Objective:To evaluate the clinical value of temporal pole and external capsule white matter hyperintensities (WMHs) on the diagnosie of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) by meta-analysis.Methods:PubMed, Cochrane, Embase, VIP database, China Biomedical Literature database, CNKI, Wanfang Data Service Platform were retrieved. The relevant literature of temporal pole and external capsule WMHs for the diagnosis of CADASIL was collected. The retrieval time limit was from the establishment of the databases to April 1, 2020. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of literature. Stata 15.1 software was used for statistical analysis. The fitted Summary Receiver Operating Characteristic (SROC) curve and combined diagnostic effect size were used to evaluate the diagnostic value of temporal pole and external capsule WMHs for CADASIL.Results:A total of 9 articles involving 10 studies were enrolled, including 880 patients. The combined sensitivities of temporal pole and external capsule WMHs for CADASIL were 0.67 (95% confidence interval [ CI] 0.54-0.78) and 0.84 (95% CI 0.72-0.91) respectively, the combined specificities were 0.64 (95% CI 0.47-0.78) and 0.44 (95% CI 0.36-0.53) respectively, the combined positive likelihood ratios were 1.9 (95% CI 1.4-2.6) and 1.5 (95% CI 1.2-1.8) respectively, the combined negative likelihood ratios were 0.51 (95% CI 0.42-0.63) and 0.37 (95% CI 0.20-0.69) respectively, the odds ratios of combined diagnosis were 4 (95% CI 3-5) and 4 (95% CI 2-9) respectively, and the area under the SROC curves were 0.71 (95% CI 0.66-0.74) and 0.62 (95% CI 0.58-0.66) respectively. Conclusions:The temporal pole and external capsule WMHs have limited diagnostic value for CADASIL, and other factors need to be comprehensively considered in the clinical diagnosis process.

Objective:To evaluate the clinical outcomes of implant-retained overdentures.Methods:57 patients treated by implant-retained overdentures were included.Parameters for peri-implant tissue conditions (e.g.peri-implant probing depth,plaque index,bleeding on probing,mucosal hyperplasia,peri-implant marginal bone loss) and prosthetic complications were examined and recorded.The precentage of satisfaction of the patients was assessed using the visual analog scale (VAS).Results:After an average follow-up of (48±11.3) months,the survival rate of the implants was 98.1%,the marginal bone loss was (1.38±0.74) mm.There was no statistically difference among the different attachment groups(bar,magnet and ball) regarding the peri-implant marginal bone loss or bleeding on probing(P>0.05).The peri-implant probing depth and plaque index in patients with magnet and ball attachments were lower than those in patients with bar attachments(P<0.05).The major complications were the upper abutment fracture,prostheses fracture and screw loosening.Most patients were satisfied with their prostheses and there was no statistically significant difference between the attachment types(P>0.05),except that magnet and ball attachments were much easier to clean compared with bar attachments(P<0.05).Conclusion:Implant-retained overdenture is a successful and satisfactory treatment option for patients with edentulous jaw.The patients should been given regular clinical examinations to keep peri-implant tissue health and reduce the complications,especially those with bar attachments.

Objective:To evaluate the effect of epigallocatechin-3-gallate (EGCG) and epigallocatechin-3-O-(3-O-methyl)-gallate (EGCG-3Me) on the anti-bacterial effect and the stability of intraradicular dentin-adhesive interface.Methods:EGCG and EGCG3Me with the concentration of 400 μg/ml were incorporated into Single Bond 2 (SB2) respectively to obtain 2 modified adhesives E-SB2 and E3-SB2.Confocal laser scanning microscopy(CLSM) and ultraviolet spectrophotometry were used to evaluate the anti-bacterial effect of the modified adhesives.Micro-Raman spectrum was used to test the degree of conversion (DC) of the adhesives.Push-out bond strength test was conducted to examine the immediate bond strength and the bond strength after themocycling.Results:E-SB2 and E3-SB2 both showed inhibiting effect on the proliferation of E.faecalis,while E3-SB2 performed stronger inhibiting effect.DC and the immediate push-out bond strength of SB2 were not decreased with the incorporation of EGCG or EGCG-3Me(P ＞ 0.05).E-SB2 and E3-SB2 showed significantly higher push-out bond strengths than that of SB2 (P ＜ 0.05) after themocycling.Conclusion:EGCG and EGCG-3Me modified adhesives have anti-bacterial effect and can enhance the stability of bonding between intraradicular dentin and adhesive,EGCG-3Me may have stronger anti-bacterial effect.

Objective:To investigate the impact of bifurcation angle (BA) on side branch occlusion (SBO) during percutaneous coronary intervention (PCI) in relevant patients.
Methods: A total of 1171 consecutive patients with 1200 bifurcation lesions who received one stent technique were studied. Based on the median BA of 52°, the patients were divided into 2 groups:Low angle group, n=587 patients with 600 bifurcation lesions and High angle group, n=584 patients with 600 bifurcation lesions. SBO was deifned by either side branch blood lfow disappeared or TIMI grade decreased after PCI. The occurrence rate of SBO was investigated and the impact of BA on SBO during PCI was evaluated by multivariate Logistic regression analysis.
Results:SBO occurred in 88/1200 (7.33%) bifurcation lesions. The occurrence rate of SBO in High angle group was igher than Low angle group (10.5%vs 4.2%, P<0.001). Multivariable Logistic regression analysis showed that high angle was the independent predictor of SBO occurrence (OR=1.026, 95%CI 1.014-1.037, P<0.01).
Conclusion:High BA was an independent predictor of SBO after the main vessel stent implantation, which should not be ignored in clinical practice.

Objective:To summarize the clinical and imaging features of five patients of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) with cysteine-sparing NOTCH3 gene missense mutations and explore potential pathogenicity of gene mutations.Methods:The clinical data from five patients who were admitted to the People′s Hospital of Zhengzhou University from March 2017 to November 2018 were collected. The patients were found to carry cysteine-sparing NOTCH3 gene mutations through genetic testing and diagnosed pathologically. They were probands confirmed from five unrelated family and all five patients were performed full exon detection and skin biopsy.Results:Genetic testing identified five patients with cysteine-sparing NOTCH3 gene missense mutations, a total of five different mutations, including p.R75Q, p.D80G, p.V237M, p.S1418L and p.R1761H. The first three mutations were found in the epidermal growth factor-like repeats (EGFr), the latter two mutations near the transmembrane domain. Granular osmiophilic material was identified in all cases examined with skin biopsy. The age at initial symptom onset of these five cases was ranged from 22 to 58 years and three cases presented cardiovascular risk factors. The primary clinical manifestations included migraine in one case, ischemic stroke in three cases, psychiatric disturbances in four cases, cognitive dysfunction in five cases, while gait disturbance, pseudobulbar palsy, and seizures accounted for only one case each. Magnetic resonance imaging of five patients all showed white matter hyperintensities (WMLs) and lacunar infarcts, and WMLs involved the anterior temporal pole and external capsules in three cases separately. According to the criteria proposed by Mui?o et al for evaluating the pathogenicity of cysteine-sparing NOTCH3 mutations, all five mutations are potentially pathogenic.Conclusions:Most characteristics of CADASIL patients with cysteine-sparing NOTCH3 gene mutations are similar to those of CADASIL patients with cysteine NOTCH3 gene mutations. Mutations not involving the EGFr may also have potential pathogenicity, and the specific mechanism still needs further study.

Objective:Exploring the surgical method and safety of robot assisted kidney transplantation (RAKT) with a kidney implanted through the vagina, currently there is no such surgery in China.Method:Retrospective analysis of the data of a 44-year-old postpartum woman with stage 5 chronic kidney disease admitted to the kidney transplantation ward of West China Hospital, Sichuan University on June 28, 2021. RAKT with a kidney inserted through the vagina was performed on the recipient. The transplanted kidney was cooled using continuous surface cooling technology (CSCT) using ice physiological saline. The recipient was followed up for 3 months after surgery. In addition, we searched the Wanfang database, China National Knowledge Infrastructure, VIP database, China Biomedical Literature Service System, PubMed, Embase, and Central databases. The Chinese search keywords were "robot kidney transplantation" and "vagina", while the English search keywords were "kidney transplantation" and "robot" and "vacuum". The literature was published from June 1990 to June 2022, and a detailed summary of all published cases was provided.Result:a perineal approach was used to open the posterior fornix of the vagina and the graft was successfully implanted. The surgery was successfully completed, with a total duration of 250 minutes, vascular anastomosis time of 45 minutes, and warm ischemia time of 63 minutes. The recipient recovered smoothly without vaginal pain and postoperative pain relief; There was also no abdominal infection. Using CSCT, the surface temperature of the graft was maintained at 10~16 ℃ during anastomosis. After literature review, a total of 12 cases of renal RAKT implantation through vagina have been reported. All cases were successful, except for one case where the graft was poorly positioned and converted to open surgery. The average surgical time reported in the literature is (210 ± 37) minutes, vascular anastomosis time is (41 ± 8) minutes, and warm ischemia time is (50 ± 10) minutes. There were no surgical complications.Conclusion:Transvaginal insertion of RAKT into the kidney is safe and feasible, but special types of recipients should be selected for this surgical method and evaluated before surgery.

Objective:To investigate the changes, distribution and influencing factors of ocular dominance after small incision lenticule extraction (SMILE).Methods:A retrospective observational case series study was conducted.One hundred and twelve patients (224 eyes) with an average age of 25.1±5.4 years who underwent SMILE surgery at Tianjin Eye Hospital from November 2017 to February 2018 were enrolled.There were 42 male and 70 female patients.The dominant eye was determined using the hole-in-the-card test before and after the surgery.Subjective and objective refraction and uncorrected visual acuity examination were performed before operation, and 1 day, 1 week, 1 month and 3 months after operation.The subjects were divided into switch group and non-switch group based on whether the dominant eye changed after surgery.Binary logistic regression was used to analyze the main influencing factors of dominant eye switches.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Eye Hospital (No.201905). Written informed consent was obtained from each patient before any medical examination.Results:There were 18 patients (16.1%) in the switch group including 7 males (38.9%) and 11 females (61.1%), and 94 patients (83.9%) in the non-switch group including 35 males (37.2%) and 59 females (62.8%). No statistically significant difference was found in sex between the two groups ( χ2=0.02, P=0.89). At 1 month and 3 months after the surgery, there was a statistically significant difference in the cylindrical power between the dominant and non-dominant eye ( t=2.31, 1.95; both at P<0.05). Binary logistic regression equation showed that spherical equivalent[odds ratio ( OR)=0.47, 95%confidence interval ( CI): 0.35-0.66]and refractive error difference ( OR=3.04, 95% CI: 2.12-4.36) were significantly related to the eye dominance switches. Conclusions:There were 16.1% of patients having eye dominance switches after SMILE.The dominant eye transfomation is associated with higher spherical equivalent and anisometropia difference before surgery.

Objective:To explore the safety and early prognosis of robot assisted living donor kidney transplantation(KT)and plot the learning curve of mastering the operation.Methods:From July 2020 to March 2021, 30 cases of living robot assisted KT were completed.The follow-up period was 3 months.Cumulative sum analysis was performed for plotting the learning curve.According to the learning curve, they were divided into two groups of practice period(the first 17 cases)and proficiency period(the last 13 cases). Time of each operative stage and early prognosis were compared.Kidney function and perioperative complications of two groups were compared for evaluating the safety and effectiveness of robot assisted KT.Results:The average operative duration was (221.4±36.1)min.No intestinal obstruction, delayed graft function, urinary leakage and incision infection occurred during perioperative period.The average anal exhaust time was(1.9±0.2)days.During follow-ups, both pulmonary infection(2 cases)and acute rejection(1 case)improved after treatment.According to the learning curve, venous anastomosis(10 cases), arterial anastomosis(12 cases), warm ischemic time(12 cases)and ureteral anastomosis(17 cases)should be performed for reaching a proficiency level.An average of 15 operations was required for achieving proficiency throughout operations.Significant inter-group differences existed in operative duration [(235.5±31.6)vs(203.0±34.3)min, P=0.012] and warm ischemic time [(63.7±24.9)vs(47.0±11.3)min, P=0.033]. At some postoperative timepoints, creatinine of proficiency group was lower than that of practice group, such as Day 7 post-operation [(192.7±135.2)vs(107.8±27.9)μmol/L, P=0.022] and Day 30 post-operation [(147.8±46.3)vs(112.3±28.0)μmol/L, P=0.021]. However, no significant difference existed in estimated glomerular filtration rate at Day 7 post-operation [(56.1±34.1)ml/(min·1.73m 2)vs(72.0±18.5)ml/(min·1.73m 2), P=0.14] and Day 30 post-operation [(56.2±18.9)ml/(min·1.73m 2)vs(68.7±15.3)ml/(min·1.73m 2), P=0.14]. Conclusions:Robot assisted KT is both safe and feasible.And the learning curve requires 17 cases for reaching a proficiency level.

Objective:To investigate the differences in refractive astigmatism, the anterior corneal surface astigmatism and ocular residual astigmatism between dominant and non-dominant eyes in myopia.Methods:A corss-sectional study was conducted.Two hundred and seventy-six eyes from 138 patients with myopia who were to receive corneal refractive surgery in the Refractive Surgery Center of Tianjin Eye Hospital from January to March 2018 were included.Ocular dominance was assessed with the hole-in-the-card test.The manifest refraction and corneal topography were performed in order to measure the sphericity, spherical equivalent, the astigmatism of anterior corneal surface and total cornea.Vector analysis was used to calculate the value of the ocular residual astigmatism and the components of astigmatism, including J0 and J45 of both the refractive astigmatism and the astigmatism of anterior corneal surface.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Eye Hospital (No.201909).Results:It was found that 61.6%(85/138) of the subjects was right-eye dominant.There was no significant difference in sphericity and spherical equivalent, J0 and J45 of the refractive astigmatism and the astigmatism of anterior corneal surface between dominant and non-dominant eyes (all at P>0.05). The magnitude of the ocular residual astigmatism of the dominant eye was 0.607(0.451, 0.808)D, which was lower than 0.701(0.497, 0.901)D of the non-dominant eye, showing a statistically significant difference ( Z=-2.52, P=0.01). Conclusions:In the myopic population with no significant difference in the sphericity and spherical equivalent between the dominant and non-dominant eyes, the magnitude of the ocular residual astigmatism of the dominant eye is significantly lower than that of the non-dominant eye, which may play an important role in the ocular dominance formation.

Objective:To explore the safety, efficacy and preliminary clinical application of the single plantar approach or in combination with the dorsalis pedis approach in the treatment of Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions.Methods:(1) Six fresh cadaveric specimens of adult foot were collected and dissected through the plantar approach in order to determine the skin incision of the plantar approach and the safe area for plate-screw internal fixation, including start-stop points and courses of plantar nerves, blood vessels, tendons and ligaments, followed by plate-screw fixation on the specimens. (2) After feasibility of the plantar approach was confirmed by our anatomical study, it was used to treat the 3 patients who were admitted to Department of Orthopedics, The Third Hospital Affiliated to Southern Medical University between September 2020 and November 2021 for Lisfranc injury with severe necrosis due to dorsalis pedis skin contusion or metatarsal base avulsion fracture. They were 2 males and one female, with an average age of 51 years (from 34 to 68 years). The preliminary clinical efficacy was evaluated in terms of visual analogue scale (VAS), midfoot score of American Orthopaedic Foot and Ankle Surgeons (AOFAS), Maryland score, Kofoed score, fracture healing at the last follow-up and postoperative complications.Results:(1) Regarding the anatomical exposure range, the metatarsal side of the first metatarsal wedge joint was exposed medially and the metatarsal side of the third metatarsal wedge joint was exposed laterally; the peroneus longus tendon, Lisfranc plantar ligament and interosseous ligament were explored. X-ray films after the simulated operation showed satisfactory plate positions. (2) As for the preliminary clinical application, all patients were followed up for 6 to 14 months (mean, 11 months). At the last follow-up, the VAS score ranged from 0 to 1 (mean, 0.5), AOFAS score from 85 to 92 (mean, 89), Maryland score from 93 to 96 (mean, 95), and Kofoed score from 92 to 95 (mean, 94). There were no early complications such as fascial compartment syndrome, skin necrosis or infection. All fractures got united, with no complications like traumatic arthritis, muscle atrophy or screw loosening.Conclusion:Testified by the anatomical study, the plantar approach can be used to treat Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions, leading to safe, effective and satisfactory clinical outcomes.