ObjectiveTo evaluate the reading speed and related factors of normally-sighted middle-aged and elderly people, and compare with those assessed in age-related macular degeneration (AMD) patients.MethodsProspective case control study. Participants aged 45 to 85 years old with junior high school or above education and BCVA no less than 0.6 from the community around the First Hospital of Tsinghua University were recruited. People with ocular and nervous system diseases were excluded. AMD patients without other ocular and nervous system diseases, with the BCVA of their better eye above 0.05, were recruited from the Low Vision Clinic of the First Hospital of Tsinghua University. The best corrected vision, contrast sensitivity, and reading acuity were tested. Reading speed was evaluated with IReST Chinese version. Single factor correlation analysis was used to assess different factors which may be related with the reading speed, then multiple linear regression analysis was conducted further.ResultsFrom January to April, 2016, 53 volunteers aged 60.7±8.8 years old participated in the survey including 17 males and 36 females. Their median of best vision acuity both distance and near was 1.0, and their average reading speed was 244±55 characters/min. The average reading speed of younger participants in the middle-aged group (45-59 years old) was statistically faster (P＜0.05) than the elderly group (≥60 years old), which was 267±53 and 227±51 characters/min separately. The reading speed was correlated with age (r=－0.476, P=0.000), gender (t=－2.291, P=0.031), educational level (t=2.656, P=0.011), reading habits (t=7.346, P=0.000), best corrected distance vision (r=－0.293, P=0.033), best corrected near vision (r=－0.460, P=0.001), and reading acuity (r=－0.558, P=0.000) by single factor correlation analysis. Further analysis with multiple linear regression showed that reading acuity, gender, education level, and reading habits were significantly correlated with reading speed (β=－283.312, 28.303, －37.700, －45.505; P=0.000, 0.022, 0.019, 0.023). Totally 22 AMD patients aged 77.4±8.2 (59-90) years old joined the study from September 2016 to August 2018, including 16 males and 6 females. The median reading speed was 118 characters/min. Compared with the normally-sighted elderly, there were more males in AMD patients (χ2=3.981, P=0.046). They were older (t=－4.285, P=0.000), with significant poorer visual acuity (t=-6.176, P=0.000) and lower reading speed (t=-5.719, P=0.000). Significant correlation was found between reading speed and best binocular distance or near vision, reading acuity and contrast sensitivity (r=－0.771, －0.805, －0.776, 0.511; P=0.000, 0.000, 0.000, 0.015), no statistic relationship was found between reading speed and age(r=0.021, P=0.926) or gender(Z=－0.382, P=0.703) in AMD patients.ConclusionsThe reading speed of normally-sighted people declined with age. Reading acuity may be a better predictive factor than distance vision for reading function. Compared with normally-sighted group, the reading acuity and reading speed of AMD patients was significantly lower. The main factor affecting their reading speed was the severity of their visual impairment.
目的 探讨大剂量西地兰联合小剂量酒石酸美托洛尔经静脉途径治疗急性左心衰伴快速心室率心房颤动的疗效与安全性。 方法 将2005年6月－2012年2月收治的76例急性左心衰伴快速心室率心房颤动患者，随机分配至对照组（39例）与治疗组（37例），对照组静脉注射西地兰，治疗组静脉注射西地兰与小剂量酒石酸美托洛尔，分别在用药开始时及用药开始后全程监测收缩压、心室率、呼吸频率、手指脉搏血氧饱和度（SpO2）、呼吸困难程度、肺部啰音与治疗2 h时尿量，记录急性左心衰改善时间。 结果 两组患者在治疗开始时心室率（P=0.246）、呼吸频率（P=0.390）、收缩压（P=0.525）与SpO2（P=0.482）均无统计学意义；在治疗整个过程中，两组患者收缩压与治疗2 h尿量均无统计学意义（P=0.264）；在治疗开始后30、60、90、120 min时治疗组患者心室率均显著低于对照组（P=0.000）。治疗组患者从在治疗开始到急性左心衰改善的时间明显短于对照组（P=0.003）。试验期间无1例患者出现病情恶化或死亡。 结论 在排除美托洛尔禁忌症的前提下，在严密监测肺部啰音及指氧饱和度的情况下，对那些平时心功能Ⅰ~Ⅱ级的急性左心衰伴快速心室率心房颤动患者，在经静脉途径给予大剂量西地兰的同时，间断多次静脉注射小剂量美托洛尔，能安全有效地控制过快心室率，缩短急性左心衰竭持续时间。
ObjectiveTo investigate the clinical significance of applying digitalis preparations after pneumonec-tomy. MethodsWe retrospectively analyzed the clinical data of 78 patients who underwent pneumonectomy in the Tangdu Hospital of The Fourth Military Medical University from August 2010 to August 2013. The patients were divided into a control group (39 patients with 27 males and 12 females at a mean age of 56.8±14.8 years) and a trial group (39 patients with 24 males and 15 females at a mean age of 57.4±10.1 years). After pneumonectomy, the trial group received low dose of digitalis treatment. On 3, 5, and 7 days, the arterial partial pressure of oxygen (PaO2), systolic pulmonary artery pressure (SPAP), mean arterial pressure (MAP), diastolic pulmonary artery pressure (DPAP), and the rate of complications were examined. ResultsAfter treatment with the low dose of digitalis, the SPAP, MAP, DPAP of the trial group were statistically lower than those of the control group (P < 0.05). Incidence of arrhythmia in the trial group was statistically lower than that of the control group (P < 0.05). There was no statistical difference between the two groups in the PaO2, the incidence of pulmonary infection, and circulation disorder (P > 0.05). ConclusionLow dose of digitalis preparations can improve cardiac function after pneumonectomy.
The quality of clinical trials is key to determine the value of a clinical research and whether it can transform achievements. In this paper, the characteristics and direction of the implementation of quality control in clinical trials in China, and the characteristics of quality control in clinical trials of Chinese medicine are discussed, and the development direction of quality control in clinical trials in China is explored in order to improve the overall level of clinical trials in China.
ObjectiveTo compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. MethodsA total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: <25 mm and ≥25 mm. Gender, age, and fracture side and AO type were recorded. The patients in each group were reviewed whether there was delayed fracture union or nonunion, whether the screw blade moved axially, whether the femoral neck collapsed or even screw blade cut out, whether the internal fixator became loose or broken within 12 months after operation. Then statistical analysis was performed. ResultsThere were 119 patients with TAD<25 mm and 69 patients with TAD≥25 mm, and 142 patients with Cal-TAD<25 mm and 46 patients with Cal-TAD≥25 mm. There was no significant difference in gender, age, or fracture side and AO type between groups (P>0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm (P<0.05). ConclusionIn the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications.
Objective To explore the feasibility and safety of liver transplantation （LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension， and to compare the therapeutic effects with conventional operation （CO）. Methods The clinical data of 303 patients with bleeding portal hypertension from Feb. 2009 to Feb. 2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed. One hundred and one patients received LT procedure （LT group）， whereas the other 202 patients received CO procedure （CO group）. Postoperative follow-up period was 8-44 months （average 26 months）. Results Liver function before operation in CO group was significantly better than that in LT group（P＜0.01）. The mortality of CO group and LT group were 7.4%（14/189） and 3.0%（3/101， P=1.00）， respectively. The rebleeding rate of patients underwent LT was 2.0%（2/101）， significantly lower than that of CO group 〔9.5%（18/189）， P＜0.05〕. The vanish rate of esophagogastric varice in patients underwent LT was 86.1%（87/101）， significantly lower than that of CO group 〔54.5%（86/189）， P＜0.01〕. Conclusions LT treatment for bleeding portal hypertension is feasible and safe. Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery. LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.