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Objective@#To establish finite element models of skull, fronto-orbital advancement and fronto-orbital distraction osteogenesis of craniosynostosis, to analyze the mechanical characteristics of skull base and fronto-orbital operation area, so as to guide the later application of tractors.@*Methods@#One 6-year-old male patient with unilateral coronal synostosis was enrolled in October 2015. Three-dimensional (3D) computed tomography (CT) scan of skull was performed. DICOM data was imported into Mimics 17.0 for contour extraction and cranial 3D reconstruction. The skull model was processed by Mimics, Geomagic Studio 12.0, Hypermesh 12.0 and other software to establish a three-dimensional finite element model. The unilateral and bilateral fronto-orbital anterior osteotomy models were simulated respectively. The mechanical analysis was performed at point A in forehead area and point B in temporal area. Three different groups of traction forces were loaded: (1) 50 Newton for point A, 50 Newton for point B; (2) 80 Newton for point A and 50 Newton for point B; (3) 100 Newton for point A and 50 Newton for point B, to obtain the optimized traction force.@*Results@#Stress analysis was performed on established cranial finite element model, as well as unilateral and bilateral fronto-orbital advancement procedures. The stress distribution of the anterior and middle cranial fossae was found to be concentrated. After unilateral fronto-orbital advancement, the stress of anterior cranial fossa, especially the affected side, was decreased. The stress on both side in anterior cranial fossa was decreased after bilateral fronto-orbital advancement. After force was applied to point A and point B, the optimum deviation result at supraorbital notch point, midpoint of supraorbital margin, frontal temporal point and frontal zygomatic suture point in 3D (Deviation result of X value: -29.4%, -20.5%, -8.6%, -9.3%; Deviation result of Y value: 20.9%, 31.5%, 73.0%, 539.4%; Deviation result of Z value: 4.4%, 1.9%, 0.1%, 11.8%) demonstrated the application of traction force can inwardly, downwardly and forwardly move the bone flap. The optimized traction was 80 Newton at point A and 50 Newton at point B by preliminary assessment.@*Conclusions@#The finite element analysis of the fronto-orbital advancement can be used for more accurate preoperative simulation, to clarify the influence of fronto-orbital advancement on craniofacial morphology and development, as well as skull base. It also facilitates surgical decision and predicts the postoperative distraction vectors.
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Objective To measure the change of facial volume maintenance rate after autologous fat grafted for repaired progressive facial hemiatrophy by using three-dimensional digital technology.Methods 3D scanner was used to acquire facial data in 10 patients with progressive facial hemiatrophy before operation;Mimics 17.0 software was used to reconstruce patients' facial 3D model and to calculate the volume of facial tissue defect;autologous fat was grafted to repair facial deformity.The facial volume maintenance rate was calculated in all the patients 3 months and 6 months after operation.Results We had performed facial 3D data acquisition and facial repaired with autologus fat grafted in 10 patients;patients' facial morphology was improved.The mean facial volume maintenance rate was (35.80±3.44)％ in 3 months and (27.82±3.80)％ 6 months after surgery.Conclusions The mean facial volume maintenance rate in postoperative 3 months is inferior to that in 6 months in single autologous fat grafted for repairing progressive facial hemiatrophy.
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Objective@#The purpose of this study was to explore the surgery-first approach in sequential combined orthodontic-orthognathic treatment to shorten total treatment duration and improve the clinical outcome.@*Methods@#This study included 185 patients with Angle classⅢ malocclusion. The patients were divided into 3 different types according to cephalometry analyses and facial features. ①Type Ⅰ: mandibular prognathism or asymmetry mandibular prognathism; ②Type Ⅱ: mandibular prognathism and maxillary retrusion; ③ Type Ⅲ: mild Angle′s Class Ⅲ malocclusion, cross bite in anterior teeth, or normal overlap and overbite relation with midfacial hypoplasia. All of patients received surgery first approach therapy. The surgical procedures were chosen according to different malformation types. Type Ⅰ was treated with the sagittal split ramus osteotomy (SSRO). Type Ⅱ was treated by Le Fort Ⅰmaxillary osteotomy combined with SSRO. Type Ⅲ underwent anterior subapical osteotomy combined pyriform aperture augmentation with biomaterials as well as maxillary anterior orthodontics. All patients received postoperative rapid orthodontic treatment for 6-12 month after 2 weeks of operation. Using the straight arch wire techniques and the class Ⅲ intermaxillary traction, we removed the overcrowding upper and lower teeth, the compensatory axial tilt of teeth, and the deviation of the dental arch and maintained the neutral relationship of the molar. The mandible Hawley retaining devices were used during the maintaining stage.@*Results@#The cases in study acquired satisfactory clinical outcome, which included the shortened overall treatment duration, the significantly improved facial features, the corrected occlusion relationship, and the restored function of mastication and temporomandibular joint. There were some complications as follows: intraoperative fracture (6 cases, 3.24%), the inferior alveolar nerve bundle injury (2 cases, 1.1%), and temporary open-bite that diminished by inter-maxillary elastic distraction one month after operation (19 cases, 10%). All cases in this study accepted postoperative orthodontic treatment. Follow-up time ranged from 6 months to 5 years. The cephalometric analysis results of 126 cases who had complete image data and over 6 months of follow-up showed that hard and soft tissue indexes were restored to normal range after combined orthognathic-orthodontic treatment. The stability of the maxillary and occlusive relationship of SFA(surgery-first approach) was similar to that of the COS(conventional orthodontics-first system) [relapse ratio=(T2-T1)/(T1-T0)×100%]. Over six months of follow-up , SNB and ANB showed that the average relapse ratio were 22% and 19.8%, whereas the relapse angle are less than 2°.@*Conclusions@#The Surgery-first approach could be used to treat most patients with Angle skeletal Class Ⅲ malocclusion, but the indications and the surgical procedures should be noticed and chosen.
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Objective@#Explore the method for volumetric measurement of alveolar bone defect.@*Methods@#This study applied 2 advanced preoperative volume measurement methods: three-dimensional (3D) printing and computer-aided engineering (CAE). Twenty-six unilateral alveolar cleft patients were enrolled in this study from April 2015 to December 2016. Their computed tomographic data were sent to 3D printing and CAE software. A simulated graft was used on the 3D-printed model, and the graft volume was measured by water displacement. The volume calculated by CAE software used mirror-reverses technique.@*Results@#The volume of alveolar bone defect could be detected by both methods. The average volume of the simulated bone grafts by 3D-printed models was 1.61 ml, a little higher than the mean volume of 1.60 ml calculated by CAE software. The difference between the 2 volumes was from -0.34 ml to 0.54 ml. The paired Student t test showed no statistically significant difference between the volumes derived from the 2 methods.@*Conclusions@#This study demonstrated that the volume of alveolar bone defect is about 1.6ml in unilateral alveolar cleft patients aged 9-12 years. The mirror-reversed technique by CAE software is as accurate as the simulated operation on 3D-printed models. These findings further validate the use of 3D printing and CAE technique in alveolar defect repairing.
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Objective@#This study is to manufacture the templates for costal cartilage carving, by digital simulation and three-dimensional printing technology, to realize the individualization of rhinoplasty.@*Methods@#Preoperative simulated images and 6-month postoperative images, of 10 patients were included in this study. The simulation was produced using Geomagic Studio 2013 and 3-matic Research 9.0 software, according to patients′requirements. The templates for costal cartilage carving during the operation, were designed, measured and three-dimensional printed. Statistical analyses were performed using paired t-test.@*Results@#The dorsal length in preoperative simulation was significantly shortened, compared with postoperative [(4.73±0.11) cm vs. (4.88±0.16) cm, t=-0.465, P=0.001). The nasal tip projection in preoperative simulation is parallel with postoperative[(2.66±0.10) cm vs. (2.66±0.11) cm, t=0.068, P=0.947). The nasolabial angle in preoperative simulation is slightly greater than postoperative, yet failed to reach statistical significance (95.3±3.1 degrees vs. 94.3±3.0 degrees, t=1.936, P=0.085). Most of the patients were satisfied with both the preoperative simulation and the surgical outcomes.@*Conclusions@#With the assistance of digital simulation and three-dimensional printing technology, the expectation of rhinoplasty patients can be visualized, which is helpful to minimize the difference between surgical outcomes and the patient′s anticipation. Therefore, the digital simulation and three-dimensional printing technology should be considered, to provide individually surgical plan for this group of patients.
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Objective@#To assess the surgical outcome of fronto-orbital advancement (FOA)in the patients with craniosynostosis by quantitative analysis of the cranial volume using the three-dimensional digital technology.@*Methods@#From January 2010 to February 2016, 10 cases of craniosynostosis were included in the study. The average age of patients was 3.2 years (1 year old to 6.5 years old). All patients underwent modified FOA.Based on the uncompressed digital imaging and communications in medicine (DICOM) data of 3D cranial CT scan, the intracranial volume was measured by Proplan CMF 1.4.The average follow-up time was 23.6 months. We quantitatively analysed brain volume in ten patients with craniosynostosis, comparing with the normal data of age- and sex-matched healthy controls. Paired t tests were performed to compare mean value of the variables.@*Results@#The volume of intracranial cavity was(1 117.39 ± 105.83) ml before surgery and the preoperative volume of intracranial cavity in the control group was (1 251.37 ± 114.35) ml. The difference between the preoperative group and the preoperative control group was statistically significant(P=0.00030). The volume of intracranial cavity was (1 260.84 ± 122.08) ml after surgery. The volume was increased significantly after surgery(P=0.00002). There was no significant difference between the postoperative group and the preoperative control group(P=0.60000). The volume of intracranial cavity was (1 368.65 ± 94) ml at least one year follow-up and the cranial volume of the control group was (1 321.96 ± 80.21) ml. There was no statistically significant difference between the two groups(P=0.07000). There were statistically significant differences between the cranial volume at two weeks after operation and that of one year follow-up (P=0.00300). This result showed that the cranial vault and brain of patients grew and developed normally after FOA surgery.@*Conclusions@#Preoperative cerebral volume in the patients with craniosynostosis was lower than normal. The cranial volume has been effectively expanded and basically reached the normal level after fronto-orbital advancement. Especially, the intracranial volume maintained normal during follow-up.
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Objective To explore the present human resources and problems at community health centers in Shandong province .Methods PPS sampling method was used to extract data of 333 community health centers in 17 cities in Shandong province in 2015 .Then the human resource status was analyzed and evaluated by descriptive research indexes .Results Data showed that 333 community health centers had 19809 employees ,and 12271 of them having staffing quota. These employees include 6355 physicians ,5169 nurses ,and 3064 medical and pharmaceutical technicians .For the physicians ,4841 of them are medical practitioners ,1313 were assistant medical practitioners ,while the numbers of obstetricians and gynecologists ,general practitioners ,and TCM practitioners were 756 , 2124 and 432 respectively .Conclusions These community health service centers are faced with such problems as lack of human resources ,irrational personnel makeup ,and obvious shortage of public health ,general practitioners and medical/pharmaceutical professionals. It is recommended to increase and optimize manpower by means of motivating existing personnel ,introducing new manpower and training opportunities for the retention.Medical alliances are expected to encourage more high-end professionals to the primary institutions .
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Objective To investigate the deformity of cranial base in patients with craniosynostosis and to evaluate the effect of modified fronto-orbital advancement (FOA) for craniosynostosis using three-dimensional digital technology.Methods From January 2010 to December 2016,10 cases of craniosynostosis were included in the study.All patients underwent modified FOA,we quantitatively analysed the pre-operative deformity and the surgical outcome of FOA performed in ten patients with craniosynostosis.The measurements of skull base were performed based on 3D computed tomography (CT) scan.We assessed the symmetry of skull base and the deflection of anterior cranial fossa.Results The mean patients' age at FOAs was 3.2 years.A significant asymmetry of skull base was found in all patients.The growth of anterior and middle fossae was restricted.On the follow-up CT images 23.6 months after surgery,there was prominent change (P＜0.05) between the two hemibases (CSO(-)ratio) and between the lengths and angles of anterior and middle cranial hemi-fossae (CX,CSX(-),XSM(-) ratio).Anterior cranial vault asymmetry index obviously decreased from 12.4％ to 1.05％ before surgery (P＜0.05).In addition,anterior cranial vault deflection angle proved to also be less after surgical correction (20.33°±9.19° versus 13.13°±5.28°,P＜0.05).Conclusions The asymmetry of skull base can be presented by intracranial view at over 1 year of age.FOA can correct the skeletal malformation of frontotemporal region and the asymmetry of skull base is improved after surgical treatment.
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Objective To explore the feasibility of treating the microtia aided with the digital technology,harvesting the rib cartilage precisely,and carving fabric the ear framework in more details.Methods From July 2015 to January 2017,22 microtia patients accepted clinical therapy aided with digital technology.Preoperatively,the three-dimensional model of the costal cartilage and ear were made to design the cartilage scaffold fabrication.After the operation,the difference of the three dimensional morphology between the reconstructed ear and the normal ear was measured by digital technology.Results With average 7 months follow up,19 cases were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance.The outcomes were acceptable in 3 cases.There were no postoperative complications related to chest wall deformity or affected normal physical function.Conclusions Digital technology can achieve accurate harvesting and reasonable utilization of autogenous rib cartilage,provide accurate guidance for the sculpture of auricle scaffold and objective evaluation for the three-dimensional structure of the reconstructed ear.
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Objective@#To invesigate the therapeutic effect of anterior subapical osteotomy combined with postoperative orthodontic treatment for bimaxillary protrusion based on surgery-first approach(SFA).@*Methods@#From April 2015 to April 2016, 22 adult patients with bimaxillary protrusion were treated with bimaxillary anterior subapical osteotomy without peroperative orthodontic treatment. Digital computer-aided technology was used for preoperative design and dental model simulation surgery. Then the occlusal guide plate was made for intraoperative built-up of temporary occlusion. Two weeks after orthognathic surgery, a short-term orthodontic treatment was carried out to improve the occlusion. Cephalometric analysis was done to evaluate the treatment effects. 19 cephalometric parameters about hard and soft tissues were measured and compared in all cases before and after SFA combined treatments. All data were statistically analyzed by SPSS software package.@*Results@#Primary healing was achieved in all the 22 cases without any infection or necrosis of bone and dental pulp. During the follow-up period of 6-12 months, all the patients were satisfied with the profile contour. The cephalometric parameters of hard and soft tissues changed remarkably. U1E-McN and L1E-McN set back (-10.5±4.9) mm and (-8.0± 6.9) mm respectively. Upper and lower lip set back obviously. SNA decreased from (82.5±2.8) to (77.9±2.3) degrees on average. SNB decreased from (79.1±5.4) to (74.6±3.8) degrees on average. Upper and lower lip protrusion decreased obviously. TUL-E line decreased from the mean value of (2.7±2.7) mm to (0.5±3.2) mm and TLL-E line from (5.2±4.0) mm to (1.4±2.7) mm. The aesthetic contours were remarkably improved.@*Conclusions@#Anterior subapical osteotomy combined with postoperative orthodontic treatment based on SFA could correct adult bimaxillary protrusion effectively with normal occlusion, satisfactory soft tissue aesthetic profile.
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Abstract BACKGROUND: As an emerging technology, tissue-engineered skin has great application prospects. Keratinocyte growth factor (KGF) is proved to promote the proliferation of epidermal cels. OBJECTIVE: To evaluate the effect and characteristics of tissue-engineered skin carrying KGF nanocapsules in repairing skin defects of nude mice. METHODS:(1) The acelular dermal matrix loading KGF (KGF-ADM) was constructed. The human epidermal stem cel population and fibroblasts were captured and cultivated, and then identified. Epidermal stem cels were cultivated on the KGF-ADM and their growth was observed. The tissue-engineered skin loading KGF nanocapsules was transplanted onto the ful-skin defects on the back of nude mice compared with a blank group without keratinocyte growth factor nanocapsules and a control group with skin autograft. In 2, 4 and 6 weeks after transplantation, the contraction and histological healing of the skin were observed respectively. Then anti-human keratin 10-FITC and β1-integrin-Cy3 immunofluorescence were applied to detect the origin, growth and differentiation of stem cels in the epidermis and dermis. RESULTS AND CONCLUSION: The epidermal stem cel population grew wel on the surface of KGF-ADM and attached tightly. There were smal round epidermal stem cels and polygonal terminaly-differentiated cels, which presented with partly cloning growth and a tendency of merging into pieces. The results of tissue-engineered skin with KGF nanocapsules in repairing the skin defects were better than those of the blank group and the control group in 2, 4 and 6 weeks after transplantation. The transplanted skin could fuse with adjacent skin completely, but stil showed some contraction. Under the microscope, they showed good epidermis with layers and normal keratose stratum, and meanwhile, there were stil some β1-integrin+ cels at 8 and 10 weeks, which were epidermal stem cels or transient amplifying cels identified by immunofluorescence. These findings indicate that the tissue-engineered skin carrying KGF nanocapsules has good outcomes in repairing skin defects of nude mice, which is better than common tissue-engineered skin without KGF nanocapsules and autogeneous skin transplantation.
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BACKGROUND:The proliferation and differentiation of hair-folicle-generating stem cels are influenced by the joint action of their own genes and external signals. Wnt/β-catenin signaling pathway plays an important role in the development of hair folicles, but the detailed mechanisms are not yet clear. OBJECTIVE:To investigate, with interruption of keratinocyte growth factor and lithium chloride, the function and the interrelationship of Wnt/β-catenin signaling pathway with other signal factors when human hair-folicle-generating stem cels differentiate into dermal papila cels or epidermal cels. METHODS: Hair-folicle-generating stem cels were isolated from the bulge and cultivated. Then the growth curve of hair-folicle-generating stem cels was tested and formed in order to observe the cellproliferation ability cultivated at different densities (1×106/L, 1×107/L, 1×108/L, 1×109/L) at each time. Immunoflurorescene staining was performed to identify hair-folicle-generating stem cels and their differentiated cels. Lithium chloride (0, 0.5, 1.5, 10, 25 mmol/L individualy) and keratinocyte growth factor(0, 10, 25, 50, 100 μg/L individualy) were used to induce the differentiation of hair-folicle-generating stem cels. Then, we contrasted and analyzed the proliferation ability in each case, thereby investigating the most appropriate concentration of keratinocyte growth factor and lithium chloride to spur the differentiation of hair-folicle-generating stem cels. At days 3, 5, 7 and 9, we tested and compared the mRNA expressions of β-catenin, APC, GSK-3β, Axin and Lef1 from cels in control group, 10 mmol/L lithium chloride group and 10 μg/L keratinocyte growth factor group. RESULTS AND CONCLUSION:Isolating cultured hair-folicle-generating stem cels stil had a great reproductive activity and multi-lineage potential even after various times subculturein vitro. With higher lithium chloride concentration, the proliferation ability of hair-folicle-generating stem cels declined; while it increased when keratinocyte growth factor concentration increased. In K-SFM medium which contained lithium chloride, the transformation of hair-folicle-generating stem cels was obvious, showing distinct differences among groups. Especialy, the level ofβ-catenin reached the peak when lithium chloride > 10 mmol/L. However, in K-SFM medium which contained keratinocyte growth factor, hair-folicle-generating stem cels differentiated into epidermal cels and the level of β-catenin changed slightly. We found that, while spurring the differentiation of hair-folicle-generating stem cels, lithium chloride could activate Wnt/β-catenin signal pathway and inhibit GSK-3β, a vital component of degradation compound. This facilitated β-catenin expressing in the cytoplasm to translocate into the nucleus. As a result, the transcription of target gene increased. It is the most appropriate concentration to spur hair-folicle-generating stem cels differentiation when lithium chloride level is > 10 mmol/L, but the proliferation ability declines correspondingly. Keratinocyte growth factor, which can facilitate hair-folicle-generating stem cels differentiated into epidermal cels, is a key factor to accelerate proliferation ability and migration of hair-folicle-generating stem cels, re-epithelialization and healing of wound. The mechanisms of hair-folicle-generating stem cels oriented differentiation induced by lithium chloride and keratinocyte growth factor are activating Wnt/β-catenin signal pathway, inducing change of β-catenin expression, and activating the transcription of target gene related to Wnt/β-catenin signaling pathway .