Feasibility of Delaire cephalometric analysis to predict the ideal sagittal position of the maxilla and chin for surgery-first patients in orthognathic surgery / 北京大学学报(医学版)

OBJECTIVE@#There is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. The purpose of this study was to compare how well the Delaire's cephalometric analysis correlated with postoperatively findings in patients who underwent orthognathic surgery planned using other cephalometric analyses, as well as to evaluate the feasibility of the Delaire's cephalometric analysis in predicting the ideal sagittal position of the maxilla and chin.@*METHODS@#In the study, 35 patients with skeletal Class III malocclusion were involved and met the criteria. Treatment plans were developed using photographs, 3-D photographs, radiographs, and standard cephalometric measurements. The Delaire's cephalometric analysis data, like the phase measurements (∠C1-L1 and ∠C1-L2) of the sagittal positions of the maxillary and the chin separating the reference line (L1) of NP point and the reference line (L2) of Me point, were analyzed using Dolphin Imaging software. At the same time, the analyses on standard measurements were also performed. Four orthognathic doctors, 4 orthodontic doctors and 4 college students from non-medical majors were selected as aesthetic evaluators to assess the patients' profile aesthetic by visual analogue scale (VAS). The results through the Delaire's cephalometric analysis were statistically compared with that through standard methods.@*RESULTS@#The mean of ∠C1-L1 was 83.93°±2.99° and∠C1-L2 was 89.08° ±2.48° for males postoperatively, and 85.67° ±3.60° and 88.30° ±4.20° for females postoperatively. Compared with the reference values of Chinese goodlooking people, there was no significant difference of NP point, whereas there was a significant difference of Me point. The postoperative aesthetic scores were: the mean was 6.71±0.25 of upper jaws, 6.81±0.30 of chins and 6.90±0.29 of the overall for males; and 7.19±0.22, 7.26±0.34 and 7.39±0.29 for females. Compared with preoperative scores, there was a significant improvement. Furthermore, the scores of chins and the overall scores were related to the sagittal position of the chins.@*CONCLUSION@#Compared with standard cephalometric analysis, the Deliare's cephalometric analysis well unravel the preoperative deformity and the final esthetic sagittal positions of maxillary and chin in the present sample, and could be a useful tool for the planning of surgery-first approach in orthognathic surgery.

Impact of multidisciplinary team working on the management of colorectal cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline. Colorectal cancer multidisciplinary team (MDT) working model is recommended by UK and other countries, but there is little information on the impact of MDT working on management of colorectal cancer in China. The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT.</p><p><b>METHODS</b>A total of 595 consecutive colorectal cancer patients were referred to the Department of Gastroenterological Surgery, the pre-MDT cohort include 297 patients, recruited from January 1999 to November 2002, and the MDT cohort had 298 patients enrolled from December 2002 to September 2006. Information recorded included: TNM stage from histological reports, degree of differentiation, the number of examined lymph nodes and CT TNM staging performed or not, and its accuracy, including local and distant recurrence.</p><p><b>RESULTS</b>The number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group. CT TNM staging was more accurate in the MDT group compared to the pre-MDT group (P = 0.044). The rate of tumor recurrence in the MDT group was lower than pre-MDT group (log-rank test, P < 0.001). Multivariate analysis revealed that age (P = 0.001), management after inception of the MDT (P = 0.002), degree of differentiation (P = 0.003), number of examined lymph nodes (P = 0.002), and TNM stage (P = 0.000) were important factors that independently influence overall survival.</p><p><b>CONCLUSIONS</b>The inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients. MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis, evidence-based decision making, and optimal treatment planning.</p>