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    Oral surgery
    Diagnosis and treatment protocol of mandibular condylar fracture: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
    HE Dongmei, YANG Chi
    2022, 42 (6):  695-701. 
    doi: 10.3969/j.issn.1674-8115.2022.06.001

    Abstract ( 173 )   HTML ( 11 )   PDF (2911KB) ( 38 )  

    Mandibular condylar fracture is common in clinic. Improper treatment will cause sequelae such as malocclusion, ankylosis and limited mandibular development. This paper combines the literature review and the diagnosis and treatment experience of the team to provide reference for clinicians. Imaging diagnosis, especially coronal CT reconstruction, is the basis for classification and treatment of condylar fracture. According to the fracture location, it is divided into condylar (intracapsular) fracture, condylar neck fracture and subcondylar fracture. And intracapsular fracture can be further divided into four types: A, B, C and M. The treatment of condylar fracture includes non-surgical treatment and surgical treatment. For non-surgical treatment, intermaxillary elastic traction is recommended for malocclusion correction. The absolute indication of surgical treatment is the ramus stump dislocated out of the fossa. The relative indications include the stump of the mandibular ramus contacting the articular fossa, severe displacement or dislocation of the condylar neck and subcondylar fracture. The key points of successful operation include adequate exposure, anatomic reduction and stable fixation, protection of lateral pterygoid muscle attachment and articular cartilage, and reposition of the temporomandibular joint disc. For the condylar fracture combined with mandibular fracture, lingual fissure of the mandible should be closed during reduction and fixation for restoring the mandibular width and condylar position in the fossa. When the condylar fracture is combined with midface fracture, the condylar fracture and occlusal relationship should be restored first, and then the maxillary fracture should be fixed according to the lower dentition. The children under 6 years old have the stronge ability of condylar remodeling, so non-surgical treatment is commonly used. The healing and remodeling ability of condyle gradually decreases with age. The condyles of the teenagers over 12 years old are close to those of the adults, so the indications of surgical treatment for condyle fracture refer to the adults.

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    Diagnosis and treatment protocol of temporomandibular joint (TMJ) ankylosis: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
    HE Dongmei, YANG Chi
    2022, 42 (6):  702-708. 
    doi: 10.3969/j.issn.1674-8115.2022.06.002

    Abstract ( 110 )   HTML ( 6 )   PDF (1828KB) ( 25 )  

    Temporomandibular joint (TMJ) ankylosis is characterized by limited mouth opening, facial deformity when it happened during growth and obstructive sleep apnea. It is a refractory disease which will seriously affect the mandibular function and facial appearance of the patients. With the development of new technology and accumulating experience, the treatment results have been significantly improved. Based on the literature review, this paper concludes the surgical treatment experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for clinicians. In the imaging diagnosis of TMJ ankylosis, CT coronal reconstruction is fundamental for the classification of TMJ ankylosis. It can be divided into four types according to the presence and size of residual condyle structure on the medial side of the bony fusion. In addition, jaw deformities, occlusal relationship disorders and respiratory structural disorders associated with TMJ ankylosis can be further classified. Surgical treatment of TMJ ankylosis includes lateral gap arthroplasty (LAP) and joint reconstruction. When there is a condylar structure medially to the bony fusion, which is greater than or equal to 1/2 of the internal and external diameter of the normal condyle, LAP is selected to preserve the condyle and joint disc structure; other types of joint reconstruction include autogenous bone transplantation, artificial joint reconstruction, distraction osteogenesis, etc. Orthognathic surgery can be performed simultaneously or in the second stage to correct combined jaw deformities. Autologous fat transplantation can significantly reduce the recurrence of TMJ ankylosis.

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    Protocols for diagnosis and treatment of temporomandibular joint osteoarthritis: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
    ZHANG Shanyong, YANG Chi
    2022, 42 (6):  709-716. 
    doi: 10.3969/j.issn.1674-8115.2022.06.003

    Abstract ( 173 )   HTML ( 3 )   PDF (1625KB) ( 59 )  

    Temporomandibular joint osteoarthritis (TMJOA) is the most common degenerative disease in the temporomandibular joint, mainly manifesting with pain in the joints and the muscles, joint locking, popping, crepitus, and limited mouth opening, which may undermine the quality of patients' life. The main pathological features of TMJOA include chronic synovitis, progressive articular cartilage degeneration, and abnormal subchondral bone remodeling. At present, its pathogenesis is still unclear, and abnormal mechanical load, trauma, heredity, metabolism, gender and age can all be regarded as pathogenic factors. Commonly used diagnostic methods for TMJOA include magnetic resonance imaging (MRI) and computed tomography [(CT/cone beam CT (CBCT)]. The staging standards of TMJOA mainly include Wilkes staging system and Yang's staging system. The clinical treatment of TMJOA mainly includes two categories: non-surgical treatment and surgical treatment. Non-surgical treatment includes health education, psychological consultation, medication, occlusion treatment, etc. Surgical treatment includes arthrocentesis, arthroscopic surgery, disc anchoring, autogenous tissue graft, and total joint replacement. This paper summarizes the diagnosis, staging, surgical treatment and postoperative evaluation of TMJOA on the basis of literature review, and proposes diagnosis and treatment protocols based on the experience of the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for clinicians.

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    Functional detection and prognostic analysis of inferior alveolar nerve injury after mandibular third molar extraction
    DONG Yabing, HAO Yunbo, ZHANG Wenhao, WANG Yiwen, CHEN Minjie
    2022, 42 (6):  717-722. 
    doi: 10.3969/j.issn.1674-8115.2022.06.004

    Abstract ( 104 )   HTML ( 4 )   PDF (1309KB) ( 22 )  
    Objective

    ·To quantitatively evaluate the injury degree and prognosis of inferior alveolar nerve injury in patients with lower lip numbness caused by inferior alveolar nerve injury by using current perception threshold (CPT), electrical pulp test (EPT) and two-point discrimination (2PD), establish a diagnosis and detection scheme for inferior alveolar nerve injury and provide reference for prognosis evaluation.

    Methods

    ·We selected patients with unilateral inferior alveolar nerve (IAN) injury for more than one month caused by mandibular third molar extraction who went to the outpatient department of oral surgery of the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from July 2018 to January 2021. All patients were followed up regularly, and the visual analog scale (VAS) was used to determine the degree of numbness recovery. During the follow-up, if the patient's VAS<3, it was determined that the patients recovered from numbness and were included in the recovery group. The follow-up ended. If the follow-up time was more than 1 year, and the patients' VAS≥3, it was judged that the patients' numbness didn't recover and they were included in the unrecovered group. We performed current perception threshold (CPT), electrical pulp test (EPT) and two-point discrimination (2PD) on patients of different groups, and compared the values of the three tests on the healthy side and the correlation with prognosis.

    Results

    ·A total of 60 patients were included in this study, including 14 males and 46 females. At the end of follow-up, 44 patients had VAS<3, and were setted as recovery group. The average recovery time was (4.1±1.4) months. The remaining 16 patients did not have VAS<3, and were setted as the non-recovery group. The differences of two sides of all patients' CPT, EPT and 2PD were statistically significant (all P<0.05). For the data of affected side of patients with and without lower lip sensation recovery, only CPT 5 Hz and EPT were significantly different (both P=0.000). CPT (5 Hz) had high sensitivity (93.8%) and specificity (87.5%) in the evaluation of prognosis. Similarly, EPT also had high sensitivity (93.8%) and specificity (93.8%). The CPT (5 Hz) of the affected side was consistent with the value of EPT of the posterior teeth.

    Conclusion

    ·CPT, EPT and 2PD can evaluate the injury of inferior alveolar nerve. The value measured at CPT 5 Hz and posterior tooth EPT can evaluate the prognosis of nerve recovery.

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    Clinical evaluation of Chinese embeded temporomandibular joint anchoring nail
    MAO Yi, CHEN Xuzhuo, WANG Xuehong, XIE Xinru, XU Weifeng, HUANG Hui, ZHANG Shanyong
    2022, 42 (6):  723-728. 
    doi: 10.3969/j.issn.1674-8115.2022.06.005

    Abstract ( 129 )   HTML ( 7 )   PDF (2127KB) ( 23 )  
    Objective

    ·To introduce and evaluate a Chinese embedded temporomandibular joint (TMJ) anchoring nail in a clinical trial.

    Methods

    ·From June 2018 to November 2018, 43 patients with anterior disc displacement without reduction were selected from the Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. TMJ disc reposition and fixation was performed to them all. For unilateral patients, a Chinese embedded nail was used to reduce the articular disc. For bilateral patients, a Chinese embedded anchoring nail was used on the right side and a traditional anchoring nail was used on the left side. Clinical and magnetic resonance imaging (MRI) examination were performed before surgery, 1 month after surgery, 6 months after surgery and 1 year after surgery. Clinical evaluation indexes included maximum interincisal opening (MIO) and TMJ pain score. The disc position, disc length and condylar height were measured by MRI, by using three-circle method. Repetitive measnre analysis of variance was used for statistical analysis of preoperative and postoperative MIO, visual analog scale (VAS) score for TMJ pain, disc length and condyle height.

    Results

    ·Thirty-one patients with fifty-three joints finished all follow-up periods. The success rates of Chinese embedded anchoring nail and traditional anchoring nail were 90.3% and 90.9%, respectively. One year after surgery, the patients' jaw motion improved significantly. The MIO increased from (34.65±8.63) mm before surgery to (42.84±7.46) mm 1 year after surgery (P=0.000). The pain was significantly alleviated, and the VAS score for TMJ pain decreased from (2.94±1.13) before surgery to (0.39±0.55) 1 year after surgery (P=0.000). Postoperative MRI examination result showed increased disc length. The condyle height did not change significantly 6 months after surgery (P>0.05), but it increased by an average of 1.54 mm 1 year after surgery (P=0.002). None of the 31 joints with the Chinese embeded anchorage nail had foreign body sensation, while of the 22 joints with the traditional anchorage nail, 7 patients could feel the protrusion in front of the tragus, and 2 of them had obvious foreign body sensation.

    Conclusions

    ·Improved Chinese embedded TMJ anchoring nail has similar success rate and less foreign body sensation than traditional anchoring nail. TMJ disc repositioning and fixation is beneficial to improve joint function and relieve pain. New bone can be detected 1 year after surgery.

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    Efficacy of modified ridge preservation on socket healing after mandibular third molar extractions
    LU Yeping, CHEN Minjie
    2022, 42 (6):  729-734. 
    doi: 10.3969/j.issn.1674-8115.2022.06.006

    Abstract ( 104 )   HTML ( 5 )   PDF (3083KB) ( 22 )  
    Objective

    ·To evaluate the efficacy of the preservation of alveolar crest in situ for regeneration of periodontal osseous defect distal to the mandibular second molar (M2) after mandibular third molar extractions.

    Methods

    ·After screening by evaluation, a total of 19 patients were enrolled and accepted the mandibular third molar extractions with modified ridge preservation at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from August 2020 to August 2021. Meanwhile, 8 cases of traditional tooth extraction were included in the control group. All the patients were followed up at 1 week, 3 months and 6 months after operation. Postoperative symptoms including pain, swelling and nerve injury were also recorded in detail. Intraoral clinical examination was performed on M2, including cold and heat stimulation, tooth percussion results and looseness. Osseous defect depth (ODD) on the disto-buccal aspect of M2 was taken as the primary outcome variable. Probing depth (PD) and clinical attachment level (CAL) were taken as the secondary outcome variables during the follow-up period. In the meantime, all the patients received cone beam computed tomography (CBCT), and the data were analyzed and reconstructed for the measurement of ODD through CS3DImaging software.

    Results

    ·No obvious postoperative complications such as infection or never injury were found in any patient. The PD, CAL and ODD on the disto-buccal aspect of M2 at 6 months after operation in the two groups were both improved compared with those at 3 months after operation (P<0.05 for all). Furthermore, all the data in the experimental group were lower than those of the control group at any time of the follow-up (P<0.05 for all).

    Conclusion

    ·Modified ridge preservation has a notable improvement in regeneration of periodontal osseous defect distal to the M2 after mandibular third molar extractions.

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    Basic research
    Adeno-associated virus serotype 8-mediated gene therapy in Gjb2 mutant c.109G>A homozygous mice
    CHENG Zhenzhe, JIN Chenxi, FENG Baoyi, ZHENG Xiaofei, LIU Yiqing, WU Hao, TAO Yong
    2022, 42 (6):  735-741. 
    doi: 10.3969/j.issn.1674-8115.2022.06.007

    Abstract ( 117 )   HTML ( 4 )   PDF (3168KB) ( 43 )  
    Objective

    ·To determine the expression and safety of the wild-type gap junction protein β 2 (Gjb2) gene delivered by adeno-associated virus serotype 8 (AAV8) into cochlear supporting cell region, and its effect on furosemide-induced hearing loss in Gjb2 mutant c.109G>A homozygous mice (Gjb2 homozygous mice).

    Methods

    ·The AAV8-GFP viruses with green fluorescent protein (GFP) were injected into the inner ears of newborn Gjb2 homozygous mice through the cochlear scala media, and the GFP expression in the basilar membrane was evaluated by fluorescence microscope 14 d after injection. AAV8-GJB2-GFP viruses with wild-type Gjb2 gene were injected into the inner ears of neonatal Gjb2 homozygous mice, and then the Gjb2 mRNA and its encoded protein connexin 26 (CX26) expression level and location in the cochleae were detected by RT-qPCR, Western blotting and immunofluorescence. The auditory brainstem response (ABR) test was performed to evaluate the hearing thresholds at 5.66?45.00 kHz of the 4-week-old homozygous mice, which were injected with AAV8-GJB2-GFP at the neonatal stage. The furosemide test was used to compare the changes of ABR thresholds before and after intraperitoneal injection in wild-type mice and Gjb2 homozygous mice, and observe whether furosemide-induced hearing loss could be alleviated by AAV8-GJB2-GFP injection in the homozygous mice.

    Results

    ·Fourteen days after AAV8-GFP injection, the transfection rates of supporting cells in the apex, middle, and basal turns of the cochleae were (11.60±1.28)%, (10.33±1.55)%, and (5.40±0.86)%. Four weeks after AAV8-GJB2-GFP injection, the Gjb2 mRNA expression level was 26% higher than that in the uninjected side, and CX26 protein level was 31% higher than that in the uninjected side. The expression of CX26 protein was observed in the supporting cells and ectopic expression of CX26 was also observed between the inner hair cells by using fluorescent microscope. The ABR thresholds did not shift after AAV8-GJB2-GFP injection, indicating its safety. Gjb2 homozygous mice exhibited worse hearing loss than wild-type mice after furosemide injection, whereas AAV8-GJB2-GFP alleviated furosemide-induced hearing loss in Gjb2 homozygous mice, and the thresholds measured at 8.00, 11.32 and 16.00 kHz were significantly different between the treated mice and the untreated ones (P<0.05).

    Conclusion

    ·The injection of AAV8-GJB2-GFP into the scala media of neonatal Gjb2 homozygous mice can make the cochlear supporting cells express exogenous Gjb2 in the adulthood, which alleviate the furosemide-induced hearing loss.

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    Study on the function of TRMT61A in liver cancer cell and its mechanism
    HU Zhexuan, ZHANG Xin, WO Lulu, LI Jingchi, WANG Jiao, ZHOU Cixiang, ZHAO Qian
    2022, 42 (6):  742-750. 
    doi: 10.3969/j.issn.1674-8115.2022.06.008

    Abstract ( 113 )   HTML ( 11 )   PDF (3318KB) ( 35 )  
    Objective

    ·To investigate the effect of tRNA methyltransferase 61 homolog A (TRMT61A) on liver cancer cell function and its mechanism.

    Methods

    ·The expression of TRMT61A in tumor and paired peri-tumor tissues of hepatocellular carcinoma patients was analyzed from TCGA database and the survival curves were plotted by using bioinformatics software. Stably-TRMT61A-knockdown Huh7 cells and HepG2 cells were established by using CRISPR-Cas9 system. TRMT61A protein levels in negative control group and knockdown group were detected by Western blotting. M1A methylation levels in the two groups were detected by Dot blot assay. The cell proliferation of the two groups was investigated through CCK-8 assay and colony formation assay. Flow cytometry was used to analyze cell cycle after propidium iodide (PI) staining. Cell cycle-related protein level was detected by Western blotting. Cell apoptosis was detected by using Annexin V/PI kit. Cell apoptosis-related protein level was detected by Western blotting.

    Results

    ·TRMT61A was highly expressed in hepatocellular carcinoma samples from TCGA database through bioinformatic analysis. Survival curves showed that TRMT61A was negatively correlated with patient prognosis. TRMT61A protein level and m1A modification level were lower in TRMT61A-knockdown liver cancer cells. CCK-8 assay showed that the proliferation ability was aberrantly inhibited in Huh7 and HepG2 cells after TRMT61A knockdown. Colony formation assay showed that the number of colonies was reduced in Huh7 and HepG2 cells after TRMT61A knockdown. Mechanism investigation showed that TRMT61A-knockdown Huh7 and HepG2 cells both displayed cell cycle arrest on G0/G1 phase with elevated P21 protein level and decreased cyclin D1 protein level. Cell apoptosis rates were higher in Huh7 and HepG2 cells after TRMT61A knockdown with elevated cleaved-caspase3 protein level.

    Conclusion

    ·TRMT61A knockdown inhibits the proliferation of liver cancer cells and induces cell apoptosis.

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    Inflammatory expression in IgA nephropathy cell model and anti-inflammatory effect of sodium valproate
    DAI Qin, WANG Weiming
    2022, 42 (6):  751-757. 
    doi: 10.3969/j.issn.1674-8115.2022.06.009

    Abstract ( 75 )   HTML ( 6 )   PDF (2541KB) ( 16 )  
    Objective

    ·To study the effects of aggregated IgA1 (P-aIgA1) from patients with IgA nephropathy on the secretion of inflammatory factors and cell proliferation of human renal mesangial cells (HMCs), and observe the anti-inflammatory and anti-proliferation effects of histone deacetylation (HDAC) inhibitor sodium valproate (VPA) in vitro.

    Methods

    ·N-IgA1 (IgA1 from health control) and P-IgA1 (IgA1 from patients with IgA nephropathy) were prepared by affinity chromatography, and P-aIgA1 and N-aIgA1 were prepared by thermal polymerization. The expression of inflammatory factors in HMCs culture supernatant was detected by human inflammatory factor protein chip. The proliferation of HMCs was detected by MTT assay. The expression of related proteins was detected by Western blotting or ELISA.

    Results

    ·The results of inflammatory factor protein chip showed that the concentration of interleukin-6 soluble receptor (IL-6sR), regulated upon activation normal T cell expressed and secreted factor(RANTES), tissue inhibitor of metalloproteinase 1 (TIMP1), tissue inhibitor of metalloproteinase 2 (TIMP2), tumor necrosis factor-α(TNF-α) and tumor necrosis factor type Ⅱ receptor (TNFR Ⅱ) in the culture supernatant of HMCs in the P-aIgA1 group were significantly up-regulated compared with the control group, which were 34, 124, 269, 100, 1.6 and 52 times higher than those in the control group, respectively; N-aIgA1, P-IgA1 and P-aIgA1 could promote the expression of TIMP2, and there were significant differences (P=0.000, P=0.000, P=0.001). The proliferation of HMCs was observed by MTT method. The results showed that: ① Compared with the control group, N-IgA1 group had no significant effect on the proliferation of HMCs, and P-IgA1 and P-aIgA1 could significantly promote the proliferation of HMCs (P=0.045 and P=0.003); compared with the N-IgA1, HMCs in the P-aIgA1 group had significant proliferation, and the differences was statistically significant (P=0.036). ② The results of the effects of different concentrations of P-aIgA1 on the proliferation of HMCs showed that: 25 μg/mL P-aIgA1 could significantly promote the proliferation of HMCs (P=0.038), in a dose-dependent manner. ③ 400 μg/mL VPA could significantly inhibit the proliferation of HMCs (P=0.028). The effect of different IgA1 on HDAC1 in HMCs showed that the expression of HDAC1 in each group was (8.64±0.59) times (P-aIgA1), (5.42±0.16) times (P-IgA1) and (5.87±0.58) times (N-IgA1) higher than that in the control group, respectively; compared with N-IgA1, the expression of HDAC1 was significantly increased in the P-aIgA1 group (P=0.021). The effect of VPA on TNF-α secretion by mesangial cells showed that the protein expression of TNF-α in the P-aIgA1 group was significantly increased compared with the normal control group (P=0.001); compared with the P-aIgA1 group, the protein expression of TNF-α in the P-aIgA1+VPA group decreased significantly (P=0.035).

    Conclusion

    ·P-aIgA1 can significantly promote the release of pro-inflammatory factors and mesangial cell proliferation, and the effect of promoting cell proliferation is concentration-dependent.Abnormal acetylation modification exists in IgA nephropathy cell model in vitro, which is involved in mesangial cell proliferation and inflammatory response. The HDAC inhibitor sodium valproate can partially reverse the above reaction. The above results suggest that sodium valproate has a certain application prospect in IgAN disease intervention, and provide a new idea for the prevention and treatment of IgA nephropathy from the perspective of epigenetics.

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    Effect of low-dose decitabine on the biological behavior of bone marrow mesenchymal stem cells derived from patients with immune thrombocytopenia
    WANG Xinpeng, WANG Junying, CAI Jiayi, FU Wanbing, ZHONG Hua
    2022, 42 (6):  758-767. 
    doi: 10.3969/j.issn.1674-8115.2022.06.010

    Abstract ( 86 )   HTML ( 9 )   PDF (4375KB) ( 13 )  
    Objective

    ·To investigate the effects of low-dose decitabine on the biological behaviors of proliferation and apoptosis of bone marrow mesenchymal stem cells (MSC) derived from the patients with primary immune thrombocytopenia (ITP).

    Methods

    ·Ten patients with ITP onset who were outpatients or inpatients in the Department of Hematology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, from April 2020 to October 2021 were included, and 10 non-ITP patients without bone marrow abnormalities were included as controls (normal control, NC). The bone marrow aspiration specimens were collected, MSCs were isolated, and flow cytometry was used to detect their surface antigenic markers. Differences in MSC proliferation levels between the ITP patients (MSC-ITP) and the controls (MSC-NC) were detected by using the CCK-8 kit and the EdU cell proliferation assay kit, and the changes in cell morphology were detected by using microtubule fluorescent probes. Apoptosis was observed by using Hoechst 33258 staining, and the level of apoptosis was detected by using Annexin V-FITC/PI apoptosis double-staining kit. The optimal concentration and treatment time of decitabine to promote the proliferation of MSC-ITP were explored by treatment with different concentrations and different durations. Western blotting was performed to detect the expression of apoptosis-related proteins and the effect of decitabine.

    Results

    ·Compared with MSC-NC, MSC-ITP showed abnormal morphology, more nuclear fragmentation and crinkling, reduced proliferation level in vitro, and increased basal apoptosis rate. The optimal working concentration of decitabine to stimulate MSC-ITP proliferation was 2.5 μmol/L, and the optimal treatment time was 24 h. After 2.5 μmol/L decitabine treating MSC-ITP for 24 h, cell nuclear morphology was improved, nuclei fragmentation and coalescence were reduced, and apoptosis rate was significantly decreased (P<0.05). Western blotting results showed that BAX, a mitochondrial apoptosis pathway-related protein, cystatin protease 3 (caspase3) and cleaved-caspase3 were reduced in MSC-ITP after treatment with decitabine (P<0.05).

    Conclusion

    ·The MSCs originating from ITP patients' bone marrow have abnormal morphology, reduced proliferation level and increased basal apoptosis rate in vitro; low-dose decitabine can promote the proliferation and inhibit the apoptosis of the cells, which may be mediated through the mitochondrial apoptosis pathway.

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    Clinical research
    Application of a tent-pole screw technology in reconstruction of severe alveolar bone defect: a retrospective study of 30 patients
    WU Jing, ZHAO Zhengyi, ZOU Duohong, YANG Chi, ZHANG Zhiyuan
    2022, 42 (6):  768-777. 
    doi: 10.3969/j.issn.1674-8115.2022.06.011

    Abstract ( 161 )   HTML ( 8 )   PDF (6442KB) ( 55 )  
    Objective

    ·To explore the effect of a tent-pole screw technology on reconstruction of severe alveolar bone defect.

    Methods

    ·Thirty patients underwent tent-pole screw technology to reconstruct severe alveolar bone defects in the Department of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to January 2021 were enrolled. By analyzing and reconstructing the image data of cone-beam computed tomography (CBCT) before and 8 months after operation, the effects of repairing and reconstructing the horizontal, vertical and mixed alveolar bone defects were counted. The alveolar bone volumetric parameters were evaluated by micro-computed tomography (Micro-CT), and trabecular bone number (Tb. N), trabecular bone thickness (Tb. Th), bone volume/total volume (BV/TV) and bone mineral density (BMD) were calculated to assess the maturity of regenerated bone. The regeneration of alveolar bone and remanent scaffold were calculated by analyzing histological sections.

    Results

    ·Eight months after using the tent-pole screw, the vertical bone gain value was 4.81 (1.58, 7.66) mm, and the horizontal post-operative width was 3.96 (2.38, 5.67) mm. Additionally, the bone volume gain was 2 157.22 (776.59, 2 831.63) mm3. Micro-CT analysis of bone core, which was collected 8 months after the surgery, and Tb. N was (3.09±0.68)/mm, Tb. Th was (0.08±0.01) μm, BV/TV was (25.24±5.60)% and BMD was (0.24±0.05) g/cm3. Histological sections showed that the percentages of regenerated bone and remanent scaffold were (16.30±3.57)% and 34% (31.75%, 38.25%), respectively. These data suggested good new bone formation in targeted area. There were no complications or adverse events during surgery or post-operative healing.

    Conclusions

    ·Based on “stability-oriented” alveolar ridge augmentation, using tent-pole screw, membrane pins and packaging structure in a standard operation procedure can achieve beneficial results for bone augmentation, while complications seldom occurre. The tent-pole screw may offer predictable and exceptional outcomes for implantation site preparation, especially for large alveolar defects, which will provide advantages to subsequent implantation and restoration.

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    Clinical characteristics and health economics evaluation of real-world-based ischemic cardiovascular and cerebrovascular co-morbidities
    Xieyire·HAMULATI , ZHAO Qian, LI Cheng, SONG Ning, WANG Ying, Gulijiehere·TUERXUN , PU Jun, YANG Yining, LI Xiaomei
    2022, 42 (6):  778-785. 
    doi: 10.3969/j.issn.1674-8115.2022.06.012

    Abstract ( 90 )   HTML ( 10 )   PDF (1388KB) ( 18 )  
    Objective

    ·To investigate the clinical characteristics of ischemic cardiovascular and cerebrovascular co-morbidities and the actual factors influencing the extension of hospitalization days.

    Methods

    ·Patients with first diagnosis of coronary artery heart disease (CHD) or cerebrovascular disease in the First Affiliated Hospital of Xinjiang Medical University from December 2009 to June 2020 were selected as participants by retrieving electronic medical record (EMR) and divided into CHD group, cerebrovascular disease group, and cardiovascular and cerebrovascular co-morbidities group. Retrospective analysis was performed to compare the characteristics, hospitalization days and costs of each group, and compare the correlation between different costs and total hospitalization costs in each group. Logistic regression analysis was used to explore the influencing factors associated with hospitalization days extension.

    Results

    ·A total of 22 216 patients were selected. Compared with single-disease groups, the patients in the comorbid group were older [(67±9) years] and had a higher prevalence of hypertension and atrial fibrillation, 75.4% and 9.0%, respectively; low-density lipoprotein cholesterol (LDL-Ch), leukocyte, and hemoglobin (Hb) levels were the highest (all P< 0.05). CHD group had a higher proportion of males (65.8%, P=0.000), 37.2% and 23.5% of patients with smoking and drinking habits,and high prevalence of diabetes and dyslipidemia, 43.8% and 64.0%, respectively (all P<0.05). In terms of hospitalization costs, the total hospital costs had a stronger correlation with consumables costs in the cardiovascular and cerebrovascular co-morbidity group (P=0.000). The occurrence of co-morbidities led to increased costs for supplies and out-of-pocket expenses. Multifactorial Logistic regression analysis showed that gender (OR=1.158,95%CI 1.004?1.336, P=0.045), age (OR=1.317,95%CI 1.112?1.559, P=0.000) and prevalence of dyslipidemia (OR=1.361, 95%CI 1.167?1.586, P=0.000) all correlated with longer hospitalization days (all P<0.05). Elevated blood pressure, higher low-density lipoprotein, and atrial fibrillation prevalence increased the number of hospital days in the cardiovascular and cerebrovascular co-morbidities group.

    Conclusion

    ·Patients with cardiovascular and cerebrovascular co-morbidities are characterized by older age, high prevalence of hypertension and atrial fibrillation, as well as higher LDL-Ch, WBC, and Hb levels. The male age, and prevalence of dyslipidemia are the main risk factors that mainly influence the extension of hospitalization days in patients with cardiovascular and cerebrovascular co-morbidities.

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    Study on the interaction between body weight and C1q tumour necrosis factor-related protein 1 in patients with myocardial infarction
    HU Xiao, ZHANG Xin, GU Yang
    2022, 42 (6):  786-791. 
    doi: 10.3969/j.issn.1674-8115.2022.06.013

    Abstract ( 99 )   HTML ( 8 )   PDF (1485KB) ( 18 )  
    Objective

    ·To investigate relationship between body weight and serum level of C1q tumor necrosis factor-related protein 1 (CTRP1), and its effect on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI).

    Methods

    ·A total of 200 patients diagnosed as STEMI in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from January 2018 to January 2020 were selected. Their basic data, laboratory indexes and cardiac function indexes were collected and analyzed. After discharge, patients should continue to take oral drugs and have regular outpatient or telephone follow-up. According to whether serious adverse event (SAE) occurred or not within 1 year after discharge, patients were divided into SAE group and non-SAE group. Multivariate Logistic regression model was used to analyze the influencing factors of SAE in STEMI patients. The interaction between gender, age and body weight of patients and the serum level of CTRP1 was analyzed by forest plot.

    Results

    ·A total of 192 patients were followed up. Among them, 24 patients (12.5%) developed SAE. Compared with the non-SAE group, patients in the SAE group were older [(67.08±10.30) years vs (62.99±9.04) years, P=0.043], had lower body weight [(65.41±9.45) kg vs (70.49±10.23) kg, P=0.023)], and had higher CTRP1 levels [(21.59±4.48) ng/mL vs (17.67±5.87) ng/mL, P=0.002)]. After adjusting for gender and age, multivariate Logistic regression analysis showed that high CTRP1 level was a risk factor for the incidence of SAE in STEMI patients (P=0.003), while body weight had no effect on the incidence of SAE (P>0.05). The results of subgroup analysis showed that there was an interaction between body weight and CTRP1 (P=0.011), and CTRP1 level was a risk factor for SAE occurring in patients with lower body weight (HR=22.303, P=0.003).

    Conclusion

    ·There is an interaction between body weight and serum CTRP1 level in STEMI patients. The higher the level of serum CTRP1 in STEMI patients with lower body weight, the worse the prognosis they have.

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    Prophylactic antifungal effect of posaconazole on patients with hematological malignant tumor undergoing chemotherapy
    JIN Lei, XU Wenbin, YE Chenjing, YAN Hua
    2022, 42 (6):  792-796. 
    doi: 10.3969/j.issn.1674-8115.2022.06.014

    Abstract ( 123 )   HTML ( 8 )   PDF (1261KB) ( 32 )  
    Objective

    ·To observe the efficacy and safety of posaconazole in the prevention of invasive fungal disease (IFD) in patients with acute leukemia (AL) including myelodysplastic syndrome (MDS).

    Methods

    ·The clinical data of 121 patients with AL (including MDS) treated in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from June 2016 to May 2021 were analyzed retrospectively. All the patients received clinical prophylaxis and treatment according to the Expert Consensus on ClinicalUse of Posaconazole. According to the study of China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR), the patients were divided into three groups, including low-risk group, medium-risk group and high-risk group according to the IFD risk stratification, among which the efficacy and safety of posaconazole in different risk groups were observed. Patients proved or probable to have fungal infection while receiving posaconazole were considered to have breakthrough fungal infection. Patients who reported no fungal infection during the three-month follow-up after discontinuation were regarded as effective prophylaxis. If any fungal infection was found, it was regarded as a prevention failure. During the period of neutropenia, blood routine and body temperature were monitored daily, and liver and kidney function and electrolytes were tested three times a week. Whether the patients had gastrointestinal discomfort such as abdominal distension, diarrhea, nausea and vomiting during oral posaconazole or not was observed, and the electrocardiogram of the patients was monitored.

    Results

    ·A total of 121 cases were collected, including low-risk group (n=27), medium-risk group (n=40) and high-risk group (n=54). The incidence of breakthrough fungal infection was 3.31% (4/121), and the 4 patients were in the high-risk group. Abnormal liver function was the most common adverse reaction (20 cases); among them, 13 cases in the medium-risk group and high-risk group (10.74%, 13/121) changed the regimen because of treatment intolerance. According to the time of neutropenia, the prophylactic time of posaconazole was different among the groups. The average time of use of posaconazole was 16.85 d in the low-risk group, 18.90 d in the medium-risk group and 21.31 d in the high-risk group. The overall prevention effective rate of posaconazole was 85.95% (104 /121). There was no significant difference in the effective rate of prevention between the low-risk group (100%, 27/27) and the medium-risk group (95.00%, 38/40) (P=0.242), but the differences in the comparison of the high-risk group (72.22%, 39/54) with the low-risk group and the medium-risk group were both significant (P=0.003, P=0.005).

    Conclusion

    ·Posaconazole is effective and safe in the prophylactic treatment of invasive fungal infection in patients with AL (including MDS), but liver function should be closely monitored in moderate and high risk patients.

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    Public health
    Evaluation of the application effect of “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases on the improvement of blood pressure in target surveillance population in community
    LI Guodong, YAN Shaohua, ZHANG Qiuxia, LEI Li, ZHANG Xinlu, LIANG Hongbin, LU Junyan, XIAO Min, LUO Wei, PU Jun, XIU Jiancheng
    2022, 42 (6):  797-804. 
    doi: 10.3969/j.issn.1674-8115.2022.06.015

    Abstract ( 91 )   HTML ( 9 )   PDF (1552KB) ( 21 )  
    Objective

    ·To evaluate the effect of “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases on the improvement of blood pressure in target surveillance population in community.

    Methods

    ·Target surveillance population in community who participated in the annual physical examination provided by the National Basic Public Health Service project at least twice in Xintang Town, Zengcheng District, Guangzhou from January 2020 and July 2021 were enrolled, and divided into regular management group (n=2 987) and “co-prevention and co-management” model group (n=2 876) based on whether they had received “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases or not. The regular management group received the regular management mode which included an annual physical examination. In addition to regular treatment, the “co-prevention and co-management” model group received “Internet+ health education”, and their villages were provided with wearable electrocardiogram monitoring equipment. The baseline levels (before the intervention) of the two groups were compared, and the differences of blood pressure changes between the two groups before and after the interventions were observed. Covariance analysis was used to analyze whether the effect of different intervention measures on blood pressure was affected by its baseline blood pressure level. Multi-variable linear regression model was used to explore the association between the “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases and the control of blood pressure and other cardio-cerebrovascular disease risk factors.

    Results

    ·Compared with the regular management group, the baseline levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the “co-prevention and co-management” model group were higher (both P=0.000). After the median intervention time of 227 days, the changes of SBP and DBP in the “co-prevention and co-management” model group before and after the interventions were -0.28 mmHg (95% CI -0.94?0.37, P=0.398) and -0.68 mmHg (95% CI -1.09?-0.27, P=0.001), respectively; the changes in the regular treatment group were 2.92 mmHg (95% CI 2.29?3.54, P=0.000) and -0.12 mmHg (95% CI -0.51?0.28, P=0.554), respectively; the differences of SBP and DBP before and after the intervention between the two groups were 3.20 mmHg (95% CI 2.29?4.11, P=0.000) and 0.56 mmHg (95% CI -0.01?1.13, P=0.055), respectively. Covariance analysis showed that after adjusting for SBP before the intervention, compared with the regular treatment group, the SBP in the “co-prevention and co-management” model group was reduced by 2.06 mmHg (P=0.000). In the multi-variable linear regression model, after adjusting the confounding factors, the “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases was associated with lower SBP (P=0.000).

    Conclusion

    ·The application of “Internet+”-based “co-prevention and co-management” health management model for cardio-cerebrovascular diseases among target surveillance population in community can help improving the control of systolic blood pressure.

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    Status and path analysis of influencing factors on the health information seeking behavior in elderly patients with chronic diseases
    CUI Peirong, NI Xueping, ZONG Mingchan, XIN Xiao, JIANG Yulu, LI Xianhua
    2022, 42 (6):  805-812. 
    doi: 10.3969/j.issn.1674-8115.2022.06.016

    Abstract ( 133 )   HTML ( 5 )   PDF (1552KB) ( 18 )  
    Objective

    ·To understand the status quo, influencing factors and action paths of health information seeking behavior in elderly patients with chronic diseases.

    Methods

    ·From October 2020 to September 2021, five hundred and two elderly patients with chronic diseases in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were selected by objective sampling method. General Information Questionnaire, Health Literacy Management Scale (HeLMS), Chronic Disease Self-Efficacy Scale (CDSES), Health Information Seeking Behavior Scale were used. IBM SPSS 26.0 software and Mplus 8.3 software were used for statistics analysis.

    Results

    ·The total average score of health information seeking behavior of elderly patients with chronic diseases was (3.30±0.40) points. The univariate analysis showed that different ages, residence, education, incomes, types of medical insurance, comprehensibility of health information, credibility of health information, self-efficacy, health literacy, and seeking health information for family members had statistically significant differences (all P<0.05). The path analysis results showed that comprehensibility of health information, self-efficacy, health literacy, education, credibility of health information, residence, type of medical insurance, income, and seeking health information for friends and families can directly affect health information seeking behavior, and the direct effects was 0.479, 0.225, 0.197, -0.197, 0.154, 0.145, -0.119, -0.085, 0.070 (all P<0.05). Income, comprehensibility of health information, and health literacy can indirectly affect the health information seeking behavior of elderly patients with chronic diseases through the credibility of health information, and the indirect effects were -0.036, 0.033, 0.032 (all P<0.05).

    Conclusions

    ·The current status of health information seeking behavior among elderly patients with chronic diseases is poor. The most important influencing factor is the understandability of health information, and the main influencing factors are health literacy, self-efficacy, education, credibility of health information, residence, type of medical insurance, income, and seeking health information for friends and family. It is suggested that medical staff should understand the characteristics and influencing factors of health information seeking behavior, strengthen the assessment of health information seeking behavior, and implement timely intervention measures to improve health information seeking behavior of elderly patients with chronic diseases.

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    Review
    Research progress of invasive functional assessment of coronary artery disease
    JIANG Yue, HE Ben
    2022, 42 (6):  813-818. 
    doi: 10.3969/j.issn.1674-8115.2022.06.017

    Abstract ( 104 )   HTML ( 7 )   PDF (1257KB) ( 21 )  

    Fractional flow reserve (FFR) is an invasive functional examination. Its diagnostic performance has been confirmed by a large number of studies. Because of its superiority to the traditional method of pure selective coronary angiography (CAG), it has now become the “gold standard” for diagnosing the severity of coronary artery disease. However, the need to use vasodilators for vascular pretreatment, poor coronary pressure guide wire passing performance, long inspection operation time and other factors make FFR limited in clinical application and could not be widely used. Therefore, derived indicators of FFR such as instantaneous wave-free ratio (iFR) and quantitative flow ratio (QFR) have been generated. Studies have confirmed that these indicators are in good agreement with FFR. In addition, these derived indicators simplify the operation process in the measurement, avoid the use of vasodilators, and can obtain functional data close to FFR at the same time, which provide reliable support for the operator and reduce the adverse effects of patients.Therefore, they are expected to be widely used in clinical practice as an alternative to FFR. In recent years, the publication of a number of important studies has provided new evidence-based data. These studies include the update of examination methodologies, the comparison of diagnostic performance, the expansion of examination scope, and the publication of long-term follow-up data, etc. This paper reviewed the related studies in recent years.

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    Reaearch progress of strategies and mechanisms of targeting bacteria based on nanoparticles
    LUO Zhiyuan, SHI Tingwang, RUAN Zesong, CHEN Yunfeng
    2022, 42 (6):  819-824. 
    doi: 10.3969/j.issn.1674-8115.2022.06.018

    Abstract ( 123 )   HTML ( 5 )   PDF (1289KB) ( 38 )  

    The crisis of antibiotic resistance is one of the most pressing problems in global public health. To solve the crisis of antibiotic resistance, more and more biological nanomaterials are applied to antimicrobial in recent years. Nanoparticles (NPs) are a class of nanoscale materials with unique advantages compared with traditional antibacterial drugs. However, the application of nanoparticles still faces the dilemma of poor targeting ability and the possible damage to normal tissue. In addition to improving efficacy, targeted therapies allow us to use lower concentrations of highly toxic drugs, thereby reducing the toxic side effects on healthy tissue. Therefore, how to improve the targeting of NPs to bacteria is an important issue today. This article will give an overall introduction to nanoparticles first. Surface modification, stimuli-responsiveness and biomimetic modification of cell membrane, three common bacterial targeting strategies will be introduced later, including their basic mechanisms and the latest findings. The advantages and disadvantages of the three strategies and their future direction will also be summarized. A general picture of the developments in this field will be provided to readers, and it is hoped that new ideas for targeting bacteria will emerge in the future.

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    Research progress in the role of cancer stem cell metabolism in tumor development
    ZHENG Shifan, MA Jiao
    2022, 42 (6):  825-832. 
    doi: 10.3969/j.issn.1674-8115.2022.06.019

    Abstract ( 128 )   HTML ( 12 )   PDF (1303KB) ( 34 )  

    The inability to fully eradicate cancer stem cells (CSCs) is considered to be a huge obstacle in tumor therapy. CSCs can be defined as a subpopulation of cells within heterogeneous tumors that have the potential for self-renewal and differentiation. They can also drive malignant behaviors, such as tumor initiation, resistance to chemotherapy and radiotherapy, and tumor relapse. Multiple aspects of CSCs have been studied, including specific cell surface markers, self-renewal pathways and epigenetic regulation. However, relatively little attention has yet been directed towards to the metabolism of CSCs. Based on the relevant research we currently know, here we review the properties of the energy and substance metabolism in CSCs, and we also discuss the role of CSCs in therapy resistance and tumor relapse from a metabolic perspective. In addition, we describe the linkage between CSCs metabolism and epigenetic regulation. Therefore, we highlight the huge therapeutic potential of targeting CSCs metabolism in tumor therapy.

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    Advances in cytological mechanism of neural invasion in pancreatic ductal adenocarcinoma
    ZHANG Xiuqi, SHEN Baiyong
    2022, 42 (6):  833-838. 
    doi: 10.3969/j.issn.1674-8115.2022.06.020

    Abstract ( 78 )   HTML ( 9 )   PDF (1286KB) ( 21 )  

    Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic malignant tumor, and the incidence of neural invasion of PDAC is as high as 80%?98%, far higher than any other solid tumor. Its neural invasion is defined as the discovery of PDAC cells in the nerve adventitia, perinerve and neurointima surrounding the nerve/nerve sheath. Many studies have shown that the occurrence of neural invasion in PDAC is closely related to faster disease progression, higher local recurrence rate and worse prognosis. The neural invasion of PDAC is related to the behavior/interaction of various types of specific/non-specific immune cells and glial-related cells in the pancreatic tumor microenvironment. These behaviors run through the progression of PDAC. Studies show that Schwann cells, pancreatic stellate cells, tumor-associated macrophages and even T cells, are related to the occurrence of neural invasion of PDAC, which is based on the cell-cell interaction of the above cells and a series of intracellular signal pathways. This review summarizes and introduces the research progress in the field of cytological mechanism of PDAC neural invasion in recent years. Detailed studies of its mechanism may contribute to the discovery of new targets and treatment methods, provide a theoretical basis for controlling or even reversing the neural invasion process of PDAC in the future, and make it possible to improve the prognosis of patients with PDAC.

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