Objective:To evaluate the shoulder functions of four groups of patients who underwent different kinds of neck dissections.Methods:40 patients who underwent neck dissection were included,7 patients preserved both accessory nerve and the cervical branches,8 preserved accessory nerve,11 preserved cervical branches and 14 sacrificed both of them.All patients were assessed subjectively at 2 weeks and 6 months after operation,using a questionnaire and an electromyograghy method.Results:The patients whose accessory nerves were preserved had a significant functional rehabilitation of the shoulder,while those who preserved only the cervical branches had a better result than the RND 6 months postoperation.Conclusion: Preservation of the branches from C2-C4 to trapezius muscle during the modified neck dissection should be taken into consideration to improve shoulder functions.

Objective To explore the influence of individualized nursing intervention on life quality of patients with rheumatoid arthritis. Methods 60 patients were divided into the intervention group and the control group with 30 cases in each group. The intervention group adopted individualized nursing projects according to the influencing factors of life quality based on routine nursing. The control group received routine nursing only. The life quality of the two groups was appraised by inventory before and after intervention. Results The status such as physiological function, mental function, social function and self-recognized health in the intervention group was greatly ameliorated and was statistically different from that in the control group(P＜0.05).Conclusion Individualized nursing intervention could dramatically improve the life quality of patients with rheumatoid arthritis

Objective To explore the effect of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism,environmental factor and their interactions on antidepressant treatment.Methods 340 patients of major depressive disorder (MDD) who met the diagnosis criteria of MDD ( DSM-Ⅳ Axis Ⅰ) were recruited.280 patients of them were finished 12 weeks antidepressant treatment.The severity of depression was measured with the Hamilton Depression Rating Scale (HDRS) before and after 12 weeks antidepressant treatment.Childhood Trauma Questionnaire,28-item Short Form (CTQ-SF) and Life Events Scale (LES) were used to evaluate childhood adverse and life stress before onset.Genotyping of BDNF Val66Met polymorphism was detected by Illumina GoldenGate assays.Results Male patients proportion were significantly higher in non-remitters than remitters (P =0.008 ).After adjusting by gender, the frequencies of genotype and allele for the BDNF Val66Met polymorphism were no significant difference between remitters (AA: AG: GG = 28: 79: 40, A:G = 135:159 ) and non-remitters (AA: AG: GG = 29:81:23 ,A: G = 139:127 ) (P ＞0.05 ).There was no significant difference of CTQ scores and LES scores between the two groups (P＞0.05 ).The regression analysis showed that social intercourse problem and age were the risk factor for the severity of depression.The gender, HDRS baseline scores and mental disorder family history were associated with the efficacy of 12 weeks antidepressant.However,there was no significantly relationship between the interaction of BDNF Val66Met polymorphism and environment with the antidepressant treatment.Conclusion The older men with the mental disorder family history, severe depression symptom would be less-response to antidepressant treatment.However, BDNF Val66Met polymorphism, childhood trauma, life events stress and the interaction of BDNF Val66Met polymorphism and environment have no significantly effect on the 12 weeks antidepressant treatment.

Objective:To evaluate the upper airway dimension changes in mandibular prognathism accompanied with maxillary retrognathism patients treated with bimaxillary orthognathic surgery by spiral CT.Methods:The data of patients with mandibular prognathism accompanied with maxillary retrognathism who underwent bimaxillary surgery in the Department of Oral and Maxillofacial Surgery of Nanjing Stomatological Hospital, Medical School of Nanjing University from May 2017 to October 2020 were retrospectively analyzed. The surgical method was LeFort Ⅰ osteotomy and bilateral sagittal split mandibular osteotomy. The patients were divided into 2 groups based on the sagittal setback distance of the supramentale(in group A, the setback distance of the supramentale was more than 5 mm; in group B, the setback distance of the supramentale was less than or equal to 5 mm). Spiral CT data were collected 1 week before surgery(T0), 1 month after surgery(T1), and 6-12 months after surgery(T2). Three-dimensional model reconstruction was performed. The airway cross-sectional measurements, length and volumes in T0, T1 and T2 were measured. The effect of bimaxillary orthognathic surgery on upper airway of the patients was evaluated quantitatively. We performed repeated measures analysis of variance to compare the differences of upper airway among T0, T1 and T2 in the same group. The Bonferroni method was used for multiple comparisons if the difference was statistically significant(α=0.017). We used two-factor repeated measures analysis of variance to compare the differences of the upper airway change trend between the two groups.Results:A total of 30 patients were included, including 15 patients in group A, 5 males and 10 females[aged: (21.2±2.3) years]; and 15 patients in group B, 7 males and 8 females[aged: (23.6±2.4) years]. The cross-section area and sagittal diameter of lower velopharyngeal plane(Lvp), the glossopharynx airway volume and total upper airway volume: group A decreased significantly at T1, and did not return to T0 level at T2(all P<0.017); group B decreased significantly at T1(all P<0.017), and returned to T0 level at T2(all P>0.017); the change trend of these indexes between the two groups was statistically significant(all P<0.05). The airway length of the glossopharynx and the total upper airway: group A increased significantly at T1 and T2(both P<0.017); group B had no significant changes at T1 or T2(both P>0.017); the change trend of these two indexes between the two groups was statistically significant(both P<0.05). Conclusions:The glossopharynx airway volume and total upper airway volume decreased in mandibular prognathism accompanied with maxillary retrognathism patients after bimaxillary orthognathic surgery. If the setback distance of the mandible is less than or equal to 5 mm, they can probably return to the preoperative level 6-12 months after surgery. If the setback distance of the mandible is more than 5 mm, they can not return to the preoperative level 6-12 months after surgery.

Objective:To evaluate the upper airway dimension changes in mandibular prognathism accompanied with maxillary retrognathism patients treated with bimaxillary orthognathic surgery by spiral CT.Methods:The data of patients with mandibular prognathism accompanied with maxillary retrognathism who underwent bimaxillary surgery in the Department of Oral and Maxillofacial Surgery of Nanjing Stomatological Hospital, Medical School of Nanjing University from May 2017 to October 2020 were retrospectively analyzed. The surgical method was LeFort Ⅰ osteotomy and bilateral sagittal split mandibular osteotomy. The patients were divided into 2 groups based on the sagittal setback distance of the supramentale(in group A, the setback distance of the supramentale was more than 5 mm; in group B, the setback distance of the supramentale was less than or equal to 5 mm). Spiral CT data were collected 1 week before surgery(T0), 1 month after surgery(T1), and 6-12 months after surgery(T2). Three-dimensional model reconstruction was performed. The airway cross-sectional measurements, length and volumes in T0, T1 and T2 were measured. The effect of bimaxillary orthognathic surgery on upper airway of the patients was evaluated quantitatively. We performed repeated measures analysis of variance to compare the differences of upper airway among T0, T1 and T2 in the same group. The Bonferroni method was used for multiple comparisons if the difference was statistically significant(α=0.017). We used two-factor repeated measures analysis of variance to compare the differences of the upper airway change trend between the two groups.Results:A total of 30 patients were included, including 15 patients in group A, 5 males and 10 females[aged: (21.2±2.3) years]; and 15 patients in group B, 7 males and 8 females[aged: (23.6±2.4) years]. The cross-section area and sagittal diameter of lower velopharyngeal plane(Lvp), the glossopharynx airway volume and total upper airway volume: group A decreased significantly at T1, and did not return to T0 level at T2(all P<0.017); group B decreased significantly at T1(all P<0.017), and returned to T0 level at T2(all P>0.017); the change trend of these indexes between the two groups was statistically significant(all P<0.05). The airway length of the glossopharynx and the total upper airway: group A increased significantly at T1 and T2(both P<0.017); group B had no significant changes at T1 or T2(both P>0.017); the change trend of these two indexes between the two groups was statistically significant(both P<0.05). Conclusions:The glossopharynx airway volume and total upper airway volume decreased in mandibular prognathism accompanied with maxillary retrognathism patients after bimaxillary orthognathic surgery. If the setback distance of the mandible is less than or equal to 5 mm, they can probably return to the preoperative level 6-12 months after surgery. If the setback distance of the mandible is more than 5 mm, they can not return to the preoperative level 6-12 months after surgery.

Surgical resection with adequate margins is an essential component of the treatment for patients with oral squamous cell carcinoma (OSCC). A distance of 5 mm or more between healthy tissue to the tumor front is generally accepted as a safe margin. It is very important for surgeons to precisely evaluate the resection area of tumor both pre- and intra-operatively and try to achieve a safe margin, which will result in a decreased risk of local recurrence. The relationship of surgical margin status to patients' prognosis, and factors which will affect surgical margin distance demand are discussed in this paper. We recommend that adequate margins evaluation should take consideration of many factors such as anatomical location, depth of tumor invasion, pattern of tumor invasion, mucosal dysplasia grade and so on. With the development of molecular biology, surgical margin study at molecular level can give us a new strategy to evaluate its adequacy.

Objective:To evaluate the feasibility of three-dimensional measurement in the study of jaw stability in patients with skeletal Class Ⅲ malocclusion after orthognathic surgery, and to analysis the jaw relapse of risk factors.Methods:Patients with skeletal Class Ⅲ malocclusion who underwent bimaxillary surgery in Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, from July 2019 to December 2019 were included. CT data at 1 week preoperative (T0), 3 days after surgery (T1), and 6-12 months after surgery (T2) were collected respectively. The 3D model was constructed by 3D Slicer, and the movement of maxilla and mandible after surgery was measured by Geomagic Qualify. The paired student t-test, Wilcoxon rank sum test and Pearson correlation was performed in this study. P<0.05 was considered statistically significant. Results:A total of 15 patients were included, including 5 males and 10 females. The age is from 18 to 25 year old. The average age is 21.3. In horizontal direction, the RGo coordinate has significant difference between T1[(-50.47±4.44) mm] and T2[(-50.06±4.66) mm] ( t=2.948, P=0.011), while all other landmarks have no significantly statistic difference. In the anteroposterior direction, there were significant differences for all maxillary landmarks between T1 with T2 ( P< 0.05). The relapse rates at point of A, Rp, Lp, RMF and LMF were 37.7 %(1.36/3.61), 35.7%(1.15/3.22), 25.4%(0.84/3.31), 26.9%(0.84/3.12), 14.0%(0.41/2.92), respectively. There were significant differences in all mandibular landmarks between T1 with T2 ( P<0.01). The relapse rates at point of B, Pog, Gn, Me, RGo and LGo were respectively 36.9%(1.75/4.74), 53.9%(2.45/4.55), 55.5%(2.72/4.90), 61.7%(2.90/4.70), 85.3%(2.20/2.58), 93.4%(2.40/2.57). The distance of skeletal relapse movement was significantly correlated with the surgery-induced distance ( r: 0.572-0.736, P<0.05). In the vertical direction, there was no significant difference of maxillary landmarks between T1 with T2 ( P > 0.05). For B, Pog, Gn and Me points, there were statistically significant differences ( P< 0.01). From T1 to T2, the mandible has tendency of counter-clockwise rotation. Conclusions:The three-dimensional measurement can accurately reflect the three-dimensional changes of jaw in patients with skeletal Class Ⅲ malocclusion after bimaxillary surgery. No significantly statistic relapse was in horizontal direction, while obvious relapse was occurred in anteroposterior directions. The counter-clockwise rotation of mandible was shown in vertical direction.

Objective:To evaluate the feasibility of three-dimensional measurement in the study of jaw stability in patients with skeletal Class Ⅲ malocclusion after orthognathic surgery, and to analysis the jaw relapse of risk factors.Methods:Patients with skeletal Class Ⅲ malocclusion who underwent bimaxillary surgery in Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, from July 2019 to December 2019 were included. CT data at 1 week preoperative (T0), 3 days after surgery (T1), and 6-12 months after surgery (T2) were collected respectively. The 3D model was constructed by 3D Slicer, and the movement of maxilla and mandible after surgery was measured by Geomagic Qualify. The paired student t-test, Wilcoxon rank sum test and Pearson correlation was performed in this study. P<0.05 was considered statistically significant. Results:A total of 15 patients were included, including 5 males and 10 females. The age is from 18 to 25 year old. The average age is 21.3. In horizontal direction, the RGo coordinate has significant difference between T1[(-50.47±4.44) mm] and T2[(-50.06±4.66) mm] ( t=2.948, P=0.011), while all other landmarks have no significantly statistic difference. In the anteroposterior direction, there were significant differences for all maxillary landmarks between T1 with T2 ( P< 0.05). The relapse rates at point of A, Rp, Lp, RMF and LMF were 37.7 %(1.36/3.61), 35.7%(1.15/3.22), 25.4%(0.84/3.31), 26.9%(0.84/3.12), 14.0%(0.41/2.92), respectively. There were significant differences in all mandibular landmarks between T1 with T2 ( P<0.01). The relapse rates at point of B, Pog, Gn, Me, RGo and LGo were respectively 36.9%(1.75/4.74), 53.9%(2.45/4.55), 55.5%(2.72/4.90), 61.7%(2.90/4.70), 85.3%(2.20/2.58), 93.4%(2.40/2.57). The distance of skeletal relapse movement was significantly correlated with the surgery-induced distance ( r: 0.572-0.736, P<0.05). In the vertical direction, there was no significant difference of maxillary landmarks between T1 with T2 ( P > 0.05). For B, Pog, Gn and Me points, there were statistically significant differences ( P< 0.01). From T1 to T2, the mandible has tendency of counter-clockwise rotation. Conclusions:The three-dimensional measurement can accurately reflect the three-dimensional changes of jaw in patients with skeletal Class Ⅲ malocclusion after bimaxillary surgery. No significantly statistic relapse was in horizontal direction, while obvious relapse was occurred in anteroposterior directions. The counter-clockwise rotation of mandible was shown in vertical direction.

Objective: To investigate the feasibility and accuracy using digital surgical guide to position the jaws in bimaxillary orthognathic surgery. Methods: 16 patients with dento-maxillofacial deformity were included from January to December 2018 in Nanjing Stomatological Hospital. There were 10 males and 6 females, all of which were skeletal Ⅲ deformity. The mean age was 21.3 years old (16 to 28 years). They were divided into digital guide (group A) and traditional model surgery (group B) according to the treatment sequence. All patients underwent both Lefort Ⅰ osteotomy and bilateral ascending sagittal split. Virtual surgery was performed and digital three-dimensional surgical template was printed before surgery in group A. During the operation, digital surgical templates were used to position maxilla and mandible. The accuracy was evaluated by generating color distribution map of deviation grade, which was imaging fusion of virtual surgical jaw position and actual surgical jaw position to measure the deviation distance of each marker point one week after surgery. The deviations between the preoperative design and the actual operation were compared with the t-test respectively in group A and group B, and the independent sample t test was chosen to compared the accuracy of reduction between the two groups in sagittal, horizontal, and vertical directions. Results: All 16 patients had primary healing. The maximum deviation of the patients in group A was at U6. The deviation direction was vertical, and the deviation distance was (1.67±0.32) mm. In group A, the deviation distances of all marker points in the sagittal, horizontal and vertical directions were (0.55±0.26) mm (t=2.985, P=0.205), (0.62±0.20) mm (t=2.672, P=0.193) and (1.07±0.62) mm (t=5.122, P=0.823), respectively. The result in group B was (0.63±0.28) mm(t=3.397, P=0.307), (0.71±0.42) mm (t=4.438, P=0.541) and (1.82±0.36) mm (t=1.115, P=0.021) in these directions. There was no significant difference between two groups in the sagittal (t=4.704, P=0.763) and lateral (t=4.008, P=0.615) directions, and the difference in the vertical (t=1.432, P=0.037) direction was statistically significant. Conclusions The digital guides were feasible to position jaws accurately in orthognathic surgery.