OBJECTIVES: This study aims to compare the effects of two orthodontic treatment modalities for skeletal class Ⅲ malocclusion on specific changes in airway volume, morphology, palatal angle, mandibular rotation, and bone displacement. Results provide scientific evidence for the selection of orthodontic treatment plans and reduce the risk of developing obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Thirty-six patients diagnosed with skeletal class Ⅲ malocclusion at the Department of Orthodontics, the Affiliated Stomatological Hospital of Nanjing Medical University from September 2018 to December 2023 were divided into two groups: orthodontic-orthognathic treatment group (18 patients) and camouflage orthodontic treatment group (18 patients). Changes in airway volume, cross-sectional area, palatal angle, mandibular, and tongue positions were observed through pre- and post-operative cone beam computed tomography and 3D cephalometric measurements. RESULTS: In the camouflage orthodontic treatment group, nasopharyngeal volume and oropharyngeal volume statistically increased after treatment (P<0.05). In the orthodontic-orthognathic treatment group, changes in nasopharyngeal volume, nasopharyngeal airway, distance from posterior tongue to pharyngeal wall, palatal angle, mandibular rotation, and hyoid bone displacement were statistically significant after surgery (P<0.05). In the comparison between the two groups after treatment, changes in the distance from posterior tongue to pharyngeal wall, palatal angle, and distance from hyoid bone to sella turcica point were statistically significant (P<0.05). CONCLUSIONS Patients in the orthodontic-orthognathic treatment group showed significantly greater changes in oropharyngeal cross-sectional area, palate angle, and tongue position compared with patients in the camouflage orthodontic treatment group. As individuals susceptible to OSAHS often exhibit mandibular retrusion and decreased minimum airway cross-sectional area, special attention should be paid to airway morphology changes when adopting orthodontic-orthognathic treatment to avoid adverse consequences.
Humans ; Hyoid Bone/diagnostic imaging* ; Malocclusion, Angle Class III/therapy* ; Male ; Female ; Cone-Beam Computed Tomography ; Cephalometry ; Orthodontics, Corrective/methods* ; Adult ; Mandible ; Pharynx/diagnostic imaging* ; Sleep Apnea, Obstructive/etiology* ; Orthognathic Surgical Procedures

Objective:To analyze the biological parameters of the anterior segment of age-related cataracts patients with or without zonular weakness with the new generation of sweep-source anterior optical coherence tomography (OCT) device CASIA2 to provide a basis for the diagnosis of zonular weakness.Methods:A case-control study was conducted.A total of 158 cases (186 eyes) of patients with age-related cataracts having zonular weakness as a zonular weakness group, and 80 cases (80 eyes) of cataract with age-related cataracts without zonular weakness as a normal zonule group were enroll from June 2022 to June 2023 at Beijing Tongren Hospital.All patients underwent routine preoperative ophthalmological examination including slit lamp microsopy, IOLMaster 700, ocular B-ultrasound and OCT.The anterior chamber depth (ACD), anterior chamber volume (ACV), lens thickness (LT), lens vault (LV), anterior chamber angle opening distance at 750 μm (AOD750), lens decentration and tilt, radius of curvature of the anterior lens surface (RAL), and radius of curvature of the posterior lens surface (RPL) of patients were measured with CASIA2 and compared between the two groups.The relationship between zonular weakness and anterior chamber parameters and lens parameters was evaluated by logistic regression analysis.This study followed the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital (No.TRECKY2018-049), and all enrolled patients signed the informed consent form.Results:In the zonular weakness group, ACD, ACV, RAL, and AOD750 were (2.34±0.56)mm, (85.05±40.19)mm 3, 7.52 (7.13, 8.08)mm, and 0.27 (0.07, 0.30)mm, respectively, which were smaller than (3.13±0.38)mm, (127.75±38.15)mm 3, 9.28(8.51, 9.76)mm, and 0.52 (0.31, 0.65)mm in the normal zonule group, with statistically significant differences (all P<0.05).LT and LV in the zonular weakness group were (5.14±0.45)mm and (1.22±0.53)mm, respectively, which were larger than (4.27±0.52)mm and (0.32±0.30)mm in the normal zonule group, and the differences were statistically significant (both P<0.05).Magnitude of lens decentration and tilt in the zonular weakness were 0.34 (0.13, 0.45)mm and 6.44 (3.67, 7.32)°, respectively, which were significantly larger than 0.19 (0.12, 0.25)mm and 4.88 (3.85, 5.65)° in the normal zonule group (both P<0.05).No obvious pattern was found in the direction of decentration and tilt.Logistic regression analysis showed that LV and lens decentration were risk factors of zonular weakness (odds ratios [ OR]=706.170, 335.339; both P<0.05), and RAL was a protective factor of zonular weakness ( OR=0.239, P<0.05). Conclusions:Age-related cataract patients with zonular weakness often present with a decrease in ACV due to increased anterior convexity of the lens.Decreased RAL, increased lens decentration and elevated LV are risk factors for zonular weakness.

Objective:To analyze the biological parameters of the anterior segment of age-related cataracts patients with or without zonular weakness with the new generation of sweep-source anterior optical coherence tomography (OCT) device CASIA2 to provide a basis for the diagnosis of zonular weakness.Methods:A case-control study was conducted.A total of 158 cases (186 eyes) of patients with age-related cataracts having zonular weakness as a zonular weakness group, and 80 cases (80 eyes) of cataract with age-related cataracts without zonular weakness as a normal zonule group were enroll from June 2022 to June 2023 at Beijing Tongren Hospital.All patients underwent routine preoperative ophthalmological examination including slit lamp microsopy, IOLMaster 700, ocular B-ultrasound and OCT.The anterior chamber depth (ACD), anterior chamber volume (ACV), lens thickness (LT), lens vault (LV), anterior chamber angle opening distance at 750 μm (AOD750), lens decentration and tilt, radius of curvature of the anterior lens surface (RAL), and radius of curvature of the posterior lens surface (RPL) of patients were measured with CASIA2 and compared between the two groups.The relationship between zonular weakness and anterior chamber parameters and lens parameters was evaluated by logistic regression analysis.This study followed the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital (No.TRECKY2018-049), and all enrolled patients signed the informed consent form.Results:In the zonular weakness group, ACD, ACV, RAL, and AOD750 were (2.34±0.56)mm, (85.05±40.19)mm 3, 7.52 (7.13, 8.08)mm, and 0.27 (0.07, 0.30)mm, respectively, which were smaller than (3.13±0.38)mm, (127.75±38.15)mm 3, 9.28(8.51, 9.76)mm, and 0.52 (0.31, 0.65)mm in the normal zonule group, with statistically significant differences (all P<0.05).LT and LV in the zonular weakness group were (5.14±0.45)mm and (1.22±0.53)mm, respectively, which were larger than (4.27±0.52)mm and (0.32±0.30)mm in the normal zonule group, and the differences were statistically significant (both P<0.05).Magnitude of lens decentration and tilt in the zonular weakness were 0.34 (0.13, 0.45)mm and 6.44 (3.67, 7.32)°, respectively, which were significantly larger than 0.19 (0.12, 0.25)mm and 4.88 (3.85, 5.65)° in the normal zonule group (both P<0.05).No obvious pattern was found in the direction of decentration and tilt.Logistic regression analysis showed that LV and lens decentration were risk factors of zonular weakness (odds ratios [ OR]=706.170, 335.339; both P<0.05), and RAL was a protective factor of zonular weakness ( OR=0.239, P<0.05). Conclusions:Age-related cataract patients with zonular weakness often present with a decrease in ACV due to increased anterior convexity of the lens.Decreased RAL, increased lens decentration and elevated LV are risk factors for zonular weakness.

Periodontitis imparting the increased risk of atherosclerotic cardiovascular diseases is partially due to the immune subversion of the oral pathogen, particularly the Porphyromonas gingivalis (P. gingivalis), by inducing apoptosis. However, it remains obscure whether accumulated apoptotic cells in P. gingivalis-accelerated plaque formation are associated with impaired macrophage clearance. Here, we show that smooth muscle cells (SMCs) have a greater susceptibility to P. gingivalis-induced apoptosis than endothelial cells through TLR2 pathway activation. Meanwhile, large amounts of miR-143/145 in P.gingivalis-infected SMCs are extracellularly released and captured by macrophages. Then, these miR-143/145 are translocated into the nucleus to promote Siglec-G transcription, which represses macrophage efferocytosis. By constructing three genetic mouse models, we further confirm the in vivo roles of TLR2 and miR-143/145 in P. gingivalis-accelerated atherosclerosis. Therapeutically, we develop P.gingivalis-pretreated macrophage membranes to coat metronidazole and anti-Siglec-G antibodies for treating atherosclerosis and periodontitis simultaneously. Our findings extend the knowledge of the mechanism and therapeutic strategy in oral pathogen-associated systemic diseases.
Animals ; Mice ; Endothelial Cells ; Toll-Like Receptor 2 ; Macrophages ; Apoptosis ; Atherosclerosis ; Myocytes, Smooth Muscle ; MicroRNAs

Objective:To investigate the application value of three-dimensional (3D) printing technology assisted laparoscopic anatomic liver resection of segment 8 (Lap-S8).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 liver cancer patients including 7 cases with hepatocellular carcinoma and 1 case with intrahepatic cholangio-carcinoma who underwent 3D printing technology assisted Lap-S8 in the Hunan Provincial People′s Hospital from January 2019 to December 2020 were collected. There were 7 males and 1 female, aged from 49.0 to 80.0 years, with a median age of 56.5 years. Of the 8 patients, 6 cases underwent laparoscopic anatomic liver resection of the entire segment 8, 1 case underwent laparoscopic anatomic liver resection of ventral subsegmental of the segment 8 and 1 case underwent laparoscopic anatomic liver resection of dorsal subsegmental of the segment 8. 3D printing technology was used to assist preoperative evaluation and intraoperative navigation for all 8 patients. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination, internet or telephone interview to detect survival and tumor recurrence of patients after operation up to March 2021. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations: all the 8 patients underwent 3D printing technology assisted Lap-S8 successfully, without conversion to open surgery. The operation time, hepatic portal occlusion time and volume of intraoperative blood loss of the 8 patients were (216±41)minutes, (56±11)minutes and 75 mL(range, 50 to 300 mL), respectively. There was no intraoperative blood transfusion in 8 patients, and the surgical margin of the 8 patients was negative. (2) Postoperative situations: the duration of postoperative hospital stay of the 8 patients were (9±3)days. There was no complication such as postoperative hemorrhage, biliary fistula, liver abscess or abdominal infection occurred. (3) Follow-up: all the 8 patients were followed up for 3.0?24.0 months, with a median follow-up time of 12.5 months. During the follow-up, 1 of 8 patients with preoperative diagnosis of recurrent hepatocellular carcinoma developed tumor recurrence at 5 months after operation. The patient underwent laparoscopic surgery followed with the transcatheter arterial chemoembolization and target therapy, and survived with tumor. There was no tumor recurrence in the other 7 patients.Conclusion:3D printing technology assisted Lap-S8 is safe and feasible.

Objective: To investigate the safety and feasibility of longitudinal transpancreatic U-sutures invaginated pancreatojejunostomy (Chen′s pancreaticojejunostomy technique) in laparoscopic pancreaticoduodenectomy (LPD) . Methods: Clinical data of 116 consecutive patients who underwent LPD using Chen′s pancreaticojejunostomy technique in Hunan Provincial People′s Hospital from May 2017 to December 2018 were retrospectively analyzed. Among these patients, 66 were males and 50 were females. The median age was 58 years old (32-84 yeas old). All 116 patients underwent pure laparoscopic whipple procedure with Child reconstruction method, using Chen′s pancreaticojejunostomy technique. The intraoperative and postoperative data of patients were analyzed. Results: All 116 patients underwent LPD successfully. The mean operative time was (260.3±33.5) minutes (200-620 minutes). The mean time of pancreaticojejunostomy was (18.2±7.6) minutes (14-35 minutes) . The mean time of hepaticojejunostomy was (14.6±6.3) minutes (10-25 minutes). The mean time of gastrojejunostomy was (12.0±5.5) minutes (8-20 minutes). The mean estimated blood loss was (106.0±87.6) ml (20-800 ml). Postoperative complications were: 11.2% (13/116) of cases had postoperative pancreatic fistula (POPF) , including 10.3% (12/116) of biochemical fistula and 0.9% (1/116) of grade B POPF, no grade C POPF occurred; 10.3% (12/116) had gastrojejunal anastomotic bleeding; 3.4% (4/116) had hepaticojejunal anastomotic fistula; 3.4% (4/116) had delayed gastric emptying; 4.3% (5/116) had localized abdominal infection; 12.1% (14/116) had pulmonary infection; postoperative mortality were 0(0/116) and 1.7% (2/116) within 30 days and 90 days, respectively. One patient died of massive abdominal bleeding secondary to Gastroduodenal artery pseudoaneurysm rupture, the other patient died of extensive tumor recurrence and metastasis after surgery. Conclusions Chen′s pancreaticojejunostomy technique is safe and feasible for LPD.It is an option especially for surgeons who have not completed the learning curve of LPD.

Objective: To explore the safety and feasibility of laparoscopic liver resection in the treatment of intrahepatic cholangiocarcinoma (ICC). Methods: The retrospective study was adopted. The clinical data of 58 patients with ICC who underwent laparoscopic liver resection in the Department of Hepatobiliary Minimally Invasive Surgery of the First Affiliated Hospital of Hu′nan Normal University were collected From January 2016 to December 2018. Among them, 34 patients were males and 24 were females, aged from 34 to 71 years with a median age of 54 years. Observation indicators: (1) Surgical treatment: surgical methods, operation time, intraoperative blood loss, intraoperative blood transfusion rate, intraoperative hepatic portal blocking time, conversion rate, postoperative complications, postoperative hospital stay. (2) Postoperative pathological conditions. (3) Follow-up.Follow-up visits were conducted using an outpatient clinic and telephone to understand patient survival after surgery. The follow-up period was until June 2019. Measurement data with normal distribution were expressed as (Mean±SD), count data was expressed as frequency and percentage. Results: A total of 58 patients were included in this study, of which 48 patients underwent laparoscopic radical surgical resection of intrahepatic cholangiocarcinoma and 10 patients underwent laparoscopic conversion to laparotomy. (1) Surgical treatment: laparoscopic resection of the left liver (segments Ⅱ, Ⅲ and Ⅳ), laparoscopic resection of the right liver (segments Ⅴ, Ⅵ, Ⅶ and Ⅷ), laparoscopic resection of the right posterior lobe (segments Ⅵ and Ⅶ), laparoscopic extended resection of the right posterior lobe, laparoscopic resection of the middle lobe (Ⅳ, Ⅴ and Ⅷ), laparoscopic resection of the V and Ⅵ, laparoscopic resection of the left liver (segments Ⅱ, Ⅲ and Ⅳ) combined with the caudate lobe (segments I and Ⅸ), laparoscopic extended left hemihepatectomy, laparoscopic resection of the VI, laparoscopic resection of the Ⅶ and Ⅷ, laparoscopic resection of the left lateral lobe (segments Ⅱ and Ⅲ) and laparoscopic resection of the right hepatic mass; operation time: (320.38±107.68) min; intraoperative blood loss: (262.34±76.06); intraoperative blood loss: 0 (0/58); Intraoperative hepatic portal occlusion time: (48±15) min, the conversion rate was 17.2% (10/58); the incidence of postoperative biliary fistula was 6.8% (4/58), and the patient was discharged after conservative treatment and unobstructed drainage (T-tube vacuum suction); the postoperative gastrointestinal recovery time was (1.84±0.57) d; no other serious complications occurred.Postoperative hospital stay: (9.34±3.39) d; there were no deaths and unplanned surgeries during the perioperative period. (2) Pathological conditions: 32 cases received lymph node dissection during the operation, and 26 cases showed cholangiocarcinoma without lymph node dissection; pathological examination showed that the pathological reports of all tumor margins were negative, and 4 cases showed lymph node dissection and positive lymph node metastasis. (3) Follow-up results: of the 58 patients with ICC, 49 were followed up for 6 to 36 months. The tumor survival time was (4 to 36) months. 28 patients survived without tumor. 17 patients had intrahepatic metastasis with multiple lymph node metastasis. 4 patients were treated with microwave ablation after intrahepatic metastasis was found. 9 patients were lost to follow-up. Conclusion Laparoscopic treatment of intrahepatic cholangiocarcinoma is safe and feasible in experienced centers.

Objective: To assess the safety and feasibility of the application of the laparoscopic modality in the perioperative treatment of central liver tumors. Methods: Collecting all the clinical information of a total of 40 patients with central liver tumors who received laparoscopic resection treatment carried out at Department of Hepatological Surgery of People′s Hospital of Hunan Provincial from January 2016 to December 2018 to take a retrospective review. There were 19 males and 21 females.The age was (59.5±14.5) years (range: 15 to 71 years) . There were 26 cases of primary hepatic carcinoma (24 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma) , 8 cases of hepatic cavernous hemangioma, 1 case of metastatic hepatic carcinoma, 5 cases of hepatocellular adenoma. The maximum diameter of tumors were (6.2±2.9) cm (range: 2 to 13 cm) . The patient′s information about hepatectomy methods, blocking mode and time of blood flow, operation time, intraoperative blood loss, intraoperative blood transfusion rate, post-operative hospitalization time, perioperative reoperation and postoperative complications were collected. Results: A total of 40 patients all were treated with laparoscopic surgery. The surgical procedure was as follows: 2 patients received the right hepatic lobectomy (Ⅴ, Ⅵ, Ⅶ and Ⅷ segments) , 2 patients received the left hepatic lobectomy (Ⅱ, III and Ⅳ segments) , 13 patients received mesohepatectomy (Ⅳ, Ⅰ and Ⅷ segments) , 2 patients received left hepatic trisegmentectomy (Ⅱ, Ⅲ, Ⅳ and Ⅷ segments) , 2 patients received right hepatic trisegmentectomy (Ⅳ, Ⅴ, Ⅵ, Ⅶ and Ⅷ segments) , 7 patients received Ⅷ segmentectomy, 1 patient received Ⅳ segmentectomy, 3 patients received Ⅴ and Ⅷ segmentectomy, 5 patients received hepatic caudate lobe resection (Ⅰ, Ⅸ segments) , and 3 patients received local tumors resection.Pathological results: there were 26 cases of primary hepatic carcinoma (24 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma) , 8 cases of hepatic cavernous hemangioma, 1 case of metastatic hepatic carcinoma, 5 cases of hepatocellular adenoma; the pathological reports of all malignant tumor cases all showed negative incisal edge. The operative time was (333±30) minutes (range: 280 to 380 minutes) ; the intraoperative hepatic portal occlusion period was (58±13) minutes (range: 30 to 90 minutes) ; the intraoperative hemorrhage was (173±129) ml (range: 20 to 600 ml) ; the intraoperative blood transfusion rate was 2.5% (1/40) ; the postoperative incidence of bile leakage was 2.5% (1/40) , the hospital discharge of 1 patient with bile leakage was approved after conservative treatments like T pipe decompression and adequate drainage; there was 1 case of abdominal infection and 1 case of pulmonary infection, both of which were discharged from the hospital with conservative treatments; there were no other serious postoperative complications. The postoperative hospital stay was (10.7±2.7) days (range: 6 to 16 days) ; there were no perioperative mortality and reoperation cases. Conclusion In the centers with abundant laparoscopic hepatectomy experiences, the laparoscopic resection is proved to be safe and feasible in the perioperative treatments of central liver tumors by the highly selective cases, the adequate preoperative assessment and reasonable surgical techniques and approach.

[Abstract] Objective: To investigate the effect of curcumin on angiogenesis in rats with DEN (diethylnitrosamine)-induced HCC (hepatocellular carcinoma) under hypoxia. Methods: Rat HCC was induced by DEN, and its hepatic hypoxia model was established by ligating hepatic artery. The rats with established HCC model were randomly divided into four groups according to digital table method: lipiodol embolization group (group A), lipiodol combined with curcumin embolization group (group B), lipiodol combined with peripheral liver capsule group (group C), lipiodol combined with curcumin and peripheral liver capsule group (group D), with 10 rats in each group. VEGF expression in HCC cells and tissues, microvessel density (MVD), and median survival time (MST) of rats in each group were compared. Results: VEGF protein expression and microvessel density in group B, D were significantly lower than those in A group ( P <0.01), while those in C group had no significant difference compared with group A ( P >0.05). MST in group B, C and D was significantly longer than that in group A ( P <0.05), and the MST in group D was higher than that in group B and C ( P <0.05). Conclusion: Curcumin can inhibit tumor angiogenesis and decrease VEGF expression and MVD in HCC rats under hypoxia, thus further prolong the survival time of the rats.

Objective To explore the role of defoamer enema combined with bellym assage on the colonic preparation in elderly patients with constipation. Methods One hundred patients were divided into two groups by random number table method, the experimental group and the control group with 50 cases each. Patients in the control group were told to drink polyethyleneglycolelectrolytesolution 3000 ml. Patients in the experimental group were told to drink polyethyleneglycolelectrolytesolution 2000 ml. After medicinepre paration, the patients of experimental group were given defoamer enema. After that, they were undertaken counterclockwise massage for10 mins, then massageing clockwise until defecation. Results 14 patients with oral catharsis drugs failed to give up check, 46 cases of intervention group and 40 cases of control group finally complete intestinal preparation and colonoscopy. Intervention group patients after bowel preparation before the incidence of abdominal distension, abdominal pain were 6.52% (3/46), 8.70%(4/46), lower than the control group 65.00% (26/40), 25.00% (10/40), the difference was statistically significant (χ2= 32.74, 4.17, P< 0.05). Percent of pass was 65.22%(30/46) for intestinal preparation intervention group, significantly higher than the control group 35.00% (14/40), the difference was statistically significant (χ2= 7.82, P< 0.05). Intervention group intestinal cleanliness ratings of Ottawa total score was 4.00 (4.00), which was lower than the control group 7.00 (4.50), the difference was statistically significant (Z= 3.80, P< 0.05). Endoscopic check process, the intervention group arrived at the terminal ileum and mirror back time were 7.00 (3.00) and 9.00 (1.00) min, were less than 9.00(6.50) and 10.50 (3.00) min in the control group, the difference was statistically significant (Z= 2.09, 4.53, P< 0.05). Intervention group of colons polyps detection rate was 67.39% (31/46), higher than that of control group 30.00% (12/40), the difference was statistically significant (χ2 = 11.97, P< 0.05). Conclusions The bowel preparation with defoamer enema will enhance the intestinal tract cleaness and the detection rate of polyps in elderly patients with constipation.