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Objective: To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy. Methods: A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO's recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics. Results: A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant (P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% (OR=1.42, 95%CI: 1.07-1.88, P=0.015), 46% (OR=1.46, 95%CI: 1.13-1.88, P=0.004), and 64% (OR=1.64, 95%CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study (P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age (OR=2.87, 95%CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 (OR=1.59, 95%CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes (OR=1.58, 95%CI: 1.18-2.13, P=0.002) and premature delivery (OR=1.52, 95%CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM (OR=5.34, 95%CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM (OR=1.44, 95%CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia (OR=4.11, 95%CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia (OR=1.46, 95%CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery (OR=1.47, 95%CI: 1.13-1.92, P=0.004). Conclusions: Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.
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Diabetes Gestacional , Nascimento Prematuro , Intervalo entre Nascimentos , Cesárea , China/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Lactente , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To investigate the incidence changes, clinical characteristics and pregnant outcomes of pernicious placenta previa. METHODS: A retrospective cohort analysis on 316 cases with placenta previa in the Peking University First Hospital from January 2008 to December 2014. The research group were 60 cases with the patients of placenta previa with the history of cesarean section, and the control group were placenta previa without the history of cesarean section. Compared with the incidence, intraoperative blood loss, the pregnancy outcomes and so on. RESULTS: (1) The average incidence rate of placenta previa during the past 7 years was 10.96 (316/28 837). And the cases of pernicious placenta previa was 60 (2.08, 60/28 837), the incidence of pernicious placenta previa was rising from 2008 to 2014 (0.91-3.08). (2) There were 145 cases of placenta privia had been translation from other hospitals in the past 7 years. The referral rate of pregnant women with placenta previa was 45.9% (145/316), and the referral rate of pernicious placenta previa (63.3%, 38/60) was significantly higher than that of non-pernicious placenta previa group (41.8%, 107/256; χ(2)=9.080, P=0.003). Referral the outcomes of these patients were good, and no maternal death occurred. (3) The placenta in the research group were mainly adhered in the front wall of the uterine, and the incidence was 38.5% (15/39), higher than that in the group of non-pernicious placenta previa (12.1%, 21/174; χ(2)=57.636, P<0.01). The incidence rate of complicated placenta increased in research group was 53.3% (32/60), higher than that in the group of non-pernicious placenta previa, compared with the control group, there was significant difference (15.6%, 40/256; χ(2)= 39.041, P<0.01). (4) The incidence of blood loss was more than 1 000 ml, blood transfusion rate, the rate of hysterectomy and the rate of asphyxia of newborn in the research group were respectively 41.7% (25/60), 38.3% (23/60), 8.3% (5/60), 15.0% (9/60), and the incidence of the group of non-pernicious placenta previa were respectively 4.7% (12/256), 12.9% (33/256), 1.2% (3/256), 8.6% (22/256), compared those in other two groups, there were not significant difference (P<0.05). CONCLUSIONS: The incidence rate of placenta previa increased year by year, patients with placenta previa has a history of cesarean section often combined with placenta in anterior wall of the uterus, and often with poor pregnancy outcomes. Hierarchical referral system is an effective means to reduce the mortality of the pernicious placenta previa.
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Cesárea , Placenta Prévia/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Resultado da Gravidez , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Feminino , Humanos , Histerectomia , Incidência , Recém-Nascido , Placenta Prévia/patologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , ÚteroRESUMO
The classification of impacted third molars is important in clinical diagnosis and surgical selection. At present, the common clinical impacted third molar classification is different in the maxillary and mandibular classification criteria. Through the review and analysis of various classification methods of impacted third molar, this paper proposes a more comprehensive and unified classification proposal for the classification of impacted third molar, in order to form a widely accepted application classification method.
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Objective: To investigate the cellular composition and heterogeneity of granulation tissue in human alveolar sockets and construct single-cell transcriptomic maps to elucidate the potential outcomes of natural resolution in the inflammatory microenvironment. Methods: Granulation tissues from 12 alveolar sockets undergoing tooth extraction due to periodontitis and scheduled for delayed site preservation or autologous tooth transplantation were collected in the Department of Oral and Maxillofacial Surgery, School of stomatology Fourth Military Medical University from September 2022 to August 2023. This study used HE staining and single-cell RNA sequencing (scRNA-seq) to observe the cellular composition and morphological changes of different types of granulation tissues. This approach enabled us to identify cellular sequence variations in the inflammatory dental alveolar granulation tissue within specific microenvironments, construct single-cell atlases for different types of human dental alveolar granulation tissues, and explore the spatiotemporal patterns of cell type distribution and key gene changes during the resolution process of inflammatory granulation tissue. Results: HE staining revealed extensive infiltration of inflammatory cells in the dental alveolar inflammatory granulation tissue. After allowing the inflammatory granulation tissue to naturally resolve for three weeks, its histological morphology was essentially consistent with that of reparative granulation tissue. ScRNA-seq captured a total of 20 448 cells from granulation tissues, and the gene expression quantification analysis revealed total gene counts of 33 835 for inflammatory granulation tissue, 36 058 for naturally resolved granulation tissue, and 34 719 for reparative granulation tissue. At the single-cell level, granulation tissue was annotated into ten cell subgroups, including vascular endothelial cells, mesenchymal stem cells, and fibroblasts. Differences were observed in the proportion of cell compositions between inflammatory and naturally resolved granulation tissues. Pseudo-temporal analysis illustrated two main outcomes in tissue resolution and healing, involving immune responses and angiogenesis. Among these, genes associated with inflammation regulation and immune response, such as Igbp5, Zfp36, and Hspa1b, as well as genes involved in extracellular matrix secretion and the formation of vessels and fibers such as Timp3, Postn, and Rgs5, showed significant differences in expression between the two types of granulation tissues. Conclusions: Inflammatory granulation tissue exhibits heterogeneity in cell composition, gene expression, and biological functions compared to naturally resolved granulation tissue. When the inflammatory granulation tissue in the alveolar socket is left undisturbed to undergo natural resolution, it displays a cellular composition similar to that of reparative granulation tissue at both the histological and single-cell levels. Moreover, it modulates the inflammatory response and the healing process through immune reactions and tissue remodeling.
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This article summarizes and organizes relevant publications in journals, along with a review of medical history, systematically summarizing the development process of dental alveolar surgery in China. The initial establishment phase (1935-1952) marked the starting point of Chinese Alveolar Surgery. Despite the impact of wars, it laid the foundation for subsequent research and practice. During the early development phase (1953-1966), the "Chinese Journal of Stomatology" was founded, which promoted the development of Alveolar Surgery. Research focused on tooth extraction methods and complications. Tooth Transplantation and Preprosthetic Surgery gradually began to take off. The stagnant phase (1967-1977) occurred due to the interruption of international exchanges, leading to an almost complete halt in the development of Alveolar Surgery. Entering the rapid catch-up phase (1978-1985), Alveolar Surgery scholars in China began striving to overcome the stagnation of the previous decade. While some progress was made, no significant innovative achievements emerged. In the scientific development phase (1986-2010), clinical research, basic experiments, and paper writing in modern Chinese Alveolar Surgery began to adhere to scientific standards with the rise of experimental medicine. The exploration and innovation stage (2011-2023) is the current development phase, during which Chinese Aveolar Surgery has reached its peak, making substantial progress in technology, clinical practices, and basic research, gradually reaching or even surpassing international advanced levels. Looking back at the development history in China, we can find the wisdom and hard work of the older generation of Alveolar Surgery scholars. However, contemporary challenges and issues, such as standardizing technology, promoting clinical practices, and talent cultivation, need to be addressed by present-day Alveolar Surgery professionals as they forge ahead.
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Pesquisa Biomédica , Medicina Bucal , Humanos , China , Assistência Odontológica , Tecnologia , História do Século XX , História do Século XXIRESUMO
Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.
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Angina de Ludwig , China , Consenso , Humanos , Dente Serotino , Extração DentáriaRESUMO
Objective: To determine the opening and closing action of the external muscle, the projection pathway of the axon terminal of trigeminal motor nucleus (Vmo) neuron to the lateral pterygoid muscle was revealed. Methods: In this study, 10 SD rats of 8 weeks old were included. The left lateral pterygoid muscle of SD rats was surgically exposed, and the wound was closed after intramuscular injection of hydroxystilbamidine/fluorogold (FG) 3-5 µl. Seven days after the operation, the experimental animals were perfused, samples collected and sectioned for immunofluorescence staining. After FG injection into the lateral pterygoid muscle, the FG reversed in the Vmo neurons. Results: In the Vmo neurons on the FG injection side (left side), a large number of FG reversed neurons were found in the corpus luteum and dendrites. These neurons were not only distributed in the dorsolateral part of the trigeminal motor nucleus that innervated the closed muscle, but also in the ventral medial portion of the trigeminal nucleus of the open muscle. Conclusions: The neuronal conduction pathway between the Vmo and the lateral pterygoid muscle innervates the lateral pterygoid muscle. The neurons are distributed both in the dorsolateral and in the nucleus of the ventral ventricle. It is concluded that the lateral pterygoid muscle involve in the jaw closing and opening movement.
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Músculos Pterigoides , Núcleo Motor do Nervo Trigêmeo , Animais , Feminino , Arcada Osseodentária , Movimento , Neurônios , Músculos Pterigoides/anatomia & histologia , Músculos Pterigoides/inervação , Ratos , Ratos Sprague-Dawley , Núcleo Motor do Nervo Trigêmeo/anatomia & histologia , Núcleos do TrigêmeoRESUMO
The aim of this study was to investigate the quantitative association between active/passive maximum mouth opening (AMMO/PMMO) and the severity of simulated temporomandibular joint (TMJ) bony ankylosis. Twenty-eight male sheep were divided randomly and equally into surgical and control groups. Surgical group animals underwent bilateral TMJ osteotomy during which left lateral pterygoid muscle function was blocked. Control animals did not undergo surgery. Body weight, AMMO/PMMO, and TMJ morphological features were evaluated preoperatively and at 12 and 24 weeks post-surgery. In the surgical group, only the right TMJ complexes with maintained lateral pterygoid muscle function developed TMJ bony ankylosis. The AMMO/PMMO and end-feel distance in the surgical group were significantly lower than those in the control group (P < 0.001, both) at 12 and 24 weeks post-surgery. Moreover, AMMO (r = -0.940 and -0.952, P < 0.001, both) and PMMO (r = -0.944 and -0.953, P < 0.001, both) were negatively correlated with the area (mm2) of bony fusion post-surgery. These findings may be useful for the clinical treatment of early mandibular condyle fracture, with the use of occlusal pads/open-mouth plates to relax the lateral pterygoid muscle and block its function. When bony ankylosis developed in the TMJ, the greater the area of bony fusion, the more limited were AMMO/PMMO.
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Anquilose , Transtornos da Articulação Temporomandibular , Animais , Masculino , Côndilo Mandibular , Boca , Ovinos , Articulação TemporomandibularRESUMO
The purpose of this study was to verify the role of the lateral pterygoid muscle in the reconstruction of the condyle shape during the sagittal fracture healing process by histological methods. Twenty-four adult sheep underwent an osteotomy to create a sagittal fracture of the left condyle; the sheep were then divided randomly into two groups. The lateral pterygoid muscles of the sheep in the experimental group were maintained on the internal poles of the condyles, and their functions remained stable. The lateral pterygoid muscles of the sheep in the control group were cut, and their functions were blocked. The shape, erosion, and calcification of the condyles were observed and measured after 4, 12, and 24 weeks of healing (n=4 from each group). The condyles were then submitted to haematoxylin and eosin, Ponceau S, and Sirius red studies. The results of the histology studies showed increased bone formation in the experimental group in which the functions of the lateral pterygoid muscle remained the same. The results of this study suggest that the lateral pterygoid muscle affects the reconstruction of the condylar shape during the healing process of a sagittal fracture of the mandibular condyle, and may even be involved in the formation of ankylosis.
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Anquilose/patologia , Consolidação da Fratura/fisiologia , Fraturas Mandibulares/patologia , Músculos Pterigoides/fisiologia , Articulação Temporomandibular/patologia , Animais , Côndilo Mandibular/lesões , Osteotomia , Carneiro DomésticoRESUMO
This study introduced and evaluated the clinical application of a temporary and lateral screw technique for open reduction and internal rigid fixation of sagittal mandibular condylar fractures. A preauricular approach was used to expose the fracture. A temporary screw was used to assist in the anatomical reduction, and a lateral lag screw in combination with a lateral position screw was used for internal rigid fixation. Six adult patients with sagittal condylar fractures and more than 5mm condylar height shortening were treated. The treatment outcomes were followed up clinically and radiographically for 8-27 months (mean 18 months) postoperatively. There were no complications associated with the operation. All patients recovered favorably with good occlusion, normal movement of the mandible, correct repositioning and rigid fixation of the fragment of the fracture and a good condyle shape on radiographs. The temporary and lateral screw technique is a simple, effective, fast, and minimally invasive surgical treatment for adult sagittal condylar fractures.
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Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
Carotid body tumors (CBT) are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. A retrospective survey was conducted in 33 patients, treated by curative resection of the neoplasm, from 1980 to 2005, to investigate clinical features, preoperative treatment and surgical approach, and determine the optimum management for CBT. The demographic characteristics, clinical features, surgical approach and complications were documented and analyzed. Accurate diagnosis and effective preoperative training were associated with a good surgical outcome. Carotid arteriography accurately diagnoses and evaluates the brain's collateral circulation in the circle of Willis. Ultrasonography is useful. Carotid blood flow obstruction (Matas' training) is effective. Complete excision of the carotid system without a vascular replacement is possible only after reliable Matas' training and objective observation of the establishment of circulation in the circle of Willis. Correct treatment of the internal and common carotid artery is important to reduce postoperative complications. The continuity of the common and internal carotid artery should be retained if possible, and carotid artery repair is recommended. Minor complications occurred in five (15%) patients and one patient died from a cause not related to the CBT at follow-up.