Prognostic analysis of oral cancer based on deep learning / 口腔疾病防治

@#TNM（tumor node metastasis）classification is a common way to evaluate the prognosis of patients with oral cancer; however, many years of application have proven this method to be confined merely in clinical and pathological data and it cannot be adapted to the development of modern medicine. Deep learning (DL) has been widely used in various aspects of human life, has advantages for conducting efficient and intelligent searches and can explore and analyze substantial medical information well. Additionally, the application of DL to medical practice is quickly increasing. In the field of oral cancer prognosis, DL can efficiently process and analyze the pathological, radiographic and molecular data of oral cancer patients represented by lymphocytes, gray level cooccurrence matrix (GLCM) and gene maps and make accurate prognostic judgments accordingly. By assisting physicians in optimizing treatment plans, DL can effectively improve patients’ survival. Although DL lacks sufficient data and practical clinical application in prognostic studies, it has shown good clinical application prospects.

Hand-sewn expanded polytetrafluoroethylene valved conduit for right ventricular outflow tract reconstruction / 中南大学学报(医学版)

OBJECTIVES@#Due to the lack of large-sized pulmonary valved conduit products in clinical practice, hand-sewn expanded polytetrafluoroethylene (ePTFE) valved conduit has been used for right ventricular outflow tract (RVOT) reconstruction in many heart centers around the world. This study aims to summarize the early results of the ePTFE valved conduit and the sewing technology of the conduit in combination with the latest progress, and to provide a reference for the application of ePTFE valved conduit.@*METHODS@#A total of 21 patients using ePTFE valved conduit for RVOT reconstruction in the Second Xiangya Hospital, Central South University from October 2018 to October 2020 were prospectively enrolled in this study. The age at the implantation of the conduit was 4.3 to 43.8 (median 15.1) years old, with weight of (38.9±4.1) kg. In this cohort, 14 patients underwent re-reconstruction of RVOT, including 12 patients with pulmonary regurgitation at 6.3 to 31.0 (median 13.8) years after tetralogy of Fallot (TOF) repair, and 2 patients with failed bovine jugular vein conduit (BJVC). Seven patients underwent Ross operations. Among them, 3 were for aortic valve stenosis, 2 were for aortic regurgitation, and 2 were for both stenosis and regurgitation. The ePTFE valved conduits were standard hand-sewn during the surgery. The 3 leaflets were equal in size with arc-shaped lower edge of the valve sinus. The free edge of the valve leaflets was straight with the length of about 1 mm longer than the diameter. The height of the valve sinus was 4/5 of the diameter. The junction of the valve leaflet was 3/4 of the height of the sinus. The designed leaflets were then continuous non-penetrating sutured into the inner surface of Gore-Tex vessel to make a valved conduit. Valved conduits with diameter of 18, 20, and 22 mm were used in 2, 9, and 10 cases, respectively. The surgical results, postoperative recovery time, and serious complications were summarized, and the changes of postoperative cardiac function status and hemodynamic status of the conduits were investigated.@*RESULTS@#During the implantation of ePTFE valved conduit for RVOT reconstruction, 2 patients underwent mechanical mitral valve replacement with Ross operation, 2 patients with pulmonary regurgitation with repaired TOF underwent left and right pulmonary artery angioplasty, and 1 patient with failed BJVC underwent tricuspid valvuloplasty. The cardiopulmonary bypassing time for patients underwent re-reconstruction of RVOT was (130.9±16.9) min, with aorta clamping for 1 patient to repair the residual defect of the ventricular septum. The cardiopulmonary bypassing and aorta clamping time for Ross operation were (242.7±20.6) min and (145.6±10.5) min, respectively. The duration of postoperative ventilator assistance, intensive care unit stay, and hospital stay were 3.5 h to 7.7 d (median 17.1 h),11.2 h to 29.5 d (median 1.9 d), and 6.0 to 56.0 (median 13.0) d, respectively. All patients survived after discharge from hospital. The follow-up rate after discharge was 100% with median time at 15.0 (13.0 to 39.0) months. No death happened during the follow-up. One patient underwent stent implantation due to right coronary stenosis 2 months after Ross operation. One patient underwent balloon dilation due to right pulmonary artery ostium stenosis 1 year after re-reconstruction of RVOT. The cardiac function of all patients recovered to NYHA class I 6 months after operation. The peak pressure gradient across the valve measured by transthoracic echocardiography before discharge was (9.4±2.6) mmHg (1 mmHg=0.133 kPa), and (18.3±6.1) mmHg at the last follow-up. There was no significant increase in the gradient during the follow-up (P=0.134). No patient suffered from mild or more pulmonary regurgitation.@*CONCLUSIONS@#Hand-sewn ePTFE valved conduit is feasible for RVOT reconstruction. It is a promising material for RVOT reconstruction which can effectively meet clinical need. In our experience, the ePTFE valved conduit is simple to manufacture with satisfactory early outcomes.In the application of ePTFE valved conduit, attention should be paid to implantation indications and postoperative anticoagulation management, especially to the preparation details of the valved conduit, to obtain better function and durability of the conduit after implantation.

Clinical factors affecting the early postoperative prognosis of infants suffering surgery for congenital heart diseases: A single-center experience of 511 patients / 中南大学学报(医学版)

OBJECTIVES@#The integrated model of prenatal diagnosis and postnatal treatment for congenital heart disease (CHD) leads to an increasing number of operation in infants. This study aims to reveal the risk factors for postoperative early mortality and delayed recovery in infants less than 3 months old, who underwent surgical treatment for CHD in the Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University during the past 5 years.@*METHODS@#Clinical variables were collected via medical records. Delayed recovery was defined as the time of postoperative intubation, or cardiac intensive cure unit (CICU) stay, or hospital stay longer than its third quartile. Risk factors for early postoperative prognosis and the odds ratio (OR) were analyzed with logistic regression analysis.@*RESULTS@#A total of 511 infants underwent surgical treatment for CHD from January 2016 to June 2020 were retrospectively reviewed, including 217 (42.5%) infants with complex CHD. The median age was 60 days (3 hours-90 days); and median weight was 4.5 (1.7- 8.4 kg). There were 26 postoperative mortalities, making the incidence at 5.1%, including 5 (5/294, 0.7%) mortalities in patients with uncomplicated CHD, and 21 (9.6%) mortalities in patients with complex CHD. Based on multivariable analysis, risk factors for postoperative mortality were diagnosis of complex CHD (OR=5.53, P<0.001), weight under 4.0 kg (OR=9.86, P<0.001), preoperative symptoms (OR=3.17, P=0.012), and emergency operation (OR=11.66, P<0.001). The median time for postoperative intubation, CICU stay, and hospital stay were 21.0 (0.3-979.0) hours, 3.0 (0.5-91.0) days, and 11.5 (3.0-105.0) days, respectively. A total of 177 (34.6%) infants delayed recover, with risk factors including diagnosis of complex CHD (OR=3.41, P=0.001), weight under 4.0 kg (OR=4.55, P<0.001), and preoperative symptoms (OR=3.91, P<0.001).@*CONCLUSIONS@#Surgical treatment for infants (<3 months) with CHD is still a challenge, particularly for infants with complex CHD and weight under 4.0 kg. We can improve the prognosis of CHD treatment in infants by establishing the integrated model of prenatal diagnosis and postnatal treatment to choose the most suitable time window, avoid symptoms before surgery, and reduce emergency operation.

Re-cognition of chronic obstructive diseases of the parotid gland / 口腔疾病防治

@#Chronic obstructive diseases of the parotid gland are common clinically, with repeated swelling and a prolonged course and poor treatment outcomes. Based on the summarization of clinical practice and related literature, from the viewpoint of etiology, parotid obstructive diseases can be classified as mechanical obstructions, specific obstructions and non-specific obstructions. The principles of fluid mechanics are introduced to explain the formation of parotid obstructions. According to the different causes, the methods of changing the flow pattern of saliva in the parotid to reduce the resistance and relieve the obstruction, are proposed, such as mechanical factors removals, application of drugs that promote saliva secretion and lower saliva viscosity, ductal expansion under endoscopy and stent placement, and embolization of collateral ducts. These managements can effectively increase the salivary flow rate, reduce the occurrence of the saliva stranded and parotid gland obstructions.

Modern therapeutic strategies for submandibular lithiasis / 口腔疾病防治

@#Most salivary gland stones involve the submandibular gland, which often cause recurrent swelling and pain of the glands after meals, and used to be the main reasons for the gland removals. With the trend of minimally invasive treatment, gland preservation and functional recovery in the diagnosis and the treatment of submandibular lithiasis have been paid more and more attention. New equipment and technologies such as CBCT and sialendoscopy, which are widely used in clinical practice, have contributed a lot to the accurate orientation and minimally invasive treatment of stones, and enriched the managements of submandibular lithiasis. Based on our experience and the review of relevant literature, this paper attempts to summarize the treatment strategies for submandibular stones distributed in different parts of the duct: ① emphasizing on the integrity and functions of the organ; ② endoscopy and minimal invasiveness come first; ③ scientific classifications and personal managements. Appropriate treatment options should be selected according to the features of the stones: endoscopic lithotomy helps a lot in removing those located in the anterior or middle part of the duct; endoscopic lithotomy or/and sialolithotomy are needed according to the features of hilar stones; the regular follow-up is required for the intraglandular stones. Meanwhile, the evaluation of the gland function is also important. After the removals of sunmandibular stones, the functions of the glands should be promoted to restore as far as possible.

Expert consensus on marsupialization of cystic lesions of the jaw / 口腔疾病防治

@#Marsupialization is effective in the treatment of cystic lesions of the jaw. It is a simple operation that can result in minimal trauma, the reduction of postoperative recurrence, and maximum preservation of the surrounding tissue structure and function. However, there is a certain failure rate in clinical treatment due to the improper grasp of indications and nonstandard operation. The highest failure rate reported in the literature is 32.6%. To further standardize the clinical application of marsupialization and improve the success rate of treatment, we put forward an expert consensus of marsupialization in the treatment of jaw cystic lesions by reviewing the domestic and foreign literature and summarizing the experience in marsupialization from some famous domestic experts. In this consensus, we propose three elements of marsupialization: the establishment of the opening, the maintenance of cyst plugs and regular washing. The scope of application of marsupialization includes jaw cysts and cystic ameloblastomas. It is necessary to standardize the position of the opening, the size of the opening and the manufacture of the cyst plug, and a panoramic film or cone beam computed tomography(CBCT) should be used to observe the changes in the cystic cavity before and after operation. A second-stage operation should be performed when the lesion is significantly reduced by more than 50% or at least 5 mm from important structures; furthermore, the teeth of focus should be treated according to the relationship between the lesion and tooth and the type of tooth.

Regulation of β-mercuryl alcohol metabolic flow in Saccharomyces cerevisiae cells / 中国中药杂志

In this study, citrate synthase gene(CIT2), and malate synthase gene(MLS1) were successfully knocked out in β-amyrin-producing yeast cells by using CRISPR/CAS9. The promoter of phosphoglucose isomerase gene(PGI1) was replaced by that of cytochrome c oxidase subunit Ⅶa(Cox9)to weaken its expression, aiming to channel more carbon flux into the NADPH-producing pathway. The fermentation results showed that CIT2 deletion had no effect on the β-amyrin production. Compared with the control strain, the production of β-amyrin was increased by 1.85 times after deleting MLS1, reaching into 3.3 mg·L~(-1). By replacing the promoter of PGI1, the β-amyrin yield was 3.75 times higher than that of the control strain, reaching up to 6.7 mg·L~(-1). This study successfully knocked out the CITT2 and MLS1 genes and weakened the PGI1 gene by using CRISPR/CAS9, which directly influenced the production of β-amyrin and provided some reference for the the metabolic engineering of triterpernoid producing strain.

Effect of gender factor on sufentanil-induced inhibition of responses to endotracheal intubation when combined with dexmedetomidine / 中华麻醉学杂志

Objective:To evaluate the effect of gender factor on sufentanil-induced inhibition of responses to endotracheal intubation when combined with dexmedetomidine.Methods:American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-64 yr, with body mass index <30 kg/m 2, undergoing elective surgery under general anesthesia requiring tracheal intubation, were divided into 2 groups according to gender: male group (group M) and female group (group F). Dexmedetomidine 0.4 μg/kg was intravenously infused over 5 min, and 10 min later propofol 3 μg/ml and sufentanil were given by target-controlled infusion.In the two groups, the initial target concentration of sufentanil was set at 0.35 ng/ml in the first case, the target concentration of sufentanil in the next case was determined according to whether responses to endotracheal intubation occurred, and the ratio between the two consecutive target concentrations was 1.2.The median effective concentration (EC 50) and 95% confidence interval (CI) of sufentanil inhibiting responses to endotracheal intubation were determined by Dixon′s up and down sequential trial. Results:There were 26 cases in group M and 28 cases in group F. The EC 50 (95% CI) of sufentanil was 0.264 0 (0.240 9-0.289 3) ng/ml in group M. The EC 50 (95% CI) of sufentanil was 0.158 9 (0.138 2-0.182 6) ng/ml in group F. The EC 50 of sufentanil was significantly lower in group F than in group M ( P<0.05). Conclusion:Gender-related differences exist in sufentanil-induced inhibition of responses to endotracheal intubation when combined with dexmedetomidine.

Analysis of Flavonoid Content and Key Gene Expressions in Sprout and Seedling of Tartary Buckwheat / 中国实验方剂学杂志

Objective:To reveal the dynamic changes of flavonoids secondary metabolites and relevant genes expressions in the process of germination of tartary buckwheat seeds by investigating the content of catechins，epicatechins，rutin，and quercetin，and the expressions of their relevant genes in tartary buckwheat sprouts and seedlings，in order to provide scientific basis for the selection of high-quality, high-nutrition tartary buckwheat sprouts.Method:Contents of catechin，epicatechin，rutin，and quercetin in tartary buckwheat sprouts and seedlings were detected by UPLC-ESI-QQQ-MS，and the expression levels of genes relating to flavonoids synthesis in tartary buckwheat sprouts and seedlings were detected by real-time quantitative PCR.Result:There were differences between tartary buckwheat sprouts and seedlings in the relative contents of catechin，epicatechin，rutin and quercetin，as well as the expressions of relevant genes in the synthesis pathway, including FtPAL，FtC4H，Ft4CL，FtCHS，FtCHI，FtF3H，FtF3'H，FtFLS，FtDFR，FtLAR，FtANS，FtANR. The contents of flavonoids and the expressions of relevant genes in tartary buckwheat sprouts were higher than those in tartary buckwheat seedlings.Conclusion:The higher accumulation of secondary metabolites and flavonoids in tartary buckwheat sprouts may be related to tartary buckwheat seeds' resistance to the external environment in the initial growth stage of germination. From the perspective of application，there are more flavonoids in tartary buckwheat sprouts than in tartary buckwheat seedlings, indicating that tartary buckwheat sprouts have a higher nutritional value.

Logic and clinical significance of the new WHO classification of ameloblastoma in 2017 / 口腔疾病防治

@#A substantial revision of the classification of ameloblastoma was made by the World Health Organization (WHO) in the fourth edition of the Classification of Head and Neck Tumors in 2017, which was based on the review and summary of much clinical research data and prospective evaluation of the latest results of genetic research. The new classification is simpler and more practical. It retains two subtypes, the unicystic type and extraosseous/peripheral type, classifies the remaining types as ameloblastoma (classic), defines metastatic ameloblastoma as a benign tumor and simplifies the classification of ameloblastic carcinoma, which has important guiding significance for clinical diagnosis and treatment. Moreover, the new classification included the latest advances in the genetic research on ameloblastoma, demonstrating that the BRAF gene mutation was found in approximately 60% of ameloblastoma cases. The classification provides a new concept and direction for studying the pathogenesis of ameloblastoma, and BRAF-targeted therapy may be an emerging therapy for some ameloblastoma patients with multiple recurrence or surgical contraindications. This article analyzes the intrinsic logic of these changes via a review of the relevant literature and combination of clinical experiences to better understand the new classification. In 2017, the WHO′s new classification of ameloblastoma summarized the experience and achievements in histopathology and clinical treatment of ameloblastoma in the prior 10 years, indicating that BRAF-targeted treatment may bring new treatment options and hope for patients with recurrent or inoperable ameloblastoma.

Study of heterologous efficient synthesis of β-amyrin and high-density fermentation / 中国中药杂志

In this study, the synthetic pathway of β-amyrin was constructed in the pre-constructed Saccharomyces cerevisiae chassis strain Y0 by introducing β-amyrin synthase from Glycyrrhiza uralensis, resulting strain Y1-C20-6, which successfully produced β-amyrin up to 5.97 mg·L~(-1). Then, the mevalonate pyrophosphate decarboxylase gene(ERG19), mevalonate kinase gene(ERG12), 3-hydroxy-3-methylglutaryl-CoA synthase gene(ERG13), phosphomevalonate kinase gene(ERG8) and IPP isomerase gene(IDI1)were overexpressed to promoted the metabolic fluxto the direction of β-amyrin synthesis for further improving β-amyrin production, resulting the strain Y2-C2-4 which produced β-amyrin of 10.3 mg·L~(-1)under the shake flask fermentation condition. This is 100% higher than that of strain Y1-C20-6, illustrating the positive effect of the metabolic engineering strategy applied in this study. The titer of β-amyrin was further improved up to 157.4 mg·L~(-1) in the fed-batch fermentation, which was almost 26 fold of that produced by strain Y1-C20-6. This study not only laid the foundation for the biosynthesis of β-amyrin but also provided a favorable chassis strain for elucidation of cytochrome oxidases and glycosyltransferases of β-amyrin-based triterpenoids.

Evolution of diagnostic criteria for Sjögren′s Syndrome / 口腔疾病防治

@#Sjögren′s syndrome lacks a single and objective diagnostic index, and its diagnosis often requires comprehensive analysis according to classification criteria. With increasing research and a deepening understanding of the disease, the classification criteria are constantly being adjusted and revised. The sensitivity and specificity of the diagnosis have gradually improved, which has the value of diagnostic criteria largely. Since 1965, more than ten diagnostic criterias for Sjögren′s syndrome have been published. After debate and experience, international criteria with wide applicability have gradually replaced regional criteria. In the evolution of the diagnostic criteria, the diagnostic rules and evaluation methods have become more concise and unified. Techniques with poor specificity and operative difficulty, which are not easy to popularize or apply in the clinic, have gradually been eliminated. A diagnostic system based on an objective examination and subjective symptoms has gradually formed, and lip gland biopsy and serum autoantibody sampling have demonstrated great diagnostic value. The optimization of diagnostic rules makes the diagnosis of this disease more efficient and scientific. This paper reviews the characteristics of and differences in diagnostic criteria for Sjögren′s syndrome and analyzes the internal logic of the evolution of different diagnostic criteria in light of development in research on the disease with the hope of benefitting the diagnosis, treatment and related research of Sjögren′s syndrome.

Analysis of causes for non-stone parotid obstructions / 口腔疾病防治

@#Parotid obstructions can cause repeated swelling of the glands. Previously, duct stones were thought to be the main cause of obstructions, but salivary gland endoscopy examinations have revealed the absence of stones or foreign bodies in the duct system of the parotid glands with obstructive symptoms. Diseases of the parotid gland with obstructive symptoms include chronic recurrent parotitis, non-stone chronic obstructive parotitis, Sjögren′s syndrome, IgG4-related parotitis and radiation-induced parotitis. The mechanism of obstructions is unknown, and the disease course is prolonged. In this paper, based on a brief analysis of duct stenosis, distortion and mucus emboli, which may lead to parotid obstructions, a new perspective is emphasized: the duct system of the parotid and flowing saliva constitute a microflow field. Based on the principle of fluid mechanics, the flow of saliva in the flow field can be affected by the confluence, diameter changes, and twist of the ducts. This outcome results in changes in the low velocity zone, backflow, counterflow and turbulence; affects saliva flow and normal discharge; and causes symptoms of parotid obstruction. An analysis of the possible mechanisms of parotid obstruction using two variables, duct anatomy and saliva traits, helps explain the causes of nonstone parotid obstructions.

Salivary transcriptomics and biomarkers of oral squamous cell carcinoma / 口腔疾病防治

@#Saliva is rich in DNA, RNA, proteins, microorganisms and metabolites, containing large amounts of bio⁃information, similar to blood, and reflecting the physiological or pathological state of the whole body. Additionally, with its advantages of non⁃invasive collection methods, safe transport and low transportation cost, saliva has attracted extensive attention of scholars recently as a potential substitute for blood. With the rapid development of high⁃throughput techniques such as microarray technology, whole genome sequencing and whole transcriptome sequencing, a variety of disease-specific salivary biomarkers have been discovered. Salivary transcriptomics, a bridge connecting genomics and proteomics, provides a comprehensive understanding of gene transcription, RNA composition and interactions. This methodology not only allows the investigation of salivary components with temporal and spatial specificity but also reveals regulatory networks during disease development, with high potential for the early screening and assessment of diseases. Here, we outline the development of salivary transcriptomics, highlight its current research status in oral cancer from two aspects of technological and clinical applications, and further address prospects and challenges of the near future.

Clinical thinking and evidence-based for decompression of cystic lesions in the jaw bone / 口腔疾病防治

@#Decompression is an effective and widely used treatment for jawbone cystic lesions that can, to a great extent, preserve the function and appearance of the jawbone. However, some problems exist with its clinical application, such as the inappropriate determination of indication and the lack of standardized operational guidelines, resulting in treatment ineffectiveness or even failure. This paper aimed to summarize the clinical value of decompression for jawbone cystic lesions in terms of mechanism, scientific evidence, advancement, indications and effective evaluation by reviewing relevant literature and our clinical experience.

Commentary of WHO classification in odontogenic tumours (2017 edition) / 口腔疾病防治

@#The 4th edition of WHO Classification of Head and Neck Tumours has been published in Jan. 2017. In Chapter 8 ‘Odontogenic and maxillofacial bone tumours’, the classification of odontogenic tumors was recomposed from the previous edition in 2005. In this paper, we introduced the modification of odontogenic tumors classification between 2017 and 2005 in a comprehensive discussion.

Clinical studies of interventional thrombolysis in treatment of primary acute segmental renal infarction / 中华泌尿外科杂志

Objective To investigate the feasibility and clinical efficacy of the interventional thrombolytic therapy in acute segmental renal infarction.Methods From December 2007 to November 2015 data of patients with acute segmental renal infarction treated in our institute were retrospectively reviewed. There were 5 male patients and 2 female patients, All patients age ranged from 45 to 76 years old ( median 70 years old), All patients had clinical symptoms,including left flank pain with vomiting in 3 patients and right flank pain with vomiting in 4 cases. 4 cases with cerebral thrombosis, atrial fibrillation and hypertension, 3 cases had hypertension and diabetes.4 cases was possible of renal artery embolism diagnosed by Doppler ultrasound, renal arteries showed no abnormality, while other 3 cases had no obvious symptoms.CT test revealed low density area wedge-shaped, coated substrate edge, but no obvious occupying lesions in the pole of the kidneys.Furthermore, enhanced scan showed uneven enhancement, delayed distortion, and the lesion density below the renal parenchyma in the pole of the kidneys.Digital subtraction angiography ( DSA) were performed and the patients were given saline 20 ml and urokinase200 000 U at 15 minutes interval through indwelling catheter injection two times, followed by normal saline 20 ml and urokinase100 000 U injection once.Subsequently, the patients were given urokinase 100 000 U through the indwelling catheters infusion every four hours.Concurrently, the patients were given 6 000 U of low molecular weight heparin sodium injection subcutaneously every 12 h, as well as expansion treatment. 24 hours after the treatment, observing the infarction area by the original DSA catheter angiography.Results All patients were successfully treated.Followed up for 3 months to 7 years, 1 patient died of cerebral infarction and hypertension after 8 months, other patients were alive without evidence of renal infarction recurrence in CT examination, and condition of patients with atrial fibrillation gradually recovered. Conclusion The diagnosis of ASRI requires enhanced CT and DSA examination due to its rare incidence and the high misdiagnosis rate in clinic.Early diagnosis and use of interventional thrombolytic therapy method is a feasible and effective treatment method.

Comparison of the effect and prognosis of early and late digital shaping titanium mesh cranioplasty / 国际生物医学工程杂志

Objective To analyze and compare the effect,safety and prognosis of early and late digital shaping titanium mesh cranioplasty after skull bone flap defect.Methods One hundred and twelve patients with craniocerebral trauma or cerebral hemorrhage treated by decompressive craniectomy from Jan.2012 to Dec.2013 were included.Seventy-six cases were treated by digital shaping titanium mesh cranioplasty after average 38.9 (32～ 52) d after decompressive craniectomy (early repair group),and thirty-six cases were given operation after 114.2 (90～153) d (advanced repair group).The operation time,skin flap free time,operation blood loss,complications,postoperative patients' activities of daily living (ADL) score,Fugl-Meyery score,neurological deficit score and the recovery of cognitive function of the two groups were compared and analyzed.Results Operation time of early repair group and late repair group were (92.33±13.71) min and (141.67±18.12) min,flap free time were (13.29± 3.43) min and (38.56±7.35) min,and operation bleeding volume were (352.36 ± 21.83) ml and (523.53±32.51) ml (P＜0.01).The subdural effusion rate and the dural rupture rate during skin flap free of early repair group was significantly less than that of late repair group (P＜0.01).ADL and Fugl-Meyery scores in early repair group were increased obviously compared with advanced repair group with significant difference (P＜0.05 or P＜0.01),while the neurological deficit score decreased significantly (P＜0.05).The Montreal cognitive assessment suggested that cognitive function in early repair group was better than that of the late repair group with significant difference (P＜0.05).Conclusions Early digital shaping titanium mesh cranioplasty after skull bone flap defect is better than late treatment with easy soft tissue separation,reduced bleeding and improved prognosis.Digital titanium mesh shaping can ensure precise fit with skull defect,significantly shorten the operation time,and reduce the operation risk.Early digital shaping titanium mesh cranioplasty may have promising clinical application.

The Effects of Astragalus Injection on the Morphology and Expression of Apaf-1 in Hippocampal Neurons after Cerebral Ischemia Reperfusion in Rats / 天津医药

Objective To investigate the effects of astragalus injection on the morphology and expression of Apaf-1 in hippocampal neurons after cerebral ischemia reperfusion in rats. Methods The male SD rats were randomly divided into 3 groups, sham-operated group, cerebral ischemia-reperfusion group (reperfusion group) and astragalus injection interven-tion group (experiment group). The global cerebral ischemia-reperfusion rat model was established by Pulsinelli four-vessel occlusion method. The astragalus injection group was intraperitoneally injected with astragalus 6 mL/kg, 30 mins before sur-gery and repeated every 24 h. Rat brains were removed 24 h after reperfusion in each group. HE staining was used to observe the pathological changes of the hippocampal neurons under the light microscope. The ultrastructural changes of hippocam-pal neurons were observed by transmission electron microscopy. Immunohistochemistry and Western blot methods were used to measure the expression of apoptotic protease activating factor-1(Apaf-1) protein. Results Compared with sham-operat-ed group, nuclear and mitochondrial damage was found in reperfusion group, and the expression of Apaf-1 protein increased obviously in hippocampus(Immunohistochemistry result:0.024 ± 0.001 vs 0.109 ± 0.011;Western blot result:0.270 ± 0.018 vs 0.894±0.072, P<0.01). Compared with reperfusion group, the damage in nuclear and mitochondria was relieved obviously in experiment group, and the expression of Apaf-1 protein in hippocampus was significantly decreased (Immunohistochemistry result:0.048±0.005;Western blot result:0.392±0.046, P<0.01). Conclusion Astragalus injection can reduce pathological damage of hippocampal neurons after cerebral ischemia and reperfusion in rats, and the mechanism is related with inhibiting of Apaf-1 protein.

A study of the relationship between corneal Q value and selection of aspheric intraocular lens / 中华实验眼科杂志

Background Aspheric intraocular lens (IOL) is designed to reduce the spherical aberration of the eye after cataract surgery and to obtain better visual quality.However,the selection of a personalized aspheric IOL is a problem to be solved.Objective This study was to compare the wavefront aberration and quality of vision of patients between the implantation of negative spherical aberration IOL and non-aberration IOL,and to investigate the relationship between corneal Q values and postoperative spherical aberration.Methods One hundred and four eyes of 90 patients with age-related cataract were randomized into two groups.Fifty-two eyes of 46 patients who received a Tecnis Z9001 IOL implantation were assigned as the negative spherical aberration IOL group and 52 eyes of 44 patients who received Akreos AO IOL without aberration were assigned as the non-aberration IOL group.The preoperative corneal Q values were measured and the mean Q value(Q)was computed.Then the patients in the two groups were further divided into 2 subgroups,respectively,based on their Q values were over or below (Q）.The corneal Q values,root mean square(RMS) of ocular spherical aberration,coma and total higher-order aberrations(HOAs) for 5 mm diameter pupil,scotopic contrast sensitivity with or without glare at 6 mm pupil diameter were measured 3 months after surgery.Results The pre-and post-operative corneal Q values were insignificantly changed (t =1.447,P =0.151).The spherical aberration in the negative spherical aberration IOL group was(0.059-±0.047)μm,and that in the non-aberration IOL group was(0.110±0.066)μm,with a statistically significant difference between them (t =-4.567,P=0.000).Scotopic contrast sensitivities at intermediate and high frequencies were significantly better in the negative spherical aberration IOL group than in the non-aberration IOL group (t =2.495,t =2.359,P ＜ 0.05).There was no significant difference in coma and HOAs between the two groups after operation (P ＞ 0.05).Weak positive correlations were seen between the pre-and post-operative corneal Q values and spherical aberration in the two groups(r=0.277,0.292,0.285,0.325,all at P＜0.05).However,no significant differences were found in spherical aberration,contrast sensitivity and scotopic contrast sensitivity between the different subgroups (P ＞ 0.05).Conclusions Negative spherical aberration IOL has lower spherical aberration and better scotopic contrast sensitivity than non-aberration IOL.The results suggest that it may be not enough to choose the corneal Q value only as the single reference criterion for selection of aspheric IOL.