OBJECTIVES: This study aimed to evaluate the clinical application value of in-situ crown reattachment technique combined with pulpotomy in the treatment of complicated crown-root fractures in young permanent anterior teeth. METHODS: A prospective study was conducted on 50 children with complicated crown-root fractures in young permanent anterior teeth, who were treated at the Pediatric Dentistry Department, Hospital of Stomatology, Xi'an Jiaotong University from June 2023 to June 2024. All patients underwent in-situ crown reattachment technique combined with pulpotomy. Clinical examinations, radiographic evaluations, and subjective satisfaction surveys (using a Likert scale of 1-10) were conducted at 1, 6, and 12 months postoperatively. Data were analyzed using SPSS 23.0. RESULTS: The loss-to-follow-up rate was 12% (6/50), with 44 cases completing the 12 months of evaluation. The clinical success rate was 93.18% (41/44), and the radiographic success rate was 97.73% (43/44). The subjective satisfaction scores showed a significant improvement in masticatory function from 7.03±0.52 at 1 month to 8.07±0.92 at 12 months postoperatively (P<0.05), whereas the scores for aesthetics, comfort, and quality-of-life impact showed no statistically significant differences (P>0.05). CONCLUSIONS In-situ crown reattachment technique combined with pulpotomy effectively treats complicated crown-root fractures in young permanent anterior teeth, demonstrating a high short-term clinical success rate, significantly improved masticatory function, and minimally invasive preservation of pulp vitality and root development potential. This technique provides an optimized treatment option for dental trauma in children, although its long-term efficacy requires further validation.
Humans ; Pulpotomy ; Tooth Fractures/surgery* ; Child ; Prospective Studies ; Male ; Female ; Tooth Root/injuries* ; Tooth Crown/injuries* ; Treatment Outcome ; Incisor/injuries* ; Child, Preschool

Objective:To investigate the efficacy of elastic locking intramedullary nail (ELIN) in the treatment of mid clavicle fractures.Methods:From January 2014 to December 2020, the data of 61 patients with mid-clavicle fracture treated with ELIN were retrospectively analyzed. Among them, 38 patients were from the Fourth Central Hospital Affiliated to Nankai University and 23 were from the Second People's Hospital of Hulunbuir City. There were 36 males and 25 females, aged from 19 to 85 years (average, 54.5 years), 39 cases on the left side and 22 cases on the right side. According to Robinson's classification, there were 20 cases of type 2A2, 29 cases of type 2B1 and 12 cases of type 2B2. There was no nerve or vascular injury before operation. The postoperative evaluation measures included incision length, operation time, blood loss, fracture reduction, fracture healing time, ELIN removal time, shoulder Constant-Murley score, disabilities of the arm, shoulder, and hand (DASH) score, and related complications.Results:All patients were followed up for 13-51 weeks (average, 21.8 weeks). There were 34 cases of closed reduction and 27 cases of mini-open reduction, and the length of incision was 2.04±1.08 cm. The closed reduction operation time was 20.32±7.11 min, and the mini-open reduction operation time was 20.30±5.37 min. The intraoperative blood loss was 6.47±2.31 ml in the closed reduction group and 27.41±11.55 ml in the mini-open reduction group. Compared with the healthy side, the clavicle length of the affected side was shortened by 7.74%±3.51% of pre-operation and 0.71%±1.00% of post-operation, there was statistically significant difference in the length of clavicle shortening of pre- and post-operation ( t=3.84, P<0.001). The fracture healing time was 10.48±2.39 weeks. The removal time of ELIN was 13.39±2.69 weeks. At the last follow-up, the Constant-Murley score of shoulder joint was 98.87±1.74. The average of DASH score was 1.13 (range, 0-10). There were 18 cases of skin irritation after operation, of which 13 cases formed pressure sores at the tail end 3-6 weeks after the operation, and were treated with dressing change and keeping clean; 4 cases of skin irritation at the tail end formed bursitis, which disappeared after removal of the internal fixation. In 1 case, the tip of ELIN penetrated the anterior cortex from the proximal clavicle and stimulated the skin. Radiograms showed continuous callus at 4 weeks after operation, and there was no local tenderness on the physical examination, which reached the clinical healing standard, and the symptoms were relieved after the nail was removed. No serious complications such as neural and vascular injury, nail breaking, delayed healing, infection, numbness or discomfort in the subclavian area occurred in all cases, and all patients were satisfied or basically satisfied with the aesthetic of the skin appearance. Conclusion:Minimally invasive and microstress shielding fixation of mid-clavicle fracture with ELIN have the advantages of simple operation, minimally invasive, beautiful appearance, anti-short-shrinkage and rapid fracture healing etc. It is an effective surgical method for the treatment of mid-clavicle fractures.

Objective:To compare the efficacy of double thread elastic locking intramedullary nail (ELIN) and threaded elastic intramedullary nail (TEIN) in the treatment of mid-shaft clavicular fracture.Methods:From August 2017 to September 2020, 33 patients with mid-shaft clavicular fractures were treated with ELIN (double threaded nail group), including 14 males and 19 females, age 52.09±16.32 years old; Robinson classification: 20 cases of type 2A2, 6 cases of type 2B1, and 7 cases of type 2B2. Thirty-two patients were selected as the control group with TEIN fixation (single threaded nail group) during the same period, including 13 males and 19 females; age 43.25±15.03 years old; Robinson classification: 19 cases of type 2A2 and 5 cases of type 2B1, 8 cases of 2B2 type. The operation time, intraoperative incision length, fracture healing time, internal fixation removal time, Constant-Murley shoulder joint score, disabilities of the arm, shoulder, and hand (DASH) score, fracture reduction and postoperative complications were compared between the two groups.Results:The patients in both groups were followed up after operation, the double-threaded screw group was followed up for 16-48 weeks (average, 23.7 weeks), and the single threaded nail group was followed up for 15-51 weeks (average, 22.9 weeks). The operation time of the double threaded nail group and the single threaded nail group were 19.45±6.74 min and 19.59±4.98 min, and the length of the incision was 1.70±0.79 cm and 1.73±0.84 cm. The fracture healing time were 12.12±1.29 weeks and 13.88±1.84 weeks. The internal fixation removal time was 13.09±1.31 weeks and 15.69±1.94 weeks. The Constant-Murley shoulder score was 93.18±3.78 points and 90.09±4.03 points, and the DASH scores were 1.49± 0.49 points and 3.85±1.13 points; There was no significant difference in operation time and incision length between the two groups ( t=0.01, 0.19; P>0.05), while fracture healing ( t=3.70, P<0.001), internal fixation removal time ( t=6.34, P<0.001), Constant-Murley shoulder score ( t=3.19, P<0.001), DASH score ( t=10.95, P<0.001) differences were statistically significant. The length of the clavicle on the healthy side was 16.38±1.09 cm in the double threaded nail group, and the length of the clavicle on the affected side after internal fixation removal was 16.33±1.12 cm. There was no obvious shortening deformity on the affected side, and there was no significant difference in the length of the clavicle between the two sides ( t=1.57, P=0.127). The clavicle lengths of the healthy side and the affected side after internal fixation removal in the single threaded nail group were 16.55±1.12 cm and 15.12±1.18 cm, and the difference was statistically significant ( t=8.02, P<0.001). The postoperative shortening values of the double-threaded screw group and the single-threaded screw group were 9.47±2.12 mm and 17.41±2.42 mm, and the difference was statistically significant ( t=14.07, P<0.001). Postoperatively, 5 cases of bursitis and 2 cases of skin irritation occurred in the double threaded nail group; While 6 cases of bursitis, 3 cases of skin irritation, 4 cases of shortening malunion, and 1 case of broken nail occurred in the single threaded nail group (fracture delayed union after replacement of internal fixation); the other patients did not experience screw retraction, wound infection, delayed fracture union or nonunion, neurovascular injury, and achieved osseous union. Conclusion:Both elastic intramedullary nails are effective surgical methods for the treatment of middle clavicle fractures, and the operation time is short and minimally invasive. However, compared with the TEIN, the fracture healing time of the double-threaded ELIN is shorter, the internal fixation removal time is earlier, the shoulder joint and upper limb function is better, and the shortening deformity is less likely to occur.

ObjectiveTo estimate the value of transthoracic coronary flow Doppler imaging to detect coronary flow reserve (CFR) changes in patient with obstructive sleep apnea syndrome (OSA). Methods Fifty patients with OSA who hospitalized or were outpatient in Aerospace 731 Hospital during the period of 2010 March to 2013 December were enrolled in this study and were divided into three groups according to apnea hypopnea index (AHI). Eighteen cases of patients which AHI was greater than 5 and less than 20 were defi ned as mild group, 16 cases of patients which AHI was more than 20 and less than 40 were defi ned as middle group, 16 cases of patients which AHI was greater than 40 were defi ned as severe group. The diastolic peak velocity (PDV) and meanfl ow velocity (MDV) of the distance segment of left anterior descending coronary (LAD) were measured by transthoracic echocardiography at rest and after intravenous infusion of adenosine triphosphate (ATP). Meanwhile, CFR was calculated. Forty healthy persons were chosen as control group. Thettest was used to compare the difference of PDV, MDV and CFR between OSA group and healthy controls. The single factor analysis of variance was used to compare the difference of PDV, MDV and CFR in patients with different AHI. SNK -q test was used to compare in different OSA groups. Thet test was used to compare the difference of PDV, MDV among OSA group, healthy control and OSA groups with different AHI at rest and after intravenous infusion of ATP.ResultsCoronaryfl ow velocity Doppler signals were successfully obtained in all the groups. PDV ([92.78±7.68] cm/s) and MDV ([85.93±6.98] cm/s) after intravenous infusion of ATP in control group were significant higher than those at rest ([28.09±4.55] cm/s and [21.76±5.09] cm/s) (t=49.687 and 58.259, bothP<0.001). PDV ([82.73±6.91] cm/s) and MDV ([77.39±6.73] cm/s) after intravenous infusion of ATP in OSA group were signifi cant higher than those at rest ([29.93±3.66] cm/s and [22.28±4.15] cm/s) (t=55.381 and 47.700, bothP<0.001). There was no statistically signifi cant difference between PDV and MDV at rest in OSA group and control group. The difference of PDV and MDV between OSA group and normal group was statistically signifi cant after intravenous infusion of ATP (t=6.524 and 5.884, bothP<0.01). There was no statistically signifi cant difference between OSA groups with different AHI at rest. There were statistically signifi cant difference between OSA groups with different AHI after intravenous infusion of ATP (5≤AHI<20:t=-32.903 and-32.771, both P=0.000; 20≤AHI<40:t=-37.122 and-32.623, bothP=0.000; AHI>40:t=-28.197 and-20.184, both P=0.000). PDV and MDV of patients with AHI>40 were less than those of patients with 5≤AHI <20 and 20≤AHI<40 and the differences were statistically signifi cant (PDV:q=21.048 and 15.667, bothP<0.05; MDV:q=12.958 and 18.182, bothP<0.05). However, the differences of PDV and MDV was not statistically signifi cant between patients with 5≤AHI<20 and patients with 20≤AHI<40.The CFRmax and CFRmean in OSA group were lower than those in control group (t=5.310 and 6.430, bothP=0.000). There were statistically signifi cant difference for CFRmax and CFRmean in patients with different AHI and the difference decreased with severity of OSA increased. The CFRmax and CFRmean in patients with 5≤AHI<20 were higher than those in patients with 20≤AHI<40 and AHI>40 (CFRmax:q=2.889 and 4.142, bothP<0.05; CFRmean:q=3.080 and 4.204, bothP<0.05). There was no statistical signifi cant difference for CFRmax and CFRmean between patients with 20≤AHI<40 and patients with AHI>40.ConclusionsIn patients with obstructive sleep apnea syndrome, transthoracic coronaryfl ow imaging combined with intravenous infusion of adenosine triphosphate shows impaired in CFR. It means the patients with OSA have a coronary artery microcirculation impairment in early stage. Assessing CFR in the patients with OSA is of important clinical value for the evaluation of treatment effective of medicine and surgery and follow-up.

Objective To evaluate arterial stiffness in middle-age and elderly patients on the treatment of hemodialysis and to investigate the risk factors of arterial stiffness. Method A total of 87 in middle-age and elderly patients on the treatment of hemodialysis were enrolled. The distensibility coefficient (DC) of the common carotid artery was evaluated by an ultrasonic phase-locked echo-tracking system. Serum albumin, total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), glucose, creatinine,calcium, phosphorus, and intact parathyroid hormone (iPTH) were determined with well established methods. Results The ages of 87 patients ranged from 45 to 81 years, and the duration of treatment with hemodialysis was varied from 3 to 204 months . The carotid DC was ( 13.39 ± 5.32 ) × 10-3/kPa in middle-age and elderly patients on hemodialysis. In stepwise multiple regression analysis, systolic blood pressure (β = -0.349, P ＜ 0.001), age (β=-0.323, P ＜ 0.001), diabetes (β =-0.195,P = 0.027), and serum calcium (β =-0.276,P =0.002) were independently correlated with carotid DC. Conclusions Systolic blood pressure, age, diabetic,serum calcium were independent determinants for arterial stiffness of carotid artery in middle-age and elderly patients on hemodialysis.