To assess the postoperative outcomes of piggyback implantation using Acrysof Toric intraocular lens ( lOL ) in high myopia combined with corneal astigmatism.
●METHODS: Sixty patients who had phacoemulsification with lOL implantation due to high myopia, cataract and corneal astigmatism from January 2010 to June 2013 were randomly divided into observation group (piggyback Toric lOL implantation, both an Acrysoft lQ Toric lOL and a minus foldable acrylic three piece lOL were implanted in the capsular bag, n= 30) and control group (foldable lOL implantation, n = 30). Postoperative follow - up went on 6mo. lnformation collected included uncorrected visual acuity ( UCVA), lOL position, residual astigmatism and complications.
● RESULTS: The UCVA increased from 3. 52 ± 0. 03 preoperatively to 4. 78±0. 01 at 6mo postoperatively in the observation group, from 3. 51±0. 03 preoperatively to 4. 30± 0. 13 at 6mo postoperatively in the control group. The observation group's postoperative UCVA was better than that of the control group. There was statistically significant difference ( t = 3. 612, P < 0. 05 ). The preoperative corneal astigmatism was 2. 97 ± 0. 87 (1. 70 -4. 27) D in the observation group and 2. 92 ± 0. 97 (1. 50 -4. 90)D in the control group. The postoperative residual astigmatism was 0. 48 ± 0. 23 ( 0. 25 - 1. 00 ) D in the observation group and 2. 87 ± 1. 11 (1. 00 - 5. 20) D in the control group. There was statistically significant difference postoperatively (t = - 11. 995, P < 0. 05) between the two groups. No complications occurred.
●CONCLUSlON: Piggyback implantation using Toric lOL can help to solve the problem of no matching Toric lOL power for the high myopia combined with corneal astigmatism at the current stage. lt improves the UCVA and reduces the astigmatism after the cataract surgery.

Objective To investigate the development of ultrastructure in grafts from a xenograft model of human hemangioma on nude mice.Methods Human infantile hemangioma tissue was obtained in surgery and planted into subcutaneous layer of nude mice in small pieces.The grafts were harvested on the 2~(nd),5~(th),15~(th),30~(th),45~(th) day and then at 2~(nd),3~(rd),4~(th),6~(th) month for transmission electron microscopic view.Results In early stage after transplantation,signs of degeneration and necrosis were more evident.On the 30~(th) day,the number of endothelial cells increased and some of the endothelial cells were larger in size with high nuclear to plasm ratio.At the 2~(nd) month,the number of endothelial cells increased,while some of these cells turned flat.Later,high endothelial cells decreased in number and collapse and pyknosis of plasm,formation of secondary lysosome,margination of chromatin,fragmentation of nucleus were evident with surrounding deposition of adipose and collagen.Conclusions With xenotransplantation of human infantile hemangioma tissue onto nude mice,the grafts may survive ischemia and proliferate,and then gradually involute.The development resembles a natural course of human infantile hemangioma.

Objective To evaluate the value of diffusion-weighted imaging(DWI)on differential diagnosis of intracranial cystic lesions.Methods Seventy-six patients with surgically and pathologically confirmed intracranial cystic lesions undergone conventional MRI,DWI and contrast enhanced MRI examination.The signal characteristics of intracrania]cystic lesions on DWI were analysed retrospectively, the apparent diffusion coefficient(ADC)values of cystic areas were measured quantitatively.Results Nineteen brain abscesses showed hyperintense signal on DWI.Among 34 brain tumors,3 brain gliomas were hyperintense signal,1 brain glioma was isointense signal and 1 metastasis was hyperintense signal;the other 29 brain tumors showed hypointense signal on DWI.The ADC values of all lesions were:(0.62?0.15)? 10~(-3)mm~2/s in brain abscesses,(2.39?0.78)?10~(-3)mm~2/s in brain gliomas,(2.68?0.40)? 10~(-3)mm~2/s in brain hemangioblastomas,(2.79?0.79)?10~(-3)mm~2/s in brain metastases,respectively. There were significant differences between the ADC values of brain abscess and the cystic or necrotic portions of brain glioma,hemangioblastoma,metastasis(P0.05). Seven intracranial arachnoid cysts showed hypointense signal and 16 epidermoid cysts strikingly hyperintense signal on DWI.The ADC values of arachnoid cysts and epidermoid cysts were(2.96?0.36)?10~(-3)mm~2/s and(0.94?0.13)?10~(-3)mm~2/s respectively.There was significant difference between the ADC values of arachnoid cysts and epidermoid cysts(P

Objective To study the psychological and psychosomatic status of children with pectus exca vatum and the significance of orthotherapy. Method Eighty-seven patients and 87 healthy children were interviewed with the Achenba ch Child Behavior Checklist (CBCL),the symptom Checklist (SCL-90)and the psycho logical and psychosomatic status checklist contrived. Results The children with pectus excavatum showed higher frequency in interpersonal sens itivity, depression,anxiety,obsession compulsion and also more mental difficul ties than those of control group.The differences between the patients and health y children were significant statistically.Conclusions The psychological and psychosomatic status of children with pectus excavatum are worse than those of healthy children,so it is reasonable to perform an operati on earlier for improvement of physiological, psychological ,social aspects in ch ildren with pectus excavatum. J Appl Clin Pediatr,2005,20(2):178-179

OBJECTIVETo analyze and evaluate the fatigue of shoulder skeletal muscle caused by different lifting loads with surface electromyography (sEMG).

METHODSAccording to the loading standard of1 Repetition Maximum (1RM), ten male volunteers performed 3 tasks of upper limb flexion, i.e. 10%, 50% and 90%-1RM. During action process, the signals of Upper Trapezius (UT), Lower Trapezius (LT), Serratus Anterior (SA) and Anterior Deltoid (AD) were recorded by sEMG. The Mean Amplitude (MA) served as an index to evaluate the changes in skeletal muscle fatigue.

RESULTSThe scores of Borg were 15.6, 15.9 and 15.2 for 3 loads of 10%-1RM, 50%-1RM and 90%-1RM, respectively (P > 0.05). The mean amplitudes (MAs) of Upper Trapezius, Lower Trapezius, Anterior Deltoid and Serratus Anterior in shoulders increased obviously. Under the load intensity of 10%-1RM, the MAs of Upper Trapezius and Anterior Deltoid increased significantly (P < 0.05), which were 0.898 and 0.736, respectively. After the exhaustion, the contribution of mean amplitude in shoulder muscle did not change significantly (P > 0.05).

CONCLUSIONThe low-load action for long time can induce easily the fatigue of upper trapezius and anterior deltoid.

Adult ; Electromyography ; Humans ; Lifting ; Male ; Muscle Fatigue ; physiology ; Muscle, Skeletal ; physiology ; Shoulder ; physiology ; Workload

BACKGROUNDOld pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures.

METHODSFirst, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8-17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure.

RESULTSThe accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6-9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3-29 months (median: 5 months). The fracture healing time was 9-17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The results were excellent in two cases, good in five, and poor in two based on the Majeed score.

CONCLUSIONSThe 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.

Adolescent ; Adult ; Female ; Fractures, Bone ; diagnosis ; pathology ; Humans ; Imaging, Three-Dimensional ; methods ; Male ; Middle Aged ; Pelvic Bones ; surgery ; Reconstructive Surgical Procedures ; Young Adult

OBJECTIVESTo investigate a new targeting mechanical arm for CT-based navigated percutaneous fixation of pelvic fractures, and to evaluate the safety and efficiency of the procedures.

METHODSUsing CT-based 3D navigation software combined with targeting mechanical arm, percutaneous insertion of pelvic models (3 dry human cadaver pelvic skeletons and 5 plastic Sybone pelvic models) were performed, 8 pelvic models allowed percutaneous cannulated screw insertion of both S-I joint (2 S-I screws placement for each side, total 32 screws in this experiment) and both superior ramus (1 ramus medullary screw placement for each side, total 16 screws in this experiment). Percutaneous insertion of pelvic models (4 dry human cadaver pelvic skeletons and 4 plastic Sybone pelvic models, 1 S-I screws and 1 ramus medullary scre placement for each side, 32 screws in this experiment) were performed using fluoro-navigation system (Stryker, USA). Time necessary for every screw insertion were recorded. Accuracy of screw placement was assessed using C-arm imaging and direct eyes inspecting. The time and accuracy of the two methods were compared.

RESULTSThe time required for the CT-based 3D navigation procedure (3.6 ± 1.2) min was significantly less than using the targeting mechanical arm compared to drilling freehand with navigation (9.1 ± 0.8) min (t = 2.50, P < 0.01). There was no significant difference in accuracy between the two methods.

CONCLUSIONCT-based 3D navigation software combined with targeting mechanical arm should be potential to apply percutaneous sacroiliac screwing for pelvic fractures with more accurate and more reliable.

Bone Screws ; Cadaver ; Fracture Fixation, Internal ; methods ; Humans ; Models, Anatomic ; Pelvic Bones ; surgery ; Software ; Surgery, Computer-Assisted ; methods

OBJECTIVETo study the incidence of cases with rash and fever illness (RFIs) after measles vaccine (MV) inoculation.

METHODSDuring 1999 to 2002, 150 RFIs cases reported by the special measles surveillance system in Shandong province, China, were investigated and analyzed epidemiologically.

RESULTS7 674 690 ml MV were distributed during 1999 to 2002 and the annual average incidence of RFIs cases after MV inoculation was 0.20/10 000 ml (0.2 ml per dose). There was significant difference of incidences each year (chi(2) = 10.13, P < 0.05). All RFIs cases were sporadically distributed without epidemiological links. Clinical symptoms showed that 88.67% of the 150 RFIs cases having > 38.5 degrees C fever and 75.33% of all cases appeared typical rash after 4 to 11 days (the medium was 8 days) after MV inoculation. The order of rash onset among RFIs cases was consistent with that of regular measles cases caused by wild virus. 68.67% of the RFIs cases had first MV inoculation and 94.71% were 8 to 12 month-olds. IgM sera antibody test from RFIs cases were rubella negative and 45.65% positive for measles.

CONCLUSIONRFIs due to allergic reaction or measles vaccine virus infection might occur after MV inoculation. There seemed to be a correlation between RFIs incidence and the doses of MV. Measles virus genotype analysis needs to be carried out to confirm if the onset of some RFIs cases is aetiologically associated to MV vaccine virus infection.

Exanthema ; etiology ; virology ; Fever ; etiology ; virology ; Humans ; Measles ; prevention & control ; Measles Vaccine ; adverse effects ; Measles virus ; immunology ; Polymerase Chain Reaction ; Vaccination

OBJECTIVETo develop a traction reductor for the reduction of lower limb fractures during the minimally invasive surgery and explore its safety and efficacy.

METHODSFrom February 2007 to March 2009, closed or limited open reduction plus percutaneous plate and screw internal-fixation were conducted in 34 patients with fracture of distal femur and tibia metaphysic, among which there were 3 distal femoral fractures (2 33-B, 1 33-C), 14 proximal tibial fractures (9 41-A, 3 41-B, 2 41-C) and 17 distal tibial fractures (9 43-A, 5 43-B, 3 43-C, 2 Gustilo I a), according to the Association for Osteosynthesis-Orthopaedic Trauma Association (AO-OTA) classification. Besides, closed reduction plus interlocking intramedullary nailing on tibial shaft fracture were applied in 36 patients (7 42-A, 21 42-B, 8 42-C, 2 Gustilo I a). All the 70 patients, with an average age of 37.6 years (range: 17 to 63 years) and average time before surgery of 4.7 d (range: 0.7 to 12.0 d), underwent reduction by self-designed traction reductor for lower limb fracture in the surgery. The reduction duration and C-arm fluoroscopy time were recorded. Recovery of the force line of affected limbs after surgery was determined by whether the line from anterior superior iliac spine to the interdigit between the first and second toe-web passed the patella center. And the distance from bilateral anterior superior iliac spine to medial malleolus tip as well as the difference between lower limbs were recorded to determine the recovery of length after surgery. Meanwhile, the varus-valgus and anteroposterior angulations after reduction were measured by AP and lateral X-ray.

RESULTSThe reduction duration was 12.7 min (range: 7 to 31 min); X-ray fluoroscopy time, 1.3 min (range: 0.4 to 3.0 min); length difference between both lower limbs (6.5 ± 1.1) mm; and axial alignment difference (7.0 ± 1.8) mm. The X-ray result showed that varus-valgus angle was (2.75 ± 0.16)°; and anteroposterior angulation (5.13 ± 0.51)°.

CONCLUSIONThe traction reductor for lower limb fracture could achieve satisfying fracture reduction in the minimally invasive surgery of distal femur, tibia metaphysic and tibial shaft fracture.

Adolescent ; Adult ; Equipment Design ; Female ; Fractures, Bone ; surgery ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Traction ; instrumentation ; Young Adult

BACKGROUNDComputer-assisted procedures have recently been introduced for navigated femoral neck screw placement. Currently there is little information available regarding accuracy and efficiency of the different navigated procedures. The aim of this study was to compare two fluoroscopic navigation tracking technologies, a novel bi-planar robot navigation and standardized optoelectronic navigation, versus standard freehand fluoroscopic insertion in a Synbone hip model.

METHODSEighteen fixed Synbone hip models were divided into 3 groups. C-arm navigated cannulated screws (AO-ASIF, diameter 7.3 mm) were inserted using freehand targeting (control group). A novel bi-planar robot system (TINAV, GD2000) and an optoelectronic system (Stryker OTS Navigation System) were used for the navigated procedures (robot group and optoelectronic group). Accuracy was measured using radiographic evaluation including the measurement of screw parallelism and decentralization, and joint penetration. To evaluate the efficiency, the number of guidewire passes, operative time and fluoroscopic images taken were noted.

RESULTSThe two computer-assisted systems provided significantly improved accuracy compared to the freehand technique. Each of the parameters, including guidewire passes and number of fluoroscopy images, was significantly lower when using the computer-assisted systems than for freehand-unguided insertion (P <0.05), but operative time was significantly shorter when using freehand-unguided insertion than for the computer-assisted systems (P <0.05). Accuracy, operative time and number of fluoroscopy images taken were similar among the two navigated groups (P >0.05), but guidewire passes in the robot group were significantly less than in the optoelectronic group (P <0.05).

CONCLUSIONSBoth bi-planar robot navigation and optoelectronic navigation were similarly accurate and have the potential to improve accuracy and reduce radiation for freehand fluoroscopic targeting for insertion of cannulated screws in femoral neck fractures. Guidewire passes in the robot group were significantly less than in the optoelectronic group. However, both navigated procedures were associated with time-consuming registration and high rates of failed matching procedures.

Bone Screws ; Femoral Neck Fractures ; surgery ; Hip ; diagnostic imaging ; surgery ; Humans ; Radiography ; Surgery, Computer-Assisted ; methods