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 compare the outcomes of 23G and 20G vitrectomy in treatment of proliferative diabetic retinopathy (PDR). Methods This was a prospective randomized study. One hundred twenty six patients (142 eyes) suffering from PDR with symptoms requiring vitrectomy were randomly divided into 20G vitrectomy group (66 patients, 74 eyes) and 23G vitrectomy group (60patients,68eyes). Visual acuity, intraocular pressures,indirect ophthalmoscopy, B-scan ultrasound, tear film break up time (BUT), Schirmer Ⅰ test (S Ⅰ T), astigmatic power and the astigmatic axial at 6 mm area of anterior and posterior corneal surface were observed and measured before surgery. The follow-up period was 15.0 and 12.5 months separately in 20G and 23G groups. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications, reoperation, and postoperative ocular conditions including changes of astigmatic power and the astigmatic axial measurements were analyzed. Results At last follow-up, there was 49 eyes (66.2%) and 47 eyes (69.1%) with visual acuity ge;0.05 in 20G and 23G groups. Comparing visual acuity ge;0.05, there was no statistical difference between the groups (chi;2=0.14, P＞0.05). The eyes suffering from iatrogenic injuries were 18 (24.3%) and seven (10.3%). There was obvious difference in iatrogenic injury between the two groups (chi;2=4.81, P＜0.05). The mean surgical times were (69.0plusmn;8.2) and (51.0plusmn;6.3) minutes in 20G and 23G group, which was significantly different (t=3.65, P＜0.05). The postoperative third day, hypotony was detected in three (4.1%) and 11 eyes (14.7%) in 20G and 23G group, which was a significantly different (chi;2=5.85, P＜0.05). Postoperatively high intraocular pressures were not significantly different between the two groups (chi;2=2.54,P＞0.05). There were 24 (32.4%) and 14 eyes (20.6%) in 20G and 23G group. There were significant differences in BUT, SⅠT, astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first month after operation (t=3.35, 4.12, -3.12, -3.22; P＜0.05), but no significant differences in them at the third and sixth month after operation (third month: t=0.45, 0.98, -2.12, -1.02; P＞0.05, and the sixth month: t=0.95, 1.48, -1.02, -2.11; P＞0.05). In 23G group, there were no significant differences in BUT, SⅠT, astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first, third and sixth month after operation (first month: t=1.21, 1.46, -2.32, -1.61; P＞0.05, third month: t=1.45, 2.21, -2.19, -1.89; P＞0.05, and sixth month: t=1.92, 1.25, -1.76, -2.35; P＞0.05). Conclusion 23G vitrectomy is a safe and effective treatment for PDR with shorter surgery time, fewer surgical complications and postoperative ocular surface changes.
Objective To compare the outcomes and safety of 23G and 20G vitrectomy for treatment of infectious endophthalmitis. Methods This was a retrospective case study. Sixtyseven eyes of 67 eyes suffering from infectious endophthalmitis with a history of trauma or intraocular operation history were enrolled in this study. They were diagnosed by the examinations of best corrected visual acuity, intraocular pressures, slit lamp microscope, indirect ophthalmoscopy, B-scan ultrasound and CT. There were 49 males (49 eyes) and 18 females (18 eyes). The patients aged from 18 to 72 years with a mean age of (43plusmn;13) years. There were 60 patients (60 eyes) with a history of trauma, 7 patients (7 eyes) with intraocular operation history. The patients were enrolled into 20G vitrectomy group (35 patients, 35 eyes) before December, 2009 and 23G vitrectomy group (32 patients, 32 eyes) after January, 2010 when 23G vitrectomy system was imported in this hospital. Vitreous purulence was taken in all patients at the beginning of the surgery for bacteria and fungal culture and drug sensitivity test. A standard vitrectomy with artificial posterior vitreous detachment followed by internal limiting membrane peeling, and (or) intraocular laser photocoagulation, cryocoagulation, fluidair exchange with intraocular silicone oil or gas tamponade were performed in all cases. Broadspectrum antibiotics and glucocorticoids were used systematically for one week after surgery, but glucocorticoids were not used for fungal infections. The followup was ranged from two to nine months with a mean of (7plusmn;1) months. The surgical time, inflammation situation, visual acuity, intraocular pressure, retinal reattachment rate, iatrogenic retinal hole rate, bulbar conjunctiva scar formation rate, reoperation rate and eye retention situation before and after surgery were comparatively analyzed. Results The mean surgical times were (126plusmn;12) and (89plusmn;12) minutes in 20G and 23G group, which was significantly different (t=3.125, P＜0.05). The major surgery complications were ora serrata dialysis and other iatrogenic retinal breaks, and were occurred in 34 eyes, including 30 eyes (85.71%) in 20G group and 4 eyes (12.50%) in 23G group (chi;2=35.85,P＜0.05). These 4 eyes in 23G group received foreign body removal surgery previously. The inflammation was controlled in 65 eyes (97.01%) including 34 eyes (97.14%) and 31 eyes (96.88%) in 20G and 23G group respectively, which was not significantly different (chi;2=0.004,P＞0.05). At last follow-up, There was no statistical difference of visual acuity between the two groups (t=3.12, P＞0.05). Fourteen eyes underwent silicone oil tamponade including 13 eyes (37.14%) and 1 eye (3.13%) in 20G and 23G group respectively, which was significantly different (chi;2=11.703, P＜0.05). Nine eyes underwent reoperation (13.43%), including 8 eyes (22.86%) and 1 eye (3.13%) in 20G and 23G group respectively, which was significantly different (chi;2=5.597,P＜0.05). The 8 re-operated eyes in 20G group included 1 eye of recurrent endophthalmitis and 7 eyes with retinal detachment, the 1 re-operated eye in 23G group was of recurrent endophthalmitis. There was significantly different (chi;2=7.147,P＜0.05) for the rate of retinal detachment between the 2 groups. There were 40 eyes with bulbar conjunctiva scar including 35 eyes (100.00%) and five eyes (15.63%) in 20G and 23G group. Conclusion 23G vitrectomy is an effective treatment for infectious endophthalmitis with shorter surgery time, lower reoperation rate, lower retinal reattachment rate and fewer bulbar conjunctiva scar.
Objective To summarize and compare the functional characteristics and technical parameters of the comprehensive global clinical practice guideline (CPG) databases, so as to provide references for the construction of CPG database of China. Methods CPG databases were collected worldwide by discussing with experts in the guideline and database fields. Studies on guideline databases were searched in PubMed and CNKI to additionally collect CPG databases mentioned in these studies. Representative comprehensive CPG databases were finally selected by consulting relevant guideline experts. The basic information, functional characteristics (including column settings, service contents, and related file types) and technical parameter data were extracted and summarized. A descriptive analysis was conducted to compare different CPG databases. Results Nine guideline databases which are distributed in eight countries of the Americas, Europe, Oceania and Asia were included. The number of included guidelines of the nine databases ranged from 31 to 15 410. The earliest database was established in 1993. Except that the MINDS database didn’t provide search function, eight databases provided basic search function, and six provided further advanced search function. PDF and HTML formats of guidelines were available in most databases, but the XML format was only available in National Guideline Clearinghouse (NGC). Responsive Web design was an important feature for most websites of databases and four databases developed mobile applications. Local mainstream social media sharing function was provided by six databases. All databases’ construction was professional in technical parameters including network transmission, Web server, programming language and the selection of server room. Conclusion This study compares the functional features and technical parameters of the comprehensive global CPG databases, which provides important information that should be considered in establishing a guideline database, to strengthen the top-level design or to help optimize the functionality of a guideline database. It also helps guideline databases users to find more proper resources.
OBJECTIVE: To compare the clinical results of repairing bone defect of limbs with tissue engineering technique and with autogeneic iliac bone graft. METHODS: From July 1999 to September 2001, 52 cases of bone fracture were randomly divided into two groups (group A and B). Open reduction and internal fixation were performed in all cases as routine operation technique. Autogeneic iliac bone was implanted in group A, while tissue engineered bone was implanted in group B. Routine postoperative treatment in orthopedic surgery was taken. The operation time, bleeding volume, wound healing and drainage volume were compared. The bone union was observed by the X-ray 1, 2, 3, and 5 months after operation. RESULTS: The sex, age and disease type had no obvious difference between groups A and B. all the wounds healed with first intention. The swelling degree of wound and drainage volume had no obvious difference. The operation time in group A was longer than that in group B (25 minutes on average) and bleeding volume in group A was larger than that in group B (150 ml on average). Bone union completed within 3 to 7 months in both groups. But there were 2 cases of delayed union in group A and 1 case in group B. CONCLUSION: Repair of bone defect with tissue engineered bone has as good clinical results as that with autogeneic iliac bone graft. In aspect of operation time and bleeding volume, tissue engineered bone graft is superior to autogeneic iliac bone.
Objective To compare effects, advantages and disadvantages of simple internal fixation to that of l imited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group (n=39) and the external fixator group (n=27). The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The external fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups (P gt; 0.05). Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the princi ple of internalfixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases inthe internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture heal ing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture heal ing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups (P gt; 0.05). Conclusion The therapeutic effects of simple internal fixation and l imited internal fixation with external supporting frame fixation were similar in the treatment of complex fractures of tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.
ObjectiveTo compare the effect of problem-based learning (PBL) and traditional teaching method (lecture-based learning) on clinical practical teaching of orthopedic surgery. MethodsBetween May 2012 and December 2013, 55 orthopedic interns were chosen to be divided into two groups: PBL group (n=29) and traditional lecture group (control group, n=26). Case report and examination on a completion of orthopedic surgery were used to assess the teaching outcomes. ResultsPerformance differences in content of presentation and capability of answers to questions were significant between PBL group and the traditional group in the report test (P<0.05). The test scores of case analysis examination in PBL group were significantly higher than those in the traditional lecture group (P<0.05). There was no significant difference between the two groups in other types of questions (P>0.05). ConclusionThe participants in PBL group have performed significantly better in culturing clinical thinking and comprehensive analysis, competence and in no circumstance did they perform worse than traditional lecture method.
A comparative study of four methods of laryngeal muscle reinnervation in dogs is presented. Twenty-eight cases were divided into four groups to undergo main branch and branch of ansa cervicalis nerve anastomosis, and nerves implantation an neuromuscular pedicles transfer respectively for restoration of vocal cord adduction on left sides. The results showed that the four procedures seemed to induce effective reinnervation of adductor muscles. But the main branch of ansa cervicalis nerve suture was superior to the other methods among which little difference was noted in the functional recovery, electrophysiological activity and muscle strength. It demonstrated that main branch of ansa nerve suture was the best procedure for treatment of unilateral vocal cord paralysis among the four methods.
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)
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer. MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared. ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups. ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.