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Objective:To investigate the effects of cone beam computed tomography measurement of maxillary anterior teeth on implant success and patient satisfaction of maxillary anterior teeth.Methods:120 patients who underwent maxillary anterior teeth implantation in Hangzhou Dental Hospital from October 2017 to October 2019 were included in this study. They were randomly assigned to receive either conventional maxillary anterior teeth implantation (control group, n = 60) or cone beam computed tomography measurement of maxillary anterior teeth and maxillary anterior teeth implantation (study group, n = 60). The implant success rate was compared between the two groups. Alveolar bone thickness and ISQ value immediately, 3 and 12 months after implantation as well as patient satisfaction were compared between the two groups. Results:Implant success rate in the observation group was significantly higher than that in the control group [96.67% (58/60) vs. 85.00% (51/60), χ2 = 4.904, P < 0.05]. In the observation group, alveolar bone thickness at 3 and 12 months after implantation was (1.53 ± 0.05) mm and (1.78 ± 0.12) mm, respectively, which was significantly higher than that in the control group [(1.46 ± 0.04) mm, (1.64 ± 0.10) mm, t = 9.839, 8.066, both P < 0.001]. In the observation group, ISQ value at 3 and 12 months after implantation was (76.83 ± 5.49) and (82.91 ± 4.85), respectively, which was significantly higher than that in the control group [(67.81 ± 4.61), (74.18 ± 5.21), t = 11.324, 11.038, both P < 0.001). Total satisfaction rate in the observation group was significantly higher than that in the control group [95.00% (57/60) vs. 81.67% (49/60), χ2 = 5.175, P < 0.05]. Conclusion:Cone beam computed tomography measurement of maxillary anterior teeth can help increase implant success rate and patient satisfaction.
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Objective:To investigate the learning curve of laparoscopic transanal total mesorectal excision (taTME) for rectal cancer operated by one or two surgery teams.Methods:The retrospective cross-sectional study was conducted. Based on the concept of real-world research, the clinical data of 1 458 patients undergoing laparoscopic rectal cancer taTME from 44 medical centers who were registered in the Chinese taTME registry collaborative (CTRC) database from May 2010 to May 2020 were collected. The 1 458 patients were divided into cohorts with one surgery team or two surgery teams according to the operation method. Patients with one surgery team underwent taTME by transabdominal operation and then by transanal operation. Patients with two surgery teams underwent taTME by transabdominal and transanal operation simultaneously with duration of the simutaneous operation time ≥30 minutes. The entire surgical process of patients with two surgery teams is not required to be performed by two surgery teams simutaneously. The clinical data were collected from the medical centers with similar operation amount according to the operation time sequence to analyze the difference between different operation stages and explore the learning curve. The operation time was taken as the parameter to carry out cumulative sum analysis and draw the learning curve of laparoscopic rectal cancer taTME in each medical center. The clinicopathological characteristics of patients from two medical centers with the largest difference in learning curves were analyzed. Observation indicators: (1) screening results of clinical data; (2) clinical data collection of patients with one surgery team; (3) surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages; (4) learning curve of the one surgery team; (5) clinical data collection of patients with two surgery teams; (6) surgical situations of laparoscopic rectal cancer taTME from the two surgery teams; (7) learning curve of the two surgery teams. The cumulative sum was calculated by the CUSUM=∑i=1nXi-U, where Xi represented the operation time of each taTME, U represented the average operation time of all cases, and n represented the operation number. Fitting process was conducted on scatter plot of learning curves. Taking the apex of learning curve as the boundary, the learning curve was divided into two stages. The abscissa corresponding to the apex of learning curve was the number of operations that needed to be performed to cross the learning curve. Measurement data with normal distribution were represented as Mean±SD. Comparison between two groups was conducted using the t test and comparison between multiple groups was conducted using the ANOVA. Measurement data with skewed distribution were represented as M( P25,P75), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was analyzed using the rank sum test. Count data were analyzed using the chi-square test or Fisher exact probability. Results:(1) Screening results of clinical data:the clinical data of 661 patients from 7 medical centers with one surgery team and two surgery teams were collected. (2) Clinical data collection of patients with one surgery team: the clinical data of 312 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected including 42 cases in the number 2 medical center, 97 cases in the number 20 medical center, 82 cases in the number 33 medical center, 35 cases in the number 37 medical center and 56 cases in the number 39 medical center, respectively. (3) Surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages: three medical centers including the number 2, number 37 and number 39 medical center with close operation volume provided the clinical data of cases distributed in five operation stages. Among the five operation stages, the proportion of high-quality operation of total mesorectal excision (TME) was ≥17/18, the incidence of postoperative complications was ≤13.3%(4/30) and the incidence of anastomotic leakage was ≤10.0%(3/30). There was no significant difference in the TME quality, postoperative complications or anastomotic leakage among the five operation stages ( P>0.05). There was no significant difference in the operation time among the five operation stages ( χ2=6.950, P>0.05). (4) Learning curve of the one surgery team: the number of operations corresponding to the turning point of learning curve in number 2 and number 20 medical center was 22 and 39, respectively. The number of operations corresponding to the turning points of learning curve in number 33 and number 37 medical center was 15, 66 and 10, 28, respectively. The number of operations corresponding to the turning point of learning curve in number 39 medical center was 20. The overall curve of number 20 medical center was in line with the trend of learning curve and 39 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 20 and number 33 medical center. Cases with the gender of male or female, age, body mass index, cases classified as stage 1, stage 2, stage 3 or stage 4 of the American Society of Anesthesiologists (ASA) Classification, cases with neoadjuvant therapy, duration of postoperative hospital stay of the number 20 medical center were 77, 20, (60±10)years, 24 kg/m 2(22 kg/m 2, 26 kg/m 2), 1, 88, 8, 0, 8, 8, 11 days (9 days, 13 days), respectively, versus 51, 31, (64±11)years, 23 kg/m 2(21 kg/m 2, 26 kg/m 2), 0, 35, 43, 1, 31, 16 days (13 day, 21 day) of number 33 medical center, showing significant differences in the above indicators between the two medical centers ( χ2 =6.442, t=-2.265, Z=-2.032, -6.870, χ2 =22.120, Z=-8.408, P<0.05). (5) Clinical data collection of the two surgery teams: the clinical data of 259 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected, including 46 cases in the number 2 medical center, 47 cases in the number 8 medical center, 78 cases in the number 18 medical center, 43 cases in the number 33 medical center and 45 cases in the number 44 medical center, respectively. (6) Surgical situations of laparoscopic rectal cancer taTME from the two surgery teams: four medical centers including the number 2, number 8, number 33 and number 44 medical center with close operation volume provided the clinical data of cases distributed in four operation stages. Among the four operation stages, the proportion of high-quality operation of TME was ≥50.0%(13/26), the incidence of postoperative complications was ≤35.0%(14/40) and the incidence of anastomotic leakage was ≤22.5%(9/40). There was no significant difference in the TME quality, postoperative complications or operation time among the four operation stages ( χ2 =3.252, 4.733, 8.848, P>0.05). There was a significant difference in the incidence of anastomotic leakage among the four operation stages ( P<0.05). (7) Learning curve of the two surgery teams: the number of operations corresponding to the turning point of learning curve in number 2 and number 8 medical center was 28 and 16, respectively. The number of operations corresponding to the turning points of learning curve in number 18, number 33 and number 44 medical center was 12 and 58, 10 and 36, 14 and 36, respectively. The overall curve of number 2 medical center was in line with the trend of learning curve and 28 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 2 and number 33 medical center. The age and cases with tumor in stage T0 and (or) Tis, stage T1, stage T2, stage T3 or stage T4 of the T staging of the number 2 and number 33 medical center were (60±12)years, 3, 1, 9, 11, 20 and (65±10)years, 2, 3, 22, 15, 0, respectively, showing significant differences in the above indicators between the two medical centers ( t=-2.280, Z=-4.033, P<0.05). Conclusion:Thirty-nine cases of operations was the minimum number for the one surgery team to cross the learning curve of laparoscopic rectal cancer taTME and 28 cases of operations was the minimum number for the two surgery teams to cross the learning curve of laparoscopic rectal cancer taTME.
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The abdominoperineal excision (APE) is still one of the standard operations for low rectal cancer. The exralevator APE can reduce the positive rate of circumferential margin and perforation rate of rectal cancer, but the incidence of postoperative complications is relatively high. With the continuous development of minimally invasive surgery, the transperineal minimally invasive Abdominoperineal excision (Tpm-APE) is proposed. Compared with traditional APE, the Tpm-APE has potential technical advantages, but there is a lack of large sample and multicenter clinical research evidence. The authors share the design and results of an international multicenter clinical study to investigate the clinical practice of Tpm-APE in the treatment of low rectal cancer.
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It is critical to ensure complete mesorectal excision for rectal cancer surgery.Different surgical approaches including laparoscopy and expensive robotic surgical system,are currently unable to achieve the same therapeutic effects as traditional open surgery.Transanal total mesorectal excision (TaTME) is a new technique in rectal cancer surgery in recent years,which can effectively solve the problems of traditional transabdominal approach due to poor operative vision caused by low pelvic anatomy.After nearly 10 years of development,TaTME has shown the potential to improve the quality of rectal cancer surgery.With the continued development of emerging surgical techniques,TaTME relies on extensive,continuous structured training and high-quality clinical researches.
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Colorectal anastomosis remains a key aspect in mid- and lower-rectal surgery, particularly in patients who are male, obese, status post neoadjuvant chemoradiation, or possess narrow pelvic anatomy. Transanal total mesorectal excision (taTME) and transabdominal total mesorectal excision (TME) both primarily allow position of the tumor to dictate whether circular stapling or hand-sewing is utilized to achieve anastomosis. Given that taTME only requires a single circular stapler to achieve anastomosis, it consequently decreases the risk of jeopardizing blood supply to the anastomotic site. Should transanal hand-sewing be pursued, numerous points in performing the purse-string suture warrant particular attention: (1) Before suturing, separate the distal rectum to be anastomosed from the surrounding tissues, and ensure the full-layer suture of the distal purse-stitched suture. (2) It is recommended that beginners complete the suturing process under direct visualization without removing the transanal platform. (3) Commonly used anastomosis designs include end-to-end, side-to-end, J-pouch, or coloplasty, depending on patient characteristics and surgeon preferences. Our single-institution clinical experience suggests that taTME patients who underwent neoadjuvant chemoradiation or transanal hand-sewn anastomosis should still have a temporary colostomy created. To date, literature has yet to demonstrate the superiority of taTME anastomosis outcomes. This publication aims to point out anastomosis techniques and safety pointers, as well as clinical experiences.
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Humans , Male , Anastomosis, Surgical , Digestive System Surgical Procedures , Neoadjuvant Therapy , Rectal Neoplasms , Rectum , General SurgeryABSTRACT
Objective To observe the serum vascular endothelial growth factor (VEGF),apelin and heme oxygenase-1 (HO-1) levels in patients with type 2 diabetes mellitus (T2DM) and to explore their their relationship with diabetic retinopathy (DR).Methods A total of 208 patients with T2DM and 50 healthy subjects (control group) from the Central Hospital of Western Hainan during January 2014 and December 2017 were selected in this study.Vision,slit lamp microscope,indirect ophthalmoscope and FFA examinations were performed on all the subjects.According to the results of the examinations combined with the DR clinical staging criteria,the patients were divided into non-DR (NDR) group,non-proliferative DR (NPDR) group,and proliferative DR (PDR) group,with 72,76 and 60 patients in each,respectively.The clinical data of each group were recorded,and the levels of fasting blood glucose (FPG),HbA1c,total cholesterol (TC),three acylglycerol (TG),high density lipoprotein (HDL-C),low density lipoprotein (LDL-C),VEGF,apelin and HO-1 were detected in each group.The receiver operating characteristic curve (ROC) were used to analyze the value of VEGF,apelin and HO-1 in predicting the occurrence of PDR.Correlation analysis of serum VEGF,Apelin and HO-1 with clinical parameters in PDR patients by Pearson correlation analysis.Results The level of VEGF (56.82± 10.16 vs 91.74±22.83,140.15±36.40,195.28±42.26 pg/ml)and apelin (2.95±0.53 vs 4.68±0.74,7.25±1.13,10.16± 1.35 ng/ml) in PDR group were significantly higher than those in NPDR,NDR and control groups (F=17.306,21.814;P＜0.05).The level of HO-1 (50.37±10.14 vs 43.58±8.16,30.25t6.28,22.60±4.72 mmol/L) in PDR group was significantly lower than those in NPDR,NDR and control groups (F=15.827,P＜0.05).The ROC curve analysis showed that the best cut-offvalues of serum VEGF,apelin and HO-1 were 162.50 pg/ml,8.30 ng/ml,27.13 mmol/L,and the three combined to predict PDR of AUC (95％CI)was 0.906 (0.849-0.962),and their sensitivity (90.3％) and specificity (83％) were better.The correlation analysis showed that the VEGF,apelin and HO-1 of PDR patients were correlated with the course of diabetes (r=0.382,0.416,-0.36;P＜0.05),FPG (r=0.438,0.460,-0.397;P＜0.05) and HbAlc (r=0.375,0.478,-0.405;P＜0.05),and the serum VEGF were correlated with apelin and HO-1 (r=0.793,-0.594;P＜0.01).Conclusion Elevated serum VEGF and apelin levels and reduced HO-1 levels are associated with the progression of DR,and the three combination helps predict the occurrence of PDR.
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Objective To detect the expression levels of renal tissue M-type phospholipase A2 receptor 1(PLA2R1) antigen and its antibody in the patients with membranous nephropathy(MN).Methods Fifty-eight cases of biopsy-proved idiopathic membranous nephropathy(IMN),fifteen cases of hepatitis B-associated membranous nephropathy(HBV-MN) and seventeen cases of V type lupus nephritis(V-LN) were selected.Renal tissue PLA2R1 antigen was detected by indirect immunofluorescence and colocaliazed with IgG4.Serum anti-PLA2R1 antibody was simultaneously examined.The expression difference of PLA2R1 antigen and antiPLA2R1 antibody in MN was analyzed.And the differences of clinical data were analyzed between PLA2R1 positive and negative patients.Results The PLA2R1 antibody was not found in the renal tissue and serum of the patients with LN and HBV-MN;PLA2R1 antigen was found in 81.03％ of IMN patients,and its antibody was found in serum of 70.69％ of IMN patients.PLA2R1 antigen and IgG4 co-localization all deposited along glomerular capillary loop presenting as fine granules.The 24 h urine protein level in the patients with PLA2R1 antigen deposition in renal tissues was higher than that in the patients without PLA2R1 deposition (P＜0.05),moreover serum albumin level was lower than that in the patients without PLA2R1 deposition(P＜0.05).Conclusion The sensitivity and specificity of renal tissue PLA2R1 antigen in the diagnosis of IMN are higher.The expression of PLA2R1 antigen in renal tissue by biopsy is significantly correlated with the clinical severity.
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BACKGROUND:It can be theoretical y speculated that the combination of titanium, micro-arc oxidation coating and arginine-glycin-aspartic acid (RGD) polypeptide wil show better mechanical and biological properties. OBJECTIVE:To observe the microstructure and cellproliferation of the titanium and micro-arc oxidation coatings modified with RGD polypeptide by different modification methods. METHODS:Ninety specimens of pure titanium and micro-arc oxidation coatings were divided into three groups, with 30 specimens in each group. The first 30 specimens were pure titanium physical y decorated with RGD polypeptide only. The other two groups of specimens were physical and chemical coupling adsorption RGD polypeptide micro-arc oxidation samples, respectively. The fluorescence microscope was used to observe the effects and amounts of grafting RGD polypeptide on each sample. Content of the RGD polypeptide on the surface of the specimens were measured by X-ray photoelectron spectroscopy. The mouse bone marrow stromal cells were cultured on the surfaces of three groups samples, and the adhesion and proliferation of the cells cultured for 3 hours, 12 hours, 24 hours and 3 days were observed by optical microscope respectively. RESULTS AND CONCLUSION:There were green fluorescence spots, with varying size and amount, on the surface of specimens in three groups. In the unit field of view, the fluorescence was the strongest in chemical coupling adsorption RGD polypeptide micro-arc oxidation samples, indicating that these specimens were grafted with many polypeptides. In physical coupling adsorption RGD polypeptide micro-arc oxidation samples, smal amount of polypeptides were found on the surface, and the content of the RGD polypeptide was the highest in chemical coupling adsorption RGD polypeptide micro-arc oxidation samples. No apparent cytotoxicity was observed in three groups. The cellproliferation was the best in chemical coupling adsorption RGD polypeptide micro-arc oxidation samples. Experimental findings suggest that, chemical coupling method can wel fix the RGD polypeptides on the surface of pure titanium samples containing micro-arc oxidation, without any cytotoxicity, which contribute to promote the cellgrowth and proliferation.
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ObjectiveTo investigate the expression of E-cadherin and β-catenin in the primary colorectal carcinoma and metastatic lymph nodes and it's clinical significance. MethodsImmunohistochemical analysis of Ecadherin and β-catenin was performed in colorectal mucosa( n =20 ,group A) ,colorectal carcinoma without metastasis ( n = 25, group B) and colorectal carcinoma with metastatic lymph nodes ( n = 39, group C) The expression of E-cadherin and β-catenin and the metastasis and prognosis of colorectal carcinoma were observed. ResultsThe strongly positive expression of E-cadherin in primaries of group C (5.1％ ) was obviously lower than in group B ( U = 2. 149,P =0. 032) ,whereas no statistic differences of the expression of E-cadherin between primaries and metastases of group C were observed(P =0.186). There was no difference of the expression of β-catenin between group B and group C,the same of primary colorectal carcinoma and self control lymph nodes of group C(P =0.235 and P =0. 715). There was positive correlation between membranous down regulation of E-cadherin and β-catenin in group C( r = 0.387 ,P =0.024) ,but no relationship was found in group B( r = 0.080 ,P = 0.723 ). ConclusionThe decreased membranous expression of E-cadherin in the colorectal carcinoma was correlated with lymph nodes metastasis, and was obviously related to membranous down regulation of β-catenin. There was no relevance between the expression of β-catenin and the lymph nodes metastasis of colorectal carcinoma.
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A porous hydroxylapatite-containing titania film was prepared by an electrochemical oxidation method, i.e. micro-arc oxidation (MAO). During the oxidation treatment, the titanium sample was immersed in electrolytic solution containing calcium acetate monohydrate and sodium biphosphate dihydrate by using a pulse power supply. The thickness, phase, composition and morphology of the oxide coating were monitored with X-ray diffraction (XRD) and scanning electron microscopy (SEM) with energy dispersive X-ray spectrometer (EDS). The thickness of the MAO film is about 20 microm and the coating where each porous size is no more than 5 microm was porous and uneven, without apparent interface to the titanium substrates. The coating formed in the Ca- and P-containing solution with MAO contained Ca and P along with Ti and O. The Ca/P ratio on the surface is 1.63, while that in the interface is 0.51. XRD showed that the porous coating was made up of anatase, rutile and hydroxyapatite. Such MAO films are expected to have significant medical applications as dental implants and artificial bone joints.
Subject(s)
Humans , Coated Materials, Biocompatible , Chemistry , Durapatite , Chemistry , Oxidation-Reduction , Particle Size , Porosity , Surface Properties , Titanium , ChemistryABSTRACT
Objective To discuss the foreground of application of reverse engineering reconstruction of dental models and to establish the foundation of developing a system for complete denture CAD/CAM. Methods The models of an edentulous jaw were measured with reverse engineering, and the 3D models were reconstructed with a computer. Results 3D models of the edentulous jaw were achieved. The characteristics of these 3D images were clear and accurate. Conclusion CAD models are reconstructed with reverse engineering accurately and technical problems in 3D model of complete denture CAD/CAM are resolved.
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Objective To establish 3D data-base on artificial resin teeth with 3D layer scanning digitizer. Methods Artificial resin teeth were measured with a CMS-400 3D digitizer by cutting and scanning layer-by-layer, 3D data points of each tooth acquired and the 3D models of these teeth reconstructed with a computer. Results 3D models of 3D data-base on artificial resin teeth were obtained. The characteristics of these 3D images were clear and accurate. Conclusion The complicated teeth moulds can be measured accurately with the 3D digitizer since there are no measuring blind spots.
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Objective: To study the effect of treatment of articulation disorder in patients with velopharygeal incompetence(VPI) after operation for cleft palate. Methods: Articulation disorder was treated by velophary-geal obturator in 135 patients with VPI, the rate of VPI(RVPI),improving rate of VPI(IRVPI),the value of third formant frequency(F3)of Chinese vowels and pronunciation were observed before and 180 days,1 and 2 years after treatment. Results: After treatment RVPI was decreased (P