Objective To evaluate the application of tendency-oriented perimetry (TOP) in detecting the visual function of glaucoma. Methods The traditional threshold perimetry (Normal/Normal strategy) and TOP (TOP/Normal strategy) carried out by Octopus 101 perimetry were used to examine the visual field of 20 normal subjects (20 eyes), 32 cases (32 eyes) of primary open-angle glaucoma (POAG), and 14 cases (14 eyes) of suspected POAG, respectively. The visual field outcomes, indices, point by point threshold variability and defective points of the two perimetries were compared and analysed. Results The negative rate of TOP was 90% in normal subjects. The positive rate of TOP was 75% in POAG , and 100% in middle and late stage of POAG. The visual field indices of two perimetries were positively correlated, with mean sensitivity (MS) of r=0.9335, mean defect (MD) of r=0.9189, and loss variance (LV) of r=0.9621. The point by point threshold variability and defective points of TOP were higher than those of traditional threshold perimetry, but the difference between the two perimetries was not significant (P=0.2019, P=0.4448). Conclusion The visual field indices of TOP and traditional threshold perimetry are positively correlated. The sensitivity and reproducibility of TOP are high in detecting the visual function of middle and late stage of POAG. (Chin J Ocul Fundus,Dis, 2002, 18: 269-272)
To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty (TKA).Methods From June 2005 to June 2006, 102 patients (43 males, 59 females; aged 59-77 years, averaged 68 years) underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis.The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.Results The blood loss was 256±149 ml in Group A and 306±214 ml in Group B during operation; there was no significant difference between the two groups（P＞0.05）. The postoperative drainage volume was 478±172 ml in Group A and 814±156 ml in Group B, and the total blood loss was 559±159 ml in Group A and 1.208±243 ml in Group B; there were significant differences between the two groups (P＜0.05). The averaged amount of blood transfusion was 556±174 ml in Group A and 1 024± 278 ml in Group B; there was a significant difference between the two groups (P＜0.05). The postoperative hemoglobin concentration was higher in GroupA than that in Group B (1.0-1.1 g/dL vs. 0.6-0.8 g/dL). The ostoperative follow-up for 612 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation (0.92±0.56 mg/L vs. 0.35±0.13 mg/L in Group A; 1.32±0.79 mg/L vs. 0.37± 0.21 mg/L in Group B) (P＜0.05). The D-dimeride level 3 hours after operation was significantly higher n Group B than in Group A（P＜0.05）. There were no significant differencesin the levels of fibrinogen, prothrombin time, and activated partial thromboplastin time between the two groups（P＞0.05）.Conclusion During and after the TKA operation, a shortterm use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
Objective To study and analyze both merits and demerits of 4 famous foreign evidence-based medicine databases, so as to provide references for the development of Chinese evidence-based medicine databases. Methods By means of document analysis and web search, the databases including UpToDate, MD Consult, Clinical Evidence and DynaMed were comprehensively analyzed from the following aspects: management ideas, editing process, personalized services and so on. Results a) Time of foundation: UpToDate founded in 1992 is the earliest-established evidence-based medicine database; b) Management ideas: All 4 databases aim to integrate all the high quality evidences about some clinical topics and help doctors to make the most reasonable decisions at present; c) Editing process: The inclusive criteria of Clinical Evidence is more strict than other databases, for the evidence needs to go through 18 steps before it is included; and d) Update rate: DynaMed updates every day as the fastest than other databases. Conclusion A mature evidence-based medicine database needs a powerful methodology team, b financial support and a large number of literature services. Besides learning good foreign experiences, it is also very important to assemble a methodology team, and particularly to integrate domestic characteristics for the establishment of domestic evidence-based medicine database.
Objective To evaluate the treatment results of LCP and locked intramedullary nailing for tibial diaphysis fractures.MethodsFrom October 2003 to April 2006, 55 patients with tibial diaphysis fractures ( 58 fractures) were treated. Of them there were 39 males and 16 females with an average of 39 years years ( 14 to 62 years). The fractures were on the left side in 27 patients and on the right side in 31 patients (3 patients had bilateral involvement). Thirtyfour fractures were treated by intramedullary nailing (intramedullary nailing group) and 24 fractures by LCP fixation (LCP group). The average disease course was 3 days (intramedullary nailing group) and 3.1 days(LCP group). The operation time, the range of motion of knee and ankle joints, fracturehealing time, and complications were evaluated. Results The patients were followed up 8-26 months(13 months on average). The operation time was 84.0±9.2 min (intramedullary nailing group) and 69.0±8.4 min (LCPgroup)； the average cost in hospital was￥19 297.78 in the intramedullary nailing group and ￥14 116.55 in the LCP group respectively, showing significant differences(P＜0.05). The flexion and extension of knee joint was 139.0±3.7° and 4.0±0.7° in intramedullary nailing group and 149.0±4.2° and 0±0.4° in LCP group, showing no significant difference(Pgt;0.05). The doral flexion and plantar flexion of ankle joint were 13.0±1.7° and 41.0±2.6° in intramedullary nailing group, and 10.0±1.4° and 44.0±2.3° in LCP group, showing nosignificant differences(Pgt;0.05). The mean healing time was 3.3 months in intramedullary nailing group, and 3.1 months in LCP group. Length discrepancy occurred in 1 case (2.5 cm), delayed union in 1 case and nailing endtrouble in 3 cases in intramedullary nailing group; moreover rotation deformityoccurred 1 case and anterior knee pain occurred in 6 cases(17.1%). One angulation and open fracture developed osteomyelitis in 1 case 1 week postoperatively and angulation deformity occurred in 1 case of distalthird tibial fractures in LCP group. Conclusion LCP and locked intramedullary nailing can achieve satisfactory results in treating tibial diaphysis fracture LCP has advantages in less complication, operation time and cost in hospital.
Objective To evaluate the effect of self-designed antirotation reduction internal fixator(ARRIF) on treating different spine segment fracture.Methods From August 1999 to March 2003, 76 patients(48 males and 28 females, aged from 22 to 59 with an average of 34.1) with thoracolumbar fracture were operatively treated by ARRIF. The follow-up period ranged from 6 to 21 months(15 months in average). Classification according to injury segment: flexion compression racture 27 cases, burst fracture 42 cases, flexion distraction injury 3 cases, flexion revolving type fracture dislocation 2 cases, shear force type dislocation 2 cases. Classification according Frankel’s grade:A grade 16 cases, B grade 15 cases, C grade 27 cases, D grade 10 cases, E grade 8 cases.Operation duration, volume of bleeding, incidence postoperation complication and effect of reduction fixation were observed. Results The operation duration of ARRIF was 1.2 h in average, and there was about 200 ml volume of bleeding during operation. The nerve function showed one Frankel’s grade improvement after operation were as follows:A grade 8 cases(50%), B grade 11 cases (73.3%), C grade20 cases(74.1%), D grade 3 cases (30%); 2 Frankel’s E cases have no nerve function changes.The nerve function damage have no aggravation in all the patients,the postoperation Cobb’s angle was averagely corrected 22°. The horizontal displacement of dislocation vertebrae was averagely corrected 28% in sagittal plane, the statistical analysis had significant variance(Plt;0.01).ARRIF had no complications of the breakage of screws and rods. Conclusion ARRIF proves to be a valid internal fixator in reducing and fixing different thoracic lumbar segment spine fracture.
Objective To observe the biocompatibility of the acellular corneal stroma materials prepared by three different methods. Methods Three different serial digestion methods were used to produce the acellular corneal stroma materials. The biocompatibility of the materials was investigated by the cell seeding and the materials were implanted into the rabbit corneal stroma layer. Results The cells in the materials 1 and 2 were not decellularized completely. The rabbit corneal fibroblasts died on the materials 1 and 2 after the cell seeding for 3-4 days. An obvious rejection could be observed after the implantation. The cells in material 3 were decellularized completely and the collagen fibers or elastic fibers were reserved integrally，showing a typical three-dimensional net work. The rabbit corneal fibroblasts could expand on the materials in vitro. No obvious rejection could be observed and the materials were gradually absorbed. Conclusion The acellular porcine cornea stroma materials prepared by trypsin-Dnase-Rnase are suitable for reconstruction of the tissue engineered cornea.
Objective To evluate the clinical outcome of autograftsof ilium and interbody fusion cage or bone morphogenetic protein(BMP)／artificial bone material／ cage in treating lumbar spondylolisthesis. Methods From January 1997 to January 2004，114 patients with lumbar spondylolisthesis were treated with posterior lumbar interbody fusion and pedicle screw fixation． There were 45 males and 69 females with an average age of 43 years ranging from 32 to 61 years. Of 114patients, 85 cases were classified as degree Ⅰ, 24 cases as degree Ⅱ and 5 cases as degree Ⅲ. The patients were divided into three groups accordingto the material used for interbody fusion: autografts of ilium (group A, n=42), interbody fusion cages(group B, n=36), and BMP／artificial bone material／ cage (group C, n=36)．The clinical and radiographic results of the patients were compared among three groups． Results All patients were followed from 13 to 30 months with an average of 15 months． There were no statistically significant differences in surgical time, blood loss, and disc space height of preoperation(P＞0.05) among three groups. No severe complication occurred in the three groups(P＞0.05). The excellent and good rates in groups A，B and C were 81.0％, 80.6％, and 83.3％ respectively, showing no statisticallysignificant difference(P＞0.05)．The fusion rate of group C(97.0%) was significantly higher than those of group A(81.0%) and group B(83.3%) (P＜0.05) after 1 year of operation．And the average loss of disc space height in groups B and C was significantly lower than that in group A(P＜0.05). Conclusion Higher fusion rate and lower loss of disc space height can beobtained in treating lumbar spondylolisthesis with BMP／artificial bone materiel.It is an effective method in the treatment of spondylolisthesis.
Purpose To evaluate differences in the pattern of optic disc and retinal nerve fiber layer (RNFL) damage in normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) patients. Methods We enrolled 49 eyes of 49 patients:30 NTG (IOP≤21 mm Hg,1 mm Hg=0.133 kPa), 19 HTG(IOP≥25 mm Hg). Mean age was 59.2±12.3 (range, 36-75) for HTG patients, and 59.6±8.6(range, 39-71) for NTG patients. All patients underwent complete ophthalmic examination, achromatic automated perimetry (AAP), scanning laser ophthalmoscopy (SLO), scanning laser polarimetry (SLP), optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT). All patients had glaucomatous optic nerve damage and abnormal AAP. Results There were no differences in mean deviation on AAP between NTG and HTG eyes (P=0.37), while the corrected pattern standard deviation was larger in NTG than in HTG eyes (P=0.014). Cup∶disc area ratios in global (P=0.03) and three sectors (Plt;0.05) except nasal sector were significantly larger in the NTG group, whereas rim area in global (P=0.03) and three sectors (Plt;0.05) except nasal quadrant obtained by SLO were smaller in NTG than in HTG eyes. The other numerical parameters obtained by three imaging technologies could not detect differences in the optic disc or RNFL anatomy between the two groups. Conclusions Cup∶disc area ratio was larger in patients with NTG than in those with HTG, whereas significant thinning of rim was associated with NTG eyes. The measurement of retinal nerve layer thickness in global and each quadrant was similar between two groups. More focal or segmental analysis of the data contained within SLO, SLP and OCT images are needed to detect localized differences in eyes with varying levels of IOP. (Chin J Ocul Fundus Dis, 2002, 18: 109-112)
Purpose To evaluate the correlation of retinal thickness between optical coherence tomography (OCT) images and histologic slides ． Methods Retinal thickness was measured in 16 rabbit retinal histologic slides．The same eyes were previously viewed by OCT for the comparison of results between two methods．Retinal thickness of each OCT image section was measured using both the manually assisted (requiring observer localization of reflectivity peaks) and the automated modes of the computer software． Results Retinal thickness as measured by OCT demonstrated a high degree of correlation with retinal histologic study．The automate d method (gamma;=0．66，P＜0.01) was less reliable than the manually assisted one (gamma;=0．84，P＜0．001)．The former had an error in 95% confidence interval，ranged in-0.71～11.09 mu;m，the latter had a less error，ranged in-2.99～5.13mu;ｍ． Conclusion Retinal thickness can be quantitatively measured by OCT examination．However，computer automatic identification of the reflective boundaries may result in errors in some cases．To measured the retinal thickness by manually assisted mode can increase the degree of accuracy． (Chin J Ocul Fundus Dis，2000，16：71-138)
Objective The rising medical expenditure is an international problem. By comparing theories and methods of medical expenditure control between China and the US, this paper aims to find out the medical expenditure strategies fitting for our country and to help with the new round of medical and health system reform. Methods This evidence-based research searched for literatures using the search strategy and screened literatures according to inclusion and excluding criteria. Useful information in the literatures was extracted through quantitative analysis of literature tables and descriptive statistical analysis. Results We found that the US academia showed a sustainable and steady trend of increased concern on the medical expenditure control, while the Chinese academia showed a larger volatility on it. There were some obvious differences such as reasons for expenditure increase, the reasonableness of the medical expenditure increase, and the specific methods and strategies of the medical expenditure control between Chinese and American authors. Conclusion On the one hand, the purpose of medical expenditure control is based on the different stages of development. On the other hand, the main interest group determines the main body who is responsible for the medical expenditure control. According to our national context, China should develop effective strategies and methods for medical expenditure control.