Effect of a Thermosensitive Hydroxybutyl Chitosan Hydrogel on Postoperative Sequalae and Quality of Life After Impacted Mandibular Third Molar Extraction.

BACKGROUND: Third molar (M3) extraction is a common surgery in oral and maxillofacial surgery, and composite wound dressings such as hydroxybutyl chitosan (HBC) may improve postoperative sequala following M3 removal. PURPOSE: The study purpose was to measure and compare differences in pain, swelling, trismus, wound healing, and quality of life (QOL) between the HBC and the control sides in patients undergoing M3 removal. STUDY DESIGN, SETTING, SAMPLE: This study is a double-blind, split-mouth, randomized clinical trial. Patients who required M3 removal between June 2022 and May 2023 were included. Exclusion criteria included seafood allergies, smoking, poor oral hygiene, and systemic diseases. PREDICTOR VARIABLE: The predictor variable was the socket treatment technique. Subjects were randomly assigned to the HBC or control (physiological saline) side. MAIN OUTCOME VARIABLE: The primary outcome variables, including pain assessed by visual analog scale, swelling, and maximal incisional opening, were measured on the first, third, and seventh postoperative days. The secondary outcome variables included QOL and wound healing score measured on the third and seventh days after surgery. COVARIATES: The covariates included age, sex, and operation time. ANALYSES: The Shapiro‒Wilk test was used to evaluate the normality of the data distribution. The paired t test or Wilcoxon signed-rank test was adopted. Statistical significance was set at P < .05. RESULTS: The study included 60 patients (mean age: 25.81 ± 4.91; 23 (38%) males, 37 (62%) females). A statistically significant difference in the level of pain (HBC: 37.58 ± 4.39 mm, control: 47.00 ± 4.33 mm, day 1, P < .001; 21.88 ± 3.25 mm, 35.95 ± 1.57 mm, day 3, P < .001), maximal incisional opening (23.92 ± 1.38 mm, 18.22 ± 1.82 mm, day 1, P < .001; 30.00 ± 1.61 mm, 23.78 ± 1.70 mm, day 3, P < .001), and swelling (6.86 ± 0.70 mm, 7.15 ± 0.80 mm, day 3, P = .006) was detected after surgery. A statistically significant difference in QOL was detected (HBC: 13.70 ± 1.65, control: 18.60 ± 2.14, day 3, P < .001). CONCLUSION AND RELEVANCE: The application of HBC hydrogels to wounds after impacted mandibular M3 extraction reduces postoperative sequalae, promotes wound healing and improves postoperative QOL.

Near-infrared fluorescence imaging technology guided margin design in oral squamous cell carcinoma: a single-centre retrospective study.

Objective: The margin status of oral squamous cell carcinoma patients is considered to be predictive of recurrence and long-term survival. Therefore, precise intraoperative margin assessment is crucial. This study investigated the feasibility of using near-infrared fluorescence imaging technology to guide margin design in oral squamous cell carcinoma patients. Methods: In this retrospective study, indocyanine green solution was intravenously injected preoperatively into patients. Intraoperatively, the surgical area was illuminated using a near-infrared fluorescence imaging system, which caused the lesion to fluoresce in the surgical area. Surgery was performed with the assistance of fluorescence imaging. The fluorescence intensity of the lesion area and surrounding normal tissue was recorded during surgery. Intraoperative margins were sent for rapid pathology, and postoperative margin pathology results were documented. Results: Sixteen patients were included in this study (7 males, 9 females), with an average age of 65.65 ± 12.37 years. Preoperative biopsy and postoperative pathology confirmed oral squamous cell carcinoma in all patients. No cancer cells were found in the margin pathology results. The average fluorescence intensity of the lesion area was 214 ± 4.70, and that of the surrounding normal tissue was 104.63 ± 3.14. There was no significant difference in the fluorescence intensity values of the lesion areas among all patients (F=0.38, P>0.05). There was a significant difference in fluorescence intensity between the lesion area and surrounding normal tissue (t=33.76, P<0.05). Conclusion: Near-infrared fluorescence imaging technology can aid in real-time imaging differentiation of lesion areas based on differences in fluorescence intensity during surgery. The use of this technology can assist surgeons in assessing the safety margin and reliably guide surgery.

ATRX is a predictive marker for endocrinotherapy and chemotherapy resistance in HER2-/HR+ breast cancer through the regulation of the AR, GLI3 and GATA2 transcriptional network.

Drug resistance in breast cancer (BC) is a clinical challenge. Exploring the mechanism and identifying a precise predictive biomarker for the drug resistance in BC is critical. Three first-line drug (paclitaxel, doxorubicin and tamoxifen) resistance datasets in BC from GEO were merged to obtain 1,461 differentially expressed genes for weighted correlation network analysis, resulting in identifying ATRX as the hub gene. ATRX is a chromatin remodelling protein, therefore, ATRX-associated transcription factors were explored, thereby identifying the network of AR, GLI3 and GATA2. GO and KEGG analyses revealed immunity, transcriptional regulation and endocrinotherapy/chemotherapy resistance were enriched. Moreover, CIBERSORT revealed immunity regulation was inhibited in the resistance group. ssGSEA showed a significantly lower immune status in the ATRX-Low group compared to the ATRX-High group. Furthermore, the peaks of H3K9me3 ChIP-seq on the four genes were higher in normal tissues than in BC tissues. Notably, the frequency of ATRX mutation was higher than BRCA in BC. Moreover, depressed ATRX revealed worse overall survival and disease-free survival in the human epidermal growth factor receptor 2 (HER2)-/hormone receptor (HR)+ BC. Additionally, depressed ATRX predicted poor results for patients who underwent endocrinotherapy or chemotherapy in the HER2-/HR+ BC subgroup. A nomogram based on ATRX, TILs and ER exhibited a significantly accurate survival prediction ability. Importantly, overexpression of ATRX significantly inhibited the IC50 of the three first-line drugs on MCF-7 cell. Thus, ATRX is an efficient predictive biomarker for endocrinotherapy and chemotherapy resistance in HER2-/HR+ BC and acts by suppressing the AR, GLI3 and GATA2 transcriptional network.

Combined use of 3D printing and computer-assisted navigation in the clinical treatment of multiple maxillofacial fractures.

OBJECTIVES: In the field of computer-assisted surgery, 3D printing technology and computer-aided navigation (CAN) technology have led to advances in craniofacial surgery. However, the application of these two techniques in maxillofacial fractures is mostly limited to unilateral zygomatic bone and zygomatic arch fractures, and few studies have investigated their use for multiple maxillofacial fractures. This study summarizes the combined application of 3D printing technology and CAN for complex maxillofacial fractures to guide clinical practice. MATERIALS AND METHODS: Twenty-six patients with multiple maxillofacial fractures from 09/2017 to 03/2021 were retrospectively studied and divided according to surgical method into an experimental group (navigation-aided surgery combined with a 3D-printed guide) and a control group (navigation-aided surgery only). The surgical time was compared between the groups, and posttreatment computed tomography and follow-up visits were conducted at 1 week and 3 months, respectively, to compare the quality of treatment in terms of infection, occlusal disorder, restricted mouth opening, midline displacement, and bilateral asymmetry. RESULTS: According to our results, the combined use of CAN and 3D printing significantly improved the treatment results of double-sided maxillofacial fractures (rs = 0.448, P < 0.05). The surgical time of the experimental group was significantly shorter than that of the control group (Z = -2.083, P < 0.05). CONCLUSIONS: This study broadens our understanding of the treatment of multiple maxillofacial fractures. The combined use of 3D printing technology and CAN effectively shortened the operation time and achieved a better therapeutic effect.

Analysis of the disease constituent ratio and prognosis of patients undergoing ambulatory surgery in oral and maxillofacial medicine: A monocentric retrospective analysis of 427 patients.

BACKGROUND: Ambulatory surgery and single-visit surgery are becoming increasingly accepted and practiced. MATERIALS AND METHODS: The clinical data of patients undergoing ambulatory surgery were collected, and information on their chief complaint and basic information was specifically included. Follow-up phone calls were conducted 1 and 3 days, 1 and 2 weeks, and 1 month after treatment. Information on their recovery and well-being was collected. RESULTS: A total of 427 patients (males: 224, females: 203, average age: 23.07±11 years) were recruited for this study. A total of 43.55% of the patients chose ambulatory surgery. A total of 62.9% of them selected it for convenience, while 43.55% selected it for pain reduction. The top three diseases treated by ambulatory surgery were impacted teeth (56.7%), jaw cyst (14.75%) and supernumerary teeth (10.07%). Postoperative complications occurred in 248 of the 427 patients, with an incidence rate of 58.08%. The complication that occurred most frequently was postoperative pain (56.44%). Complications frequently occurred on Day 3 after the operation and resolved after 2 weeks. CONCLUSION: After being diagnosed, ambulatory surgery is an effective mode of treatment for oral and maxillofacial diseases. Oral hygiene, professional postoperative follow-up visits and rigorous anesthesia evaluation are very important for ambulatory surgery for oral and maxillofacial diseases.

Newly Developed Graft Failure Detected Using Computed Tomography Within 1 Year After Coronary Artery Bypass Grafting Surgery: One Single-Center Experience.

BACKGROUND: Newly developed graft failure negatively affects the short- and long-term outcomes of patients who experience coronary artery bypass grafting (CABG) surgery. This study explored the value of transit time flow measurement (TTFM) parameters for predicting the risk of newly developed graft failure that occurs within 1 year after CABG, as well as investigated the relationship between newly developed graft failure and adverse cardiovascular events. METHODS: A total of 134 patients who underwent CABG and had CT angiography (CTA) data (1 year post-operatively) were divided into two groups: the patient group, in which patients did not have newly developed graft failure, and the occluded group, in which patients developed newly developed graft failure between 1 and 12 months after CABG. The patency rate of grafts in different targets was analyzed. The correlations between graft failure and TTFM parameters and between graft failure and the occurrence of adverse cardiovascular events were investigated. RESULTS: The overall rate of newly developed graft failure was 7.2%, the venous graft failure was 10.8%, and the arterial graft failure was 0.7%. The occluded group had a higher pulse index (PI) (2.9 vs. 2.4, P = 0.007), a lower mean graft flow (MGF) (20 vs. 25 ml/min, P = 0.028), and a lower diastolic flow fraction (DF) (63.5 vs. 70%, P = 0.019) than the patent group. The cut-off value for predicting newly developed graft failure was PI > 2.75 (P = 0.007), MGF < 23.5 ml/min (P = 0.03), and DF < 65.5% (P = 0.019). Compared with the patent group, the newly developed graft failure group had higher rates of recurrent angina (13.6 vs. 0.9%, P = 0.0014) and revascularization intervention (9.1 vs. 0% P = 0.026). However, there were no differences in death, cardiac death, myocardial infarction, and cerebral infarction after CABG operation between these two groups (P > 0.05). CONCLUSIONS: A high PI and low MGF and DF are risk factors for newly developed graft failure. The patients with newly developed graft failure had higher rates of recurrent angina and revascularization intervention. TTFM parameters may be used to predict the occurrence of newly developed graft failure in patients after CABG surgery.

Angiotensin-converting enzyme 2 regulates autophagy in acute lung injury through AMPK/mTOR signaling.

Autophagy exerts a dual role in promoting cell death or survival. Recent studies have shown that it may play an important role in lipopolysaccharide (LPS)-induced acute lung injury (ALI). It was also suggested that angiotensin converting enzyme 2 (ACE2) may participate in the regulation of autophagy. The present study aims to investigate the role of autophagy in ALI and the involvement of ACE2. The regulation of the APMK/mTOR pathway was explored to clarify the underlying mechanism. The results showed that autophagy played an important role in ALI induced by LPS, as the autophagy inhibitor 3-methyladenine (3-MA) mitigated the severity of ALI. ACE2 activator resorcinolnaphthalein and inhibitor MLN-4760 significantly affected the histological appearance and wet/dry (W/D) ratio of the lung and altered the ACE2 activity of the lung, tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) levels in bronchoalveolar lavage fluid (BALF) and myeloperoxidase (MPO) levels in lung tissue. Furthermore, LPS, resorcinolnaphthalein and MLN-4760 significantly affected the expression of autophagy proteins Beclin-1, LC3-I and LC3-II. To explore the mechanism of ACE2 on lung autophagy, we measured the phosphorylation of AMPK/mTOR after mice were treated with LPS and resorcinolnaphthalein or MLN-4760. The results revealed that resorcinolnaphthalein and MLN-4760 both significantly altered the phosphorylation of AMPK/mTOR. Finally, we found that AMPK inhibitor (8-bAMP) and mTOR activator (propranolol) both abolished the effects of ACE2 activator (resorcinolnaphthalein) on the expression of lung autophagy proteins Beclin-1, LC3-I and LC3-II. In conclusion, these findings suggest that ACE2 could alleviate the severity of ALI, inflammation and autophagy in lung tissue through the AMPK/mTOR pathway.

Independent risk factors for hypoxemia after surgery for acute aortic dissection.

OBJECTIVES: To determine risk factors associated with postoperative hypoxemia after surgery for acute type A aortic dissection. METHODS: We retrospectively analyzed the clinical data of 192 patients with acute type A aortic dissection who underwent surgery in Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, China between January 2007 and December 2013. Patients were divided into hypoxemia group (n=55) [arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤ 200 mm Hg] and non-hypoxemia group (n=137) [PaO2/FiO2 > 200 mm Hg]. Perioperative clinical data were analyzed and compared between the 2 groups. RESULTS: The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.6% (55/192). Perioperative death occurred in 13 patients (6.8%). Multivariate regression identified body mass index (BMI) > 25 kg/m2 (OR=21.929, p=0.000), deep hypothermic circulatory arrest (DHCA) (OR=11.551, p=0.000), preoperative PaO2/FiO2 ≤ 300 mm Hg (OR=7.830, p=0.000) and blood transfusion > 6U in 24 hours postoperatively (OR=12.037, p=0.000) as independent predictors of postoperative hypoxemia for patients undergoing Stanford A aortic dissection surgery. CONCLUSION: Our study demonstrated that BMI > 25 kg/m2, DHCA, preoperative PaO2/FiO2 ≤ 300 mm Hg, and blood transfusion in 24 hours postoperatively > 6U were independent risk factors of the hypoxemia after acute type A aortic dissection aneurysm surgery.

Independent risk factors for ventilator-associated pneumonia after cardiac surgery.

OBJECTIVE: To investigate the related factors and pathogens of ventilator-associated pneumonia (VAP) after heart surgery so as to provide evidences for clinical prevention and therapy. METHODS: In total 1,688 cases were collected from January 2004 to January 2011. Overall 105 patients developed VAP. Retrospectively analyzed these patients after heart surgery to determine the clinical data, pathogens and treatment measures. RESULTS: The frequency of ventilator-associated pneumonia was 6.2% (105/1 688), and mortality was 25.7% (27/105), 198 pathogen strains were isolated by bacterial culture, in which Gram negative bacteria accounted for 69.2% (137/198), Gram positive bacteria 27.8% (55/198), and fungi 3.0% (6/198). The independent risk factors for VAP after cardiac surgery were: age >70 (p < .01), emergent surgery (p < .01), perioperative blood transfusions (p < 0.01), reintubation (p < .01) and days of mechanical ventilation (MV) (p < .01). Median length of stay in the ICU for patients who developed VAP or not was, respectively, (24.7 ± 4.5) days versus (3.2 ± 1.5) days (p < .05), and mortality was, respectively, 25.7% versus 2.9% in both populations (p < .05). CONCLUSION: Age >70, emergent surgery, perioperative blood transfusions, reintubation and days of MV are the risk factors for VAP in patients following cardiac surgery. P. aeruginosa, P. klebsiella, S. aureus, and Acinetobacter baumannii were the main pathogens of VAP. According to the cause of VAP, active prevention and treatment measures should be developed and applied to shorten the time of MV and improve chances of survival.

Perioperative levosimendan therapy is associated with a lower incidence of acute kidney injury after cardiac surgery: a meta-analysis.

OBJECTIVE: Levosimendan is a calcium sensitizer that enhances myocardial contractility without increasing myocardial oxygen use. Limited data are available on its renal-protective effect, and no statistically significant effects have been found. A meta-analysis was conducted for randomized studies to show whether perioperative levosimendan use could reduce acute kidney injury (AKI) in patients undergoing cardiac surgery. DATA SOURCES: BioMed Central, PubMed EMBASE, and the Cochrane Central Register of Controlled Trials were searched for pertinent studies. STUDY SELECTION: Randomized trials that compared levosimendan versus placebo or any other control in cardiac surgery with data on AKI were included. Exclusion criteria were duplicate publications, nonadult studies, oral administration of levosimendan, and studies with no data on AKI. DATA EXTRACTION: Study endpoints, study design, population, clinical setting, levosimendan dosage, and treatment duration were extracted. DATA SYNTHESIS: Data from 529 patients in 5 randomized trials were analyzed. The analysis showed that levosimendan decreased postoperative incidence of AKI in the levosimendan group. CONCLUSIONS: This analysis suggests that levosimendan might reduce renal injury in adult patients undergoing cardiac surgery. More prospective randomized studies are needed to further demonstrate the benefits of levosimendan on renal protection in cardiac surgery.

[Clinical analysis of 105 cases of ventilator-associated pneumonia after heart surgery].

OBJECTIVE: To investigate the related factors and pathogens of ventilator-associated pneumonia (VAP) after heart surgery. METHODS: VAP was diagnosed in 105 patients out of 1688 cases (6.2%) who underwent heart surgery in our department between January 2004 and January 2011. Clinical data, pathogens and treatments were analyzed. RESULTS: Incidence of VAP was 6.2% (105/1688), and 53.0% (105/198) in patients who required more than 48 hours of mechanical ventilation. One hundred and ninety-eight pathogen strains were isolated by bacterial culture, in which Gram negative bacteria accounted for 69.2% (137/198), Gram positive bacteria 27.8% (55/198), and fungi for 3.0% (6/198). Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus were the main pathogens of VAP. The independent risk factors for VAP were: age > 70 years, emergent surgery, perioperative transfusions, reintubation and days of mechanical ventilation (all P < 0.01). Median length of stay in the ICU for patients who developed VAP or not was (24.7 ± 4.5) days versus (3.2 ± 1.5) days, respectively (P < 0.05) and in-hospital mortality was 25.7% (27/105) versus 2.9% (46/1583) respectively (P < 0.05). CONCLUSIONS: Patients undergoing heart surgery have a high frequency of developing VAP, especially in patients that require more than 48 hours of mechanical ventilation. VAP is associated with high in-hospital mortality. Age > 70 years, emergent surgery, perioperative transfusions, reintubation and prolonged mechanical ventilation use are independent risk factors for VAP in patients following cardiac surgery. Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus are the main pathogens of VAP.

Effects of metallothionein on isolated rat heart.

To investigate the effects of metallothionein (MT) on isolated rat heart, 16 Wistar rats were randomly divided into 2 groups. In control group (group C), distilled water was injected intraperitoneally and 24 h later isolated hearts were perfused with Langendorff and stored at 4 degrees C for 3 h with histidine-tryptophan-ketoglutarate (HTK) solutions, and then isolated hearts were perfused for 2 h by Langendorff. In experimental group (group E), 3.6% ZnSO(4) was injected intraperitoneally, 24 h later isolated hearts were perfused by Langendorff and stored at 4 degrees C for 3 h with HTK solutions, and then the isolated hearts were perfused for 2 h with Langendorff. MT content, the recovery of hemodynamics, myocardial water content (MWC), lactate dehydrogenase (LDH) and creatine kinase (CK) leakage, adenosine triphosphate (ATP) and malondialdehyde (MDA) content, superoxide dismutase (SOD) activity, myocardial cell Ca(2+) content, Ca(2+)-ATPase activity of mitochondria ([Ca(2+)-ATPase](m)) and its Ca(2+) content ([Ca(2+)](m)), synthesizing ATP activity of mitochondria ([ATP](m)), and the ultrastructure of cells were examined. There were a significant increase in group E in hemodynamic recovery, ATP content, SOD activity, [Ca(2+)-ATPase](m) activity, [ATP](m) activity, and substantial reduction in MWC, LDH and CK leakage, MDA content, myocardial cell Ca(2+) content, [Ca(2+)](m) content, and the ultrastructural injury were obviously milder than that of group C. This study demonstrated that MT has protective effects on isolated rat heart.