Comparison of aspirin and low molecular weight heparin in pulmonary lobectomy after percutaneous coronary intervention / 中华胸心血管外科杂志

Objective:To compare the clinical application of aspirin and low molecular weight heparin in pulmonary lobectomy after percutaneous coronary intervention(PCI), and to explore the effect of aspirin monotherapy in anti-platelet therapy.Methods:From January 2018 to December 2019, the clinical data of 48 patients with coronary atherosclerotic heart disease(coronary heart disease) who underwent lobectomy in the Thoracic Surgery Department of Beijing Anzhen Hospital within 12 months after PCI were retrospectively analyzed. There were 37 males and 11 females. The age ranged from 41 to 76(67.6±10.4) years. There were 22 cases with hypertension, 18 cases with diabetes and 2 cases with cerebrovascular disease. Iliac artery stents were inserted in 2 cases and vertebral artery stents in 1 case. Preoperative atrial fibrillation in 2 cases. There were 46 patients with gradeⅠand 2 patients with gradeⅡcardiac function(NYHA). According to the preoperative antiplatelet treatment, the patients were divided into aspirin group(25 cases) and low molecular weight heparin group(LMWH group, 23 cases). In the aspirin group, clopidogrel or ticagrelor was stopped 5 days before lobectomy, and aspirin single drug antiplatelet therapy was used, orally 100 mg every day until the morning of operation. In the LMWH group, aspirin, clopidogrel or ticagrelor were stopped 7 days before surgery, and 0.6 ml LMWH calcium was injected subcutaneously, once every 12 hours, and stopped 12 hours before surgery. Perioperative clinical data of the two groups were recorded and analyzed, and major adverse cardiac event(MACE) and bleeding events were observed.Results:There was no death in all groups. MACE and bleeding occurred in 1 case respectively in LMWH group. There were no significant differences between the two groups in length of hospital stay, duration of operation, diameter of lesion, total postoperative thoracic drainage and retention time of thoracic drainage tube( P>0.05). The intraoperative blood loss and chest drainage in the aspirin group were significantly lower than those in the LMWH group in the first 3 days after surgery, with statistical significance( P<0.05). Conclusion:The incidence of MACE increases after lobectomy for coronary heart disease within 12 months after PCI, and aspirin monotherapy is safe and effective in antiplatelet therapy.

Understanding and treatment strategy for disc displacement of temporomandibular disorders / 中华口腔医学杂志

Understanding and treatment strategy for disc displacement of temporomandibular disorders (TMD) were discussed in the present review. It has been strongly recommended by the author that the treatment strategy for disc displacement, one subtype of TMD, should be mainly the reversible conservative treatment methods. The most important goal of treatment for disc displacement is to recover the mobility and function of the joint in order to improve the quality of the patient's life. Comprehensive assessments both from somatic and psychological aspects for each TMD patient are necessary, especially for the patients with chronic pain. Although the role of surgical operative treatments is very limited in the general treatment strategy for TMD, it is still important for a few patients who had definite diagnosis of intra-articular disorders, severe symptoms affecting the quality of patient's life and failed to response to the correct conservative treatments. It should be very careful to treat the TMD patients by surgical operation or irreversible occlusion treatments changing the natural denture of the patient, such as full mouth occlusional reconstruction and extensive adjustment of occlusion.

Accuracy of computer aided measurement for detecting dental proximal caries lesions in images of cone-beam computed tomography / 中华口腔医学杂志

Objective@#To establish and validate a computer program used to aid the detection of dental proximal caries in the images cone beam computed tomography (CBCT) images. @*Methods@#According to the characteristics of caries lesions in X-ray images, a computer aided detection program for proximal caries was established with Matlab and Visual C++. The whole process for caries lesion detection included image import and preprocessing, measuring average gray value of air area, choosing region of interest and calculating gray value, defining the caries areas. The program was used to examine 90 proximal surfaces from 45 extracted human teeth collected from Peking University School and Hospital of Stomatology. The teeth were then scanned with a CBCT scanner (Promax 3D). The proximal surfaces of the teeth were respectively detected by caries detection program and scored by human observer for the extent of lesions with 6-level-scale. With histologic examination serving as the reference standard, the caries detection program and the human observer performances were assessed with receiver operating characteristic (ROC) curves. Student t-test was used to analyze the areas under the ROC curves (AUC) for the differences between caries detection program and human observer. Spearman correlation coefficient was used to analyze the detection accuracy of caries depth. @*Results@#For the diagnosis of proximal caries in CBCT images, the AUC values of human observers and caries detection program were 0.632 and 0.703, respectively. There was a statistically significant difference between the AUC values (P=0.023). The correlation between program performance and gold standard (correlation coefficient rs=0.525) was higher than that of observer performance and gold standard (rs=0.457) and there was a statistically significant difference between the correlation coefficients (P=0.000). @*Conclusions@#The program that automatically detects dental proximal caries lesions could improve the diagnostic value of CBCT images.

The monitoring and management for patients following lung transplatation surgery during early stage in intensive care unit: 9 cases report / 中华胸心血管外科杂志

Objective To summarize the experience during early stage of postoperative monitoring and treatment for the patients follwing lung transplantation in surgical intensive care unit,and to improve the patient's outcome of lung transplantation.Methods A retrospective analysis of 9 cases of orthotopic lung transplantation admitted to surgical intensive care unit (SICU) of Beijing Anzhen Hospital from May 2005 to May 2011 was made.Results There 5 male patients and 4 female patients with the age 21 -67 (46.1 ± 14.1 ) years old in present group,and among them 6 patients survived (survival rate:66.7％ ).The etiological indication of admission were idiopathic pulmonary fibrosis (n =4),pulmonary lymphangioleiomyomatosis ( n =3 ),and bronehiectasis ( n =2).Bilateral sequential lung transplantation ( n =5 ),single left lung transplantation ( n =1 ) and single rigbt lung transplantation ( n =3) were performed.The postoperative duration of mechanical ventilation,stay duration in SICU and in hospital were 2 -32 d,3 -42 d,and 3 -60 d respeetively.Postoperative complication taking place after surgery were acute rejection in 2 cases and pneumonia 4 cases (3 cases were treated with extracorporeal membrane oxygenator).Postoperative in hospital death was 3 cases of 9 resulting from severe intection (n =2) and cireulation failure ( n =1 ).Conclusion Well-planned postoperative management stroategy in SICU plays an important role in outcome control after lung transplantation,including monitor and respiratory and cardiacvascular management,reasonable implementation of vasoactive medications and diuretics,protective mechanical ventilation strategy,reducing the time of ventilation.

Effect of stabilization occlusal splint on intra-articular pressure of the temporomandibular joint / 北京大学学报(医学版)

Objective: To find out the influence of stabilization occlusal splint on intra-articular pressure of the temporomandibular joint. Methods: A muti-channel measuring and analysis system for intra-articular pressure of the temporomandibular joint was developed in this study. Twenty-two subjects were selected to detect the intra-articular pressure of the temporomandibular joint before and after wearing stabilization splint. Results: Before splint wearing, the intra-articular pressure of the temporomandibular joint at intercuspal occlusion status was 61.3?48.5 mm Hg (1 mm Hg=0.133 kPa), the negative pressure at open mouth status was 33.2?34.2 mm Hg. After splint wearing, the pressure at intercuspal occlusion status was 39.5?24.5 mm Hg, the negative pressure at intercuspal at open mouth status was 36.3?25.3 mm Hg. The intra-articular pressure of the temporomandibular joint after wearing splint was significantly lower than the pressure before splint was used, the pressure of mouth opening status was stable before and after splint was used. Conclusion: Stabilization occlusal splint can reduce the intra-articular pressure of the temporomandibular joint.

Analysis of the mitochondrial mutations of articular chondrocyte in temporomandibular joint osteoarthrosis / 北京大学学报(医学版)

Objective :To explore the significance of mitochondrial DNA mutations of articular chondrocytes in the rat model of temporomandibular joint osteoarthrosis (TMJOA). Methods:TMJOA models were created in left sides of TMJ of 15 SD rats by the partial resection of the articular disc.The experimental rats were killed 3 months after operation. After the chondrocytes culture, the entire mtDNA were amplified using 32 pairs of overlapping. DNA fragments showing different banding patterns between normal and experimental mtDNA by temporal temperature gradient gel electrophoresis were sequenced to identify the mutations. Results: Of the 35 heteroplasmic pattern PCR products, 42 novel mutations were found, Majority of the novel mutations were in the tRNA and D-loop regions. Conclusion:The mutations occurred in the mtDNA of TMJOA articular chondrocytes.

Effects of estradiol on proliferation and metabolism of rabbit mandibular condylar cartilage cells in vitro / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effects in vitro of 17 beta-estradiol (E2) on the proliferation and metabolism of rabbit mandibular condylar cartilage cells.</p><p><b>METHODS</b>Chondrocytes were derived from neonatal rabbit mandibular condylar cartilage using a modified enzyme method. 17 beta-estradiol was added to the culture medium in a variety of concentrations. Cell growth and DNA, collagen, and proteoglycan synthesis were used as indicators of proliferation and differentiation of condylar chondrocytes. These were measured by cell number, 3H-proline and 35S-incorporation, respectively.</p><p><b>RESULTS</b>E2 increased cell number and 3H-thymidine incorporation at 10(-8) to 10(-10) mol/L, and 10(-8) to 10(-11) mol/L in a dose-dependent manner, peaking at 10(-8) mol/L and 10(-9) mol/L, respectively. However, further increase in the concentration of estradiol caused inhibition of both cell number and 3H-thymidine incorporation, and this was significant at 10(-6) mol/L. The effect of E2 on proteoglycan synthesis was similar; the maximum stimulating effect was at 10(-8) mol/L, and inhibition was significant at 10(-6) mol/L. There was no obvious stimulatory effect of E2 on 3H-thymidine incorporation observed.</p><p><b>CONCLUSIONS</b>Estradiol affects condylar chondrocyte cell growth, DNA, and proteoglycan synthesis in a biphasic manner depending on its concentration. This indicates that estrogen may be important in the proliferation and differentiation of mandibular condylar chondrocytes, and could be relevant to some aspects of certain temporomandibular joint diseases by modulating the function of the chondrocytes.</p>

Investigation of temporomandibular joint space of healthy adults by using cone beam computed tomography / 北京大学学报(医学版)

0.05).Conclusion:All the results of the five measurement methods showed that the condyle was located in the center of the fossa with a variation in the healthy adults in intercuspal position.The CBCT image of the sagittal middle layer of the joint could show the joint space accurately and has an important value in the research related to the changes of TMJ space.

Alteration of the expression of cartilage matrix molecule in the cartilage by the chondrocytes from rabbit temporomandibular joint with experimental osteoarthritis and its response to interleukin-1? / 北京大学学报(医学版)

Objective: To study the effect of interleukin 1(IL 1?) on the metabolism of osteoarthritic and normal mature condylar chondrocytes in temporomandibular joints, and investigate the role of IL 1? in the pathogenesis of temporomandibular joint osteoarthritis. Methods: The primary generation of osteoarthritic and normal condylar chondrocytes cultured in the monolayer condition was treated with 20 ?g?L -1 recombined human interleukin 1? (rhIL 1?), and then collected to be detected with RT PCR method for the cellular metabolism including mRNA expression of type Ⅱ collagen, aggrecan, collagenase, insulin like growth factor 1 (IGF 1), and transforming growth factor?1(TGF?1). Results: The normal mature condylar chondrocytes showed the obviously decreased mRNA expression of type Ⅱ collagen and aggrecan after the intervention of exogenous IL 1?, but less influence could be found for the collagenase expression. The osteoarthritic condylar chondrocytes exhibited the decreased mRNA expression of type Ⅱ collagen and collagenase under the effect of IL 1?, while the cellular mRNA expression of aggrecan didn’t change obviously. The intervention of exogenous IL 1? didn't show an obvious influence on the cellular expression of endogenous growth factors such as IGF 1 or TGF ?1 for both the normal and osteoarthritic condylar chondrocytes cultured in vitro. Conclusion: IL 1? could not only disturb the expression of cartilage matrix molecules by the normal condylar chondrocytes, which lead to the lesion of condylar cartilage, but also worsen the abnormal cartilage matrix environment within the osteoarthritic condylar cartilage.

Angiographic study of dangerous anastomasis of the external carotid artery / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the dangerous anastomasis between the external carotid artery and the intracranial arteries.</p><p><b>METHODS</b>Angiograms of the external carotid artery in 250 cases were analyzed, including 35 cases of moyamoya and 215 cases of head and neck lesions.</p><p><b>RESULTS</b>The 35 cases of moyamoya, 14 middle meningeal arteries (MMA) were found to participate in the blood supply of the brain. In addition, 11 superficial temporal arteries and 7 occipital arteries supplied the brain. All the cases with ligated external carotid artery (ECA) had the pharyngo-occipital anastomasis. Moreover, the ophthalmic arteries in three cases were found to originate from the MMA.</p><p><b>CONCLUSIONS</b>The external carotid artery has a variety of anastomasis with the internal carotid artery (ICA) and the vertebral artery. Under such circumstances, special measures must be taken to circumvent inadvertent intracranial embolization.</p>

Manipulation aided by joint cavity extension followed by occlusal splint for treatment of acute anterior disk displacement without reduction / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate a new treatment method for temporomandibular joint acute disk displacement without reduction.</p><p><b>METHODS</b>Twenty-one patients diagnosed as acute anterior disk displacement without reduction were treated by manipulation with the aid of joint cavity extension followed by anterior repositioning splint. All and eleven of twenty-one patients were re-examined two weeks after insertion of splint and at the end of treatment (3 approximately 6 months later).</p><p><b>RESULTS</b>(1) Degree of maximum mouth opening was increased from 25.8 mm before treatment to 46.6 mm 2 weeks after, 48.1 mm at the end of treatment; (2) Mean pain level (VAS) dropped from 2.62 before treatment to 0.43 2 weeks after, 0.18 at the end of treatment; (3) Fricton's TMJ dysfunction index and craniomandibular index decreased from 0.337 and 0.185 respectively before treatment to 0.021 and 0.011 respectively 2 weeks after, 0.031 and 0.018 respectively at the end of treatment.</p><p><b>CONCLUSIONS</b>The treatment method should be considered for acute anterior disk displacement without reduction if medication and physical therapy failed to have disk successfully reduced.</p>

Application of alginate three-dimensional culture system for in vitro culture of mandibular condylar chondrocytes from human osteoarthritic temporomandibular joint / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the use of alginate three-dimensional culture system for mandibular condylar chondrocytes culture in vitro from human osteoarthritic temporomandibular joint.</p><p><b>METHODS</b>The cultured mandibular condylar chondrocytes from the operatively removed cartilage from a patient with osteoarthritic temporomandibular joint were harvested by mechanical dissection and enzyme digestion. Partial chondrocytes were suspended in the aqueous sodium alginate beads with high seeding density and cultured for 4 weeks, while the others were cultured in monolayer culture condition for 1 week. Thereafter, the alginate beads were embedded in paraffin and sectioned, then studied immunologically with type II collagen antibody and aggrecan antibody, same studies were adopted for the monolayer cultures.</p><p><b>RESULTS</b>The monolayer cultures were confirmed as chondrocytes. The chondrocytes cultured in the alginate medium showed well. These cells exhibited the excellent differentiated phenotype after 4 weeks culture in alginate gel.</p><p><b>CONCLUSIONS</b>The condylar chondrocytes from human osteoarthritic temporomandibular joint were successfully cultured in vitro. The alginate three-dimensional culture system was successfully adopted for in vitro culture of condylar chondrocytes from human osteoarthritic temporomandibular joint, in which the chondrocytes exhibited the excellent differentiated phenotype.</p>

Study on the use of temporomandibular joint dysfunction index in temporomandibular disorders / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the methodological techniques in measuring the severity of temporomandibulr disorders (TMD) and in evaluating the effectiveness of therapies in clinic.</p><p><b>METHODS</b>Both Fricton's Craniomandibular Index (CMI) and Helkimo's Clinical Dysfunction Index were calculated from 60 TMD patients. Inter-rater reliability was tested to assess the consistency in use between different examiners. Fricton's CMI was used to assess the clinical improvement after accepting a treatment in 21 TMD patients diagnosed as acute disk displacement without reduction.</p><p><b>RESULTS</b>Correlation Coefficient for inter-rater reliability in two groups was 0.879 and 0.939 respectively for Fricton's CMI and 0.744 and 0.838 for Helkimo Clinical Dysfunction Index. Fricton's TMJ dysfunction index was decreased from 0.337 to 0.021 (P < 0.001) and Fricton's CMI was decreased from 0.185 to 0.011 (P < 0.001) after the treatment in 21 TMD patients with disk displacement without reduction.</p><p><b>CONCLUSIONS</b>To avoid using subjective and descriptive report in assessment of the severity of TMD and the effectiveness of therapies, Fricton's CMI is recommended as an objective criteria which is simple in clinical use, and ease in scoring.</p>

Assessment of efficacy of endovascular embolization for central arteriovenous malformations (AVM) in the jaw / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the angiographic properties of central AVMs in the jaw, and to investigate the efficacy of embolization of them.</p><p><b>METHODS</b>Eleven cases of central AVMs underwent angiography and embolization, nine cases experienced surgery after embolization, and the other two cases were embolized alone; all these cases were followed up after treatment. The angiographic features and embolization results were analyzed.</p><p><b>RESULTS</b>Large venous pouches were angiographically opacified in 9 of 11 AVMs. Of the nine operated cases, curettage was safely performed. The intraoperative bleeding was evidently decreased, and the continuity of the jaw was preserved. Five of these operated cases were free of recurrence during 18 - 27 months in follow-up. The two cases embolized alone were free of recurrence during 24 months' follow-up.</p><p><b>CONCLUSIONS</b>Via arterial and venous approaches, embolization could greatly decrease the intraoperative bleeding and thus help to preserve the continuity and potentiality of development of the jaw for intraosseous AVMs, moreover, it may be curative in some cases.</p>

Ultrastructural changes of TMJ articular cartilage and synovial membrane following occlusal trauma in rabbit / 中华创伤杂志(英文版)

OBJECTIVE: To study the effects of occlusal trauma on the ultra-structure of synovial membrane and articular cartilage in rabbit's temporomandibular joints (TMJ). METHODS: TMJs from six rabbits with occlusal trauma and three control rabbits were studied by transmission electron microscopy. RESULTS: Degenerative changes in synovial membrane and articular cartilage of TMJ were induced following occlusal trauma. The structure of the articular surface was damaged, and chondrocytes in cartilage showed signs of degeneration. The synovial lining cells contained dense accumulations of vimentin intermediate filaments (IFs), which were especially prevalent in the cellular processes as well as paranuclearly. Microvilli on the synovial cell membrane were commonly seen. The "vermiform bodies" in the deeper interstitium of the synovial tissue were also found. Our findings of the punctate adherens between synovial lining cells were described in detail. CONCLUSIONS: The occlusal trauma is really a factor inducing degenerative changes of the TMJ.