Cataract surgery is one of the most common ophthalmologic procedures. Advances in technology and medical policies have made it more precise. Residual refractive errors and deviation of target diopters are a main cause of dissatisfaction among patients. Refractive enhancement after cataract surgery can correct or eliminate these errors, improving patients' visual quality of life. There are multiple options for correcting residual refractive errors. The best approach depends on factors like the cause of the error, degrees of residual refractive errors, type of intraocular lens, ocular comorbidities, and patient preference. This paper summarizes the incidence and types of residual refractive errors, advancements in refractive enhancement surgeries, and provides practical solutions for clinical practice.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Objective:To compare the clinical efficacy of rotator cuff repair combined with transposition of the long head of the biceps tendon in the treatment of massive rotator cuff tears with or without subscapularis injury.Methods:A total of 73 patients with massive rotator cuff tears who underwent arthroscopic rotator cuff repair combined with transposition of the long head of the biceps tendon in the Department of Upper Arm, Sichuan Orthopaedic Hospital from January 2019 to September 2022 were retrospectively analyzed, including 35 males and 38 females, aged 58.8±7.6 years (range, 46-73 years). There were 11 cases on the left side and 62 cases on the right side. Causes of injuries: 6 cases of car accidents, 13 cases of fall injuries, 54 cases of no obvious cause of injury. The patients were divided into subscapularis injury group (37 cases) and no subscapularis injury group (36 cases) according to the subscapularis injury or not. The visual analogue scale (VAS), Constant - Murley score, University of California Los Angeles (UCLA) shoulder score and range of motion were used to evaluate shoulder pain and functional improvement. MRI of the shoulder was taken at the final follow-up and the rotator cuff was assessed for retear using Sugaya grading.Results:All patients successfully completed the operation. The VAS score at 1 year postoperatively in the group without subscapularis injury was 0.58±0.87, which was less than 1.16±1.14 in the group with subscapularis injury ( t=-2.426, P=0.018). The Constant-Murley score and UCLA score at 1 year postoperatively in the group without subscapularis injury were 94.03±6.19 and 32.94±2.59, respectively, which were greater than those of the group with subscapularis injury, which were 86.51±11.96 and 30.38±3.33, and the difference was statistically significant ( P<0.05). Anterior flexion and body external rotation at 1 year postoperatively in the group without subscapularis injury were 137.22°±26.79° and 54.72°±13.20°, which were greater than those in the group with subscapularis injury of 121.08°±22.83° and 38.65°±17.19°, and the difference was statistically significant ( P<0.05), and the difference between the two groups in body internal rotation was not statistically significant ( P>0.05). The subacromial spacing at 1 year postoperatively was 9.4±1.3 mm in the group without subscapularis injury and 9.0±1.5 mm in the group with subscapularis injury, and the difference was not statistically significant ( t=1.318, P=0.192). There were 2 cases of rotator cuff retear 1 year after surgery without subscapular muscle injury and 5 cases of subscapular muscle injury. Conclusion:The clinical efficacy of arthroscopic rotator cuff repair combined with transposition of the tendon of the long head of the biceps tendon in the treatment of massive rotator cuff tears with or without subscapularis muscle injury is satisfactory, and the improvement of pain and function is more obvious in patients without subscapularis muscle injury.

Currently, cataract surgery has entered into the refractive cataract surgery era, and accurate control of the target refractive power and the rapid and effective improvement of patient's visual quality have become the common pursuit of cataract surgeons. Application of femtosecond laser-assisted cataract surgery, surgical navigation technology, active control fluidic phacoemulsification technology, special high-quality intraocular irrigation fluid, non-drop surgery mode, ocular surface repair and dry eye management, functional intraocular lens, and postoperative visual function training can further improve the patient's diagnosis and treatment experience, accelerate patient's recovery, improve postoperative visual quality, and enhance patient's satisfaction, thus promoting the development of refractive cataract surgery.

Objective:To investigate the common types of elbow joint injuries in skiing or snowboarding and their treatment.Methods:A retrospective study was conducted to analyze the data of 90 patients with elbow injury caused by skiing or snowboarding who had been admitted to Department of Upper Limbs, Sichuan Orthopaedic Hospital from February, 2015 to February, 2022. There were 53 males and 37 females with an age of (31.8±8.4) years. The types of elbow injury, visual analogue scale (VAS), range of motion (ROM) of the elbow and Mayo elbow performance score (MEPS) of the patients were recorded before treatment and at the last follow-up.Results:Of the patients, 18 were treated conservatively (3 simple Mason type I radial head fractures and 15 O'Driscoll type I coronal process fractures) and 72 surgically. Their follow-up time was (31.3±18.7) months. The fractures all healed by the time of the last follow-up. Simple elbow fracture was observed in 63 patients, simple elbow dislocation in 2 patients, fracture plus dislocation in 25 patients. The posterior dislocation was the most common (22 cases). Among the elbow fractures, radial head fracture occurred in 27 patients, ulnar coronoid process fracture in 41 patients, proximal ulnar fracture in 13 patients, and distal humeral fracture in 28 patients. Collateral ligament injuries were complicated in 65 cases. In the patients undergoing conservative treatment, their VAS, elbow ROM, and MEPS were all improved significantly from 4.7±1.4, 92.2°±14.4° and 63.9±6.5 before treatment to 0.4 (0,1.0), 110.6°±0.6°, and 92.2±3.9 at the last follow-up ( P<0.05); in the patients undergoing surgical treatment, their VAS, elbow ROM, and MEPS were also all improved significantly from 5.6±1.7, 24.3°±18.4°, and 26.9±12.2 before surgery to 0.6 (0,1.0), 97.4°±14.0° and 86.6±7.1 at the last follow-up ( P<0.05). After surgery, 8 patients presented with neurological symptoms and 7 patients developed heterotopic ossification. Conclusions:In skiing or snowboarding, the coronoid process of the ulna is the most vulnerable to fracture. In the elbow injuries due to skiing or snowboarding, posterior dislocation is the most common type which is often accompanied by injuries to the medial and lateral collateral ligaments. For simple Mason type Ⅰ radial head fractures and O'-Driscoll type Ⅰ coronoid process fractures in which the elbow is stable, conservative treatment can be adopted; surgical treatment is indicated for the other injuries.

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

OBJECTIVE: To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations. METHODS: Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index. RESULTS: Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R ²=0.084. CONCLUSION Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.
Female ; Male ; Humans ; Adult ; Shoulder Joint/diagnostic imaging* ; Shoulder Dislocation/diagnostic imaging* ; Joint Dislocations ; Scapula/diagnostic imaging* ; Thorax

Objective:To evaluate the short-term effects of arthroscopic biceps rerouting along with rotator cuff repair in treating large to massive rotator cuff tears.Methods:Retrospective evaluation of patients with large to massive rotator cuff tears who were treated with arthroscopic biceps rerouting along with rotator cuff repair was conducted from May 2017 to September 2020. There were 48 patients with average age 58.7±18.4 years (range from 45-72 years), of which 19 cases were males and 29 cases were females. The following outcomes, range of motion, functional outcomes, pain and radiological outcomes, were assessed perioperatively. Pain symptom was assessed according to visual analogue scale (VAS). The functional outcomes were assessed according to American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score. MRI was used to evaluate radiological outcomes preoperatively and at 3, 6, 12 months postoperatively.Results:All forty-eight patients were followed-up. The mean duration of follow-up was 24.2±33.5 months (range from 13-53 months) after surgery. The average VAS of the patients decreased from 6.4±1.8 before surgery to 4.6±2.2 at 6 months after surgery, to 1.9±2.1 at 12 month after surgery, and to 1.7±2.0 at the last follow-up with significant difference ( F=4.47, P<0.001) . ASES score decreased from 56.4±20.9 before surgery to 48.3±29.1 at 6 months after surgery, and increased to 77.2±18.2 at one year after surgery, and to 82.3±13.8 at the last follow-up with statistically significant difference ( F=36.34, P<0.001). The Constant-Murley decreased from 52.7±17.5 before surgery to 49.4±27.5 at 6 months after surgery, and increased to 80.1±20.1 at one year after surgery and to 87.4±11.9 at the last follow-up, respectively. The difference between the preoperative and the last follow-up was statistically significant ( F=52.68, P<0.001). The forward flexion increased from 102°±24° preoperatively to 121°±33° at 6 months, to 140°±17° at 12 months, and to 148°±15° at the last follow-up ( F=34.24, P<0.001). External rotation decreased from 57°±32° before surgery to 45°±37° at 6 months, and increased to 70°±31° at 12 months after surgery and to 75°±30° at the last follow-up with significant difference ( F=19.68, P=0.042). Internal rotation decreased from 8±3 before surgery to 7±4 at 6 months, and increased to 9±3 at 12 months after surgery and to 10±2 at the last follow-up with significant difference ( F=11.86, P=0.015). Six patients (12.5%) underwent retear of the repaired rotator cuff on the postoperative MRI, of which 4 cases were confirmed at 3 months after surgery and 2 cases at 6 months after surgery. Conclusion:Arthroscopic biceps rerouting along with rotator cuff repair for the treatment of large to massive rotator cuff injuries could significantly relieve pain symptoms and improve shoulder joint function without the help of scaffold. The present technique has lower retear rate.

Objective:To compare the clinical effects of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part proximal humeral fractures in the elderly.Methods:The clinical data of 58 elderly patients with three- or four-part proximal humeral fractures treated with hemiarthroplasty or reverse shoulder arthroplasty from June 2014 to June 2020 were retrospectively analyzed. Among them, 46 cases were from Sichuan Provincial Orthopaedic Hospital (22 cases of hemiarthroplasty and 24 cases of reverse shoulder arthroplasty), and 12 cases were from Tianjin Hospital (5 cases of hemiarthroplasty and 7 cases of reverse shoulder arthroplasty). In the hemiarthroplasty group, there were 27 patients, including 7 males and 20 females, with an average age of 70.29±6.81 years (range, 61-87 years), and there were 10 cases of 3-part fractures and 17 cases of 4-part fractures. In the reverse shoulder arthroplasty group, including 9 males and 22 females, with an average age of 75.06 ±4.25 years (range, 67-86 years), and there were 9 cases of 3-part fractures and 22 cases of 4-part fractures. The postoperative efficacy evaluation indexes included visual analogue scale (VAS), range of motion (ROM), prosthesis upward displacement, healing of greater tuberosity, scapular glenoid notch, American Shoulder and Elbow Surgeons (ASES) and Constant-Murley score.Results:The average follow-up was 50.63±16.02 months (range, 24-75 months) in the hemiarthroplasty group and 28.32±11.93 months (range, 14-56 months) in the reverse shoulder arthroplasty group. The anterior elevation in the reverse shoulder arthroplasty group was 118.22°±27.22°, and those in the hemiarthroplasty group was 102.77°±25.88°, which was significant difference ( t=2.21, P=0.032); the results of external rotation (ER) and internal rotation (IR) in two groups were similar, and no significant difference (ER: t=0.57, P=0.616; IR: χ 2=2.61, P=0.273); the average Constant-Murley and ASES in the reverse shoulder arthroplasty group were significantly better than those in the hemiarthroplasty group ( P=0.019 and 0.018); the complication rates of hemiarthroplasty group and reverse shoulder arthroplasty group were 37% (10/27) and 13% (4/31), respectively (χ 2=4.59, P=0.032). In the hemiarthroplasty group, 6 patients had upward movements of the prosthesis and 2 patients had wear of the glenoid side; notching (sirveaux grade 1) was noted in 1 patient in the reverse shoulder arthroplasty group. Conclusion:In the treatment of three- or four-part proximal humeral fractures in the elderly, reverse shoulder arthroplasty achieves significantly better functional results compared to hemiarthroplasty.

Objective:To investigate the relationship between fracture line morphology, bone quality and fracture type in the posterior medial humeral talus of proximal humerus fractures.Methods:Retrospective analysis of CT data of patients with proximal humeral fractures diagnosed in our hospital from June 2020 to June 2021. Based on 3D reconstruction, the fracture line of the posterior medial humeral calcar was described, substituted into the proximal humeral template to depict the fracture map;and the coordinates of the turning point of the posterior medial fracture line were recorded, and the most concentrated coordinate interval was displayed using Matlab heat mapscript, substituted into the proximal humeral template to mark the area of concentration of the turning point of the fracture line. And according to the inclination angle of the humeral head to establish internal and external rotation and normal group, three groups of humeral distance posterior medial bone density, bone thickness and fracture horizontal line angle were performed and recorded by unordered multicategorical Logistic regression analysis.Results:A total of 62 patients with proximal humeral fractures were included; 21 (34%) were internally turned, 24 (39%) were externally turned and 17 (27%) were normal. Inversion: bone density 0.59±0.12 g/cm 3, bone thickness 2.33±0.48 mm, fracture horizontal line angle 4.54°±14.13°. Normal: Bone density 0.57±0.15 g/cm 3, bone thickness 2.60±0.33 mm, fracture level angle -1.87°±9.98°. Ectropion: bone density 0.62±0.11 g/cm 3, bone thickness 2.69±0.54 mm, fracture horizontal angle -5.64°±20.03°. Epiphyseal extension occurs most often posteriorly and medially, with the fracture line turning point located posterior to the greater tuberosity. Unordered multicategorical Logistic regression of the data showed that: inversion fracture horizontal line angle ( β=0.06, P=0.018), statistically significant, OR=1.06 [95% CI (1.00, 1.12)]; bone thickness ( β=-2.02, P=0.041), statistically significant, OR=0.13 [95% CI (0.03, 0.71)]; bone density ( β=-0.43, P=0.887), not statistically significant; none of the ectropion patterns were statistically significant ( P>0.05). Conclusion:The trend of the fracture line and bone thickness of the posterior medial humeral calcar are factors that influence internal rotation of the humeral head. The incidence of internal rotation is positively correlated with the upward trend of the fracture line and negatively correlated with the thickness of the bone. The fracture line turning point is most often located posterior to the greater tuberosity.