Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective To study the optical imaging quality of multifocal intraocular lens (IOL) following Nd∶YAG laser damage.Methods Three hydrophobic acrylate discs used to make multifocal IOL were placed in line,and the Nd∶YAG laser was used to emit the posterior surface,mid-plane and anterior surface of the discs by gradually increasing the emitting energy to determine the damaged threshold energy of various planes.Eight multifocal IOLs were divided into 2 groups.IOL damage models were established by emitting 12 points along 12 clocks on circle of 3.0 mm in diameter in the group 1 (IOLs NO.1,2,3,4) and 6 points with 1-clock interval on circle of 1.0 mm in diameter in the group 2 (IOLs NO.5,6,7,8) with Nd∶YAG laser.The modulation transfer function (MTF),line spread function (LSF) and United States air force (USAF) test target images of the IOLs were tested under the optical aperture at 2.0,3.0 and 4.5 mm.Results The damage thresholds of laser power were not significantly different among three hydrophobic acrylate discs (Fgroup =1.100,P =0.337),and the thresholds were significantly different among different planes in the discs (Fposition =195.279,P=0.000),with the highest damage threshold in the anterior surface and the lowest damage threshold in the mid-plane of the discs(all at P＜0.01).The shifts of far focus and near focus MTF curves,LSF curves and USAF target images of the IOLs under the 2.0,3.0 and 4.5 mm optical aperture after laser damage were in coincidence with those before laser damage both in group 1 and group 2.The glare phenomenon of the USAF target image was observed at near focus under the 4.5 mm optical aperture both before and after laser damage.Conclusions Multifocal IOL is vulnerable to injury when the laser beam focuses on the midplane,and the anterior surface of IOL can tolerate certain degree of damage.In standard model eye,the MTF curves,LSF curves and USAF target images of multifocal IOL was not impacted by laser induced spots injuries under different pupil diameters.

As the main medicinal powder for drawing out pus and removing necrotic tissue in external therapies of traditional Chinese surgery, Sheng Powder has made great contributions to the treatment of inflammatory wounds and has the unique bactericidal and decay-discharging function that can not be replaced by antibiotics. However, Sheng Powder has toxicity because it contains mercury. So far, there is no clinical research on the standards of dose and usage of Sheng Powder and there is a lack of objective and quantitative criteria for operating standards and monitoring of toxicity and side effects. Therefore, the authors choose Jiuyi Powder, one of the most commonly used Sheng Powder, to evaluate the safety of its external use, and form a standardization program for clinical implementation.

ObjectiveTo investigate the prevalence of chronic kidney diseases (CKD) from inpatients with cerebrovascular diseases in Shanghai district. MethodsInpatients with cerebrovascular diseases from neurology department of five hospitals in Shanghai from Jun. 2007 to Feb. 2008 were recruited . All the patients were respectively diagnosed by brain CT, CTA, MRI, MRA and TCD. Laboratory data included urinary microalbumin-to-creatinine ratio (ACR), routine urinalysis, fasting plasma glucose, 2-hour-postprandial plasma glucose, Scr, uric acid, etc. All the serum creatinine samples were uniformly tested in central laboratory of Shanghai Ruijin Hospital.Glomendar filtration rate (GFR) was estimated by complicated MDRD equation and CKD stage was classified according to K/DOQI guidelines. ResultsA total of 1014 hospitalized patients with cerebrovascular diseases were enrolled during the observation period, with M/F ratio of 559/455 and mean age of (68.56±12.17) years. Cerebrovascular diseases included ischemic stroke (708 cases), hemorrhagic stroke (197 cases) and transient cerebral ischemie attack (TIA) (109 cases). Microalbuminuria (MAU) was detected in 11.2%, while 24.8% patients had proteinuria. The prevalence of CKD was 47.7%. The percentage of these inpatients in CKD stage 1 to 5 was approximately 6.90%, 14.69%, 21.60%, 2.56% and 1.97% respectively. The Logistic regression model showed that the risk factors of short-term (<30 days) prognosis were albuminuria, hyperglycemia (fast glucose) and anemia. ConclusionsThe prevalence of CKD in inpatients with cerebrovascular diseases was 47.7% in Shanghai. It is significant to evaluate CKD among patients with cerebrovascular diseases, especially to use the screening of ACR in the early stage.

Objective:To determine whether implantation of an intraocular lens(IOL) with a modified prolate anterior surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery.Methods: Consecutively 72 eyes were selected from 53 senile cataract patients who had received phacoemulsification and IOL implantation in Peking University Eye Center.Each was randomly assigned to receive Tecnis Z9001 IOL or Sensar AR40e(both made by AMO).Three months after operation,the eyes underwent several tests including visual acuity,optometry and wavefront aberration examination.Mesopic contrast sensitivity test was measured with ROLAND BA-4 Contrastometer.Results: The eyes treated with Tecnis Z9001 had significantly less spherical aberration.The eyes treated with Tecnis IOL got lower C12 coefficient and RMS4 than those with Sensar AR40e(P value

Objective: To observe the pathological changes of the lens and anterior lens capsule of the patients with familial congenital aniridia, and discuss the histopathological etiology of the fragility of the anterior capsule and the significance of surgical project. Methods: Anterior lens capsules and lens specimens were obtained from aniridic patients during cataract surgery. The intraoperative behavior of each capsule was noted, after which the specimens were submitted for histopathologic evaluation and electron microscope examination. Results: The anterior lens capsule was extremely fragile and remarkably thin. Degenerative changes(degeneration, necrosis, loss) of the lens epithelium and discontinuity of the lens epithelium were found in some specimens. Proliferation and double layer of the epithelial cells in some area of the specimens can be seen also. Ply structure of the anterior capsule became thin or disappeared. Conclusion: Degenerative or proliferative changes of the lens epithelial cells were associated with the thinness and extreme intraperative fragility of the anterior lens capsules in familial aniridia with cataract. Greater awareness of anterior capsule fragility in some aniridic patients with cataract may reduce the risk of capsule complications and lead to safer surgical outcomes.

Serum levels of leptin, insulin like growth factor (IGF)Ⅰ, IGF binding protein 1(IGFBP1), fasting insulin (FINS) were determined in 36 patients with polycystic ovary syndrome (PCOS) and 26 control subjects. The results showed that serum leptin, IGF Ⅰ, FINS in PCOS patients were significantly higher than those in control subjects, and serum IGFBP1 level was significantly lower than that in control subjects. Serum leptin was positively correlated with FINS in PCOS patients.