Objective:To evaluate the mechanical stability of the bone block after LeFort Ⅰ osteotomy with maxillary advancement using absorbable plates fixed with tenon-and-mortise structures.Methods:This study developed three finite element models: one for the maxillary LeFort Ⅰ osteotomy with anterior advancement fixed with absorbable plates (Model 1); another for the maxillary LeFort Ⅰ osteotomy with anterior advancement fixed with absorbable plates assisted by tenon-and-mortise structures (Model 2); and the last one for the maxillary LeFort Ⅰ osteotomy with anterior advancement fixed with titanium plates and screws (Model 3). Simulated occlusal forces were applied on the anterior and posterior teeth in each model. The displacement changes of the nasal-palatine point (NP) and posterior nasal spine point (PNS) in the finite element coordinate system were compared and analyzed. The Mises equivalent stress distributions of the metal and absorbable plates were also examined to assess the mechanical stability of the three finite element models. Clinical data from 45 patients with dentofacial deformities treated from January 2017 to January 2023 at the Stomatology Hospital of China Medical University were collected. The age of the patients was 21±3 years. Among these, 15 patients had absorbable plates for fixation, 15 had absorbable plates assisted by tenon-and-mortise structures, and 15 had titanium plates and screws fixation after maxillary advancement. All patients underwent preoperative (T0), postoperative 3 days (T1), and 6 months (T2) spiral CT scans. The CT data in DICOM format were input into digital software, which was used to calculate the distances from the NP and PNS points to the horizontal plane (HP), right sagittal plane (FZSR), and coronal plane (CP) at T1 and T2. The distances at T1 and T2 were statistically analyzed using the Wilcoxon signed-rank test with SPSS 20.0, and a P value of<0.05 was considered statistically significant.Results:The finite element analysis showed that in the absorbable plate-only fixation group, the maximum displacement of the NP point (mm) under anterior and posterior tooth force conditions were 0.6 and 0.12, respectively, and for the PNS point, the maximum displacements were 0.5 and 0.11. In the tenon-and-mortise-assisted absorbable plate fixation group, the displacement of the NP point was 0.40 and 0.02 mm, and the displacement of the PNS point was 0.5 and 0.015 mm. In the titanium plate-screw fixation group, the NP point displacement was 0.33 and 0.055 mm, and the PNS point displacement was 0.16 and 0.1 mm. The Mises equivalent stress on the absorbable plates with tenon-and-mortise structure was significantly lower than that in the absorbable plate-only fixation group, while the titanium plate experienced the highest Mises equivalent stress. The clinical data analysis showed that in the horizontal direction, the postoperative stability of the three fixation methods was similar. However, in the vertical and anterior-posterior directions, the absorbable plate-only fixation group showed significant differences in the distances of PNS-HP, PNS-CP, and NP-CP between T1 and T2 ( P=0.018, P=0.009, P=0.017), suggesting significant postoperative bone displacement. In contrast, the tenon-and-mortise-assisted absorbable plate fixation group and the titanium plate-screw fixation group showed no significant differences in displacement during surgery and postoperatively(all P>0.05), demonstrating higher stability. Conclusions:The tenon-and-mortise-assisted absorbable plate fixation provides comparable stability to titanium plate fixation in clinical results, and it is more stable than absorbable plate-only fixation. In the mechanical study, when force was applied on the anterior teeth, the stability of the tenon-and-mortise-assisted absorbable plate fixation was slightly less than that of titanium plate fixation, but when posterior teeth were used, its stability exceeded both titanium plate fixation and absorbable plate-only fixation. The tenon-and-mortise-assisted absorbable plate fixation serves as an effective alternative to titanium plate fixation after LeFort Ⅰ osteotomy.

Objective To explore the therapeutic effect of microsurgical vascular decompression(MVD)under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary trigeminal neuralgia(TN),and its impacts on prognosis.Methods 108 primary TN patients from November 2021 to November 2023 were retrospectively selected and grouped into combined group and control group based on the surgical plan,with 54 cases in each group.The control group received MVD treatment under the microscope,while the combined group received complete neuroendoscopic MVD combined with nerve combing surgery.The total effective rate,pain degree,stress indicators,quality of life,and complications were compared between the two groups.Results The total effective rate of the combined group(96.30%)was greatly higher than that of the control group(83.33%),the difference was statistically significant(P<0.05).The visual analogue scale(VAS)scores of both groups after surgery were significantly lower than those before surgery,and the combined group was lower than the control group,the differences were statistically significant(P<0.05).After surgery,the levels of norepinephrine(NE),superoxide dismutase(SOD),and cortisol(Cor)increased in both groups compared with those before surgery,but the combined group was greatly lower than that of the control group,the differences were statistically significant(P<0.05).The generic quality of life inventory-74(GQOL-74)scores in both groups after surgery were significantly higher than those before surgery,and the combined group was higher than the control group,the differences were statistically significant(P<0.05).There was no difference of the total complication rate between the two groups(P>0.05).Conclusion MVD under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary TN,can relieve pain,reduce stress response and improve the quality of life of patients.It is worthy of clinical promotion and application.

OBJECTIVE: To block family transmission of a small fragment copy number variation (CNV) with combined 1 Mb resolution preimplantation genetic testing for aneuploidy (PGT-A) and target region preimplantation genetic testing for monogenic disease (PGT-M) strategies. METHODS: A couple who attended the Reproductive and Genetic Medicine Center of Dalian Women and Children's Medical Center (Group) in 2024 were selected as the study subject. Upon the woman's two pregnancies, ultrasound examination revealed fetal abnormalities, and CNV-seq based on low-depth whole genome sequencing revealed that both fetuses had carried a maternal 17p12 microduplication of approximately 1.43 Mb. Microduplication in this region has been associated with Charcot-Marie-Tooth disease type 1A. In view of the fact that the resolution of conventional PGT-A detection cannot meet the requirement of small fragment CNV analysis, and conventional PGT-M assay cannot directly determine the CNV, two detection schemes were adopted. On the one hand, PGT-A testing with 1 Mb resolution was performed on the embryo to directly determine whether it carries the above microduplication. At the same time, the couple and their fetus were subjected to chromosomal typing scheme for the 17p12 region to indirectly identify embryos carrying the risk chromosome for microduplication. This study has been approved by the Medical Ethics Committee of the Hospital (Ethics No: FEJT-KY-2025-51). RESULTS: Three embryos were tested after the first PGT cycle, of which 1 was not carrying the pathogenic variant and was euploid, whilst the other 2 embryos were carrying the 17p12 microduplication, and 1 of them was aneuploid. After genetic counseling, the euploid embryo without the 17p12 microduplication was selected for transfer, and prenatal diagnosis based on amniotic fluid sample showed that the fetal chromosomal karyotype was normal and did not carry the 17p12 microduplication. CONCLUSION The combined application of high-resolution PGT-A and PGT-M typing detection of the target region can effectively block family transmission of the CNVs of small fragments.
Humans ; Female ; DNA Copy Number Variations/genetics* ; Preimplantation Diagnosis/methods* ; Pregnancy ; Pedigree ; Genetic Testing/methods* ; Male ; Adult ; Aneuploidy ; Chromosomes, Human, Pair 17/genetics* ; China ; East Asian People

Objective:To block family transmission of a small fragment copy number variation (CNV) with combined 1 Mb resolution preimplantation genetic testing for aneuploidy (PGT-A) and target region preimplantation genetic testing for monogenic disease (PGT-M) strategies.Methods:A couple who attended the Reproductive and Genetic Medicine Center of Dalian Women and Children′s Medical Center (Group) in 2024 were selected as the study subject. Upon the woman′s two pregnancies, ultrasound examination revealed fetal abnormalities, and CNV-seq based on low-depth whole genome sequencing revealed that both fetuses had carried a maternal 17p12 microduplication of approximately 1.43 Mb. Microduplication in this region has been associated with Charcot-Marie-Tooth disease type 1A. In view of the fact that the resolution of conventional PGT-A detection cannot meet the requirement of small fragment CNV analysis, and conventional PGT-M assay cannot directly determine the CNV, two detection schemes were adopted. On the one hand, PGT-A testing with 1 Mb resolution was performed on the embryo to directly determine whether it carries the above microduplication. At the same time, the couple and their fetus were subjected to chromosomal typing scheme for the 17p12 region to indirectly identify embryos carrying the risk chromosome for microduplication. This study has been approved by the Medical Ethics Committee of the Hospital (Ethics No: FEJT-KY-2025-51).Results:Three embryos were tested after the first PGT cycle, of which 1 was not carrying the pathogenic variant and was euploid, whilst the other 2 embryos were carrying the 17p12 microduplication, and 1 of them was aneuploid. After genetic counseling, the euploid embryo without the 17p12 microduplication was selected for transfer, and prenatal diagnosis based on amniotic fluid sample showed that the fetal chromosomal karyotype was normal and did not carry the 17p12 microduplication.Conclusion:The combined application of high-resolution PGT-A and PGT-M typing detection of the target region can effectively block family transmission of the CNVs of small fragments.

Objective:To evaluate the mechanical stability of the bone block after LeFort Ⅰ osteotomy with maxillary advancement using absorbable plates fixed with tenon-and-mortise structures.Methods:This study developed three finite element models: one for the maxillary LeFort Ⅰ osteotomy with anterior advancement fixed with absorbable plates (Model 1); another for the maxillary LeFort Ⅰ osteotomy with anterior advancement fixed with absorbable plates assisted by tenon-and-mortise structures (Model 2); and the last one for the maxillary LeFort Ⅰ osteotomy with anterior advancement fixed with titanium plates and screws (Model 3). Simulated occlusal forces were applied on the anterior and posterior teeth in each model. The displacement changes of the nasal-palatine point (NP) and posterior nasal spine point (PNS) in the finite element coordinate system were compared and analyzed. The Mises equivalent stress distributions of the metal and absorbable plates were also examined to assess the mechanical stability of the three finite element models. Clinical data from 45 patients with dentofacial deformities treated from January 2017 to January 2023 at the Stomatology Hospital of China Medical University were collected. The age of the patients was 21±3 years. Among these, 15 patients had absorbable plates for fixation, 15 had absorbable plates assisted by tenon-and-mortise structures, and 15 had titanium plates and screws fixation after maxillary advancement. All patients underwent preoperative (T0), postoperative 3 days (T1), and 6 months (T2) spiral CT scans. The CT data in DICOM format were input into digital software, which was used to calculate the distances from the NP and PNS points to the horizontal plane (HP), right sagittal plane (FZSR), and coronal plane (CP) at T1 and T2. The distances at T1 and T2 were statistically analyzed using the Wilcoxon signed-rank test with SPSS 20.0, and a P value of<0.05 was considered statistically significant.Results:The finite element analysis showed that in the absorbable plate-only fixation group, the maximum displacement of the NP point (mm) under anterior and posterior tooth force conditions were 0.6 and 0.12, respectively, and for the PNS point, the maximum displacements were 0.5 and 0.11. In the tenon-and-mortise-assisted absorbable plate fixation group, the displacement of the NP point was 0.40 and 0.02 mm, and the displacement of the PNS point was 0.5 and 0.015 mm. In the titanium plate-screw fixation group, the NP point displacement was 0.33 and 0.055 mm, and the PNS point displacement was 0.16 and 0.1 mm. The Mises equivalent stress on the absorbable plates with tenon-and-mortise structure was significantly lower than that in the absorbable plate-only fixation group, while the titanium plate experienced the highest Mises equivalent stress. The clinical data analysis showed that in the horizontal direction, the postoperative stability of the three fixation methods was similar. However, in the vertical and anterior-posterior directions, the absorbable plate-only fixation group showed significant differences in the distances of PNS-HP, PNS-CP, and NP-CP between T1 and T2 ( P=0.018, P=0.009, P=0.017), suggesting significant postoperative bone displacement. In contrast, the tenon-and-mortise-assisted absorbable plate fixation group and the titanium plate-screw fixation group showed no significant differences in displacement during surgery and postoperatively(all P>0.05), demonstrating higher stability. Conclusions:The tenon-and-mortise-assisted absorbable plate fixation provides comparable stability to titanium plate fixation in clinical results, and it is more stable than absorbable plate-only fixation. In the mechanical study, when force was applied on the anterior teeth, the stability of the tenon-and-mortise-assisted absorbable plate fixation was slightly less than that of titanium plate fixation, but when posterior teeth were used, its stability exceeded both titanium plate fixation and absorbable plate-only fixation. The tenon-and-mortise-assisted absorbable plate fixation serves as an effective alternative to titanium plate fixation after LeFort Ⅰ osteotomy.

Objective To investigate the blood flow difference of transcranial Doppler ultrasound of bilateral middle cerebral arteries in patients with acute anterior circulation ischemic stroke(AACIS)after endovascular treatment,and analyze the influencing factors for prognosis of AACIS patients treated with stent combined with thrombolysis.Methods A retrospective analy-sis was conducted on 168 AACIS patients undergoing mechanical embolectomy in our department from May 2020 to April 2022.According to the treatment regimens,they were divided into simple thrombolysis group(72 patients)and combined thrombolysis group(96 patients).The combined thrombolysis group was assigned into good prognosis subgroup(65 cases)and poor prognosis subgroup(31 cases)according to the score Modified Rankin scale(mRS).Kaplan-Meier curve and multivariate logistic regression analyses were employed to identify the influencing factors for the poor prognosis in AACIS patients.Results Kaplan-Meier survival curve analysis showed that the combined thrombolysis group was associated with a good prognosis(P=0.013).After treatment,the combined thrombolysis group obtained significantly higher average blood flow velocity(Vm)of middle cerebral artery(MCA)and Alberta stroke program early computed tomography score(ASPECTS)than the simple thrombolysis group(P＜0.01).The good prognosis subgroup had significantly younger age,larger ratios of blood sugar ≤6.8 mmol/L and ASPECTS＞2,higher collateral circulation score in MCA region,and elevated Vm than the poor prognosis subgroup(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that blood glucose ≤ 6.8 mmol/L,collateral circulation score in MCA region,ASPECTS＞2 and Vm were protective fac-tors for good prognosis of AACIS patients(P＜0.05,P＜0.01).Conclusion Stent combined with thrombolytic therapy for AACIS has a lower risk for poor prognosis,and blood glucose ≤6.8 mmol/L,higher Tan score,DWI-ASPECTS＞2,and higher Vm are protective factors.

Objective:To evaluate the clinical outcomes of total knee arthroplasty (TKA) assisted by 3D printing in the treatment of traumatic osteoarthritis secondary to severe knee deformity after old tibial plateau fracture.Methods:A retrospective study was conducted to analyze the clinical data of the 18 patients who had been treated for traumatic osteoarthritis secondary to severe knee deformity after old tibial plateau fracture at Department of Orthopaedics, The People's Hospital of Guizhou Province from March 2015 to June 2017. The cohort included 7 males and 11 females, with a mean age of (64.0±7.7) years. The left knee was affected in 12 cases and the right in 6 ones. The injury was caused by a traffic accident in 12 cases, by a fall from heights in 4 cases, and by a heavy object in 2 cases. The time from fracture to TKA was (5.9±2.8) years. All patients underwent TKA assisted by 3D printing after admission. Knee range of motion (ROM), Hospital for Special Surgery (HSS) knee score, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared between preoperation and postoperative 6 months. Complications during the follow-up period were also recorded.Results:All the 18 patients completed a 6-month follow-up. At 6 months after operation, the knee ROM increased significantly from preoperative 85.1°±2.9° to 125.3°±1.3°, the HSS knee score increased significantly from preoperative (39.6±1.4) points to (75.8±1.8) points, and the WOMAC score decreased significantly from preoperative (49.3±1.0) points to (8.3±0.7) points in the 18 patients ( P<0.05). One patient experienced poor wound healing 1 week after operation, and 3 patients developed low-lying patella postoperatively. No such complications as prosthesis loosening, infection, or joint stiffness were reported during the follow-up period. Conclusion:For patients with traumatic osteoarthritis secondary to severe deformity following old tibial plateau fracture, TKA assisted by 3D printing can significantly improve their knee ROM and restore their limb function, but lead to no serious complications.

Objective To explore the therapeutic effect of microsurgical vascular decompression(MVD)under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary trigeminal neuralgia(TN),and its impacts on prognosis.Methods 108 primary TN patients from November 2021 to November 2023 were retrospectively selected and grouped into combined group and control group based on the surgical plan,with 54 cases in each group.The control group received MVD treatment under the microscope,while the combined group received complete neuroendoscopic MVD combined with nerve combing surgery.The total effective rate,pain degree,stress indicators,quality of life,and complications were compared between the two groups.Results The total effective rate of the combined group(96.30%)was greatly higher than that of the control group(83.33%),the difference was statistically significant(P<0.05).The visual analogue scale(VAS)scores of both groups after surgery were significantly lower than those before surgery,and the combined group was lower than the control group,the differences were statistically significant(P<0.05).After surgery,the levels of norepinephrine(NE),superoxide dismutase(SOD),and cortisol(Cor)increased in both groups compared with those before surgery,but the combined group was greatly lower than that of the control group,the differences were statistically significant(P<0.05).The generic quality of life inventory-74(GQOL-74)scores in both groups after surgery were significantly higher than those before surgery,and the combined group was higher than the control group,the differences were statistically significant(P<0.05).There was no difference of the total complication rate between the two groups(P>0.05).Conclusion MVD under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary TN,can relieve pain,reduce stress response and improve the quality of life of patients.It is worthy of clinical promotion and application.

Objective:To improve the understanding of recurrent adult Langerhans cell histiocytosis complicated with diabetes insipidus.Methods:The clinical data of 1 patient with recurrent adult Langerhans cell histiocytosis complicated with diabetes insipidus admitted to the First Affiliated Hospital of Shihezi University in January 2024 was collected. Its disease characteristics, effectiveness and safety of treatment scheme were analyzed, and literatures were reviewed.Results:The 42-year-old female patient was diagnosed as Langerhans cell histiocytosis in June 2021. After treated with cytarabine, the symptoms improved and the patient achieved sustained remission. In January 2024, the patient was admitted to the hospital due to pain in the middle part of the front chest. The PET-CT results indicated disease progression, which was manifested by new bone destruction, enlarged lymph nodes, and increased nocturnal urination, with urine volume of 3-5 L within 24 h. Based on the clinical manifestations such as cranial bone lesions, periorbital soft tissue lesions, and enlarged lymph nodes at onset, multiple systems and multiple foci involvement was considered. The diagnosis of combined diabetes insipidus was confirmed through the water deprivation and pressure test. After MACOP-B regimen (doxorubicin liposome, cyclophosphamide, vincristine, bleomycin, prednisone), the patient's bone pain was completely relieved, and no serious complications occurred.Conclusions:Recurrent adult Langerhans cell histiocytosis complicated with diabetes insipidus is rare; MACOP-B regimen is safe and effective in treatment of the disease.

ObjectiveTo investigate the regulatory effect of icariin （ICA） on transforming growth factor-β₁ （TGF-β₁）/Smad pathway in bone microvascular endothelial cells （BMECs） and the effect on autophagy in BMECs. MethodsBMECs were isolated and cultured， and the cell types were identified by immunofluorescence. Cells were divided into the control group， model group （0.1 g·L^-1 methyl prednisolone）， ICA group （0.1 g·L^-1 methyl prednisolone +1×10^-5 mol·L^-1 ICA）， and TGF-β inhibitor group （0.1 g·L^-1 methyl prednisolone +1×10^-5 mol·L^-1 ICA +1×10^-5 mol·L^-1 LY2157299）. Transmission electron microscopy was used to observe the ultrastructure and autophagosome number of BMECs. Autophagy double-standard adenovirus was used to monitor the confocal autophagy flow generation of each cell. Real-time quantitative polymerase chain reaction （Real-time PCR） and Western blot were used to detect the gene and protein expression of autophagy in the TGF-β₁/ Smad pathway. ResultsAfter cell separation culture， platelet endothelial cell adhesion molecule （CD31） and von willebrand factor （vWF） immunofluorescence identified BMECs. Transmission electron microscopy showed that the cell membrane was damaged， and the nucleus was pyknotic and broken in the model group. Compared with the model group， the ICA group had complete cell membranes， clear structures， with autophagy-lysosome sparsely distributed. The confocal photo showed that BMECs had autophagosomes and autophagy-lysosomes， and the autophagy expression of the ICA group was similar to that of the blank group. Compared with the blank group， in the model group and the LY2157299 group， autophagosomes and autophagy-lysosomes were barely seen in the autophagy flow. Compared with the blank group， the mRNA and protein expressions of autophagy effector protein 1 （Beclin1） and microtubule-associated protein 1 light chain 3B （LC3B） in the model group were significantly decreased （P<0.01）， and those of ubiquitin-binding protein （p62） were significantly increased （P<0.01）. The mRNA expression of TGF-β₁， Smad homolog 2 （Smad2）， and Smad homolog 3 （Smad3） decreased （P<0.05， P<0.01）. The protein expressions of TGF-β₁， p-Smad2， and p-Smad3 were significantly decreased （P<0.01）. Compared with those of the model group， the mRNA and protein expression of Beclin1 and LC3B in BMECs of the ICA group increased （P<0.01）， and those of p62 significantly reduced （P<0.01）. The mRNA expression of TGF-β₁， Smad2， and Smad3 increased significantly （P<0.01）. The protein expression of TGF-β₁， p-Smad2， and p-Smad3 increased significantly （P<0.01）. Compared with those in the model group， the mRNA and protein expressions of Beclin1， LC3B， and p62 in the inhibitor group were not statistically significant. The expression of key genes and proteins of the TGF-β₁ pathway in the inhibitor group was not statistically significant. ConclusionICA can promote glucocorticoid-induced autophagy expression of BMECs， and its mechanism may be related to activating the TGF-β₁/Smad signaling pathway.