AIM:To evaluate the effectiveness of EYESI binocular indirect ophthalmoscope simulation system as a training platform for fundus examination skills of general practitioner.METHODS:Prospective randomized study. A total of 40 general practitioners who received clinical ophthalmology training at Shenzhen Eye Hospital from January 2021 to December 2024 were selected and randomly divided into two groups by random number table method, with 20 cases in the study group and 20 cases in the control group. The study group was trained by EYESI binocular indirect ophthalmoscope simulation system and the control group was trained by conventional teaching. Training effects of the two groups were analyzed.RESULTS: The general information of the two groups was comparable. Through training with the EYESI binocular indirect ophthalmoscope simulator, the study group showed significant improvements in total examination and drawing scores compared to pre-training results(all P<0.001). Additionally, examination duration, retinal light exposure time, and drawing time were all significantly shorter than those before training(all P<0.001).The study group achieved significantly higher total examination and drawing scores than the control group during the EYESI binocular indirect ophthalmoscope simulator assessment(all P<0.001). Furthermore, examination duration, retinal light exposure time, and drawing time were all significantly shorter in the study group compared to the control group(all P<0.001). Moreover, ratings for the novelty of the training method and overall satisfaction with the training were significantly higher in the study group than in the control group(all P<0.001); while the perceived psychological stress during training was significantly lower in the study group(P<0.001).CONCLUSION:The EYESI binocular indirect ophthalmoscope simulaton system effectively enhances both the proficiency in fundus examination skills and overall training satisfaction among general practitioners.

Hashimoto thyroiditis (HT) is the most common autoimmune disease of the thyroid. The thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) always increase greatly in the patients. Thyroid cancer is the most common malignant tumor in the endocrine system. And papillary thyroid carcinoma (PTC) is the most common pathological type of it. Recently, the coexistence of HT and PTC has shown an increased incidence. And these two diseases have many similarity in immunology, endocrine, genetics, implying the links between them. However the underlying mechinisms remain unclear. On the ground of the characteristics of epidemiology and histopathology, this article reviews and summarizes possible mechanism in many ways for the coexistence of these two disease, including precancerous lesion, cell proliferation and apoptosis disorder, immunology, endocrinology, genetics, etc.

Objective: To evaluate the clinical effects of the implantation of porous tantalum rod under three-dimensional (3D) C-arm positioning in the treatment of ARCO I and II non-traumatic femoral head necrosis. Methods: Fifty patients (58 hips, 39 males and 11 females, mean age 33.52 years) with non-traumatic femoral head in ARCO I-II were included from January 2009 to December 2011. All patients received implantation of porous tantalum rod. The 3D C-arm X-ray positioning was used in 24 patients (29 hips), while traditional C-arm X-ray positioning was performed in the other patients. The visual analogue scale (VAS), Harris score and superior rate were evaluated at 0.5, 1, 2, and 4 years after the surgery. Total hip arthroplasty was regarded as the end event for survival rate. Results: In the 3D C-arm X-ray positioning group, the VAS score decreased from 7.17±1.00 points preoperatively to 2.38±0.86 points at half year, to 2.10±1.40 points at 1 year, to 2.38±1.66 points at 2 years, and to 2.21±1.47 points at 4 years postoperatively (F=98.78, P=0.00). Meanwhile, the Harris score increased significantly from 73.97±3.49 points preoperatively to 89.90±1.93, 89.93±3.26, 89.21±5.83, 88.57±5.70 points at the follow up, respectively (F=84.35, P=0.00). According to the analysis of the pre-operative and post-operative image data, there was no significant difference in progress in the ARCO staging at 23 hips duration the follow-up. Four hips were developed to ARCO III and two hips to ARCO II. Thus, the success rate of operation was 79% (23/29). There were two hips underwent total hip arthroplasty, so the survival rate of femoral head was 93% (27/29). The trend of VAS score and Harris score in the C-arm X-ray positioning group was in accordance with the 3D C-arm X-ray positioning group but without statistically significant difference (P>0.05). The operation duration 31.38±3.96 min, blood loss 36.72±5.59 ml, the ratio of distance of metal rod to bone cortex in femoral neck 0.48±0.10, and the distance of mental rod to center of necrosis 0.18±0.07 cm in 3D C-arm X-ray positioning group was superior to C-arm X-ray positioning group (respectively 41.97±4.64 min, 41.49±4.46 ml, 0.46±0.06, 0.23±0.10 cm, P<0.05). Conclusion The implantation of tantalum rod in treating ARCO I-II non-traumatic femoral head necrosis can increase the function of hip joint, relieve the symptoms of necrosis of femoral head, alleviate the progress of femoral head necrosis in X-ray, and obtain a higher survival rate. The 3D C-arm positioning in surgical operation could improve the accuracy and safety of surgery.

Objective To evaluate the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing heterotopic ossification after hip arthroscopy.Methods Literature search was conducted in PubMed,Embase,Cochrane Library,CNKI and Wanfang data with time range from January 1973 to November 2017.Clinical case control articles on NSAIDs in preventing heterotopic ossification after hip arthroscopy were screened based on the inclusion and exclusion criteria.Meta analysis was done using RevMan 5.3 software to investigate the incidence of complications such as heterotopic ossification and gastrointestinal bleeding after hip arthroscopy in patients taking NSAIDs orally.Results Six articles were included in the study,with a total of 754 cases and 536 controls.NSAIDs reduced the incidence of heterotopic ossification after hip arthroscopy (RR =0.09,95％ CI 0.03-0.27,P ＜ 0.05).Selective COX-2 inhibitor celecoxib (RR =0.17,95％ CI 0.03-0.91,P ＜ 0.05) and PG synthase inhibitor of naproxen (RR =0.17,95％ CI 0.09-0.32,P ＜ 0.05) were also effective in preventing heterotopic ossification.There was no significant difference in the incidence of gastrointestinal complications between the cases and controls after NSAIDs prophylaxis (RR =2.17,95％ CI 0.92-5.12,P ＞ 0.05).Conclusion NSAIDs can effectively reduce the incidence of heterotopic ossification after hip arthroscopy and does not increase the incidence of postoperative gastrointestinal complications.Therefore,it is effective and safe to use NSAIDs to prevent the occurrence of heterotopic ossification after hip arthroscopy.

Objective To evaluate the clinical effects of the Masquelet technique combined with antibiotic calcium sulfate pellets in treating infected bone defects.Methods From February 2014 to February 2016,9 patients with infected bone defects were treated in our department,including 7 males and 2 females,with an average age of 37.0 years (range,24-56 years).6 cases were infected because of open fractures,3 infected after internal fixation operation.All defects were located in the lower limb diaphysis and metaphysis (3 cases in femur,6 cases in tibia).The length of the bone defects were 4-12 cm after debridement,all defects filled with PMMA loaded with Vancomycin,and fixed with exterual fixators.After 6-10 weeks,the bone cement spacers were taken out and the antibiotic calcium sulfate pellets were implanted into the membrane.A certain amount of autogenous cancellous bone granules would be mixed into the calcium sulfate pellets if the defect was larger than 6-8 cm.5 cases remained fixed with external fixators,3 cases replaced for plates,1 case replaced for plaster external fixator.Regular X-ray follow-ups were taken and complications recorded as well.Evaluate the healing of bone defect and functional recovery of adjacent joints by Samantha X score system,visual analogue scale (VAS) and Paley method,respectively.Results The 9 cases were followed up for a mean duration of 9.3 months (range,6-15 months).All bone defects healed after a mean time of 14 weeks (range,10-24 weeks).The wound poor healing occurred in only 1 case in the first stage of surgery,and cured by dressing changes.No complications of the recurrence of infection and implant failure.At the last follow-up,the average Samantha X score was 4.9,the VAS score was 0 to 3 (average 1.5) for patients standing on crutches and all the bone defect healing graded excellent evaluated by Paley method,the functional recovery of the adjacent joints graded:excellent in 6 cases,good in 2 cases,and fair in 1 case (the excellent and good rate was 89％).Conclusion Masquelet technique combined with antibiotic calcium sulfate particles is effective in the treatment of infected bone defects.

Objective To compare the effect and safety between cemented and uncemented long-stem hip arthroplasty for treatment of unstable intertrochanteric fracture in the elderly.Methods A retrospective review was made on 70 cases (70-87 years old) undergone artificial long-stem hip arthroplasty of unstable intertrochanteric fracture between June 2012 and June 2014.According to the material of prostheses,the cases were assigned to cemented group (n =36) and uncemented group (n =34).Operation-related index,postoperative complications,ambulation time,Harris hip score and prosthesis stability and excellent results were compared between the two groups.Results There were no significant differences in operation time,bleeding volume and ambulation time between the two groups (P ＞ 0.05).Postoperative drainage volume and blood transfusion volume in cemented group [(277.4 ± 22.0) ml and (245.1 ± 17.8) ml] were lower than these in uncemented group[(294.2 ± 33.7) ml and (262.8 ± 30.9)ml] (P ＜0.05).Harris scores in cemented group were higher than these in uncemented group 1 and 3 months after operation(P ＜0.05),and there were no significant differences 6 and 12 months after operation(P ＞ 0.05).Complication rate had no significant difference between the two groups (P ＞ 0.05).Two cases were died of cement poisoning,one case of subsequent acute myocardial infarction,and two cases of subsequent acute cerebral infarction.Sixty-five cases were followed up for 12-36 months,which showed no complications such as prosthesis loosening,displacement or infection.Prosthesis stability and treatment excellent rate between the two groups were not significantly different (P ＞ 0.05).Conclusions Clinical efficacy of the two treatments is comparable,including good function recovery and early off-bed activity.Cemented long-stem hip arthroplasty reduces blood requirements,but the risk of cement poisoning exists.

Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture.Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study.The patients aged 67.2 years (range, 41-80 years) composed 6 males and 11 females.There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture.The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients.Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation.Harris score was used for evaluation of the results of hip arthroplasty.Preoperative Harris score was (32.6 ± 6.8)points.Results All the patients were followed up for 6 to 48 months.One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery.One patient had secondary subsidence of the femoral stem without pain and limitation of motion.One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation.Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening.Harris hip score signficantly improved to (79.2 ± 15.9) points at the final follow-up (P ＜ 0.01).Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture.The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability,and avoids the complications of bone cement use.

BACKGROUND:The bone morphogenetic protein 2 (BMP2)/vascular endothelial growth factor (VEGF) dual gene activated nanobone putty has been constructed in the previous experiments.
OBJECTIVE:To investigate the effects of osteogenesis and osteogenic gene expression in mice by implanting BMP2/VEGF dual gene activated nanobone putty.
METHODS:Twenty-four Kunming mice (48 sides) were randomly divided into four groups. Animals in each group (12 samples) were injected different materials into the right thigh muscle pouches:nanobone putty+hBMP2/VEGF plasmid;nanobone putty+hBMP2 plasmid;blank plasmid+nanobone putty;nanobone putty only. The effects of osteogenesis were evaluated by radiography, histology and molecular biology analysis in 2, 4 weeks after operation.
RESULTS AND CONCLUSION:Bone-like tissues were observed in groups of nanobone putty+hBMP2/VEGF plasmid and nanobone putty+hBMP2 plasmid after operation. There was apparent BMP2 and VEGF mRNA expression in group of nanobone putty+hBMP2/VEGF plasmid. Group of nanobone putty+hBMP2/VEGF plasmid was significantly better than group of nanobone putty+hBMP2 plasmid in the alkaline phosphatase levels, the speed of osteogenesisas and amount of new bone (P<0.05). Groups of blank plasmid+nanobone putty and nanobone putty had no obvious osteogenesis performance. Either BMP2/VEGF dual gene activated nanobone putty or BMP2 gene activated nanobone putty had the osteogenic ability in vivo. And the former was significantly enhanced in the speed and quality of osteogenesis.

OBJECTIVETo assess efficacy of membrane peeling combined with intravitreal injection of bevacizumab in the treatment of macular epiretinal membrane.

METHODSFrom January, 2012 to June, 2013, 33 patients (33 eyes) with the diagnosis of macular epiretinal membrane underwent vitreous surgery and membrane peeling. The patients were randomly divided into intravitreal bevacizumab group (IVB group) and non-intravitreal bevacizumab group (non-IVB group). All the patients underwent standard three-port vitrectomy and peeling of epiretinal membrane, with intravitreal injection of 1.5 mg bevacizumab at the end of operation in IVB group. The best corrected visual acuity and optical coherence tomography (OCT) were examined before and after the treatment. The patients were followed up for 3-14 months (mean 6.5 months).

RESULTSMacular epiretinal membranes were successfully peeled during operation in all the patients without postoperative intraocular infection or bleeding. Fifteen eyes received vitrectomy combined with intravitreal injection of bevacizumab, and 18 underwent only vitreous operation and membrane peeling. At the end of the follow up, the visual acuity improved in 11 eyes (73.3%) in IVB group, as compared to 13 eyes (72.2%) in the non-IVB group (P=0.627). Central macular thickness decreased by 143∓62 µm in IVB group and by 96∓28 µm in non-IVB group, showing a significant difference between the two groups (t=5.564, P<0.01).

CONCLUSIONVitrectomy and membrane peeling combined with intravitreal injection of bevacizumab can promote the recovery of macular morphology but not visual function, and its clinical use still needs to be tested in a long-term and large-sample randomized controlled study.

Angiogenesis Inhibitors ; administration & dosage ; therapeutic use ; Antibodies, Monoclonal, Humanized ; administration & dosage ; therapeutic use ; Bevacizumab ; Epiretinal Membrane ; drug therapy ; pathology ; Humans ; Intravitreal Injections ; Postoperative Complications ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity ; Vitrectomy ; Vitreous Body ; surgery

Objective: To study retrospectively 20 hip revison patients treated by cementless total hip arthroplasty with structural allograft.
Methods: Twenty patients suffering from aseptic loosening of an uncemented cup complicated by a large defect underwent cementless total hip arthroplasty with structural allograft and were followed up for at least 5 years. Clinical results were evaluated by Harris score and leg length measurements. Radiographic analysis included implants migration, graft absorbance, osteolysis and liner wear.
Results: No cup loosening or graft reabsorption was found at final follow-up. Clinical improvements in pain and functional status were demonstrated during the follow-up period. The mean Harris hip scores improved from 29 preoperatively (range 20-41) to 81 postoperatively (range 73-89).
Conclusion: Our study shows that cementless total hip arthroplasty with allograft is a good way for massive defect in acetabular bone stock.