Purpose To measure and compare the difference of multifocal electroretinogram in normal subjects and patients with age related macular degeneration. Methods Seventeen cases(20 eyes)of normal subjects,7 cases(10 eyes)of dry form AMD(age related macular degeneration),8 cases(8 eyes)of wet form AMD and 11 cases(11 eyes)of idiopathic macular hole(IMH)were tested with VERIS Sciences TM 4.0 made by EDI company of America.The latencies and average response densities of 6 ring retinal regions in normal subjects were compared with those in various types of age related maculopathies. Results The N 1 and P 1 wave latencies of all 6 rings in wet form AMD and the N 1 wave latencies of 3～6 rings in dry form AMD were delayed statistically.The N 1 and P 1 wave average response densities of 1～4 rings in and the P 1 wave average response densities of 1～6 rings wet form AMD and the N 1 wave average response densities of 1～5 and the P 1 wave average response densties of 1～6 rings in dry form AMD were decreased statistically.The N 1 and P 1 wave average response densities of 1～2 and the P 1wave average response densities of 1～3 rings were decrease statistically in IMH. Conclusion Multifocal electroretinogram can be used to quantitate the visual function of the affected location in age related macular degeneration.

Purpose To observe the features of multi-focal electroretinogram (mERG) in Stargardt′s disease, and evaluate the validity of mERG on diagnosis of this disease. Methods mERG had been recorded in 7 cases (14 eyes) of Stargardt′s disease with VERIS 4.0,and the findings were compared with normal individuals. Results The mERG were remarkably abnormal in all cases of the disease, as the amplitudes of N 1 and P 1 waves were seriously decreased and the latencies were prolonged in all the 6 regions ( P

Objective To measure and compare the difference between the normal control and retinoschisis with multifocal electroretinography. Methods Nineteen cases (21 eyes) of normal control and 8 cases (15 eyes) of inherited retinoschisis were measured with VERIS Science TM 4.0. Three cases (6 eyes) of inherited retinoschisis were tested with Ganzfeld ERG. Results There was statistically significant difference of average response density and latencies in all 6 ring retinal regions between the normal control and retinoschisis. The topography of multifocal ERG showed that multifocal amplitude decreased with disappearing or decreasing of central peak amplitude in patients with retinoschisis. The P 1/N 1 ratio of the multifocal ERG average response densities in 6 ring retinal regions was different from the b/a ratio of the Ganzfeld ERG. Conclusion Each of the multifocal ERG and Ganzfeld ERG has its advantage in the diagnosis of the retinoschisis.

Objective: To evaluate the effectiveness of open reduction and internal fixation (ORIF) in treatment of acute and delayed occult Lisfranc injuries. Methods: A retrospective review of 26 patients with occult Lisfranc injuries who were treated with ORIF between July 2010 and July 2015 was applied. Fourteen patients were treated within 6 weeks after injury (acute group) and 12 patients were treated after 6 weeks of injury (delayed group). There was no significant difference between the two groups in gender, age, affected sides, and preoperative visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, and physical and mental scores of Study Short Form 12 Health Survey (SF-12) ( P<0.05). The joint reduction, internal fixator, and traumatic osteoarthritis were observed by X-ray films. The pain degree, midfoot function, and quality of life were evaluated with VAS score, AOFAS score, and physical and mental scores of SF-12. Results: All incisions healed by first intention with no complications. All patients were followed up with the mean follow-up time of 15 months (range, 12-24 months) in acute group and 15 months (range, 12-23 months) in delayed group. At last follow-up, the VAS score, AOFAS score, and physical and mental scores of SF-12 were superior to those before operation in the two groups ( P<0.05). And there was no significant difference in all indicators between the two groups ( P>0.05). The satisfaction rates were 100% and 83.3% (10/12) in acute group and delayed group, respectively. The internal fixators were removed in 20 patients (11 cases in acute group and 9 cases in delayed group) at 9-24 months after operation (mean, 14.5 months). The results of X-ray films showed no traumatic osteoarthritis, midfoot collapse, internal fixation failure, or reduction loss during follow-up period. Conclusion: ORIF is an ideal method for both acute and delayed occult Lisfranc injuries and can obtain the similar effectiveness.

Objective To investigate the influence of experimental scotoma on multifocal visual evoked potential (mf-VEP). Methods The mf-VEP of 10 healthy individuals (20 eyes) was measured with VERIS Science 4.0. Every eye was measured for 3 times. The right eye was measured with full field stimulation and upper hemi-field or lower hemi-field masked. The left eye was measured with full field stimulation and central three-rings area or lower nasal field masked. The first slice responses of the second order in different field were analyzed and compared by VERIS software. Results The mf-VEP in masked area was undetectable or obviously decreased in all subjects. In most unmasked field, the amplitudes of mf-VEP were not changed, except that in some place decreased slightly with statistically significant difference in comparison to the full field stimulation mode. Conclusion mf-VEP is influenced with experimental scotoma. The mf-VEP changes are consistent with the visual field masked.

OBJECTIVETo study the effect of radiotherapy of nasopharyngeal carcinoma on visual evoked potential (VEP).

METHODSVEP of 63 patients with nasopharyngeal carcinoma were tested before, at the end of, half a year, one year, 2 years and 3 years after their radiotherapy.

RESULTSWithin the male group, one year after radiotherapy, the latency of VEP was significantly delayed than that before and at the end of radiotherapy, while the amplitude was decreased significantly. Two years after radiotherapy, the latency of VEP was significantly delayed more than that before radiotherapy. However there was no significant difference among VEP at the end of, half a year and 3 years after radiotherapy. Within the female group, 2 years after radiotherapy, the latency of VEP was significantly delayed than that before radiotherapy. Three years after radiotherapy, the latency of VEP was significantly delayed than that before, at the end of, half a year and one year after radiotherapy. There was no significant difference in VEP amplitudes before and after radiotherapy.

CONCLUSIONWithin the male group, the abnormal delay of VEP latency mostly happens one or two years after radiotherapy. Within the female group, the significant delay of VEP latency happens at the end of radiotherapy and lasts for 3 years, while the VEP amplitude does not change significantly during the 3 years after radiotherapy. The result indicates that the sustained radiation damage within the female visual nerve system starts at the end of radiotherapy, but to a lesser degree. It was shown that radiotherapy of nasopharyngeal carcinoma certainly damages the visual nerve system, though there is sex difference in the impairment.

Adult ; Evoked Potentials, Visual ; radiation effects ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Sex Factors ; Time Factors

Objective To evaluate open reduction and internal fixation (ORIF) combined with Ilizarov joint distraction in the treatment of comminuted talar body fractures.Methods Between July 2010 and May 2016,16 patients with comminuted talar body fracture underwent ORIF followed by ankle joint distraction by Ilizarov external fixator at our department.They were 9 males and 7 females,aged from 17 to 56 years (average,35.6 years).Radiological assessments were conducted by plain radiographs and computed tomography (CT) scans pre-and post-operatively.Clinical outcomes were evaluated according to visual analogue scale (VAS),American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score,the short form (SF)-36 health survey scores and patients' satisfaction.Results Two patients were lost to follow-up.The remaining 14 patients were followed up for an average duration of 33.3 months (from 13 to 52 months).All the fractures united.Superficial wound infection occurred in one case.Eight patients developed post-traumatic osteoarthris;4 patients presented with avascular necrosis.At final follow-ups,the AOFAS scores ranged from 30 to 97 points (mean,69.8 points),the VAS scores from 0 to 6 points (mean,2.5 points),the physical component summary in SF-36 from 18.0 to 55 points (mean,41.7 points),and the mental component summary from 40 to 70 points (mean,54.1 points).Two patients reported strong satisfaction,5 satisfaction,4 moderate satisfaction,and 3 dissatisfaction.Conclusion For comminuted talar body fractures,ORIF combined with Ilizarov joint distraction is a new and effective treatment which can not only provide adequate fixation strength but also reduce the incidence of post-traumatic osteoarthris or avascular necrosis.

Objective To analyze the clinical outcomes of a standard protocol of open reduction and internal fixation using a variable angle foot plate for a consecutive series of patients with acute Lisfranc joint injury.Methods This study retrospectively evaluated the clinical outcomes of 11 Chinese patients(13 feet) with acute Lisfranc joint injury who had been treated by open reduction and internal fixation with a variable angle foot plate from December 2016 to June 2017 at Department of Orthopaedics,West China Hospital.They were 8 men(10 feet) and 3 women(3 feet),aged from 19 to 57 years(average,36.4 years).Of them,10 were complicated with fracture of metatarsus,6 with cuneiform fracture and/or dislocation,4 with cuboid fracture,and one with cuboid fracture.According to the Myerson classification for Lisfranc fracture-dislocations,one case(one foot) belonged to type A,2(2 feet) to type Bl,5(6 feet) to type B2,2(3 feet) to type Cl and one(one foot) to type C2.The outcomes were evaluated using the visual analogue scale(VAS) and the midfoot scores of American Orthopedic Foot and Ankle Society(AOFAS).Results This cohort was followed up for 18 to 24 months(average,22 months).Their VAS scores were decreased significantly from preoperative 7.3±1.2(from 6 to 9) to postoperative 1.2±0.2(from 0 to 2)(P<0.05);their AOFAS midfoot scores were increased significantly from preoperative 0 to postoperative 84.6±4.6(P<0.05) Anatomic reduction was obtained in all the patients and all the fractures united successfully without any delayed union or nonunion.Superficial necrosis of the wound edge occurred in 2 cases without deep infection;skin anesthesia occurred in 2 and skin hypesthesia in 4,indicating a lesion of the superficial peroneal nerve.Conclusion Fixation of acute Lisfranc joint injury with a variable angle foot plate can lead to rigid stability,precise reduction and satisfactory short-term clinical outcomes.

Objective:To identify the essential quality, expected quality and charm quality of outpatient doctors based on Kano model.Methods:The Kano model quality attribute questionnaire for outpatient doctors was designed from 4 dimensions and 18 indicators of service, quality, safety and cost. 220 outpatients were investigated in a tertiary hospital. The reliability and validity of 212 valid questionnaires were tested and the questionnaire data were analyzed.Results:Both the Cronbach α coefficient and the KMO value were higher than 0.7, which indicated that the reliability and validity were good. Nine of the 18 survey indicators were essential quality, focusing on the quality dimension and service dimension; 4 items were expected quality; 4 items were charm quality, focusing on disease cognition, prevention and drug safety; 1 item was indifferent quality.Conclusions:The essential quality of outpatient doctors is to provide basic and standardized medical services to patients. Studying the quality attribute can provide behavior guidance for outpatient doctors, improve patient satisfaction and quality of outpatient medical services.

Objective:To investigate the clinical efficacy of transfer of a free segment of the proximal second toe interphalangeal joint composite tissue flap in reconstruction of defects of interphalangeal joint of fingers, and simultaneously reconstruct the donor site defect left with the second toe by a transfer of a pedicled bone flap of the fibular proximal great toe.Methods:From December 2020 to April 2023, a total of 9 patients with interphalangeal joint defects of fingers were treated in the Department of Hand Microsurgery of Shunde Heping Surgery Hospital. The patients were 7 males and 2 females, aged 18-55 years old, with an average age of 31 years old. Firstly, transfers of a free segment of the proximal second toe interphalangeal joint composite tissue flap were performed to reconstruct the defects of finger joints. Simultaneously in the surgery, transfers of the fibular pedicled bone flap of the proximal great toe were conducted to reconstruct the donor site defects left in the second toe. Patients were instructed with appropriate postoperative functional exercises. K-wires were removed at 8-12 weeks after surgery. Outpatient visits, telephone and WeChat follow-ups were conducted to evaluate the appearance and functional recovery of the reconstructed interphalangeal joints and donor feet. Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, Vancouver Scar Scale (VSS) and American Orthopedic Foot and Ankle Society (AOFAS) foot function scoring standards were employed in the evaluation.Results:Postoperative follow-up lasted for 6 to 30 months. All of the 9 interphalangeal joint composite tissue flaps in the fingers survived with complete and good appearance. Function of the reconstructed interphalangeal joints of the fingers recovered well. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the average score achieved 12 points, with 6 patients of excellent, 2 of good and 1 of fair. After surgery, the appearance and function of the donor great toes and second toes all recovered well. The average score of the scars in donor second toe evaluated by VSS was 4 points. All the donor feet were kept with 5 toes, with full, intact and good in appearance. According to the AOFAS foot function scoring standard, the average score achieved 95 points, and were excellent.Conclusion:Application of transfer of free proximal segment of interphalangeal joint composite tissue flap of the second toe in reconstruction of the interphalangeal joint defect of a finger, and simultaneously reconstruct the defect left with the donor second toe with a fibular proximal great toe flap pedicled with bone tissue can achieve good clinical efficacy in reconstruction of the defects of interphalangeal joint of fingers, restore the function of the interphalangeal joint of fingers and the appearance and function of the donor foot.