Implante Inmediato en Zona Estética Anterior con Pérdida Parcial de la Cortical Vestibular: Reporte De Caso y Revisión de Literatura

El tratamiento con implantes dentales hoy en día es un procedimiento clínico de rutina que permite rehabilitar a los pacientes con prótesis fijas. En este caso presentamos un tratamiento complejo de implantación inmediata del sector anterior con pérdida parcial de la cortical vestibular en el que se realizó una regeneración ósea guiada y provisionalización en un tiempo quirúrgico en un paciente con patología renal. Complementamos el estudio con una revisión de la efectividad de las técnicas utilizadas y las posibles respuestas celular asociadas a la patología renal.

Treatment with dental implants nowadays is a routine clinical procedure that allows patient rehabilitation with fixed prostheses. In this case we present a complex treatment of immediate implantation of the anterior sector with partial loss of the vestibular cortex, in which guided bone regeneration and provisionalization was performed in surgical time in a patient with kidney pathology. The study was complemented with a review of the effectiveness of the techniques used and the possible cellular responses associated with kidney pathology.

Effectiveness of leukocyte- and platelet-rich fibrin in the management of medication-related osteonecrosis of the jaws ­ a systematic review / Efectividad de la fibrina rica en leucocitos y plaquetas en el tratamiento de osteonecrosis mandibular relacionada con medicamentos: una revisión sistemática

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but significant adverse event primarily associated with the intake of antiresorptive and antiangiogenic medications. Although antiresorptive and antiangiogenic the-rapies improve life expectancy, particularly in cancer patients, MRONJ may hamper the patient's quality of life due to pain, discomfort, anxiety, depression, speech impairment, difficulty in swallowing and eating, frequent medical and dental evaluations and treatments, and the possibility of treatment discontinuation. Leukocyte­ and Platelet-rich Fibrin (L-PRF) is an autologous platelet aggregate that promotes wound healing by stimulating re-epithelialization, angiogenesis, and extracellular matrix production. Aim: The present systematic review aimed to compare the results in the published literature on whether L-PRF is an effective and predictable adjuvant to surgical debridement of necrotic bone for improving the healing efficacy in patients with MRONJ. Materials and Methods: The PubMed, Scopus, Cochrane, Science Direct, LILACS, and Web of Science databases were searched using the predetermined MeSH terms and eligibility criteria, and the search yielded a total of five articles. Two studies were retrospective, and three studies were case series. Results: Seventeen participants received a combination of surgical debridement, L-PRF membrane, and antibiotics. Complete wound healing was observed in 70% of the participants, and most of them healed without any complications. Conclusions: L-PRF as an adjuvant to surgical debridement of necrosed bone appears to have a positive association with the healing outcome in patients with MRONJ.

Introducción: La osteonecrosis mandibular relacionada con medicamentos (ONMRM) es un evento adverso raro pero significativo asociado principalmente con la ingesta de medicamentos antirresortivos y antiangiogénicos. Aunque las terapias antirresortivas y antiangiogénicas mejoran la esperanza de vida, particularmente en pacientes con cáncer, la ONMRM puede obstaculizar la calidad de vida del paciente debido a dolor, incomodidad, ansiedad, depresión, discapacidad del habla, dificultad para tragar y comer, evaluaciones y tratamientos médicos y dentales frecuentes, y la posibilidad de interrupción del tratamiento. La fibrina rica en plaquetas y leucocitos (L-PRF) es un agregado de plaquetas autólogo que promueve la curación de heridas al estimular la reepitelización, la angiogénesis y la producción de la matriz extracelular. Objetivo: La presente revisión sistemática tuvo como objetivo comparar los resultados en la literatura publicada sobre si L-PRF es un adyuvante efectivo y predecible al desbridamiento quirúrgico del hueso necrótico para mejorar la eficacia curativa en pacientes con ONMRM. Materiales y Métodos: Las bases de datos de PubMed, Scopus, Cochrane, ScienceDirect, LILACS y Web of Science se registraron utilizando los términos DeCS/MeSH predeterminados y los criterios de elegibilidad, y la búsqueda arrojó un total de cinco artículos. Dos estudios fueron retrospectivos, y tres estudios fueron series de casos. Resultado: Diecisiete participantes recibieron una combinación de desbridamiento quirúrgico, membrana L-PRF y antibióticos. Se observó curación completa de heridas en el 70% de los participantes, y la mayoría de ellos se curaron sin ninguna complicación. Conclusión: L-PRF como adyuvante para el desbridamiento quirúrgico del hueso necrótico parece tener una asociación positiva con el resultado de curación en pacientes con ONMRM.

Evaluación de Protocolos de Autotrasplante Dental Guiado y sus Tasas de Supervivencia y Éxito. Una Revisión Sistemática

Actualmente los factores que influyen en la supervivencia de los dientes trasplantados han podido ser controlados con el uso de la tecnología. El autotrasplante dental guiado ha logrado más predictibilidad y eficiencia, además, h a reducido los tiempos de transferencia desde la extracción hasta el trasplante. El objetivo de esta revisión es describir los protocolos de autotrasplante dental guiado, sus tasas de supervivencia y éxito publicados en la literatura actual. Esta revisió n fue realizada siguiendo la pauta PRISMA. La búsqueda se realizó en MEDLINE, Google Académico, ScienceDirect y SciELO, con los términos "autotransplant", "autotransplantation", "autotransplanting", "dental", "tooth", "teeth", "guided", "guide" con filtro de publicación de 10 años. Se realizó evaluación de riesgo de sesgo mediante pautas Joanna Briggs Institute (JBI) a los estudios, incluyendo en esta revisión sólo con riesgo medio y bajo. Los datos de cada artículo se tabularon en una tabla realizada en el procesador de texto en línea "Google Docs". Diez estudios cumplieron los criterios mencionados y fueron incluidos. Fueron evaluados un total de 37 pacientes entre 9 a 64 años. Los dientes donantes más frecuentes fueron premolares y terceros molares. En la mayoría de los casos los pacientes se encontraban sin antecedentes mórbidos de relevancia. El éxito fue evaluado mediante diversos criterios clínicos y radiográficos. Por otro lado, la supervivencia fue evaluada durante los seguimientos respecto a la permanencia del diente en boca. Este tipo de tratamiento no es muy conocido y los estudios incluidos fueron escasos, por otro lado, estos son de bajo nivel de evidencia (reportes de casos y serie de casos). Los protocolos evaluados difieren en algunas características, sin embargo, todos logran altas tasas de supervivencia y éxito. Igualmente, se presentan algunos fracasos, dónde los dientes debieron ser extraídos por movilidad e inflamación.

Currently, the factors that influence the survival of transplanted teeth have been controlled with the use of technology. Guided dental autotransplantation has achieved greater predictability and efficiency, and has also reduced transfer times from extraction to transplantation. The aim of this review is to describe the protocols of guided dental autotransplantation, their survival and success rates published in the current literature. This review was performed following the PRISMA guideline. The search was carried out in MEDLINE, Google Scholar, ScienceDirect and SciELO, with the terms "autotransplant", "autotransplantation", "autotransplanting", "autotransplanting", "dental", "tooth", "teeth", "guided", "guide" with a 10-year publication filter. Studies were assessed for risk of bias using Joanna Briggs Institute (JBI) guidelines, including only medium and low risk studies in this review. The data for each article were tabulated in a table created in the online word processor "Google Docs". Ten studies met the selection criteria and were included. A total of 37 patients between 9 and 64 years of age were evaluated. The most frequent donor teeth were premolars and third molars. In most cases the patients had no relevant morbid history. Success was evaluated by means of various clinical and radiographic criteria. On the other hand, survival was evaluated during the follow-ups with respect to the permanence of the tooth in the mouth. This type of treatment is not very well known, and the studies included were scarce; on the other hand, they are of a low level of evidence (case reports and case series). The evaluated protocols differ in some characteristics, however, all of them achieve high survival and success rates. There are also some failures, where teeth had to be extracted due to mobility and inflammation.

Fibroma ameloblástico mandibular: caso clínico / Fibroblastic fibroma mandibular: a clinical case

El fibroma ameloblástico (FA) se describe como una neoplasia benigna de origen odontogénico mixto que suele presentarse entre la primera y segunda década de vida, frecuentemente en los molares permanentes inferiores. Por lo general es asintomático, pero las lesiones de gran tamaño suelen acompañarse con dolor e inflamación. Su tratamiento por lo regular es conservador. Se describe el caso de un fibroma ameloblástico en un paciente de 13 años de edad, que involucraba cuerpo y ángulo mandibular izquierdo, tratado de manera conservadora, se realiza extirpación del tumor, regeneración ósea guiada y rehabilitación con implante dental (AU)

Ameloblastic fibroma (AF) is described as a benign neoplasm of mixed odontogenic origin that usually presents between the first and second decade of life, frequently in lower permanent molars. It is usually asymptomatic, but large lesions are usually accompanied by pain and inflammation. His treatment is generally conservative. The clinical case of an ameloblastic fibroma in a 13-year-old patient is described, involving the left mandibular body and angle, treated conservatively, tumor removal, guided bone regeneration and rehabilitation with dental implants are performed (AU)

Research progress on cemental tears in terms of clinical diagnosis and treatment / 口腔疾病防治

@#A cemental tear is defined as an incomplete or complete detachment of the cementum along the dentino-cemental junction (CDJ) or the incremental line within the body of the cementum, which can also involve part of the root dentine adjacent to the cementum. The pathogenesis of cemental tears is not fully elucidated. From the literature review, possible predisposing factors were identified, including tooth type, sex, age, periodontitis, previous periodontal treatment or root canal treatment, history of dental trauma, and occlusal trauma or excessive occlusal force. The morphology of cemental tears can be either piece-shaped or U-shaped, which usually contributes to periodontal and periapical breakdown. Clinically, cemental tears have a unitary periodontal pocket and present with symptoms mimicking localized periodontitis, apical periodontitis, and vertical root fractures. Imaging examination is of great significance for the clinical diagnosis of cemental tears, which often manifest as thin ‘prickle-like’ radiopaque masses located longitudinally adjacent to the affected root surface. Exploratory surgery is needed in some cases. Although intraoperative cemental fragments and cemental lines on the root surface can assist in the diagnostic process, histopathology examination is the gold standard for the diagnosis of cemental tears. The treatment methods vary depending on the timing of the correct diagnosis and the clinical or radiological manifestations. With the development of regenerative biomaterials and the development of intentional replantation, an increasing number of affected teeth can survive for a long time. The aim of this review is to systematically describe the biological basis and predisposing factors, clinical features, radiographic and histological characteristics, diagnosis and clinical management of cemental tears, and treatment outcomes to help make a clear diagnosis and develop a personalized treatment plan.

Bionic design,preparation and clinical translation of oral hard tissue restorative materials / 北京大学学报(医学版)

Oral diseases concern almost every individual and are a serious health risk to the popula-tion.The restorative treatment of tooth and jaw defects is an important means to achieve oral function and support the appearance of the contour.Based on the principle of"learning from the nature",Deng Xu-liang's group of Peking University School and Hospital of Stomatology has proposed a new concept of"microstructural biomimetic design and tissue adaptation of tooth/jaw materials"to address the worldwide problems of difficulty in treating dentine hypersensitivity,poor prognosis of restoration of tooth defects,and vertical bone augmentation of alveolar bone after tooth loss.The group has broken through the bottle-neck of multi-stage biomimetic technology from the design of microscopic features to the enhancement of macroscopic effects,and invented key technologies such as crystalline/amorphous multi-level assembly,ion-transportation blocking,and multi-physical properties of the micro-environment reconstruction,etc.The group also pioneered the cationic-hydrogel desensitizer,digital stump and core integrated restora-tions,and developed new crown and bridge restorative materials,gradient functionalisation guided tissue regeneration membrane,and electrically responsive alveolar bone augmentation restorative membranes,etc.These products have established new clinical strategies for tooth/jaw defect repair and achieved inno-vative results.In conclusion,the research results of our group have strongly supported the theoretical im-provement of stomatology,developed the technical system of oral hard tissue restoration,innovated the clinical treatment strategy,and led the progress of the stomatology industry.

Clinical application of MR-guided radiotherapy based on MR-linac in esophageal cancer patients / 国际肿瘤学杂志

Objective:To explore the application process, efficacy and safety of MR-guided radiotherapy based on MR-linac in esophageal cancer.Methods:The clinical data of patients with esophageal cancer treated with MR-linac at Shandong Cancer Hospital and Institute from September 2021 to July 2022 were retrospectively analyzed, to investigate the treatment process of esophageal cancer with MR-linac, and to analyze the efficacy and safety of patients. All patients received MR-guided radiotherapy, underwent CT and MR localization, target area delineation, and design of the Monaco treatment planning system plan. Adaptation-to-position adjustment was conducted during the pre-treatment evaluation. The median number of fractions was 25, the median single dose of planning target volume was 1.8 Gy, and the median total dose was 50.2 Gy. Median follow-up was 16 months.Results:Among the 12 patients in the whole group, there were 1 case of cervical esophageal cancer, 3 cases of upper thoracic esophageal cancer, 4 cases of middle thoracic esophageal cancer and 4 cases of lower thoracic esophageal cancer, including 3 cases of neoadjuvant radiotherapy and 9 cases of radical radiotherapy. All patients had a smooth treatment process. The median treatment time was 33 min, and the patients had good compliance. For patients with radical radiotherapy, one month after radiotherapy, the number of objective remission cases was 3, and the number of disease-control cases was 9; six months after radiotherapy, the number of objective remission cases was 3, and the number of disease-control cases was 6. All patients treated with neoadjuvant radiotherapy underwent surgery within 2 months, and one patient achieved pathological complete remission. The most common acute adverse reactions were radiation esophagitis (7 cases) and leukopenia in bone marrow suppression (8 cases), with late-stage adverse reactions being radiation pneumonia (1 case). The adverse reactions to radiotherapy were slight, and no grade 4 or above adverse reactions were observed.Conclusion:The clinical treatment process for esophageal cancer under MR-guided radiotherapy based on MR-linac is feasible, with good curative effects and mild adverse reactions.

Application and evaluation study of 3D ultrasound in image guided radiotherapy for prostate cancer / 国际肿瘤学杂志

Objective:To evaluate the accuracy of 3D ultrasound calibration in image guided radiotherapy for prostate cancer by taking cone beam CT calibration as the gold standard, and to analyze the risk factors of accuracy.Methods:From December 2018 to December 2021, 51 patients with prostate cancer from the Department of Radiation Oncology, First Affiliated Hospital of Hebei North University were selected as the study subjects. They received cone beam CT calibration based on bone and 3D ultrasound calibration based on soft tissue before fraction volumetric modulated arc therapy treatment three times a week. Taking cone beam CT calibration data as the gold standard, the Bland-Altman method was used to analyze the consistency of 3D ultrasound calibration data with the former. Taking 3 mm as the allowable threshold of accuracy, the calibration accuracy of 3D ultrasound relative to cone beam CT was evaluated. Logistic regression was used to analyze the risk factors affecting the accuracy of 3D ultrasound calibration.Results:A total of 765 pairs of cone beam CT and 3D ultrasound calibration data were obtained from 51 patients in left-right, superior-inferior and anterior-posterior directions. The calibration data of 3D ultrasound and cone beam CT were (1.39±0.11) and (1.13±0.07) mm in the left-right direction, (1.98±0.20) and (1.61±0.12) mm in the superior-inferior direction, (2.68±0.48) and (1.78±0.27) mm in the anterior-posterior direction, respectively, with statistically significant differences ( t=-6.42, P<0.001; t=-7.07, P<0.001; t=-7.34, P<0.001). The analysis results of Bland-Altman showed that the consistency of calibration data of the two methods were acceptable in three directions. The number of pairs of 3D ultrasound relative to cone beam CT calibration data difference <3 mm in the three directions were 676 (88.37%) on the left-right direction, 604 (78.95%) on the superior-inferior direction, and 577 (75.42%) on the anterior-posterior direction. The factors with statistically significant differences in the left-right direction included age ( χ2=18.27, P<0.001), prostate volume ( χ2=14.55, P<0.001), Charlson comorbidity index (CCI) ( χ2=8.01, P=0.005) and field range ( χ2=11.30, P<0.001). Age ( OR=2.02, 95% CI: 1.90-3.39, P=0.010) and the field range ( OR=1.45, 95% CI: 1.18-2.55, P=0.020) were the independent risk factors affecting the accuracy of 3D ultrasound calibration in the left-right direction. The factors with statistically significant differences in the superior-inferior direction included age ( χ2=80.68, P<0.001), body mass index ( χ2=35.89, P<0.001) and field range ( χ2=40.39, P<0.001). Age ( OR=1.49, 95% CI: 1.15-2.09, P=0.021) and the field range ( OR=1.10, 95% CI: 1.01-1.90, P=0.034) were the independent risk factors affecting the accuracy of 3D ultrasound calibration in the superior-inferior direction. The factors with statistically significant differences in the anterior-posterior direction included age ( χ2=46.07, P<0.001), CCI ( χ2=47.97, P<0.001) and field range ( χ2=11.86, P=0.001). Age ( OR=1.91, 95% CI: 1.22-3.45, P=0.015) and the field range ( OR=2.89, 95% CI: 1.45-3.90, P=0.001) were the independent risk factors affecting the accuracy of 3D ultrasound calibration in the anterior-posterior direction. Conclusion:The consistency and accuracy of the calibration results of 3D ultrasound relative to cone beam CT are acceptable. It is necessary to consider the patient's age and field range to reduce the impact on accuracy before conducting 3D ultrasound calibration.

Application value of hydrogel in image guided radiotherapy for prostate cancer / 解放军医学杂志

Objective To evaluate the application value of hydrogel in image guided radiotherapy(IGRT)for prostate cancer(PCa).Methods Eighty PCa patients in the First Affiliated Hospital of Hebei North University from October 2022 to February 2023 were collected.The patients were divided into experiment group injected with hydrogel(n=33)and control group without hydrogel(n=47)by central random system allocation.The acute and advanced radiation proctitis(RP)incidence rate of the two groups were compared.Patients in experimental group were divided into RP group(n=5)and non-RP group(n=28).The independent risk factors leading to RP were analyzed by using logistic regression for PCa patients.Results In experiment group,12.1％(4/33)of the patients developed acute grade Ⅰ RP,and 3.0％(1/33)developed advanced grade Ⅰ RP.In control group,31.9％(15/47)of the patients developed acute grade Ⅰ RP,and 12.8％(6/47)developed acute grade Ⅱ RP;19.1％(9/47)of patients developed advanced grade Ⅰ RP,4.3％(2/47)developed advanced grade Ⅱ RP,and 2.1％(1/47)developed advanced grade Ⅲ RP.The incidence of acute and advanced RP in experiment group was lower than that in control group(P<0.05).The application of hydrogel effectively reduced rectal toxicity.Age,rectal volume,V70 and V78 were independent risk factors for the incidence of RP in Pca patients(P<0.05).The characteristics of hydrogel injection were not related to the incidence of RP for Pca patients.Conclusions Hydrogel can effectively reduce the rectal toxicity for Pca patients in IGRT and has little impact on the overall treatment.Hydrogel has certain clinical application and promotion value.

The value of CT-guided percutaneous transhepatic gallbladder drainage in the treatment of high-risk acute cholecystitis / 实用放射学杂志

Objective To evaluate the safety and efficacy of CT-guided percutaneous transhepatic gallbladder drainage(PTGBD)in treatment of high-risk acute cholecystitis(AC)patients.Methods CT-guided PTGBD was performed in 29 patients with high-risk AC.The therapeutic results were evaluated by comparing the preoperation and postoperation clinical manifestations and laboratory results.Results The implantation of PTGBD catheter was successfully accomplished with single procedure in all patients.Complica-tions occurred in 2 cases,including abdominal pain in 1 case and a small amount of gallbladder bleeding in 1 case,and the incidence of complications was 6.9%.Compared with preoperation,the pain number rating scale(NRS)score,temperature(T),white blood cell count(WBC),C-reactive protein(CRP),total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were significantly decreased 3 days after PTGBD(P<0.001).Except for 1 case of choledocholithiasis with continuous abdominal pain after PTGBD,the postoperation symptoms of the other patients were significantly relieved.Followed up for 3 months,2 cases of calculous AC recurred after PTGBD,and the recurrence rate of cholecystitis was 25.0%.Conclusion For high-risk AC,the CT-guided PTGBD is a safe and effective treatment method,and it can remarkably relieve the clinical symptoms.Patients with calculous AC have higher risk of recurrence and might benefit from definitive cholecystectomy.

Guided endodontics for the treatment and vital pulp concervation of type Ⅲ Dens Invaginatus in an immature maxillary lateral incisor with periapical periodontitis / 实用口腔医学杂志

A young maxillary lateral incisor of Oehlers type Ⅲ Dens invaginatus with peri-invagination periodontitis was reconstructed by CBCT,with the help of guided endodontics,the pathway to invagination was successfully established.The invaginated pseudo-root canal was treated with Vitapex mediation while preserving the pulp.After 6-month follow-up,the tooth was clinically asymptomatic.Radiological ex-amination indicated complete healing of the peri-invagination lesion with narrowed open apex,and the thickened root canal wall.

Effectiveness of high voltage long duration pulsed radiofrequency versus low temperature plasma radiofre-quence ablation in the treatment of cervicogenic headache / 实用医学杂志

Objective To compare the short-term efficacy and safety of low temperature plasma radiofre-quence ablation(LA)vs.high voltage long duration pulsed radiofrequency(HL-PRF)in the treatment of cervico-genic headache(CEH).Methods Eighty patients with cervicogenic headache were divided two groups:one treated with low temperature plasma radiofrequence ablation group as group L(n = 50)and the other treated with high voltage long duration pulsed radiofrequency group as group H(n = 30).The two groups were compared in terms of the score by the Visual Analog Scale,score by the Range of Motion Scale,postoperative pain relief rate,postop-erative complication incidence,1,4,12,and 24 weeks after the operation,as well as the therapeutic effectiveness and safety.Results Both groups showed significantly lower VAS and ROM scores after operation(P<0.05).Compared with group L,group H had significantly lower VAS(all P<0.05)but insignificantly lower ROM scores(all P>0.05)at each time point.At T4,group H had significantly higher therapeutic effectiveness rate(P<0.05)and higher incidence of scalp numbness at T3,as compared to group L(P<0.05).Conclusion The low tempera-ture plasma radiofrequency ablation and high voltage long duration pulsed radiofrequency both are effective and safe in the treatment of CEH,the latter approach can achieve better therapeutic effectiveness 24 weeks after the operation than the former.

Standard operating procedure for endobronchial ultrasound guided laser multi-point ablation of mediastinal tumors / 天津医药

The treatment of mediastinal tumor has always been a clinical difficulty due to its complex anatomical location and many important organs.Compared with traditional local treatment,endobronchial ultrasound guided laser multi-point ablation of mediastinal tumors has many advantages,including real-time monitoring of ablation range and effect,avoidance of damage to normal tissue and organs,few side effects and good tolerance.This article describes the standard operating procedure for endobronchial ultrasound guided laser multi-point ablation of mediastinal tumors.

Standard operating procedure of the indwelling nasal cannula with or without anchoring for the treatment of pulmonary mycosis / 天津医药

Systemic application of effective antifungal drugs is the basic treatment for pulmonary mycosis,meanwhile,drug spraying under bronchoscope is one of the most important treatment options for tracheal,bronchial and pulmonary mycosis.Compared with bronchoscopic drug injection,indwelling guided drug injection cannula through nasal suspension with or without anchoring has more advantages in the treatment of pulmonary mycosis,including the ability to connect to a syringe pump for continuous and slow injection of drugs,which can avoid repeatedly performing bronchoscopy.This article describes the standard operating procedure of indwelling nasal cannula with or without anchoring for the treatment of pulmonary mycosis.

Preparation and characterization of silk fibroin/bioactive glass composite fiber membrane / 中国组织工程研究

BACKGROUND:In the construction of guided bone regeneration membrane with biological function,a single material cannot meet the clinical needs due to its insufficient function,so the composite of multiple materials has become a trend of tissue repair engineering. OBJECTIVE:To prepare silk fibroin/bioactive glass composite fiber membranes by electrospinning technology,and to characterize the physicochemical properties and biocompatibility in vitro. METHODS:The solution of electrospinning was prepared by dissolving 0.8 g silk fibroin protein in 10 mL hexafluoro-isopropanol alcohol,and the nanofiber membrane of silk fibroin protein was prepared by electrospinning technology(denoted as SF fiber membrane).0.1,0.3,0.5,and 0.8 g of bioactive glass were added to the electrospinning solution,and the silk fibroin/bioactive glass composite fiber membrane was prepared by electrospinning technology(recorded as SF/1BG,SF/3BG,SF/5BG,and SF/8BG fiber membrane in turn).The physicochemical properties and biocompatibility of five groups of fiber membranes were characterized. RESULTS AND CONCLUSION:(1)The scanning electron microscopy results showed that nanofibers of the prepared composite membrane were smooth,continuous and uniform and had no beaded structure.There was no obvious adhesion between the silk fibers,and they all showed random arrangement of disordered porous structures.The fiber diameter of the fiber membrane decreased after the addition of bioactive glass.Fourier infrared spectroscopy and X-ray diffraction detection results showed that the chemical structure of silk fibroin protein and bioactive glass in fiber membrane was stable.The water contact angles of SF,SF/1BG,SF/3BG,SF/5BG,and SF/8BG were 105.02°,72.58°,78.13°,79.35°,and 72.50°,respectively.(2)Bone marrow mesenchymal stem cells were inoculated on five groups of fiber membranes.CCK-8 assay results showed that SF/1BG,SF/3BG,and SF/5BG fiber membranes could promote the proliferation of bone marrow mesenchymal stem cells compared with SF and SF/8BG.Live cell/dead cell staining showed that the cell vitality on the surface of the five groups of fiber membranes was better,and the number and distribution of cells on the surface of SF/5BG fiber membrane were more uniform.Rhodamine phalloidin staining and scanning electron microscopy exhibited that compared with SF fiber membrane,the SF/5BG fiber membrane was more favorable to the adhesion of bone marrow mesenchymal stem cells.Bone marrow mesenchymal stem cells were inoculated on the fiber membrane of the five groups for osteogenic induction differentiation,and the alkaline phosphatase activity of the SF/3BG and SF/5BG groups was higher than that of the other three groups(P＜0.05,P＜0.01,P＜0.001).Alizarin red staining showed that the formation of calcium nodules in fiber membrane increased after the addition of bioactive glass,and the formation of calcium nodules in the SF/5BG group was the most.(3)The results show that silk fibroin/bioactive glass composite fiber membrane has good biosafety and biocompatibility.

Near-infrared fluorescence imaging for intraoperative neuroimaging:current applications and future development / 中国组织工程研究

BACKGROUND:Existing neuroimaging techniques,including magnetic resonance imaging,computed tomography,and high-resolution ultrasound,lack the capability to provide real-time intraoperative positioning images to surgeons.However,the clinical implementation of near-infrared fluorescence imaging technology has made it possible to directly visualize surgical target areas,offering a novel solution for real-time nerve identification during surgery. OBJECTIVE:To provide a summary and overview of the research progress in near-infrared fluorescence imaging technology for intraoperative neuroimaging. METHODS:The first author used the computer to search for the documents published from January 2010 to July 2023 in WanFang,CNKI,and PubMed with the key words of"near-infrared fluorescence imaging,optical imaging,nerve imaging"in Chinese and English.A few classic old documents were also included.Initial screening was performed by reading the titles and abstracts;duplicate,low-quality,and irrelevant content documents were excluded.A total of 69 articles were finally included for review. RESULTS AND CONCLUSION:Near-infrared fluorescence imaging guided by indocyanine green has been clinically used to identify and locate tubular organs such as blood vessels,ureters,and bile ducts,as well as various tumors during surgery.This technique is currently considered a well-established imaging method in precision surgery.In the field of intraoperative neurofluorescence imaging,indocyanine green is currently the only near-infrared fluorescent dye used in clinical research.The ideal neuroimaging agent should possess certain characteristics,including easy administration in the perioperative period,logD between 0.5 and 3 at pH=7.4,molecular mass below 500 Da,excitation and emission wavelengths within the near-infrared window,long-term retention in nerve tissue,high signal-to-background ratio,and high safety.In the future,the development of near-infrared neurofluorescence imaging agents should focus on synthesizing complexes of indocyanine green and neural-specific targets.This technology not only enables intraoperative neurofluorescence imaging,but also holds promising prospects for in-situ monitoring of nerve regeneration and diagnosis of neurological diseases.

Diagnostic value of endoscopic ultrasound-guided tissue acquisition with rapid on-site evaluation performed by endoscopists in immunohistochemistry-required solid pancreatic lesions / 中华胰腺病杂志

Objective:To evaluate the diagnostic value of rapid on-site evaluation (ROSE) performed by endoscopists for solid pancreatic lesions requiring tissue for immunohistochemistry (IHC) staining with different approach of endoscopic ultrasound-guided tissue acquisition (EUS-TA).Methods:After screening 1 573 cases who underwent EUS-TA operation at the Endoscopy Center of Peking Union Medical College Hospital between August 2018 and October 2022, a total of 65 cases of solid pancreatic lesions whose diagnosis rely on IHC staining was collected and summarized with clinical data of each case. Among 65 cases, there were 46 cases of pancreatic neuroendocrine tumors (PNETs), 13 cases of pancreatic solid pseudo-papillary tumors (SPTs), and 6 cases of lymphomas and mesenchymal. Patients were categorized into ROSE group (36 cases) and non-ROSE group (29 cases) according to the presence or absence of endoscopists performed ROSE during EUS-TA operation. They were further divided into subgroups of FNA-ROSE (26 cases), FNB-ROSE (10 cases), FNA-non-ROSE (24 cases) and FNB-non-ROSE (5 cases) according to the type of EUS-TA. Diagnostic accuracy and IHC success rate were compared between different groups and subgroups. Binomial logistic multifactorial regression analysis was used to evaluate the influence of ROSE and EUS-TA type on diagnostic accuracy and IHC success rate.Results:There were no statistically significant differences between ROSE group and non-ROSE group in terms of age, gender, bilirubin level, CA19-9 level, lesion site, lesion size, composition ratio of diagnosis, and surgical rate. The differences in mean size of lesions, needle gauge, location of puncturation, and number of needle pass between subgroups were not statistically significant. The diagnostic accuracy was 88.9% in ROSE group and 79.3% in non-ROSE group, and the difference between the two groups was statistically significant ( P=0.023). The diagnostic accuracy of FNA-ROSE group was higher than that of FNA-non-ROSE group (88.5% vs 75.0%), but the difference was not statistically significant ( P>0.100). The differences in diagnostic accuracy and success rate of IHC between FNB-ROSE group and FNB-non-ROSE group were not statistically significant. Binomial logistic multifactorial regression analysis did not reveal any independent influences on diagnostic accuracy. Conclusions:ROSE performed by endoscopists improved diagnostic accuracy of EUS-TA in solid pancreatic lesions requiring IHC staining, and therefore is potentially valuable for improving the diagnostic efficiency of EUS-TA for such diseases.

Clinical characteristics analysis of primary pancreatic lymphoma / 中华胰腺病杂志

Objective:To analyze clinical characteristics of primary pancreatic lymphoma (PPL) patients.Methods:Clinical features of 22 patients diagnosed as PPL admitted to Peking Union Medical College Hospital from January 2002 to May 2023 were analyzed retrospectively.Results:The median age was 56.4±13.3 years. The median time from onset to diagnosis was 1.0 (1.0, 3.0) months. The main clinical manifestations were abdominal pain (15/22), weight loss (14/22) and jaundice (10/22). Elevated lactate dehydrogenase (LDH) was observed in 15/20 (75%) patients. Only 2 (2/9, 22.2%) patients had increased CA199 levels and 2 (2/9, 22.2%) patients had increased CEA levels. The maximum tumor diameter was 5.0 (3.8, 6.9) cm. Contrast-enhanced CT mostly showed low enhancement lesions. Major pancreatic duct dilatation were rare on CT scan (4/20). Fifteen patients were confirmed by pancreatic pathology, of which 8 were obtained by surgery, 4 were obtained by CT or ultrasound-guided percutaneous biopsy, and 3 were obtained by EUS-FNA. The main pathological type was diffuse large B-cell lymphoma (14/22). 19 patients received chemotherapy, and 6 patients died with a median follow-up of 5.0 (1.5, 35.5) months.Conclusions:PPL is rare and easy to be misdiagnosed. Elevated LDH levels, normal tumor markers, and non-dilatation of main pancreatic duct are important diagnostic clues. It is important to obtain pathology by EUS-FNA and other methods for definite diagnosis.

Application of electromagnetic-guided placement of nasoenteral feeding tubes among aged bedridden patients / 中华护理杂志

Objective To investigate the application effect of electromagnetic navigation bedside nasoenteral intubation technology in elderly bedridden patients.Methods A total of 92 elderly patients with tube feeding in bed in a tertiary A hospital in Beijing from June 2021 to December 2022 were selected by convenience sampling method,and they were divided into an experimental group and a control group with 46 patients in each group by random number table method.The experimental group adopted the electromagnetic navigation bedside nasoenteral catheterization technique and the control group adopted the blind catheterization method.The total success rate of catheterization,the success rate of the first catheterization,the time taken for catheterization,the proportion of catheter tip reaching jejunum,and the incidence of catheter-related complications were compared between the 2 groups.Results There were no shedding cases in both groups.The success rate of total catheterization was 95.7％in the experimental group and 80.4％in the control group.The success rate of first catheterization was 95.7％in the experimental group and 71.7％in the control group.The time taken for catheterization was(12.37±4.19)min in the experimental group and(19.22±5.48)min in the control group.The proportion of catheter tip reaching the jejunum was 60.9％in the experimental group and 28.3％in the control group.The above data were compared between the 2 groups,and the differences were statistically significant(P＜0.05).In terms of the incidence of catheter-related complications,the incidence of epistaxis in the experimental group was 6.5％and it was 21.7％in the control group,and the difference was statistically significant(P=0.036).The positive rate of fecal occult blood test was 2.2％in the experimental group and 17.4％in the control group,and the difference was statistically significant(P=0.030).There was no significant difference in the incidence of nausea,vomiting and abdominal distension between the 2 groups(P＞0.05).No serious complications such as catheter ectopic placement,pneumothorax and perforation occurred in the 2 groups.Conclusion The application of electromagnetic navigation bedside nasoenteral intubation technology for elderly bedridden patients has a high success rate and takes a short time,which can improve the proportion of catheter tip reaching the jejunum and reduce the incidence of epistaxis and fecal occult blood test.

Clinical practice of endoscopic ultrasound-guided liver biopsy among the liver transplant recipients / 中华消化内镜杂志

Objective:To investigate the application of endoscopic ultrasound-guided liver biopsy (EUS-LB) to liver transplant recipients.Methods:In this retrospective cohort study, a total of 12 liver transplant recipients who underwent EUS-LB by the same endoscopist and specimens were diagnosed and reported by the same pathologist due to abnormal liver function or need to be evaluated for graft fibrosis in the Organ Transplantation Center of the Affiliated Hospital of Qingdao University were enrolled into the EUS-LB group from December 2021 to March 2022, meanwhile, a total of 23 patients whose PLB was completed by the same hepatologist and specimens were diagnosed by the same pathologist during the same period were enrolled in the PLB group. Acquisition of liver specimens and postoperative adverse events of the two groups were compared.Results:Patients in both groups were punctured 1-2 times on average, and the median total length of liver specimens in the EUS-LB group was significantly longer than that in the PLB group (61 mm VS 17 mm, Z=11.362, P=0.002). There was no significant difference in the length of the longest liver specimens between the two groups (17.6±6.9 mm VS 13.7±3.5 mm, t=2.382, P=0.086), while the number of liver specimens in the EUS-LB group was more than that in the PLB group (4.8±2.1 VS 2.3±1.2, t=9.271, P=0.001). The number of complete portal tracts was 11.3±4.6 in the EUS-LB group and 6.2±3.3 in the PLB group ( t=8.457, P=0.003). Abdominal pain was the only postoperative adverse event, and only 1 patient in the EUS-LB group had postoperative abdominal pain, which was fewer than that in the PLB group [8.3% (1/12) VS 43.5% (10/23), χ2=4.893, P=0.036]. Conclusion:Compared with PLB, EUS-LB delivers longer liver biopsy specimens with more complete portal tracts in liver transplant recipients, and fewer recipients complain about postoperative pain in EUS-LB group. Therefore, EUS-LB is a safer, more effective and more comfortable liver biopsy method.