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Temporomandibular joint (TMJ) related signs and symptoms are frequently found in adolescent and adult orthodontic patients. TMJ health has long been considered important in orthodontic treatment for many decades, and routine screening and management of TMJ problems should be emphasized in orthodontic population. This paper was to review the TMJ problems in orthodontic patients and to set the strategy in clinical orthodontics.
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Objective@#To compare the MRI features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.@*Methods@#The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed. Of the 26 males and 7 females aged (56.0±9.8) years, there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients. All patients underwent contrast-enhanced abdominal MRI scans. The differences in the MRI features, including morphology, margin, signal intensity on plain scanning and enhancement patterns were compared statistically. The apparent diffusion coefficient (ADC) values of peliosis hepatis, hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.@*Results@#In 14 lesions of the 11 patients with peliosis hepatis, 10 lesions were ill-defined and 4 lesions were well-defined. In 31 lesions of the 22 patients with hepatic metastases, 5 lesions were ill-defined and 26 lesions were well-defined. Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P<0.05). The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P<0.05). In all the 14 lesions of peliosis hepatis, 10 lesions showed gradual filling enhancement, and 4 lesions showed marked and persistent enhancement. In all the 31 lesions of hepatic metastases, 28 lesions showed a ring-shaped enhancement, and 3 lesions showed "quick in and quick out" enhancement.@*Conclusions@#The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined, with no restriction of water diffusion in the diffusion weighted imagings, and with progressive enhancement. The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Objective To compare the MR] features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.Methods The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed.Of the 26 males and 7 females aged (56.0 ± 9.8) years,there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients.All patients underwent contrast-enhanced abdominal MRI scans.The differences in the MRI features,including morphology,margin,signal intensity on plain scanning and enhancement patterns were compared statistically.The apparent diffusion coefficient (ADC) values of peliosis hepatis,hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.Results In 14 lesions of the 11 patients with peliosis hepatis,10 lesions were ill-defined and 4 lesions were well-defined.In 31 lesions of the 22 patients with hepatic metastases,5 lesions were ill-defined and 26 lesions were well-defined.Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P ＜ 0.05).The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P ＜ 0.05).In all the 14 lesions of peliosis hepatis,10 lesions showed gradual filling enhancement,and 4 lesions showed marked and persistent enhancement.In all the 31 lesions of hepatic metastases,28 lesions showed a ring-shaped enhancement,and 3 lesions showed "quick in and quick out" enhancement.Conclusions The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined,with no restriction of water diffusion in the diffusion weighted imagings,and with progressive enhancement.The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Objective To evaluate the preventive effect of a high loading dose of Rosuvastatin on contrast-induced nephropathy (CIN )after PCI in high-risk patients. Methods A total of 199 patients with diabetes mellitus and chronic kidney disease (CKD)(45< GFR<90 ml · min-1 · 1.73 m -2 )scheduled for PCI were included and randomized into two groups ,one group receiving a high loading dose of rosuvastatin(20 mg Rosuvastatin in 3 days before and after PCI ,Rosuvastatin Group-RG)and the other one (Control-Group-CG)receiving 10 mg/d Rosuvastatin.Serum samples were collected at baseline ,48 and 72 hours after PCI for testing of creatinine ,C-reactive protein (CRP ) , interleukin-6(IL-6) ,and malondialdehyde(MDA). Results Post-PCI levels of CRP ,IL-6 ,and MDA in the RG were significantly lower than in the CG [(10.44 ± 3.82 )mg/L vs. (12.62 ± 3.68) mg/L , (14.66 ± 3.61 )ng/L vs. (16.41 ± 4.73 )ng/L ,(7.2 ± 2.2) mmol/L vs. (8.6 ± 1.5) mmol/L ,P=0.000 ,0.004 ,and 0.000 ,respectively].The levels of creatinine after PCI in both groups were found to be higher than baseline levels ,while the increase in the RG was smaller than in the CG [(10 ± 10)μmol/L vs. (15 ± 15)μmol/L ,P=0.007]. The incidence of CIN in the RG was lower than in the CG (8.2％ vs.19.8％ ,χ2 = 5.573 ,P= 0.018). Conclusions High-dose Rosuvastatin treatment can reduce the incidence of CIN in high-risk patients undergoing PCI.
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Objective To explore the effect of trans theoretical model in changing on healthy behavior of soldiers on plateau area to prevent hemorrhoids. Methods Fifty-four soldiers respectively from the artillery troops and air defenses force troops were selected and divided into control group that received normal healthy education and treatment group that received the healthy behavior intervene based on transtheoretical model and the changes of the behavior at each stage of intervention were observed and contrasted between two groups. Results There was no statistically significant difference in the number of each stage between two groups at 1 and 3 months after intervention (χ2= 1.514, 6.554, P> 0.05). The number of former intention stage, intention stage, preparation stage, action stage, maintain stage at 6 months after intervention in treatment group were respectively 0, 0, 0, 15, 39 cases, and 2, 3, 6, 20, 23 cases in control group respectively, the difference was statistically significant (χ2=15.843, P0.05). The number of daily training of the levator ani less than 5, 6-15, 16-25, 26-35,>35 times at 3, 6 months after intervention respectively was 5, 6, 6, 17 cases and 20, 0, 0, 0, 14, 40 cases in treatment group respectively, 9, 13, 14, 10, 8 cases, and 3, 4, 6, 22, 19 cases in control group,the differences were statistically significant (χ2=13.459, 22.252, P<0.01). The incidence of bloody at 6 months after intervention was 3.70% (2/54) in treatment group and 16.67% (9/54) in control group, the difference was statistically significant (χ2 = 4.960, P < 0.05). Conclusions The intervene based on transtheoretical model can effectively promote the healthy behavior to prevent hemorrhoids and reduce the recurrence rate of hemorrhoids.
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Objective To evaluate the safety of anesthesia endoscopic retrograde cholangio pancreatography (ERCP) under general anesthesia.Methods From January 1st,2008 to June 30th,2016,patients underwent ERCP under general anesthesia were enrolled as anesthesia group and from January 1st,2005 to December 31st,2007,patients accepted ERCP without anesthesia were enrolled as control group.Chi-square test was performed to analyze disease composition,conditions during operation,success rate of operation and complications in these two groups.Results A total of 14 724 patients with ERCP under general anesthesia and 2 102 patients received ERCP without anesthesia were enrolled.In 14 724 patients with ERCP under general anesthesia,1 799 cases had malignant biliary and pancreatic diseases and 12 925 cases with biliary and pancreatic diseases.During the operation,transient hypoxemia occurred in 441 cases (3.00％) and relieved by increasing oxygen flow,lower anesthetic dose or lifting lower jaw.The success rate of ERCP in the anesthesia group (98.41 ％,14 490/14 724) was higher than that in the control group (97.34％,2 046/2 102),and the difference was statistically significant (x2 =11.500,P=0.001).The incidence rate of post-ERCP pancreatitis in the anesthesia group was 2.35％ (346/14 724),which was lower than that in the control group (3.85％,81/2 102),and the difference was statistically significant (x2 =16.813,P＜0.01).Conclusion ERCP under general anesthesia is safe,which could increase the success rate of operation and reduce the incidence rate of post-ERCP pancreatitis.
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Objective To investigate the effects of antibiotic prophylaxis on post-operation complications after endoscopic retrograde cholangio-pancreatography (ERCP).Methods From January 1st,2011 to December 31st,2013,1 951 patients undergoing ERCP were enrolled and divided into postoperative antibiotic prophylaxis group (antibiotics group,630 cases) and postoperative non-antibiotic treatment group (non-antibiotics group,1 321 cases).Complications after ERCP were compared between the two groups.Chi square test,single factor analysis and multiple factor analysis were performed for statistical analysis.Results Among the 1 951 patients,277 patients had postoperative complications:101 patients (5.18％) with post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP),54 patients (2.77％) with hyperamylasemia,134 patients (6.87％) with biliary infection,eight patients (0.41％) with hemorrhage,one patient (0.05％) with intestinal obstruction and one patient (0.05％) with perforation.The incidence of postoperative biliary infection of antibiotics group was 4.44％ (28/630),which was lower than that of non-antibiotics group (8.02％,106/1 321),and the difference was statistically significant (x2 =8.546,P =0.030).The incidences of PEP of antibiotics group and nonantibiotics group were 4.92％ (31/630) and 5.30％ (70/1 321),respectively.The incidences of postoperative hyperamylasemia of antibiotics group and non-antibiotics group were 3.02％oo (19/630) and 2.65％ (35/1 321),respectively.The incidences of upper gastrointestinal hemorrhage were 3.02％ (19/630) and 2.65％ (35/1 321),respectively.The incidences of intestinal obstruction were 0 (0/630) and 0.08％ (1/1 321),respectively,while the incidences of perforation post-operation were 0.16％ (1/630) and 0 (0/1 321),respectively,and the differences were not statistically significant (all P＞0.05).Cholangiocarcinoma (odd ratios (OR)=2.93,95％ confidence interval (CI) 1.88 to 4.56,P＜0.01) and repeated ERCP during hospitalization (OR=2.53,95 ％ CI 1.63 to 3.93,P＜0.01) were the independent risk factors of cholangitis after operation.However,endoscopic sphincterotomy (OR=0.65,95 ％ CI 0.44 to 0.97,P =0.030) and antibiotics prophylaxis (OR =0.64,95％ CI 0.39 to 0.95,P =0.030) were the protective factors.Conclusions Antibiotic prophylaxis after ERCP can reduce the occurrence of postoperative cholangitis.Paitents with cholangiocarcinoma,repeated ERCP procedures during hospitalization or without endoscopic sphincterotomy should be recommended for antibiotic prophylaxis.
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Objective To investigate the risk factors for post-ERCP complications. Methods Data of the patients who underwent ERCP in the First Affiliated Hospital of Nanchang University from 1 January 2011 to 31 December 2013 were retrospectively analyzed. Post-ERCP complications were analyzed by univariate and multivariate analyses. Results A total of 277 patients out of 1 951 developed complications, 101(5.18%)pancreatitis, 54(2.77%)hyperamylasemia(not including pancreatitis), 134(6.87%) biliary infection,8(0.41%)hemorrhage,1(0.05%)obstruction and 1(0.05%)perforation.Multivariate analyses showed cholangiocarcinoma(P=0.002,OR=2.39, 95% CI:1.38-4.14), long operation time(>60 min)(P=0.020,OR=3.77,95%CI:1.23-11.53)and endoscopic sphincterotomy(EST)(P=0.008, OR=2.56,95% CI:1.28-5.14)and entrance of guidewire to pancreatic duct(P=0.012,OR=1.43, 95%CI:1.08-1.87)were independent risk factors for PEP. Cholangiocarcinoma(P<0.01, OR=2.93, 95%CI:1.88-4.56),multiple times of ERCP during the period of hospitalization(P<0.01, OR=2.53, 95%CI:1.63-3.93)were independent risk factors for post-cholangitis. However, EST(P=0.03, OR=0.65,95%CI:0.44-0.97)and antibiotics prophylaxis after ERCP(P=0.03, OR=0.64, 95% CI:0.39-0.95)were protective factors for post-cholangitis. ConclusionCholangiocarcinoma, endoscopic sphincterotomy, long operation time(> 60 min)and entrance of guidewire to pancreatic duct were independent risk factors for PEP. Cholangiocarcinoma and multiple ERCP during the period of hospitalization are independent risk factors for post-cholangitis.EST and antibiotics prophylaxis after ERCP might reduce the occurrence of cholangitis.
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Objective To investigate the effect of sevoflurane preconditioning on lung injury induced by limb ischemia-reperfusion in rats and the relationship with endoplasmic reticulum stress.Methods Forty-five healthy male Sprague-Dawley rats,aged 6-8 weeks,weighing 250-300 g,were randomly allocated into 3 groups (n =15 each) using a random number table:sham operation group (group S),limb ischemia-reperfusion group (group LIR),and sevoflurane preconditioning group (group SP).Limb ischemia-reperfusion was induced by clamping bilateral femoral arteries for 3 h followed by 3 h reperfusion in LIR and SP groups.In group SP,2.5％ sevoflurane was inhaled for 30 min,and 15 min later the model was established.Before ischemia and at 3 h of reperfusion (at the corresponding time point in group S),arterial blood samples were collected for blood gas analysis,and arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2) were recorded.The rats were sacrificed at 3 h of reperfusion,and lung specimens were obtained for determination of wet to dry lung weight ratio (W/D ratio) and total lung water content (TLW) and for microscopic examination of the pathological changes,and index of quantitative evaluation for alveolar damage (IQA) was calculated.The expression of glucose-regulated protein 78 (GRP78) and CCAAT/enhancer-binding protein homologous protein (CHOP) protein and mRNA in lung tissues was detected by Western blot and real-time polymerase chain reaction,respectively.Results Compared to group S,the PaO2was significantly decreased at 3 h of reperfusion,the W/D ratio,TLW and IQA were significantly increased,the expression of GRP78 and CHOP protein and mRNA was significantly up-regulated (P＜0.05),and no significant change was found in PaCO2 in group LIR (P＞0.05).Compared to group LIR,the PaO2 was significantly increased at 3 h of reperfusion,the W/D ratio,TLW and IQA were significantly decreased,the expression of GRP78 and CHOP protein and mRNA was significantly down-regulated (P＜ 0.05),and no significant change was found in PaCO2 in group SP (P＞0.05).Conclusion Sevoflurane preconditioning can ameliorate lung injury induced by limb ischemia-reperfusion in the rats,and the mechanism is related to inhibition of endoplasmic reticulum stress.
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Objective To observe the efficacy and safety of endoscopic variceal ligation (EVL) and esophageal variceal sclerotherapy (EVS) with different hardeners for esophageal variceal bleeding (EVB).Methods Clinical data of 314 patients with EVB were retrospectively reviewed.The patients were divided into 5 groups according to the endoscopic treatments they have received,i.e.,endoscopic variceal ligation (EVL) group (n =112),sodium morrhuate sclerotherapy (EVS1) group (n =48),lauromacrogol sclerotherapy (EVS2) group (n =40),EVL plus sodium morrhuate sclerotherapy (EVLS1) group (n =26) and EVL plus lauromacrogol sclerotherapy (EVLS2) group (n =88).The efficacy,variceal recurrence rate and complication rate were evaluated.Results There was no significant difference in efficacy of stop bleeding among 5 groups,which was 85.7％ (96/112) in EVL group,83.3％ (40/48) in EVS1 group,92.5％(37/40) in EVS2 group,92.3％ (24/26) in EVLS1 group and 94.3％ (83/88) in EVLS2 group (P ＞0.05).The complete cure rates in EVLS1 group (88.5％,23/26) and EVLS2 group (87.5％,77/88)were significantly higher than those in 3 other groups (P ＜ 0.05).Rebleeding rates in EVS1 group (18.8％,9/48) and EVL group (11.6％,13/112) were significantly higher than those in other 3 groups (P ＜0.05).The patients were followed up for 6-18 months,and the varices recurrence rate was highest in group EVL (23.2％,26/112) and lowest in EVLS2 (10.2％,9/88,P ＜0.05).The complication rate in group EVS1 (32.2％,49/152) was significantly higher than that in other 4 groups (P ＜0.05).Conclusion EVL plus EVS,either with sodium morrhuate or lauromacrogol EVS is safe and effective for EVB,especially EVL plus Lauromacrogol EVS,may become an optimal therapy to control esophageal variceal bleeding and rebleeding.
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Objective To compare the predictive value of the model for end-stage liver disease (MELD), MELD-Na and Child-Pugh (CP) for rebleeding in decompensated liver cirrhosis patients with esophageal varices within 3-month and 1-year. Methods A cohort of 365 decompensated liver cirrhotic patients with esophageal varices, who were admitted to hospital between Jan.2003 and Oct.2008, were retroseptively studied and followed up at least for one year. Patients were divided into hyponatremia group and normal group. MELD-Na, MELD and Child-Pugh scores were calculated for each patients on the first day of admission.Receiver operating characteristics curves (ROC) and the area under ROC (AUC) were used to determine the ability of three models for predicting rebleeding in 3-month and 1-year. Z-test was used to compare predictive ability of three models. Results At 3-month and 1 year of enrollment, AUC of MELD-Na was 0.825 and 0.842, respectively, whereas AUC of MELD was 0.779 and 0.802, respectively. MELD-Na and MELD were superior to Child-Pugh in rebleeding prediction (0.678 and 0.634, P＜0.05). But there was no significantly difference between MELD-Na and MELD in rebleeding prediction for 3-month and 1-year (P＞ 0.05). Conclusions MELD-Na and MELD are superior to Child-Pugh score in exactly predicting the rebleeding risk in decompensated liver cirrhosis patients with esophageal varices. MELD-Na compensates a deficiency of MELD.
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Objective To evaluate the effect of combined laparoscopic and endoscopic treatment for cholelith of gallbladder and common bile duct(CBD).Methods Diagnosis was established in 44 patients by ERCP , and endoscopic Oddi′s sphincteromy (EST) was performed in all patients, then choledocholith was removed by endoscopic netbasket and balloon. 3～5 days after laparoscopic cholecystectomy(LC) was carried out. Results The success rate of combined treatment in this study was 98%(43/44), and stones were removed in 100%(44/44). There was no conversion to open surgery in our series, and no severe complications. All patients were discharged in 5～15 days postoperatively. Conclusions Combined laparoscopic and endoscopic procedure is a safe and effctive method to treat patients suffering from cholelith of the gallbladder and CBD.