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@#Objective To analyze the trend of the hemagglutinin(HA) and ovalbumin contents in the lot release of influenza virus split vaccines in 2021,and evaluate the quality and quality control level of the vaccines.Methods The HA and ovalbumin content data of influenza virus split vaccines from two domestic enterprises in 2021 were collected and collated. The mean value and standard deviation were calculated according to the first 40 batches of data of the enterprise in the year,and the warning limit and action limit were established. The trend analysis of the above indexes was carried out to evaluate the stability and consistency of the product quality of the enterprise. Statistical data comparison and consistency analysis were made between the test results of the batch inspected by the lot release institution and the results of the enterprise.Results Through the retrospective data analysis of quadrivalent influenza virus split vaccines from two vaccine enterprises A and B,it was found that the content of H1N1 subtype HA and ovalbumin in the two enterprises and the content of Bv HA in the B enterprise had out of trend(OOT)situations,while the trend of other items was stable. The results of paired student's t test or Wilcoxon signed-rank test of the samples inspected by the lot release institution showed that except Bv subtype HA(t = 1. 094 and 0. 742 respectively)and ovalbumin(w =-64 and 36 respectively)contents showed no statistically significant difference(P > 0. 05),the HA contents of H1N1(t = 3. 862,w = 232),H3N2(t = 8. 225 and3. 473 respectively)and By(t = 5. 616 and 4. 934 respectively)of the two enterprises had significant differences(P <0. 05). The results of enterprises were generally higher than the lot release institution. Bland-Altman test analysis found that the consistency between the test data of enterprise A's HA content and the data of the lot release institution was better than that of enterprise B.Conclusion The stability and consistency of data trends of active ingredients and main impurity ingredients of quadrivalent influenza virus split vaccine batches in 2021 were generally good. The trend analysis can identify potential problems in vaccine production,and enterprises should carefully implement trend analysis and effectively monitor the product quality of vaccines.
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Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.
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The mandibular advancements performed in orthognathic surgeries can be stabilized with several techniques when using stable internal fixation. This study aims to comparatively evaluate, in vitro, the mechanical strength in a polyurethane mandibular model for four fixation techniques for sagittal split ramus osteotomy mandibular. 60 samples were divided into 4 groups, with 15 units for each group: group A, group B, group C and group D. Advances of 5 mm were made for each subgroup and fixed with 2.0 mm system plates and monocortical screws in the replicas of human hemimandibles in polyurethane resin. The samples were submitted to mechanical tests of linear loading, being evaluated the peak load and peak deformation. Technique B presented higher peak load (Kgf) and techniques A and B presented higher peak strain (p<0.05). Technique D presented lower peak load and lower peak strain (p<0.05). It is concluded that the study based on the development of new techniques for fixation for sagittal osteotomy of the mandibular ramus is of great importance for the advancement of orthognathic surgery, provided by the technical innovation of more favorable plate models.
Los avances mandibulares realizados en cirugías ortognáticas pueden estabilizarse con varias técnicas cuando se utiliza fijación interna estable. Este estudio tuvo como objetivo evaluar comparativamente, in vitro, la resistencia mecánica en un modelo mandibular de poliuretano para cuatro técnicas de fijación para la osteotomía sagital de la rama mandibular. Se dividieron 60 muestras en 4 grupos, con 15 unidades para cada grupo: grupo A, grupo B, grupo C y grupo D. Se realizaron avances de 5 mm para cada subgrupo y se fijaron con placas de sistema de 2,0 mm y tornillos monocorticales en las réplicas de hemimandíbulas humanas en resina de poliuretano. Las muestras fueron sometidas a pruebas mecánicas de carga lineal, siendo evaluadas la carga máxima y la deformación máxima. La técnica B presentó mayor pico de carga (Kgf) y las técnicas A y B presentaron mayor pico de deformación (p<0,05). La técnica D presentó menor carga máxima y menor tensión máxima (p<0,05). Se concluye que el estudio basado en el desarrollo de nuevas técnicas de fijación para la osteotomía sagital de la rama mandibular es de gran importancia para el avance de la cirugía ortognática, proporcionada por la innovación técnica de modelos de placas más favorables.
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Avanço Mandibular/métodos , Osteotomia Sagital do Ramo Mandibular/métodos , Mandíbula/cirurgia , Fenômenos Biomecânicos , Cirurgia Ortognática/métodos , Fixação Interna de Fraturas/métodosRESUMO
La pérdida ósea en el sector anterior, ya sea por un defecto horizontal, vertical o combinado, actualmente es un desafío, no sólo por la integración del implante, sino por la estética involucrada. Entre las técnicas de regeneración ósea que permiten solucionar estos defectos, cabe destacar la técnica de expansión de crestas. Se presenta el caso de una paciente de 58 años con reborde atrófico, que se sometió a la expansión de crestas con colocación simultánea de implantes en sector anterior, con xenoinjerto previo a técnica de expansión de crestas con piezoeléctrico, colocación simultánea de implantes Narrow Connection SLActive Straumann. Se logró ganancia ósea y estabilidad primaria de los implantes, sin complicaciones. En escenarios seleccionados, la técnica de expansión de crestas de manera predecible permite ganancia de hueso horizontal adecuada, el éxito de los implantes con tasa de supervivencia y mínimas complicaciones intra y postoperatorias (AU)
Bone loss in the anterior sector, both a horizontal, vertical or combined defect is a challenge today; not only for the integration of the implant but also the aesthetic involved. There are techniques of bone regeneration that help us to solve this type of defects, among them we should highlight the crest expansion technique. We present the case of a 58-year-old patient with atrophic flange, who underwent the expansion of crests with simultaneous placement of implants in the anterior sector, with xenograft prior to the piezoelectric crest expansion technique, Simultaneous placement of Narrow Connection SLActive Straumann implants, bone gain and primary stability of the implants were obtained, without complications. In selected scenarios, the crest expansion technique could be considered a predictable approach that demonstrates a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications (AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Implantação Dentária Endóssea/métodos , Aumento do Rebordo Alveolar/métodos , Osteotomia/métodos , Piezocirurgia/métodos , XenoenxertosRESUMO
El bad split es un término clínico que refiere a una fractura no planificada que ocurre al momento de realizar una osteotomía sagital de rama mandibular (OSRM). Afecta aproximadamente al 2,3% de los pacientes y se han descrito factores de riesgo tales como la presencia de terceros molares mandibulares, edad avanzada al momento de la cirugía, técnica de osteotomía inadecuada, entre otros. Se recomienda efectuar manio-bras preventivas para evitar la aparición de patrones de fractura no deseados al realizar la OSRM. Sin embargo, al momento de pesquisar un bad split, éste debe ser tratado por un equipo capacitado y de manera oportuna para evitar retardo en la consolidación, infecciones y secuestros óseos que puedan comprometer los resultados de la cirugía. En este artículo se presenta el manejo de un caso clínico de bad split bilateral intraoperatorio por el Servicio de Cirugía Maxilofacial del Hospital San José, enfatizando su tratamiento quirúrgico.
Bad Split is a clinical term referring to an unplanned fracture that occurs during the bilateral sagittal split osteotomy (BSSO). It affects approximately 2,3% of the patients undergoing orthognathic surgery and several risk factors have been described such as the presence of mandibular third molars, advanced age at the moment of orthognathic surgery, inadequate osteotomy technique, etc. Preventive maneuvers are recommended in order to avoid the appearance of undesired fracture patterns during BSSO. However, if a bad split is detected it must be managed and treated by a qualified team to avoid further complications such as delayed bone consolidation, bone infection and necrosis. In this article we present the management of a case of bilateral bad split by the Maxillofacial Surgery Service of Hospital San José, emphasizing on its surgical treatment.
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Humanos , Feminino , Adulto , Osteotomia/efeitos adversos , Cirurgia Ortognática/métodos , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Complicações Intraoperatórias , Mandíbula/cirurgia , Fraturas MandibularesRESUMO
Objective:To compare the clinical effectiveness between arthroscopic hollow screws combined with a suture anchor, hollow screws and proximal humerus internal locking system (PHILOS) in the treatment of split-type fractures of humeral greater tuberosity.Methods:A retrospective study was conducted to analyze the 54 patients with split-type fracture of humeral greater tuberosity who had been admitted to Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University from May 2015 to August 2020. There were 17 males and 37 females with an age of (58.4±12.1) years. According to different treatment methods, they were divided into 3 groups. Group A of 18 cases was treated with arthroscopic hollow screws combined with a suture anchor, group B of 18 cases with hollow screws, and group C of 18 cases with PHILOS. The length of surgical incision, and range of shoulder motion, visual analogue scale (VAS), and American Shoulder and Elbow Surgeons (ASES) score at the last follow-up were recorded and compared between the 3 groups.Results:There was no statistically significant difference in the preoperative general information between the 3 groups, indicating the 3 groups were comparable ( P>0.05). The surgical incision in group A [(0.7±0.1) cm] was the shortest, followed by (5.0±1.4) cm in group B, and (12.8±2.1) cm in group C, showing statistically significant differences in pairwise comparison ( P<0.05). In the 3 groups at the last follow-up, respectively, the shoulder forward flexion was 159.7°±13.4°, 154.9°±16.2°, and 160.5°±12.9°, and the shoulder abduction 149.6°±11.3°, 142.4°±12.0°, and 145.1°±10.4°, showing no statistically significant difference among the 3 groups ( P>0.05); the external rotation was 41.1°±8.1°, 38.1°±7.8° and 43.7°±6.2°, showing a statistically significant difference between groups B and C ( P<0.05); the dorsal extension was T 12 (L 5 to T 6), T 12 (L 5 to T 7), and T 12 (L 3 to T 6), showing no statistically significant difference among the 3 groups ( P>0.05). There was no statistically significant difference among the 3 groups in the VAS score or ASES score at the last follow-up ( P>0.05). Respectively, there were 2, 6, and 4 patients in groups A, B and C who developed complications, showing statistically significant differences between the 3 groups ( P<0.05). Conclusions:In the treatment of split fractures of humeral greater tuberosity, arthroscopic hollow screws combined with a suture anchor, hollow screws and PHILOS can all relieve pain and restore joint function of the shoulder. However, arthroscopic hollow screws combined with a suture anchor are the most recommendable due to their advantages in minimally invasiveness and reduction in complications.
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【Objective】 To use hairy enhancer of split 1 (Hes1) to regulate the differentiation of liver epithelial progenitor cells (LEPCs) into cholangiocytes. 【Methods】 The vectors, pTet-on and pTRE2hyg-Hes1, were transfected into LEPCs. The expression of Hes1 was induced by doxycycline (DOX) with different concentrations (0, 0.1, 1, 5, 10, 50, 100 and 500 μg/mL). The expressions of Hes1, molecular markers of hepatocyte and cholangiocyte, glutathione synthetase (Gss), keratin 19 (Krt19) and hepatic nuclear factor 1β (HNF1β) in LEPCs were verified by Western blotting, RT-PCR, Real-time PCR, immunocytochemistry and immunofluorescence. 【Results】 The expression of Hes1 in LEPCs transfected by pTet-on/pTRE2hyg-Hes1 was increased by 11.21 fold when induced by DOX at 10 ug/mL, which drove the LEPCs to differentiate into biliary epithelial cells. With increasing expression of Hes1, cholangiocyte markers, Krt19 and HNF1β, were significantly upregulated, while the hepatocyte marker, Gss, was obviously downregulated. 【Conclusion】 DOX at 10 μg/mL may induce a suitably up-regulated expression of Hes1 in LEPCs double-transfected by pTet-on and pTRE2hyg-Hes1, and the suitable high-expression rather than over-expression of Hes1 can regulate LEPCs to differentiate into cholangiocytes.
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Drug resistance of cancer cells is the main causes of chemotherapy failure, and gene mutation or function loss is key factor to induce drug resistance. Previous studies have shown that hairy and enhancer of split 1 (HES1) is up-regulated in herceptin-resistant gastric cancer cells, and inhibition of its activity can reverse its resistance while the potential mechanism has not yet been elucidated. In this study, we employed CRISPR/Cas9 to establish HES1 knock-out cell line (△HES1/NCI N87R) to investigate the functions of HES1 in herceptin resistance of NCI N87R cells and its potential mechanisms. We investigated proteomics profiling of △HES1/NCI N87R cells based on quantitative proteomics. Gene ontology analysis was conducted by GeneSet Enrichment Analysis (GSEA) and Metascape database, and pathway enrichment analysis was done using GeneAnalytics database. The selected molecules were quantified by Western blot and some pathways were verified by using inhibitors. The results showed that the resistance to herceptin of △HES1/NCI N87R cells decreased compared to NCI N87R cells. Proteomic data demonstrated that the expression of 1 263 genes changed significantly in △HES1/NCI N87R cells, among which 761 genes were up-regulated while 502 ones down-regulated comparing with NCI N87R cells. Pathway analysis showed that ferroptosis, fatty acid β-oxidation, autophagy and glutathione metabolism, etc. exhibited notable changes in △HES1/NCI N87R cells. The functional studies showed that the levels of iron ion and malondialdehyde increased, and glutathione decreased in △HES1/NCI N87R cells. It was further found that Fer-1, a ferroptosis inhibitor, could reverse the expression of pTP53, solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) in △HES1/NCI N87R cell, and reduce the sensitivity of △HES1/NCI N87R cells to herceptin. It is suggested that HES1 regulated the resistance of NCI N87R cells to herceptin through TP53/SLC7A11/GPX4 signaling pathway, and targeting TP53/SLC7A11/GPX4 signal axis mediated by HES1 is a potential strategy to reverse herceptin resistance in gastric cancer.
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Objective:To investigate the association between split foot and electrophysiology in patients with amyotrophic lateral sclerosis (ALS).Methods:The clinically definite or clinically probable ALS patients hospitalized in the Department of Neurology, the First Medical Center of Chinese People′s Liberation Army General Hospital from April 2021 to December 2022 were prospectively collected. From April 2021 to December 2022, patients who visited the Chinese People′s Liberation Army General Hospital for other reasons without abnormal electrophysiological examination were collected as the control group. The incidence of split leg [the limb whose modified Medical Research Council Muscle Strength Scale (mMRC) score of ankle dorsiflexors was lower than that of ankle plantarflexors] in ALS patients was calculated, and the incidence of split foot (the limb whose mMRC score of hallux dorsiflexors was lower than that of hallux plantarflexors) in ALS patients was calculated. The amplitude of compound muscle action potential (CMAP) of common peroneal nerve and tibial nerve was detected to observe the involvement of motor neurons innervating ankle dorsiflexors and ankle plantarflexors. The characteristics of split leg and split foot in ALS patients were analyzed from the perspective of muscle strength, and the characteristics of split foot in ALS patients were analyzed from the perspective of electrophysiology. Receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of peroneal nerve/tibial nerve CMAP amplitude ratio in distinguishing ALS patients from controls.Results:A total of 101 ALS patients with lower limb involvement and 110 controls with normal lower limb muscle strength were collected. Among the 101 ALS patients with lower limb involvement, strength of ankle plantarflexors was greater than that of ankle dorsiflexors in 35.64% (36/101) patients, strength of ankle dorsiflexors was greater than that of ankle plantarflexors in 5.94% (6/101) patients, and strength of ankle plantarflexors and ankle dorsiflexors was equal in 58.42% (59/101) patients. Strength of hallux dorsiflexors was lower than that of hallux plantarflexors in 53.47% (54/101) patients, strength of hallux dorsiflexors was greater than that of hallux plantarflexors in 1.98% (2/101) patients, and the strength of hallux dorsiflexors and hallux plantarflexors was equal in 44.55% (45/101) patients. The incidence of split leg was negatively correlated with age ( OR=0.25, 95% CI 0.16-0.40, P<0.05), course of disease ( OR=0.52, 95% CI 0.38-0.80 P<0.05) and ALS functional revised scores ( OR=0.29, 95% CI 0.12-0.67, P<0.05). The incidence of split foot was negatively correlated with the onset time of lower limb symptoms ( OR=0.96, 95% CI 0.93-0.99, P<0.05). Compared with the control group, the differences of the decrease of CMAP amplitude in the common peroneal nerve and tibial nerve [the common peroneal nerve (6.45±2.56) mV vs (3.63±1.83) mV, tibial nerve (12.87±4.72) mV vs (9.18±6.22) mV] were statistically significant ( t=-4.65, t=-3.44, both P<0.001) and the differences of the peroneal nerve/tibial nerve CMAP amplitude ratio (0.54±0.24 vs 0.36±0.18) decrease was statistically significant ( t=-4.31, P<0.001) in patients with split foot. ROC curve analysis showed that the area under the ROC curve of CMAP amplitude ratio of common peroneal nerve/tibial nerve in ALS patients with split foot was 0.70, indicating that the accuracy of CMAP amplitude of common peroneal nerve/tibial nerve in distinguishing ALS patients from controls was low. Conclusions:In ALS patients with lower limb involvement, strength of ankle dorsiflexors is weaker than that of ankle plantarflexors, and strength of hallux dorsiflexors is weaker than that of hallux plantarflexors. At the diagnostic level, the CMAP amplitude ratio of common peroneal nerve/tibial nerve in ALS patients with split foot has a lower accuracy in the diagnosis of ALS.
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AIM:To compare the curative effect of different surgical methods combined with Toric intraocular lens(IOL)implantation on age-related hard nuclear cataract.METHODS:According to retrospective study, 104 patients(104 eyes)with age-related hard nuclear cataract confirmed in the hospital between January 2020 and December 2021 were enrolled. They were divided into phacoemulsification group(52 eyes, phacoemulsification combined with Toric IOL implantation)and small-incision group(52 eyes, small-incision split nuclear technique in horizontal space combined with Toric IOL implantation)according to different surgical methods. The best corrected distance visual acuity(BCDVA), corneal astigmatism, number of corneal endothelial cells, proportion of normal hexagonal cells, tear film function and complications were compared between the two groups.RESULTS:There was no significant difference in BCDVA(LogMAR)between the two groups before and at 3mo after surgery(all P>0.05), while BCDVA(LogMAR)was better in small-incision group than phacoemulsification group at 1wk after surgery(0.15±0.04 vs. 0.20±0.05, P<0.001). The corneal astigmatism of the patients in both groups was lower at 1wk and 3mo after surgery than that before surgery, and it was lower at 3mo than 1wk after surgery(all P<0.05), while there was no significant difference in corneal astigmatism between the two groups before and after surgery(all P>0.05). At 1wk and 3mo after surgery, number of corneal endothelial cells in small-incision group was more than that in phacoemulsification group(1wk after surgery: 2363.8±315.3 vs. 2231.4±326.4 cells/mm2, P<0.05; 3mo after surgery: 2414.6±245.7 vs. 2322.9±221.0 cells/mm2, P<0.05). Before and at 1wk after surgery, there was no significant difference in the proportion of normal hexagonal cells between the two groups(all P>0.05). At 3mo after surgery, proportion of normal hexagonal cells in small-incision group was higher than that in phacoemulsification group(21.77%±1.91% vs. 20.59%±1.65%, P<0.001). Before and at 3mo after surgery, there was no difference in break up time(BUT)or ocular surface disease index(OSDI)score between the two groups(P>0.05). At 1wk after surgery, BUT in small-incision group was longer than that in phacoemulsification group(6.8±0.8 vs. 5.9±1.0s, P<0.001)and OSDI score was lower than that in phacoemulsification group(17.62±5.47 vs. 20.34±6.18 points, P<0.05). The incidence of postoperative complications in small-incision group was lower than that in phacoemulsification group(3.9% vs. 17.3%, P<0.05).CONCLUSION: Small-incision split nuclear technique in horizontal space combined with Toric IOL implantation can significantly improve visual acuity and astigmatism in patients with age-related cataract, with slight damage to corneal endothelium and tear film function.
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Objective:To investigate the surgical outcome and prognostic factors of para-split laminotomy for removal of lumbar spinal canal tumors.Methods:Retrospectively review the clinical data of 35 patients suffering lumbar spinal canal tumors, who underwent the para-split laminotomy for tumor resection in Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to August 2019, including 16 males and 19 females, and the age was(40.1±10.6)years. Intraoperative blood loss, operation time, tumor resection, tumor pathological results, perioperative complications were observed. Follow-up situations, including tumor recurrence, bony fusion of laminae and spinal stability. Follow-up using outpatient examination and telephone interview was performed by the end of August 2022. The JOA back pain scoring system was used to evaluate the neurological function of the spinal cord, and paired t-test were performed to compare the overall preoperative and postoperative spinal cord neurological function scores. Linear regression and multiple linear regression were used to analyze the prognostic factors. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and the comparison before and after operation was performed by paired t-test. Mearsurement data of skewed distribution were expressed as M( Q1, Q3). Count data were expressed as cases. Results:The tumors of 35 patients were resected completely. The median blood loss was 100(75, 140)mL and the average operative duration was (181.1±42.7) min. The postoperative pathological results were as follows: 24 neurilemmomas, 6 meningiomas, 4 ependymomas and 1 neurofibroma. There were no surgery-related complications occurred. The postoperative follow-up ranged from 36 to 69 months, with no tumor recurrence or spinal instability, and bony fusion of laminae seen in some patients on CT imaging. The overall spinal cord neurological function scores of pre and post operation were(19.5±3.4)versus(25.4±2.2), Paired t-test analysis revealed a significant difference between the overall postoperative spinal cord neurological function scores and the preoperative scores, and the postoperative scores were better than the preoperative scores( P<0.05). Multiple linear regression analysis showed a positive correlation between preoperative JOA scores and postoperative JOA scores, and postoperative JOA scores has negative correlation with tumor volume and the age at the time of operation ( P<0.05). Conclusion:Para-split laminotomy with less damage to the posterior spinal structures can effectively improve the neurological function of the spinal cord and protect the stability of the lumbar spine in patients with lumbar spinal canal tumors, and the better the preoperative neurological function of the spinal cord, the better the prognosis of patients, and the smaller the tumor volume, the better the prognosis.
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OBJECTIVE@#To summarize the application and recent development of orthognathic surgery in treating syndromic craniosynostosis.@*METHODS@#The related literature at home and abroad in recent years was extensively reviewed, and the indications, routine procedures, and protocols of orthognathic surgery in the treatment of syndromic craniosynostosis were summarized and analyzed.@*RESULTS@#Craniosynostosis is a common congenital craniofacial malformation. Syndromic craniosynostosis usually involves premature fusion of multiple cranial sutures and is associated with other deformities. Orthognathic surgery is the necessary and effective means to improve the midfacial hypoplasia and malocclusion. Le Fort I osteotomy combined with sagittal split ramus osteotomy are the common surgical options. Orthognathic surgery should combine with craniofacial surgery and neurosurgery, and a comprehensive long-term evaluation should be conducted to determine the best treatment plan.@*CONCLUSION@#Orthognathic surgery plays an important role in the comprehensive diagnosis and treatment of syndromic craniosynostosis. The development of digital technology will further promote the application and development of orthognathic surgery in the treatment of syndromic craniosynostosis.
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Humanos , Cirurgia Ortognática , Craniossinostoses/cirurgia , Osteotomia , Osteotomia Sagital do Ramo MandibularRESUMO
Interosseous atrophy of the hand is not an exclusive finding of rheumatoid arthritis, and in the case of amyotrophic lateral sclerosis it has a significant diagnostic and prognostic value. The physical examination and evidence of the "split hand" sign or sign of the double anatomical snuffbox is a finding that should alert the clinician to the need for complementary studies in order to rule out neurological pathology.
La atrofia de interóseos de la mano no es un hallazgo exclusivo de la artritis reumatoide, en el caso de la esclerosis lateral amiotrófica tiene un valor diagnóstico y pronóstico significativo, por lo que la exploración física y la evidencia del signo de la mano partida o signo de la doble tabaquera anatómica es un hallazgo que debe alertar al clínico de la necesidad de realizar estudios complementarios para descartar una enfermedad neurológica.
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Humanos , Feminino , Idoso , Doenças da Medula Espinal , Doenças do Sistema Nervoso Central , Esclerose Lateral Amiotrófica , Doenças do Sistema NervosoRESUMO
Purpose: To assess the incidence and cause of idiopathic, irreversible loss of vision (“wipe?out”) in the early post?operative period after glaucoma?filtration surgery in advanced glaucoma. Methods: It was a prospective, interventional cohort study. Patients with advanced glaucoma and macular split fixation underwent either only trabeculectomy (group A) or combined phaco?emulsification with trabeculectomy (group B). The incidence and cause of visual loss, changes in intra?ocular pressure, visual acuity, and visual field indices during 2 months post surgery were assessed. Results: Thirty patients (30 eyes) were divided in two groups. No significant difference was noted between the pre?operative and post?operative mean deviations in both groups (P = 0.41, P = 0.65). Two eyes in group A and one eye in group B had visual loss of two lines or more at the end of 2 months because of cataract and choroidal detachment. None of the eyes showed “wipe?out”. Conclusion: “Wipe?out” is a rare phenomenon after surgery in advanced glaucoma
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Aims and Objectives: The aim of the current cross?sectional study was to conduct a survey among the oral and maxillofacial surgeons of South India regarding their experiences of incidence of inferior alveolar nerve (IAN) neurosensory deficit after bilateral sagittal split osteotomy (BSSO) for correction of mandibular retrognathism and to assess the intra?operative nerve encounters and its effect on the inferior alveolar neurosensory deficit (NSD), 6 months post?operatively. Materials and Methods: A self?administered questionnaire (SAQ) was prepared using Google Forms (Google Inc.) and sent to the prospective participants through various social media outlets such as Facebook, WhatsApp groups etc., of the maxillofacial surgery specialty for a period of 3 months. SAQ from surgeons with more than 5 years of experience in orthognathic surgery were included. Results: The incidence of NSD post?BSSO advancement surgery from 859 cases after 6 months was 15.1% (130). After splitting the mandible, the IAN was seen in the proximal fragment in 472 sites and needed dissection. The nerve was transected and neurorrhaphy was carried out in 26 sites. A Chi?square test was used to analyse the qualitative variables. The IAN was not visible post?osteotomy in 140 sites and in the distal fragment in 1080 sites. These groups had decreased incidence of NSD. The NSD was significantly higher in cases where the nerve was transected and sutured, P value <0.001 as compared with the other nerve status, followed by the nerve in the proximal fragment needing dissection. Conclusion: The IAN status intra?operatively can be assumed to have a significant role in persisting NSD
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RESUMEN: Habitualmente los pacientes buscan estética en un tratamiento de ortodoncia, y al tener que someterse a una cirugía ortognática, lo que más les preocupa es cómo se verán luego de ésta. Hoy en día existe variados softwares para mostrar una imagen virtual del resultado del tejido esquelético y blando luego de una cirugía, pero no se ha llegado a consenso de que tan fiables son, ya que cada ortodoncista puede utilizar distintos métodos de medición. En este estudio queremos realizar una revisión bibliográfica para evaluar el efecto de la cirugía Lefort I y sagital bilateral de rama sobre el tejido blando del tercio medio e inferior en pacientes que han tenido tratamiento ortodóncico. Para así, en un futuro, poder predecir el comportamiento del tejido blando a través del tratamiento quirúrgico.
ABSTRACT: Usually patients seek aesthetics in orthodontic treatment, and having to undergo orthognathic surgery, what they are most concerned about is how they will look after it. Nowadays there are various softwares to show a virtual image of the result of skeletal and soft tissue after surgery, but no consensus has been reached on how reliable they are, since each orthodontist can use different measurement methods. In this study, we want to carry out a bibliographic review to evaluate the effect of Lefort I and bilateral sagittal branch surgery on the soft tissue of the middle and lower third in patients who have undergone orthodontic treatment. Thus, in the future, to be able to predict the behavior of soft tissue through surgical treatment.
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Objective:To determine the clinical efficacy and safety of a fractional CO 2 laser and a 1 064 nm, Q-switched Nd∶YAG laser therapy in the treatment of xanthelasma palpebrarum. Methods:From October 2020 to October 2021, 30 patients (5 males and 25 females) with bilateralxanthelasma palpebrarum of the eyelid were enrolled in the Department of Dermatology, the First Affiliated Hospital of Xiamen University. The age ranged from 38 to 67 (51±7) years. One side was randomly treated with fractional CO 2 laser as the fractional group, and the other side was treated with Q-switch 1 064 nm Nd∶YAG laser as the Q-switch group. The treatment was given every 28 days for 4 times. Before treatment and 1 month after the last treatment, the general pictures were taken to compare the clinical effect. Skin ultrasound was used to measure the difference of tumor thickness before and after treatment. The incidence of adverse reactions, such as local scar, hyperpigmentation or hypopigmentation after inflammation, were recorded. Results:Under general photos, there was statistically significant difference in efficacy scores between the two groups before and after treatment ( Z=-3.082, P<0.05). By comparison of tumor thickness under skin ultrasound, the difference between the two groups before and after treatment was statistically significant ( t=21.60, P<0.05; t=17.29, P<0.05); there was no statistically significant difference between the two groups before treatment ( t=0.46, P=0.650), but there was statistically significant difference between the two groups after treatment ( t=8.41, P<0.001). No serious adverse reactions occurred in both groups. Conclusions:Fractional CO 2 laser or Q-switch 1 064 nm Nd∶YAG laser can safely and effectively improve xanthelasma palpebrarum, in which the effect of fractional CO 2 laser is much better.
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Objective:To explore the feasibility of technological modification and innovation of full-left/full-right liver splitting in situ for donors and examine the safety of clinical application for liver transplantation (LT).Methods:From March 2021 to June 2022, clinical and surgical data are retrospectively reviewed for 27 donors undergoing full-left/full-right liver splitting in situ and the corresponding 49 recipients undergoing full-left/full-right LT.According to the split liver technique used in donor liver surgery, they are divided into conventional split group(group A, 13 cases)and innovative split group(group B, 14 cases). The corresponding recipients are divided into two groups of recipient C(25 cases)and recipient D(24 cases). General profiles, intraoperative findings, type of vascular allocation and short-term outcomes in two groups are compared.After full-size split liver transplantation(fSLT), follow-ups continued until the end of September 2022.Results:There are 23 males and 4 females in donors.The causes of mortality for donors are traumatic head injury(12 cases)cerebrovascular accident(13 cases)and anoxia encephalopathy(2 cases). Baseline characteristics of two groups indicate that body weight and body mass index(BMI)are higher in group B and blood sodium level is lower than that in group A( P<0.05). No statistical differences exist for the others.Liver splitting time is significantly shorter in group B than that in group A(175 vs.230 min, P=0.022). No significant inter-group difference exists in type of vascular allocation.Retrohepatic inferior vena cava(IVC)is split in one case in group A and 10 cases in group B( P=0.001). Among 20 cases of right hemiliver requiring a reconstruction of segment Ⅴ/Ⅷ venous outflow, 12 cases in group A and 3 cases in group B are reconstructed with conventional independent bridging method(independent type)while another 5 cases in group B reconstruct with innovated technique by bridging Ⅴ/Ⅷ vein for splitting IVC with iliac vessel and molding all outflows as one for anastomosis(combined typ e). There is significant inter-group difference( P=0.004). No significant differences exist in operative duration, anhepatic phase or blood loss between groups C and B, except for T tube retaining in 7 cases of group A and 14 cases of group D( P=0.032). Twelve cases developed a total of 26 instances of≥Clavien-Dindo grade Ⅲ complications.Of which, 7 cases in group C and 5 cases in group D show no significant difference in postoperative morbidity.However, for serious biliary complications(≥Clavien Dindo grade Ⅲ), there are 6 cases in group C versus none in group D( P=0.016). Two cases died from postoperative complication with a postoperative mortality rate of 4.1%.Postoperative hospital stay is similar in two groups.And accumulates 6/12-month survivals were 95.9% and 87.7% for grafts and 95.9% and 92.4% for recipients respectively. Conclusions:Operative duration of full-left/full-right liver splitting in situ tends to shorten with an accumulation of a certain amount of cases.Technological modification and innovation in IVC splitting and segment Ⅴ/Ⅷ vein reconstruction should be further validated as both feasible and safe by short-term outcomes of the corresponding recipients.
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ObjectiveTo observe the effects of Bufei Yishen prescription on airway mucus hypersecretion and Notch signaling pathway related protein Notch3 and enhancer of split homologue 1 （HES1） in rats with chronic obstructive pulmonary disease （COPD） and to explore its action mechanism. MethodForty-eight SD rats were randomly divided into the control group， model group， Bufei Yishen prescription group， and aminophylline （APL） group，with 12 rats in each group. The stable COPD rat model was established via cigarette smoking exposure combined with Klebsiella bacterial infection for 12 weeks， and the corresponding drugs （3.7 g·kg-1·d-1 Bufei Yishen prescription and 54 mg·kg-1·d-1 APL） were administered by gavage during the next eight weeks. After the last administration at week 20， the lung tissue was sampled for observing the pathological changes and the rat lung function was detected. The tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and mucoprotein 5AC （MUC5AC） in bronchial alveolar lavage fluid and the mRNA and protein expression levels of Notch3， HES1， and MUC5AC in lung tissues were assayed. ResultCompared with the control group， the model group exhibited significantly weakened pulmonary function （P<0.05，P<0.01）， reduced average number of alveoli （P<0.01）， elevated mean linear intercept （P<0.01）， and up-regulated TNF-α， IL-6， and MUC5AC in bronchial alveolar lavage fluid and Notch3， HES1， and MUC5AC mRNA and protein expression in lung tissue （P<0.05，P<0.01）. Compared with the model group， Bufei Yishen prescription and APL remarkably enhanced pulmonary function， alleviated its pathological injury （P<0.05，P<0.01）， and down-regulated TNF-α， IL-6， and MUC5AC in bronchial alveolar lavage fluid and the mRNA and protein expression levels of Notch3， HES1， and MUC5AC in lung tissues （P<0.05，P<0.01）. ConclusionThe mechanism of Bufei Yishen prescription in inhibiting airway mucus hypersecretion of COPD rats was related to its regulation of Notch3 and HES1.