Assessing the Quality of Life in Patients With Dentofacial Deformities Before and After Orthognathic Surgery.

PURPOSE: This study aimed to assess the effect of health-related quality of life (QoL) among patients with dentofacial deformities who underwent orthognathic surgery compared with a control group without dentofacial deformities by use of generic oral health and condition-specific approaches. PATIENTS AND METHODS: In this prospective study, 2 questionnaires were administered to 85 patients (31 male and 54 female patients) who were evaluated before undergoing orthognathic surgery. The Short Form Oral Health Impact Profile Questionnaire (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were administered before and 5 to 7 months after orthognathic surgery. The control group comprised 96 young university student volunteers without dentofacial deformities. RESULTS: The questionnaires were collected 5 to 7 months after surgery. The preoperative scores of the patients and the control group were contrasted separately. The respondents' postoperative OHIP-14 and OQLQ scores were significantly lower (P < .001 for total scores). The preoperative OQLQ scores for all domains were significantly higher among the patients than among the controls (P < .001 for total scores), whereas the total scores and 3 subscale scores of the OHIP-14 in the functional and psychological domains were significantly higher among the patients than among the controls (P < .05 for total scores). The preoperative and postoperative OQLQ total scores were remarkably different between male and female patients (P < .05). The postoperative OQLQ total scores were considerably higher in older patients than in younger patients (P < .05). All patients in the Class III group who underwent double-jaw surgery showed remarkable changes after surgery (P < .001 for total scores). CONCLUSIONS: Patients with dentofacial deformities had a poorer QoL compared with the healthy population, especially in functional and psychological aspects. Orthognathic surgery had a significant positive impact on QoL. Patients with Class III malocclusion who underwent double-jaw surgery seemingly benefitted the most after surgery.

Progress and challenges in the use of latent HIV-1 reactivating agents.

Highly active antiretroviral therapy (HAART) can effectively suppress the replication of human immunodeficiency virus-1 (HIV-1) and block disease progression. However, chronic HIV-1 infection remains incurable due to the persistence of a viral reservoir, including the transcriptionally silent provirus in CD4(+) memory T cells and the sanctuary sites that are inaccessible to drugs. Reactivation and the subsequent elimination of latent virus through virus-specific cytotoxic effects or host immune responses are critical strategies for combating the disease. Indeed, a number of latency reactivating reagents have been identified through mechanism-directed approaches and large-scale screening, including: (1) histone deacetylase inhibitors (HDACi); (2) cytokines and chemokines; (3) DNA methyltransferase inhibitors (DNMTI); (4) histone methyltransferase inhibitors (HMTI); (5) protein kinase C (PKC) activators; (6) P-TEFb activators; and (7) unclassified agents, such as disulfram. They have proved to be efficacious in latent cell line models and CD4(+) T lymphocytes from HIV-1-infected patients. This review comprehensively summarizes the recent progress and relative challenges in this field.

Treatment of malignant triton tumor in zygomatic region.

Malignant triton tumor (MTT) is extremely rare and supposed to be highly aggressive because of high propensity for local recurrence and metastasis. To date, only about 170 cases were reported in various body locations including trunks, maxillary sinus, neck, extremities, retroperitoneal, and so on. We present a case of MTT in the zygoma with good outcome. A 27-year-old male patient with progressive swelling and pain in the right zygoma was proved to have an MTT by biopsy. Radical resection accompanying postoperative radiotherapy was adopted, and then the soft and hard tissue defects were repaired by prosthesis. The patient recovered well and was satisfied with the facial contour. At 45-month follow-up, there was no recurrence or metastasis that occurred. According to literature review, one third of MTTs appeared in the head and neck regions and seem to have a better prognosis. Radical resection is the most important remedy, and adjuvant radiotherapy could be helpful. With early finding and effective treatments, satisfactory outcome could be achieved.

Experimental Study on the Bone Morphogenetic Protein 1-Modified Bone Marrow Mesenchymal Stem Cell Sheets to Promote Mandibular Distraction Osteogenesis.

OBJECTIVE: The present study aims to increase the concentration of genetically modified bone marrow mesenchymal stem cells (BMSCs) in the distraction osteogenesis (DO) interstitial space and induce the conversion of BMSCs to osteoblasts to improve the osteogenic efficiency in DO and shorten the treatment period. METHODS: Bone morphogenetic protein 1 (BMP-1) and green fluorescent protein (GFP) gene-modified cell sheets of BMSCs were constructed by tissue engineering. Thirty-six New Zealand white rabbits were randomly divided into three groups: group A (the blank control group), group B (the GFP group) with the injection of GFP gene-modified BMSC sheets into the DO gap, and group C (the BMP-1 group) with the injection of BMP-1 gene-modified BMSC sheets into the DO gap. Rabbits in all three groups were distracted for 5 days at a distraction rate of 2.0 mm/d, once/day. After distraction, the above-mentioned cell sheet suspension was injected into the distraction gap to observe osteogenesis, which was observed by gross specimen observation, micro-computed tomography (Micro-CT) scanning, and histomorphology. RESULTS: The gross specimen observation showed that all animals had smooth and continuous bone cortex in the distraction region with relatively high hardness. The osteogenesis quality or hardness was ranked from the highest to the lowest, as Group C > Group B > Group A. Micro-CT and histomorphological observation revealed that group C had better maturation and bone volume of the new bone in the DO region at weeks 3 and 6 than groups B and A. CONCLUSION: BMP-1 gene-modified BMSC sheets could effectively promote the formation of new bone during rapid DO in the mandible, compensating for the poor osteogenesis caused by rapid distraction and providing a new approach to shorten the DO treatment period in clinical practice.

[Effect of electroacupuncture on serum melatonin and dopamine in aged insomnia].

OBJECTIVE: To observe the clinical effect of electroacupuncture (EA) on aged insomnia, and explore its possible mechanism. METHODS: A total of 60 patients with aged insomnia were randomly divided into an EA group (30 cases) and a sham EA group (30 cases, 1 case dropped off). The patients in the EA group were treated with acupuncture at Baihui (GV 20), Yintang (GV 29), Shenmen (HT 7), Sanyinjiao (SP 6), Xinshu (BL 15) and Shenshu (BL 23), and EA was used at Baihui (GV 20) and Yintang (GV 29), with intermittent wave, 2 Hz in frequency. In the sham EA group, the acupoints and the EA connection acupoints were the same as those in the EA group, 2-3 mm in depth, but no current was connected. The intervention was given 30 min each time, once every other day, 3 times a week for 4 weeks in the both groups. Before and after treatment, the Pittsburgh sleep quality index (PSQI) and Montreal cognitive assessment (MoCA) scale were used to assess sleep quality and cognitive function, and serum melatonin (MT) and dopamine (DA) levels were detected. RESULTS: After treatment, the total score and sub-item scores of PSQI in the EA group were lower than those before treatment (P<0.01, P<0.05), among them, the sub-item scores of sleep quality, time to fall asleep, sleep time and sleep efficiency, daytime dysfunction and total score were all lower than those in the sham EA group (P<0.01, P<0.05). After treatment, the MoCA score and serum MT and DA levels in the EA group were higher than those before treatment (P<0.01), and the MoCA score and serum MT level in the EA group were higher than the sham EA group (P<0.01, P<0.05). CONCLUSION: Electroacupuncture can improve sleep quality and cognitive function in aged insomnia patients, and its mechanism may be related to regulating serum MT and DA levels.

Accurate reconstruction of discontinuous mandible using a reverse engineering/computer-aided design/rapid prototyping technique: a preliminary clinical study.

PURPOSE: To improve the reconstructive surgical outcome of a discontinuous mandibular defect, we used reverse engineering (RE), computer-aided design (CAD), and rapid prototyping (RP) technique to fabricate customized mandibular trays to precisely restore the mandibular defects. Autogenous bone grafting was also used to restore the bony continuity for occlusion rehabilitation. PATIENTS AND METHODS: Six patients who had undergone block resection of the mandible underwent reconstruction using a custom titanium tray combining autogenous iliac grafts. The custom titanium tray was made using a RE/CAD/RP technique. A virtual 3-dimensional model was obtained by spiral computed tomography scanning. The opposite side of the mandible was mirrored to cover the defect area to restore excellent facial symmetry. A bone grafting tray was designed from the mirrored image and manufactured using RP processing and casting. The mandibular defects were restored using the trays in combination of autologous iliac grafting. An implant denture was made for 1 of the 6 patients at 24 weeks postoperatively for occlusion rehabilitation. RESULTS: The trays fabricated using this technique fit well in all 6 patients. The reconstructive procedures were easy and time saving. Satisfactory facial symmetry was restored. No severe complications occurred in the 5 patients without occlusion rehabilitation during a mean 50-month follow-up period. The reconstruction in the patient with occlusion lasted for only 1 year and failed eventually because of bone resorption and infection. CONCLUSIONS: Mandibular reconstruction was facilitated using the RE/CAD/RP technique. Satisfactory esthetic results were achieved. However, the rigidity of the cast tray could cause severe stress shielding to the grafts, which could lead to disuse atrophy. Therefore, some modification is needed for functional reconstruction.

Modified approach to construct a vascularized coral bone in rabbit using an arteriovenous loop.

The most important factor for the survival of thick three-dimensional tissues is the degree of vascularization. In this study, a modified arteriovenous loop (AVL) model was developed to prefabricate an axial vascularized tissue-engineered coral bone. In group A (n = 28), an arteriovenous fistula between rabbit femoral artery and vein was anastomosed to form an AVL. The AVL was placed in a coral block (6 x 8 x 10 mm (3)) as a vascular carrier. The complex was wrapped with polytetrafluoroethylene membrane and implanted subcutaneously. In group B (n = 20), there was no vascular carrier, and the same dimensional coral was directly implanted beneath inguinal skin. After 2, 4, 6, and 8 weeks, the rabbits were perfused with heparinized saline (for scanning electron microscopy), India ink (for histological examination), and ethylene perchloride (for vascular casts) via the abdominal aorta. In group A, histology showed that newly formed vasculature extended over the surfaces and invaded the entire coral blocks. The vascular density was significantly superior to that in group B. Vascular casts showed that new blood vessels robustly sprouted from the AVL. Scanning electron microscopy demonstrated that there were minute sprouting cavities in the vascular endangium. In this model, an axial vascularized coral bone could be effectively constructed.

A high-throughput and untargeted lipidomics approach reveals new mechanistic insight and the effects of salvianolic acid B on the metabolic profiles in coronary heart disease rats using ultra-performance liquid chromatography with mass spectrometry.

High-throughput lipidomics provides the possibility for the development of new therapeutic drugs. Accordingly, herein, we reveal the protective role of salvianolic acid B (Sal B) in rats with coronary heart disease (CHD) and propose a new mechanism for its action through a high-throughput and non-targeted lipidomics strategy. A CHD animal model was induced by consecutive high-fat diet feeding with vitamin D3 injection. At the end of the 8th week, the serum sample was analyzed to explore the metabolic biomarker and pathway changes using untargeted lipidomics based on ultra-performance liquid chromatography with mass spectrometry (UPLC/MS). In addition, blood and heart tissue samples were collected and processed for the detection of biochemical indicators and liver histological observation. After salvianolic acid B treatment, the levels of LDH, CK, CK-MB, MYO, CTn1, TG, TC, LDL-c, and Apo(b) were significantly lower than that in the model group, while the levels of HDL-c and Apo(a1) were significantly higher than that in the model group. Furthermore, the histological features of fibrosis and steatosis were also evidently relieved in the model group. A total of twenty-six potential biomarkers were identified to express the lipid metabolic turbulence in the CHD animal models, of which twenty-two were regulated by salvianolic acid B trending to the normal state, including TG(20:0/20:4/o-18:0), PC(20:4/18:1(9Z)), PC(18:3/20:2), PA(18:0/18:2), LysoPE(18:2/0:0), SM(d18:0/22:1), PE(22:6/0:0), LysoPE (20:4/0:0), sphinganine, Cer(d18:0/18:0), PS(14:0/14:1), PC (18:0/16:0), LysoPC(17:0), PE(22:2/20:1), PC(20:3/20:4), PE(20:4/P-16:0), PS(20:3/18:0), cholesterol sulfate, TG(15:0/22:6/18:1), prostaglandin E2, arachidonic acid and sphingosine-1-phosphate. According to the metabolite enrichment and pathway analyses, the pharmacological activity of salvianolic acid B on CHD is mainly involved in three vital metabolic pathways including glycerophospholipid metabolism, sphingolipid metabolism and arachidonic acid metabolism. Thus, based on the lipidomics-guided biochemical analysis of the lipid biomarkers and pathways, Sal B protects against CHD with good therapeutic effect by regulating glycerophospholipid metabolism, sphingolipid metabolism and arachidonic acid metabolism, inhibiting oxidative stress damage and lipid peroxidation.

The Possible Anti-Inflammatory Effect of Dehydrocostus Lactone on DSS-Induced Colitis in Mice.

BACKGROUND: Dehydrocostus lactone (DL), one of the main active constituents in Aucklandia lappa Decne. (Muxiang), reported to have anti-inflammatory, antiulcer, and immunomodulatory properties. However, the effect of DL on ulcerative colitis (UC) has not been reported. To analyze the anti-inflammatory potential role of DL in UC, we provide a mechanism for the pharmacological action of DL. METHODS: The experimental model of UC was induced by using oral administration of 2% dextran sulfate sodium (DSS) with drinking water in BALB/c mice. Mesalazine (Mes, 0.52 g/kg/d), DL-high doses (DL-H, 20 mg/kg/d), DL-middle doses (DL-M, 15 mg/kg/d), DL-low doses (DL-L, 10 mg/kg/d) were gavaged once a day from day 4 to day 17. Disease activity index (DAI) was calculated daily. On day 18, mice were rapidly dissected and the colorectal tissues were used to detect the levels of UC-related inflammatory cytokines (TNF-α, IL-1ß, MCP-1, MPO, SOD, IL-6, IL-17, and IL-23), IL-6/STAT3 inflammatory signaling pathway (iNOS, COX2, IL-6, GP130, L-17, and IL-23), and colorectal mucosal barrier-related regulatory factors (MUC2, XBP1s, and α, IL-1. RESULTS: DL reduced the colorectal inflammation histological assessment, decreased UC-related inflammatory cytokines (TNF-α, IL-1ß, MCP-1, MPO, SOD, IL-6, IL-17, and IL-23), IL-6/STAT3 inflammatory signaling pathway (iNOS, COX2, IL-6, GP130, L-17, and IL-23), and colorectal mucosal barrier-related regulatory factors (MUC2, XBP1s, and α, IL-1. CONCLUSIONS: DL possessed the potential of anti-inflammatory effect to treated colitis. The protective mechanism of DL may involve in reducing inflammation and improving colorectal barrier function via downregulating the IL-6/STAT3 signaling.

Risk of Colorectal Cancer in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Ulcerative colitis (UC) patients have an increased risk for the development of colorectal cancer (CRC). Our aim was to assess the risk of CRC in UC patients compared with disease extent, disease duration, and geographic variation. METHODS: In this systematic review and meta-analysis, we searched PubMed, scientific meetings, and the bibliographies of identified articles, with English language restrictions for studies published from 1988 to 2018, and assessed the risk of CRC in UC patients. Patients with Crohn's disease, family history of CRC, and colorectal adenomatous polyp (CAP) were excluded from this research. The study was registered with PROSPERO, number CRD42018102213. FINDINGS: We included 58 studies that included 267566 UC patients. Extensive UC and left-sided UC had a higher risk of CRC than proctitis UC. Geography also played a role in UC-associated CRC development. The time of malignant transformation in Asian UC patients started after 10-20 years of this disease duration. North American UC-associated CRC patients significantly increased in more than 30 years of this disease duration. CONCLUSION: In a systematic review of the literature, we found that disease extent, disease duration, and geography were strong, independent risk factors in UC-associated CRC development.

Myofibroblasts and their resistance to apoptosis: a possible mechanism of osteoradionecrosis.

Osteoradionecrosis (ORN) in the head and neck area is the most devastating long-term complication of radiotherapy, with slow progression and inability to heal spontaneously. ORN can lead to intolerable pain, fractures, and sequestration of devitalized bone and fistulae, making oral feeding impossible and causing facial deformation. In spite of its notorious reputation over at least 90 years, the precise pathogenesis of ORN has not been fully clarified, which has led to obstacles in the management of the disease. Several theories about its pathogenesis have been formulated, and radiation-induced fibrosis is the newest one. According to this theory, ORN is essentially a type of fibrosis induced by radiotherapy, and antifibrosis therapy has been shown to be effective in its treatment. We assumed that ORN, like fibrosis in other organs, is the result of a process of fibrogenesis in which myofibroblasts are the key effector cells. The uninterrupted accumulation of myofibroblasts and consequent persistent excess production of collagenous extracellular matrix and tensile force result in loss of normal function and ultimately radiation-induced fibrosis. During this process, myofibroblasts may be protected from apoptosis by acquiring an immune-privileged capacity, which allows continuous matrix synthesis. If this hypothesis proves to be correct, it would enable better understanding of the cellular and molecular mechanisms underlying the pathogenesis and progression of ORN, and would help improve our ability to prevent occurrence of ORN, give an earlier diagnosis, and treat it more effectively.

Prefabrication of axial vascularized tissue engineering coral bone by an arteriovenous loop: a better model.

The most important problem for the survival of thick 3-dimensional tissues is the lack of vascularization in the context of bone tissue engineering. In this study, a modified arteriovenous loop (AVL) was developed to prefabricate an axial vascularized tissue engineering coral bone in rabbit, with comparison of the arteriovenous bundle (AVB) model. An arteriovenous fistula between rabbit femoral artery and vein was anastomosed to form an AVL. It was placed in a circular side groove of the coral block. The complex was wrapped with an expanded-polytetrafluoroethylene membrane and implanted beneath inguinal skin. After 2, 4, 6 and 8 weeks, the degree of vascularization was evaluated by India ink perfusion, histological examination, vascular casts, and scanning electron microscopy images of vascular endangium. Newly formed fibrous tissues and vasculature extended over the surfaces and invaded the interspaces of entire coral block. The new blood vessels robustly sprouted from the AVL. Those invaginated cavities in the vascular endangium from scanning electron microscopy indicated vessel's sprouted pores. Above indexes in AVL model are all superior to that in AVB model, indicating that the modified AVL model could more effectively develop vascularization in larger tissue engineering bone.

[Digital surgical technology in reconstruction of orbital frame].

OBJECTIVE: To evaluate the application of digital surgical technology in reconstruction of orbital frame and assess the treatment outcomes. METHODS: Seven patients with post-traumatic orbital defect were included in this study. Images of the orbit were obtained for each individual through computed tomography (CT). Preoperative design was finished according to rapid prototyping, computer-aided design and computer-aided manufacturing (CAD-CAM) and other digital surgical techniques. Surgical fracture reductions with internal fixation and implant of Medpor were used in operation to reconstruct orbit as well as correct enophthalmos and diplopia. RESULTS: Accurate realignment of the displaced orbital rim was obtained in all the 7 patients, and enophthalmos and diplopia were corrected in 4 and 2 patients, respectively. CONCLUSIONS: Digital techniques provide a precise means for preoperative design and operation implementation during orbital reconstruction. As a result, complications can be reduced, and the patient's facial appearance can be maximally improved.

[Controlled clinical trials on different surgical methods for the treatment of acromioclavicular dislocation].

OBJECTIVE: To compare clinical effects of clavicular hook plate fixation, coracoid transplantation, and clavicular hook plate fixation combined with modified dynamic muscle transfer for the treatment of the complete acromioclavicular dislocation. METHODS: From January 2006 to November 2009, 65 patients with sustained complete acrominoclavicular dislocation were treated with clavicular hook plate fixation, coracoid transplantation,and clavicular hook plate fixation combined with modified dynamic muscle transfer. All the patients were divided into three groups: 22 patients in group A were treated with clavicular hook plate fixation, including 17 males and 5 females, with an average age of (31.0 +/- 10.0) years; 21 patient in group B were treated with coracoid transplantation, including 16 males and 5 females,with an average age of (33.0 +/- 6.4) years; 22 patients in group C were treated with clavicular hook plate fixation combined with modified dynamic muscle transfer,including 18 males and 4 females, with an average age of (30.0 +/- 5.3) years. Postoperative functional recovery was evaluated by Karlsson criteria. RESULTS: All the patients were followed up, and the duration ranged from half to three years (averaged 1.5 years). In group A, 8 patients got half re-dislocation, 2 patients got complete re-dislocation and arthritis of acromioclavicular joint after internal fixations removal, 1 patient had clavicular hook plate broken after operation. In group B, 7 patients got half re-dislocation, 1 patient got complete re-dislocation,and 5 patients had arthritis of acromioclavicular joint with acute pain and limited shoulder function after internal fixations removal. In group C,2 patients got half re-dislocation, no complete re-dislocation and arthritis of acromioclavicular joint occurred after internal fixations removal. According to Karlsson evaluation, in group A, 12 patients obtained an excellent result, 8 good and 2 poor; in group B, the data were 9, 7 and 5 respectively; in group C, they were 20, 2 and 0 respectively. There were remarkable differences of therapeutic effects between the clavicular hook plate fixation combined with modified dynamic muscle transfer and that with either of the former two treatment methods (P < 0.05). CONCLUSION: Clavicular hook plate combined with modified dynamic muscle transfer is a reliable and good treatment for the complete acrominoclavicular dislocation, with advantages such as easy to handle,stable fixation and early exercise.

[Management of complicated midface deficiencies with external distraction].

OBJECTIVE: To treat complicated midface deficiencies with external distraction device. METHODS: Four patients (one with acquired midface hypoplasia, two with Crouzon syndrome and one with Parry Romberg) with severe midface deficiencies underwent external distraction osteogenesis. After Le Fort III or Le Fort III plus I osteotomies were performed, the external distraction devices were activated on the 7th postoperative day with a rate of 1 mm per day. The distraction devices were removed after consolidation for 3 months. RESULTS: All patients completed the distraction treatment. The distraction distance ranged from 10 to 14 mm. The appearance of all patients was significantly improved. CONCLUSIONS: External distraction osteogenesis provides an effectively treatment for patients with severe and complicated midface deficiencies.

Reconstruction of curved mandibular angle defects using a new internal transport distraction device: an experiment in goats.

A new internal distraction device, comprising a square-bodied bow, a transport plate, a traction mechanism, and two stabilisers, was developed to allow transportation of bone around an arc. Eight adult goats were studied. A curved mandibulectomy 3cm long was made on the mandibular angle. The distractor was implanted to restore the defect. The bone was distracted at a rate of 1mm per day after a 5-day latent period. Distraction lasted 25 to 32 days. Curvilinear distraction was successful in six of the eight goats. After consolidation periods of four or eight weeks, smooth curved bone masses were restored in the distracted areas. Radiographically, there was considerable bone density in the distraction area and opaque columns streamed in the direction of distraction. Histological examination showed membranous bony regeneration in the restored bone. These results suggest that restoration of curved bone defects using the new internal transport distraction device was feasible in goats.

[Influence of different temperatures on internalization of epidermal growth factor receptor complexes in Tca-8113 cells].

OBJECTIVE: To investigate the effect of different temperatures on internalization of epidermal growth factor receptor complexes in human tongue squamous carcinoma cells(Tca-8113). METHODS: Human epidermal growth factor r (hEGF) was labeled with 125I according to Chloramine-T method. The quantity of surface binding and internalization of 125I-hEGF in Tca-8113 cells at 4 degrees C and at 37 degrees C was compared respectively with radiobinding assay. RESULTS: At 37 degrees C, the amount of EGFR complexes internalization exceeded that of surface binding after 10 min. At 4 degrees C, the level of interlization maintained very low. CONCLUSION: The study indicated that the surface binding of 125I-hEGF at 4 degrees C was steadier than that at 37 degrees C. The study on phenomenon of EGFR complexes internalization provide the experimental basis for selecting anti-EGFR monoclonal antibody in clinic.