Objective To observe the effect of hyperbaric oxygen therapy (HBOT) on mineral density and biomechanics of new-formed bone in distraction gap.Methods The mandibles were subjected to osteotomy and distractors were placed bilaterly in 30 rabbits,which were divided randomly into 2 groups.After 5 days for latency,the mandibles were distracted at a rate of 0.8 mm/day for 10 days,and then for consolidation.After surgery,group A received HBOT with daily distraction,whereas group B only distracted without HBOT served as control group.The animals in groups A and B were sacrificed 1 wk,2 wk,4 wk of consolidation,respectively.The mandibles were harvested and subjected to examination for new bone formation,and bone mineral density (BMD) and biomechanics of newly formed bone in the distraction gap.Results At one week of consolidation,no significant differences were observed between the BMD of newly formed bone in the two groups (P＞0.05);however,at the other time points,BMD of newly formed bone in group A was significantly higher than that in group B (P＜0.05).Moreover,at 4 weeks of consolidation,the strength,maximum fragile energy and modulus of elasticity of newly formed bone in group A were significantly higher than those in group B (P＜0.05).Conclusions The results suggest that HBOT improves mineral density and strength of new formed bone in distraction gap.

Objective To observe the effect of continuous elastic outside distraction on the expression of basic fibroblast growth factor (bFGF) and transforming growth factor-beta 1 (TGF-β1) in the female porcine nipples,and to further investigate the mechanism of continuous elastic outside distraction stimulation on the proliferation of supporting tissue in nipples.Methods Three female minipigs were employed,each of them had 12 nipples.Four nipples of each minipig were used as control group,while the other eight nipples were continuously distracted with prefabricated instruments.One nipple without distraction and two distracted nipples of each minipig were excised at 2,4,8,and 12 weeks after operation under general anesthesia respectively.The excised nipples were prepared for immunohistochemical staining to observe the expression of bFGF and TGF-β1.Image analysis software was employed for quantitative analysis.Results bFGF and TGF-β1 expression of control groups was weaker than those of the distracted groups at any time (P＜0.01).The expression of bFGF increased gradually after tracted and reached the peak at 4 weeks.There was significant difference (P＜0.05) in the expression of bFGF between 4 weeks and 12 weeks groups.The expression of TGF-β1 was increased to the peak after 2 weeks.The expression of TGF-β1 between 8 weeks and 12 weeks groups and 2 weeks group had statistical significance (P＜0.05).The expression of bFGF and TGF-β1 had a positive correlation during the traction.Conclusions Continuous elastic outside distraction can promote female minipig nipple to synthesis and secretion of b-FGF and TGF-β1.

Objective To investigate the optimal time and molecular mechanism of gene therapy for promoting distraction osteogenesis by observing the effect of gene transfecting at different time on expression of cyclins in mandibular distraction area.Methods Forty eight New-Zealand rabbits were employed.After accomplishing bilateral mandibular distraction osteogenesis model,the rabbits were randomly divided into the group A,B,C and D.The group A,B and C were transfected by recombinant plasmids pIRES-hBMP2-hVEGF165 2 μg(0.1 μg/μL)at the distraction area instantly after operation,on postoperative 4,14 d and given local electroporation stimulation.The four groups entered the consolidation stage after 10 d continuous traction at a rate of 1 mm/d on postoperative 4 d.Three rabbits in each group were respectively sacrificed on 7,14,28,56 d of the consolidation stage.The expression of cyclin A,D1,and E of fresh bone tissue in distraction area were detected by immunohistochemical staining.Results Cyclin A,D1,and E were strongly expressed in the traction gap on 7,14 d of consolidation stage found,which was strongest on 7 d,moreover the group A,B and C were stronger than the group D.The expression in each group was weakened on 28,56 d.The expression on 7 d in the group B was stronger than that in the4 group A,C and D(P<0.05),the expression had no statistical difference between the group A and C(P>0.05),but all were stronger than the group D(P<0.05);the expression in the group B and C on 14 d was stronger than that in the group A and D,but the expression had no statistical difference between the group B and C and between the group A and D(P>0.05).Conclusion The high expression of cyclin A,D1 and E can promote the cellular division,proliferation and differentiation in distraction area,thus accelerates the new bone formation in the distraction area,prompting that the distraction period is the best time for distraction osteogenesis under gene therapeutic intervention.

Objective Cephalometry has been used to measure the changes of mandibular shape before and after the surgery.The aim of this study was to evaluate the effect of mandibular angle osteotomy.Methods A lot of 42 cases with complete data were selected,cephalometric analysis were performed before operation and one week and 6 months after surgery,respectively.Furthermore,the data of six months postoperatively were compared to those of the beauty people reported in the literature.Results At one week after surgery,the average distance between the gonions decreased (17.70± 8.46) mm,the average length of the mandibular ramus reduced (5.84±3.26) mm,the average mandibular body length increased (4.61±2.74) mm,the average gonial angle increased (14.78±6.65)°,and the average mandibular plane angle increased (10.29±3.82)° (P＜0.05).At six months postoperatively,the first three linear measurements increased (3.68±2.91) mm,(1.66±2.51) mm and (2.10±2.37) mm,respectively;however,the last two angular measurements reduced (2.86±3.02)°and (1.77±2.62)° respectively.The data of six months postoperatively were compared to those of the beauty people reported in the literature,and there were statistically differences between the linear measurements,but no statistically differences between the angular measurements.Conclusions Re duction mandibuloplasty can modificate mandibular contouring three-dimensionally.Despite bone regeneration resuhs in linear or angular measurements change,postoperative angular shape is predominantly maintained,and so the patients can reach the level of beauty papulation.

Objective To explore the effect of elastic outside distraction on microvessel density and to illustrate the mechanism correcting inverted nipples. Methods Three female 3-month-old minipigs,with 12 nipples each,were employed.4 nipples of each minipig were remained without distraction were control group,and the other 8 nipples were continuously distracted with inverted nipple correction instruments.Corresponding nipples were excised at 2,4,8 and 12 weeks after traction.The excised nipple specimens were employed with immunohistochemical staining to detect the expression of vascular endothelial cells growth factor (VEGF) and CD34 in those tissues,and the percentageof positive cells and microvessel density (MVD) changes were counted.Results The expression of CD34 and VEGF in the experimental groups increased at 2 weeks after tracted,and reached at the peak at 4 weeks,then gradually decreased during 8 to 12 weeks after tracted.While those were weakly positive in control group.Compared with the control group,the integral optical density of VEGF-positive cells and MVD were significantly different (P＜0.01),and there was a significantly positive correlation between MVD and VEGF.Conclusions Continuous elastic outside distraction can promote the expression of VEGF and CD34 in female minipig nipple and enhance angiogenesis,which increases oxygen supply locally,and therefore those local tissue proliferation may be one of key mechanisms of correcting the inverted nipple by continuous elastic outside distraction.

Objective To explore the procedures of reconstruction emergency for skin and soft tisue defects due to trauma with local flap based on plastic surgical principles and techniques.Methods Thirty-two patients with facial defects caused by tramua were treated.After strict debridement of the wound of the skin and soft tissue,the flaps were designed according to the wound condition with plastic surgical principles.Subcutaneous SMAS pedicle flap,V-Y advancement flap,orbicularis flap,nasolabial groove flaps and others were chosen for wound repair,to suture and close the wound meticu lously.Results All of 32 treated cases,the wounds were primary healing.After 6-18 months follow-up,there was no obvious scar formation or functional problems.Second stage reconstruction was not needed since the cosmetic effect was perfect.Conclusions It is a satisfactory and effective method to emergently treat the skin and soft tissue defects after facial trauma with local flap based on the plastic surgical principles,which is well worth popularizing in clinic.

Objective To investigate the effect of gene therapy which was mediated by electroporation on the expression of basic fibroblast growth factor (bFGF) duning mandible distraction.Methods Bilateral mandibular osteotomies were performed in New-Zealand rabbit.After a latency of 3 days,the mandibles were elongated using distractors with a rate of 0.8 mm/d for 7 days.The rabbits were randomly divided into 5 groups:2 μtg recombinant plasmids pIRES-hVEGF165-hBMP2,pIRES-hBMP2,pIRES-hVEGF165,pIRES and normal saline (NS) were injected into the distraction area of groups A,B,C,D and E,after completion of distraction,respectively.The lengthened mandibles were harvested and processed for immunohistochemical detection of bFGF,and the mean optic densities and integral optical density of bFGF positive cells were measured by computerized image analyzer.Results bFGF mainly located in fibroblasts,giant monocytes,polynuclear phagocytes,osetocytes,and osetoblasts in the connective tissue around bone tissue.The strongest expression was observed at the 7th day,and weakened at 14th day of consolidation stage,there were no significant difference among groups A,B and C,at the 7th day of consolidation.However,there were significant differences between gene therapy groups (A,B and C) and control groups (D and E) (P＜0.01).Conclusions Gene therapy can enhance and prolong the expression of bFGF in distraction gap,which promotes the cell differentiation and proliferation,extracellular matrix synthesis and new bone formation during distraction osteogenesis.This is probably one of the molecular mechanisms of the gene therapy promoting new bone formation in distraction gap.

OBJECTIVETo investgate the expression patterns of bone morphogenetic protein-2 (BMP-2) in the distraction area following plRES-hBMP2-VEGFI65 gene transfection at different time during mandibular distraction osteogenesis in a rabbit model.

METHODS48 New-Zeland rabbits were employed to underwent osteotomy and distraction devices implantation on mandible bilaterly. After 3 days of latency period, the devices were activated at the rate of 0. 8 mm per day for 10 days. The rabbits were randomly divided into 4 groups (group A, B, C and D). Group A, B and C were transfected recombinant plasmids pIRES-hBMP2-hVEGF165 via electroporation-mediated approach at latency period, distraction period, consolidation period respectively. Group D was used as control group without gene transfection. Three rabbits in each group were sacrificed at 1, 2, 4 weeks of consolidation respectively. The mandibles were harvested for immunohistochemical staining detection of BMP-2 expression respectively, which were analyzed by CMIAS series multifunction color quantitative analysis of pathological image analysis system.

RESULTSBMP-2 expression was found to be mainly located in the monocyte, fibroblast of the granulation tissue, the osteoblasts, osteocyte on the surface of new formed trabecular, and the connective tissues surrounding the new formed bone. The expression in group B was superior to other groups. Image analysis showed that, at the first week and second week of consolidation, the expression abosordbance A in group B (0. 58 ± 0. 03 and 0. 34 ± 0. 02) was relatively higher, when compared with that in group A (0. 42 ± 0. 02 and. 31 ±0.01), C(0.32 ±0.01 and 0.30 ±0.01)and D(0.27 ±0.01 and 0.23 ±0.02), showing a significant difference(P <0. 05). It was also relatively higher in group A(0. 42 ± 0. 02 and 0. 31 ± 0. 01) and C(0. 32 ± 0.01 and 0.30 ± 0.01), when compared with that in group D(0. 27 ±0.01 and 0.23 ± 0. 02), showing a significant difference( P < 0. 05) , but there was no significant difference ( P > 0. 05) between group A and group C. At the fourth week of consolidation, the expression decreased and there was no significant difference among group A, B, C, D.

CONCLUSIONSThe electroporation-mediated gene transfection which is transfected at the beginning of traction can promote BMP-2 expression effectively, stimulate bone marrix synthesis and induce proliferation and differentiation of fibroblasts, osteoblasts, endothelial cells, which further effectively promote the new bone formation. It suggests that the distraction stage is the optimal time for gene therapy.

Animals ; Bone Morphogenetic Protein 2 ; metabolism ; Electroporation ; methods ; Genetic Therapy ; methods ; Mandible ; surgery ; Osteogenesis ; Osteogenesis, Distraction ; Osteotomy ; Rabbits ; Time Factors ; Transfection ; methods

Objective To investigate the expression patterns of major bone growth factors and bone morphogenetic protein-2 (BMP2) in the distracted calluses following transfected gene during mandibular distraction osteogenesis in a rabbit model.Methods Bilateral mandibular osteotomies were performed in New-Zeland rabbits.After a latency of 3 days,the mandibles were elongated using distractors for 7 days.After the completion of distraction,the rabbits were randomly divided into 5 groups.Three animals each were sacrificed at the end of the delay phase,at 7,14,and 28 days after completion of distraction,respectively.The lengthened mandibles were harvested and processed for immunohistochemical detection of BMP2 expression,the mean optic densities and integral optical density of BMP2 positive cells were measured by computerized image analyzer.Results Elevated cellular expression of BMP2,in the distraction gap,was observed following mandibular distraction.BMP2 staining was mainly located in inflammatory cells,and the connective tissues arrounding the new bone.Their strongest expression was the 7th day,some of those growth factors expressed weakly or negatively.Conclusions Electroporation-mediated gene transfection can promote BMP2 expression effectively,which plays an important role in cell differentiation and proliferation during distraction osteo genesis.The BMP2 stimulates extracellular matrix synthesis,induces the proliferation and differentiation of fibroblasts and osteoblasts,which then promotes the new bone formation and repair.

Objective To explore the clinical effect of endoscopic-assisted intraoral reduction mandibuloplasty.Methods From January 2010 to December 2014,a total of 186 patients with prominent mandibular angles underwent one stage long-curved ostectomy combined with splitting corticectomy through an intraoral approach with endoscopic assistence according to preoperative design for reduction mandible three-dimensionally,and achieved reduced width of the lower face with smooth curve of mandibular edge.The distance between both gonions was measured and the complications recorded to evaluate the clinical effect of the surgery during follow-up.Results All the 186 patients had no complications of bleeding and infection.The mean distance between both gonions measurement was (117.3±2.5) mm before surgery and (102.6±2.3) mm after operation;it was reduced (14.1 ±2.4)mm.After 1 month to 2 years of follow up,the width of the lower face was reduced in the frontal view and the mandibular angle appeared natural and inconspicuous in the lateral view.The patients were satisfied with both their frontal and lateral appearances.Conclusions Intraoral approach mandibular ostectomy with endoscopic-assisted allows surgeons to perform accurate,safe and reproducible ostectomies and to recontour mandible symmetrically and reduce the complications.