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

Objectives:To investigate the application effect of a self-designed transpedicular intravertebral bone grafting device in percutaneous pedicle screw fixation for thoracolumbar fractures,and to evaluate its safety and the role in preventing the"shell"phenomenon.Methods:A retrospective analysis was performed on 49 patients with thoracolumbar fractures who underwent percutaneous pedicle screw fixation combined with intravertebral bone grafting at our hospital from January 2018 to January 2023.Among them,25 patients were treated with a self-designed transpedicular intavertebral bone grafting device[Self-designed device group:8 males,17 females,aged 48.0±9.7 years;Body mass index(BMI)21.6±2.7kg/m2;T11 3 cases,T12 9 cases,L17 cases,L2 6 cases;Thoracolumbar injury classification and severity(TLICS)score 4.3±0.5;AO classification:A3 18 cases,A4 7 cases].The other 24 patients were treated with a conventional technique bone grafting funnel(Conventional technique group:11 males,13 females,aged 48.2±10.7 years;Body mass index 21.4±2.7kg/m2;T11 6 cases,T12 6 cases,L1 8 cases,L2 4 cases;TLICS score 4.3±0.5;AO classification:A3 17 cases,A4 7 cases).There were no statistically significant differences between the two groups in age,gender ratio,body mass index,fracture level,AO classification,or TLICS score(P＞0.05).The total operativetime,graft implantation time,fluoroscopy frequency during bone grafting,intraoperative blood loss,hospital stay,and in-traoperative complications were compared between the two groups.Low back pain was assessed using visual analogue scale(VAS)score,lumbar function was evaluated using Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score preoperatively,at 3 months and 1 year postoperatively.The local kyphotic angle(LKA)and anterior vertebral height ratio(AVHR)were measured and compared preoperatively,immediately postoperatively,at 3 months and 1 year postoperatively.Immediate postoperative CT scan was performed to determine bone graft distribution,assess iatrogenic injuries to the pedicle or anterior vertebral wall,and iden-tify the"shell"phenomenon.Follow-up CT at 1 year postoperatively was performed to evaluate bony fusion and the outcomes of the"shell"phenomenon.Results:All the patients successfully completed the surgery and were followed up for over 12 months(17.0±3.1 months).The self-designed device group was significantly lower in fluoroscopy frequency during bone grafting(11.0±1.5 vs.13.5±1.7,P＜0.05)and longer in graft implan-tation time(15.0±1.7min vs.12.7±1.9min,P＜0.05)than the conventional technique group,but there was no significant difference in total operative time between the two groups(P＞0.05).In the conventional technique group,3 cases(12.5％)had pedicle injuries,9 cases(37.5％)had anterior vertebral wall injuries,and 12 cases(50.0％)had bone graft material leakage;In contrast,the self-designed device group had no pedicle or ante-rior wall injuries,and there were 4 cases(16％)of bone graft leakage.The difference in complication rates be-tween the two groups was statistically significant(P＜0.05).Both groups showed significant improvement in LKA and AVHR immediately postoperatively,at 3 months,and at 1 year compared to preoperative values(P＜0.05).VAS score,ODI,and JOA score also significantly improved at 3 months and 1 year postoperatively compared to preoperative scores(P＜0.05).The"shell"phenomenon occurred in 5 cases in the self-designed device group,with 1 case healed at the 1-year follow-up,which occurred in 8 cases in the conventional technique group,with 2 cases healed at 1 year,and the difference was no statistically significant(P＞0.05).Conclusions:The application of the self-designed minimally invasive transpedicular vertebral bone grafting device in percu-taneous pedicle screw fixation combined with vertebral bone grafting for thoracolumbar fractures can reduce intraoperative fluoroscopy frequency and complications,therefore to improve surgical safety.

Objective To observe the effect of energy CT and color mapping to optimize displaying of ossification after lumbar interbody fusion.Methods A total of 76 patients who underwent lumbar fusion were retrospectively enrolled.According to the way of rescanning CT,the patients were divided into energy CT group(n=30)and traditional CT group(n=46).Subjective scoring of imaging quality of both groups on anatomic details,i.e.ossification of bone graft particles in the interbody fusion zone,cancellous bone growth near the endplate in the vertebral body,bone bridge connecting the interface between the fusion zone and the endplate in the vertebral body,as well as image artifacts were performed using a five-point scale.The image noise(SD value),and radiation dose represented by dose length product(DLP)were measured and compared between groups.Results Compared with traditional CT group,energy CT group had elevated subjective scores for anatomical details(4.50[4.28,4.50]vs.3.80[3.50,4.00])and image artifacts(4.30[4.00,4.50]vs.3.60[3.50,4.00]),while significantly lower SD value(37.22[34.90,38.85]HU vs.57.50[53.30,68.59]HU)and DLP(255.28[177.57,321.26]mGy·cm vs.327.60[298.13,415.95]mGy·cm)(all P＜0.05).Compared with grayscale images,images processed with color mapping demonstrated enhanced visualization of osseous details.Conclusion Energy CT after lumbar fusion could reduce image artifacts and improve the visualization of anatomical details at a lower radiation dose compared to conventional CT,while color mapping might further enhance the clarity of osseous details.

Objectives:To investigate the application effect of a self-designed transpedicular intravertebral bone grafting device in percutaneous pedicle screw fixation for thoracolumbar fractures,and to evaluate its safety and the role in preventing the"shell"phenomenon.Methods:A retrospective analysis was performed on 49 patients with thoracolumbar fractures who underwent percutaneous pedicle screw fixation combined with intravertebral bone grafting at our hospital from January 2018 to January 2023.Among them,25 patients were treated with a self-designed transpedicular intavertebral bone grafting device[Self-designed device group:8 males,17 females,aged 48.0±9.7 years;Body mass index(BMI)21.6±2.7kg/m2;T11 3 cases,T12 9 cases,L17 cases,L2 6 cases;Thoracolumbar injury classification and severity(TLICS)score 4.3±0.5;AO classification:A3 18 cases,A4 7 cases].The other 24 patients were treated with a conventional technique bone grafting funnel(Conventional technique group:11 males,13 females,aged 48.2±10.7 years;Body mass index 21.4±2.7kg/m2;T11 6 cases,T12 6 cases,L1 8 cases,L2 4 cases;TLICS score 4.3±0.5;AO classification:A3 17 cases,A4 7 cases).There were no statistically significant differences between the two groups in age,gender ratio,body mass index,fracture level,AO classification,or TLICS score(P＞0.05).The total operativetime,graft implantation time,fluoroscopy frequency during bone grafting,intraoperative blood loss,hospital stay,and in-traoperative complications were compared between the two groups.Low back pain was assessed using visual analogue scale(VAS)score,lumbar function was evaluated using Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score preoperatively,at 3 months and 1 year postoperatively.The local kyphotic angle(LKA)and anterior vertebral height ratio(AVHR)were measured and compared preoperatively,immediately postoperatively,at 3 months and 1 year postoperatively.Immediate postoperative CT scan was performed to determine bone graft distribution,assess iatrogenic injuries to the pedicle or anterior vertebral wall,and iden-tify the"shell"phenomenon.Follow-up CT at 1 year postoperatively was performed to evaluate bony fusion and the outcomes of the"shell"phenomenon.Results:All the patients successfully completed the surgery and were followed up for over 12 months(17.0±3.1 months).The self-designed device group was significantly lower in fluoroscopy frequency during bone grafting(11.0±1.5 vs.13.5±1.7,P＜0.05)and longer in graft implan-tation time(15.0±1.7min vs.12.7±1.9min,P＜0.05)than the conventional technique group,but there was no significant difference in total operative time between the two groups(P＞0.05).In the conventional technique group,3 cases(12.5％)had pedicle injuries,9 cases(37.5％)had anterior vertebral wall injuries,and 12 cases(50.0％)had bone graft material leakage;In contrast,the self-designed device group had no pedicle or ante-rior wall injuries,and there were 4 cases(16％)of bone graft leakage.The difference in complication rates be-tween the two groups was statistically significant(P＜0.05).Both groups showed significant improvement in LKA and AVHR immediately postoperatively,at 3 months,and at 1 year compared to preoperative values(P＜0.05).VAS score,ODI,and JOA score also significantly improved at 3 months and 1 year postoperatively compared to preoperative scores(P＜0.05).The"shell"phenomenon occurred in 5 cases in the self-designed device group,with 1 case healed at the 1-year follow-up,which occurred in 8 cases in the conventional technique group,with 2 cases healed at 1 year,and the difference was no statistically significant(P＞0.05).Conclusions:The application of the self-designed minimally invasive transpedicular vertebral bone grafting device in percu-taneous pedicle screw fixation combined with vertebral bone grafting for thoracolumbar fractures can reduce intraoperative fluoroscopy frequency and complications,therefore to improve surgical safety.

Objective To observe the effect of energy CT and color mapping to optimize displaying of ossification after lumbar interbody fusion.Methods A total of 76 patients who underwent lumbar fusion were retrospectively enrolled.According to the way of rescanning CT,the patients were divided into energy CT group(n=30)and traditional CT group(n=46).Subjective scoring of imaging quality of both groups on anatomic details,i.e.ossification of bone graft particles in the interbody fusion zone,cancellous bone growth near the endplate in the vertebral body,bone bridge connecting the interface between the fusion zone and the endplate in the vertebral body,as well as image artifacts were performed using a five-point scale.The image noise(SD value),and radiation dose represented by dose length product(DLP)were measured and compared between groups.Results Compared with traditional CT group,energy CT group had elevated subjective scores for anatomical details(4.50[4.28,4.50]vs.3.80[3.50,4.00])and image artifacts(4.30[4.00,4.50]vs.3.60[3.50,4.00]),while significantly lower SD value(37.22[34.90,38.85]HU vs.57.50[53.30,68.59]HU)and DLP(255.28[177.57,321.26]mGy·cm vs.327.60[298.13,415.95]mGy·cm)(all P＜0.05).Compared with grayscale images,images processed with color mapping demonstrated enhanced visualization of osseous details.Conclusion Energy CT after lumbar fusion could reduce image artifacts and improve the visualization of anatomical details at a lower radiation dose compared to conventional CT,while color mapping might further enhance the clarity of osseous details.

Objective To explore the therapeutic mechanism of maggot for psoriasis-like lesions in mice from the perspective of immune stress and complement activation regulation.Methods Thirty-six male C57BL/6 mice were randomly divided into control group,model group,maggot(1.25%,2.5%,and 5%)groups,and Benvitimod(1%)group.Psoriasis-like lesions were induced by application of imiquimod cream,and the severity of skin lesions was assessed using the modified Psoriasis Area and Severity Index(MPASI)score.Auricular swelling of the mice was observed,and histopathological changes of the skin lesions were examined with HE staining.Scratching behavior of the mice was observed and the spleen index was calculated.Toluidine blue staining was used to detect mast cells in the skin lesions,and serum levels of IgG,IgM,the complements CH50,C1s,C3,C3a,C5 and C5a,and the inflammatory factors IL-23,IL-17A and TNF-α were determined with ELISA.Results In mice with imiquimod-induced psoriasis-like skin lesions,treatment with the maggot at the 3 doses significantly decreased MPASI score,alleviated auricular swelling and pathologies in the skin lesions,reduced scratching behaviors,spleen index,and the number of mast cells in the lesions.Treatment with high-dose maggot significantly lowered serum levels of IgG,C1s,C3a,C5a,IL-23,IL-17A and TNF-α and the levels of C1s,C3,C3a,C5 and C5a in the lesion tissue,and increased serum levels of CH50,C3,and C5.The therapeutic effect of maggot showed a dose-effect dependence.Conclusion Maggot can alleviate psoriasis-like skin lesions in mice by inhibiting immune stress and complement activation.

Objective To explore the therapeutic mechanism of maggot for psoriasis-like lesions in mice from the perspective of immune stress and complement activation regulation.Methods Thirty-six male C57BL/6 mice were randomly divided into control group,model group,maggot(1.25%,2.5%,and 5%)groups,and Benvitimod(1%)group.Psoriasis-like lesions were induced by application of imiquimod cream,and the severity of skin lesions was assessed using the modified Psoriasis Area and Severity Index(MPASI)score.Auricular swelling of the mice was observed,and histopathological changes of the skin lesions were examined with HE staining.Scratching behavior of the mice was observed and the spleen index was calculated.Toluidine blue staining was used to detect mast cells in the skin lesions,and serum levels of IgG,IgM,the complements CH50,C1s,C3,C3a,C5 and C5a,and the inflammatory factors IL-23,IL-17A and TNF-α were determined with ELISA.Results In mice with imiquimod-induced psoriasis-like skin lesions,treatment with the maggot at the 3 doses significantly decreased MPASI score,alleviated auricular swelling and pathologies in the skin lesions,reduced scratching behaviors,spleen index,and the number of mast cells in the lesions.Treatment with high-dose maggot significantly lowered serum levels of IgG,C1s,C3a,C5a,IL-23,IL-17A and TNF-α and the levels of C1s,C3,C3a,C5 and C5a in the lesion tissue,and increased serum levels of CH50,C3,and C5.The therapeutic effect of maggot showed a dose-effect dependence.Conclusion Maggot can alleviate psoriasis-like skin lesions in mice by inhibiting immune stress and complement activation.