A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions / 北京大学学报(医学版)

OBJECTIVE@#To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask.@*METHODS@#In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis.@*RESULTS@#Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R2=42.5%.@*CONCLUSION@#RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.

Evaluation of maxillary three-dimensional changes in maxillary protraction with alternating rapid palatal expansion and constriction based on the cone-beam computed tomography / 北京大学学报(医学版)

OBJECTIVE@#To use the cone-beam computed tomography (CBCT) to evaluate the three-dimensional (3D) changes of maxillary landmarks in the maxillary protraction with alternating rapid palatal expansion and constriction and with rapid palatal expansion, and to provide some clinical suggestions for the early treatment of Class III malocclusion.@*METHODS@#A total of 36 maxillary retrusive patients were included and randomized in a 1:1 ratio to either the intervention group (alternating rapid palatal expansion and constriction group, RPE/C) or the control group (rapid palatal expansion group, RPE). Randomization was accomplished with permuted block randomization based on participation sequence. The patients in the RPE/C were treated for 10 weeks (0.5 mm/d) with the repetition of two-week palatal expansion and two-week palatal constriction. The patients in the RPE were taught to complete rapid palatal expansion for 2 weeks (0.5 mm/d ). The patients were instructed to come to the office for the follow-up to ensure the correct procedures. Damaged expanders were repaired (or replaced) and rebanded quickly. Sequential CBCT images including pretreatment (T1), post-expansion (T2) and post-protraction (T3) were required for 3D reconstruction, establishment of landmarks, measurement and analysis by Mimics 10.01.@*RESULTS@#There was significant forward movement of subspinale (A) in the RPE/C after the treatment with (3.06±1.29) mm, compared with RPE (2.16±1.27) mm, P<0.05. There were more symmetrical changes of the landmarks in the RPE/C and there was no statistic significance of the entire treatment time between the two groups. Moreover, the maxillary skeletal landmarks had the following 3D changes of a forward and downward movement during the expansion stages T2-T1, a forward and upward movement during the protraction stages T3-T2 and a forward and downward movement during the total treatments T3-T1 compared with the control group. And the width between the bilateral landmarks increased during the expansion stages T2-T1, narrowed down during the protraction stages T3-T2 and increased during the total treatments T3-T1.@*CONCLUSION@#The maxillary protraction with alternating rapid palatal expansion and constriction provided clinical benefits on maxillary advancement and symmetrical changes in the orthopedic treatment of the patients with maxillary retrognathism and it required further study on the orthodontic analysis and measurements of CBCT.

An investigation of serum and hair levels of selenium in patient with Keshan disease and in healthy controls of Keshan disease area / 中国地方病学杂志

Objective To measure the serum selenium levels in patient with Keshan disease(KSD)and in healthy controls in Shandong,Sichuan and Inner Mongolia KSD areas,to monitor the long-term dynamic changes of hair and serum selenium levels in Shandong KSD areas,and to provide scientific basis for preventing KSD.Methods A cross-sectional survey was carried out in KSD areas of Shandong,Sichuan and Inner Mongolia in 2009.The research subjects which come from KSD areas were 77 cases and 63 healthy controls from Shandong;35 patients and 36 healthy controls from Sichuan;and 17 patients and 18 healthy controls from Inner Mongolia.Additional 33 healthy people from Jinan city were selected as controls of non-KSD areas.Blood and hair samples were collected and selenium levels were measured by 2,3-diaminonaphthalene fluorescence spectrometry.Retrospective method was used to analyze the hair and serum selenium data collected between 1976 and 2004 in Shandong KSD areas.and these data were eompard with the data of 2009 to observe the long-term dynamic changes.Results ① The serum selenium levels of KSD patients in Shandong and Inner Mongolia were significantly lower than that of healthy subjects of KSD areas[(0.0773±0.0113)vs(0.0895±0.0256),(0.0347±0.0107)vs(0.0469±0.0161),t=3.52,3.87,all P<0.01].No significant difference was found between KSD patients and healthy people in Sichuan[(0.0792±0.0162)vs(0.0774±0.0103),t=0.55,P>0.05].②The serum selenium levels of KSD patients in Shandong,Sichuan and Inner Mongolia KSD areas were lower than that of non-KSD area[(0.0988±0.0231)mg/L,q=6.74,5.83,19.47,all P<0.01].The serum selenium levels of healthy people in Sichuan and Inner Mongoha KSD areas were significantly lower than that of non-KSD area(q=6.68,16.36,all P<0.01).The serum selenium levels of healthy controls in Inner Mongolia were lower than that of in Shandong and Sichuan(q=13.63,14.74,13.62,1.46,all P<0.01).③From 1976 to 2009,the hair and serum selenium levels of Shandong resident were increased 1.68 times(0.343/0.128-1)for hair and 0.98 times(0.091/0.046-1)for serum,respectively.But there was no significant difference between the average growth rate of hair and serum selenium levels(χ2=1.38,P>0.05).Conclusions ①The hair and serum selenium levels of KSD patients are lower than that of healthy controls in non-KSD area.②The serum selenium levels of Shandong,Sichuan and Inner Mongolia are different between KSD patients and healthy controls in the diseased areas.③The hair and serum selenium data of Shandong resident show an upward vend over the past 30 years.We suggest to continue the comprehensive measures of adding selenium in KSD areas.

Analysis of clinical characteristics and diagnosis of 163 patients with chronic Keshan disease / 中国地方病学杂志

Objective To observe the incidence and clinical characteristics of chronic Keshan disease in recent years, and to provide evidence for diagnosis of the disease. Methods From March to August 2009, 163 patients with chronic Keshan disease were chosen from Shandong, Sichuan, Inner Mongolia and Cansu. Of these patients, 62 cases were from Shandong, 34 cases from Sichuan, 37 cases from Inner Mongolia, and 30 cases from Gansu. All of the subjects underwent detailed natural history of the disease, careful physical examination and electrocardiogram (ECG), X-ray chest radiography and cardiac ultrasound examination. The incidence and clinical features were analyzed. Results Adults accounted for 98.8%(161/163) and children for 1.2%(2/163) in 163 cases of chronic Keshan disease, with an average age of 45.8 years. Slow onset accounted for 62.6%(102/163), other types that evolved into chronic-type accounted for 37.4%(61/163). Low blood pressure( 116.5/72.4 mmHg),often with cardiac function grade Ⅱ accounted for 65.6%(107/163). Common symptoms were: palpitation[86.5%(141/163)], asthma [76.7% (125/163)], fatigue[76.1%(124/163)], precordial discomfort [54.6% (89/163)], dizziness[50.3%(82/163)], edema of lower limbs[44.8%(73/163)], and anorexia[38.0%(62/163)]. Common signs were: low-weak first heart sound[66.9%(109/163)], heart enlargement[64.4%(105/163)], apical pulse dispersion[42.3%(69/163)], arrhythmia[40.5%(66/163)], hepatomegalia[39.3%(64/163)], systolic murmur [25.2%(41/163)], and edema[20.9%(34/163)]. Abnormal ECG detection rate was 93.9%(153/163), with common types followed by ST-T changes[ST-T changes, ST segment changes, Tchange, 36.2%(59/163)], ventricular premature [occasional and frequent ventricular premature, 26.4% (43/163)], complete right bundle branch block [25.8% (42/163)], atrial fibrillation[19.0%(31/163)], and atrioventricular conduction block[8.6%( 14/163)]. X-ray results showed that significant and moderate heart enlargement were common, accounting for 73.4%( 105/143), followed by mild enlargement of 25.2%(36/143). Color doppler ultrasound examination results showed that the atrio-ventricular cavity diameter increased, followed by left ventricular end-systolic diameter increased[81.3%(52/64)], left ventricular end-diastolic diameter increased[65.6%(42/64)], left atrial enlargement[51.6%(33/64)], right atrial enlargement [43.8%(28/64)], and right ventricular enlargement[32.8%(21/64)]. Left ventricular wall and interventricular septum thinning accounted for 15.6%( 10/64) and 7.8%(5/64), respectively. Conclusions In recent years, most cases of chronic Keshan disease occur as natural chronic type, and at older age at onset with low blood pressure.Main clinical features of the disease are cardiac enlargement, inadequate tissue perfusion, and venous stasis performance caused by cardiac decompensation. Correct diagnosis of chronic Keshan disease can be made based on these clinical features.

A clinical study on orthodontic treatment after tooth autotransplantation / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the pulp vitality, the periodontal condition and the success rate of autotransplanted teeth after orthodontic treatment.</p><p><b>METHODS</b>A total of 20 permanent teeth (one of them had been treated by root canal therapy), 17 with completely developed roots and 3 with developing roots, were autotransplanted to the region of missing teeth in 16 admitted patients. Orthodontic treatment was carried out in all cases. Clinical and radiographic evaluation of the transplanted teeth was done.</p><p><b>RESULTS</b>The average time of postoperative orthodontic treatment was 1.9 months. In all, one autotransplanted tooth was lost because of periodontal disease during follow-up. Eight autotransplanted ones had positive electric pulp testing (EPT) response. Fifteen out of 20 autotransplanted teeth were surrounded by newly-formed periodontal space with normal size and lamina dura. The numbers of surviving and successful autotransplanted teeth were 19 and 15, respectively, after an average observation period of 24.5 months.</p><p><b>CONCLUSIONS</b>Orthodontic treatment of autotransplanted teeth was acceptable and the pulp vitality of the teeth might be preserved.</p>