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Objective:To analyze the clinical characteristics of elderly acute pulmonary thromboembolism(APE)patients complicated with preexisting atrial fibrillation(AF)and the impact of preexisting AF on in-hospital adverse outcomes in elderly patients with APE.Methods:A retrospective analysis was performed on elderly APE patients with preexisting AF hospitalized in Beijing Anzhen Hospital, Capital Medical University between January 1, 2008 and December 31, 2021.We compared the comorbidities, symptoms, signs, laboratory test results and echocardiographic features, simplified pulmonary embolism severity index(sPESI)scores and adverse in-hospital outcomes between the preexisting AF group and the non-AF group.Logistic regression was used to analyze the risk factors of in-hospital adverse outcomes in elderly patients with APE.Results:A total of 240 patients diagnosed with APE were enrolled.There were 120 patients in the AF group and 120 patients in the non-AF group.For patients in the AF group and the non-AF group, the proportions with chronic heart failure were 38.3%(46/120)and 15.8%(19/120), the proportions with lower extremity deep vein thrombosis(DVT)were 36.7%(44/120)and 65.8%(79/120), the left ventricular ejection fractions(LVEF)were(59±10)% and(62±7)%, and hospital stays were(15±7)and(11±4)days, respectively, and the differences were statistically significant( χ2=15.381, 20.429, t=2.527, -4.710, all P<0.05). The incidences of in-hospital adverse outcomes in the AF group and the non-AF group were 4.2%(5/120)and 3.3%(4/120), respectively, with no significant difference( χ2=0.000, P=1.000). The overall incidence of in-hospital adverse outcomes was 3.8%(9/240). Multivariate Logistic regression analysis showed that elevated lactic acid was an independent risk factor for in-hospital adverse outcomes( OR=2.753, 95% CI: 1.367-5.542, P=0.005). However, AF( OR=2.880, 95% CI: 0.587-14.141, P=0.192)and sPESI score( OR=2.056, 95% CI: 0.904-4.673, P=0.086)were not associated with in-hospital adverse outcomes. Conclusions:Elderly APE patients with preexisting AF have a relatively low incidence of DVT, but a higher proportion have concurrent chronic heart failure and need a longer hospital stay.Elevated lactic acid is an independent risk factor for in-hospital adverse outcomes of elderly APE patients with preexisting AF.However, preexisting AF has no predictive value for in-hospital adverse outcomes in elderly patients with APE.
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Objective:To investigate the efficacy of internal fixation maintenance after fracture-related infection (FRI).Methods:Retrospectively analyzed were the data of 81 patients with deep FRI after 6 weeks of internal fixation who had been treated with hardware maintenance at Department of Orthopedics, The Second Hospital Affiliated to School of Medicine, Zhejiang University between 2013 and 2021. They were 61 males and 20 females, aged from 11 to 73 years (average, 11 years). After admission, the patients received bacterial culture, thorough debridement, negative pressure suction, soft tissue repair, and local and intravenous antibiotics. If a joint was affected by FRI, its cavity was cleaned and drained. Infection control and fracture healing were regularly observed in all patients. A treatment was considered successful when the internal fixation was maintained until fracture union, and considered as unsuccessful when the internal fixation was removed before fracture union. Risk factors associated with treatment failure were identified from gender, age, smoking, diabetes, fracture type, methicillin-resistant Staphylococcus aureus (MRSA) infection, methicillin-susceptible staphylococcus (MSSA) infection, Pseudomonas aeruginosa infection, Escherichia coli infection, infection by two kinds of bacteria, negative bacterial culture, early infection (within 2 weeks) and local use of antibiotics.Results:All patients were followed up for an average of 30 months (from 6 to 84 months). Fracture union was achieved in 62 (76.5%) patients with infection control and internal fixation retained. Masquelet technique was used to treat bone defects in 2 patients; a muscle flap or skin flap was used to reconstruct soft tissue coverage in 11 cases; fracture union was achieved by antibiotics and dressing changes in 2 patients with sinus tract. Amputation was performed in one unsuccessful case due to uncontrollable infection, and internal fixation was changed to external fixation in the other 18 unsuccessful cases, of which 3 achieved final bone union after application of Masquelet technique, 7 achieved final bone union after application of bone transfer technique, and 3 achieved soft tissue coverage after reconstruction with flap technique. Pseudomonas aeruginosa infection, open fractures and FRI for more than 2 weeks were high risk factors for failure in internal fixation maintenance ( P<0.05). Conclusions:If internal fixation is still stable and effective, hardware maintenance should be tried first in the patients with FRI within 6 weeks after fracture internal fixation. Muscle flap or skin flap surgery should be performed as soon as possible to effectively control infection and promote fracture union in the patients with soft tissue defects after thorough and effective debridement. History of open fracture, Pseudomonas aeruginosa infection, and FRI for over 2 weeks may be risk factors for failure in internal fixation maintenance.
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Objective To investigate the incidence of intercalary fragment in adult ankle fractures and analyze the morphological characteristics of intercalary fragment as well as its relationship with the type of posterior malleolus fractures.Methods Data of 247 cases with posterior malleolus fractures from 369 cases of adult ankle fractures who were treated from January 2014 to January 2016 were retrospectively analyzed.The pre-operative Ⅹ-ray and CT data of the group were analyzed,and the incidence of intercalary fragment was measured.The intercalary fragment was classified by position,size and shape of its morphological features.The posterior malleolus fracture was classified according to Bartonícek classification system.The relationship between type of posterior malleolar fracture and the intercalary fragment was studied.The incidence of malreduction was also studied using the criterion of more than 2 mm separation or step.Results One hundred and six cases had intercalary fragment,accounting for 42.91％ (106/247) of the posterior malleolus fracture,and 28.73％ (106/369) of all ankle fractures.There were 81 cases with intercalary fragment larger than 2 mm,accounting for 32.79％ (81/247) of the posterior malleolus fracture.There were 33 cases with intercalary fragment larger than 5 mm,accounting for 13.36％ (33/247) of the posterior malleolus fracture.The incidence of intercalary fragment occurred in the posterolateral side was 64.15％ (68/247).According to Bartonícek classification,the incidence of type Ⅰ,Ⅱ,Ⅲ,and Ⅳ posterior ankle fracture was 8.91％ (22/247),49.39％ (122/247),21.86％ (54/247),and 19.84％ (49/247),respectively.The incidence of intercalary fragment was 4.54％ (1/22) in type Ⅰ posterior ankle fractures,40.16％ (49/122) in type Ⅱ,70.37％ (38/54) in type Ⅲ,and 36.73％ (18/49) in type Ⅳ.The incidence in type Ⅲ posterior malleolus fracture was significantly higher than that of other types of posterior malleolus fracture.CT scan after operation was conducted in 43 cases in which 19 cases had their intercalary fragment malreducted,accounting for 44.19％(19/43).Conclusion Intercalary fragment has high incidence in the posterior malleolus fracture,and the highest incidence occurs in Bartoníeek Ⅲ type posterior malleolus fracture.The study helps to further understanding and treatment of the posterior malleolus fracture.
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Objective To investigate the value of echocardiography in assessing the right heart function of patients with chronic obstructive pulmonary disease (COPD). Methods Forty-four COPD patients who were treated in Beijing Anzhen Hospital of Capital Medical University, from April 2016 to April 2017, were selected as COPD group; and 12 healthy physical examiners were included in healthy control group during the same period. Patients were divided into COPD with pulmonary hypertension (PH) group and COPD without PH group. All subjects were routinely examined by transthoracic echocardiography. The parameters of right heart function of all subjects were measured by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). Independent sample t test was used to compare echocardiographic routine parameters and recommended parameters of ASE guideline between COPD group and healthy control group. One-way analysis of variance was used to compare the routine parameters of echocardiography and the recommended parameters of the ASE guide in the patients of COPD with PH group and COPD without PH group and the healthy control group. SNK-q test was used for comparison between groups. Results The right ventricle diameter (RVD) in group COPD was wider than that in healthy control group [(20.68±4.21) mm vs (18.17±1.75) mm], and the difference was statistically significant (t=2.92, P=0.005). There was no significant difference in the right ventricular outflow tract (RVOT), main pulmonary artery diameter (MPAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) between the COPD group and the healthy control group. Compared with the healthy control group, the diameter of right ventricle basal segment in the COPD group increased [(35.92±8.12) mm vs (27.75±3.17) mm], tricuspid annular plane systolic excursion (TAPSE) decreased [(19.61±4.08) mm vs (22.67±2.67) mm], right ventricular index of myocardial performance (RIMP) increased [(0.52±0.10) cm/s vs (0.43±0.04) cm/s)], and the differences were statistically significant (t=3.39, P=0.001; t=-2.44, P=0.019; t=4.31, P ＜ 0.001). There was no significant difference in right atrium area, E/A, E/E' and S' between COPD group and healthy control group. There was no significant difference in RVOT, RVD, MPAD, LVEDD, LVESD and LVEF in the patients of COPD with PH group and COPD without PH group and in the healthy control group. There was no significant difference in the right atrium area, E/A, E/E', TAPSE and S'. The right ventricular basal segment diameter and RIMP of COPD with PH group and COPD without PH group were higher than those of healthy control group [(37.99±9.66) mm, (34.47±6.70) mm vs (27.75±3.17) mm; (0.54±0.13) cm/s, (0.51±0.08) cm/s vs (0.43±0.04) cm/s]. The differences were statistically significant (q=6.960, 4.905, 5.796, 4.348, all P＜0.05). However, there was no significant difference in right ventricular basal segment diameter and RIMP between COPD with PH group and COPD without PH group. The RVWT of COPD with PH group was higher than that of COPD without PH group [(5.29±0.69) mm vs (4.54±0.70) mm], and the difference was statistically significant (t=3.313, P=0.002). Conclusions The method recommended in the ASE guidelines for this study was more sensitive than conventional methods for the detection of changes in the structure of the right heart. The change of the right ventricular structure was the first manifestation of right heart involvement in COPD patients, and then the systolic function of the right ventricle diminished. The long-term effect of pulmonary hypertension was thickening of the right ventricular wall at the early stage and then enlargement of the right ventricle.
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<p><b>OBJECTIVE</b>This study aims to identify the effects of corticotomy-assisted orthodontic premolar intrusion andevaluate the changes of root resorption and the alveolar bone.</p><p><b>METHODS</b>Both sides of the mandible of eight male Beagle dogswere randomly assigned into experimental and control groups. The third (P3) and fourth (P4) premolars were intruded withboth mini-screw implant anchorage (MIA) and corticotomy on the experimental side. By contrast, P3 and P4 were intrudedwith MIA alone on the control side. During pre-operation and after 2, 4, 8, and 12 weeks of orthodontic force applications,cone beam computed tomography was performed on every dog. The distance of tooth intrusion and root resorption of furcation, as well as the apex and height changes of the alveolar bone were measured and analyzed.</p><p><b>RESULTS</b>The intrusion distanceof premolars on the experimental side was greater than that on the control side (P < 0.05). The root of furcation and apex onboth sides occurred in root resorption, and the root resorption of the apex on the experimental side was lighter than that onthe control side after 12 weeks of force application (P < 0.05). The alveolar bone height decreased, and the height reductiondistance on the experimental side was greater than that on the control side after 8 and 12 weeks of force application (P < 0.05).</p><p><b>CONCLUSION</b>Corticotomy accelerates orthodontic molarintrusion and reduces root resorption.</p>
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Animals , Dogs , Male , Bicuspid , Bone Screws , Cone-Beam Computed Tomography , Mandible , Root Resorption , Tooth Movement Techniques , Tooth RootABSTRACT
BACKGROUND:Whether the functional mandibular deviation wil cause osteal mandibular deviation and whether the mandibular growth pattern wil change are stil controversial. Vascular endothelial growth factor can increase the endothelial permeability, stimulate endothelial cel mitosis and promote angiogenesis and regulate the formation of bone. OBJECTIVE:To investigate the effect of functional mandibular deviation on the expression levels of vascular endothelial growth factor in condylar cartilage in growing rats. METHODS:Sixty four-week-old male Sprague-Dawley rats were randomly divided into control group (n=20) and experimental group (n=40). Each animal in experimental group received a nichrome appliance which was designed by our team. Lower mandible suffered from left functional deviation (2.1±0.3) mm to simulate functional mandibular asymmetry. RESULTS AND CONCLUSION:The number of vascular endothelial growth factor-positive cels in the sagittal posterior deviation region of rats with functional mandibular deviation was less than that in the non-deviation region at 7-28 days after model establishment. The number of vascular endothelial growth factor-positive cels was less in the sagittal central and coronal central deviation region than in the non-deviation region in rats with functional mandibular deviation at 14-28 days after model establishment, but was close to the control group. The number of vascular endothelial growth factor-positive cels was less in the coronal lateral deviation region than in the non-deviation region and control group in rats with functional mandibular deviation at 14-28 days after model establishment. These results indicated that after the mandible functional lateral deviation in adolescent rats, the expression of vascular endothelial growth factor was different in bilateral condylar cartilage, caused the alterations in osteoblast activity in cartilage, and possibly affected the normal growth and development of rat mandible, suggesting that functional mandibular deviation should be corrected as early as possible.
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<p><b>OBJECTIVE</b>To study the influence of nasolabial angle alteration on facial profile attractiveness and investigate the perception differences in profile attractiveness among laypeople.</p><p><b>METHODS</b>A young Chinese female with normal hard and soft tissue cephalometric values was chosen as a research object. Profile photograph was taken in a natural head position. Photoshop software was chosen to rotate the nose tip and upper lip, thus changing the degree and direction of nasolabial angle. A total of 33 different profile pictures were achieved. Thirty-three professional orthodontists and 64 non-professionals were chosen to score these 33 pictures.</p><p><b>RESULTS</b>When the upper lip position was fixed, the profile was considerably attractive because the angle of nasal tip was not changed or altered. When the nasal tip rotation angle was fixed, profiles with a retroclined upper lip were considered significantly attractive by the layperson and professional groups. Regardless of the direction of the nasal tip rotation, the respondents considered the profile with a retroclined upper lip highly attractive.</p><p><b>CONCLUSION</b>The soft tissue profile with a retroclined upper lip looks considerably attractive in Chinese female populations. Therefore, during an orthodontic treatment, appropriate retraction of the incisor is recommended to improve soft tissue profile attractiveness.</p>
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Female , Humans , Cephalometry , Esthetics , Face , Incisor , Lip , NoseABSTRACT
<p><b>OBJECTIVE</b>This study aims to construct a three-dimensional finite element model of a maxillary anterior teeth retraction force system in light wire technique and to investigate the difference of hydrostatic pressure and initial displacement of upper anterior teeth under different torque values of tip back bend.</p><p><b>METHODS</b>A geometric three-dimensional model of the maxillary bone, including all the upper teeth, was achieved via CT scan. To construct the force model system, lingual brackets and wire were constructed by using the Solidworks. Brackets software, and wire were assembled to the teeth. ANASYS was used to calculate the hydrostatic pressure and the initial displacement of maxillary anterior teeth under different tip-back bend moments of 15, 30, 45, 60, and 75 Nmm when the class II elastic force was 0.556 N.</p><p><b>RESULTS</b>Hydrostatic pressure was concentrated in the root apices and cervical margin of upper anterior teeth. Distal tipping and relative intrusive displacement were observed. The hydrostatic pressure and initial displacement of upper canine were greater than in the central and lateral incisors. This hydrostatic pressure and initial intrusive displacement increased with an increase in tip-back bend moment.</p><p><b>CONCLUSION</b>Lingual retraction force system of maxillary anterior teeth in light wire technique can be applied safely and controllably. The type and quantity of teeth movement can be controlled by the alteration of tip-back bend moment.</p>
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Humans , Finite Element Analysis , Incisor , Maxilla , Tooth Movement Techniques , Methods , Tooth Root , TorqueABSTRACT
<p><b>BACKGROUND</b>Exposure of adult mice to more than 95% O2 produces a lethal injury by 72 hours. Nuclear factor kappa B (NF-κB) is a transcriptional factor that plays a key role in the modulation of cytokine networks during hyperoxia-induced acute lung injury (ALI). Osteopontin (OPN) is a phosphorylated glycoprotein produced principally by macrophages. Studies have reported that exogenous OPN can maintain the integrity of the cerebral microvascular basement membrane and reduce brain damage through inhibiting NF-κB activities in the brain after subarachnoid hemorrhage. However, it is not clear whether OPN can reduce lung injury during ALI by inhibiting transcriptional signal pathways of NF-κB and consequent inhibition of inflammatory cytokines. Thus we examined the effects and mechanisms of recombinant OPN (r-OPN) on ALI.</p><p><b>METHODS</b>Ninety-six mice were randomly divided into phosphate buffered saline (PBS) and r-OPN groups. Mice were put in an oxygen chamber (>95% O2) and assessed for lung injury at 24, 48, and 72 hours. Expressions of NF-κB, matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9), and tissue inhibitors of MMP-2 and MMP-9 (TIMP-1, TIMP-2) mRNA in lungs were examined with RT-PCR. Expression and distribution of NF-κB protein in lungs were measured with immunohistochemistry.</p><p><b>RESULTS</b>Exposure to hyperoxia for 72 hours induced more severe lung injury in the PBS group compared with the r-OPN group. Expression of NF-κB mRNA in the PBS group exposed to hyperoxia for 48 and 72 hours was significantly higher than the r-OPN group (P < 0.05). With 72-hour exposure, expression of TIMP-1 mRNA in the r-OPN group was significantly higher than that of the PBS group (P < 0.05). Expression of TIMP-2 mRNA in the r-OPN group at 48 and 72 hours was significantly higher than those in the PBS group (P < 0.05). After 72-hour exposure, expression of NF-κB protein in airway epithelium in the PBS group was significantly higher than that in the r-OPN group (P < 0.05).</p><p><b>CONCLUSION</b>r-OPN can inhibit the release and activation of MMPs through inhibition of the expression of NF-κB and promotion of the expression of TIMPs, and alleviate hyperoxia-induced ALI.</p>
Subject(s)
Animals , Mice , Acute Lung Injury , Genetics , Metabolism , Hyperoxia , Metabolism , Matrix Metalloproteinase 2 , Genetics , Metabolism , Matrix Metalloproteinase 9 , Genetics , Metabolism , NF-kappa B , Genetics , Metabolism , Osteopontin , Genetics , Metabolism , Tissue Inhibitor of Metalloproteinase-1 , Genetics , Metabolism , Tissue Inhibitor of Metalloproteinase-2 , Genetics , MetabolismABSTRACT
Objective To investigate the role of interstitial collagenase in the pathogenesis of acute lung injury induced by hyperoxia outside of sealed cages and breath room air,and to study the mechanism of The severity of lung injury.Methods Seventy-two C57BL/6 mice were divided into normal control group,hyperoxia for 24 hours group,hyperoxia for 48 hours and hyperoxia for 72 hours group randomly,18 mice in each group.The hyperoxia group exposedin sealed cages with＞95%oxygen,and the control group were put in the inspiratory room.The expression of interstitial collagenase mRNA and protein in lung tissues was studied by reverse transcript-polymerase chain reaction(RT-PCR)and immunohistochemistry.Results Hyperoxia caused acute lung injury in mice.by The expression of interstitial collagenase mRNA in lung tissues was increased after 24 hours of hyperoxia compared with their control group[0.59±0.11 vs 0.07±0.01,q=3.t5 P＜0.01],the expression was higher at 72 hours of hyperoxia(0.68±0.12,q=3.78 P＜0.01).Immunohistochemistry study showed interstitial collagenase protein was mainly expressed in cytoplasm of airway epithelial cells,while Ⅱ type alveolar epithelial cells mainly and vascular smooth muscle cells in hyperoxia mice.The expression of interstitial collagenase protein in airway epithelium significantly increased at 24 hours of hyperoxia compared with their control group[(28.54±9.60) vs (13.48±4.32)q=2.62 P＜0.05],and the expression level was lower after 48 and 72 hours of hyperoxia(20.32±5.68) vs, (15.24±4.65).Conclusion Hyperoxia cause acute lung injury in mice;interstitial collagenase play an important role in the development of hyperoxia-induced lung injury in mice.