Objective To observe the baseline characteristics and visual outcomes after two years follow-up of exudative age-related macular degeneration (AMD) patients treated with ranibizumb. Methods Forty-four eyes of 44 patients with exudative AMD were enrolled into this retrospective study, 19 were men and 25 were women. The mean age was 78 years (range 64 – 92 years). All patients were underwent best corrected visual acuity (BCVA, Early Treatment of Diabetic Retinopathy Study), fundus color photography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). The mean BCVA was (50.36±14.43) letters, the mean central foveal thickness (CFT) was (291.95±82.19) μm, and the fluorescence leakage area of choroidal neovascularization (CNV) was (7.61±5.84) mm2. All patients received three initial intravitreous injection of ranibizumb (IVR) and were retreated with monthly IVR when needed. The mean follow up time was 25.6 months (range 24 – 29 months). On 1, 2, 3, 6, 12, 18 and 24 months after treatment, BCVA and OCT were repeated. On 3, 6, 12, 18 and 24 months after treatment, FFA and ICGA were repeated. The change of BCVA, CFT and fluorescence leakage area of CNV were observed. The association of baseline characteristics and two year visual outcomes were analyzed. Results On 1, 2, 3, 6, 12, 18 and 24 months after treatment, the BCVA were improved significantly (t= −1.89, −3.51, −4.61, −4.04, −5.77, −4.69;P＜0.05), the CFT were decreased significantly (t=1.51, 2.30, 3.40, 3.28, 3.54, 3.88, 3.73;P＜0.05). On 3, 6, 12, 18 and 24 months after treatment, the fluorescence leakage area of CNV were reduced significantly (t=2.12, 2.90, 3.51, 4.12, 4.06;P＜0.05). The lower baseline BCVA, the more improved after treatment. The BCVA improvement degree has a negative relationship with baseline BCVA and fluorescence leakage area of CNV (r=0.505, −0.550;P＜0.05), but no correlation with baseline CFT (r=0.210,P＞0.05). Conclusion Two year visual outcomes of exudative AMD patients treated with ranibizumb is negative correlated with baseline BCVA and fluorescence leakage area of CNV, but not correlated with baseline CFT.
In order to find the most suitable algorithm of T-wave end point detection for clinical detection, we tested three methods, which are not just dependent on the threshold value of T-wave end point detection, i.e. wavelet method, cumulative point area method and trapezium area method, in PhysioNet QT database (20 records with 3 569 beats each). We analyzed and compared their detection performance. First, we used the wavelet method to locate the QRS complex and T-wave. Then we divided the T-wave into four morphologies, and we used the three algorithms mentioned above to detect T-wave end point. Finally, we proposed an adaptive selection T-wave end point detection algorithm based on T-wave morphology and tested it with experiments. The results showed that this adaptive selection method had better detection performance than that of the single T-wave end point detection algorithm. The sensitivity, positive predictive value and the average time errors were 98.93%, 99.11% and (-2.33±19.70) ms, respectively. Consequently, it can be concluded that the adaptive selection algorithm based on T-wave morphology improves the efficiency of T-wave end point detection.
ObjectiveTo study the clinical efficacy of core decompression and allogeneic nonvascularized fibular grafting on patients with different femoral head necrotic area. MethodsBetween January 2010 and December 2011, 59 hips in 59 patients with Ficat stage Ⅱ osteonecrosis of femoral head were treated with core decompression and allogeneic nonvascularized fibular grafting. Fifty-four patients (54 hips) were followed up. According to the necrotic area of femoral head, patients were divided into three groups: 6 hips in type A, 37 hips in type B and 11 hips in type C. We analyzed the outcomes by changes in radiographic images, Harris hip scores, hip activity and visual analogue scale (VAS) pain scores. The mean follow-up time was 40.1 months. ResultsThe postoperative X-ray images were good with no fibula prolapse, fracture or infection. Six femoral heads collapsed in patients of type C group. No head collapsed in patients grouped into type A or type B. The three groups' Harris hip scores were better than those before surgery (P<0.05). But the Harris hip score of patients with femoral head collapse was as bad as that before surgery (P>0.05). The Harris score of group C was significantly lower than group A and B (P<0.01). The joint movements of type A and type B patients were similar with those before surgery, and the VAS pain score was lower. But patients of type C suffered worse joint movement and the pain was not relieved. ConclusionThe clinical efficacy of femoral head necrotic patients treated with core decompression and allogeneic nonvascularized fibular grafting is generally good. But the risk of femoral head collapse in type C patients is high, and the clinic outcome is worse than patients of type A and B. Therefore this type of surgery is more suitable for patients with type A and B femoral head necrotic area.
ObjectiveTo study the effects of visceral adipose tissue area (VTA) and subcutaneous adipose tissue area (STA) on pulmonary ventilation function (PVF), and then to evaluate the impact of abdominal fat distribution on PVF.Methods Patients who underwent both PVF examination and abdominal CT between January 1st and December 31st, 2017 were selected from the electronic medical record system of West China Hospital of Sichuan University. The demographic data and PVF indexes [vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and 1 s rate (FEV1/FVC)] were collected. VTA and STA were obtained by abdominal CT measurement. The correlations between PVF indexes and VTA or STA were compared. Results A total of 224 patients were included. According to the VTA/STA ratio, there were 92 cases (41.07%) in group VTA/STA<1 and 132 cases (58.93%) in group VTA/STA≥1. VTA was not correlated with FVC (rs=−0.078, P=0.244), but negatively correlated with VC (rs=−0.138, P=0.040), FEV1 (rs=−0.141, P=0.034) and FEV1/FVC (rs=−0.137, P=0.041); STA had no correlation with VC, FVC, FEV1 or FEV1/FVC (P>0.05). VTA/STA was negatively correlated with VC (rs=−0.220, P=0.001), FEV1 (rs=−0.273, P<0.001) and FEV1/FVC (rs=−0.380, P<0.001), but it had no correlation with FVC (rs=−0.083, P=0.214). In group VTA/STA<1, VTA/STA was negatively correlated with FEV1 (rs =−0.205, P=0.050) and FEV1/FVC (rs=−0.317, P=0.002), but it had no correlation with VC or FVC (P>0.05). In group VTA/STA≥1, VTA/STA was negatively correlated with VC, FVC, FEV1 and FEV1/FVC (P<0.05). Conclusions VTA and STA are negatively correlated with PVF. The ratio of VTA/STA can be used as an index to evaluate the effect of abdominal fat distribution on lung function.
Objective To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose. Methods The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm. ResultsOne patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any “cat ear” malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction.ConclusionThe bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.
Objective To study the effect of various doses of estrogen on tissue injury, blood supply and survival area of skin flap and to investigate its mechanism. Methods Thirty New Zealand white rabbits aged 3-4 months old and weighing 1.5-2.2 kg (male or female) were used. Random pattern skin flap (12 cm × 3 cm in size) taking the central l ine of the rabbit dorsum as axis and with the pedicle attached at the proximal end was prepared, and the flap pedicle division was performed 7 days after operation. The rabbits were divided randomly into three groups (n=10 rabbits per group). At 2, 4, and 6 days after operation, the proximal edge of flap in group A and B received 100 ?g/kg and 50 ?g/kg subcutaneous injection ofestradiol benzoate, respectively, while group C received no further treatment serving as control group. General condition ofthe rabbits was observed after injection, gross observation was performed 3 and 7 days after injection, survival area of the skin flap was measured 7 days after injection, contents of malondialdehyde (MDA) and nitric oxide (NO) were tested 5 days after injection, and the flaps were harvested 4 and 7 days after injection to receive histology and no significant difference was noted between group A and group B (P gt; 0.05). The NEU counts 4 days after injection were (18.20 ±6.24) cells/HP in group A, (21.27 ± 5.34) cells/HP in group B, and (28.78 ± 7.92) cells/HP in group C, and at 7 days after injection, there were (15.16 ± 7.02) cells/HP in group A, (18.12 ± 6.44) cells/HP in group B, and (29.67 ± 9.12) cells/HP in group C. The VEGF score 4 days after injection was (4.02 ± 0.48) points in group A, (4.19 ± 0.66) points in group B and (3.67 ± 0.49) points in group C, and at 7 day after injection, it was (4.96 ± 0.69) points in group A, (5.12 ± 0.77) points in group B, and (3.81 ± 0.54) points in group C. Significant difference was evident between 4 days and 7 days after injection in group A or B in terms of NEU counts and VEGF score (P lt; 0.05), and difference between 4 days and 7 days after injection in group C was not significant (P gt; 0.05), and the differences among 3 groups were significant (P lt; 0.05). Conclusion Estrogen injection can increase VEGF expression and NO content of flap, decrease MDA content and NEU infiltration of flat, and improve survival area of flap.
Objective To investigate the cl inical effect of Meek technique skin graft in treating exceptionally large area burns. Methods The cl inical data were retrospectively analysed from 10 cases of exceptionally large area burns treated with Meek technique skin graft from April 2009 to February 2010 (Meek group), and were compared with those from 10 casesof exceptionally large area burns treated with the particle skin with large sheet of skin allograft transplantation from January 2002 to December 2006 (particle skin group). In Meek group, there were 8 males and 2 females with an average age of 34.5 years (range, 5-55 years), including 6 cases of flame burns, 2 cases of hot l iquid burns, 1 case of electrical burn, and 1 case of hightemperature dust burn. The burn area was 82.6% ± 3.1% of total body surface area (TBSA). The most were deep II degree to III degree burns. The time from burn to hospital ization was (3.5 ± 1.3) hours. In particle skin group, there were 8 males and 2 females with an average age of 36.8 years (range, 18-62 years), including 5 cases of flame burns, 2 cases of hot l iquid burns, and 3 cases of gunpowder explosion injury. The burn area was 84.1% ± 7.4% of TBSA. The most were deep II degree to III degree burns. The time from burn to hospital ization was (4.9 ± 2.2) hours. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The skin graft survival rate, the time of skin fusion, the systemic wound heal ing time, and the treatment cost of 1% of burn area were 91.23% ± 5.61%, (11.14 ± 2.12) days, (38.89 ± 10.36) days, and (5 113.28 ± 552.44) yuan in Meek group, respectively; and were 78.65% ± 12.29%, (18.37 ± 4.63）days, (48.73 ± 16.92) days, and (7 386.36 ± 867.64) yuan in particle skin group; showing significant differences between 2 groups (P lt; 0.05). Conclusion Meek technique skin graft has good effect in treating exceptionally large area burns with the advantages of high survival rate of skin graft, short time of skin fusion, and low treatment cost of 1% of burn area.
To assess the rel iabil ity of diabetic cutaneous ulcer surface area (DCUSA) measurement usingdigital planimetry method (A) and transparency tracing method (B). Methods Images of diabetic cutaneous ulcers from35 inpatients with diabetic skin ulcers from September 2005 to April 2007 were taken by a digital camera once a week or twice a week over a period of 12 weeks, resulting in 305 photographs; the ulcers were traced on a grid with acetate wound tracings, simultaneously. A total of 305 pairs of DCUSA which were calculated respectively throughout digital camera combined with Image J medical imaging software and transparency tracing with grid sheet by two independent observers sequentially were obtained. The intraclass correlation coefficients (ICCs, one-way random effect model) was used as an indicator of chancecorrected agreement to estimate the relative rel iabil ity for the interobserver data. Multiple l inear regression analysis was also used to measure the relationship of these two methods. Results DCUSA obtained from method A and obtained from method B was (4.84 ± 7.73) cm2 and (5.03 ± 7.89) cm2, respectively; no significant difference was found (P gt; 0.05). ICCs was high (ICCs=0.949 for method B and 0.965 for method A), indicating that the relative rel iabil ity for the interobserver was excellent. The method A were highly correlated with measurements obtained from method B (r = 0.957, P lt; 0.05). Conclusion The digital planimetry method described in this study represents a simple, practical, without any wound damage and contamination, and inexpensive technique to accurately evaluate the areas of diabetic cutaneous ulcers. The photographic technique combined with Image J medical imaging software should be considered for wound measurement.
Objective To observe the changes of force bearing area and pressures of the rabbit tibiofemoral contact area and the biomechanical reconstruction level of joint after meniscal allograft. Methods A total of 28 Japanese rabbits were involved, weighing 3.0-3.5 kg, male or female. Of 28 rabbits, 7 were selected as meniscus donors, the remaining 21 rabbits were randomized into group A (n=7), group B (n=7), and group C (n=7). Group A underwent single knee opening and suturing, group B underwent medial meniscus excision and suturing, and group C underwent medial meniscus allograft after medial meniscus excision and suturing. The rabbits were sacrified at 12 weeks after operation for biomechanical observation through biomechanical machine and color imaging system. The meniscus tissue specimens were harvested from groups A and C to perform histological and immunohistochemical staining. Results After operation, all rabbits in 3 groups survived to the end of experiment. There were significant differences in the force bearing area and pressures at 0-90° flexion between group B and groups A, C (P lt; 0.05) at 12 weeks, showing no significant difference between group A and group C (P gt; 0.05); and there were significant differences in the force bearing area and pressures at 120° flexion among 3 groups (P lt; 0.05). The histological observation showed that the number of cartilage cells and collagen fibers returned to normal in group C, and the immunohistochemical staining showed that transplanted meniscus of group C contained large amounts of collagen fibers consisting of collagen type I and collagen type II. After 12 weeks of operation, the collagen type I contents were 0.612 5 ± 0.059 8 in group A and 0.587 2 ± 0.063 9 in group C, showing no significant difference (t=0.765, P=0.465); the collagen type II contents were 0.772 4 ± 0.081 5 and 0.814 3 ± 0.051 7, respectively, showing no significant difference (t= —0.136, P=0.894). Conclusion The allograft of rabbit meniscus can significantly increase the force bearing area of the tibiofemoral contact area and reduce the average pressure. Therefore, biomechanically speaking, the meniscus allograft can protect the articular cartilage and reconstruct the biomechanical balance.