Eye diseases associated with developmental abnormality of neural crest / 国际眼科杂志(Guoji Yanke Zazhi)

The neural crest represents a dynamic population of embryonic stem cells, playing a pivotal role in the development of the eye. Through interactions with the surrounding neuroectoderm, superficial ectoderm and mesoderm, the neural crest contributes to the formation of numerous ocular structures, encompassing the corneal stroma and endothelium, trabecular meshwork, iris stroma, ciliary muscle, vitreous and choroidal vessels, and Müller cells. Aberrant migration and development of neural crest cells within the eye can instigate a complex series of ocular diseases. Such diseases include anterior segment like Axenfeld-Rieger syndrome, Peters anomaly, aniridia, primary congenital glaucoma, and Nail-Patella syndrome. Defects that impact the posterior segment may lead to CHARGE syndrome and Branchio-oculo-facial syndrome. Further, rare neurocristopathies such as Waardenburg syndrome, Treacher-Collins syndrome, and Char syndrome can also present with ocular abnormalities. In this review, we explore the ocular diseases that arise from abnormal neural crest cell development, and delve into the related genes involved in neural crest migration and development. We further discuss how mutations and defects in these genes can precipitate ocular diseases.

Split crest con colocación simultánea de implantes en sector anterior: reporte de un caso / Split crest with simultaneous placement of implants in the anterior sector: a case report

La pérdida ósea en el sector anterior, ya sea por un defecto horizontal, vertical o combinado, actualmente es un desafío, no sólo por la integración del implante, sino por la estética involucrada. Entre las técnicas de regeneración ósea que permiten solucionar estos defectos, cabe destacar la técnica de expansión de crestas. Se presenta el caso de una paciente de 58 años con reborde atrófico, que se sometió a la expansión de crestas con colocación simultánea de implantes en sector anterior, con xenoinjerto previo a técnica de expansión de crestas con piezoeléctrico, colocación simultánea de implantes Narrow Connection SLActive Straumann. Se logró ganancia ósea y estabilidad primaria de los implantes, sin complicaciones. En escenarios seleccionados, la técnica de expansión de crestas de manera predecible permite ganancia de hueso horizontal adecuada, el éxito de los implantes con tasa de supervivencia y mínimas complicaciones intra y postoperatorias (AU)

Bone loss in the anterior sector, both a horizontal, vertical or combined defect is a challenge today; not only for the integration of the implant but also the aesthetic involved. There are techniques of bone regeneration that help us to solve this type of defects, among them we should highlight the crest expansion technique. We present the case of a 58-year-old patient with atrophic flange, who underwent the expansion of crests with simultaneous placement of implants in the anterior sector, with xenograft prior to the piezoelectric crest expansion technique, Simultaneous placement of Narrow Connection SLActive Straumann implants, bone gain and primary stability of the implants were obtained, without complications. In selected scenarios, the crest expansion technique could be considered a predictable approach that demonstrates a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications (AU)

Reconstruction Plate Fracture: Mechanism and Recent Advances

Reconstruction plates with or without bone grafts are used to restore mandibular continuity, form and function following segmental resection of mandible. Fracture of reconstruction plate is observed in 2.9 % to 10% of cases reported in the literature excluding other complications. In this case, we report the fracture of stainless steel reconstruction plate used without bone graft and its management using locking reconstruction plate with non vascularised iliac crest graft following removal of the fractured plate. Review of literature describing incidence, pattern and causes of reconstruction plate fracture and its management is discussed.

Dental implant treatment in vascularized bone flaps after jaw reconstruction / 华西口腔医学杂志

Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.

Whole-body vibration exposure characterization in bus drivers of Haikou City: A comparison between two health risk assessment methods / 环境与职业医学

Background Long-term exposure to whole-body vibration (WBV) will affect the health of occupational drivers. However, research on the characteristics of WBV exposure by urban bus drivers and health risk evaluation is still insufficient. Objective To identify the characteristics of occupational WBV exposure of bus drivers serving 31 bus routes provided by three branches of Haikou Public Transport Group, and to evaluate their occupational health risks related to WBV. Methods A total of 31 out of 142 bus routes run by three branches of Haikou Public Transport Group were selected to monitor WBV exposure of 31 bus drivers during driving. WBV parameters such as triaxial frequency weighted acceleration (awx, awy, awz) and triaxial crest factor (CFx, CFy, CFz) of the drivers were determined with a six-channel human vibration meter. Two methods, 8-hour daily value of the weighted root mean square average weighted vibration [A(8)] based on aw and 8-hour daily value of vibration dose [VDV(8)] based on vibration dose value (VDV), were used for health risk assessment and classified WBV health risk results into three levels (high, medium, and low) by the exposure action value (EAV) and exposure limit values (ELV) for A(8) and VDV(8) recommended by ISO 2631-1:1997. The two evaluation methods, A(8) and VDV(8), were compared by Fisher's exact test. Results Regarding the WBV parameters, the vector sum of acceleration (av) was 0.321-0.680 m·s−2, the VDV of monitoring interval was 3.824-10.174 m·s−1.75, and the VDV(8) was 6.039-13.505 m·s−1.75; their values in mean ± standard deviation were (0.480±0.100) m·s−2, (6.987±2.737) m·s−1.75, and (9.773±4.540) m·s−1.75, respectively. Positive correlations were found between awx and awz, av and awz, CFx and CFy, CFy and CFz. No bus route's WBV exposure level was graded as high health risk by either A(8) or VDV(8). The number of routes graded as low health risk by A(8) was 26, while the number by VDV(8) was 12. The consistency rates of health risk levels evaluated by the two methods were 66.7% (6/9), 54.6% (6/11), and 45.5% (5/11) for the three bus group branches, respectively. The difference in WBV health risk assessment results between the two evaluation methods was not statistically significant. Conclusion Positive correlations are found between triaxial acceleration and triaxial crest factor. There is no difference in the results of using A(8) and VDV(8) to evaluate health risks of WBV in urban bus routes.

3D finite element analysis of the influence of upper lip pressure on the maxilla for patients with unilateral alveolar cleft / 口腔疾病防治

Objective @#To investigate the biomechanical effects of upper lip pressure on the maxilla in patients with a unilateral alveolar cleft and provide evidence for clinical diagnosis and treatment. @*Methods @#A 3D finite element maxillary model was generated based on cone beam CT (CBCT) data from an 11-year-old female patient with a unilateral alveolar cleft. Two different kinds of upper lip pressure, postsurgery pressure and normal pressure, were applied to the model. The displacement and stress of each reference node were compared and analyzed. @*Results @# By loading upper lip pressure, the maxillary alveolar crest rotated toward the defect and was displaced downward and backward. The displacement of the noncleft side was greater than that of the cleft side and it decreased gradually from the anterior to the posterior. The stress was concentrated on the anterior portion of the alveolar crest. The stress on the noncleft side was greater than that on the cleft side and it decreased gradually from the anterior to the posterior. The maximum stress was concentrated on the palate around the defect. The displacement and stress in the postsurgery group were greater than those of the normal group (P<0.05). @*Conclusion @#By loading upper lip pressure, the maxilla demonstrated asymmetry three-dimensionally. The adverse effects on the maxilla could be mitigated by reducing the upper lip pressure.

Transiliac endoscopic assisted ilif: a cadaveric study / Ilif assistida por endoscopia por via transilíaca: estudo em cadáver / Ilif asistida por endoscopia transilíaca: estudio en cadáver

ABSTRACT Objective: Demonstrate the feasibility of endoscopic assisted L5S1 intraforaminal lumbar interbody fusion (iLIF) through a transiliac approach. Methods: Ten transiliac iLIF and ten supra iliac iLIF were performed bilaterally at L5S1 in five randomly selected fresh-frozen human cadavers. The following measurements were recorded: distances from the transiliac track to the iliac crest, posterior superior iliac spine, and superior gluteal neurovascular bundle; pelvic parameters; approach angles; cage's lateral and AP center point ratio (CPR); percentage of the cage crossing the midline in the AP and lateral views. Endplate integrity was assessed through endoscopic visualization. In addition, the facet joint, sacroiliac joint, iliolumbar ligament, and exiting and traversing nerve roots were checked for integrity through anatomic dissection. Results: In the transiliac technique, the axial and coronal approach angles were significantly decreased by 13.5º (95% CI -15.5; -11.5; p value<0.001) and 13.2º (95% CI -15.3; -11.1; p value<0.001), respectively, the sagittal approach angle was significantly increased by 5.4º (95% CI 1.8,8.9; p-value = 0.008), and the AP CPR was significantly higher (MD 0.16; 95% CI 0.12,0.20; p value<0.001). The percentage of the cage crossing the AP view's midline was increased by 31.6% (95% CI 19.8,43.4; p value<0.001). The integrity of endplates, facet joints, sacroiliac joints, iliolumbar ligament, and exiting and traversing nerve roots was maintained. Conclusion: L5S1 transiliac iLIF is a feasible surgical technique. It allows a more centrally placed interbody cage in the coronal plane without compromising the anterior position in the lateral plane. The integrity of the major anatomic structures at risk was preserved. Evidence Level III: A case-control study.

Resumo: Objetivo: Demonstrar a viabilidade da fusão intersomática lombar assistida por endoscopia (iLIF) em L5S1 através de abordagem transilíaca. Métodos: Dez iLIF por via transilíaca e dez iLIF por via suprailíaca foram realizados bilateralmente em L5S1 em cinco cadáveres selecionados aleatoriamente. Foram registadas as seguintes medidas: Distâncias da via transilíaca até a crista ilíaca, crista ilíaca póstero-superior e feixe neurovascular do glúteo superior; parâmetros pélvicos; ângulos da abordagem; relação do ponto central lateral e AP do cage (CPR); percentagem do cage cruzando a linha média nas incidências AP e perfil. A integridade das placas vertebrais foi avaliada através de visualização endoscópica. Foi verificada através de dissecção anatómica a integridade das articulações facetárias, sacroilíacas, ligamento iliolombar e raízes de L5 e S1. Resultados: Na técnica transilíaca, os ângulos de abordagem axial e coronal foram significativamente menores em 13,5º (CI 95% -15,5;-11,5; p<0,001) e 13,2º (CI 95% -15,3;-11,1; p<0,001 ), respectivamente, o ângulo de abordagem sagital aumentou significativamente em 5,4º (CI 95% 1,8,8,9; p = 0,008), e o AP CPR foi significativamente maior (MD 0,16; CI 95% 0,12,0,20; p <0,001). A percentagem do cage cruzando a linha média em AP foi superior em 31,6% (CI 95% 19,8,43,4; valor p<0,001). A integridade das placas vertebrais, articulações facetadas, articulações sacroilíacas, ligamento iliolombar e raízes de L5 e S1 foi mantida. Conclusão: A realização de iLIF L5S1 por via transilíaca é uma técnica cirúrgica viável. Permite que o cage seja colocado mais centrado no plano coronal sem comprometer a posição anterior no plano sagital. A integridade das principais estruturas anatómicas em risco foi preservada. Nível de Evidencia III: Estudo caso-controle.

Resumen: Objetivo: Demostrar la viabilidad de la fusión intersomática lumbar asistida por endoscopia (iLIF) en L5S1 con un abordaje transilíaco. Métodos: Se registraron las siguientes mediciones: distancias del abordaje transilíaco a la cresta ilíaca, la cresta ilíaca posterosuperior y el haz neurovascular glúteo superior; parámetros pélvicos; ángulos de abordaje; relación del punto medio lateral y AP del cage (CPR); porcentaje del cage que cruza la línea media en las incidencias AP y perfil. Se evaluó la integridad de las placas vertebrales por visualización endoscópica. Se comprobó la integridad de las articulaciones facetarias, las articulaciones sacroilíacas, el ligamento iliolumbar y las raíces de L5 y S1 mediante disección anatómica. Resultados: En la técnica transilíaca, los ángulos de abordaje axial y coronal fueron significativamente menores en 13,5° (IC 95% -15,5;-11,5; p<0,001) y 13,2º (IC 95% -15,3;-11,1); p<0,001 ), respectivamente, el ángulo de aproximación sagital aumentó significativamente en 5,4º (IC 95% 1,8,8,9; p = 0,008), y el AP CPR fue significativamente mayor (MD 0,16; IC 95% 0,12,0,20; p <0,001). El porcentaje del cage que cruzaba la línea media en AP era mayor en un 31,6% (IC 95% 19,8,43,4; valor p <0,001). Se mantuvo la integridad de las placas vertebrales, las articulaciones facetarias, las articulaciones sacroilíacas, el ligamento iliolumbar y las raíces de L5 y S1. Conclusión: La iLIF transilíaca L5S1 es una técnica quirúrgica viable. Permite colocar el cage más centrado en el plano coronal sin comprometer la posición anterior en el plano sagital. Se preservó la integridad de las principales estructuras anatómicas en riesgo. Nivel de evidencia III: Estudio de casos y controles.

Multiple Grade IV Pressure Injuries in a Young Boy: A Look Into the Pathognomic and Management of Iliac Crest Pressure Injury

Pressure injury (PI) not only exerts a physical burden on a patient’s body but also adds to his mental and economic stress. We, hereby, present a case report of a 17-year-old boy, who sustained a cervical spine injury after a road traffic accident, 10 months back, and later developed multiple pressure injuries over the bilateral trochanter and the left ilium. We discuss the pathognomic of the occurrence of PI at unusual sites like the ilium and our management for coverage of such defects.

A CLINICAL STUDY ON LOWER LIMB CELLULITIS IN NONDIABETIC PATIENTS

Background:Lower limbs are commonly involved in cellulitis as they are more susceptible to injuries. Thisstudy analyses various causes and risk factors for cellulitis in non-diabetics.Method: This retrospective observational study was conducted at department of surgery,AMCMET medical college and Sheth L.G. Hospital, Mani Nagar, Ahmedabad and included 30nondiabetic patients. The severity of cellulitis was graded according to CREST guidelines.Demographics, Risk factors, grades, management and treatment outcomes were recorded andanalyzed.Results: Cellulitis was more common in males and in young adults. It was more unilaterallyand resulted more commonly by trauma. Severe grades needed surgical intervention.Conclusions: Non diabetic patients with lower limb cellulitis can also result in severe morbidconsequences but in the absence of co-morbid illness, they usually recover with minimal residualdisabilities.

The functional outcomes of scaphoid nonunion with deformity treated with anterior wedge bone grafting: A case series

INTRODUCTION@#Scaphoid nonunion is one of the most difficult fractures to treat. Restoration of carpal alignment and fracture stability can provide good outcomes in the management of scaphoid nonunion.@*OBJECTIVE@#The purpose of this study was to determine the functional outcomes of scaphoid nonunion associated with humpback deformity treated with anterior wedge bone grafting and internal fixation.@*METHODS@#A retrospective review of all patients with scaphoid nonunion treated with anterior wedge bone grafting from January 1, 2014 to December 31, 2019 was done. Outcome measurements were time to union, pre- and postoperative FIL-DASH scores, grip, pinch, and scapholunate angle improvement. The other outcome measures were pain and complications.@*RESULTS@#A total of 12 patients were included in the study. All were males with an average age of 27.4 years (SD, 9.6). The average delay to surgery was 9.5 months (SD, 10). All fractures were at the waist, except for three proximal pole fractures, none had established avascular necrosis. Eleven out of 12 scaphoids healed at an average of 11.5 weeks (SD, 3.2). There was a significant improvement in the FIL-DASH score and scapholunate angle after surgical reconstruction. Grip strength averaged 83% of the contralateral side. All returned to previous normal activities. One patient with persistent proximal pole nonunion was managed with a 4-corner arthrodesis.@*CONCLUSION@#Anterior wedge bone grafting for scaphoid nonunion restored the scapholunate angle and was able to establish union in 11 of 12 scaphoid nonunions with good outcomes.

Radiologic evaluation of the anterior and posterior ethmoidal foramen and optic canal by paranasal sinus computed tomography scan among adult Filipinos

Objective@#To measure the average distances from anterior lacrimal crest (ALC) to anterior ethmoidal foramen (AEF), anterior ethmoidal foramen to posterior ethmoidal foramen (PEF) and posterior ethmoidal foramen to optic canal (OC) using plain paranasal sinus (PNS) computed tomography (CT) scans of adults in a tertiary private hospital in the Philippines. @*Methods@#Design: Retrospective review of plain PNS CT scans. Setting: Tertiary Private Teaching Hospital. Participants: One hundred four (104) plain PNS CT scans from January 2018 to December 2020 were considered for inclusion. @*Results@#Of the 104 PNS CT scans, 35 were excluded - seven for age less than eighteen, six for undistinguishable PEF and twenty-two for chronic rhinosinusitis. The remaining 69 PNS CT scans demonstrated identifiable structures, with overall average distances from ALC to AEF of 23.71 ± 2.43 mm, AEF to PEF of 10.87 ± 2.39 mm and PEF to OC of 7.39 ± 2.28 mm. @*Conclusion@#Our study suggests average distances for localization of vital structures such as the anterior ethmoidal artery, posterior ethmoidal artery and optic nerve among Filipinos. Because of considerable variation between and within sexes, individual measurements should still be obtained for each patient in performing endonasal, skull base and orbital surgery.

Research progress on the regulation of craniofacial development and malformation by fibroblast growth factor 8 / 口腔疾病防治

@#Fibroblast growth factor 8 (FGF8) is a kind of secretory polypeptide that has crucial roles in the development of various tissues and organs. Current studies have found that FGF8 can regulate the differentiation of cranial neural crest cells by activating the mitogen-activated protein kinase (MAPK) signaling pathway and affect the establishment of mandibular arch polarity and the development of craniofacial symmetry by regulating the expression of target genes. Cleft lip with or without cleft palate, ciliopathies, macrostomia and agnathia are four developmental malformations involving the craniofacial region that seriously affect the quality of life of patients. The abnormal FGF8 signal caused by gene mutation, abnormal protein conformation or expression is closely related to the occurrence of craniofacial malformations, but the molecular mechanism and signaling pathway underlying these malformations have not been fully elucidated. Craniofacial development is a complex process mediated by a variety of signaling molecules. In the future, the role of various signaling molecules in craniofacial development and malformations need to be explored to provide a new perspective and vision for the prevention and treatment of these craniofacial malformations.

Promoting effect of nicotinamide on generation of neural crest stem cells derived from human embryonic stem cells / 中华实验眼科杂志

Objective:To investigate the role of nicotinamide (NIC) in the differentiation of neural crest cells from human embryonic stem cells (hESCs), and lay the foundation for the induction of hESC-derived corneal endothelial cells.Methods:hESCs line H1 cultured for 5-7 days was used for induction.According to the different components of the neural crest induction medium, cells were assigned into different groups for 7-days induction, including group treated without NIC cultured in induction medium only, group treated with NIC cultured in induction medium containing 10 mmol/L NIC, NIC+ resveratrol (Res) group cultured in induction medium containing 10 mmol/L NIC and 10 μmol/L Res and Sirtinol group cultured in induction medium containing 10 μmol/L Sirtinol.Res and Sirtinol were used as SIRT1 activity agonist and inhibitor, respectively.The relative mRNA expression levels of hESCs and neural crest cell markers were detected by real-time fluorescence quantitative PCR at 1, 3, 5 and 7 days during the induction.The expression of neural crest cells markers after 7 days of induction was assayed by immunofluorescence staining.The induction efficiency of NIC and the effect of SIRT1 regulation on human natural killer 1 (HNK-1) positive cells expression were evaluated through flow cytometry analysis of percentages of nerve growth factor receptor (P75) and HNK-1 + cells. Results:Compared with the group treated without NIC, the mRNA expressions of totipotent genes octamer transcription factor 4 (OCT4) and homeodomain proteins (NANOG) were significantly decreased, and the mRNA expression levels of neural crest cell markers P75, HNK-1, SRY-related HMG box (SOX) 9 and SOX10 were significantly increased in the group treated with NIC after 5 days of induction (all at P<0.05). In the group treated without NIC, P75 was weakly expressed, and HNK-1 was sporadically expressed, and transcription factor AP-2β (AP-2β) and paired-like homeodomain transcription factor 2 (PITX2) were not detected.In the group treated with NIC, P75, HNK-1, AP-2β and PITX2 were strongly expressed.The proportion of P75 + HNK-1 + cells and P75 + cells were both significantly higher in the group treated with NIC than without NIC ( t=8.481, P=0.001; t=2.987, P=0.041). The percentage of HNK-1 + cells in groups treated without and with NIC, NIC+ Res group and Sirtinol group were (34.267±12.522)%, (89.633±1.358)%, (64.667±6.429)% and (86.300±3.460)%, respectively, with a statistically significant overall difference ( F=36.799, P<0.001). The proportion of HNK-1 + cells in NIC+ Res group was significantly lower than that in the groups treated with NIC and Sirtinol (all at P<0.05). Conclusions:NIC promotes the differentiation of hESCs-derived neural crest cells by inhibiting the activity of SIRT1 to enhance the expression of HNK-1.NIC treatment may provide a new strategy for source of seed cells in the treatment of neural crest cell-related diseases, such as corneal endothelial transplantation.

Mandibular distraction of free iliac crest bone graft as treatment in a patient with a history of gunshot wound. case report

ABSTRACT Introduction: The combination of non-vascularized iliac crest bone graft and distraction osteogenesis in a second surgical intervention has only been described to achieve alveolar ridge augmentation. This technique is not recommended to treat bone defects of the jaws caused by firearm projectile. Case presentation: 40-year-old woman with a segmental mandibular defect in the mandible body caused by the impact of a firearm projectile at the age of 1 year. The patient developed a severe Class II dentofacial anomaly that required a two-stage treatment; she underwent mandibular reconstruction with free iliac crest bone graft followed by a bilateral mandibular distraction at the level of the iliac crest bone graft. With these interventions, a remarkable improvement of the patient's malformation was achieved. Conclusion: Horizontal distraction of the free iliac crest bone graft is a safe and predictable procedure to treat dentolabial anomalies requiring mandibular reconstruction. This procedure was performed in the patient without complications. Further studies on the effectiveness of this technique are required.

RESUMEN Introducción. La combinación del injerto de la cresta ilíaca no vascularizado y la distracción osteogénica del injerto en una segunda intervención quirúrgica solo ha sido descrita para lograr un aumento del reborde alveolar. Esta técnica no se recomienda para tratar defectos óseos en la mandíbula causados por proyectil de arma de fuego. Presentación del caso. Mujer de 40 años con un defecto mandibular segmentario en el cuerpo mandibular causado por el impacto de un proyectil de arma de fuego a la edad de 1 año. La paciente desarrolló una anomalía dentofacial grave Clase II que requirió dos tratamientos en diferentes momentos: en primer lugar, se le practicó una reconstrucción mandibular con injerto de cresta ilíaca libre y posteriormente, una distracción mandibular bilateral que incluyó un injerto libre de cresta ilíaca. Con estas intervenciones se logró una mejoría notable de la malformación de la paciente. Conclusión. La distracción horizontal del injerto de cresta ilíaca libre es un procedimiento seguro y predecible para tratar anomalías dentolabiales que requieran reconstrucción de la mandíbula; no obstante, es necesario realizar más estudios sobre la efectividad de la técnica frente este tipo de malformaciones.

Surgical management of ossifying fibroma in the maxilla and its challenges associated with an immediate reconstructive approach with autogenous graft, an unusual case report / Manejo quirúrgico del fibroma osificante en el maxilar y sus desafíos asociados con un enfoque reconstructivo inmediato con el injerto autógeno, un informe de caso inusual

Ossifying Fibroma is a gingival mass in which calcified foci are found. It is a nodular lesion that involves the inserted and interdental gum. There is a predilection for the female sex and for the anterior region of the maxilla. This work aims to report the surgical management of a Ossifying Fibroma in the maxilla and the immediate reconstructive with autogenous graft. Female patient, in the third decade of life, presenting Ossifying Fibroma in the region between maxillary incisors and premolars. She was treated surgically by means of marginal resection of the lesion under general anesthesia and immediate reconstruction with autologous iliac crest graft. Followed up for 12 months with no signs of recurrence.

El Fibroma osificante es una masa gingival en la que se encuentran focos calcificados. Es una lesión nodular que involucra la encía adherida e interdentaria. Hay una predilección por el sexo femenino y por la región anterior del maxilar. Este trabajo tiene como objetivo informar sobre el manejo quirúrgico de un fibroma osificante periférico en el maxilar y su reconstrucción inmediata con injerto autógeno. Paciente de sexo femenino, en la tercera década de vida, presenta un Fibroma osificante en la región entre incisivos maxilares y premolares. Fue tratada quirúrgicamente por medio de una resección marginal de la lesión bajo anestesia general y reconstrucción inmediata con injerto de cresta ilíaca autóloga. Seguimiento durante 12 meses sin signos de recurrencia.

Traumatic recurrent hip dislocation associated with femoral head fracturere constructed with iliac crest autograft / Luxación recurrente de cadera asociada a fractura de cabeza femoral reconstruida con autoinjerto de cresta iliaca

Hip femoral head fractures are extremely uncommon, but likely associated with traumatic hip dislocations. Both lesions require emergent treatment to avoid further complications.19-year-old male patient was received after a high-energy motor vehicle accident with severe brain and thoraco-abdominal trauma and a displaced femoral head fracture with posterior hip dislocation with no acetabular fracture. An emergent open reduction and internal fixation with 2 headless screws was performed, as well as posterior capsule repair. After 1 month as an inpatient in Intensive Care Unit, he sustained a new episode of posterior hip dislocation. Consequently, a second successful surgical reduction was obtained, and hip stability was achieved by posterior reconstruction with iliac crest autograft fixed with cannulated screw and posterior structure repair. Two years later, he was able to walk independently and he does not present any signs of degenerative joint disease nor avascular necrosis.

Las fracturas de la cabeza femoral son extremadamente raras y están asociadas comúnmente con una luxación de cadera traumática. Ambas lesiones requieren tratamiento urgente con el objetivo de evitar complicaciones posteriores. Un paciente varón de 19 años fue trasladado tras un accidente de tráfico de alta energía en el que sufrió un traumatismo craneoencefálico y toracoabdominal grave, además de una fractura de cabeza femoral desplazada junto a una luxación posterior de cadera sin afectación acetabular. De manera urgente, fue intervenido mediante una reducción abierta y fijación interna de la fractura con dos tornillos canulados sin cabeza y reparación de la cápsula articular posterior. Tras un mes de ingreso en la unidad de cuidados intensivos, sufrió un nuevo episodio de luxación posterior de cadera. Debido a ello, se realiza una segunda intervención quirúrgica con reducción abierta y en la que se obtiene una adecuada estabilidad de la cadera mediante reconstrucción posterior con la adición de autoinjerto tricortical de cresta ilíaca y reparación capsular posterior. Después de dos años de seguimiento, el paciente deambula de manera independiente, sin dolor y sin signos degenerativos ni de necrosis avascular en las pruebas de imagen.

Reconstrução mandibular com enxerto livre de crista ilíaca: relato de caso / Mandibular reconstruction with iliac crest free graft: case report

Os defeitos ósseos nos maxilares podem ser causados por patologias como ameloblastoma, carcinoma de células escamosas e sarcomas, bem como, por traumatismos faciais que vão desde acidentes de trânsito a agressões por arma de fogo. As reconstruções de tais defeitos ósseos não deverão apenas devolver a anatomia e contorno da região, mas também, restabelecer a estética e função. A escolha do melhor tipo de enxerto para reconstrução mandibular deverá ser feita de acordo com a característica do defeito e, principalmente, a observação do seu tamanho. O presente trabalho relata o caso clínico de um paciente que procurou o serviço de CTBMF do Hospital da Restauração, queixando-se de deformidade em terço inferior de face após agressão por projétil de arma de fogo (PAF) há, aproximadamente, 2 anos. Ao exame físico apresentava perda de continuidade óssea em região de parassínfise mandibular direita, oclusão pouco funcional e com prometimento funcional. Para o caso foi proposta cirurgia para reconstrução do defeito mandibular com enxerto livre de crista ilíaca. Diante disso, um diagnóstico preciso, planejamento minucioso e boa execução da técnica de reconstrução mandibular com enxerto livre de crista ilíaca proporcionam resultados estéticos satisfatórios, contorno e volume ósseos adequados possibilitando um restabelecimento funcional da área receptora... (AU)

Bone defects in the jaws can be caused by pathologies such as ameloblastoma, squamous cell carcinoma, and sarcomas, as well as facial trauma ranging from traffic accidents to gunshot wounds. Reconstructions of such bone defects should not only restore the anatomy and contour of the region, but also restore aesthetics and function. The choice of the best graft type for mandibular reconstruction should be made according to the characteristic of the defect and, especially, the observation of its size. The present study reports the clinical case of a patient who sought the CTBMF service of the Hospital da Restauração, complaining of deformity in the lower third of the face after aggression by FAP for approximately 2 years. Physical examination showed loss of bone segment in a region of right mandibular paresis, malocclusion and functional impairment. For the case, surgery was proposed to reconstruct the mandibular defect with free iliac crest graft. Therefore, a precise diagnosis, careful planning and good execution of the mandibular reconstruction technique with free iliac crest graft provide satisfactory aesthetic results, adequate bone contour and volume allowing a functional reestablishment of the receiver area... (AU)

A downtrend of mesenchymal cells derived from the second heart field and cardiac neural crest in the outflow tract of cx43 knockout embryonic mouse heart / 中国组织工程研究

BACKGROUND: Cx43 plays an important role in human congenital heart disease. However, there is still no consistent conclusion about the formation mechanism of cardiac malformation in Cx43 knockout mouse embryos. OBJECTIVE: To investigate the cardiac development defects and the migration and differentiation of progenitor cells of the second heart field and cardiac neural crest in Cx43 knockout mouse embryo. METHODS: Serial sections of Cx43 gene knockout homozygous (Cx43-/-) mouse and Cx43 wild-type (Cx43+/+) mouse embryos from embryonic day (ED) 10 to ED13 were made for immunohistochemical and immunofluorescent staining, and three-dimensional reconstruction of the heart. RESULTS AND CONCLUSION: (1) In Cx43 gene knockout mouse embryos at ED10-ED11, Isl1 positive second heart field cells in the ventral mesenchyme of the foregut extended through the area between the bilateral arch arteries to the dorsal wall of pericardial cavity. Meanwhile, Isl1 positive cells in the core mesenchyme of the branchial arches were continuous with those in the dorsal wall of pericardial cavity and the distal wall of the outflow tract. At ED13, the distribution of Isl1 positive cells was observed in the wall of the ascending aorta and pulmonary trunk as well as the wall of the left and right outflow tracts of the septated ventricles. However, compared with wild-type mouse embryos, fewer Isl1 positive second heart field cells were found in Cx43 gene knockout mouse embryos (P < 0.01). (2) During ED10 to ED11, Ap2α positive neural crest cells were still found in the wall of the arch artery and the dorsal and ventral walls of the aortic sac in Cx43 gene knockout mouse embryos, but the number of neural crest cells was less than that of wild-type mouse embryos (P < 0.01). (3) These results indicate that the migration path and distribution pattern of Isl1 positive second heart field cells and Ap2α positive cardiac neural crest cells are similar between the Cx43 gene knockout and wild-type mouse embryos, but the number of two kinds of migrating cells is reduced after Cx43 gene knockout. This suggests that in addition to cardiac neural crest derived cells, the decrease of second heart field progenitor cells might be involved in the formation of outflow tract malformations in Cx43 knockout mouse embryos.

Neural crest stem cells can be induced in vitro from human-induced pluripotent stem cells using a novel protocol free of feeder cells / Journal of Rural Medicine

Objective: Our knowledge of human neural crest stem cells (NCSCs) is expanding, owing to recent advances in technologies utilizing human-induced pluripotent stem cells (hiPSCs) that generate NCSCs. However, the clinical application of these technologies requires the reduction of xeno-materials. To overcome this significant impediment, this study aimed to devise a novel method to induce NCSCs from hiPSCs without using a feeder cell layer.Materials and Methods: hiPSCs were cultured in feeder-free maintenance media containing the Rho-associated coiled-coil forming kinase inhibitor Y-27632. When the cells reached 50–70% confluence, differentiation was initiated by replacing the medium with knockout serum replacement (KSR) medium containing Noggin and SB431542. The KSR medium was then gradually replaced with increasing concentrations of Neurobasal medium from day 5 to 11.Results: Immunocytochemistry and flow cytometry were performed 12 days after induction of differentiation and revealed that the cells generated from hiPSCs expressed the NCSC markers p75 and HNK-1, but not the hiPSC marker SOX2.Conclusion: These findings demonstrate that hiPSCs were induced to differentiate into NCSCs in the absence of feeder cells.

Cresta neural, cuarta hoja, germinativa embrionaria / Neural crest, fourth embryonary germinative leaf

RESUMEN Las células de la cresta neural son pluripotenciales y son llamadas la cuarta hoja germinativa del embrión. Con el objetivo de estructurar los referentes teóricos actualizados que sustenten la afirmación precedente y que constituirá material de estudio para los estudiantes de las Ciencias Médicas, se realizó la revisión de 28 referencias bibliográficas, de ellas 89% actualizadas. Estas células aparecen durante la neurulación y pasado este proceso transitan de epitelial a mesenquimatosa; migran siguiendo señales de la matriz extracelular a todo el cuerpo del embrión diferenciándose en tejidos disimiles. Muy vinculados en su evolución a mecanismos epigenéticos, hacen a esta población celular vulnerables a ser dañadas invocándose en la etiología de diferentes defectos congénitos y enfermedades crónicas no trasmisibles como cáncer. Como conclusión por su pluripotencialidad y por los mecanismos moleculares que distinguen su evolución son consideradas por muchos autores la cuarta hoja germinativa del embrión (AU).

SUMMARY Neural crest cells are pluripotentials, and are called the fourth germinative leaf of the embryo. With the objective of structuring the updated theoretical referents backing up the precedent affirmation that will be study material for the students of Medical Sciences, the authors reviewed 28 bibliographic references, 89 % of them updated. These cells appear during neurulation and after this process they transit from epithelial to mesenchymal; following extracellular matrix signals, they migrate to the whole embryo body differentiating themselves in dissimilar tissues. Tightly related in their evolution to epigenetic mechanisms, this cell population is very likely to be damaged and so they are invoked in the etiology of different congenital defects and noncommunicable chronic diseases like cancer. In conclusion, due to their pluripotentiality and the molecular mechanisms distinguishing their evolution, many authors consider them the embryo´s fourth germinative leaf (AU).