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Objective@#To analyze the prevalence of elevated blood pressure among primary and middle school students in Anhui Province in 2022, as well as its influencing factors, so as to provide scientific evidence for the development of effective measures to prevent and control elevated blood pressure among children and adolescents.@*Methods@#Using data from the 2022 "Monitoring of Common Diseases and health Influencing Factors of Students" in Anhui Province, a total of 210 360 primary and middle school students aged 7 to 17 with complete information. Statistical analysis, including independent sample t tests, analysis of variance, and Chi square tests, were conducted to compare blood pressure differences and prevalence rates among students with different characteristics. Generalized linear mixed models were established to analyze the influencing factors of elevated blood pressure in children and adolescents.@*Results@#The overall prevalence of elevated blood pressure among primary and middle school students in Anhui Province was 22.3%, higher among high school students (25.6%) and junior high school students ( 23.7%) than elementary school students (20.4%) ( χ 2=528.49, P < 0.01 ); higher among obese(33.3%) and overweight students (24.9%) than that of normal students (18.6%) ( χ 2=3 704.52, P <0.01), higher among rural students (23.1%) than urban students (21.4%) ( χ 2=83.39, P <0.01), and higher in the northern part of Anhui Province (26.9%) than in the central part (21.9%) and southern part (17.6%) ( χ 2=1 777.51, P <0.01). The generalized linear mixed models revealed that girls, high school stage, overweight, obese, living in the northern part of Anhui Province, and living in rural were all positively correlated with elevated blood pressure( OR =1.11，1.25，1.47，1.45，2.24，1.21，1.67， P <0.01).@*Conclusions@#The prevalence of elevated blood pressure among children and adolescents in Anhui Province is the highest in the country. It is recommended that relevant departments promptly formulate corresponding measures to curb the increasing trend of elevated blood pressure and protect the physical and mental health of children and adolescents.
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Objective:To investigate the clinical effect of W-shaped genioplasty in the correction of broad and short chin deformity.Methods:Thirty-eight patients (5 males, 33 females, aged 20 to 41 years, mean 27.3 years) complained with broad and short chin were admitted to the Affiliated Friendship Plastic Surgery Hospitalof Nanjing Medical University from January 2019 to December 2021. CBCT scan and three-dimensional reconstruction were performed to design osteotomy line and determine the distance of chin lengthening, narrowing and advancing or retrocession preoperatively. Under general anesthesia, the W-shaped osteotomy was performed using an intraoral incision, and the angle between the bilateral free bone fragments, the distance of downward and forward movement were adjusted to change the curvature, width, length and prominence of the lower edge of the chin according to the preoperative designs. The results were evaluated by clinical appearances and image analyses at a follow-up of 3-24 months.Results:The amount of vertical lengthening of the chin in 38 cases were 2 mm to 5 mm, with an average of 3.02 mm. The horizontal narrowing width distances were 3-7 mm, with an average of 5.6 mm. The patients were followed up for 3-24 months, with an average of 10.6 months. There were no complications such as hematoma, wound dehiscence, accidental fracture, surgical area infection and permanent neurosensory disorder. 38 patients had transient sensory loss in the lower lip region of varying degrees, but all recovered spontaneously during routine follow-up period. All patients were satisfied with the improvement of facial contour.Conclusions:W-shaped geinoplasty preserves the central bone of the chin and the attachment of genioglossus muscle, which does not affect the normal anatomy and physiological function of the oral cavity. After osteotomy, the bone is removed and the bilateral bone fragments move flexibly. It can effectively change the radian, width, length and protrusion of the lower edge of the chin in three dimensions, so as to correct the wide and short deformity of the chin.
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Objective:To evaluate the clinical effects of the dissection of the implant pockets with ultrasonic scalpel or traditional electroscalpel through the axillary approach under endoscopic assistant.Methods:A total of 125 female patients with an average of 32.5 years, ranged from 21 to 44 years, underwent endoscopic-assisted transaxillary breast augmentation in the Department of Plastic Surgery, the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, from January 2019 to December 2020, were analyzed retrospectively. The implant pockets were dissected with ultrasonic scalpel (ultrasonic scalpel group) in 64 patients or with traditional electroscalpel (electroscalpel group) in 61 patients. The operation time, operation speed, postoperative drainage, drainage tube removal time and hospital stay of the two groups were compared and analyzed statistically.Results:Compared with the electroscalpel group, the average operation time of the ultrasonic scalpel group 75(71-90) min was significantly shorter than that of the electroscalpel group 105(80-135) min ( t=4.10, P<0.001), the operation speed (3.27±0.44 ml/min) was faster than that of the electroscalpel group (2.52±0.72 ml/min) ( t=4.71, P<0.001), the postoperative drainage 130.5(98.8-193.3) ml was significantly less than that of the electroscalpel group 281.75(145.5-328.3) ml ( t=2.21, P<0.05), and the drainage tube removal time 3 (3-4) d and hospital stay 3 (3-4) d were remarkablely shorter than that of the electroscalpel group 4 (3-4) d, 5 (4-6) d ( t=3.58; t=4.06, P<0.05). Conclusions:The application of ultrasonic scalpel in endoscopic-assisted transaxillary breast augmentation is safe and reliable. In addtion to improving the surgical efficiency, ultrasonic scalpel can reduce blood loss, shorten the time of hospital stay and reduce complications, which is worthy of further promotion in clinical application.
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Objective:To investigate the effect of eyebrow arch augmentation with personalized polyether ether ketone (PEEK) implant assisted by endoscope.Methods:From January 2019 to August 2021, 9 patients with low and flat eyebrow arch requiring eyebrow arch augmentation were treated in the plastic surgery department of the Friendship Plastic Surgery Hospital Affiliated to Nanjing Medical University. The cranial and maxillofacial CT scanning data were obtained before operation, the eyebrow arch elevation range and height were designed according to the patient's requirements, and personalized peek implants were manufactured. During the operation, a small temporal hairline incision was used to accurately separate the implantation cavity of individualized peek implants under the periosteum of the eyebrow arch implantation area with the aid of endoscope. Personalized PEEK implants were implanted under endoscope to make them fully fit with the eyebrow arch bone and fixed with titanium nails. Photos were taken and analyzed before and after operation.Results:All patients were followed up for 3 months to 2 years. Their facial expressions were normal, and there were no motor nerve injury, rejection and iatrogenic infection. The patients were satisfied with the postoperative effect. Compared with before operation, the low level of orbital bone in eyebrow area was improved, and the facial contour was three-dimensional and harmonious.Conclusions:The eyebrow arch augmentation with individualized peek implant assisted by endoscope is safe and effective. It can greatly reshape the upper contour of the face, deepen the upper eyelid fossa and improve the convex eye phenomenon, so as to achieve the cosmetic effect of enhancing the three-dimensional sense of the eyebrow orbital area, which is worthy of clinical application.
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Objective:To investigate the effect of electroporation-mediated local gene therapy on the expression of Wnt3a and β-catenin in callus of distraction gap during mandibular distraction osteogenesis of rabbits.Methods:The experiments were conducted in the laboratory of the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University from September 2019 to December 2019. Forty eight New-Zealand rabbits were randomly divided into control group (group A), gene therapy group (group B) and normal saline group (group C), with 16 rabbits in each group. After bilateral mandible osteotomy and distractors were implanted, the distractors were activated at a speed of 0.8 mm/d on 4th day, postoperatively, and lasted for 7 days, followed by consolidation period. Group A distracted only, group B was subject to local injection of recombinant plasmid pIRES-hBMP2-hVEGF165 in the distraction gap and electroporation stimulation at the beginning of activation distractors; and group C local injection of the same dose of normal saline in the distraction gap and electroporation stimulation at the beginning of activation distractors. Four animals in each group were sacrificed on the day at the end of distraction, 7th, 14th, 28th days of consolidation period, respectively. The callus in the distraction gap was taken for immunohistochemical staining and RT-PCR to detect the expression of Wnt3a and β-catenin, and image analysis was performed. SPSS 22.0 statistical software was used for data analysis.Results:Immunohistochemical staining showed that Wnt3a and β-catenin were mainly located in the cytoplasm and nuclei of fibroblasts, chondrocytes and osteoblasts in callus tissue. Immunohistochemistry and RT-PCR showed that the expression of Wnt3a and β-catenin reached a peak at the end of distraction. With the disappearance of distraction tension, the expression of Wnt3a and β-catenin gradually decreased. After gene therapy intervention, the expression of Wnt3a and β-catenin was significantly increased, and the expression of Wnt3a and β-catenin in group B was the highest at each time point, with statistically significant difference compared with groups A and C ( F=96.3, P<0.01). Conclusions:Gene therapy promotes the expression of Wnt3a and β-catenin in the callus of distraction gap, regulating the balance of the bone reconstruction system and thus promoting the formation of new bone in the distraction gap.
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Objective:To investigate the effect of mandibular angle osteotomy on the morphological changes of mandible by using cone beam computed tomography (CBCT) scanning data and three-dimensional cephalometry.Methods:According to included and excluded criteria, the complete CBCT data of 20 female patients (aged 20-35 years with an average age of 25.5 years) from January 2016 to June 2018 who underwent curved mandibular angle osteotomy combined with splitting cortiectomy were selected. Seven items reflecting mandibular morphology before and after surgery were measured respectively. All the data were analyzed by the means of SPSS 12.0; linear correlation analysis and paired t test were used to evaluate the change of andibular morphology.Results:The measurement results of the mandible pre- and post-operative 10 days showed as follows: Go-Go decreased, both sides of Cd-Go, Go-Ri and MR-MA decreased, both sides of Go-Me became longer, both sides of Ar-Go-Me and MP-FH increased. The paired t-test results showed that there was significant difference before and after operation ( P<0.05), but there was no significant difference between the left and right measurement items ( P>0.05). Compared with that in 10 days after operation, the measurement items also changed 6 months after operation. There was no statistical difference between the above measurement items 6 months after surgery and 10 days after surgery ( P>0.05), and no statistical difference between the left and right sides ( P>0.05). Conclusions:The mandibular three-dimensional model which is reconstructed based on CBCT data, not only displays the three-dimensional anatomical structure that cannot be presented on X-ray film visually and comprehensively by means zoom, rotation and other operations, but also precisely and accurately shows the change of the shape of the mandible from the sagittal, coronal and horizontal plane with arbitrary cutting and rotation. The measurement of mandible is more accurate and reliable, and the surgical plan of mandibular angle osteotomy can be accurately planned preoperatively, and the operative effect can be quantitatively evaluated postoperatively.
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Objective:To investigate the clinical outcomes of personalized polyetheretherketone (PEEK) implant in the correction of nasolabial fold depression.Methods:A total of 30 patients with nasolabial fold depression (5 males, 25 females, aged 26 to 52 years, mean 36.3 years) admitted to the Affiliated Friendship Plastic Hospital of Nanjing Medical University who want to undergo nasolabial fold augmentation from January 2019 to January 2021. All patients underwent CBCT scan and three-dimensional simulation, the personalized PEEK implant was designed and produced with CAD/CAM technique, the personalized PEEK was implanted during the operation. The patients were followed up for 3-12 months, and the wrinkle score and satisfaction were compared before operation and 3 months and 6 months after operation.Results:The depressions of nasolabial fold were significantly improved in all patients, and there were no complications such as hematoma and infection after operation. During the follow-up, there was no implant displacement or exposure, and the effect was stable and lasting. The scores of wrinkles at 3 months after operation (2.30±0.47) and 6 months after operation (2.17±0.38) were significantly lower than those before operation (4.03±0.67), and the scores of satisfaction were significantly higher than those before operation ( P<0.05). The scores of satisfaction at 3 months after operation (3.97±0.56) and 6 months after operation (4.23±0.57) were significantly higher than those before operation (1.70±0.60). The difference was statistically significant ( P<0.05). Conclusions:3D printing personalized PEEK prosthesis is effective in correcting nasolabial fold depression, and it is safe and stable, so it is recommended for clinical application.
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Objective:To investigate the serum 25-hydroxyvitamin D [25(OH) D] levels in elderly patients with hip and vertebral compression fractures (VCF).Method:Ninety patients (58 males and 32 females) aged over 60 years with hip fracture and 120 patients (88 males and 32 females) aged over 60 years with VCF admitted in the Aviation General Hospital from January 2017 to June 2019 were enrolled. Serum 25(OH)D levels were measured.Results:Serum level of 25 (OH) D in hip fracture patients was (9.0±6.8) μg/L, the 25 (OH) D level was lower than the normal value(<19.0 μg/L)in 79 patients and<3 μg/L in 24 patients. The level of 25(OH)D in VCF patients was (16.7±10.6) μg/L, the 25 (OH) D level was<19.0 μg/L in 78 patients (65.0%) and <3 μg/L in 10 patients (8.3%). The low level of 25(OH)D was negatively correlated with age in two groups ( r=-0.367, P=0.01; r=-0.313, P=0.04). The mean level of 25 (OH) D in the hip fracture group was lower than that in the VCF group ( t=5.960, P<0.01), and the low 25(OH)D rate in the former group was significantly higher than that in the latter group (χ 2=14.14, P<0.01; χ 2=12.74, P<0.01). The 25(OH)D value of female VCF patients was (14.5±8.8) μg/L, which was significantly lower than that of male patients (22.5±12.9) μg/L ( t=3.882, P<0.01).Among hip fracture patients, the 25(OH)D level in patients with fracture history was (8.3±6.9) μg/L, which was significantly lower than that of patients without fracture history (10.8±6.9) μg/L, and the difference was statistically significamt ( t=2.123, P=0.04). The serum osteocalcin level was (20.5±19.8) μg/L in patients with fracture history, which was significantly higher than that in patients without fracture history [(10.6±5.4) μg/L, t=3.245, P<0.01]. Conclusion:Elderly patients with new hip fractures have more severely low vitamin D level than patients with new VCF, and patients with previous fracture history have lower vitamin D levels than patients without fracture history.
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Objective:To seek a minimally invasive method for costal cartilage harvest by using two different costal cartilage harvest techniques in rhinoplasty and to compare their influence on donor site pain.Methods:Fourty-three female patients who underwent costal cartilage harvest for rhinoplasty from Dec. 2016 to Dec. 2017 were randomly divided into two groups. We harvested the right side seventh costal cartilage in both groups. In control group, we harvested a full thickness segment of costal cartilage in each patient, whereas we harvested a split thickness segment of costal cartilage by preserving the superior strip in experimental group. Donor site pain was evaluated via visual analogue scale (VAS) 6 h, 24 h, 48 h and 72 h after surgery.Results:The VAS scores (mean±standard deviation) at different time points in the control group were (5.515±1.085), (5.250±1.302), (5.315±1.117) and (4.895±1.042). And in the experimental group, they were (2.665±0.713), (2.261±0.642), (1.609±0.398) and (1.383±0.514), respectively. The VAS scores at different time points were significantly higher in the control group than that in the experimental group ( P<0.05). Conclusions:The superior strip preserved costal cartilage harvest technique significantly reduces postoperative donor site pain.
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Objective@#To explore the role of β-catenin in distraction osteogenesis of new bone formation, the expression of β-catenin in the distraction gap callus was detected during rabbit mandibular distraction osteogenesis.@*Methods@#26 New-Zealand rabbits were randomly divided into 3 groups. Group A is a normal control group with 2 rabbits, group B is the mandibular defect control group, and group C is the distraction group. Group B and C with 12 rabbits, respectively. The two rabbits in group A without surgery, their mandibles are normal control. In group B, vertical osteotomy was performed between the first molar and the mental foramen on the mandibles bilaterally, followed by rigid internal fixation with titanium plates and screw with 5 mm gap immediately. In group C, after the same osteotomy was performed, the fragments of mandibles were reduced and fixed with mandibular distractors bilaterally. On the fourth day postoperatively, the distraction started at a rate of 0.8 mm/d and lasted for 7 days, followed by consolidation period. Two rabbits of group B and C were sacrificed at 6th, 10th, 17th, 24th, 31st, 38th day postoperatively, respectively. The newly formed callus in the distraction gap of mandibles was harvested for Western blotting and immunohistochemistry examination to detect the distribution and expression of β-catenin. The experimental data were analyzed by SPSS 22.0 statistical software using Spearman function.@*Results@#The result of Western blotting showed that the expression of β-catenin gradually increased at distraction period(6-10 days after surgery) and reached the peak at the end of the distraction period(10th day postoperatively), it gradually decreased during the consolidation period. However, the expression of β-catenin in group C was higher than that of group B. Immunohistochemistry stain showed that the expression of β-catenin mainly located in inflammatory cells(eg. monocyte), fibroblast of the granulation tissue, the osteoblasts, osteocyte on the surface of new formed trabecular, and the connective tissues surrounding the new bone in the new formed callus. Cytoplasmic and nuclear staining were positive. In group C, the expression of β-catenin was strong (3.245 8±0.132 3) after distraction (6th day postoperatively), and reached a peak (4.602 8±0.021 9) on the 10th day postoperatively. With the disappearance of the distraction stress, the expression of β-catenin gradually decreased since17th day postoperatively(3.639 8±0.125 5), but the staining was still positive. In group B, the strong positive staining of β-catenin on the 6th day after surgery (2.734 0±0.134 7), the strongest staining on the 10th day after surgery (3.101 3±0.104 8), and the expression of β-catenin on the 17th day after surgery (2.542 8±0.211 1) was weaker than that on the 10th day after surgery. At each time point, the expression of β-catenin in group C was significantly higher than that in group B, and the difference was statistically significant (r=0.943, P=0.005 6).@*Conclusions@#During mandibular distraction osteogenesis, the distraction stress activates the Wnt signal pathway to enhance the expression of β-catenin, it suggests that β-catenin plays an important role in the transformation of the mechanical signal to chemical signals during the process of distraction osteogenesis, and participates in the regulation of new bone formation during distraction osteogenesis.
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Objective To investigate the effect of hyperbaric-oxygen therapy on osteoprotegerin (OPG) and integrin β1 (Itgβ1 ) expression during mandibular distraction osteogenesis .Methods Forty New-Zealand rabbits were used .The animals were randomly divided into two groups (experimental group and control group) with 20 animals each ;after accomplished osteotomy and implant distraction devices on mandible bilaterally for 3 days of latency period ,the device was activated at the rate of 0 .8 mm per day for 10 days .All animals in the experimental group were subjected to hyperbaric oxy -gen for 90 minutes once a day since the beginning of distraction ,and lasted for four weeks .In control group ,all the distractors were activated following the same distraction protocol as the experimental group ,but without hyperbaric oxygen therapy .Five animals of each group were sacrificed at 10th day after distraction ,7th ,14th and 28th day of consolidation , respectively .The lengthened mandibles were harvested and processed for immunohistochemical examinations to detect OPG and Itg β1 expres-sion in the distraction gap .Semi-quantitative analysis was carried out by image analysis software . Results OPG staining was mainly located in the membrane and cytoplasm of osteoprogenitor cells and osteoblasts in the distraction zones .The expression of OPG increased after distraction accomplished and reached to the peak at 7th day of consolidation ,and then decreased gradually .At every time point , the level of expression of OPG in the experimental group was remarkably higher than those in control group .There were significant differences between the experimental group and control group ( P <0 .01) .Itgβ1 mainly located in actively proliferating osteoblasts ,fibroblasts and mesenchymal cells . The expression of Itgβ1 decreased significantly after reached to the peak at the 10th day distraction .At 10th day distraction ,7th and 14th day of consolidation ,Itgβ1 expressed more strongly than that in the experimental group ,which was remarkably higher than those in control group .There were significant differences between experimental group and control group (P < 0 .05) .At 28th day of consolidation , Itgβ1 expressed weakly ; there was no significant difference between the two groups ( P > 0 .05 ) . Conclusions Hyperbaric oxygen therapy can up-regulate the expression of OPG and Itgβ1 in the dis-traction gap ,which may promote osteoblast differentiation ,proliferation ,enhance osteoblast func-tion ,and new bone formation in distraction gap .
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Objective To investigate the effects of ulinastatin combined with octreotide in patients with severe acute pancreatitis TAP, SAA and serum inflammatory factors. Methods From February 2011 to September 2016,one hundred and seventy-eight patients with severe acute pancreatitis treated in the Second Affiliated Hospital of Hainan Medical University were enrolled in the study and were divided into the control group(81 cases) and observation group (97 cases). On the basis of routine treatment,the control group was treated with 0. 50 mg octreotide +0. 9% sodium chloride injection,continuous intravenous infusion at 20 mg/h, and 1 time /d,with a total of 3 d. On the basis of the control group,the observation group was given ulinastatin 100 thousand U+250 ml 0. 9% sodium chloride solution intravenous drip,2 times /d,with a total of 3 d. Before and after treatment,TAP,SAA and serum inflammatory factors in two groups were detected and analyzed. Results The levels of TAP,SAA,lipase and amylase in the observation group were (45. 21±9. 64) nmol/L,(458. 62 ±75. 41) mg/L, ( 14731. 7 ± 812. 5) U/L and ( 9341. 3 ± 831. 3) U/L respectively, compared with ( 26. 38 ±7. 13) nmol/L, ( 201. 23 ± 64. 31 ) mg/L, ( 10 321. 4 ± 762. 8) U/L and ( 5 416. 7 ± 306. 8) U/L after treatment. Before treatment,the control group were (43. 14±8. 53) nmol/L,(463. 71±62. 83) mg/L,(13826. 2 ±731.3) U/L and (9126.4±835.1) U/L,and the control group were (37.41±8.32) nmol/L,(316.42 ±68. 71) mg/L,(12 318. 5±797. 3) U/L and (7 423. 1±752. 3) U/L. After treatment,the two groups were lower than those before treatment (P＜0. 05),and the decrease was more obvious in the observation group after treatment. Compared with the control group,the difference was statistically significant ( P＜0. 05) . The level of calcitonin,C reactive protein and triglyceride in the observation group were ( 6. 04 ± 1. 25) ng/mL, ( 237. 3 ±13. 2) mg/L and ( 32. 18 ± 1. 32) mmol/L respectively before treatment. After treatment, they were ( 2. 37 ±0. 96) ng/mL,(48. 9±11. 2) mg/L and (12. 73±3. 61) mmol/L. Before treatment,the control group was (5. 72 ± 1. 43 ) ng/mL, ( 213. 1 ± 16. 2 ) mg/L, ( 30. 76 ± 1. 94 ) mmol/L and ( 5. 32 ± 1. 21 ) mmol/L, respectively. After treatment,they were (4. 21±1. 32) ng/mL,(156. 2±14. 7) mg/L and (24. 69±1. 26) mmol/L respectively. The levels of calcitonin,C reactive protein and triglyceride in the two groups were lower than those before treatment (P＜0. 05),and the decrease was more obvious in the observation group after treatment,and the difference was statistically significant compared with the control group. (P＜0. 05); tn the observation group,the levels of interleukin 6,interleukin 8,TNF - alpha,thromboxane and prostacyclin were (292. 48±19. 57) ng/L, (105. 52 ± 11. 41 ) ng/L, ( 4. 31 ± 0. 58 ) ng/L, ( 442. 16 ± 40. 23 ) ng/L and ( 167. 42 ± 12. 29 ) ng/L respectively.After treatment,they were (67.43±9.21) ng/L,(23.19±3.26) ng/L,(1.27±0.32) ng/L, (192. 20± 16. 89) ng/L and ( 364. 57 ± 27. 02) ng/L respectively. Before treatment, the control group was (278. 31±22. 49) ng/L,(113. 21±11. 45) ng/L,(4. 32±0. 48) ng/L,(428. 32±36. 54) ng/L and (159. 31 ±13. 42) ng/L,compared with (125. 74±16. 52) ng/L,(67. 21±7. 65) ng/L,(3. 16±0. 29) ng/L,(321. 46 ±25. 51) ng/L,(246. 73±20. 52) ng/L after treatment. After treatment,the levels of IL-6,IL-8,TNF-alpha and thromboxane in the two groups were all lower than those before the treatment ( P＜0. 05 ) . The levels of prostacyclin in the two groups were all higher than those before treatment ( P＜0. 05) . Conclusion Ulinastatin combined with octreotide in the treatment of severe acute pancreatitis can reduce the level of blood lipid,reduce inflammatory factors,reduce systemic inflammatory response, improve the patient's inhibition of inflammatory response and promote the balance of inflammatory reaction, and test the patient's TAP, SAA and serum inflammatory response factors to the diagnosis of SAP and the judgment of the disease,and have certain clinical guidance.
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Objective To investigate the expression of Wnt/β-catenin signal antagonist DKK1 protein in callus of distraction gap during mandibular distraction osteogenesis (MDO).Methods Twenty four healthy New Zealand rabbits were randomly divided into distraction group,fracture control group,with twelve rabbits each,respectively.In distraction group,bilateral mandibular distraction models were established.In control group,after bilateral mandibular osteotomy,the two bone fragments were fixed by titanium plate and screws with a 5 mm gap.The expression of DKK1 in the distracted calluses was analyzed by cell digital imaging software.Results Expression of DKK1 was colocalized in the nucleus and cytoplasm of osteoblasts,fibroblasts,cartilageand newly embedded osteocytes.The expression of DKK1 increased following distraction activated after surgery,peaked at 10 days after surgery,the population of cells that stained for DKK1 decreased gradually.At 31 to 38 days postoperatively,DKK1 expression reduced gradually,mainly located in the osteocyte,and both nucleus and cytoplasm were positive staining.At each time point,the expression of DKK1 in distraction group was higher than that in the control group and the difference was statistically significant (P＜0.05).Conclusions During MDO,the Wnt/β-catenin pathway is activated due to the distraction and mechanical strain on the bone.With the increased expression of Wnt-related factors,the endogenous negative feedback is enhanced to induce DKK1 expression and to regulate the activated Wnt/β-catenin pathway.This would be beneficial to the new bone formation and remodeling in the distraction gap.
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Objective To investigate the optimal time and molecular mechanism of gene therapy for promoting distraction osteogenesis by observing the effect of gene transfecting at different time on expression of cyclins in mandibular distraction area.Methods Forty eight New-Zealand rabbits were employed.After accomplishing bilateral mandibular distraction osteogenesis model,the rabbits were randomly divided into the group A,B,C and D.The group A,B and C were transfected by recombinant plasmids pIRES-hBMP2-hVEGF165 2 μg(0.1 μg/μL)at the distraction area instantly after operation,on postoperative 4,14 d and given local electroporation stimulation.The four groups entered the consolidation stage after 10 d continuous traction at a rate of 1 mm/d on postoperative 4 d.Three rabbits in each group were respectively sacrificed on 7,14,28,56 d of the consolidation stage.The expression of cyclin A,D1,and E of fresh bone tissue in distraction area were detected by immunohistochemical staining.Results Cyclin A,D1,and E were strongly expressed in the traction gap on 7,14 d of consolidation stage found,which was strongest on 7 d,moreover the group A,B and C were stronger than the group D.The expression in each group was weakened on 28,56 d.The expression on 7 d in the group B was stronger than that in the4 group A,C and D(P0.05),but all were stronger than the group D(P0.05).Conclusion The high expression of cyclin A,D1 and E can promote the cellular division,proliferation and differentiation in distraction area,thus accelerates the new bone formation in the distraction area,prompting that the distraction period is the best time for distraction osteogenesis under gene therapeutic intervention.
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Objective To observe the effect of hyperbaric oxygen therapy (HBOT) on mineral density and biomechanics of new-formed bone in distraction gap.Methods The mandibles were subjected to osteotomy and distractors were placed bilaterly in 30 rabbits,which were divided randomly into 2 groups.After 5 days for latency,the mandibles were distracted at a rate of 0.8 mm/day for 10 days,and then for consolidation.After surgery,group A received HBOT with daily distraction,whereas group B only distracted without HBOT served as control group.The animals in groups A and B were sacrificed 1 wk,2 wk,4 wk of consolidation,respectively.The mandibles were harvested and subjected to examination for new bone formation,and bone mineral density (BMD) and biomechanics of newly formed bone in the distraction gap.Results At one week of consolidation,no significant differences were observed between the BMD of newly formed bone in the two groups (P＞0.05);however,at the other time points,BMD of newly formed bone in group A was significantly higher than that in group B (P＜0.05).Moreover,at 4 weeks of consolidation,the strength,maximum fragile energy and modulus of elasticity of newly formed bone in group A were significantly higher than those in group B (P＜0.05).Conclusions The results suggest that HBOT improves mineral density and strength of new formed bone in distraction gap.
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Objective Cephalometry has been used to measure the changes of mandibular shape before and after the surgery.The aim of this study was to evaluate the effect of mandibular angle osteotomy.Methods A lot of 42 cases with complete data were selected,cephalometric analysis were performed before operation and one week and 6 months after surgery,respectively.Furthermore,the data of six months postoperatively were compared to those of the beauty people reported in the literature.Results At one week after surgery,the average distance between the gonions decreased (17.70± 8.46) mm,the average length of the mandibular ramus reduced (5.84±3.26) mm,the average mandibular body length increased (4.61±2.74) mm,the average gonial angle increased (14.78±6.65)°,and the average mandibular plane angle increased (10.29±3.82)° (P＜0.05).At six months postoperatively,the first three linear measurements increased (3.68±2.91) mm,(1.66±2.51) mm and (2.10±2.37) mm,respectively;however,the last two angular measurements reduced (2.86±3.02)°and (1.77±2.62)° respectively.The data of six months postoperatively were compared to those of the beauty people reported in the literature,and there were statistically differences between the linear measurements,but no statistically differences between the angular measurements.Conclusions Re duction mandibuloplasty can modificate mandibular contouring three-dimensionally.Despite bone regeneration resuhs in linear or angular measurements change,postoperative angular shape is predominantly maintained,and so the patients can reach the level of beauty papulation.
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Objective To explore the clinical effect of endoscopic-assisted intraoral reduction mandibuloplasty.Methods From January 2010 to December 2014,a total of 186 patients with prominent mandibular angles underwent one stage long-curved ostectomy combined with splitting corticectomy through an intraoral approach with endoscopic assistence according to preoperative design for reduction mandible three-dimensionally,and achieved reduced width of the lower face with smooth curve of mandibular edge.The distance between both gonions was measured and the complications recorded to evaluate the clinical effect of the surgery during follow-up.Results All the 186 patients had no complications of bleeding and infection.The mean distance between both gonions measurement was (117.3±2.5) mm before surgery and (102.6±2.3) mm after operation;it was reduced (14.1 ±2.4)mm.After 1 month to 2 years of follow up,the width of the lower face was reduced in the frontal view and the mandibular angle appeared natural and inconspicuous in the lateral view.The patients were satisfied with both their frontal and lateral appearances.Conclusions Intraoral approach mandibular ostectomy with endoscopic-assisted allows surgeons to perform accurate,safe and reproducible ostectomies and to recontour mandible symmetrically and reduce the complications.
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Objective To analyze the effect of the rhinoplasty on body image in the patients receiving cosmetic surgery,to investigate the change of postoperative body image disturbance(BDD)and to analyze the influencing factors of preoperative BDD in order to provide a basis for the psychological health management and reference for the diagnosis and treatment of plastic surgery.Methods A prospective study was performed on 84 patients with rhinoplasty admitted to the Affiliated Friendship Aesthetic Plastic Surgery Hospital of Nanjing Medical University from January 2015 to March 2016.The general data were investigated.The Plastic Psychological State Self-rating Scale was adopted to evaluate the patient′s body image situation,which was reexamined at postoperative 1-3 months.Results The preoperative non-BDD accounted for 60.71％,the occurrence rate of BDD was 19.05％,the other mental disorders,mental diseases or nervous system disease which had no relation with the BDD accounted for 20.24％;the occurrence rate of postoperative BDD was significantly lower than that of preoperative BDD(P＜0.05),moreover the patients with non-BDD had no postoperative BDD occurrence.The scores of question 1-10 before operation in the BDD group were higher than those in the non-BDD group,the scores of question 1-4 after operation in the non-BDD group were decreased,the scores of question 1-4,6-10 in the BDD group were decreased,while the scores of question 1,7,9-10 in the BDD group were higher than those in the non-BDD group(P＜0.05).The proportion of preoperative rhinoplasty and plastic surgery in the BDD group was higher than that in the non-BDD group,the difference was statistically significant(P＜0.05).Conclusion The occurrence rate of BDD in the patients with rhinoplasty is higher,operation is conducive to lessen the BDD,moreover operation itself will not result in new BDD.
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Objective To explore the clinical effect of surgery-first approach (SFA) for correcting adult skeletal class Ⅲ malocclusion deformity patients.Methods A total of 28 adult patients diagnosed with skeletal class Ⅲ malocclusion were treated.Bilateral sagittal split ramus osteotomy (BSSRO) and geniplasty were performed without presurgical orthodontics treatment;postoperative orthodontics treatment was carried out after a healing period of 2-4 weeks.Lateral cephalometric radiographs were taken preoperatively (T1),within a week posoperatively (T2) and six months posoperatively (T3);cephalometric measurements were carried out by the software.Results All the patients were satisfied with the effect,no complications occured.The mean postoperative orthodontics treatment duration was 13.2 months.The mean setback of mandible at Po and B point was (7.74 ± 3.93) mm (P＜0.01) and (8.13±3.84) mm (P＜0.01),and superior movement lengths were (2.73±1.83) mm and (2.76±1.67) mm,respectively.Compared to T2,Po and B point moved forwardly with (2.36±1.23) mm and (2.66±1.65) mm,and inferior movment were (2.16±1.37) mm and (1.21±0.87) mm,respectively.The mean decrease of SNB and GA was (3.74± 1.61)° (P＜ 0.01),(3.41± 1.87)° (P＜0.01),respectively.During postoperative period,both of them increased,although these were no statistical differences.Conclusions SFA combined postoperative orthodontics therapy is feasible for the correction of adult skeletal class Ⅲ malocclusion,which has shorter treatment duration than traditional joint orthognathic-orthodontic.With the advantages of earlier improvements in patient's facial aesthetics and dental function,the reduction in difficulty and treatment duration of orthodontic management,and increasing patient acceptance.
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Objective To assess the perioperative hidden blood loss in aged patients with femoral intertrochanteric fracture.Methods Clinical data of 243 patients (111 males and 132 females) with intertrochanteric fracture admitted from 2009 September to 2015 September were retrospectively reviewed.Two hundred and seventeen patients aged 60-98 years received surgical treatment and 26 patients aged 62-91 years received conservative treatment (non-surgical group).In surgical group,17 cases were operated within 1 d after fracture,71 within 3 d,73 within 7 d,31 within 14 d,and 25 cases were operated after 14 d.Hidden blood loss was evaluated and blood routine was tested.Results The hidden blood loss was (340 ± 216) ml in non-surgical patients,(602 ± 216) ml in patients operated after 14 d,(671 ± 327) ml in patients operated 8-14,(596 ± 362) ml in patients operated 4-7 d,and (505 ± 119) ml in patients operated 2-3 d,(498 ± 244) ml in patients operated within 1 d;there was significant difference among groups (F =14.758,P =0.001).The hemoglobin level in non-surgical group was (121.8 ± 17.6) g/Lwithin 1 d after fracture,(101.1 ±23.3) g/L on 1-3 d,(91.5 ±31.9) g/L on4-7 d,(92.2 ±31.6) g/L on 8-14 d,and (108.3 ± 22.4) g/L after 14 d;there was statistically significant among groups (F =12.457,P =0.001).Conclusions Hemoglobin level in elderly patients with femoral intertrochanteric fracture is dynamically changed,and reaches the lowest point within 1-2 weeks after injury;and operation is an important factor of hidden blood loss in femoral intertrochanteric fracture patients.