Grade 0 Research Articles

Neurosensory Recovery Following Skeletonization of Mental Nerve During Open Reduction & Internal Fixation for Mandibular Fractures

Background: Intraoral open reduction and internal fixation (ORIF) procedures used to treat mandibular fractures can result in neurosensory abnormalities due to soft tissue and nerve manipulation. While treating fractures located in the parasymphysis and anterior body regions, where the inferior alveolar and mental nerves are located, there is limited access which can impede correct reduction and hinder the use of optimal fixation. To counter these problems, better access can be gained through skeletonization of the mental nerve, which is known to result in neurosensory disturbances. However, the extent of neurosensory deficits that may result from these procedures and the degree of their recovery remain unknown in current literature. Objective: The primary purpose of our study was to evaluate and correlate the objective and subjective neurosensory recovery of the mental nerve following skeletonization during Open Reduction and Internal Fixation of mandibular fractures. Study Design: This was a prospective observational study. Settings: The adult subjects having mandibular fractures treated at Jinnah Hospital, Lahore Pakistan, a level III tertiary care hospital. Duration: The study duration was from July 1, 2022 and December 31, 2022. Methods: Demographic details were taken and preoperative objective and subjective neurosensory assessment was performed. Following surgery, postoperative objective and subjective neurosensory assessment was performed on post op day 1, after 1 and 6 weeks. Collected data was analysed with significance level of <0.05. Results: Twenty four subjects who completed regular follow-up visits for 6 weeks were included in this study. All subjects had objective or subjective neurosensory deficit preoperatively. Following surgery, all the subjects had FSR grade S0 and subjective loss of sensation at immediate postoperative assessment after surgery. 87.5% of the subjects had complete objective and subjective neurosensory recovery at the end of 6 weeks. There was a significant negative correlation between objective and subjective neurosensory recovery during the initial stages of the study, which became non-significant by the end of 6 weeks. Conclusion: Following mental nerve skeletonization during ORIF of subjects with mandibular fractures having some degree of preoperative paraesthesia, a majority of subjects achieved complete neurosensory recovery 6 weeks postoperatively. Therefore, it is expected for a skeletonized mental nerve to return to normal function within 2 months after ORIF for mandibular fractures.

F-ACTIN DISTRIBUTION OF THE CHONDROCYTE CYTOSKELETON AND ITS ASSOCIATION WITH EARLY OSTEOARTHRITIC CHONDROCYTE PROPERTIES

AbstractObjectivesOsteoarthritis (OA) is a painful and debilitating disorder of diarthroidal joints. Progressive degeneration of the cartilage extracellular matrix (ECM) together with abnormal chondrocyte characteristics occur leading to a switch to a fibroblast-like phenotype and production of mechanically-weak cartilage. Early changes to chondrocytes within human cartilage have been observed including chondrocyte swelling[1] together with the development of thin cytoplasmic processes which increase in number and length with degeneration[2]. Changes to chondrocyte phenotype in degenerate cartilage are associated with F-actin redistribution and stress fibres (SF) formation, leading to morphologically-dedifferentiated (fibroblast-like) chondrocytes[3,4]. It is unclear if these processes are a consequence of ‘passive’ cell swelling into a defective ECM or an ‘active’ event driven by changes in cell metabolism resulting in alterations to cell shape. To address this, we have quantified and compared the distribution and levels of F-actin, a key cytoskeletal protein involved in the formation of cytoplasmic processes, within in situ chondrocytes in non-degenerate and mildly degenerate human cartilage.MethodsHuman femoral head cartilage was obtained from 21 patients [15 females, 6 males, average age 69.6yrs, (range 47–90yrs)] following femoral neck fracture, with Ethical Approval and patient's permission. Cartilage explants were removed from areas graded non-degenerate grade 0 (G0) or mildly degenerate grade 1 (G1) and cultured for up to 3wks in Dulbecco's Modified Eagle's Medium (DMEM) +/− 25% human serum (HS). In situ chondrocytes were stained with CMFDA (5-chloromethylfluoresceindiacetate, Cell-Tracker Green®) and phalloidin (F-actin labelling) and imaged by confocal microscopy and analysed quantitatively using ImageJ and Imaris® software.ResultsThere were significant increases in the total amount (TA) of F-actin and its distribution [intense punctuate (IP) and intense areas (IA)] between the whole chondrocyte populations of G0 and G1 cartilage (P=0.0356; 0.0112; 0.016, respectively). Where the volume of chondrocytes was divided into normal (<1000 µm³) and swollen (≥1000 µm³) cells, F-actin TA increased in swollen cells (P=0.036 within G0 and G1, and P=0.0009 between grades) compared to chondrocytes of normal volume in each grade. Moreover, IP and IA within and between G0 and G1 were higher compared to normal chondrocytes (with P<0.0001 for IP and P<0.001 for IA). In addition, tissue culture experiments demonstrated that 90% of chondrocytes with cytoplasmic processes had strong F-actin intensity (either IP or IA with P<0.0001). Furthermore, 83% of this F-actin was associated with cytoplasmic processes, with >65% situated at the base of the process (P<0.0001).ConclusionsThe increases in chondrocyte F-actin levels (TA) and its localisation (IP, IA) appear to be associated with cell swelling and development of cytoplasmic processes, which are both characteristics of early OA cartilage[1]. This suggests the formation of chondrocyte cytoplasmic processes is an ‘active’ event potentially involving changes to matrix metabolism rather than a ‘passive’ cell swelling into a defective extracellular matrix.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Influence of the presence of dental implants on the accuracy and difficulty level of diagnosis of furcation involvement in molars: An in vitro CBCT study.

The aim of this study was to investigate the possible interference of image artifacts (IA) generated by dental implants in the evaluation of furcation involvement (FI) in molars. Tomographic scans of first molars (1M) were performed in dry skulls in the absence and presence of titanium (TI) and zirconia (ZI) dental implants. FI grades were simulated in the alveoli of the 1Ms. Diagnostic accuracy of FI and level of difficulty were verified. Chi-squared test and logistic regression analysis were used. There was no difference in the diagnostic accuracy of FI between the arches (p = .117). The highest diagnostic accuracy value for the implant variable was found in the absence of implants (88.3%) and the lowest in the presence of two ZI implants (66.7%). The highest diagnostic accuracy value for FI was observed in grade 0 (G0). There was no significant difference between the arches regarding the evaluators' perception of difficulty (p > .05). Assessments were considered difficult in 12.7% of the TI implants and in 29% of the ZI implants. Regarding the number of dental implants, assessments were considered difficult in 24.4% cases including one implant and 17.4% cases including two implants. The logistic regression model showed a significant p-value only for one and two ZI implants (p = .0061 and p = .0096, respectively). The presence of dental implants in the region adjacent to the area of investigation of FI decreased the diagnostic accuracy while increasing the perception of difficulty by the examiners, especially in cases with ZI implants.

Simultaneous liver steatosis, fibrosis and iron deposition quantification with mDixon quant based on radiomics analysis in a rabbit model

PurposeTo evaluate the feasibility of simultaneous quantification of liver fibrosis, liver steatosis and abnormal iron deposition using mDixon Quant based on radiomics analysis, and to eliminate the interference among different histopathologic features. MethodsOne hundred and twenty rabbits that were administered CCl4 for 4–16 weeks and a cholesterol rich diet for the initial 4 weeks in the experimental group and 20 rabbits in the control group were examined using mDixon. Radiomics features of the whole liver were extracted from PDFF and R2* and radiomics models for discriminating steatosis: S0-S1 vs. S2-S4, fibrosis: F0–F2 vs. F3–F4 and iron deposition: normal vs. abnormal were constructed respectively and evaluated using receiver operating characteristic (ROC) curves with the histopathological results as reference standard. Combined corrected models merging the radscore and the other two histopathologic features were evaluated using multiple logistic regression analyses and compared with radiomics models. ResultsThe area under the ROC curve (AUC) of the radiomics model with PDFF features was 0.886 and 0.843 in the training and the test set, respectively, for the diagnosis of liver steatosis grade S0–1 and S2-S4. The radiomics model based on R2* features were 0.815 and 0.801 for distinguishing F0-F2 and F3-F4 and 0.831 and 0.738 for discriminating abnormal iron deposition in the training and test set, respectively. The corrected model for liver steatosis and fibrosis (0.944 and 0.912 in the test set) outperformed the radiomics models by eliminating the interference of histopathologic features(P < 0.05), but had comparable diagnostic performance for abnormal iron deposition(P > 0.05). ConclusionsIt is feasible for mDixon to simultaneously quantify whole liver steatosis, fibrosis and iron deposition based on radiomics analysis. It is valuable to minimize the interference of different pathological features for the assessment of liver steatosis and fibrosis.

Quantitative ultrasound, elastography, and machine learning for assessment of steatosis, inflammation, and fibrosis in chronic liver disease.

To develop a quantitative ultrasound (QUS)- and elastography-based model to improve classification of steatosis grade, inflammation grade, and fibrosis stage in patients with chronic liver disease in comparison with shear wave elastography alone, using histopathology as the reference standard. This ancillary study to a prospective institutional review-board approved study included 82 patients with non-alcoholic fatty liver disease, chronic hepatitis B or C virus, or autoimmune hepatitis. Elastography measurements, homodyned K-distribution parametric maps, and total attenuation coefficient slope were recorded. Random forests classification and bootstrapping were used to identify combinations of parameters that provided the highest diagnostic accuracy. Receiver operating characteristic (ROC) curves were computed. For classification of steatosis grade S0 vs. S1-3, S0-1 vs. S2-3, S0-2 vs. S3, area under the receiver operating characteristic curve (AUC) were respectively 0.60, 0.63, and 0.62 with elasticity alone, and 0.90, 0.81, and 0.78 with the best tested model combining QUS and elastography features. For classification of inflammation grade A0 vs. A1-3, A0-1 vs. A2-3, A0-2 vs. A3, AUCs were respectively 0.56, 0.62, and 0.64 with elasticity alone, and 0.75, 0.68, and 0.69 with the best model. For classification of liver fibrosis stage F0 vs. F1-4, F0-1 vs. F2-4, F0-2 vs. F3-4, F0-3 vs. F4, AUCs were respectively 0.66, 0.77, 0.72, and 0.74 with elasticity alone, and 0.72, 0.77, 0.77, and 0.75 with the best model. Random forest models incorporating QUS and shear wave elastography increased the classification accuracy of liver steatosis, inflammation, and fibrosis when compared to shear wave elastography alone.

Assessing financial toxicity in patients with metastatic breast cancer: A single institution experience during the COVID-19 pandemic.

176 Background: Assessment of financial toxicity (FTox) is recommended as a component of comprehensive supportive care for patients with metastatic cancer. FTox is common in patients with metastatic breast cancer (MBC) and is associated with poor quality of life. Available data suggest many patients with cancer have faced financial hardship during the COVID-19 pandemic. Methods: We evaluated FTox using the COmprehensive Score for Financial Toxicity (COST) measure in patients with MBC at Johns Hopkins clinical sites. Respondents were patients with MBC who completed the COST measure as part of the baseline assessment for one of two IRB-approved quality improvement projects initiated during the COVID-19 pandemic: 1) a pilot project evaluating incorporation of patient-reported outcome (PRO) measures into routine care (RC), and 2) a needs assessment prior to attending a multi-disciplinary clinic (MultiD-C) focusing on supportive care. COST scores range from 0-44 with higher scores indicating better financial well-being. FTox was graded as: Grade 0 (G0): &gt;26, Grade 1 (G1): &gt;14-26, Grade 2 (G2): &gt;0-14 and Grade 3 (G3): 0. Results: 40 patients with MBC completed the COST measure May 2020 through April 2021 as a component of RC and 17 patients with MBC completed the COST measure September 2020 through May 2021 in advance of anticipated attendance at the MultiD-C. Median age (range) for RC and MultiD-C respondents was 64 (36-85) and 55 (37-75) years, respectively. 4 (10%) and 4 (24%) of RC and MultiD-C respondents respectively reported household income &lt; $50,000. The majority of respondents in both groups were White [RC: 28 (70%), MultiD-C: 14 (82%)], non-Hispanic [RC: 36 (90%), MultiD-C: 16 (94%)], had more than high school education [RC: 37 (93%), MultiD-C: 17 (100%)] and all were insured. 27 (68%) of RC respondents and 11 (65%) of MultiD-C respondents were receiving oral cancer therapies. COST scores and grading are shown in the Table. Approximately half of the respondents in each group reported their illness has been at least “a little bit” of a financial hardship [RC: 22 (55%), Multi-D: 8 (47%)]. Conclusions: Patients with MBC receiving care during the COVID-19 pandemic frequently report FTox. Implementation of routine assessment for FTox via PRO measures and identification of strategies to support patients with MBC experiencing FTox are priorities both during the pandemic and beyond.[Table: see text]

Severity of Coronary Artery Disease associated with Non-Alcoholic Fatty Liver

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is closely related to several metabolic disorders and is also associated with increased risk of cardiovascular disease (CVD), including coronary artery disease (CAD). Patients and methods: This was a prospective study involving patients who underwent coronary catheterization and had proven coronary artery diseases.All patients were subjected to abdominal ultrasonography and transient elastography to detect NAFLD and grading of steatosis . Results: A total of 100 patient, with mean ageof 47.9 ± 8.4 years, 70% were males , 70% were diabetics. According to ultrasonographic findings, there were 58 patients (58%) normal and 42 patients (42%) with fatty liver. As regard degree of steatosis, there were 12 patients (12%) of S0, 38 patients (38%) of S1, 22 patients (22%) of S2 and 28 patients (28%) of S3.The mean of Genseni score was 50.9.There was highly statistical significant correlation (p-value < 0.001) between degree of steatosis and Genseni score in studied patients,the mean of Gensini score was 10.5, 21.7, 57.6 and 102.6 in Grade S0, S1, S2 and S3 respectively. Conclusion: The present study indicated a Statistically significant correlation between CAD and NAFLD.

Value of shear-wave elastography of the liver and spleen for predicting the risk of esophageal - gastric varices and bleeding in patients with advanced schistosomiasis

To assess the value of shear-wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal-gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis. The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non-EGV and EGV groups, and the low- and high-risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB. The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non-EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high-risk EGV group (45.6%) and 49 cases in the low-risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non-EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut-off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high-risk EGVB groups than in the low-risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut-off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high-risk EGV, respectively. SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.

Exploration of the relationship between puerperal shivering and amniotic fluid entering into the blood during cesarean section

Objective To investigate the relationship between shivering and amniotic fluid entering into the blood during cesarean section, and provide new thoughts for prevention and treatment of shivering during cesarean section. Methods This was a prospective, double-blinded, and controlled study. A total of 57 puerperants [American Society of Anesthesiologists (ASA)ⅠorⅡ] received subarachnoid block, whose shivering were observed and classified by chief anesthesiologists. Their general information (name, age, height and weight), blood loss, fluid intake, gestational age, neonatal weight, the length of operation, neonatal 1 minute Apgar score and shivering grade were recorded. Their anal temperatures before anesthesia, 30 min after anesthesia and at the end of the operation were measured and recorded. The puerperants were divided into four groups according to Dewitte shivering classification: grade 0 is a non-shivering group (group 0); shivering grades 1 to 3 were divided into groups 1, 2 and 3, respectively, where groups 1 to 3 were defined as shivering groups. Then, 2 ml of venous blood were taken from all the puerperants before the end of the operation to detect the concentration of sialyl Tn (sTn) antigen. The correlations between shivering degree and sTn antigen concentrations, gestational age, blood loss, fluid intake, the length of operation, neonatal weight and anal temperature at three time points were analyzed. Results There was no significant difference in age, height, weight, blood loss, fluid intake, gestational age, neonatal weight, the length of operation, and anal temperature at three time points among these groups (P>0.05). Compared to groups 0 and 1, groups 2 and 3 produced higher concentrations of sTn antigen (P<0.05), while the concentration of sTn antigen in group 1 was higher than that in group 0 (P< 0.05). The concentrations of sTn antigen in the shivering groups were significantly higher than that in the non-shivering group (P<0.05). The correlation coefficient between shivering degree and sTn antigen concentration was 0.895 (P<0.01). There was no correlation between shivering degree and gestational age, blood loss, fluid intake, the length of operation, neonatal weight and anal temperature at three time points. Conclusions Puerperant shivering is related with amniotic fluid entering into the blood during cesarean section. Key words: Cesarean section; Shivering; Amniotic fluid; Sialyl Tn antigen

Prenatal ultrasonographic diagnosis and prognosis of fetal meconium peritonitis

Objective To investigate the maternal and neonatal outcomes of fetal meconium peritonitis (FMP) cases with different ultrasonic manifestations. Methods The clinical data of 31 pregnant women with FMP diagnosed by prenatal ultrasound and confirmed by postnatal imaging examination in Guangzhou Women and Children's Medical Center from January 2011 to December 2018 were analyzed retrospectively. According to the last prenatal ultrasonographic findings, the 31 cases were classified into the following grades: grade 0 (three cases), grade 1 (20 cases, grade 1A: nine cases, grade 1B: three cases, grade 1C: eight cases), grade 2 (seven cases) and grade 3 (one case). All neonates were also divided into two groups: the operation group (19 cases) and conservative treatment group (12 cases) based on whether or not underwent surgery. Statistical methods were independent sample t-test and Chi-square test. Results (1) The gestational ages at the first diagnosis of FMP and birth of the operation group were both lower than those of the conservative treatment group [(29.9±4.5) vs (38.2±1.0) weeks, t=-6.202; (36.2±2.7) vs (38.2± 1.0) weeks, t=-2.426; both P<0.05]. (2) The operation rates in cases of grade 0, 1, 2 and 3 groups were 0/3, 55%(11/20), 7/7 and 1/1, respectively (χ2=10.136, P=0.017). However, the operation rates in grade 1A, 1B and 1C groups were 7/9, 1/3 and 3/8, respectively (χ2=3.446, P=0.179). Conclusions The rate of operation of FMP newborn was related to the gestational age of the first prenatal ultrasound diagnosis of FMP and the ultrasonic grade. The different grades of prenatal ultrasound in FMP cases can provide important information for guiding perinatal treatment. Key words: Peritonitis; Meconium; Ultrasonography, prenatal; Fetal diseases

Assessing the correlation between sublingual varices and hypertension among the adults of Satara district, Maharashtra: An observational study

Aim: In most of the times, sublingual varices (SLV) are noticed during aging process, cardiovascular disease, and smoking. The aim of this study was to find the relation of SLV and the presence of hypertension. Materials and Methods: A total of 215 dental patients were enrolled for the study, of which 14 were dropped, and the status of tongue and blood pressure of a total of 201 study subjects was recorded. The patients with an average blood pressure (at home) of ≥85 mm Hg (diastolic) and ≥135 mm Hg (systolic) were reported to the hospital, where three hypertension measurements were recorded with an interval of 1 week. Student t test and Pearson chi-square test were used for the analysis. Results: An association was found between hypertension and SLV (odds ratio = 2.16, P < 0.001). The systolic blood pressure was found to be 121.2 mm Hg and 138.1 mm Hg in subjects with grade 0 and grade 1 SLV, respectively (P < 0.001). The mean diastolic blood pressure was found to be 81.2 mm Hg and 85.2 mm Hg in patients with grade 0 and grade 1 SLV, respectively (P < 0.05). Conclusion: An association was observed between SLV and hypertension. Examination of lateral borders of tongue can be performed easily, and causes no harm to the patients, and can be considered as an important diagnosis method for the dentists to take an active role in preventive and primary health care.

MRI of foot pain in amateur marathoners and analysis of related factors

Objective To study the MRI manifestations of foot injuries in amateur marathoners and the diagnostic value of MRI for foot injuries. Methods Forty-eight amateur marathoners were prospectively recruited from October 2018 to March 2019. Participants were grouped according to the FASS criteria. All participants underwent bilateral foot MRI examinations. The MRI features of foot in amateur marathoners with and without foot pain were analyzed.The association with gender, age, time to participate in marathon, amount of running per week, number of times to complete the whole marathon and the symptoms of foot pain was studied. Results There were 28 sides in FASS in grade 0, including 8 males and 20 females, 8 hydrocele of the first metatarsophalangeal joint, 6 edema of bone marrow, 4 edema of soft tissue, 4 hydrocele of tendon sheath, and 6 without abnormal manifestations of MRI. There were 68 sides in FASS grade 1, including 42 males and 26 females, 38 Achilles tendinitis, 14 plantar fasciitis, 12 Achilles tendon bursitis and 4 posterior ankle impingement syndrome. The incidence of foot pain in amateur marathoners was related to gender (OR=1.060, P=0.043), unrelated to age (OR=0.248, P=0.078), number of marathons completed (OR=1.006, P=0.956), time to participate in marathon (OR=1.008, P=0.944), amount of running per week (OR=0.971, P=0.407). Conclusion Among amateur marathon runners, the foot pain is mainly caused by Achilles tendon and plantar fascia, while those without foot pain are mainly characterized by joint effusion, tendon sheath effusion and bone marrow edema. Gender is the only factor affecting the incidence of foot pain in amateur marathoners. MRI examination is an effective method to determine foot injury and has important clinical application value in the diagnosis and treatment of foot injury. Key words: Athletic injuries; Foot; Magnetic resonance imaging; Marathon

Efficacy of postoperative medication in the treatment of cataract with uveitis

Objective To evaluate the efficacy of postoperative application of diclofenac sodium combined with triamcinolone acetonide in the treatment of cataract with uveitis. Methods The data of 85 patients of cataract with uveitis from Jan. 2016 to Jun. 2018 in Luhe Hospital were studied retrospectively.According to the random number table, all patients were divided into the observation group and the control group.The two groups were performed phacoemulsification and intraocular lens implantation.The control group, 40 cases, received injection of triamcinolone subconjunctival postoperatively, and treated with Tobramycin and Dexamethasone ophthalmic suspension eye drops after injection.The observation group, 45 cases, received diclofenac sodium eye drops on the basis of eyes drops of the control group.The course of medication was 1 month. The changes after treatment were compared between the two groups. Results The aqueous humor sCD44, TGF-β2 and MCP-1 in the observation group at 1 month after treatment were significantly better than those in the control group (P 0.05). In the observation group, the visual acuity, the incidence of grade 0 anterior chamber reaction, the total incidence of corneal edema, macular edema and photophobia were significantly better than those in the control group (P 0.05). Conclusion Application of Diclofenac sodium combined with triamcinolone acetonide is effective for cataract with uveitis, can reduce the aqueous humor sCD44, TGF-β2 and MCP-1 levels, alleviate anterior chamber reaction, and reduce the complications. Key words: Cataract; Uveitis; Phacoemulsification; Triamcinolone acetonide; Factor, aqueous humor

3D printed navigation template assists pedicle lag-screw placement for atypical Hangman’s fracture

Objectives To evaluate the 3D printed navigation template used to assist axis pedicle lag-screw placement in the treatment of atypical Hangman’s fracture (AHF). Methods From May 2015 to January 2017, 12 patients with AHF were treated at Department of Orthopedics, The Fourth People’s Hospital of Zigong.In their operation, the axis pedicle lag-screw placement was assisted by a 3D printed navigation template.They were 8 men and 4 women, aged from 27 to 53 years (average, 45.6 years).There were 7 cases of type Ⅰ, 4 cases type Ⅱ and one case of type ⅡA according to the Levine-Edwards classifi-cation.There were 2 cases of grade D and 12 cases of grade E according to the assessment of America Spinal Injury Association (ASIA).Their preoperative and postoperative neck pain was evaluated by visual analogue scale (VAS); their preoperative and postoperative ranges of cervical motion were recorded and compared.To evaluate the postoperative safety of screws, the insertion point, position within the pedicle, axial angle and sagittal angle of the screws and maximum fracture displacement were compared between actual operation and simulative operation. Results A total of 12 guide plates were designed and printed; a total of 24 lag-screws were placed.All patients underwent surgery uneventfully.They were followed up for 12 to 20 months, with an average of 14.7 months.Two patients with ASIA grade D recovered to ASIA grade E at the last follow-up.All patients showed a significant improvement in neck pain.Their VAS score at 5 days after surgery (5.86±2.02) was significantly lower than their preoperative score (8.29±1.88) (P 0.05).Their postoperative X-ray and CT images showed that the dislocation was all corrected.The last follow-up showed no obvious vertebral in-stability, screw breakage or loosening.Postoperative CT showed that the 24 screws had been located com-pletely in the pedicle (grade 0), indicating that the screw placement was 100% accurate.The postoperative deviation at insertion point (0.70±0.78 mm), deviation within the pedicle (1.3±0.82 mm), axial angle (8.26°±0.88°) and sagittal angle (22.62°±0.86°) of the screws showed no significant differences from the preoperative simulative data (P>0.05).There was a significant difference in the maximum fracture dis-placement between the preoperative data (3.94±0.38 mm) and the postoperative data (2.21±0.39 mm) (P<0.05). Conclusion The 3D printed navigation template can be used to better assist axis pedicle lag-screw placement in the treatment of AHF, because it ensures safe screw placement, leading to good re-duction and fixation and precise match with the preoperative plan. Key words: Axis; Fracture; Fractures fixation, internal; Bone screw; 3D printing tech-nology

Correlation between treatment-related lymphopenia and pathologic response in esophageal squamous cell carcinoma patients undergoing neoadjuvant chemoradiotherapy

Objective To investigate the relationship between treatment-related lymphopenia and pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC). Methods Clinical data of 220 ESCC patients treated with neoadjuvant CRT followed by surgery between 2002 and 2016 were retrospectively analyzed. Absolute lymphocyte count was determined before and at 1 month after neoadjuvant CRT. Treatment-related lymphopenia was graded using Common Terminology Criteria for Adverse Events (CTCAE, 4.0 version). The relationship between lymphopenia, pCR and recurrence was evaluated by chi-square test and Cox’s regression model. Results Ninety-five patients (43.2%) achieved a pCR after neoadjuvant CRT and 71 cases (32.3%) recurred postoperatively. During neoadjuvant CRT, the incidence rates of grade 0, 1, 2, 3, and 4 lymphopenia were 1.8%, 6.8%, 31.4%, 38.2%, and 21.8%, respectively. Patients with grade 4 lymphopenia had a significantly lower pCR rate than those with grade 0-3 lymphopenia (22.9% vs.48.8%, P=0.001). Moreover, grade 4 lymphopenia was significantly associated with a higher risk of recurrence (45.8% vs.28.5%, P=0.023). Multivariate analysis identified that primary tumor length, tumor location and radiation dose were the independent predictors for grade 4 lymphopenia during neoadjuvant CRT (P=0.013, 0.001, 0.002). Conclusions The incidence of grade 4 lymphopenia in ESCC patients undergoing neoadjuvant CRT is correlated with a low pCR rate and a high risk of recurrence. Lymphopenia can be used as an economic and effective predictor for pCR. Key words: Esophageal neoplasm/neoadjuvant chemoradiotherapy; Lymphopenia; Pathologic response

The effects of excessive pre-operative anterior tibial translation on post-operative knee stability after anterior cruciate ligament reconstruction

Objective To investigate the effects of excessive pre-operative anterior tibial translation (ATT) on post-operative knee stability after anterior cruciate ligament (ACL) reconstruction. Methods From January 2016 to December 2016, a total of 348 patients with noncontact ACL injuries who underwent primary anatomic single-bundle ACL reconstruction were retrospectively analyzed. The hamstring autograft was used as the grafted tendon. The ATT relative to the lateral femoral condyle was measured on pre-operative magnetic resonance imaging (MRI) scans. Among them, twenty patients (ATT positive group) who demonstrated >10 mm ATT distance were matched in a 1∶2 fashion to 40 control participants (ATT negative group) with <3 mm ATT distance. All patients were followed for at least 2 years. The post-operative clinical outcomes, including the ATT distance, the KT-1000 side-to-side difference, and the pivot-shift tests were compared between the two groups. Results The ATT distance of the ATT positive group was 13.5±1.3 mm, which was significantly larger than that of the ATT negative group (2.5±1.4 mm) (t=45.435, P=0.013) pre-operatively. At 2-year follow-up, the ATT distance of the ATT positive group was 9.7±1.8 mm, which was significantly larger than that of the ATT negative group (0.9±1.6 mm) (t=49.655, P=0.011). Moreover, the KT-1000 side-to-side difference of the ATT positive group was 4.4±1.5 mm, which was also significantly larger than that of the ATT negative group (0.8±1.1 mm) (t=38.945, P=0.014). There was significantly difference in the pivot-shift test between the two groups (ATT positive group: 1 grade 0, 18 grade I, 1 grade II vs. ATT negative group: 39 grade 0, 1 grade I) (χ2=40.521, P=0.012). Conclusion Excessive ATT could not be completely restored to normal after isolated anatomic single-bundle ACL reconstruction. Compared to the ATT negative group, the ATT positive group has inferior knee stability at 2-year follow-up. Key words: Anterior cruciate ligament reconstruction; Wounds and injuries; Joint instability

Effects of graded nursing intervention on wound healing of type 2 diabetic foot

Objective To expolre the effects of grading nursing on wound healing of type-2diabetic foot ulcer of patients. Methods A total of 84 patients with type 2 diabetic foot were randomly divided into the control group and the observation group, with 42 cases in each group.The two groups received the same treatment.The control group received routine nursing intervention, including diet and sports complications knowledge education, regular monitoring of blood glucose.The observation group was divided into three groups according to risk factors: low risk group, middle risk group and high risk group.The foot pain score, healing of foot ulcers, patient compliance and self-caring ability of the two groups were compared. Results After graded nursing intervention, there were statistically significant differences in pain score, foot ulcer area and self-care ability between the two groups(P<0.05), and the observation group was significantly better than the control group.At the last follow-up, grade 0 of foot ulcer wounds in the observation group was significantly higher than that in the control group, while grade 1 was significantly lower than that in the control group(P<0.05). The compliance scores of patients in the two groups were significantly increased in such dimensions as drug, diet, exercise, blood glucose monitoring and review, and the increase rate in the observation group was significantly higher than that in the control group(P<0.05). Conclusion The graded nursing intervention for type 2 diabetic foot ulcer can improve the pain degree of foot ulcer, promote the healing of foot ulcer, improve the self-care ability of patients, and reduce the risk of the recurrence of diabetic foot. Key words: Type-2 diabetic foot; Grading nursing; Foot ulcer; Self-care ability

Association between uric acid and coron ary collateral circulation in stable coronary artery disease patients

Objective The aim of this study was to investigate the association between serum uric acid levels and the development of coronary collateral circulation (CCC) in patients with stable coronary artery disease. Background Serum uric acid can cause atherosclerosis. High serum uric acid levels may be associated with poor CCC in patients with stable coronary artery disease. Patients and methods A cross-sectional study was carried out on 100 patients with stable CAD who underwent coronary angiography and documented total occlusion in one or more of the major coronary arteries in Cardiovascular Department Menoufia University Hospital during the period from 1 February 2016 to 30 January 2017. Development of CCC will be graded according to the Cohen–Rentrop method: grades 2–3 will be classified as good CCC (group A) and grades 0–1 as poor CCC (group B). Results A significant relationship between high level of serum uric acid and poor coronary collaterals was observed. Mean value of uric acid in group A was 4.72 ± 1.69 mg/dl and mean value of uric acid in group B was 6.68 ± 2.36 mg/dl (P Conclusion The measurement of uric acid level provides a good predictor of poor CCC in stable coronary artery disease patients.

Pathological features and prognostic value of renal tumor thrombus

Objective To investigate the pathological features and prognostic value of renal tumor venous thrombus. Methods The clinical data of 55 cases of renal cell carcinoma with inferior vena cava tumor thrombus treated from January 2015 to January 2017 were collected and analyzed retrospectively, including 46 males and 9 females, with the mean age of 60 years (29-82 years), and the body mass index of 16.4-33.0 kg/m2 (mean 24.2 kg/m2). Renal tumors are located on the right side of 37 cases and on the left side of 18 cases. The diameter of the tumor was 2.0-21.1 cm (mean 8.0 cm). Mayo classification were 13 cases of grade 0, 11 cases of grade Ⅰ, 19 cases of grade Ⅱ, 7 cases of grade Ⅲ, and 5 cases of grade Ⅳ. The patients′ paraffin pathology was reviewed and the classification, grade, nuclear grade, tumor composition, and vascular wall adhesion were recorded. All patients were followed up after surgery and the relationship between the characteristics and the prognosis was analyzed. Results There were 47 cases of renal clear cell carcinoma and 8 cases of papillary renal cell carcinoma type 2. Nuclear grade was 4 cases of grade 1, 20 cases of grade 2, 25 cases of grade 3, and 6 cases of grade 4. There were 11 cases of large tumor necrosis, 6 cases of sarcoma, and 38 cases of focal or no necrosis. There were 20 cases of extensive blood vessels adhesion of cancer thrombus, and 35 cases of focal or no adhesion. Vascular adhesion was associated with pathological types and tumor types (P=0.021, P=0.036). The median follow-up duration was 17 months. The postoperative one-year survival rate was 87.3%. Overall survival was different in patients with different tumor types, vascular adhesion and nuclear grade, among which the overall survival rate (33.3%) of the sarcoma group was significantly lower than that of the non-necrotic group (84.8%, P=0.003) and large necrotic group (100.0%, P=0.002). Overall survival rate (65.0%) was significantly lower in the vascular extensive adhesion group than in the focal or non-adhesion group (94.3%, P=0.005). The survival rate decreased as nuclear grade increased, among which the overall survival rate of patients at level 1, 2, 3 and 4 were 100%, 95%, 80% and 50% respectively (P=0.045). There was no difference in survival among patients with different Mayo grading and pathological classification (P=0.426, P=0.604). Conclusions The pathology of tumor thrombus in renal cancer helps to predict prognosis. There is no significant difference in survival among patients with different pathological types and Mayo grades. Sarcoma, advanced tumor nuclear grade and vascular adhesion of tumor thrombus are adverse prognostic factors. Key words: Kidney neoplasms; Tumor thrombus; Pathological features; Prognosis

Clinical characteristic and surgical outcomes of children′s epilepsy caused by rolandic focal cortical dysplasia

Objective To investigate the clinical features, evaluation methods and value of resective surgery in children with epilepsy caused by rolandic focal cortical dysplasia (FCD). Methods Eight patients with epilepsy related to rolandic FCD were admitted to Epileptic Center, Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2015 to June 2017 and enrolled into this retrospective study. All patients underwent head MRI, positron emission tomography (PET)-CT and video-EEG. Three patients underwent stereo-electroencephalography (SEEG) electrode implantation and EEG monitoring lasting for 1-7 days. According to the patient's epileptic symptoms, imaging, and scalp or intracranial EEG results, the epileptogenic zone was identiried and surgical resection was performed. All patients were followed up through outpatient visits or telephone. The Engel scale was used to evaluate the surgical outcome and the limb strength was also assessed. Results Among 8 patients, the epileptogenic zone was confined to the central area in 2 and surrounding areas of the central area in the other 6 cases, which included the operculum, secondary motor area, premotor area and insula. Postoperative pathological findings showed FCD type Ⅱ in 7 and FCD type Ⅲd in 1. Image post-processing techniques and SEEG techniques facilitated the determination of epileptogenic zone. The follow-up duration for the 8 patients was 0.3-2.5 years, with the median of 0.6 year. All patients showed epilepsy remission (Engel Ⅰ). At 1 week post surgery, 7 patients had varying degrees of decline in contralateral limb muscle strength and grade 0 was reported in the most severe case. Until the last follow-up, the limb muscle strength of 7 patients improved with varying degrees. Conclusions Children with rolandic FCD have complicated epilepsy symptoms. The prognosis could be satisfactory following resection surgery. The muscle strength might decrease during a short term post operation and gradually recover. Early surgical intervention in children with such conditions may provide more benefits. Key words: Epilepsy; Child; Follow-up studies; Prognosis; Focal cortical dysplasia