Objectives To assess the clinical effectiveness of laser in situ keratomileusis (LASIK) versus laser epithelial keratomileusis (LASEK) for the correction of myopia. Methods Randomised controlled trials (RCTs) were searched in PubMed, EMbase, The Cochrane Library (Issue 2, 2010), CNKI, VIP, and WangFang Data from January, 1990 to October, 2010. The RCTs were included in accordance with the Cochrane review’s methodology, the valid data were extracted, the quality was evaluated, and then the RevMan 5.0 software was used for statistical analyses. Results Seven RCTs involving 1 134 eyes with myopia were included. The results of meta-analyses showed that the efficacy (OR=1.23, 95%CI 0.73 to 2.07), accuracy (OR=1.73, 95%CI 0.74 to 2.53) and safety (OR=1.10, 95%CI 0.22 to 5.59) outcomes between LASIK and LASEK were comparable. Compared with LASIK, LASEK was higher in the incidence rate of postoperative eye pain (RR=0.13, 95%CI 0.08 to 0.22). Conclusion LASIK and LASEK have the same effectiveness for myopia, but LASEK induces more postoperative eye pains. A large number of strictly-designed multi-centred RCTs are required for further verifying this result because of the low quality and instable results of the included studies．
Objective To evaluate the efficacy and safety of latanoprost versus travoprost for primary open-angle glaucoma (OAG) and ocular hypertension (OH). Methods All the randomized controlled trials (RCTs) about treating primary open-angle glaucoma and ocular hypertension with latanoprost and travoprost were collected by searching MEDLINE, EMbase, OVID and CNKI. The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers, and the meta-analysis was conducted with RevMan 5.0 software. Results A total of 13 RCTs involving 1 433 patients were included. The results of meta-analyses showed that, a) At the second week, travoprost showed greater intraocular pressure (IOP) lowering efficacy compared with latanoprost (WMD= –1.47, 95%CI –2.62 to –0.33). At the first month (WMD= –0.50, 95%CI –1.52 to 0.52) and the sixth month (WMD= –0.12, 95%CI –0.85 to 0.61), the difference of IOP reduction between latanoprost and travoprost group was not significant; and b) The latanoprost-treated group showed fewer reported conjunctival congestion than the travoprost-treated group (OR=0.47, 95%CI 0.35 to 0.63). The difference in adverse events of eye pain (OR=0.55, 95%CI 0.27 to 1.12) and iris or skin depigmentation (OR=1.25, 95%CI 0.53 to 2.92) between latanoprost and travoprost group was not significant. Conclusion Latanoprost and travoprost are comparable in lowering IOP for OAG and OH patients. Latanoprost shows greater ocular tolerability with lower incidence of side effects as conjunctival congestion. This conclusion is not powerful enough in proof due to the medium methodology quality of the included studies, so a large number of high-quality RCTs with large sample are needed for objectively, entirely and precisely evaluating the efficacy.
目的 探讨冠状动脉钙化检测联合动态心电图对冠心病的诊断价值及临床应用。 方法 对2010年5月－2011年8月住院的108例拟诊冠心病的患者同期进行128排螺旋CT冠状动脉钙化积分检测、动态心电图和冠状动脉造影，对比研究冠状动脉钙化检测联合动态心电图预测冠心病的价值。 结果 冠状动脉钙化阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为75.6%、81.0%、73.9%、82.3%；动态心电图阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为73.3%、76.2%、68.8%、80.0%；冠状动脉钙化检测联合动态心电图的系列实验的特异度和阳性预测值分别达到96.8%和92.9%，平行试验的灵敏度和阴性预测值分别达到93.3%和92.7%，均显著高于单项试验的相应指标（P＜0.05）。 结论 高分辨率螺旋CT冠状动脉钙化检测联合动态心电图显著提高冠心病的诊断价值，可作为老年患者及基层医院冠心病首选的筛选检查。
Objective To investigate the effectiveness of arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the posterior cruciate ligament (PCL) via posteromedial incision. Methods Between January 2010 and January 2012, 22 patients with acute tibial insertion avulsion of the PCL underwent arthroscopic reduction and fixation via posteromedial incision. There were 14 males and 8 females with an average age of 32 years (range, 18-48 years). The injury causes included traffic accident injury in 14 cases, sport injury in 4 cases, and falling injury in 4 cases. The disease duration ranged from 7 to 16 days (mean, 10 days). Of 22 patient, 14 had simple PCL injury, 6 had PCL injury with meniscus injury, and 2 with cartilage injury. The results of posterior drawer test were positive in all patients. The preoperative Lysholm score was 51.1 ± 3.4. Results All incisions healed by first intention without infection, deep venous thrombosis of lower limbs, or vessel and nerve injuries. All patients were followed up 12-24 months (mean, 18.4 months). X-ray films showed that all fractures healed with the healing time of 2-4 months (mean, 3 months). The Lysholm score was improved to 96.0 ± 2.2 at 6 months after operation, showing significant difference when compared with preoperative score (t=43.020, P=0.000). Conclusion Arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the PCL via posteromedial incision is a safe, easy, and effective method.
Objective To investigate the effects of nuclear factor kappa B decoy oligodeoxynucleotides ( NF-κB decoy ODN) transfection on biological characteristics of mature dendritic cells ( mDCs) in mice. Methods Immature DCs were harvested from Balb / c mice bone marrow, followed by the incubation with antigen OVA and LPS, and mature DCs were evaluated by the expressions of CD11c and MHC-Ⅱ detected by FACS. Mature DCs were transfected with NF-κB decoy ODN and the changes of NF-κB activity after the transfection were detected by EMSA. The expressions of the costimulatory molecules( CD40,CD80 and CD86) on DCs were detected by FACS and the proliferation of T cells was tested by mixed lymphocyte reaction( MLR) . Results The mature DCs were cultured successfully. The NF-κB activity of NF-κB decoy ODN transfected DCs was decreased significantly( P lt; 0. 05) . There was no difference in the expressions of CD40 and CD80, but the expression of CD86 was decreased significantly in NF-κB decoy ODN transfection group( P lt; 0. 05) . MLR test showed that the proliferation of T lymphocyte cells was inhibited by NF-κB decoy ODN transfected DCs, but was stimulated bly by the DCs of other groups. Conclusions Mature DCs transfected with NF-κB decoy ODN could inhibit the proliferation and activation of antigenspecical T cells, which was probably related to the down-regulation of CD86 on DCs. This modified DCs might be a promising vaccine for the treatment of asthma in the future.
Objective To evaluate the effectiveness of prosthetic revision using custom-made long stem prosthesis and allograft-prosthesis composite (APC) for aseptic loosening after bone tumor resection. Methods Between January 2002 and June 2008, 14 patients with aseptic loosening after bone tumor resection were treated. There were 8 males and 6 females,aged 21-70 years (mean, 43.9 years). The locations were distal femur (8 cases), proximal femur (2 cases), and proximal tibia (4 cases). Pain of the affected l imb occurred after 6-31 years of prosthesis replacement and worsened when bearing and walking; 6 patients had shortened l imb. The functional results were assessed quantitatively according to the functional rating system of the Musculoskeletal Tumor Society (MSTS). The MSTS score was 16.36 ± 1.50 before revision. The X-ray films showed obvious prosthetic loosening and subsidence. The average time of symptom was 4.5 years (range, 3-9 years). In 7 patients having severe bone loss (the decrease of the thickness of cortical bone was more than 50%) and the prosthetic subsidence was more than 2 cm, the revision operation with the APC was performed; in 7 patients having less bone loss (the decrease of the thickness of cortical bone was less than 50%), the custom-made long stem prosthesis was performed. Results All wound healed by first intention. Two patients had temporary peroneal nerve paralysis and recovered after 3 months. All the patients were followed up 3.6 years on average (range, 2 years and 2 months-7 years) after revision. After revision, pain was rel ieved and the range of joint was improved. The MSTS score was 23.43 ± 2.56 at 12 months after revision showing significant difference when compared with the preoperative score (t=8.910, P=0.024). The X-ray films showed that lucency space l ine around stem cement in 2 patients at 12 months, and no prosthesis loosening and infection occurred. Conclusion The prosthetic revision after l imb salvage surgery with prosthesis for bone tumors was acceptable. The good functional results can be achieved by the revision with the APC or the custom-made long stem prosthesis according to the bone loss.
Objective To evaluate the cl inical outcomes of the wide resection and the functional reconstruction for treating mal ignant tumors of the proximal femur. Methods The cl inical data were analysed from 62 patients with mal ignant tumors of the proximal femur treated between January 1987 and December 2007. There were 29 males and 33 females with a median age of 35 years (range, 14-73 years). In 41 patients with primary mal ignant tumors having a disease course of 0.5-14.0 months, there were 16 cases of osteosarcoma, 7 cases of fibrosaroma, 6 cases of chondrosarcoma, 6 cases of mal ignant fibrous histiocytoma, 4 cases of mesenchymal sarcoma,1 case of Ewing sarcoma, and 1 case of angiosarcoma, including 3 cases of type IB, 2 cases of type IIA, 35 cases of type IIB, and 1 case of type III according to Enneking stage. In 21 patients with metastatic tumors, 16 had a mal ignant tumor history; the disease course was 0.1-28.0 months (3.4 months on average). Radical resection was performed in 9 cases, extensive resection in 39 cases, and marginal resection in 14 cases. After resection, 39 cases underwent reconstruction with prostheses (prostheses group) and 14 cases underwent reconstruction with allograft-prosthetic composites (APC, APC group). Results All incision healed by first intention. Twenty-six cases died of tumor metastasis,their postoperative survive time was 16-56 months (28 months on average). The average follow-up time was 64 months (range, 28-221 months) in 36 survival patients. The local recurrence rate of primary mal ignant tumors was 4.88% (2/41). In prostheses group, dislocation of femoral head occurred in 2 cases, fracture of prosthetic stem in 1 case, hip pain in 3 cases, acetabular wear in 3 cases, and stem loosening in 5 cases. In APC group, nonunion of APC occurred in 3 cases and acetabular wear in 1 case. At last follow-up, the average Musculoskeletal Tumor Society (MSTS) functional scores were 77.69% ± 6.50% in prostheses groupand 85.71% ± 7.45% in APC group, showing significant difference (P lt; 0.001). Conclusion When the wide resection isperformed for mal ignant tumors of the proximal femur, better local control could be achieved. Compared with econstruction of the prosthesis, the APC reconstruction can provide better function.
Objective To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting. MethodsA total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively. Results In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane. Conclusion In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.
To investigate the biomechanical effects of direct ventricular assistance and explore the optimal loading mode, this study established a left ventricular model of heart failure patients based on the finite element method. It proposed a loading mode that maintains peak pressure compression, and compared it with the traditional sinusoidal loading mode from both hemodynamic and biomechanical perspectives. The results showed that both modes significantly improved hemodynamic parameters, with ejection fraction increased from a baseline of 29.33% to 37.32% and 37.77%, respectively, while peak pressure, stroke volume, and stroke work parameters also increased. Additionally, both modes showed improvements in stress concentration and excessive fiber strain. Moreover, considering the phase error of the assist device's working cycle, the proposed assist mode in this study was less affected. Therefore, this research may provide theoretical support for the design and optimization of direct ventricular assist devices.
Objective To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods. Methods From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females. Twenty-five patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years. The crushed time was 30 minutes to 154 hours. Sixty cases of openinjuries were treated by debridement and dressing or suture; 16 cases of damaged extremities (18 l imbs) and 6 cases of acute renal failure due to crush syndrome (8 l imbs) received amputation; 32 cases of interfascial space syndrome crisis (42 l imbs) were treated by fascia cavity decompression; 15 cases received the resection of necrotic muscle for 31 times; and 9 cases received continuous renal replacement therapy (CRRT). Results All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT. Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment. The average hospital ization time was 53 days. Twenty-two cases (26 l imbs) were fixed with artificial l imbs 3-6 months after amputation and achieved good functional outcome. Conclusion The treatment principle of crush injury is “be active to decompress and be prudent to amputate”, the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression. Decompression at an earl ier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.