction of prosthesis infection rate requires further exploration.
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Objective:To explore the epidemiological characteristics and clinical outcomes of patients diagnosed with novel coronavirus (COVID-19) pneumonia (NCP), and to provide clinical reference for subsequent epidemic prevention and control.Methods:The pathogenesis, clinical characteristics and clinical outcomes of 62 patients with imported novel coronavirus COVID-19 pneumonia in Qingdao area from January 21, 2020 to April 6, 2020 were analyzed.Results:There were 24 males and 38 females, aged from 5 to 91 (52.5±15.7)years. Among them, 31 cases (31/62, 50%) were family cluster disease, 11 cases (17.74%) were nosocomial cross infection, 14 cases (22.58%) came back from Wuhan to Qingdao and community contact infection, and 6 cases (9.68%) were imported from abroad. The longest time from fever to diagnosis was 26 days. Clinical classification: 40 cases were mild, 13 were general, 7 were severe, 2 were critically ill. 61 cases were discharged from hospital, and 1 was dead. The clinical cure rate was 98.39%. The average stay was (18.5±4.8)days. All patients were treated combined with Chinese medicine on the basis of symptomatic treatment.Conclusions:The clinical symptoms of imported NCP are relatively mild, and mild cases were more, the recovery rate was higher. The intervention strategy of traditional Chinese medicine is conducive to rehabilitation. The external input cases and symptomless infected patients are important for epidemic situation in the future.
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Diabetic macular edema is the leading cause of central vision loss and even blindness in diabetic retinopathy.Compared to FFA,OCT can obtain the high-resolution 3D image quickly,easily to reflect the details of the tissue and realize the quantitative measurement.As a novel technology,OCT angiography (OCTA) can display microvascular structure from different layers of retina and choroid,having its advantage of quantifying the vessel density and the lesion area.By detecting fundus morphology,quantifying and quantitating the retinal vessels and vessel density,the combination of OCT and OCTA could play a guiding role in diagnosis,classification,treatment and prognosis of diabetic macular edema.
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Objective@#To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH).@*Methods@#Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cases were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement.@*Results@#All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78%) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of patients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years.@*Conclusion@#The SONFH can be diagnosed early by screening, and is treated by different reserving hip methods according to severe stages. The short-term clinical effects are satisfied.
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Objective To evaluate the efficacy and safety of cardiac shock wave therapy(CSWT) in coronary heart disease in elderly patients.Methods Eleven patients with refractory angina pectoris were enrolled.The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT) and coronary angiography,and treated with CSWT.The CSWT were performed during treatment of 3 months,with 9 times totally.The clinical evaluations included the clinical symptoms,Canadian Cardiovascular Society (CCS) class scores,New York Heart Association class (NYHA),Seattle angina questionnaire (SAQ),6-min walking distance and the use of dosage of nitroglycerin,left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF).The amelioration of ischemic myocardial was analyzed by SPECT.The safety of CSWT was evaluated by changes in clinical symptoms,ECG monitoring,blood pressure and oxygen saturation,blood levels of creatine kinase,creatine kinase myocardial band isoenzymes (CK-MB),troponin T (TnT),alanine transfer enzyme (ALT),creatinine (CR),brain natriuretic peptide and high sensitive C reactive protein (hs CRP).Results The CCS class scores,NYHA,6-min walking distance and the dosage of nitroglycerin were significantly improved at 4 and 12 months after treatment as compared with pretreatment.The steady state of angina pectoris and the frequency score in SAQ were significantly improved.The 21 cardio-vessel segments were treated,and the improvement rate of resting myocardial perfusion was 46.2％ (6/13),the effective rate was 38.5％ (5/13),and the obvious effective rate was 7.8％ (1/13) after treatment.The improvement rate of loaded myocardial perfusion was 57.1％ (12/21),the effective rate was 47.6％ (10/21),and the obvious effective rate after treatment was 9.5％ (2/21).There were no significant changes in levels of CK,CK-MB,TNT,ALT,Cr,BNP and hs CRP,heart rate,systolic blood pressure,diastolic blood pressure and oxygen saturation after treatment as compared with pretreatment.Conclusions The CSWT is a safe and effective treatment for coronary heart disease in the elderly,and the curative effect could maintain at least one year.
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Objective To investigate the high risk factors,pathology and clinical features in fatal pulmonary embolism in the elderly patients with malignant tumor,and to analyze the characters of the embolus and provide experimental data for clinical prevention and treatment offatal pulmonary embolism.Methods Autopsy and clinical data of 19 malignancy cases with fatal pulmonary embolism admitted to Beijing Hospital from 1975 to 2006 were retrospectively analyzed.Results 33.9％ of total pulmonary embolism were from malignant diseases (19/56).Saddle and massive pulmonary embolism were in 84.2％ of total 19 cases,and micro-embolism cases were in only 15.8％.The 84.2％ of embolisms were from pulmonary thromboembolism,15.8％ from tumor emboli,and 5.26％ from fungi emboli.Pulmonary adenocarcinoma was the most common (36.5％),the second was pancreatic cancer (15.8％).In all the clinical symptoms,78.9％ of symptoms were dyspnea,15.8％ were syncope.Tachycardia and cyanosis were the common physical signs.Conclusions Malignant tumor is an important risk factor for pulmonary embolism in elderly patients.There are various kinds of emboli in pulmonary embolism in elderly patients with malignant tumor.We should comprehensively consider the causes of pulmonary embolism and give the reasonable and effective treatment to the patients.
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BACKGROUND:Porous tantalum rods, possessing high porosity and highly similar elastic modulus to the trabecular bone, not only can provide effective mechanical support for the femoral head, but also can enhance revascularization in the areas of necrosis, reduce stress shielding, and provide guarantee for bone ingrowth in necrotic area. OBJECTIVE:To investigate the attachment and proliferation of bone marrow mesenchymal stem cells on the surface of porous tantalum rod. METHODS:The purified bone marrow mesenchymal stem cells which were separated from canines were seeded on the surface of porous tantalum rod by the celldensity of 1.5×109/L. cellattachment and proliferation was observed under phase microscope and scanning electron microscope at 5, 10 and 15 days under co-cultured condition. RESULTS AND CONCLUSION:(1) Inverted microscope:Within 1-5 days after co-culture, the cells began to proliferate, and less cells were found near the tantalum rod, but more cells far from the rod. At 6-10 days after co-culture, the cells increased significantly and gradual y migrated to the rod, and even some cells attached to the edges of the rod. After 14 days, the cells were interconnected to form a film, packing the surrounding and dents of the tantalum rod. cells were visible to agglomerate and cellcalcification occurred. (2) Scanning electron microscope:At 5 days after co-culture, no celladhesion appeared on the the tantalum rod surface. At 10 days after co-culture, the cells scattered on the surface of tantalum rod, but there was no interconnection between them. After 15 days, cells were polygon shaped and connected into pieces. It could be seen that the cells secreted large amounts of col agen fibers, and the cells that were fusiform and polygon shaped were surrounded by a great amount of extracellular matrice. Bone marrow mesenchymal stem cells appear to have good adhesion and proliferation capability on the surface of tantalum rod.
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Objective To investigate the incidence of osteonecrosis of the femoral head (ONFH) in divers of Dalian.Methods From January 2010 to December 2010,all registered 855 divers in Dalian were enrolled in this study.All divers underwent a unified medical examination and a questionnaire including height,weight,blood pressure and hip inspection.Radiological examination (anteroposterior and frog position)was used for all divers.Suspicious persons with hip pain but normal X-ray performance were confirmed by MRI.Results Sixty-eight divers were confirmed as ONFH,and the incidence of ONFH in divers of Dalian was 7.95％.According to the Ficat classification,12 patients (12 hips) were in Phase 1,40 patients (47 hips)in phase Ⅱ,3 patients (3 hips) in phase Ⅲ,13 patients (15 hips) in phase Ⅳ.The mean age of divers was 32.6+5.5 years (range,18-55 years).The onset ages of most patients ranged from 30 years to 50 years,accounted for 83.82％ (57/68).Among all patients,primary school education accounted for 10.58％ (38/359),junior high school education 6.28％ (28/446),high school education 4.26％ (2/47),university education 0 (0/3); seniority less than 5 years accounted for 4.55％ (20/440),6-10 years 9.69％ (28/289),11-15 years 13.04％ (12/92),16-20 years 21.05％ (4/19),more than 20 years 26.67％ (4/15); self-employed accounted for 11.88％ (19/160),private enterprise 8.41％ (38/452),and national enterprise 4.53％ (11/243).Conclusion The incidence of ONFH is high in divers of Dalian,which is different in terms of age,seniority,level of education,enterprise nature.
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Based on the discuss of Yin-Yang in classics, five states method is reasoned,in which one of the states is indescribable,without no disbalance between Yin and Yang, and the rest could be named by more or less in Yinqi or Yangqi as pathologic states. To state the pathologic states, Zhang Zhongjing had established a six-disease system named by Yin-Yang which benefited from the Four-Season Model in Neijing Bible as reference. Therefore the general principle of treatments and the six-disease system in Treatise on Febrile Disease, such as “the patients in a state of Autumn unbalance sould be treated with cathartic while that in Summer unbalance treated with diaphoretic”, can be easily understood in the Four-Season Model.
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Objective: Our purpose was to study the expression of protein of nm23 gene in patients with epithelial ovarian carcinoma.Methods:Protein of nm23 gene was detected by immunohistochemical technique in 45 patients with epithelial ovarian cancer, 12 with borderline, and 10 with benign ovarian tumor.Results:The positive expression rate in ovarian cancer (73.3%) was significantly higher than that of the benign and borderline tumors. There was no significant correlation between the expression of nm23 gene and the histological type, grade, the existence of ascites or the size of residul after operation. However, the expression of nm23 gene protein was negatively related with the FIGO stage. The overall survival rate of the patients with positive expression of nm23 gene was much higher than that of the patients with negative expression. Conclusion:The findings suggest that nm23 gene protein might serve as a valuable and independent marker for the prognosis of ovarian cancer.