Clinical management and prognosis for descending necrotizing mediastinitis / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the clinical characteristics, treatment experiences and prognostic factors for descending necrotizing mediastinitis (DNM). Methods: A retrospective analysis was performed on the data of 22 patients with DNM diagnosed and treated in Henan Provincial People's Hospital from January 2016 to August 2022, including 16 males and 6 females, aged 29-79 years. After admission, all patients underwent CT scanning of the maxillofacial, cervical, and thoracic regions to confirm their diagnoses. Emergency incision and drainage were performed. The neck incision was treated with continuous vacuum sealing drainage. According to the prognoses, the patients were divided into cure group and death group, and the prognostic factors were analyzed. SPSS 25.0 software was used to analyze the clinical data. Rusults: The main complaints were dysphagia (45.5%, 10/22) and dyspnea (50.0%, 11/22). Odontogenic infection accounted for 45.5% (10/22) and oropharyngeal infection accounted for 54.5% (12/22). There were 16 cases in the cured group and 6 cases in the death group, with a total mortality rate of 27.3%. The mortality rates of DNM typeⅠand typeⅡwere respectively 16.7% and 40%. Compared with the cured group, the death group had higher incidences for diabetes, coronary heart disease and septic shock (all P<0.05). There were statistically significant differences between the cure group and the death group in procalcitonin level (50.43 (137.64) ng/ml vs 2.92 (6.33) ng/ml, M(IQR), Z=3.023, P<0.05) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score (16.10±2.40 vs 6.75±3.19, t=6.524, P<0.05). Conclution: DNM is rare, with high mortality, high incidence of septic shock, and the increased procalcitonin level and APACHE Ⅱ score combined diabetes and coronary heart disease are the poor prognostic factors for DNM. Early incision and drainage combined with continuous vacuum sealing drainage technique is a better way to treat DNM.

Effect of Eupolyphaga Sinensis Walker on mandibular distraction osteogenesis in rabbits / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the effect of Eupolyphaga Sinensis Walker on mandibular distraction osteogenesis (DO) in rabbits.</p><p><b>METHODS</b>30 Japanese white rabbits (weight 2.0-2.5 kg, about 3 months old) were divided randomly into control group (n = 15) and experimental group (n = 15). Unilateral mandibular DO models were established at the right mandible of the rabbits. Distraction was started 7 days after the surgery at the speed of 0.4 mm per time twice a day and continued for 10 days. From the first day of distraction to the day of execution, the experimental group rabbits were fed with 2 g of ESW power once a day at 9 o' clock. Three animals in each group were executed respectively at 24 hours, 72 hours, 1 week, 4 weeks and 7 weeks after completion of distraction, and the specimens of DO were harvested. The general observation, X-ray examination, histological study and immunohistochemical staining of bone morphogenetic proteins (BMPs) and vascular endothelial growth factor (VEGF) were performed. The images of immunohistochemical staining of BMPs and VEGF were analyzed by the image analysis software, and the results were analyzed by statistical software SPSS 17.0.</p><p><b>RESULTS</b>The rate of the new bone formation in the experimental group was faster than that in the control group, and the immunohistochemical staining of BMPs and VEGF in the experimental group was higher than that in the control group.</p><p><b>CONCLUSIONS</b>ESW can promote the formation of the new bone in the distracted gap during mandibular DO in rabbits, which may be due to its enhancement effect on the expression of BMPs and VEGF.</p>