Point-of-care ultrasound in pre-bronchoscopy assessment of acute dyspnea: A case of concurrent massive pulmonary embolism and deep vein thrombosis.

Point-of-care ultrasound (POCUS) leads to efficient real-time diagnosis in a wide range of medical specialties. We describe the use of cardiac, lung and lower limb POCUS to rapidly diagnose massive pulmonary embolism and deep vein thrombosis in a 64-year-old patient presenting with acute dyspnea prior to elective bronchoscopy. Left femoral vein thrombus and features of increased right heart pressure on POCUS led to the decision to administer fibrinolytic therapy, with subsequent CT pulmonary angiogram confirming bilateral PE. The use of POCUS allowed for rapid imaging and interpretation leading to a rapid diagnosis of PE, thus fast-tracking lifesaving anticoagulation, especially in an outpatient setting.

Potential Threats to Human Health from Eurasian Avian-Like Swine Influenza A(H1N1) Virus and Its Reassortants.

During 2018-2020, we isolated 32 Eurasian avian-like swine influenza A(H1N1) viruses and their reassortant viruses from pigs in China. Genomic testing identified a novel reassortant H3N1 virus, which emerged in late 2020. Derived from G4 Eurasian H1N1 and H3N2 swine influenza viruses. This virus poses a risk for zoonotic infection.

Platelet rich plasma enhanced neuro-regeneration of human dental pulp stem cells in vitro and in rat spinal cord.

Background: Human dental pulp stem cells (hDPSCs) exhibit excellent differentiation potential and are capable of differentiating into several different cellular phenotypes, including neurons. Platelet-rich plasma (PRP) contains numerous growth factors that can stimulate stem cell differentiation. In this study, we investigated the potential stimulatory effects of PRP on neurogenic differentiation and anti-apoptosis of hDPSCs in injured spinal cords. Methods: The unipotential differentiation capacity of hDPSCs was analyzed by cell surface antigen identification and cell cycle analysis. A spinal cord injury rat model composed of 40 Sprague-Dawley (SD) rats was used to facilitate an in vivo study. Rats were divided into four groups: a double-treatment group (receiving both neurogenic-induced hDPSCs and PRP), two single-treatment groups (receiving neurogenic-induced hDPSCs or PRP) and a sham group (receiving normal saline). The Basso, Beattie, Bresnahan Locomotor Rating Scale was subsequently used to evaluate the motor function of the spinal cord. Cell viability and differentiation of hDPSCs in the damaged spinal cords were analyzed and apoptosis of neural cells was evaluated using the terminal uridine nucleotide end labeling (TUNEL) assay. Results: Growth pattern, cell surface marker and cell cycle analyses revealed that hDPSCs have a high degree of multi-directional differentiation potential and can be induced into neurons in vitro. In the rat spinal cord injury model, double-treatment with hDPSC/PRP or single treatment with hDPSCs or PRP significantly improved motor function compared with the sham group (P<0.05). Apoptosis of neural cells was observed to be significantly higher in the sham group compared to any of the treatment groups. Double-treatment with hDPSCs and PRP resulted in the lowest apoptotic rate among the groups analyzed. Conclusions: hDPSCs exhibit differentiation potential and are capable of transforming into neural cells both in vitro and in vivo. Significantly increased inhibition of neuronal apoptosis and improved motor function recovery of the spinal cord were observed following double-treatment with hDPSCs and PRP compared with the single-treatment groups.

Association of High-Volume Centers With Survival Outcomes Among Patients With Nontraumatic Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.

Importance: Although high volume of cases of out-of-hospital cardiac arrest (OHCA) is a key feature of cardiac arrest centers, which have proven survival benefit, the role of center volume as an independent variable associated with improved outcomes is unclear. Objective: To assess the association of high-volume centers with survival and neurological outcomes in nontraumatic OHCA. Data Sources: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to October 11, 2021, for studies including adult patients with nontraumatic OHCA who were treated at high-volume vs non-high-volume centers. Study Selection: Randomized clinical trials, nonrandomized studies of interventions, prospective cohort studies, and retrospective cohort studies were selected that met the following criteria: (1) adult patients with OHCA of nontraumatic etiology, (2) comparison of high-volume with low-volume centers, (3) report of a volume-outcome association, and (4) report of outcomes of interest. At least 2 authors independently reviewed each article, blinded to each other's decision. Data Extraction and Synthesis: Data abstraction and quality assessment were independently conducted by 2 authors. Meta-analyses were performed for adjusted odds ratios (aORs) and crude ORs using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: Survival and good neurological outcomes according to the Cerebral Performance Categories Scale at hospital discharge or 30 days. Results: A total of 16 studies involving 82 769 patients were included. Five studies defined high volume as 40 or more cases of OHCA per year; 3 studies defined high volume as greater than 100 cases of OHCA per year. All other studies differed in definitions. Survival to discharge or 30 days improved with treatment at high-volume centers, regardless of whether aORs (1.28 [95% CI, 1.00-1.64]) or crude ORs (1.43 [95% CI, 1.09-1.87]) were pooled. There was no association between center volume and good neurological outcomes at 30 days or hospital discharge in patients with OHCA (aOR, 0.96 [95% CI, 0.77-1.20]). Conclusions and Relevance: In this meta-analysis and systematic review, care at high-volume centers was associated with improved survival outcomes, even after adjustment for potential confounders, but was not associated with improved neurological outcomes for patients with nontraumatic OHCA. More studies evaluating the relative importance of center volume compared with other variables (eg, the availability of treatment modalities) associated with survival outcomes in patients with OHCA are required.

Determination of medium- and short-chain fatty acids in feces by UHPLC-QTOF-MS/MS with pre-column derivatization / 药学学报

A pre-column derivatization and ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS/MS) method was developed for qualitative and quantitative determination of medium- and short-chain fatty acids in mice feces, and was further applied to evaluate variations in the feces of mice before and after antibiotic treatment. This animal experiment had been approved by Animal Experimental Ethics Committee of Jiangsu Province Academy of Traditional Chinese Medicine. By optimizing the derivatization conditions and UHPLC-QTOF-MS/MS parameters a new UHPLC-QTOF-MS/MS method with 3-nitrophenylhydrazine as the derivatization reagent was developed for simultaneous determination of 16 medium- and short-chain fatty acids. Validation studies showed that the linearity of the calibration curves was good (R2>0.99), the RSD of intra-day and inter-day precision was less than 10%, the repeatability RSD was less than 6%, the recovery rate was between 80% - 120% at three spiked levels, and the stability RSD was less than 7% within 36 h. The types and amounts of the detected medium- and short-chain fatty acids in feces significantly changed after the mice were treated with antibiotics. The content of formic acid, acetic acid, propionic acid, butyric acid, isobutyric acid, valeric acid, and lactic acid decreased, whereas that of heptanoic acid and succinic acid increased significantly. All these results suggest that the newly established method is accurate and reliable, and can be used for determination of medium- and short-chain fatty acids in feces.

Knockdown of lncRNA XIST suppresses osteosarcoma progression by inactivating AKT/mTOR signaling pathway by sponging miR-375-3p.

BACKGROUND: Osteosarcoma (OS) is one of the most common bone tumors in adolescents and young adults. Emerging evidence suggested ncRNA (lncRNA and miRNA) are closely associated with cell progression, apoptosis and autophagy. However, the role of regulatory network between ncRNA and mRNA in OS has not been fully verified. METHODS: lncRNA XIST, miRNA expression were detected by qRT-PCR. The protein expression of LC3, p62, AKT, p-AKT, mTOR and p-mTOR was measured by western blot. MTT assay and flow cytometry were applied to measure cell proliferation and apoptosis. Luciferase assay was used to ensure the relationship between lncRNA, miRNA and mRNA. GFP-LC3 cells were observed using fluorescence microscope. RESULTS: XIST expression was up-regulated but miR-375-3p was down-regulated in OS tissues and cells. Luciferase assay results demonstrated that miR-375-3p was a target of XIST and mTOR was a target mRNA of miR-375-3p. In addition, knockdown of XIST and mTOR inhibited OS cell proliferation and autophagy, but induced apoptosis. Knockdown of XIST could reverse the effect of miR-375-3p inhibitor on OS cells. The effects of si-mTOR of OS cells could be reversed by silencing miR-375-3p. Moreover, knockdown of XIST inhibited AKT/mTOR signaling pathway via sponging miR-375-3p. CONCLUSION: Knockdown of XIST inhibited cell growth and autophagy but induced cell apoptosis by suppressing the AKT/mTOR signaling pathway by sponging miR-375-3p.

Asiatic Acid Protects Dopaminergic Neurons from Neuroinflammation by Suppressing Mitochondrial ROS Production

This study sought to evaluate the effects of Asiatic acid in LPS-induced BV2 microglia cells and 1-methyl-4-phenyl-pyridine (MPP⁺)-induced SH-SY5Y cells, to investigate the potential anti-inflammatory mechanisms of Asiatic acid in Parkinson’s disease (PD). SH-SY5Y cells were induced using MPP⁺ to establish as an in vitro model of PD, so that the effects of Asiatic acid on dopaminergic neurons could be examined. The NLRP3 inflammasome was activated in BV2 microglia cells to explore potential mechanisms for the neuroprotective effects of Asiatic acid. We showed that Asiatic acid reduced intracellular production of mitochondrial reactive oxygen species and altered the mitochondrial membrane potential to regulate mitochondrial dysfunction, and suppressed the NLRP3 inflammasome in microglia cells. We additionally found that treatment with Asiatic acid directly improved SH-SY5Y cell viability and mitochondrial dysfunction induced by MPP⁺. These data demonstrate that Asiatic acid both inhibits the activation of the NLRP3 inflammasome by downregulating mitochondrial reactive oxygen species directly to protect dopaminergic neurons from, and improves mitochondrial dysfunction in SH-SY5Y cells, which were established as a model of Parkinson’s disease. Our finding reveals that Asiatic acid protects dopaminergic neurons from neuroinflammation by suppressing NLRP3 inflammasome activation in microglia cells as well as protecting dopaminergic neurons directly. This suggests a promising clinical use of Asiatic acid for PD therapy.

Clinicopathologic Characteristics and Prognosis Analysis of Marjolin's Ulcer in 40 Cases.

Marjolin's ulcer (MU) is a rare but aggressive epidermoid carcinoma observed in scars or wounds. This article provides comprehensive characteristics and prognostic details of MU. Clinical data of 40 patients with MU between January 2010 and December 2017 were analyzed retrospectively. Squamous cell carcinoma was the most common pathological type (35/40, 87.5%). Extended resection was performed to treat all cases with skin grafting or flap grafting. Follow-up duration ranged from 6 to 96 months (median, 52 months) and recurrence was noted in 9 cases. The 1-, 3- and 5-year recurrence-free survival (RFS) rates were 87.2%, 87.2%, 83.2% respectively and the recurrence rate was 22.5%. Univariate analysis revealed that cause of scars (P=0.044), lesion appearance (P=0.036), ultraviolet radiation exposure (P=0.000), depth (P=0.001) and histological grade (P=0.027) had a statistically significant correlation with prognosis of MU. Multivariate analysis revealed that depth (P=0.034, RR=2.681, 95%CI: 1.077-6.674) and histological grade (P=0.008, RR=2.820, 95%CI: 1.315-6.050) were independent prognostic factors for RFS. In conclusion, superficial infiltration and high-grade differentiation predict more favorable prognosis. Careful follow-up of high-risk groups is strongly recommended to prevent recurrence and improve prognosis.

Clonal Spread of Escherichia coli ST93 Carrying mcr-1-Harboring IncN1-IncHI2/ST3 Plasmid Among Companion Animals, China.

The purpose of this study was to investigate the occurrence of plasmid-mediated colistin resistance gene mcr-1 in Enterobacteriaceae isolates from companion animals in Guangzhou, China. Enterobacteriaceae isolated from 180 samples collected from cats and dogs were screened for mcr-1 by PCR and sequencing. MCR-1-producing isolates were further characterized by multilocus sequence typing and pulsed-field gel electrophoresis (PFGE). Plasmid characterization was performed by conjugation, replicon typing, S1-PFGE, and Southern blot hybridization. Plasmid pHN6DS2 as a representative IncN1-IncHI2/ST3 plasmid from ST93 E. coli was fully sequenced. pHN6DS2-like plasmids were screened by PCR-mapping and sequencing. The mcr-1 gene was detected in 6.25% (8/128) Escherichia coli isolates, of which, five belonged to E. coli ST93 and had identical PFGE patterns, resistance profiles and resistance genes. mcr-1 genes were located on ∼244.4 kb plasmids (n = 6), ∼70 kb plasmids, and ∼60 kb plasmids, respectively. Among them, five mcr-1-carrying plasmids were successfully transferred to recipient by conjugation experiments, and were classified as IncN1-IncHI2/ST3 (∼244.4 kb, n = 4, all obtained from E. coli ST93), and IncI2 (∼70 kb, n = 1), respectively. Plasmid pHN6DS2 contained a typical IncHI2-type backbone, with IncN1 segment (ΔrepA-Iterons I-gshB-ΔIS1294) inserted into the multiresistance region, and was similar to other mcr-1-carrying IncHI2/ST3 plasmids from Enterobacteriaceae isolates of various origins in China. The remaining five mcr-1-bearing plasmids with sizes of ∼244.4 kb were identified to be pHN6DS2-like plasmids. In conclusion, clonal spread of ST93 E. coli isolates was occurred in companion animals in Guangzhou, China.

Changes in bone mineral density and bone metabolic indexes in ankylosing spondylitis mouse model complicated with osteoporosis.

Changes in bone mineral density and bone metabolic indexes in a model of ankylosing spondylitis (AS) mice complicated with osteoporosis (OP) were investigated. BLAB/c mice were used as the subjects. AS was induced using proteoglycan, and OP was induced using tail suspension method. The mice were randomly divided into four groups: AS group, OP group, AS + OP group and negative control group. Changes in bone mineral density, bone strength, serum calcium (Ca), phosphorus, alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRACP), in mice of each group were detected and compared. There were statistically significant differences in bone mineral density and bone strength among groups. Compared with the negative control group, bone mineral density and bone strength in the AS, the OP and the AS + OP groups were significantly decreased, and the lowest bone mineral density and bone strength were found in the AS + OP group (P<0.05). There were no significant differences in bone mineral density and bone strength between the AS group and the OP group. Significant differences in serum Ca, ALP and TRACP but not in serum phosphorus were found among groups. Compared with the control group, serum levels of Ca and TRACP in the AS, the OP and the AS + OP groups were significantly increased, while levels of ALP were obviously decreased (P<0.05). Bone destruction in AS mice complicated with osteoarthritis was more serious than that in mice with simple AS.

Expanded Paramedian Forehead Flaps for Nasal Defects: Beyond Aesthetic Subunits.

BACKGROUND: Reconstruction of nasal tip defects presents a significant challenge for plastic surgeons. The form, function, and aesthetic appeal of all nasal subunits must be addressed. The expanded paramedian forehead flap is a good choice for nasal reconstruction, providing similar texture, structure, and skin color, and high reliability. This article discusses the authors' modification of the expanded paramedian forehead flap in reconstructing defects on or around the nasal tip. METHODS: Twenty-two patients with nasal defects located on or around the nasal tip were treated in our institution. Sixteen patients underwent nasal reconstruction with expanded forehead flaps. The other 6 cases with cartilage defect underwent reconstruction with expanded forehead flaps and autogenous rib cartilage grafts. Functional and cosmetic results were assessed by surgeon, patient, and patient's relatives using a scale from 1 to 10. RESULTS: The aesthetic appearance of all patients was significantly improved after surgery. Two cases had mild hyperpigmentation. Two patients considered the flaps too thick. Three cases had minor brow elevation at the donor site. There were no obvious scars at the donor sites. There were no serious complications, such as infection, flap necrosis, deviation, or collapse. CONCLUSIONS: The expanded paramedian forehead flap is a safe and effective method for reconstructing defects located on or around the nasal tip. Moreover, this technique can result in good functional and cosmetic outcomes with very few complications.

Clinical Outcomes of Digital Three-Dimensional Hydroxyapatite in Repairing Calvarial Defects.

PURPOSE: The objective of this article is to present the long-term outcomes of digital three-dimensional (3D) hydroxyapatite (HA) implants used for calvarial defects. Porous HA provide good results and have many characteristics, making it suitable for calvarial defect reconstruction. However, using HA may be associated with potentially serious complications, including infection and exposure. The authors used digital 3D HA for cranioplasty for many years and accumulated considerable experience from using it. The authors found that digital 3D HA is an effective method for cranioplasty, showing low complication rate. METHODS: A total of 57 patients underwent calvarial defect reconstruction with 3D HA from June 2009 to August 2016. The follow-up period was 1 to 5 years. RESULTS: Most patients (91.2%) were greatly satisfied with the esthetic outcomes of the surgery. The highest rate of complication was seroma (8.8%). Two patients developed postoperative infections (3.5%). One patient with infections was successfully treated with antibiotic therapy. Another patient was required to undergo an extensive surgical debridement followed by delayed autogenous bone reconstruction. One patient suffered from implant exposure. No hematoma, unexpected fractures, asymmetry, and contour or implant abnormalities occurred. CONCLUSIONS: The digital 3D HA implant was highly biocompatible and durable for the reconstruction of calvarial defects. With appropriate treatment, the proposed method was able to achieve a functional and cosmetic reconstruction with lesser complications.

[Foshouningshen decoction improves sleeping via the serotonergic system in a rat model of insomnia].

OBJECTIVE: To evaluate the sedative and hypnotic effects of Foshouningshen decoction (FSNSD) and study its effects on expressions of 5-hydroxy tryptamine (5-HT) and 5-HT1A receptor (5-HT1AR) in the hippocampus in a rat model of insomnia. METHODS: Male KM mice were divided into control group, estazolam (0.4 mg/kg daily) group, and low-, moderate-, and high-dose FSNSD groups (daily dose of 12, 24, and 48 g/kg, respectively). After corresponding treatments for 1 week, the mice underwent sleep-inducing test with subthreshold and threshold doses of sodium pentobarbital. Forty-eight male SD rats were randomized into control group, insomnia model group, estazolam group (0.2 mg/kg daily), and low-, moderate-, and high-dose FSNSD groups (with daily dose of 6, 12, and 24 g/kg, respectively). Rat models of insomnia were established by intraperitoneal injection of 4-cholro-dl-phenylalanine (PCPA) at the daily dose of 350 mg/kg for 3 days, after which the rats received corresponding treatments via gavage for 1 week. The performance of the rats in open field test was recorded and the hippocampal expression of 5-HT was detected using ELISA; the expressions of 5-HT1AR protein and mRNA in the hippocampus were detected using immunohistochemistry and real-time PCR, respectively. RESULTS: In the sleep-inducing test with a subthreshold dose of sodium pentobarbital, the mice treated with high-dose FSNSD showed a significantly higher rate of sleep onset than the control mice (P<0.05); in the test with a threshold dose of sodium pentobarbital, treatment with moderate- and high-dose FSNSD resulted in significantly prolonged sleeping time (P<0.01) and shortened sleep latency (P<0.05) in the mice. The rats in insomnia model group showed increased total distance in open field test (P<0.05) with significantly decreased content of 5-HT (P<0.01) and expressions of 5-HT1AR protein and mRNA in the hippocampus (P<0.01). Treatment of the rats with estazolam or high-dose FSNSD obviously decreased the total distance in open field test (P<0.05) and increased the content of 5-HT (P<0.05) and expressions of 5-HT1AR (P<0.01) in the hippocampus of rats with insomnia. CONCLUSION: FSNSD can produce therapeutic effects on insomnia possibly by increasing 5-HT content and expressions of 5-HT1AR in the hippocampus.

Foshouningshen decoction improves sleeping via the serotonergic system in a rat model of insomnia / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the sedative and hypnotic effects of Foshouningshen decoction (FSNSD) and study its effects on expressions of 5-hydroxy tryptamine (5-HT) and 5-HT1A receptor (5-HTR) in the hippocampus in a rat model of insomnia.</p><p><b>METHODS</b>Male KM mice were divided into control group, estazolam (0.4 mg/kg daily) group, and low-, moderate-, and high-dose FSNSD groups (daily dose of 12, 24, and 48 g/kg, respectively). After corresponding treatments for 1 week, the mice underwent sleep-inducing test with subthreshold and threshold doses of sodium pentobarbital. Forty-eight male SD rats were randomized into control group, insomnia model group, estazolam group (0.2 mg/kg daily), and low-, moderate-, and high-dose FSNSD groups (with daily dose of 6, 12, and 24 g/kg, respectively). Rat models of insomnia were established by intraperitoneal injection of 4-cholro-dl-phenylalanine (PCPA) at the daily dose of 350 mg/kg for 3 days, after which the rats received corresponding treatments via gavage for 1 week. The performance of the rats in open field test was recorded and the hippocampal expression of 5-HT was detected using ELISA; the expressions of 5-HTR protein and mRNA in the hippocampus were detected using immunohistochemistry and real-time PCR, respectively.</p><p><b>RESULTS</b>In the sleep-inducing test with a subthreshold dose of sodium pentobarbital, the mice treated with high-dose FSNSD showed a significantly higher rate of sleep onset than the control mice (P<0.05); in the test with a threshold dose of sodium pentobarbital, treatment with moderate- and high-dose FSNSD resulted in significantly prolonged sleeping time (P<0.01) and shortened sleep latency (P<0.05) in the mice. The rats in insomnia model group showed increased total distance in open field test (P<0.05) with significantly decreased content of 5-HT (P<0.01) and expressions of 5-HTR protein and mRNA in the hippocampus (P<0.01). Treatment of the rats with estazolam or high-dose FSNSD obviously decreased the total distance in open field test (P<0.05) and increased the content of 5-HT (P<0.05) and expressions of 5-HTR (P<0.01) in the hippocampus of rats with insomnia.</p><p><b>CONCLUSION</b>FSNSD can produce therapeutic effects on insomnia possibly by increasing 5-HT content and expressions of 5-HTR in the hippocampus.</p>

Does a single cup of caffeinated drink significantly increase blood pressure in young adults? A randomised controlled trial.

BACKGROUND: Previous studies have shown that the blood pressure elevating effect of acute caffeine consumption was variable because of the heterogeneity of study participants, dosage of caffeine and study designs. OBJECTIVE: This research aimed to examine the effect of a single cup of coffee on the blood pressure of young adults. METHODS: Normotensive adults were randomised to receive either a cup of caffeinated drink (intervention group) or a cup of decaffeinated drink (control group). The main outcome measure was mean change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between intervention and control groups. RESULTS: Enrolled participants (n = 104) were randomly assigned to the intervention group (n = 53) or the control group (n = 51). The mean differences in SBP and DBP of the two groups were +2.77 mmHg (P = 0.05) and +2.11 mmHg (P = 0.64), respectively. Therefore, the rise in both SBP and DBP after caffeine consumption was not statistically significant. DISCUSSION: Our study confirmed that drinking a single cup of coffee (containing 80 mg of caffeine) does not have a significant impact on the blood pressure of healthy normotensive young adults one hour after the drink.

Effects of herbal infusions, tea and carbonated beverages on alcohol dehydrogenase and aldehyde dehydrogenase activity.

Various alcoholic beverages containing different concentrations of ethanol are widely consumed, and excessive alcohol consumption may result in serious health problems. The consumption of alcoholic beverages is often accompanied by non-alcoholic beverages, such as herbal infusions, tea and carbonated beverages to relieve drunk symptoms. The aim of this study was to supply new information on the effects of these beverages on alcohol metabolism for nutritionists and the general public, in order to reduce problems associated with excessive alcohol consumption. The effects of 57 kinds of herbal infusions, tea and carbonated beverages on alcohol dehydrogenase and aldehyde dehydrogenase activity were evaluated. Generally, the effects of these beverages on alcohol dehydrogenase and aldehyde dehydrogenase activity are very different. The results suggested that some beverages should not be drank after excessive alcohol consumption, and several beverages may be potential dietary supplements for the prevention and treatment of problems related to excessive alcohol consumption.

Application of computer techniques in repair of oblique facial clefts with outer-table calvarial bone grafts.

OBJECTIVE: This study focused on the application of computer-aided and rapid prototyping techniques in the repair of oblique facial clefts with outer-table calvarial bone. METHODS: Five patients with oblique facial clefts underwent repair with outer-table calvarial bone. A mirror technique and rapid prototyping techniques were applied to design and prefabricate the individualized template for the preoperative repair of orbital inferior wall and maxillary anterior wall defects. Using computer software, the ideal region from which to take outer-table calvarial bone was located according to the size and surface curvature of the individualized template. During the operation, outer-table calvarial bone was fixed according to the shape of the individualized template, and bone onlay grafting was carried out after appropriate trimming. Surgical accuracy was evaluated by comparing the preoperative and postoperative 3-dimensional reconstructed images. RESULTS: With computer-aided and rapid prototyping techniques, all 5 patients had an ideal clinical outcome with few complications. The 3-dimensional preoperative design images and postoperative images fit well. Six-month to 8-year postoperative follow-up demonstrated that 4 patients had good aesthetic facial appearances and 1 had developed recurrence of lower eyelid shortage. CONCLUSIONS: Computer-aided and rapid prototyping techniques can offer surgeons the ability to accurately design individualized templates for craniofacial deformity and perform a simulated operation for greatly improved surgical accuracy. These techniques are useful treatment modalities in the surgical management of oblique facial clefts.

Rotating distraction osteogenesis to enlarge the skull space.

BACKGROUND: Distraction osteogenesis has been used to treat diminished skull space caused by craniosynostosis. Our report investigated the relationship between space volume change by computer technology and the intracranial pressure change. Cerebrospinal fluid (CSF) regular test and CSF biochemistry test were also performed to ensure the safety of distraction process. METHODS: Seven minipigs, weighing 15 to 20 kilograms, were chosen; 4 × 3 cm bone flap was lifted in the left parietal bone. The dura was carefully protected. The distractor and assisted apparatus were implanted. Distraction was started with 10-day latency, 1 mm/d distraction rates for 10 days. Twelve weeks after distraction, the distraction device and the assist apparatus were removed. All pigs underwent 3-dimensional computerized scans of the craniofacial skeleton, CSF pressure measurement, CSF regular test, and CSF biochemistry test before operation, after 7 days' operation, immediately after distraction was finished, 4 weeks after distraction, 8 weeks after distraction, and 12 weeks after distraction. The 3-dimensional datum was collected, and volume change of skull was measured by 3-dimensional medicine surface rendering software. RESULTS: All pigs tolerated the procedure. The mean volume 12 weeks after distraction was 87.93 ± 3.11 cm, which was also significantly higher than 79.46 ± 3.15 cm that of before operation (P < 0.001). The CSF pressure becomes maxim after 7 days' operation. The CSF pressure went down immediately after distraction was finished. Then, the CSF pressure kept stable but lower than the CSF pressure before the operation except 1 pig whose CSF pressure after operation was higher than the CSF pressure before the operation. Cerebrospinal fluid regular test and CSF biochemistry test show stable results, and the WBC does not rise during the whole process. CONCLUSIONS: The distraction osteogenesis is an efficient and safe method to enlarge the intracranial volume. The assisted apparatus of distraction is useful for rotating distraction. Three-dimensional DICOM datum and 3-dimensional medicine surface rendering are efficient for measurement of skull volume.

Porous polyethylene combined with split calvarial bone graft to cover complex calvarial defect.

BACKGROUND: Various kinds of grafts, such as autogenous bone grafts and alloplastic materials, can be used for the reconstruction of calvarial defects. The selection of the optimum material for the repair of cranial defects is the greatest problem in the reconstruction of calvarial defects. For some complex calvarial defects, simple use of autogenous bone grafts or alloplastic materials makes functional and cosmetic reconstruction difficult to achieve. Therefore, the current study uses a new method to repair complex calvarial defects. METHODS: Eight patients with complex calvarial defects underwent cranioplasty with porous polyethylene combined with split calvarial bone graft. Follow-up visits were conducted for 6 to 72 months to monitor the patients. RESULTS: Significant improvements in the contour of the skulls as well as in the aesthetic appearance of all the patients were observed. Moreover, no serious complications, such as infections, exposure, removal of the implants, and contour or implant abnormalities, were observed. Three cases displayed a transient extradural seroma collection, which was resolved through drainage and compression bandaging. CONCLUSIONS: The results of this pilot study indicate that the combined use of porous polyethylene and split calvarial bone graft may be useful for cranial reconstruction in patients with complex cranial defects.

Clinical outcome of cranioplasty with high-density porous polyethylene.

BACKGROUND: High-density porous polyethylene (Medpor) has long been used in cranioplasty and is still one of the best materials for calvarial reconstruction. Calvarial defects can be effectively reconstructed with fewer complications by using Medpor. This article reports our study on the use of Medpor in reconstructing calvarial defects. METHODS: Twenty-three patients who underwent cranioplasty from 1999 to 2011 were included in this study. In all patients, Medpor was used for calvarial defect reconstruction, and all were followed up for at least 6 months. RESULTS: Most patients were satisfied with the reconstructive outcome. Only 1 patient had an infection and 1 had transient extradural seroma. All complications occurred within 2 years, and no new complications were found during the long-term follow-up. CONCLUSIONS: Using Medpor in cranioplasty is an effective method for reconstructing calvarial defects.