Meta-analysis of the efficacy of invisible orthodontic appliances for maxillary molar distalization in adult patients / 口腔疾病防治

Objective@#To evaluate the clinical efficacy of invisible orthodontic appliances without brackets for the distal movement of maxillary molars to improve the ability of orthodontists to predict treatment outcomes.@*Methods@#Web of Science, Cochrane Library, Embase, PubMed, Wanfang Database, CNKI Database, and VIP Database were searched for studies investigating the efficacy of invisible orthodontic appliances for distal movement of maxillary molars in adult patients and published from database inception to August 1, 2023. A total of three researchers screened the studies and evaluated their quality and conducted a meta-analysis of those that met quality standards.@*Results@#This study included 13 pre- and postcontrol trials with a total sample size of 281 patients. The meta-analysis revealed no significant differences in the sagittal or vertical parameters of the jawbone after treatment when compared with those before treatment (P>0.05). The displacement of the first molar was MD=-2.34, 95% CI (-2.83, -1.85); the displacement was MD=-0.95, 95% CI (-1.34, -0.56); and the inclination was MD=-2.51, 95% CI (-3.56, -1.46). There was a statistically significant difference in the change in sagittal, vertical, and axial tilt of the first molar before and after treatment. After treatment, the average adduction distance of the incisors was MD=-0.82, 95% CI (-1.54, -0.09), and the decrease in lip inclination was MD=-1.61, 95% CI (-2.86, -0.36); these values were significantly different from those before treatment (P<0.05).@*Conclusion@#Invisible orthodontic appliances can effectively move the upper molars in a distal direction and control the vertical position of the molars. When the molars move further away, there is some degree of compression and distal tilt movement, which is beneficial for patients with high angles. The sagittal movement of incisors is beneficial for improving the patient's profile.

Desplazamiento de Tercer Molar Inferior a Espacio Submandibular: Reporte de Caso y Revisión de Literatura / Lower Third Molar Displacement to Submandibular Space: Case Report and Literature Review

El desplazamiento de un tercer molar a un espacio anatómico adyacente, ya sea en su totalidad o un fragmento de este, se encuentra descrito como una complicación rara pero posible de las exodoncias de terceros molares. En este reporte se aborda específicamente el desplazamiento accidental de un tercer molar inferior hacia el espacio submandibular izquierdo, el cual fue resuelto quirúrgicamente mediante un abordaje intraoral bajo anestesia general por el equipo de cirugía maxilofacial del Hospital de Urgencia Asistencia Pública, Santiago, Chile. Se realizó una revisión de literatura en la plataforma PubMed con las palabras claves "third molar - submandibular - displacement" obteniendo un total de 17 artículos en los cuales se reportan 15 casos. El propósito del presente escrito fue presentar recomendaciones sobre el manejo actual de esta complicación en base a la literatura disponible.

The displacement of a third molar into an adjacent anatomical space, either in its entirety or a fragment of it, has been described as a rare but posible complication of third molar extractions. This report will specifically address the accidental displacement of a lower third molar into the left submandibular space, which was surgically removed through an intraoral approach under general anesthesia, by the maxillofacial surgeon team of "Hospital de Urgencia Asistencia Pública", Santiago, Chile. An literature review was carried out on PubMed platform with the keywords ""third molar - submandibular - displacement"", obtaining a total of 17 articles where are reported 15 cases. The purpose of this paper is to present recommendations on the current management of this complication based on the available literature.

Taquicardia ventricular polimórfica tipo Torsadess de Pointes secundaria a estimulación por marcapasos

La taquicardia ventricular polimórfica se origina en los ventrículos, cuyos complejos QRS son de morfología, amplitud y dirección variable, con frecuencias que oscilan entre 200 y 250 lpm, pudiendo ser autolimitadas o degenerar en una fibrilación ventricular. La TdP es un tipo de taquicardia ventricular polimórfica caracterizada por complejos con un eje eléctrico que gira alrededor de la línea isoeléctrica y que está asociada a QT largo. Se presenta el caso de una paciente portadora de marcapaso que presenta episodios de taquicardia ventricular polimórfica, con una morfología típica de TdP, sin documentación de QT prolongado previo ni actual, generada por la estimulación ventricular sobre onda T, de forma accidental por desplazamiento del electrodo auricular a Ventrículo Derecho (VD).

Polymorphic ventricular tachycardia is a tachycardia originating in the ventricles, where the QRS complexes have variable morphology, amplitude, and direction, with frequencies ranging between 200 and 250 bpm; it may be self-limited or degenerate into ventricular fibrillation. Torsades de Pointes (TdP) is a type of polymorphic ventricular tachycardia characterized by complexes with an electrical axis that rotates around the isoelectric line and that is associated with long QT interval. We present the case of a patient with a pacemaker who presents episodes of polymorphic ventricular tachycardia, with a typical morphology of TdP, without documentation of previous or current prolonged QT, generated by ventricular stimulation on the T wave, accidentally due to displacement of the atrial electrode to the Right Ventricle (RV).

Narrativas escolares de las estudiantes desplazadas por el conflicto armado en Colombia

(analítico) El desplazamiento forzado en Colombia ha sido una realidad compleja que ha generado la vulneración sistemática de los derechos de niños, niñas y adolescentes. Este estudio, enmarcado en el paradigma cualitativo, analizó el currículo vivenciado a partir de las narrativas construidas con 14 estudiantes desplazadas por el conflicto armado, pertenecientes a una institución educativa de Medellín (Colombia). Los métodos de recolección empleados fueron entrevistas semi-estructuradas, diarios personales y fotografías. Se presentan las inter-secciones que se establecen con la escuela, entendida como escenario de y para la construcción de paz, concluyendo en la pertinencia de las propuestas educativas flexibles. Este análisis, hilado desde una perspectiva de género, visibiliza otros modos de existir en la escuela, contribuyendo a la resignificación del currículo para la permanencia de las estudiantes que fueron desplazadas.

(analytical) Forced displacement in Colombia has been a complex reality that has led to the systematic violation of the rights of children and adolescents. This is a qualitative study that analyzed the curriculum in school in Medellin (Colombia) through the narratives constructed with 14 female students displaced by the armed conflict. Semi-structured interviews, personal diaries and photographs were used to gather data. The intersections established with the school as a scenario of and for peace building are presented and the relevance of flexible educational proposals is highlighted. This analysis, carried out using a gender perspective, highlights other modes of existence in the school and also contributes to the re-definition of the school curriculum as a determinant in the permanence of displaced students.

(analítico) A deslocação forçada na Colômbia tem sido uma realidade complexa que tem conduzido à violação sistemática dos direitos das crianças e dos adolescentes. Este estudo, estruturado no paradigma qualitativo, analisou o currículo vivido a partir das narrativas construídas com 14 estudantes desloca-das pelo conflito armado, pertencentes a uma instituição educacional em Medellín (Colômbia). Os métodos de coleta utilizados foram entrevistas semi-estruturadas, diários pessoais e fotografias. São expostas às interseções estabelecidas com a escola, entendidas como um cenário de e para a cons-trução da paz, concluindo sobre a relevância de propostas educacionais flexíveis. Esta análise, fiada a partir de uma perspectiva de gênero, torna visíveis outras formas de existir na escola, contribuindo para a re-significação do currículo para a permanência das alunas que foram deslocadas.

Trastornos de salud mental en población desplazada por el conflicto en Colombia: análisis comparado frente a la Encuesta Nacional de Salud Mental 2015

Introducción y objetivos: Colombia es uno de los países del mundo con mayor volumen de desplazamiento interno a causa de un conflicto armado interno. Esta población tiene mayores posibilidades de sufrir un trastorno de salud mental, sobre todo en territorios afectados históricamente por el conflicto. El objetivo es comparar la prevalencia de posibles trastornos de la salud mental entre las personas en condición de desplazamiento en Meta, departamento de Colombia históricamente afectado por el conflicto armado, frente a población desplazada en todo el país según la Encuesta Nacional de Salud Mental (ENSM) de 2015. Métodos: Análisis de datos recolectados en la ENSM 2015, estudio a escala nacional, y la encuesta Conflicto, Salud y Paz (CONPAS) de 2014, estudio representativo del grado de afectación por el conflicto en el municipio, realizado en el departamento del Meta. Para medir un posible trastorno de la salud mental, se utiliza el Self Report Questionnaire-25 (SRQ-25). La condición de desplazamiento fue declarada por los encuestados en ambos estudios. Se hizo un análisis descriptivo sobre el posible trastorno de la salud mental en la población desplazada de la ENSM 2015 y la CONPAS 2014. Resultados: Se encuestó a 1.089 adultos en la CONPAS 2014 y 10.870 adultos en la ENSM 2015. El 42,9% (468) y el 8,7% (943) de las personas reportaron estar en condición de desplazamiento en la CONPAS 2014 y la ENSM 2015 respectivamente. En ambos estudios, la población desplazada tiene mayores posibilidades de sufrir cualquier trastorno de la salud mental que la población no desplazada. En la CONPAS 2014, el 21,8% (intervalo de confianza del 95% [IC95%], 18,1-25,8) de esta población tenía un posible trastorno de la salud mental (SRQ+) frente al 14,0% (IC95%, 11,8-16,3) en la ENSM 2015. Los encuestados en condición de desplazamiento de la CONPAS 2014 tuvieron mayor probabilidad que los de la ENSM 2015 en depresión -el 12,4% (IC95%, 9,5-15,7) frente al 5,7% (IC95%, 4,3-7,4)-, ansiedad -el 21,4% (IC95%, 17,7-25,3) frente al 16,5% (IC95%, 14,2-19,1)-y trastornos psicosomáticos -el 52,4% (IC95%, 47,5-56,7) frente al 42,2% (IC95%, 39,0-45,4)-. Los desplazados de la ENSM 2015 tenían mayor probabilidad de ideación suicida, el 11,9% (IC95%, 9,3-14,1) frente al 7,3% (IC95%, 5,0-10,0) en la CONPAS 2014, y trastorno bipolar, el 56,5% (IC95%, 53,2-59,7) frente al 39,3% (IC95%, 34,8-43,9). Conclusiones: La mayor probabilidad de trastornos de la salud mental (SRQ+) de la población regional en condición de desplazamiento frente a toda la población nacional en esa condición puede representar una mayor necesidad de servicios de atención en salud mental en los territorios afectados por el conflicto. Así pues, y dada la necesidad de facilitar el acceso y la atención médica en salud mental a poblaciones especialmente afectadas por el conflicto armado, es importante el diseño de políticas de atención en salud que faciliten la recuperación de poblaciones afectadas por la guerra y, simultáneamente, reducir inequidades y promover el cumplimiento de uno de los objetivos en salud más importantes y, a la vez, usualmente menos priorizados en el desarrollo internacional: la salud mental. © 2021 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.

Background and objectives: Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. Methods: Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire - 25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. Results: 1,089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. Conclusions: The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.

Repercussion Of Cultural Clashes In Manju Kapur's The Immigrant

Manju Kapur primarily writes about the plight and repression of Indian women as well as their resistance to it. Marriage, families, complexities in relationships and separation are some of the most pervasive themes in her fiction. Manju Kapur's The Immigrant is a story of dislocation and cultural conflict. The novel revolves around a thirty-one-year-old spinster, Nina, who lived with her widowed mother in Delhi. She marries Ananda, an NRI, dentist and she flies to Canada to start her new life. The paper discusses how the novelist brings up the life of a married woman, with only her husband to talk to, all alone in a foreign land where Indian culture and individualism have often remained alien ideas. This paper delves into the issues of alienation and the search for cultural identity, as well as transformation of Nina and Ananda as a result of becoming an immigrant.

Neighborhood Walkability Index and Its Association With Indices of Childhood Obesity in Bengaluru, Karnataka

Background: The prevalence of childhood obesity is increasing in low-middle income countries like India. Built environment features such as walkability can influence weight-related outcomes but data from developing countries are scanty. Objective: To develop population level walkability index in urban Bengaluru, and examine its association with indices of childhood obesity in school children. Study Design: Nested cross-sectional study based on a cohort. Participants: Normal healthy children aged 6 to 15 years from urban schools in Bengaluru. The children were stratified into different land use classification such as residential, commercial and open space based on residential address. Methods: Anthropometric data, body composition data, measured using air displacement plethysmography. Outcomes: Walkability index derived using residential density, street connectivity and land-use mix environment variables. Results: The mean (SD) of age, body mass index (BMI), BMI zscore and percentage body fat (% Body fat) of 292 (50% boys) children were 10.8 (2.9) year, 17.4 (3.3) kg/m2, -0.27 (1.35) and 20.9% (8.8), respectively. The mean (SD) walkability index was 16.5, which was negatively associated with BMI (slope -0.25 and -0.08) and percentage body fat (slope -0.47 and -0.21) for age 5 and 10 years, respectively in children, but the effects decreased with increasing age. Conclusions: The findings of this pilot study suggest that the neighborhood walkability may be associated with the obesity indices in younger children. Future longitudinal studies are needed to understand how built environment affects health and body composition of children in India and other low-middle income countries.

Preliminary observation on the clinical application of rehabilitation support for lumbar disc herniation based on 3D printing technology / 中国骨伤

OBJECTIVE@#To analyze the important effect of 3D printing personalized lumbar support on lumbar pain and lumbar function in patients with lumbar disc herniation.@*METHODS@#From October 2018 to May 2021, 60 patients initially diagnosed with lumbar disc herniation were selected and divided into an observation group and a control group, with 30 patients in each group. Among them, there were 18 males and 12 females in the observation group;the age ranged from 24 to 56 years old, with an average of (45.23±6.07) years old. The course of disease ranged from 1 to 24 months, with an average of(6.25±0.82) months, and rehabilitation treatment was carried out by wearing 3D printed personalized lumbar support. There were 19 males and 11 females in the control group;the age ranged from 25 to 57 years old, with an average of (42.78±7.58) years old. The course of disease ranged from 1 to 24 months, with an average of (6.72±1.36) months, and rehabilitation treatment is carried out by wearing traditional lumbar protective equipment. The Japanese Orthopaedic Association (JOA) scores, lumbar Oswestry dysfunction index (ODI) and visual analogue scale (VAS) were evaluated and compared between the two groups before and 1 course after treatment (3 weeks).@*RESULTS@#There was no statistically significant difference in JOA, ODI, and VAS between two groups before treatment (P>0.05). After one course of treatment (3 weeks), JOA scores of both groups was increased compared to before treatment (P<0.05), while ODI and VAS decreased compared to before treatment (P<0.05). After treatment, JOA score of observation group was higher than that of control group (P<0.05), while ODI and VAS scores were lower than those of control group. No adverse events occurred in both groups.@*CONCLUSION@#The application of 3D printing personalized lumbar support can effectively alleviate the pain of patients with lumbar disc herniation and improve their lumbar function of patients.

Design of a dynamic measurement system for Bl factor spatial distribution of resonant blood viscoelastic sensor / 生物医学工程学杂志

Bl factor is a key system parameter of the resonant blood viscoelastic sensor. In this paper, a dynamic measurement system for the spatial distribution of Bl factor based on velocity amplitude and motional impedance was designed. The system extracted the velocity amplitude and motional impedance of the coil under the dynamic condition of driving the sensor to generate simple harmonic oscillations using laser displacement and impedance analysis combined with in-phase/quadrature demodulation algorithm, and controlled the equilibrium position of the coil by adjusting the direct current component of the excitation current to realize the position scanning. In the position interval of [-240, 240] μm, the maximum coefficient of variation of the measurement results was 0.077 3%, and the maximum relative error to the simulation results was 2.937 9%, with a linear fitting correlation coefficient R 2 = 0.996 8. The system can be used to accurately measure the spatial distribution of Bl factor of the resonant blood viscoelastic sensor, which provides a technical support for the verification of the design of the sensor magnetic circuit.

Three-dimensional finite element stress analysis of surface-mounted inlays in repairing pulp-penetrating non-carious cervical lesion of maxillary first premolar / 华西口腔医学杂志

OBJECTIVES@#This study aimed to explore the stress distribution of surface-mounted inlays with two ceramic materials and different strategies for fiber post-restoration on pulp-penetrating non-carious cervical lesion in a maxillary first premolar to provide minimally invasive and reasonable restorative methods.@*METHODS@#The cone beam computed tomography data of the standard right upper first premolar were selected. Healthy control (HC) and defective control (DC) finite element models were established. Then, eight experimental models were established according to two different ceramic materials (IPS e.max CAD [LD] and Lava Ultimate [LU]) and different locations of fiber post (without fiber post [NP], fiber post in buccal root canal [B], fiber post in palatal root canal [P], fiber post in both root canals [BP]), namely, LDNP, LDB, LDP, LDBP, LUNP, LUB, LUP, and LUBP. Axial load F1 and lateral load F2 were applied. Maximum principal stress and displacement of the buccal tip were investigated using finite element analysis software. Then, the percentage change of the following indicators in each experimental group was analyzed: stress of defective tip with group DC, stress of enamel and dentine, and displacement of buccal tips with group HC. It was considered similar when the percentage change was less than 5%.@*RESULTS@#LD and LU groups could effectively reduce the stress of the defective tip, but the decreasing amplitude in the former was greater than that of the latter. For the stress of surface-mounted inlays and resin adhesive layer, LD groups were higher than LU groups, and no significant difference in stress peak was found among different experimental groups in the same material. In addition, fiber posts in double root canals could significantly reduce buccal tip displacement.@*CONCLUSIONS@#For pulp-penetrating non-carious cervical lesions, the restorative strategy of surface-mounted inlays could be applied. Compared with Lava Ultimate, IPS e.max CAD could better protect the defective tip tooth. Furthermore, fiber posts in double root canals could decrease overall deformation and increase the retention of surface-mounted inlays.

Application of modified articular disc anchorage in treating the perforation and rupture of temporomandibular joint disc / 华西口腔医学杂志

OBJECTIVES@#This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy.@*METHODS@#A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed.@*RESULTS@#The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28).@*CONCLUSIONS@#Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.

Do We Ever Need to Fix Clavicle Fractures in Adolescents?

@#Introduction: Clavicle fractures in adults are increasingly being treated by surgical fixation following reports of symptomatic non-union, malunion and poor functional outcome with conservative treatment. This has led to a similar trend in the management of clavicle fractures in adolescents. This study aims to evaluate the outcome and complications of non-operatively treated clavicle fractures in adolescents. Materials and methods: This is a retrospective, single institution study on adolescents aged 13-17 years who sustained a closed, isolated clavicle fracture, between 1997- 2015. Clinical records were reviewed for demographic information, injury mode, time to radiographic fracture union, time to re-attainment of full shoulder range of motion (ROM), and time to return to full activities and sports. Complications and fracture-related issues were recorded. Radiographs were analysed for fracture location, displacement and shortening. Results: A total of 115 patients (98 males, 17 females; mean age:13.9 ± 0.89 years) were included for study. 101 (88%) sustained a middle-third fracture while the remainder sustained a lateral-third fracture. A total of 96 (95%) of the middle-third fractures were displaced, and 12 (86%) of the lateral-third fractures were displaced. All displaced fractures in this study had shortening. Sports-related injuries and falls accounted for 68 (59%) and 34 (30%) of the cases respectively. Overall, the mean time to radiographic fracture union was 7.8 ± 4.35 weeks; there were no cases of nonunion. Full shoulder ROM was re-attained in 6.6 ± 3.61 weeks, and full activities and sports was resumed in 11.4 ± 4.69 weeks. There were 5 cases of re-fracture and a single case of intermittent fracture site pain. Conclusion: Clavicle fractures in adolescents can and should be treated non-operatively in the first instance with the expectation of good outcomes in terms of time for fracture union, reattainment of shoulder full range of motion, and return to activities. Surgical stabilisation should be reserved for cases for which there is an absolute indication.

Single-center experience with vascularized adrenal displacement for the treatment of primary bilateral macronodular adrenal hyperplasia / 现代泌尿外科杂志

【Objective】 To explore a new treatment of primary bilateral macronodular adrenal hyperplasia (PBMAH) and its efficacy. 【Methods】 Clinical data of 20 PBMAH patients treated in our hospital during Mar.2010 and Apr.2021 were retrospectively analyzed. All patients underwent laparoscopic subcutaneous displacement of vascularized adrenal. The clinical symptoms, plasma free cortisol, adrenocorticotrophic hormone (ACTH), and 24 h urinary free cortisol were regularly monitored after surgery. 【Results】 Of all 20 patients, 19 were followed up for 18 to 120 months (median 60 months). Three months after surgery, reexamination showed 1 patient had decreased plasma free cortisol and increased ACTH, but had no symptoms of low corticosteroids. After another 3 months, the plasma free cortisol and ACTH returned to normal. After 4 to 48 months, the parameters recovered in all patients and the clinical symptoms disappeared. 【Conclusion】 Laparoscopic vascularized adrenal displacement is a new and effective method for the treatment of PBMAH. It can alleviate the Cushing syndrome with no obvious adverse reactions.

Preparation, physicochemical characterization and cytocompatibility study of self-assembled silk fibroin nanoparticles / 药学学报

This study aimed to prepare silk fibroin nanoparticles (SF-NPs) and assess the physicochemical properties and biocompatibility of the formulation. An optimized and simplified solvent displacement method was employed to obtain SF-NPs. Single-factor prescription screening, such as silk fibroin (SF) solution concentration, the ratio of SF solution to organic solvent, ultrasonication power and time, and different types of organic phases, was used to optimize the formulation. The characterization of the optimal formulation included particle size, polydispersity index (PDI), zeta potential, morphology, and stability. The in vitro cell compatibility of the nanoparticles was evaluated using CCK-8 and Calcein-AM/PI cell viability staining. The results showed that when SF concentration was 20 mg·mL-1, volume ratio of aqueous phase to acetone was 1∶6, ultrasonic power was 80 W and ultrasonic time was 3 min, the best SF-NPs was obtained. The nanoparticles prepared in this study exhibit a near-spherical shape, with a uniform size distribution, having an average size of 144.8 nm, a PDI of 0.174, and a zeta potential of -27.35 mV. Results from in vitro cell experiments demonstrate excellent cell compatibility of SF-NPs, showing the ability to promote cell proliferation. The SF-NPs which were successfully prepared in this study exhibit uniform particle size and excellent biocompatibility.

Analysis of the effect of midazolam on pain in a rat model of lumbar disc herniation based on the p38 MAPK signaling pathway / 中国骨伤

OBJECTIVE@#To investigate the effect of midazolam on pain in lumbar disc herniation model rats based on p38 MAPK signaling pathway.@*METHODS@#Fifty SPF-grade Sprague-Dawley healthy rats, half male and half female, were selected and randomly divided into normal group, model group, and low-dose, medium-dose, high-dose groups. Model group and low-dose, medium-dose, high-dose groups were initially modeled for lumbar disc herniation. Intraperitoneal injection of saline was performed in rats of normal and model groups; and in the low-dose, medium-dose, and high-dose groups, intraperitoneal injection of midazolam was performed with doses of 30, 60, and 90 mg/kg, respectively. Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), substance P (SP), neuropeptide Y (NPY) were detected in the serum of rats by enzyme-linked immunoassay. The expression of p38 MAPK and matrix metalloproteinase-3(MMP-3) protein were detected by Western blot in the tissues of rats of each group.@*RESULTS@#The levels of TNF-α, IL-1β and β-EP were higher and the level of 5-HT was lower in the model group than in the normal group(P<0.05);the levels of TNF-α, IL-1β and β-EP were lower and the level of 5-HT was higher in the low-dose, medium-dose and high-dose groups than in the model group(P<0.05). The levels of SP and NPY increased in the model group compared with the normal group (P<0.05) and the levels of SP and NPY decreased in the low-dose, medium-dose and high-dose groups compared with the model group (P<0.05). The expression of p38 MAPK and MMP-3 increased in the model group compared with the normal group (P<0.05); the expression of p38 MAPK and MMP-3 decreased in the low-dose, medium-dose and high-dose compared with the model group(P<0.05).@*CONCLUSION@#Midazolam may ameliorate the immune inflammatory response in rats with a model of lumbar disc herniation, possibly regulated through the p38MAPK signaling pathway.

Feasibility of enlarging the ventral space by using a drill under spinal endoscopy in the treatment of severe free lumbar disc herniation / 中国骨伤

OBJECTIVE@#To evaluate the clinical efficacy of spinal endoscopy in the treatment of severe free lumbar disc herniation and explore the feasibility and application of microscopic drills to expand ventral space.@*METHODS@#Thirty patients with severe free lumbar intervertebral disc herniation treated by spinal endoscopic technique from April 2019 to March 2021 were collected, including 19 males and 11 females;aged from 19 to 76 years with an average of (44.03±16.92) years old. All patients had a single segmental lesion with prolapse of the nucleus pulposus. Among them, there were 3 cases on L2,3, 3 cases on L3,4, 15 cases on L4,5, and 9 cases on L5S1. During operation, posterior bone of vertebral body and pedicle notch were removed by a drill under the endoscope to enlarge the ventral space. And the free nucleus pulposus was exposed and completely removed. The intraoperative blood loss, operation time, hospital stay and postoperative neurological complications were recorded, and Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were compared before operation, 2 days, 3 months and 1 year after operation, and Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All operations were successful and the free nucleus pulposus was completely removed. Pain in the lower back and legs was significantly relieved on the day after operation. Two patients experienced transient pain and numbness in lower limbs after operation, and no serious nerve injury complications occurred. ODI and VAS at each time point after surgery were significantly lower than those before surgery (P<0.01), and JOA score was significantly higher than before surgery (P<0.01). The excellent and good rates of Macnab were 66.67% (20/30), 83.33% (25/30) and 90.00% (27/30) on 2 days, 3 months and 1 year after operation, respectively.@*CONCLUSION@#For severe free lumbar intervertebral disc herniation, using of a drill under endoscope to expand the ventral space can smoothly remove the free nucleus pulposus and avoid nerve damage.

Comparison of clinical efficacy between percutaneous endoscopic transforaminal discectomy and coblation nucleoplasty in the treatment of inclusive lumbar disc herniation / 中国骨伤

OBJECTIVE@#To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups, and provide a basis for clinical formulation of precise and individualized treatments.@*METHODS@#A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed, in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤45 years old), middle-aged group(>45 years old and <60 years old) and older group(≥60 years old). Before treatment, 3 days, 1 month and 6 months after treatment, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods.@*RESULTS@#①VAS and JOA score outcomes, in the same age group and the same treatment method, the VAS and JOA scores at different time points postoperatively were obviously improved (P<0.05). For the same age group and the different treatment methods, the older group had lower VAS and higher JOA scores after PETD than after CN (P<0.05), and there was no significant difference between the young group and middle-aged group (P>0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P>0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1, 6 months after CN treatment(P<0.05). ②△T and ROM outcomes, in the same age group and same treatment method, postoperative △T and ROM at different time points were obviously improved(P<0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P>0.05), there was no significant difference in ROM between young group and middle-aged group(P>0.05), ROM was higher after PETD treatment than after CN treatment(P<0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P>0.05). There was no significant difference in △T between age groups by CN treatment, but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P<0.05).@*CONCLUSION@#Both PETD and CN for inclusive LDH have good efficacy, the curative benefit for older patients receiving PETD within 6 months after surgery more than CN, and CN is more appropriate for young and middle-aged patients.

Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy for lumbar disc herniation / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy between visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy (VPTED) and traditional percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation.@*METHODS@#The clinical data of 60 patients with lumbar disc herniation admitted from June 2019 to December, 2020 was retrospectively analyzed. There were 38 males and 22 females, aged from 26 to 58 years old with an average of (43.63±8.48) years, 47 cases were on L4,5 segment and 13 cases were on L5S1 segment. Among them, 32 were treated with VPTED (group A) and 28 were treated with traditional PTED (group B). The general conditions of all the patients were recorded, including intraoperative fluoroscopy times, operation time, hospital stay and surgical complications during follow-up. The arthroplasty area ratio was observed by sagittal CT at the middle level of the intervertebral foramen. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score of low back pain, Oswestry disability index (ODI) were used to evaluate the clinical efficacy between two groups.@*RESULTS@#All patients were followed up from 9 to 15 months with an average of (12.10±1.16) months. There was no statistical difference of preoperative general data between two groups. The operation time, fluoroscopy times and hospital stay were (70.47±5.87) min, (13.66±1.34) times and (6.31±0.69) d in group A, and (90.71±7.66) min, (22.82±2.48) times and (6.54±0.92) d in group B. The operation time and intraoperative fluoroscopy times in group A were lower than those in group B(P<0.05). There was no significant difference in hospital stay between two groups (P>0.05). No obvious surgical complications were found during the follow-up in both groups. The arthroplasty area ratio in group A was (29.72±2.84)% and (29.57±2.20)% in group B, respectively, with no significant difference (P>0.05). There was no significant difference in VAS, ODI and JOA score between two groups before operation and at the final follow-up(P>0.05), but the final follow-up was significantly improved(P<0.05).@*CONCLUSION@#The two surgical methods have definite clinical efficacy in the treatment of lumbar disc herniation. Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy has the advantages of high efficiency and rapidity when establishing the channel, and can significantly reduce the operation time and intraoperative fluoroscopy times.

Stress Distributions Affected by Different Filling Blocks in Medial Opening Wedge High Tibial Osteotomy / 医用生物力学

Objective To analyze the influence from material and size of the filling block on stress distributions of the tibial osteotomy model. Methods The filling blocks with three different materials (iliac bone, cancellous bone and polyetheretherketone (PEEK)) and five different sizes were established and implanted to the tibial osteotomy models, respectively. The mechanical loads were applied on the model, the stress distribution and edge displacement of the model were analyzed. Results For three kinds of materials, the stress at proximal end of the tibia and the plate, as well as edge displacement in the model implanted with filling block by iliac bone material were lower than those of the cancellous bone and PEEK, but the filling block by iliac bone material had the highest stress. When the filling blocks with different sizes were implanted in osteotomy space, the stress distribution on each part of the tibial osteotomy and edge displacement were different. Especially when the width of the filling block was reduced from 30 mm to 10 mm, the peak stress of the proximal tibia, steel plate and filling block was increased by 49. 3% , 92. 7% and 54. 4% on average. Conclusions Different filling block parameters will affect the stress distribution in different parts of the tibial osteotomy. The research results provide the theoretical basis for parameter selection of the tibial osteotomy filling block in clinic.

Progress in self-expanding metallic ureteral stent in the treatment of ureteral stricture in renal allografts / 器官移植

Ureteral stricture in renal allografts is one of the common postoperative complications in kidney transplant recipients. Due to short ureter in renal allografts, endovascular treatment should be adopted before reconstruction surgery to avoid irreversible injury. Alleviating renal allograft injury, easing obstruction or establishing drainage channel are the key measures to treat ureteral stricture. In endovascular treatment, balloon dilatation and internal incision yield high recurrence rate, and long-term indwelling of self-expanding metallic ureteral stents may be a better option. Compared with traditional stents, metallic stents may maintain urinary tract patency for a long time and mitigate the irritation of lower urinary tract symptoms,with different indications and efficacy. Although all metallic stents may be displaced and occluded, it still plays a positive role in the treatment of ureteral stricture in renal allografts. In this article, the application of self-expanding metallic ureteral stent in ureteral stricture of renal allografts was mainly illustrated, aiming to provide reference for optimizing the treatment of ureteral stricture in renal allografts.