Modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex fractures: A 5-year retrospective study.

Our study aimed to evaluate modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex (ZMC) fractures. The retrospective non-randomized study was conducted in a single hospital in China. All patients diagnosed with unilateral comminuted ZMC fractures between January 1, 2018 and December 31, 2022 were retrospectively reviewed. All patients underwent preoperative spiral computed tomography (CT). CT data were processed using software to DICOM format and transferred to Proplan CMF3.0 for preoperative virtual surgical planning and postoperative evaluation. All data were extracted from standardized electronic medical records. All statistical analyses were performed using SPSS version 20.0. The chi-square test and t-test were used for statistical analyses. The 54 included patients were divided into two comparable, equal cohorts of 27 patients, and followed up for at least 6 months. Fracture reduction was assisted using the modified patient-specific surgical guides in the guide group (23 males, four females; mean age 37.74 ± 12.07 years) and without the modified patient-specific surgical guides in the control group (20 males, seven females; mean age 37.44 ± 13.58 years). In the guide group, the mean eminence deviation between the affected and unaffected sides was 1.01 ± 0.92 mm, and the mean width deviation between the affected and unaffected sides was 1.29 ± 1.32 mm. In the control group, the mean eminence deviation between the affected and unaffected sides was 1.99 ± 1.69 mm, and the mean width deviation between the affected and unaffected sides was 2.68 ± 2.01 mm. The differences in facial protrusion (p = 0.001) and width (p = 0.003) symmetry between the affected and healthy sides of the two groups were statistically significant (p < 0.05). In conclusion, applying the modified patient-specific surgical guides to unilateral comminuted zygomaticomaxillary complex fracture reduction has the advantages of greater predictability and effectiveness, and improved bilateral ZMC symmetry. It should be noted that this approach would be especially beneficial for less-experienced surgeons.

Effect of lidocaine on cognitively impaired rats: Anti-inflammatory and antioxidant mechanisms in combination with CRMP2 antiphosphorylation.

OBJECTIVE: Studies have shown that lidocaine has antioxidative stress, anti-inflammatory, and nerve-protective effects. The current study investigated the effects of lidocaine on cognitive function in rats with cognitive dysfunction. METHODS: A total of 48 rats were randomly assigned to four groups of 12 rats each: control group; L (lidocaine) + D (d-galactose) group, d-galactose group (D group); and D + L group. We assessed cognitive function using a Morris water maze (MWM) and pathologic changes of hippocampal sections. An enzyme-linked immunosorbent assay (ELIZA) was used to detect serum malondialdehyde (MDA) and superoxide dismutase (SOD) levels in rats, and protein immunoblotting (western blot) was used to detect brain tissue proteins (collapsing response mediator protein-2 [CRMP2], phosphorylated-collapsing response mediator protein-2 [P-CRMP2], and ß-amyloid protein [Aß]). RESULTS: The MWM showed that the d-gal group (284.09 ± 20.46, 5.20 ± 0.793) performed worse than the L + D (265.37 ± 22.34, 4.170 ± 0.577; p = .000) and D + L groups (254.72 ± 27.87, 3.750; p = .000) in escape latency and number of platform crossings, respectively. The L + D group (44.94 ± 2.92 pg/mL, 6.22 ± 0.50 pg/mL, and 460.02 ± 8.26 nmol/mL) and D + L group (46.88 ± 2.63 pg/mL, 5.90 ± 0.38 pg/mL, and 465.6 ± 16.07 nmol/mL) had significantly lower serum inflammatory levels of interleukin-6, tumor necrosis factor-α, and MDA than the d-gal group (57.79 ± 3.96 pg/mL, 11.25 ± 1.70 pg/mL, and 564.9 ± 15.90 nmol/mL), respectively. The L + D group (3.17 ± 0.41 µg/mL) and D + L group (3.08 ± 0.09 µg/mL) had significantly higher serum inflammatory levels of SOD than the d-gal group (2.20 ± 0.13 µg/mL) (all p = .000). The levels of CRMP2, P-CRMP2, and Aß in the brain tissue homogenates of the L + D group (0.87 ± 0.04, 0.57 ± 0.0, and 0.16 ± 0.02) and the D + L group (0.82 ± 0.05, 0.58 ± 0.09, and 0.15 ± 0.02) were significantly different than the d-gal group (0.67 ± 0.03, 0.96 ± 0.040, and 0.29 ± 0.05). CONCLUSIONS: Lidocaine was shown to reduce cognitive impairment in rats with cognitive dysfunction through anti-inflammatory and antioxidative stress mechanisms in combination with CRMP2 antiphosphorylation.

Flurbiprofen axetil alleviates the effect of formalin-induced inflammatory pain on the cognitive function of rats with mild cognitive impairment through the AMPKα/NF-κB signaling pathway.

Background: Mild cognitive impairment (MCI) as a prestage of dementia shares the most risk factors with dementia. In the present study, we explored the effect of flurbiprofen axetil on reducing the response of the central nervous system to inflammatory factors and anti-inhibiting apoptosis with the aim of developing a formalin-induced inflammatory pain model using MCI rats. Methods: Rats were subjected to sham operation (Sham group) or formalin-induced inflammatory pain, with or without flurbiprofen axetil (10 mg/kg). MCI rats were administered D-galactose (1,000 mg/kg) for 7 days subcutaneously. Thereafter, formalin was injected subcutaneously into the hind paws of rats, while sham group was injected with only normal saline. In the formalin/flurbiprofen group (F/F group), flurbiprofen axetil was injected into the tail vein 15 min before formalin was given, and the formalin/saline group (F/S group) used normal saline instead of the drug for injection. The pain score was recorded, and the time-score curve was drawn. The escape latency time and the number of times crossing the platform were recorded. The expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), AMP-activated protein kinase-α (AMPKα), and nuclear factor-κB p65 (NF-κB p65) in hippocampal tissue was determined. Varying degrees of pathological changes in the hippocampal CA1 region were observed. Results: The II phase pain score of rats in the F/F group was lower than that of the F/S group rats (P<0.05). The evasion incubation period and the number of platform crossings increased in both the F/F group and the F/S group (P<0.05), and were more significant in the F/S group. The relative content of AMPKα increased sequentially in the 3 groups, and the difference between the two comparisons of each group was statistically significant (P<0.05). The relative content of IL-6, TNF-α and NF-κB in the F/S group was greater than that of the F/F group, and the difference was statistically significant (P<0.001). Pathological morphological observations can be seen that the phenomena of nuclear consolidation, deep staining, and neuronal apoptosis occur, and the F/S group is more obvious. Conclusions: Flurbiprofen axetil can reduce the inflammatory response and cognitive function of an inflammatory pain model using MCI rats through the AMPKα/NF-κB signaling pathway.

Digitally reconstructed severe trauma-induced oro-maxillofacial defects with free vascularised composite tissue flaps.

The aim of this study was to outline the characteristics of severe trauma-induced oro-maxillofacial defects and explore the application of microsurgical reconstruction of these defects by selecting appropriate free vascularised composite tissue flaps. A retrospective analysis was performed in 11 cases with severe trauma-induced oromaxillofacial defects from 2005 to 2018, All cases were reconstructed with free vascularised composite flaps using a supermicro-surgical/micro-surgical and digital technology. This study consisted of 11 patients (8 men, 3 women) with a median age (range) of 28 (6-64) years. Patients with long-standing trauma experienced severe scars and displacements. The trauma-induced oro-maxillofacial defects ranged in size from 4.0 × 5.0 cm2 to 7 × 15 cm2. Six radial forearm flaps, three fibular osteocutaneous flaps, a lateral thoracic flap, and an anterolateral thigh flap were harvested individually. All patients were treated effectively and followed up for over two years, with a 100% survival rate of these free vascularised composite tissue flaps. No uncontrollable complications occurred, and all patients were satisfied with the postoperative shape and function. The trauma-induced oro-maxillofacial defects display unique features, and microsurgical techniques play an important role in the reconstruction of shapes and function. In addition, some patients may need multi-stage surgeries to attain aesthetic refinement.

Analysis of Maxillofacial Fractures Based on the Etiology in Southeast China: A 10-Year, Multi-Center Study.

BACKGROUND: The aim of this study was to explore the characteristics and correlation of maxillofacial fractures and concurrent injuries with different injury causes. METHODS: In this retrospective study, data were collected from patients treated for maxillofacial fractures in 3 oral and maxillofacial surgery departments in Southeast China, from January 2010 to December 2019. The information was obtained from clinical notes and surgical records using a standardized data collection form, and some causes of injuries were confirmed by telephone follow-ups and police records. These patients were divided into 7 groups according to the etiology: bicycle accident, electric bicycle accident, motorcycle accident, automobile accident, fall at ground level, fall from a height, and assault-related accident. Statistical tests were performed using R software (version 3.1.1), and all P-values were computed based on Chi-square tests and set at 0.05. RESULTS: During this 10-year retrospective study, a total of 1772 patients with definite causes were analyzed. The average age was approximately 35.04 years (9 months-94 years). All patients were treated with open reduction and rigidly internal fixation, and the average duration was approximately 6.51 days (range 0 day-50 days), that from the time of the injury to the time of treatment. Traffic accidents were identified as the main cause of maxillofacial fracture (57.62%; n = 1021 of 1772 cases). In different etiology groups, there were statistically significant differences in the distribution of age, sex, maxillofacial fracture type, and concurrent injuries (all P < 0.001). However, the main cause of maxillofacial injuries was falls (fall at ground level and fall from a height) in children, and the highest incidence of the cause of maxillofacial injuries was bicycle accident in adolescents. Compared with the other groups, zygomatic complex fracture was more common in the electric bicycle accident group, panfacial fracture was more common in the automobile accident group, and mandible fracture was more common in the other groups. CONCLUSION: The results of this study suggest that patients with maxillofacial fractures caused by different injuries had their own unique characteristics. These findings may assist us in avoiding misdiagnosis and treatment delays, and may make treatment plans faster.

Hyperbaric oxygen therapy cognitive function in a rat model of mild cognitive impairment via ERK signaling.

BACKGROUND: The development of novel treatment strategies to reverse or impede cognitive dysfunction associated with mild cognitive impairment (MCI) has gained attention in recent times. Meanwhile, hyperbaric oxygen (HBO) has been widely used as a neuroprotective therapy that can promote recovery of damaged neurons. The aim of this study was to investigate the effects of HBO on cognitive function in rats with MCI and to clarify the associated mechanisms. METHODS: We established a D-galactose-induced MCI rat model and evaluated the role of extracellularregulated kinase (ERK) signaling in HBO therapy for cognitive function using a specific inhibitor, U0126. All Rats were randomly assigned to four groups with 12 rats per group: normal control group; D-gal model group (group MCI); D-gal + HBO group (group HBO); D-gal + HBO + U0126 group (group U0126). We evaluated cognitive function by Morris water maze and pathological changes by hematoxylin and eosin (HE) staining of hippocampal slices. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of caspase 3, while total ERK1/2 and phospho-ERK1/2 were assessed by Western blotting. RESULTS: Shorter escape latency was observed in the HBO group as compared to the MCI group, which was to some extent reversed by U0126. Similarly, the HBO group showed the highest number of platform crossings as compared to the MCI and U0126 groups. Pathological analysis also showed less apoptosis and better hippocampal cell morphology in the HBO group. Caspase 3 levels also differed significantly, with lowest expression in the HBO group as compared to the MCI and U0126 groups. The levels of total ERK1/2 and p-ERK1/2 were more elevated in the HBO group as compared to the MCI group. CONCLUSIONS: This study found that HBO treatment has a protective effect on early cognitive dysfunction in rats with MCI. HBO therapy may act through ERK signaling, which inhibits apoptosis and protects cognitive function.