Three-dimensional quantitative evaluation of midfacial skeletal changes after trans-sutural distraction osteogenesis for midfacial hypoplasia in growing patients with cleft lip and palate.

PURPOSE: Trans-sutural distraction osteogenesis (TSDO) is an alternative method for the early treatment of midfacial hypoplasia in growing patients with cleft lip and palate (CLP). The purpose of this study was to analyze three-dimensional (3D) midfacial skeletal changes after TSDO and to explore the mechanism in this process. MATERIAL AND METHODS: All patients with nonsyndromic CLP who underwent bone-borne TSDO for midfacial hypoplasia from 2005 to 2014 were reviewed in this retrospective study. 3D morphological and quantitative measurement analyses were performed to evaluate midfacial skeletal changes by superimposition of preoperative and postoperative computed tomographic images. RESULTS: Twenty-six patients with mean age of 11.5 years met the inclusion criteria. The 3D morphological findings exhibited the most significant suture stress changes at the pterygomaxillary suture area, with obvious bone generation in all patients. The whole midfacial skeleton had progressively increased advancement in a craniocaudal direction along the midface segment, associated with morphological changes in skeleton itself. The 3D quantitative measurement findings showed differential advancement of each landmark at the maxillary alveolar, zygomatic bone, orbital rim, and nasal bone, which was consistent with morphological findings. CONCLUSIONS: TSDO allows rotation advancement of the midfacial skeleton to achieve occlusal correction and facial harmony through the mechanism of both suture remodeling and bone remodeling.

A prospective, randomized, controlled study of hyperbaric oxygen therapy: effects on healing and oxidative stress of ulcer tissue in patients with a diabetic foot ulcer.

Although hyperbaric oxygen (HBO) therapy has been reported to help heal chronic foot ulcers in patients with diabetes mellitus (DM), production of HBO-related oxidative stress is a concern. To assess the therapeutic effect and oxidative stress of HBO, a 2-week, prospective, randomized, controlled clinical study was conducted from January 1, 2010 to January1, 2012 among 36 consecutively admitted patients with diabetic foot ulcers (DFU). Average patient age was 60.08 ± 5.97 years and average DM duration was 16.4 ± 11.3 years; 86.1% had type 2 DM, and 47.2% had Wagner grade-III foot ulcers. Patients randomized to the control group (n = 18) received standard care including offloading, wound debridement, and glucose control. HBO treatment group patients (n = 18) received standard care and twice-daily HBO sessions for 90 minutes at 2.5 atmospheres absolute (ATA) 5 days a week for 2 weeks. Transcutaneous oxygen pressure (TcPo2) at the edge of the ulcer and wound size were measured at baseline and after 7 and 14 days of treatment. Ulcer tissues were harvested on days 7 and 14 to determine oxidative stress by measuring malondialdehyde (MDA) and antioxidant enzyme (superoxide dismutase [SOD], catalase [CAT], and glutathione peroxidase [GPx]) levels. Compared to baseline, TcPo2 in the HBO group increased on day 7 (477.8 ± 118.2 mm Hg versus 37.06 ± 5.23 mm Hg, P <0.01) and day 14 (501.1 ± 137.7 mm Hg versus 35.61 ± 4.85 mm Hg, P <0.01). Ulcer size reduction in the HBO group was greater than that of the control group (42.4% ± 20.0% versus 18.1% ± 6.5%, P <0.05). MDA levels, SOD, and CAT were all significantly higher in the HBO than in the control group on day 14 (P<0.05). The results of this study suggest HBO treatment for 2 weeks initiates a healing response in chronic DFUs, but the observed oxidative stress in local ulcer tissue may offset this effect long-term. Until needed additional research has been conducted, prolonged and/or inappropriate HBO treatment should be avoided.

[Unilateral buccinator myomucosal island flap with double opposing Z-plasty for wider palatal cleft repair].

OBJECTIVE: To explore a method to repair larger cleft palate and lengthen soft palate without oral palate raw surface and scar formation, reduce the effect on maxilla and dental arch development. METHODS: A modified double opposing Z-plasty was used to lengthen soft palate and the nasal palate was closed by using large turn-over mucoperiosteal flaps on the oral surface of the junction of the hard palate and soft palate, oral raw surface on the palate was closed by a buccal myomucosal island flap. RESULTS: Thirty-six palates have been repaired by this procedure, all of which had satisfactory results without flap necrosis, infection, difficulties in opening mouth and facial nerve injury except two post-operative fistulas. Eight patients were followed up and all display complete velopharyngeal closure. CONCLUSIONS: Using unilateral buccinator myomucosal island flap with double opposing Z-plasty to repair wider palatal cleft can get a satisfactory soft palate lengthening. At the same time it can avoid bone surface exposing and scar formation; it is a safe and reliable procedure.

[Influence of scald and lipopolysaccharide on gastrointestinal motility].

OBJECTIVE: To investigate the pathogenesis of gastrointestinal motility dysfunction as a result of scald and lipopolysaccharide (LPS) challenge in guinea pigs. METHODS: Thirty guinea pigs were enrolled in the study and were randomly divided into 3 groups:i. e. control (n = 10, with intraperitoneal injection of isotonic saline), scald (n = 10, with 30% TBSA deep partial thickness burn) and LPS (n = 10, with intraperitoneal injection of LPS) groups. Thirty minutes after treatment, all animals were gavaged with carbolic ink. The propelled distance of the ink within the gastrointestinal tract was measured. The intestinal tissue was harvested and homogenized, and the contents of CGRP, Na+-K+-ATP enzyme, Mg2+-ATP enzyme, Ca2+-ATP enzyme, Ca2+-Mg2+-ATP enzyme were determined, and the delta phim of haustra coli smooth muscular cell mitochondria was assessed. RESULTS: The propelled distance of the ink in the gastrointestinal tract in scald (53 +/- 9 cm) and LPS (91 +/- 10 cm) groups was obviously shorter than that in control group (142 +/- 11 cm, P < 0.01). Furthermore, the distance in scald group was shorter than that in LPS group (P < 0.01). The CGRP content in scald and LPS groups [52.0 +/- 39.0 microg/L and 20.0 +/- 23.0 microg/L] was obviously higher than that in control group (0.8 +/-2.0 microg/L, P <0.05 or 0.01), especially in scald group ( P < 0.05). The Na+-K+-ATP enzyme, Mg2+-ATP enzyme, Ca2+-ATP enzyme, Ca2+-Mg2+-ATP enzyme and the delta phim in scald and LPS groups were remarkably lower than those in control group (P <0.005), but there was no difference between scald and LPS groups (P > 0.05). CONCLUSION: The gastrointestinal motility of guinea pigs could obviously be inhibited by scald and LPS, especially by scald. LPS might be the key factor to produce change in the membrane potential of mitochondria of intestinal smooth muscle after severe scald.