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Objective:To investigate the clinical experience of different types of femoral perforator flaps in the reconstruction of oral and maxillofacial head and neck defects.Methods:From January 2018 to January 2021, 573 patients with oral and maxillofacial head and neck defects reconstructed by femoral perforator flap were collected in the Department of Maxillofacial Oncology, the Third Affiliated Hospital of Air Force Military Medical University (age range of 21-76 years, with a male to female ratio of 1.23∶1). According to the type of perforator flap, the patients were divided into ALT group, AMT group, TFL flap group and free muscle flap group. The incidence of postoperative complications, wound healing time and drainage volume in femoral area were compared among the 4 groups.Results:The ALT flap was used in 527 cases: 22 flaps had vascular crisis, 14 flaps had infection, 8 flaps had necrosis, 519 flaps survived; the mean healing time of the wound was (14.50±3.19) days, and the mean drainage volume was (49.9±21.3) ml. 28 cases were repaired with AMT flap: 2 flaps had vascular crisis and 1 had infection. All the flaps survived; the mean healing time of the wound was (14.18±2.75) days, and the mean drainage volume was (50.3±23.0) ml. 11 cases were repaired by TFL flap: 1 flap had vascular crisis and 1 had infection. All the flaps survived. The mean healing time of the wound was (14.09±2.66) days, and the mean drainage volume was (54.1±25.0) ml. 7 cases were repaired by free muscle flap survived without vascular crisis, infection and other postoperative complications; the mean healing time of the wound was 14.14±1.86, and the mean postoperative drainage volume was (49.9±21.1) ml. There was no significant difference in complication rate (flap necrosis, vascular crisis, infection, etc.) and repair effect among 573 patients with different flap types. The postoperative follow-up was conducted for 6-24 months, and the donor area was smooth and good in appearance, without obvious scar or functional influence. The repair effect of the affected area was satisfactory.Conclusions:Although there is a certain proportion of perforator vessel variation in the femoral perforator flap, the flap can be designed freely according to different types of variation. The thigh perforator flap has an essential application value in the repair of oral and maxillofacial head and neck defects.
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Objective:To explore the effect of mixed reality (MR) application in the reconstruction of mandibular defects.Methods:Eighteen patients with mandibular defects were enrolled in this study, including 10 male patients and 8 female patients, whose age ranged from 27 to 45 years, and the mean age was 35.4 years. All the patients were from the Stomatological Hospital of the Fourth Military Medical University, during October 2019 to May 2021. Fibular flaps were used for the reconstruction of the mandibular defects. The patients were randomly divided into three groups, six in each group. In group one, MR-guided mandibular defect repair and reconstruction technique was used. In group two, 3D printed guide-assisted mandibular defect repair and reconstruction technique was used, and in the control group, traditional jaw defect repair and reconstruction technique was used. All the procedures were performed by the same team. Cone beam computed tomography (CBCT) was used for analysis of surgical accuracy, and questionnaires were used to evaluate the outcome of medical communication, occlusal relationship, appearance restoration, and medical experience satisfaction.Results:The mean surgical errors in the group one and group two were (1.75±0.44) mm and (1.81±0.16) mm respectively, which were both significantly lower than that in the control group (3.05±0.83) mm ( tMR=3.38, t3D=3.56, P<0.01). The medical communication (4.60±0.35, 4.52±0.28, tMR=2.90, t3D=2.77, P<0.05), occlusal relationship (4.17±0.32, 4.28±0.39, tMR=3.07, t3D=3.29, P<0.05), and medical experience satisfaction scores (4.26±0.45, 4.25±0.67, tMR=2.50, t3D=2.26, P<0.05) in the experimental groups were significantly higher than those in the control group (4.02±0.34, 3.58±0.33, 3.56±0.32, respectively). There was no significant difference in the satisfaction of appearance recovery among all the groups ( P>0.05). Conclusions:MR-guided mandibular repair and reconstruction surgery has high accuracy and is also beneficial to the recovery of occlusal relationship and medical communication.
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Objective To We Used high-dose paraquat to induce apoptosis of A549 cells,and observed the expression of E-cadherin,α-SMA,caspase-8,caspase-3 and caspase-9.Then explored the possible mechanisms of apoptosis.Methods A549 cells were treated with various concentrations of PQ (0.1-1.0 mmol/L) for 24 and 48 hours,then observe the cell morphology and measured cell survival rate respectively determined by MTT method.A549 cells were treated with various concentrations of PQ (0.1,0.2,0.3 mmol/L) for 24 hours.The expressions of the mRNAs for α-SMA、E-cadherin,caspase-8,caspase-3 and caspase-9 were analysed by quantitative real-time PCR.Exposed to various concentrations of PQ (0.1,0.2,0.3mmol/L) for 24 hours,we analysed the protein expressions of α-SMA、E-cadherin、caspase-8、caspase-3 and caspase-9 by Western blot analysis.Results Treated with various concentrations of PQ (0.1-1.0mmol/L) for 24 hours,the A549 cells survival rate significantly reduced by MTT method.For 48 hours,the survival rate was lower.So,in subsequent experiments,we used 0.1,0.2 and 0.3 mmol/L concentration of paraquat to A549 cells,trained for 24 hours.After high-dose (0.1,0.2 and 0.3 mmol/L) exposure to PQ,a decrease in E-cadherin was observed while a decrease in α-SMA was also detected of the mRNAs.While the expressions of the mRNAs for caspase-8、caspase-3 and caspase-9 wereincrease.The protein expressions of α-SMA and E-cadherin were decrease with the increase of concen trations by Western blot analysis,and the levels of caspase-8、caspase-3 and caspase-9 were increase.Conclusions After high-dose short-time exposure to PQ,the survival rate of A549 cells is decreased obviously,cell morphology changed significantly,and the expressions of α-SMA and E-cadherin were decrease.But the expressions of caspase-8、caspase-3 and caspase-9 were increase.
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Objective To evaluate the influence of different hemoperfusion (HP) intensities on prognosis in patients with acute paraquat (PQ) poisoning. Methods The data of patients with acute PQ poisoning admitted to Department of Emergency of Shengjing Hospital Affiliated to China Medical University from January 2012 to February 2016 were retrospectively analyzed. Patients satisfied the following criteria were enrolled in the study: adult patients, ingestion PQ within 12 hours and receiving HP treatment within 24 hours. Depending on the intensity of HP, patients were divided into lower intensity HP group (LHP, defined as receiving HP for less than 2 hours, 1 column) and higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients were divided into three groups, i.e. small dose ( 40 mL) poisoning groups on the basis of PQ ingestion volume. The baseline data of patients after hospital admission and arterial partial pressure of oxygen (PaO2), white blood cell (WBC), proportion of neutrophils (NEUT), alanine aminotransferase (ALT), total bilirubin (TBil), MB isoenzyme of creatine kinase (CK-MB), blood urea nitrogen (BUN) and serum creatinine (SCr) on the 4th day after hospital admission were compared, and 28-day mortality was followed up. Multiple logistic regression model was used to evaluate the characteristics of the dead patients within 28 days. The predictive value of each indicator for death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC). Results ① LHP group consisted 67 patients of 144 patients included with 24 in small dose group, 27 in medium dose group and 16 in high dose group. HHP group consisted of 77 patients with 28 in small dose group, 29 in medium dose group and 20 in high dose group. There were no significant differences in age, ingestion dose, time from poisoning to gastric lavage, and the time from the admission to HP between different intensities groups. ② Compared with LHP group, 28-day mortality in HHP group was significantly lowered (46.8% vs. 70.1%, χ2 = 8.032, P = 0.005). The patients receiving HHP in medium and small doses groups had lower 28-day mortality compared with those receiving LHP (41.4% vs. 74.1%, χ2 = 4.841, P = 0.017; 21.4% vs. 50.0%, χ2 = 4.661, P = 0.043). But there was no significant difference in 28-day mortality in high dose group between HHP and LHP (90.0% vs. 93.8%, χ2 = 0.000, P = 1.000). ③ The survival time of 12 patients with high dose poisoning was less than 72 hours, which were excluded for statistical analysis. Compared with LHP, the indexes of medium and small dose groups were obviously improved after HHP for 4 days. ④ Compared with survival group, PQ ingestion dose in non-survival group was increased, time from poisoning to gastric lavage and the time from the admission to HP were prolonged, and lower patients receiving HHP. ⑤ It was indicated by multiple logistic regression model that PQ ingestion dose [medium dose: odds ratio (OR) = 0.018, 95% confidence interval (95%CI) = 0.004-0.085, P < 0.001; high dose: OR = 0.075, 95%CI = 0.018-0.322, P < 0.001], time from poisoning to gastric lavage over 120 minutes (OR = 0.146, 95%CI = 0.045-0.470, P = 0.001), time from admission to HP over 4 hours (OR = 0.108, 95%CI = 0.029-0.395, P = 0.001), and LHP selection (OR = 0.363, 95%CI = 0.142-0.930, P = 0.035) were risk factors for the death at 28 days in patients with acute PQ poisoning. ⑥ It was shown by ROC curve that area under ROC curve (AUC) of PQ ingestion dose was 0.804 (95%CI = 0.723-0.885); when the cut-off value was 5.50 mL, the sensitivity was 94.0%, and the specificity was 65.6%. The AUC of time from poisoning to gastric lavage was 0.702 (95%CI = 0.617-0.786); when the cut-off value was 85.00 minutes, the sensitivity was 48.2%, and the specificity was 83.6%. AUC of time from the admission to HP was 0.719 (95%CI = 0.636-0.801); when the cut-off value was 3.50 hours, the sensitivity was 59.0%, and the specificity was 78.7%. Conclusions PQ ingestion dose, time from poisoning to gastric lavage, and time from the admission to HP are valuable factors for prognosis of the patients. HHP can improve the prognosis of patients with ingestion PQ less than 40 mL as early as possible, but for high dose group patients there was no much effect.