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    Academician forum
    Some considerations about the development of modern orthognathic surgery
    QIU Wei-liu
    2020, 40 (10):  1315-1317. 
    doi: 10.3969/j.issn.1674-8115.2020.10.001

    Abstract ( 397 )   PDF (4123KB) ( 226 )  
    This article discusses the development and concept of modern orthognathic surgery from four aspects: modern orthognathology must have the participation of orthodontist; modern orthognathic surgery has a wide range of disciplines and involves many disciplines; orthognathic surgery, craniofacial surgery, and craniomaxillofacial surgery have their own characteristics; whether orthognathic and craniofacial surgery can be integrated together.
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    Concept formation of non-expansion technology in stem cell therapy and its application prospect
    DAI Ke-rong
    2020, 40 (10):  1318-1320. 
    doi: 10.3969/j.issn.1674-8115.2020.10.002

    Abstract ( 285 )   PDF (4998KB) ( 126 )  
    Stem cell research starting in the 20th century has opened a magical door for clinical cell therapy. However, stem cell therapy has been only promoted in blood diseases up to now, while in other clinical fields, it still remains in the stage of slow development. One of the important restrictions is that the clinical application of stem cells usually need in vitro expansion, resulting in consequences such as the longtime-culture process, tendency to contaminate, high cost, and physical and chemical impact factors, and these could in a certain extent increase the risk both in pre- and post-treatment. As for the use of embryonic stem cells, it could be questioned by ethics for the harvest, the use of animal serum, and the non-diploid unstable cells that may appear after stem cell expansion in vitro. Then, some non-expansion technologies, such as the centrifugation technology, immunomagnetic beads technology, and stem cell screen-enrich-combine(-biomaterials) circulating system, have gradually been paid more attentions, and formed the new concept that are continuously developed. By these techniques, efficient therapeutic doses of stem cells could be obtained without culture in vitro, and the stem cells could be transplanted directly. These technologies have gradually shown good prospects in clinical application and promotion.
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    Oral and Maxillofacial Phenome Project: a new starting point for the sustainable development of stomatology
    ZHANG Zhi-yuan
    2020, 40 (10):  1321-1323. 
    doi: 10.3969/j.issn.1674-8115.2020.10.003

    Abstract ( 278 )   PDF (3924KB) ( 58 )  
    Human Phenome Project is a major theoretical innovation and breakthrough in the field of scientific research, and a new national science and technology strategy. Oral and Maxillofacial Phenome Project also provides a scientific theoretical basis and a new starting point for the sustainable development of stomatology. In this paper, the leading role of the Oral and Maxillofacial Phenome Project in stomatology is described, and the bridge effect between the clinical research and translational medicine on stomatology is illustrated with examples.
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    Innovative research team achievement
    Auditory brainstem implantation in young children with congenital deafness: a case report
    JIA Huan1, 2*, CHEN Ying1, 2*, ZHANG Zhi-hua1, 2, LI Jing-jie3, LI Yun1, 2, CHEN Jian-qing1, 2, LI Bei1, 2, TAN Hao-yue1, 2, WANG Zhao-yan1, 2, WU Hao1, 2
    2020, 40 (10):  1324-1329. 
    doi: 10.3969/j.issn.1674-8115.2020.10.004

    Abstract ( 454 )   PDF (7980KB) ( 115 )  
    Objective · To investigate the safety and effectiveness of the first series of auditory brainstem implantation (ABI) in young children with congenital deafness in China mainland. Methods · The consecutive pediatric cases with congenital deafness and major malformations of inner ear and/or auditory nerve undergoing ABI surgery in the Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, from January to April in 2019 were retrospectively studied. Their audiological data [aided pure tone average (PTA), scores of Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), Categories of Auditory Performance (CAP), Meaningful Use of Speech Scale (MUSS), and Speech Intelligibility Rating (SIR)], radiological data (CT and MRI), and operation and medical records were collected to evaluate the operation safety and hearing rehabilitation outcomes within 1 year after surgery. Results · Four children were included in the study with the age of (26.3±7.8) months at the time of surgery. These patients presented bilaterally profound sensorineural hearing loss. One case had bilateral common cavity malformations with cochlear nerves aplasia, and three had bilateral Michel malformations with cochlear nerves aplasia. All 4 patients were successfully implanted in right side; the pure operation time was (354.4±31.7) min with 5–15 mL hemorrhage. At the first mapping, the average number of active electrodes was 8.5±1.0. Twelve months later, the number of active electrodes was 10.0±1.6, IT-MAIS score was (31.5±1.7) score, CAP was (4.3±0.8) score, MUSS was (14.5±3.7) score, SIR was 2.0 score, and aided PTA was (38.8±5.9) dBHL. Conclusion · ABI can be safely operated in young children with bilateral profound hearing loss, and can effectively restore the hearing and promote speech development.
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    Clinical research of CO2 laser combined with photodynamic therapy in the treatment of oral leukoplakia
    YAO Yi-lin, WU Lan, TANG Guo-yao
    2020, 40 (10):  1330-1333. 
    doi: 10.3969/j.issn.1674-8115.2020.10.005

    Abstract ( 435 )   PDF (5659KB) ( 100 )  
    Objective · To explore the clinical efficacy of CO2 laser combined with photodynamic therapy (PDT) in the treatment of oral leukoplakia (OL). Methods · A total of 21 OL patients in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from June 2018 to June 2019 were recruited. They were randomly divided into experimental group (11 cases, treated with CO2 laser combined with PDT) and control group (10 cases, treated with CO2 laser). The adverse effects during the 1st week, the clinical efficacy at the 1st month and the recurrence at the 3rd and 6th months after treatment were recorded. The differences of the above indexes between the two groups were statistically analyzed. Results · At the 1st month after treatment, the significant efficiency of the experimental group and the control group was 100% and 80%, respectively, while the total treatment efficiency were 100% and 90%, respectively. There was no significant difference between the two groups. During the 1st week post-treatment, the patients experienced varying degrees of pain, edema and (or) erosion, and there was no significant difference between the two groups. At the 3rd month after treatment, the recurrence rate of the experimental group and the control group was 0 and 10%, respectively, with no statistical difference; at the 6th month after the treatment, the recurrence rate of the experimental group was significantly lower than that of the control group (P=0.038). Conclusion · Both CO2 laser combined with PDT and single CO2 laser have significant curative effect and no serious adverse effect on the treatment of OL, and the combination therapy can significantly reduce the rate of recurrence.
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    Expression of long noncoding RNA COL11A1-208 in oral squamous cell carcinoma and its clinical significance
    JIANG Ying-ying1, 2, QIN Xing1, ZHANG Jian-jun1, CHEN Wan-tao1
    2020, 40 (10):  1334-1339. 
    doi: 10.3969/j.issn.1674-8115.2020.10.006

    Abstract ( 312 )   PDF (8411KB) ( 76 )  
    Objective · To investigate the expression of long noncoding RNA (lncRNA) COL11A1-208 in oral squamous cell carcinoma (OSCC), and evaluate its potential value in prognosis prediction and diagnosis of OSCC. Methods · The differentially expressed lncRNAs from six pairs of OSCC tissues and the para-carcinoma tissues were detected by lncRNA microarray. Quantitative real-time PCR (qPCR) was used to detect the expression of COL11A1-208 in seventy-four pairs of OSCC tissues and para-carcinoma tissues. The difference of COL11A1-208 expression among the patients with different clinical features were analyzed. The potential effectiveness of COL11A1-208 level in the diagnosis of OSCC was evaluated by the receiver operating characteristic (ROC) curve. Kaplan-Meier survival analysis was used to analyze the effects of COL11A1-208 on the 3-year overall survival rate of OSCC patients. Results · Compared with the para-carcinoma tissues, COL11A1-208 was highly expressed in OSCC tissues (P=0.000), which was consistent with the results of lncRNA microarray. The expression of COL11A1-208 in the patients with advanced TNM stage (Ⅲ - Ⅳ) was significantly higher than that with TNM stage Ⅰ - Ⅱ (P=0.001). The area under ROC curve of COL11A1-208 as a biomarker for the diagnosis of OSCC was 0.702 (95%CI 0.617 -0.788, P=0.000), and the sensitivity and specificity were 87.8% and 54.1%, respectively. The 3-year overall survival rate of the patients with low expression of COL11A1-208 was significantly longer than that of the patients with high expression (P=0.002). Conclusion · The expression of COL11A1-208 is up-regulated in OSCC tissues, which is even higher in the patients with advanced TNM stage. COL11A1-208 might have potential value in prognostic prediction and diagnosis of OSCC.
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    Original article (Basic research)
    Experimental study of superior mesenteric artery remodeling in cirrhotic rats with portal hypertension
    ZHENG Lei, LIN Jia-yun, ZHANG Chi-hao, ZHAO Zhi-feng, LI Hong-jie, QI Xiao-liang, HUO Hai-zhong#, LUO Meng#
    2020, 40 (10):  1340-1346. 
    doi: 10.3969/j.issn.1674-8115.2020.10.007

    Abstract ( 341 )   PDF (8381KB) ( 70 )  
    Objective · To investigate the remodeling of superior mesenteric artery (SMA) in cirrhotic portal hypertension (PHT) rats. Methods · The rats were divided into normal group (n=8), PHT group with CCl4 inhalation for 8 weeks (n=8) and PHT group with CCl4 inhalation for 12 weeks (n=10). After the model was established, hemodynamic parameters of all the rats were measured. The liver tissues of the three groups were prepared for paraffin section, and then stained with hematoxylin and eosin staining (H-E staining), Masson staining and Sirius Red staining, respectively. After frozen sections of SMA tissues were prepared, H-E staining was performed to quantitatively analyze the lumen diameter, wall thickness and area of SMA. Caldesmon expression was detected by immunohistochemistry. The expression of elastin, cleaved caspase-3 protein (apoptotic signal) and Ki-67 protein (proliferation signal) were detected by immunofluorescence, and caldesmon and elastin of SMA in liquid nitrogen were detected by Western blotting. Results · Compared with the normal control group, portal pressure increased and mean arterial pressure decreased in PHT group with CCl4 inhalation for 8 and 12 weeks (all P<0.05), which meant the PHT model was successfully established. Compared with the normal group, the thickness and area of SMA vessel wall and the expression of caldesmon and elastin in SMA were decreased, and the apoptosis signal of SMA smooth muscle cells was increased in PHT group with CCl4 inhalation for 12 weeks (all P<0.05). Conclusion · The vascular remodeling of SMA in PHT with cirrhosis is thinning, and the expression of related contractile structural proteins such as caldesmon and elastin decrease sharply, while apoptosis signal of smooth muscle layer increases and related damage is serious.
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    Effect and mechanism of ginsenoside Re on intervertebral disc degeneration
    LIANG Zhi-hao, CHEN Zhi-qian, CHEN Chen, ZHOU Yi-fan, YANG Xiao, ZHAO Jie
    2020, 40 (10):  1347-1353. 
    doi: 10.3969/j.issn.1674-8115.2020.10.008

    Abstract ( 306 )   PDF (9163KB) ( 92 )  
    Objective · To clarify the therapeutic effect of ginsenoside Re on intervertebral disc degeneration (IDD) and the potential underlying mechanism. Methods · 10 ng/mL tumor necrosis factor-α (TNF-α) was used to stimulate nucleus pulposus (NP) cells. The expression of inflammation and cartilage-related genes, including matrix metalloproteinase 3 (Mmp 3), a disintegrin and metalloproteinase with thrombospondin 5 (Adamts 5), aggrecan and collagen typeⅡa1 (Col2a1), were measured and compared by real-time quantitative polymerase chain reaction with ginsenoside Re concentration varying from 12.5-50 μmol/L. After stimulation of NP cells with 10 ng/mL TNF-α, the amounts of nuclear factor-κB (NF-κB) pathway-related proteins were measured by using Western blotting with or without 50 μmol/L ginsenoside Re. Twelve 8-week-old rats were used to make coccyx degeneration models (coccygeal vertebrae 6/7 as sham, coccygeal vertebrae 7/8 as puncture), intraperitoneal injection of 50 μmol/L ginsenoside Re as treatment group (n=6) and phosphate buffered saline solution (PBS) as control group (n=6). One month later, the heights of the intervertebral discs were detected by X-ray. The rats' intervertebral disc NP tissues were observed by safranin O-fast green staining and hematoxylin-eosin staining, and histological grade was evaluated. By immunofluorescence, the expressions of TNF-α, MMP 3, aggrecan and COL2A1 were observed. Results · The expressions of inflammatory factors in the NP cells including Mmp 3 and Adamts 5 decreased and the expressions of aggrecan and Col2a1 increased under the treatment of 50 μmol/L ginsenoside Re (all P=0.000). Western blotting showed that compared with the NP cells only stimulated by TNF-α, the amounts of protein p-p65 and p-IκBα decreased significantly under the treatment of ginsenoside Re (both P=0.000). X-ray showed that compared with the puncture segment of PBS injection group, the puncture segment of ginsenoside Re injection group had better disc height indices (P=0.004) and degeneration grades (P=0.000). Immunofluorescence showed ginsenoside Re injection group expressed more aggrecan and COL2A1 (P=0.000), and less TNF-α and MMP 3 (P=0.000). Conclusion · GinsenosideRe can reduce the expressions of inflammatory factors by inhibiting NF-κB pathway in NP cells as well as maintain the disc heights and effectively alleviate the IDD level of rats.
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    Analysis on characteristics of diabetic foot ulceration-related genes and immune cells
    ZHOU Han, YANG Xiao-sheng, LIAO Chen-long, ZHANG Wen-chuan
    2020, 40 (10):  1354-1359. 
    doi: 10.3969/j.issn.1674-8115.2020.10.009

    Abstract ( 294 )   PDF (9953KB) ( 61 )  
    Objective · To explore the characteristics of diabetic foot ulceration (DFU)-related genes expression and immune cells. Methods · Gene expression data set GSE80178 was downloaded from the GEO database. Six DFU samples and three diabetic foot skin (DFS) samples were used to identify the differentially expressed genes (DEGs). The biological processes and cellular components of the DEGs were annotated by using Gene Ontology (GO). The relative proportions of immune cells among DFU samples, DFS samples and non-diabetic foot skin (nDFS) samples were calculated and compared by the deconvolution method. Results · A total of 296 DEGs were obtained, including 80 genes up-regulated and 216 genes down-regulated. GO analysis found that the DEGs were enriched in the cellular components such as exosomes and extracellular space, and in the biological processes such as keratinocyte differentiation, keratinization, and neutrophil chemotaxis. The comparison between DFS and nDFS showed no difference in immune cell proportions, while compared with DFS, the proportions of activated mast cells, resting natural killer cells, CD8+ T cells and monocytes increased in the DFU samples. Conclusion · In the pathogenesis of DFU, there may be active keratinization and immunoregulation in the lesion, and the infiltration of activated mast cells, resting natural killer cells, CD8+ T cells and monocytes may increase in the lesion. Hyperglycemia itself may have little effect on the relative number of immune cells in local skin.
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    Effects of periodontitis on the subsets of helper T cells in peripheral blood of rat models
    YUAN Yun, ZHANG Hong-ming, HUANG Hui
    2020, 40 (10):  1360-1364. 
    doi: 10.3969/j.issn.1674-8115.2020.10.010

    Abstract ( 289 )   PDF (6686KB) ( 99 )  
    Objective · To investigate the effects of periodontitis on the subsets of helper T (Th) cells in peripheral blood of rat models, so as to provide basis for the immunological study of periodontitis. Methods · Rat models of experimental periodontitis were induced by gingiva separation and silk tread ligation. They were divided into periodontitis group (n=5) and normal group (control group, n=5). Periodontal probing was performed two weeks after operation. Alveolar bone resorption was measured by micro-computed tomography (micro-CT). Peripheral blood was taken for flow cytometry to detect the proportions of Th1, Th2, Th17 and T-regulatory (Treg) cells. Difference of cell proportion between the two groups was performed with independent sample t-test. Results · The gingival tissue was swollen and easy to bleed, and alveolar bone resorption was obvious in the periodontitis group. Flow cytometry showed that the proportions of Th1 (P=0.002) and Th17 (P=0.028) cells in peripheral blood of the periodontitis group significantly increased, the proportion of Treg cells significantly decreased (P=0.002), and the proportion of Th2 cells did not change obviously. Conclusion · Periodontitis promotes the differentiation of pro-inflammatory Th cell subsets, while inhibiting the differentiation of inflammation-regulating Th cell subset in peripheral blood of rat models.
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    Comparative study on the regeneration capacity of tissue in root canals between concentrated growth factor and blood clot
    ZHANG Shi-yun, LAI Guang-yun, WANG Jun
    2020, 40 (10):  1365-1370. 
    doi: 10.3969/j.issn.1674-8115.2020.10.011

    Abstract ( 345 )   PDF (8611KB) ( 79 )  
    Objective · To compare the difference of the regeneration capacity of tissue in root canals between concentrated growth factor (CGF) and blood clot by animal study. Methods · CGF was prepared from the upper arm venous blood of healthy volunteers. CGF was implanted into the root segments of isolated teeth, which is the experimental group, and the whole blood was injected into the root segments to form blood clots, which is the control group, with 18 samples in each group. The samples of the control group and experimental group were injected subcutaneously on both sides of the back of nude mice, respectively, and were taken out 4 and 6 weeks after transplantation. Hematoxylin and eosin staining (H-E staining) was used to observe the structure of newly formed tissue in root canals and calculate its area proportion. Immunohistochemical analysis, immunofluorescence analysis and modified Masson staining were used to detect the components of the newly formed tissue, and the area ratio and microvessel density of each component were calculated. Results · The structure of the newly formed tissue induced by the two groups was similar, and the main components were collagen fibers, blood vessels, nerve fibers and adipose tissue. After 4 and 6 weeks of implantation, compared with the control group, the proportion of the newly formed tissue area and microvessel density in the experimental group were higher (all P<0.05). After 6 weeks of implantation, compared with the control group, the proportion of new nerve fibers in the experimental group was increased (P=0.047). Conclusion · CGF and blood clot-induced endodontic tissue regeneration ability is similar, which may imply that CGF can be an alternative to blood clot in the regenerative endodontic treatment.
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    Study on the effect of Nd: YAG water-cooled laser on the surface of titanium implant
    GE Lin-hua, SUN Meng-jun, SHU Rong
    2020, 40 (10):  1371-1375. 
    doi: 10.3969/j.issn.1674-8115.2020.10.012

    Abstract ( 228 )   PDF (6464KB) ( 77 )  
    Objective · To study the effect of Nd: YAG water-cooled laser on the titanium implant surface, and evaluate its safety in the treatment of peri-implantitis. Methods · Two different titanium sheets (mechanically polished and sandblasted and acid etched) were used and randomly divided into three groups: Nd: YAG laser treatment group (power 1.5 W, water 2 gas 3, fiber diameter 400 μm, non-contact mode), Er, Cr: YSGG laser treatment group (power 1.5 W, frequency 20 Hz, mode S, water 10%, gas 15%, optical fiber MZ6, non-contact mode) and blank control group. After laser treatment, the effect of laser irradiation on these surfaces was observed by scanning electron microscope (SEM). The amount of cell adhesion was observed by immunofluorescence, and real-time PCR was used to detect the expression of cell adhesion genes. Results · The SEM results of the laser treatment group showed no change in the surface morphology of the titanium sheet. There was no significant difference in the amount of cell adhesion and gene expression in each group of laser treatment on the surface of the titanium sheet (P>0.05), and laser treatment had no effect on it. Conclusion · Disinfection of implants by Nd: YAG water-cooled laser has no effect on the titanium implant surface and is safe for the treatment of peri-implantitis.
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    Original article (Clinical research)
    Clinical application of custom-made temporomandibular joint-mandible combined prosthesis
    ZHENG Ji-si1, JIAO Zi-xian1, BAI Guo1, ZHANG Shan-yong1, CHEN Min-jie1, JIANG Wen-bo2, YANG Chi1
    2020, 40 (10):  1376-1381. 
    doi: 10.3969/j.issn.1674-8115.2020.10.013

    Abstract ( 288 )   PDF (8262KB) ( 57 )  
    Objective · To introduce the design and manufacture of the custom-made temporomandibular joint (TMJ)-mandible prosthesis and evaluate its safety, effectiveness and accuracy in clinical application. Methods · Six patients with the TMJ osteoarthrosis were included in this study. The maxillofacial CT data for all the patients were obtained and transferred into the Mimics 18.0 software preoperatively. The custom-made TMJ-mandible prosthesis was designed based on the anatomy and movement of the TMJ, and fabricated by 3D printing and 5-axis milling technologies. The TMJ-mandible lesion has been removed completely from modified preauricular, post and sub mandibular incisions. The combined prosthesis has been implanted after complete lesion resection. Then, the iliac or fibular bone has been grafted and fixed in the medial side of the prosthesis. The clinical follow-up and radiography examinations were taken after surgery to assess the safety and effectiveness for using. The postoperative CT scan was used to measure the implanted deviation compared with the preoperative design. Results · During the operations, all prosthesis were positioned smoothly, easily adapted to the bone surfaces, and fixed excellently. There were no prosthesis displacement, loosening, and fracture in X-ray postoperatively. The pain, diet, mandibular movement and open mouth had significant improvements after 19 months' follow-up. The merged postoperative CT scans indicated that the mean differences between predesigned positions of prosthesis and postoperative implantation sites were (0.891±0.127) mm for the fossa component and (1.240±0.246) mm for the mandibular component. The total average error was (1.122±0.198) mm. Conclusion · The TMJ-mandible combined prosthesis is safe, effective, and precise for the clinical application.
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    Functional reconstruction of maxillectomy defect with zygomatic implant
    LIN Xin-yan1, ZHOU Wen-jie1, WANG Feng2, HUANG Wei2, WANG Zhen3,QU Xing-zhou3#, WU Yi-qun1#
    2020, 40 (10):  1382-1387. 
    doi: 10.3969/j.issn.1674-8115.2020.10.014

    Abstract ( 268 )   PDF (7891KB) ( 42 )  
    Objective · To evaluate the outcomes of maxillary reconstruction using zygomatic implant (ZI) technique. Methods · Eligible patients who were treated with maxillary resection and rehabilitated with ZI-supported obturator prostheses were enrolled from January 2013 to December 2019. The survival rate of the ZI, the success rate of the prosthesis, the postoperative complications, the restoration of speech and mastication, and patients' satisfaction on appearance were evaluated to determine the clinical outcomes of this technique. Results · A total of 69 ZIs and 15 conventional dental implants were inserted in 25 patients. Clip-bar, magnetic retainer and Locator? were fabricated for obturator retention. The survival rate of the ZIs was 94.2% (65/69) after a mean follow-up of 3.7 years. Reconstruction prevented the communication between oral cavity and nasopharynx so that speech and mastication function was fully recovered. The patients were satisfied with oral function and appearances after reconstruction. Postoperative complications presented an incidence of 4% (3/69), including facial fistula and soft tissue hyperplasia around ZI. Conclusion · ZI technique is a feasible treatment to reconstruct the maxillectomy defect with favorable clinical outcomes, providing good facial morphology and functional restoration, which avoids extensive bone grafting and shortens the treatment period.
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    Early outcomes of 3D printing-assisted fenestrated/branched endovascular repair in treatment of aortic diseases involving visceral branches
    LI Feng-shi, LIU Guang, LIU Xiao-bing#, LU Xin-wu#
    2020, 40 (10):  1388-1392. 
    doi: 10.3969/j.issn.1674-8115.2020.10.015

    Abstract ( 338 )   PDF (7690KB) ( 53 )  
    Objective · To evaluate the early outcomes of 3D printing-assisted fenestrated/branched endovascular repair (f/bEVAR) in the treatment of aortic diseases involving visceral branches. Methods · The clinical data of the patients with aortic diseases involving visceral branches treated by 3D printing-assisted f/bEVAR in the Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from May 2019 to May 2020 were retrospectively analyzed, including the surgical effect and the occurrence of perioperative complications. And the results of early follow-up were also evaluated. Results · A total of 13 patients were enrolled, including 11 males (84.6%), with an average age of (58.3±14.1) years. There were 7 cases of abdominal aortic aneurysm, 5 cases of dissecting aneurysm and 1 case of descending aorta aneurysm. The success rate of visceral branch artery reconstruction technique was 94.7%. One patient's right renal artery was covered by the main stent and was reconstructed by parallel stent technique. No postoperative complications, such as renal artery ischemia and intestinal ischemia, occurred, and the perioperative mortality rate was 0. The average follow-up time was (7.3±4.6) months. No patient died during the follow-up. No symptoms related to target organ damage occurred. The computed tomography angiography during follow-up showed that the blood flow of all branches was smooth. Conclusion · 3D printing-assisted f/bEVAR is a safe and effective method for the treatment of aortic diseases involving visceral branches.
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    Value of 3.0-T MR diffusion-weighted imaging combined with dynamic contrast-enhanced imaging in differentiating benign and malignant thyroid nodules
    YUE Xiu-hui, KONG Wei-dan, REN Ji-liang, YUAN Ying#, TAO Xiao-feng#
    2020, 40 (10):  1393-1397. 
    doi: 10.3969/j.issn.1674-8115.2020.10.016

    Abstract ( 281 )   PDF (7565KB) ( 55 )  
    Objective · To investigate the value of 3.0-T MR diffusion-weighted imaging (DWI) combined with dynamic contrast-enhanced MR imaging (DCE-MRI) in the differential diagnosis of benign and malignant thyroid nodules. Methods · A total of 65 patients with thyroid nodules confirmed by operation and pathology in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to October 2019 were retrospectively analyzed. All patients underwent 3.0-T MRI scan, including routine MRI, DWI (b value was 0, 1 000 s/mm2) and DCE-MRI examination before operation. The apparent diffusion coefficient (ADC) values and DCE-MRI parameters were measured. Stepwise Logistic regression model was used to analyze the independent predictors of benign and malignant nodules, and receiver operator characteristic curve was used to analyze the diagnostic efficacy of the combined model. Results · Compared with the malignant thyroid nodules, the ADC value of the benign thyroid nodules was higher and the time to peak was earlier (both P<0.05). Stepwise Logistic regression analysis showed that ADC value and time to peak were independent predictors of benign and malignant nodules. The area under the curve of combined model of ADC values and time to peak for differentiating benign and malignant thyroid nodules was 0.93, the sensitivity was 82.4%, and the specificity was 100%. Conclusion · ADC value and time to peak are important parameters to distinguish benign and malignant thyroid nodules, and their combined model may be helpful for clinical diagnosis and provide reference for preoperative diagnosis.
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    Effect of sinus inflammation on the prognosis of blowout orbital fracture
    YUAN Qing-yue, ZHUANG Ai, SONG Xue-fei, SHI Wo-dong, BI Xiao-ping
    2020, 40 (10):  1398-1401. 
    doi: 10.3969/j.issn.1674-8115.2020.10.017

    Abstract ( 293 )   PDF (5694KB) ( 101 )  
    Objective · To investigate the effect of sinus inflammation on the prognosis of blowout orbital fracture (BOF) patients. Methods · With the retrospective study method, 66 BOF patients at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2018 to August 2019 were included and divided into sinus membrane thickening group (SMT group, n=48) and no sinus membrane thickening group (NSMT group, n=18). The corrected vision, diplopia, eye movement disorder, and exophthalmia of patients were compared between the two groups. In this study, the χ2 test, one-way analysis of variance and multiple regression equations were used to analyze the correlation between SMT and the prognosis of BOF. Results · Postoperative diplopia and eye movement disorder in the NSMT group compared with the SMT group were milder (both P=0.000). The difference in exophthalmia and changes in corrected visual acuity were not correlated with the thickening of sinus membrane. Conclusion · Sinus inflammation is correlated with the recovery of diplopia and eye movement disorder of BOF.
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    Effects of different treatment regiments for diabetes mellitus, hypertension and atrial fibrillation on the risk of heart failure with preserved ejection fraction
    LIN Hao, PAN Jian-an, ZHANG Jun-feng, GU Jun, WANG Chang-qian
    2020, 40 (10):  1402-1407. 
    doi: 10.3969/j.issn.1674-8115.2020.10.018

    Abstract ( 301 )   PDF (8779KB) ( 58 )  
    Objective · To investigate the effects of different blood glucose (BG), blood pressure (BP) control levels and atrial fibrillation (AF) control strategies on the risk of the new-onset heart failure with preserved ejection fraction (HFpEF) in patients with type 2 diabetes mellitus (T2DM), hypertension and AF. Methods · A total of 418 patients with T2DM, hypertension and AF, but without clinical signs or symptoms of heart failure, admitted to the Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2008 to December 2012 were enrolled. The participants were followed up for 7 years to examine the effects of BG control [glycosylated hemoglobin (HbA1c): <7.0%, 7.0%–8.0% and >8.0%), BP control [24 h systolic BP (SBP): <120 mmHg (1 mmHg=0.133 kPa), 120–140 mmHg and >140 mmHg] and rhythm or rate control for AF on new-onset HFpEF. Univariate and multivariate Cox regression models were used to estimate the related risk factors of new-onset HFpEF. Results · With a 7-year follow-up, the new-onset HFpEF occurred in 67 of 418 enrolled patients. In different control levels for diabetes mellitus, hypertension and AF, the intensive control of BG (HbA1c<7.0%), poor control of BP (24 h SBP>140 mmHg) and rate control of AF had the highest risk (37.9%), and the conservative control of BG (HbA1c 7.0%–8.0%), intensive control of BP (24 h SBP<120 mmHg) and rhythm control of AF had the lowest risk of new-onset HFpEF (4.8%). Multivariable Cox regression analysis showed that rate control for AF (HR=1.727, 95%CI 1.079–2.997, P=0.036) was independently associated with the presence of new-onset HFpEF. Conclusion · Conservative control of BG, besides intensive control of BP and rhythm control of AF, is found to be a crucial factor to delay the progression of HFpEF among patients with T2DM, hypertension and AF.
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    Preliminary application of MR imaging-pathology co-localization by 3D printing box in pelvic tumor assessment
    LI Xiao-min1, QU Yang1, WU Wen2, ZHAO Liang3, ZHANG Shao-ting3, HAO Yong-qiang2, DAI Ke-rong2, AI Song-tao1
    2020, 40 (10):  1408-1413. 
    doi: 10.3969/j.issn.1674-8115.2020.10.019

    Abstract ( 265 )   PDF (8415KB) ( 110 )  
    Objective · To explore the feasibility of applying patient-specific pathological section boxes based on image post-processing and 3D printing technology to the study of correlating in vivo magnetic resonance imaging (MRI) with whole mount histology of the pelvic tumors. Methods · Patients who were with pelvic tumor and underwent pelvic tumor resection from July 2019 to July 2020 were enrolled. CT and MRI were performed in both patients and postoperative tumor specimens. The skeletal anatomical landmarks were used to achieve the registration between the preoperative CT, MRI images and the postoperative CT images, and the patient-specific pathological section boxes were designed and printed, which was to ensure the consistency between in vivo MRI images and postoperative pathological images. Then, the whole pelvic tumors were stained with hematoxylin-eosin staining with the whole mount section technique to obtain the pathological boundaries. Results · A total of 5 cases with bone tumors (3 chondrosarcoma, 1 osteochondroma, and 1 plasmacytoma; 4 males and 1 female) were included in this study with an average age of (46.40±15.66) years (26–65 years). According to the Enneking's classification, there were 1 in typeⅠ, 2 in typeⅠ+Ⅱ, and 1 in typeⅠ+Ⅱ+Ⅲ. The mean maximum tumor diameter was (13.96±2.42) cm. The tumor specimens within the 3D box were adequately fitted in all tumors. The pathological boundary can be completely obtained. Distinct in vivo image features corresponded to unique pathologic characteristics in the same tumor. The average weight of each box was about 2 500 g, and the average cost was about 2 500 yuan. Conclusion · The patient-specific 3D printing pathological section box can effectively achieve the co-localization between the in vivo MRI and pathology images of pelvic tumors, which will have great value in understanding the correlation between MRI and pathology images and can provide support for further standardizing the diagnosis and treatment of pelvic tumors and improving the prognosis.
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    Correlation between the morphology of alveolar bone defect in the maxillary anterior region and the outcome of guided bone regeneration
    LI Yuan, SHI Jun-yu, ZHANG Xiao, LAI Hong-chang
    2020, 40 (10):  1414-1419. 
    doi: 10.3969/j.issn.1674-8115.2020.10.020

    Abstract ( 277 )   PDF (7502KB) ( 57 )  
    Objective · To analyze the influence of the initial ridge defect morphology on the outcome of guided bone regeneration (GBR) in the maxillary anterior region. Methods · This retrospective study included patients being placed with simultaneous GBR in the implant in the maxillary anterior region from May 2018 to September 2019 in the Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital. Cone beam CT (CBCT) examinations of patients were used to measure the resorption rate of grafted bone from the moment to 6 months after surgery. The 3D surface rendering of initial defect was reconstructed based on preoperative CBCT, and morphological variables were defined in mesial-distal, buccal-lingual, and coronal-apical directions. The Spearman correlation, Logistic regression model and receiver operating characteristic (ROC) curve analysis were used to assess the possible association between initial defect morphological variables and the resorption rate of grafted bone. A prediction model was established and verified by the leave-one-out cross-validation method. Results · A total of 30 patients were included and the median value of resorption rate of grafted bone was 52.1%. The correlation analysis results showed that the resorption rate of grafted bone was significantly correlated with multiple morphological variables of initial bone defect. The results of multivariate Logistic regression analysis showed that the maximum buccal-lingual distance (mBL) of the initial bone defect and the ratio of the of maximum coronal-apical / mesial-distal distance (rmCA/mMD) were the main factors affecting the resorption rate of grafted bone. The ROC curve analysis results showed that the area under the curve of mBL- and rmCA/mMD-based prediction model to predict the postoperative resorption rate of grafted bone was 0.946. The results of the leave-one-out cross-validation method showed that the prediction accuracy of the model was 76.7%, and the sensitivity and specificity were 0.714 and 0.813, respectively. Conclusion · The initial bone defect morphology has a significant effect on the outcome of the GBR 6 months after surgery, and bone defect morphological variables have a good predictive effect on the resorption rate of grafted bone.
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    Research on nasal reconstruction using expanded forehead flap with the dominant perforator under the guidance of infrared thermography
    XIAO Wen-tian, LI Qing-feng, ZHANG Yi-xin
    2020, 40 (10):  1420-1424. 
    doi: 10.3969/j.issn.1674-8115.2020.10.021

    Abstract ( 322 )   PDF (6749KB) ( 76 )  
    Objective · To explore the effect of infrared thermography (IRT) on detecting the dominant supratrochlear artery in nasal reconstruction using expanded forehead flaps. Methods · Fifteen patients who planned to use the expanded forehead flap for nasal reconstruction were selected. Preoperatively, IRT was used to mark the supratrochlear artery in the expanded flap to determine whether the blood vessel was missing and whether the quality of the bilateral vessels was symmetrical. The results were verified by color ultrasonic Doppler blood flow imaging. According to the result of preoperative vessel detection, the supratrochlear artery on the dominant side was selected to design the flap. Results · All 15 flaps could be marked with IRT to identify the supratrochlear artery. Among them, 10 cases had symmetrical vascular calibers and flow velocity, 2 cases had unilateral vascular deficiency, and 3 cases had asymmetric vascular quality. The supratrochlear artery on the dominant side was used as the pedicle, and flaps with the size of 4 cm×6 cm- 6.5 cm× 13 cm were excised, and all flaps survived well. Conclusion · There is the possibility of bilateral vascular asymmetry in the expanded forehead flap. The use of IRT can quickly identify the dominant supratrochlear artery and ensure the blood flow after the flap is elevated.
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    Expression of aquaporin 5 in labial gland of patients with primary Sjögren's syndrome and its significance
    WANG Ling1,2, ZHANG Na1, WANG Yan-ling1, ZHAO Fu-tao1
    2020, 40 (10):  1425-1429. 
    doi: 10.3969/j.issn.1674-8115.2020.10.022

    Abstract ( 348 )   PDF (6495KB) ( 111 )  
    Objective · To investigate the expression level of aquaporin 5 (AQP5) in labial gland, and interleukin-21 (IL-21) and β2-microglobulin (β2-MG) in serum of patients with primary Sj?gren's syndrome (pSS) and their association with the activity of the disease. Methods · Thirty-nine patients with pSS were collected and inflammatory indicators such as erythrocyte sedimentation rate (ESR) and IgG were detected. Lip gland biopsy was performed. All specimens were divided into four groups according to Chisholm lip gland pathological classification:Ⅰ, Ⅱ, Ⅲ and Ⅳ. The expression of AQP5 in labial gland was detected by immunohistochemistry and the levels of IL-21 and β2-MG in serum were detected by ELISA. Results · As the number of lymphocytes in labial gland increased, the expression of AQP5 protein decreased. The expression of AQP5 in labial gland was negatively correlated with IL-21, β2-MG, ESR and IgG (r=-0.924, P=0.000; r=-0.366, P=0.022; r=-0.611, P=0.000; r=-0.741, P=0.000). As the number of lymphocytes in labial gland increased, the expression of IL-21 in serum increased, and there was significant difference among four grades. There was no significant difference in serum β2-MG among the groups. Conclusion · The expression of AQP5 in labial gland of patients with pSS is related to lymphocyte infiltration, and AQP5, IL-21 and β2-MG are related to disease activity, which can be used as biological markers for clinical disease evaluation.
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    Original article (Public health)
    Construction of quality evaluation system of experimental investigator-initiated trial
    SHI Wen-tao1, WU Si-cheng1, CUI Dong-qi1, CHEN Ling-yan1, CHEN Shi-jie1, WANG Bu-yi1, LIN Xiao-han1, ZHANG Liang1, QU Yi-hui1, XU Feng2#, WU Hao3, 4#
    2020, 40 (10):  1430-1436. 
    doi: 10.3969/j.issn.1674-8115.2020.10.023

    Abstract ( 388 )   PDF (8713KB) ( 88 )  
    Objective · To construct a quality evaluation system of experimental investigator-initiated trial (EIIT), and provide reference for EIIT quality control. Methods · The original draft of EIIT quality evaluation system was determined through literature analysis and internal discussion of the research group. Thirty-five experts were consulted using the Delphi method and then the quality evaluation system was determined. Analytic Hierarchy Process (AHP) was used to calculate the weight of each index. Results · The effective recovery rates of three rounds of experts' consultation were 100%, 91.43%, and 91.43% respectively. The authoritative coefficient were 0.84, 0.91, and 0.89 respectively. After three rounds of experts' consultation, the average scores of all indexes were>3.50, the coefficient of variation of each index was<0.30, and Kendall coefficients of concordance (Kendall's W) were 0.177- 0.331 (P<0.01). Finally, an EIIT quality evaluation system with three first-class indexes, eighteen second-class indexes and seventy third-class indexes was constructed. There were three first-class indexes including start-up period, implementation period and summary period and their weight values were 0.310 8, 0.493 4, and 0.195 8 respectively. The weight values of the second-class indexes and the third-class indexes were determined at the same time. The consistency ratios of single-sort and overall sort of all indexes were<0.1, which shows good logical consistency. Conclusion · The EIIT quality evaluation system constructed in this research is highly scientific and reliable, with guiding significance for improving the quality of EIIT.
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