Surgery-first approach for Angle class Ⅲ malocclusion: clinical retrospective analysis of 185 cases / 中华整形外科杂志

Objective@#The purpose of this study was to explore the surgery-first approach in sequential combined orthodontic-orthognathic treatment to shorten total treatment duration and improve the clinical outcome.@*Methods@#This study included 185 patients with Angle classⅢ malocclusion. The patients were divided into 3 different types according to cephalometry analyses and facial features. ①Type Ⅰ: mandibular prognathism or asymmetry mandibular prognathism; ②Type Ⅱ: mandibular prognathism and maxillary retrusion; ③ Type Ⅲ: mild Angle′s Class Ⅲ malocclusion, cross bite in anterior teeth, or normal overlap and overbite relation with midfacial hypoplasia. All of patients received surgery first approach therapy. The surgical procedures were chosen according to different malformation types. Type Ⅰ was treated with the sagittal split ramus osteotomy (SSRO). Type Ⅱ was treated by Le Fort Ⅰmaxillary osteotomy combined with SSRO. Type Ⅲ underwent anterior subapical osteotomy combined pyriform aperture augmentation with biomaterials as well as maxillary anterior orthodontics. All patients received postoperative rapid orthodontic treatment for 6-12 month after 2 weeks of operation. Using the straight arch wire techniques and the class Ⅲ intermaxillary traction, we removed the overcrowding upper and lower teeth, the compensatory axial tilt of teeth, and the deviation of the dental arch and maintained the neutral relationship of the molar. The mandible Hawley retaining devices were used during the maintaining stage.@*Results@#The cases in study acquired satisfactory clinical outcome, which included the shortened overall treatment duration, the significantly improved facial features, the corrected occlusion relationship, and the restored function of mastication and temporomandibular joint. There were some complications as follows: intraoperative fracture (6 cases, 3.24%), the inferior alveolar nerve bundle injury (2 cases, 1.1%), and temporary open-bite that diminished by inter-maxillary elastic distraction one month after operation (19 cases, 10%). All cases in this study accepted postoperative orthodontic treatment. Follow-up time ranged from 6 months to 5 years. The cephalometric analysis results of 126 cases who had complete image data and over 6 months of follow-up showed that hard and soft tissue indexes were restored to normal range after combined orthognathic-orthodontic treatment. The stability of the maxillary and occlusive relationship of SFA(surgery-first approach) was similar to that of the COS(conventional orthodontics-first system) [relapse ratio=(T2-T1)/(T1-T0)×100%]. Over six months of follow-up , SNB and ANB showed that the average relapse ratio were 22% and 19.8%, whereas the relapse angle are less than 2°.@*Conclusions@#The Surgery-first approach could be used to treat most patients with Angle skeletal Class Ⅲ malocclusion, but the indications and the surgical procedures should be noticed and chosen.

Role of orexin-A in doxapram-induced promotion of emergence from general anesthesia / 中华麻醉学杂志

Objective To investigate the role of orexin-A in doxapram-induced promotion of emergence from general anesthesia in patients.Methods Forty-four patients of both sexes,aged 18-60 yr,with body mass index of 21-25 kg/m2,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,scheduled for elective lumbar surgery under general anesthesia,were divided into 2 groups (n =22 each) using a random number table:control group and doxapram group.Anesthesia was induced by intravenously injecting propofol,sufentanil and cisatracurium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained by inhaling sevoflurane and target-controlled infusion of remifentanil.Sevoflurane inhalation and remifentanil infusion were stopped at the end of operation,oxygen flow rate was adjusted to 6 L/min,doxapram 0.5 mg/kg were intravenously injected at the same time in doxapram group,and the equal volume of normal saline was given in control group.The emergence time and extubation time were recorded.On admission to operating room (T0),at 1 h after anesthesia induction (T1) and 5 and 30 min after tracheal extubation (T2,3),arterial blood samples were collected for determination of blood glucose concentrations and plasma orexin-A concentrations (by radioimmunoassay).Results Compared with the baseline at T0,blood glucose concentrations were significantly decreased at T1 and increased at T3,and plasma orexin-A concentrations were increased at T2 in two groups (P ＜ 0.05).Compared with control group,the time to eye opening and extubation time were significantly shortened,plasma orexin-A concentrations were increased at T2 (P＜0.05),and no significant change was found in blood glucose concentrations at each time point in doxapram group (P＞0.05).Conclusion The mechanism by which doxapram promotes emergence from general anesthesia may be related to increasing plasma orexin-A concentrations in patients.

Therapeutic effect of anterior subapical osteotomy combined with postoperative orthodontic treatment for bimaxillary protrusion based on surgery-first approach / 中华整形外科杂志

Objective@#To invesigate the therapeutic effect of anterior subapical osteotomy combined with postoperative orthodontic treatment for bimaxillary protrusion based on surgery-first approach(SFA).@*Methods@#From April 2015 to April 2016, 22 adult patients with bimaxillary protrusion were treated with bimaxillary anterior subapical osteotomy without peroperative orthodontic treatment. Digital computer-aided technology was used for preoperative design and dental model simulation surgery. Then the occlusal guide plate was made for intraoperative built-up of temporary occlusion. Two weeks after orthognathic surgery, a short-term orthodontic treatment was carried out to improve the occlusion. Cephalometric analysis was done to evaluate the treatment effects. 19 cephalometric parameters about hard and soft tissues were measured and compared in all cases before and after SFA combined treatments. All data were statistically analyzed by SPSS software package.@*Results@#Primary healing was achieved in all the 22 cases without any infection or necrosis of bone and dental pulp. During the follow-up period of 6-12 months, all the patients were satisfied with the profile contour. The cephalometric parameters of hard and soft tissues changed remarkably. U1E-McN and L1E-McN set back (-10.5±4.9) mm and (-8.0± 6.9) mm respectively. Upper and lower lip set back obviously. SNA decreased from (82.5±2.8) to (77.9±2.3) degrees on average. SNB decreased from (79.1±5.4) to (74.6±3.8) degrees on average. Upper and lower lip protrusion decreased obviously. TUL-E line decreased from the mean value of (2.7±2.7) mm to (0.5±3.2) mm and TLL-E line from (5.2±4.0) mm to (1.4±2.7) mm. The aesthetic contours were remarkably improved.@*Conclusions@#Anterior subapical osteotomy combined with postoperative orthodontic treatment based on SFA could correct adult bimaxillary protrusion effectively with normal occlusion, satisfactory soft tissue aesthetic profile.

Effect of vein pump injection of epinephrine on serum potassium during gastric cancer radical surgery / 实用医学杂志

Objective To investigate vein pump injection of epinephrine on the effect of serum potassium during gastric cancer radical surgery. Method Forty patients with ASA grade Ⅱ~Ⅲ underwent surgery within a time limit of gastrointestinal under general anesthesia. All patients were randomly divided into the experimental group and the control group.Patients in the experimental group received continuous intravenous injections of adren-aline[0.03 to 0.1 μg/(kg·min)].Patients in the control group received equal dose of saline.Potassium concentra-tions at different time points were determined and compared between patients in two groups. Results No signifi-cant differences were observed in gender and age distribution of patients in the experimental group and the control group. Compared with the control group,potassium concentration was significantly decreased in patients at T3mo-ment(30 min pump injection of norepinephrine)(P<0.05),but was lower than that of patients in the experimen-tal group at T1moment(before anesthesia)(P<0.05).Compared with the control group,potassium concentration was significantly increased in the experimental group at T4moment(pump adrenaline injection for 10 min)(P <0.05),which was also significantly higher than that in the experimental group at T1moment(P < 0.05). Mean-while,compared with the control group,potassium concentration was also significantly increased in the experimen-tal group at T5moment(stop the pump adrenaline injection for 30 min),which was also significantly higher than that in the experimental group at T1moment(P < 0.05). Conclusions Intravenous injection of adrenaline can reduce potassium concentration in patients received gastrointestinal surgery,and potassium concentration can be increased after adrenalin injection was stopped.

Relevance of 5-hydroxytryptamine transporter genepolymorphism and chronic obstructive pulmonary disease / 中国药理学通报

Aim To investigate the relevance of 5-hydroxytryptamine transporter(SERT)gene polymorphism and chronic obstructive pulmonary disease(COPD).Methods A total of 51 COPD patients and 49 healthy controls were collected.SERT gene polymorphism and mRNA expression in COPD and control groups were assayed by PCR and real-time PCR,respectively.Lung function was evaluated by a forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC)and FEV1/FVC.Results Two allele gene 484 bp and 528 bp were detected.It consisted of three genotypes L/L(528/528),L/S(528/484)and S/S(484/484),and SS genotype was prevalent in control and COPD group;SERT mRNA expression in COPD group was higher than that in the control;L allele in COPD with PAH patients was higher than the control.The age at diagnosis of COPD in LS genotype patients was earlier compared with that in SS genotype patients.Conclusion SERT gene polymorphism is relevant to hereditary susceptibility of COPD,which may play an important role in the development of COPD,especially promoting PAH in advanced stage of COPD.

Role of UCH-L1 in protection of fluoxetine against pulmonary arterial hypertension in rats / 中国药理学通报

Aim To study the role of ubiquitin carboxyl terminal hydrolase L1 (UCH-L1)involved in the pro-tective effect of fluoxetine against monocrotaline-in-duced pulmonary arterial hypertension in rats.Meth-ods Monocrotaline (60 mg·kg -1 )was used to es-tablish pulmonary arterial hypertension in rats and low-dose (2 mg·kg -1 ·d -1 )or high-dose (10 mg·kg -1 ·d -1 )fluoxetine was applied to inhibit pulmonary ar-terial hypertension.The hemodynamics,morphology of pulmonary arterioles and lungs,UCH-L1 protein ex-pression and nuclear factor-κB (NF-κB)nuclear trans-location were observed.Results Monocrotaline not only increased pulmonary arterial pressure and promo-ted pulmonary arterial remodelling and lung inflamma-tion,but also down-regulated UCH-L1 protein expres-sion and increased NF-κB activity in lungs.Fluoxetine inhibited these changes in a dose-dependent manner. However,UCH-L1 protein expression of pulmonary ar-teries did not significantly change among different groups.Conclusion Fluoxetine inhibits monocrotal-ine-induced lung inflammation in rats,involved in NF-κB activity inhibited by up-regulated UCH-L1 protein expression.

Expressions of peroxisome proliferator-activated receptors in migraine rat models / 中华神经医学杂志

Objective To detect the expressions of peroxisome proliferator-activated receptor (PPAR) isotypes (PPARα,PPARβ/δ and PPARγ) in migraine rat models induced by nitroglycerin and their roles in morbidity mechanism.Methods Forty-eight SD rats were randomly divided into normal control group,physiological saline control group and migraine model group (n=16).The rat migraine models were established according to Tassorelli Cristina method and performed abdominal subcutaneous injection of nitroglycerin at a dosage of 9.5 mg/kg; rats in the physiological saline control group were given the same volume of physiological saline and that in the normal control group did not receive any treatment.The trigeminocervical complexes were separated from rats in each group.Expressions of PPARα,PPARβ/δ and PPARγ were detected by Western blotting and immunohistochemical method.Results Immunohistochemical staining showed strong positive expressions of PPARα,PPARβ/δ and PPARγ in model group,which were higher than those in normal control group and physiological saline control group.Western blotting indicated that the expressions of PPARα,PPARβ/δ and PPARγγof the trigeminocervical complexes in model group were 0.361 ±0.051,0.372 ±0.061 and 0.654 ±0.101,respectively,which were also significantly higher than those in normal control group and physiological saline control group (P＜0.05).Conclusions The expressions of PPARα,PPARβ/δ and PPARγγin the trigeminocervical complexes in migraine rats are increased,which might be a compensatory neuroprotective response in the occurrence of migraine.

Increased expression of 5-hydroxytryptamine transporter gene in monocrotaline-induced pulmonary hypertension in rats / 中国药理学通报

Aim To study the relationship between pul-monary hypertension (PHT) and 5-hydroxytrapta-mine transporter (5-HTT) in the pulmonary arteries (PAs) from normal and monocrotaline (MCT) induced pulmonary hypertension rats. Methods MCT-treated rats were used as a model for chronic PHT.Concentration-response curves of 5-hydroxytraptamine induced pulmonary vasoconstriction were established. The medial wall thickness of pulmonary arteries was measured. Semi-quantitative RT-PCR was performed to identify the expression of 5-HTT mRNA in rat PAs.Results 5-HT induced vasoconstriction response of PAs from MCT rats was significantly increased.The thickness of pulmonary vascular medial walls was increased in MCT rats. A significantly higher level of 5-HTT mRNA expression was detected in PAs from MCT rats. The ratio of the PCR products of 5-HTT gene to those of ?-actin gene was higher in MCT rats than in control rats. 5-HTT mRNA expression of pulmonary arteries correlated with the thickness of pulmonary vascular medial walls in rats.Conclusions MCT-induced pulmonary vascular remodeling and increased vascular contractile response to 5-HT were accompanied with enhanced level of 5-HTT mRNA expression and there existed correlation between the wall thickness of pulmonary arteries and 5-HTT mRNA expression,indicating 5-HTT is an important mechanism involved in pulmonary hypertension.

The expression of protein kinase C isoforms in pulmonary artery of chronic inflammatory pulmonary hypertension rats / 解放军医学杂志

Objective To observe the expression of protein kinase C(PKC)isoforms in pulmonary artery of chronic inflammatory pulmonary hypertension(PHT)rats.Methods Chronic inflammatory PHT model rats were established induced by monocrotaline(MCT).Western blotting analysis was used to detect the expression of four PKC isoforms(PKC?,PKC?Ⅱ,PKC? and PKC?)in pulmonary arteries of rats during the development of PHT.Results The values of mean pulmonary artery pressure and right ventricular hypertrophy index increased significantly after the injection of MCT,which suggested successful formation of PHT.Western blotting analysis showed that PKC?,PKC?Ⅱ and PKC? isoforms were presented in pulmonary arteries of normal and PHT rats,while PKC? isoform was not detected.The expressions of PKC? in both cytosolic and membranous fractions increased within 14 days,and decreased a little during the development of PHT.But the increase of PKC? in cytosolic fraction was much more obvious than that in membranous fraction.The highest expression of both PKC?Ⅱ and PKC? in cytosolic fractions appeared at the eighth day,while the expression of both isoforms in membranous fraction went up continuously.Conclusions PKC?,PKC?Ⅱ and PKC? isoforms were involved in the development of chronic inflammatory PHT.The changes of their expression might be the results of PKC isoforms translocation which is related to the proliferation regulation of pulmonary artery smooth muscle cells.