Objective:To investigate the effects of asymmetric trans-sutural distraction osteogenesis for severe midfacial hypoplasia in growing patients with unilateral cleft lip and palate.Methods:All the growing patients with unilateral cleft lip and palate combining severe midfacial hypoplasia treated with asymmetric trans-sutural distraction osteogenesis from January 2011 to December 2020 in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. The distraction system consisted of the bone-borne traction hooks, nickel-titanium shape memory alloy spring and rigid external distractor. Asymmtric distraction could be achieved by exerting different traction force to bilateral maxilla. The technique for relapse prevention included moderate overcorrection, prompt orthodontic treatment and face mask therapy. The changes of midfacial symmetry between the cleft and non-cleft side were analyzed by comparing the distance of subspinale A-point(A), intersection of lateral border of piriform aperture and plane parallel to midsagittal reference plane(LPA), most inferior point on nasomaxillary suture(INM) and most inferior point on profile of pterygomaxillary suture(PTM) to coronal reference plane between preoperative and postoperative, and the asymmetric ratio of LPA, INM and PTM were calculated.Results:A total of 38 patients, (34 males and 4 females, aged from 8-15 years) were included. All of the patients completed the distraction and achieved a satisfied improvement in the midface convexity and overjet. The postoperative 1-3 years follow-up showed the midface protrusion and occlusal overcoverage after distraction caused by overcorrection tended to become harmonious in the following 6 to 12 months, and 3 patients with no face mask therapy done had relapse on maxilla in various degrees after 3 years follow-up. The measurement findings of 25 patients showed the average advancement of A point was (12.67±4.62) mm(range, 6.21-23.28 mm). The distances of INM, LPA and PTM to CR plane on the cleft side were significantly less than that on the non-cleft side before the distraction( P<0.05). However, after the distraction, these distance differences of INM and PTM between the cleft and non-cleft side were eliminated ( P>0.05). The distance difference of bilateral LPA was reduced, but still significant less on the cleft side( P<0.05). Compared before and after distraction, the asymmetric rate of INM, LPA and PTM was significantly decreased( P<0.05). Conclusions:Asymmetric trans-sutural distraction osteogenesis offers an effective method for the early treatment of severe midfacial hypoplasia in growing patients with unilateral cleft lip and palate, and restores the midfacial symmetry.

Objective:To investigate the effects of asymmetric trans-sutural distraction osteogenesis for severe midfacial hypoplasia in growing patients with unilateral cleft lip and palate.Methods:All the growing patients with unilateral cleft lip and palate combining severe midfacial hypoplasia treated with asymmetric trans-sutural distraction osteogenesis from January 2011 to December 2020 in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. The distraction system consisted of the bone-borne traction hooks, nickel-titanium shape memory alloy spring and rigid external distractor. Asymmtric distraction could be achieved by exerting different traction force to bilateral maxilla. The technique for relapse prevention included moderate overcorrection, prompt orthodontic treatment and face mask therapy. The changes of midfacial symmetry between the cleft and non-cleft side were analyzed by comparing the distance of subspinale A-point(A), intersection of lateral border of piriform aperture and plane parallel to midsagittal reference plane(LPA), most inferior point on nasomaxillary suture(INM) and most inferior point on profile of pterygomaxillary suture(PTM) to coronal reference plane between preoperative and postoperative, and the asymmetric ratio of LPA, INM and PTM were calculated.Results:A total of 38 patients, (34 males and 4 females, aged from 8-15 years) were included. All of the patients completed the distraction and achieved a satisfied improvement in the midface convexity and overjet. The postoperative 1-3 years follow-up showed the midface protrusion and occlusal overcoverage after distraction caused by overcorrection tended to become harmonious in the following 6 to 12 months, and 3 patients with no face mask therapy done had relapse on maxilla in various degrees after 3 years follow-up. The measurement findings of 25 patients showed the average advancement of A point was (12.67±4.62) mm(range, 6.21-23.28 mm). The distances of INM, LPA and PTM to CR plane on the cleft side were significantly less than that on the non-cleft side before the distraction( P<0.05). However, after the distraction, these distance differences of INM and PTM between the cleft and non-cleft side were eliminated ( P>0.05). The distance difference of bilateral LPA was reduced, but still significant less on the cleft side( P<0.05). Compared before and after distraction, the asymmetric rate of INM, LPA and PTM was significantly decreased( P<0.05). Conclusions:Asymmetric trans-sutural distraction osteogenesis offers an effective method for the early treatment of severe midfacial hypoplasia in growing patients with unilateral cleft lip and palate, and restores the midfacial symmetry.

Objective:To evaluate the follow-up clinical results of W-shaped acetabular angular plate for the treatment of acetabular posterior wall fractures through a direct posterior approach (DPA).Methods:Fifteen cases (10 males and 5 females, average aged 42.1±10.0 years) were involved in this study, with acetabular posterior wall fractures treated by using the W-shaped acetabular angular plate through a DPA between March 2017 and June 2019. Nine patients with fractures were injured by traffic accidents and the other 6 cases by falling. Based on the three-column classification for acetabular fractures, all of the cases belonged to posterior wall fractures (A2.1), which included 6 cases of simple fractures and 9 cases of comminuted fractures. The mean time interval between injury and surgery was 5.6±1.1 (range, 4-8) days. The DPA was adopted in all cases. The posterior wall fractures of the acetabulum were reduced and fixed with W-shaped acetabular angular plates. The reduction quality of the acetabulum was evaluated by X-ray and CT scan during follow-up visits according to the criteria proposed by Matta. The function of the hip joint was assessed by the Merle d'Aubigné-Posteal score modified by Matta.Results:The length of the surgical incision was 9.5±1.1 (range, 8-12) cm. The operation time was 45.3±10.1 (range, 35-75) mins. The amount of intraoperative blood loss was 248.0±94.7 (range, 100-380) ml. All the patients who were followed up for 20.5±6.3 (range, 16-38) months. All cases were evaluated according to Matta's reduction quality criteria, the satisfactory ratio of reduction was 100%. Among cases, 10 cases were matched the anatomic reduction, and the other 5 cases have belonged to satisfy. All cases of fractures had healed (the mean of healing time was 9.4±1.3 (range, 8-12 weeks). At the final follow-up visit, the mean of modified Merle d'Aubigne-Postel score was 16.9±1.6 (range, 13-18). Excellent clinical outcomes were obtained in 10 cases, good in 3 cases, and fair in 2 cases. One case had deep venous thrombosis of the lower extremities. The clots disappeared after anticoagulation treatment. One case had the heterotopic ossification, Brooker grade I, without any special treatment due to not affecting the hip joint activity in the follow-up visits. One patient had incision fat liquefaction and the wound healed after intensive dressing change. No internal fixation loosening or losing of fracture reduction was found at the follow-up visits.Conclusion:This study shows that using W-shaped acetabular angular plate for the treatment of acetabular posterior wall fractures through the DPA could obtain early satisfactory clinical outcomes.

Objective:To present the clinical results and potential complications of modified maxillary distraction osteogenesis in the treatment of moderate to severe maxillary hypoplasia for patients with cleft lip and palate.Methods:All the cases were treated with a modified distraction osteogenesis in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from July 2017 to December 2019. A rigid external distraction(RED) with intranasal bone-borne traction hooks was performed after the Le Fort Ⅰ osteotomy and a maxillary internal rigid fixation was done immediately after 3-4 weeks of RED device distraction. Paired-samples t-test was used to analyze the three-dimensional reconstruction and measurements of the patient’s preoperative (T0) and immediate completion of traction (T1) cranial CT maxillofacial bony structures. Results:Fifteen patients (12 males and 3 females, ranging from 14 to 25 years in age) with moderate to severe maxillary hypoplasia were analyzed retrospectively. There were significant differences ( P<0.05) in all measures of maxillary and mandibular morphology at the completion of distraction compared to preoperatively. The mean advancement of A point (subspinale) was (10.69±9.01) mm, and the mean increase in ANB (subspinale-nasion-supramental) was (13.53±7.14)°. The average increase of alveolar plane and mandibular plane was (3.97±5.87)° and (4.65±3.67)° separately. The average growth of anterior facial height was (5.63±4.41) mm. The maxilla moved forward and downward, increasing the midface prominence and improving the facial contour. The traction process had an effect on the position of the mandible, with 5 in 15 patients experiencing moderate to severe decreased mouth opening, and the mouth opening limitation was relieved by mouth opening training after fixation at the end of distraction. One patient experienced temporomandibular joint (TMJ) dislocation, which was relieved by manual repositioning and mouth opening training after maxillary fixation and sagittal split ramus osteotomy. Conclusions:Modified maxillary distraction osteogenesis can effectively advance the maxilla, allowing clockwise rotation of mandible, improving facial contour, and significantly shortening the traction time. Limited mouth opening and TMJ dislocation may occur during traction.

Objective:To present the clinical results and potential complications of modified maxillary distraction osteogenesis in the treatment of moderate to severe maxillary hypoplasia for patients with cleft lip and palate.Methods:All the cases were treated with a modified distraction osteogenesis in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from July 2017 to December 2019. A rigid external distraction(RED) with intranasal bone-borne traction hooks was performed after the Le Fort Ⅰ osteotomy and a maxillary internal rigid fixation was done immediately after 3-4 weeks of RED device distraction. Paired-samples t-test was used to analyze the three-dimensional reconstruction and measurements of the patient’s preoperative (T0) and immediate completion of traction (T1) cranial CT maxillofacial bony structures. Results:Fifteen patients (12 males and 3 females, ranging from 14 to 25 years in age) with moderate to severe maxillary hypoplasia were analyzed retrospectively. There were significant differences ( P<0.05) in all measures of maxillary and mandibular morphology at the completion of distraction compared to preoperatively. The mean advancement of A point (subspinale) was (10.69±9.01) mm, and the mean increase in ANB (subspinale-nasion-supramental) was (13.53±7.14)°. The average increase of alveolar plane and mandibular plane was (3.97±5.87)° and (4.65±3.67)° separately. The average growth of anterior facial height was (5.63±4.41) mm. The maxilla moved forward and downward, increasing the midface prominence and improving the facial contour. The traction process had an effect on the position of the mandible, with 5 in 15 patients experiencing moderate to severe decreased mouth opening, and the mouth opening limitation was relieved by mouth opening training after fixation at the end of distraction. One patient experienced temporomandibular joint (TMJ) dislocation, which was relieved by manual repositioning and mouth opening training after maxillary fixation and sagittal split ramus osteotomy. Conclusions:Modified maxillary distraction osteogenesis can effectively advance the maxilla, allowing clockwise rotation of mandible, improving facial contour, and significantly shortening the traction time. Limited mouth opening and TMJ dislocation may occur during traction.

Sixty-three elderly patients with allergic rhinitis and symptoms of anxiety and depression attending in the Affiliated Hospital of Yangzhou University from August 2016 to August 2018 were randomly divided into two groups: 30 patients received deanxit combined with anti-allergic drugs for treatment (study group) and another 30 patients received anti-allergic drugs treatment alone (control group). Subjective nasal obstruction was evaluated by Visual Analogue Scale (VAS), and the quality of life of patients was assessed by Rhinoconjunetivitis Quality of Life Questionnaire (RQLQ).The anxiety and depression mood changes were assessed by Self-rating Anxiety Scale (SAS) sand Self-rating Depression Scale (SDS).The scores of symptoms and mood were compared after 4 weeks and 8 weeks of treatment. The clinical nasal symptoms VAS score, the total RQLQ scores and its 7 domains scores, SDS and SAS scores of patients in two groups were significantly reduced compared to those before treatment ( P<0.05). The VAS score, the total of RQLQ scores and its 7 domains scores, SDS and SAS scores were significantly lower in the study group than those in the control group after 4 weeks and 8 weeks of treatment.The total effective rate of study group was significantly higher than those of the control group (χ 2=6.922, P=0.031; χ 2=11.544, P=0.003). Deanxit combined with anti-allergic drugs shows significant clinical efficacy, it also can improve the symptoms of anxiety and depression, and the quality of life for elderly patients with allergic rhinitis.

Objective:To explore the characteristics of cognitive impairment in elderly adults with deafness and assess its influencing factors.Methods:This was a cross-sectional study.From July 2015 to July 2017, 117 elderly patients with age-related hearing loss(presbyacusis group)admitted to Otolaryngology Clinic of the Yangzhou University Affiliated Hospital and 97 healthy elderly adults(control group)undergoing healthy physical examination in the same period were included.We evaluated the cognitive function was with Montreal cognitive assessment(MoCA)scale Chinese version, and calculated their MoCA total score, and recorded the clinical data and the hearing loss level.The correlation between hearing loss level and MoCA was analyzed.Results:The total scores of MoCA was significantly lower in the presbyacusis group(21.6±5.8)than that in the control group(26.8±1.5)( t=8.49, P<0.05). Patients in the presbyacusis group were associated with significantly lower levels of visuospatial and executive function(4.1 ± 0.9 vs.4.8 ± 0.5), naming(2.2 ± 1.0 vs.3.0 ± 0.0), attention(5.2 ± 1.7 vs.5.9 ± 0.5), language(2.0 ± 0.9 vs.3.0 ± 0.2), abstraction(1.6 ± 0.5 vs.1.9 ± 0.3), delayed recall(1.8 ± 0.7 vs.2.2 ± 0.4), orientation(4.4 ± 1.2 vs.5.8 ± 0.4)than the control group( all P <0.05). The level of hearing loss was negatively correlated with the total scores of MoCA and all the subscale of MoCA(all P<0.01). Univariate analysis showed that age, educational level, marital status, hearing loss level, course of hearing loss, and hearing aid were correlated with MoCA total score in elderly patients with presbcyusis(all P<0.05). Multiple linear regression analysis showed that marital status( t=6.596, P<0.05), and hearing aid( t=2.182, P<0.05)were positively correlated with MoCA total score, and age( t=-2.691), the educational level( t=-2.691), hearing loss level( t=-7.626), and course of hearing loss( t=-6.11)was negatively associated with MoCA total score(all P<0.05). Conclusions:Cognitive function is generally decline in elderly patients with presbycusis, and age, educational level, marital status, the course of hearing loss, hearing loss level and whether or not hearing aid are important factor affecting cognitive function in elderly patients with presbycusis.

Objective: To explore the reliability, validity and best cut-off value of Chinese version Addenbrooke's cognitive examination-Ⅲ(ACE-Ⅲ) in presbycusis patients with mild cognitive impairment(MCI). Methods: A total of 43 presbycusis patients with mild cognitive impairment, 61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE), Montreal cognitive assessment(MoCA) and ACE-Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE-Ⅲ were analyzed with the SPSS 21.0, and the cut-off point was confirmed with the receiver operating characteristic(ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed. Results: Chinese version of ACE-Ⅲ had betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach's alpha, split-half reliability and intraclass correlation coefficient were 0.870(P<0.05), 0.874(P<0.05) and 0.880(P<0.05), respectively.The patients in MCI group got a lower score in the sub-scale of attention/orientation, memory, verbal fluency, language and visual space of ACE-Ⅲ compared with those in NCI group and healthy control group, and the differences were statistically significant (F=48.042, 46.594, 35.442, 19.374, 256.19, 140.319, all P<0.001). The criteria validity calculated between the Chinese version of ACE-Ⅲ and MMSE was 0.802 (P<0.001). Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals(P<0.05). The Chinese version of ACE-Ⅲ showed significantly correlation with the total scores of MoCA(r=0.802, P<0, 001). When the cut-off value for diagnosis was 86.5, the largest area under the ROC curve for the Chinese version of ACE-Ⅲ was 0.98(95% CI: 0.897-0.996). The relative sensitivity and specificity were 100.0% and 95.0%, respectively. Conclusion The Chinese version of ACE-Ⅲ had better internal consistency, reliability and validity, and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.

Objective To investigate the psychopathological characteristics in families of presbycusis patients and its influencing factors.Methods The psychopathological characteristics were evaluated with the Symptom Checklist-90(SCL-90) Chinese version in 157 families of presbycusis patients(FPP) in the Affiliated Hospital of Yangzhou University from July 2015 to July 2017. Somatization, obsessive - compulsive disorder, interpersonal sensitivity,depression,anxiety,hostility,phobic anxiety,paranoid ideation,psychoticism and other were assessed and compared with the Chinese standard norm.The correlation between SCL-90 and related data had also been analyzed. The general information and clinical data of patients were analyzed.Results The SCL-90 score in the FPP group was (146.3 ± 42.8)points.The total score and total average score of SCL-90 had statistically significant difference between the FPP group and the Chinese standard group(t=14.557,14.765,all P<0.05).The scores of somatiza-tion,interpersonal sensitivity,depression and anxiety factors in the FPP group were higher than those in the Chinese standard group(t=5.417,13.588,20.857,22.475,all P<0.05).Age,sleeping condition,educational level,hearing aids and the level of patients＇hearing loss were correlated with the total score of SCL-90( TSCL-90) in FPP( all P<0.05).Multiple linear regression analysis showed that age(t=2.550,P<0.000),the educational level( t =4.087,P<0.000),and the level of patients＇hearing loss ( t =2.188, P <0.05 ) were positively correlated with TSCL-90,and sleeping condition(t= -2.004,P<0.05) and hearing aids(t= -4.643,P<0.05) were negatively associated with TSCL-90.Conclusion The psychopathological characteristics are generally poor in families with presbycusis patients,accompanied by obvious depression and anxiety;and age,sleeping condition,educational level, hearing aids and the level of patients＇hearing loss are important influencing factors.It is important to pay attention to overall health in families with presbycusis patients.

Objective To evaluate the quality of life,emotional symptoms (anxiety and depressive symptoms)and their influencing factors in elderly patients with presbycusis.Methods From May 2015 to May 2017,288 patients with presbycusis and 123 healthy controls were consecutively included into this study.Quality of life and emotional symptoms were evaluated by a series of questionnaires including the generic questionnaire medical outcomes study short-form 36 items health survey(SF-36),self-rating depression scale (SDS) and self-rating anxiety scale (SAS).Results The prevalences of anxiety(SAS score≥50)and depression(SDS scores≥53)were 23.3％ (67/288)and 20.1％(58/288),respectively;and the prevalence of the two in combination was 13.2％ (38/288).When assessed with SF-36,the scores of physical functioning,physical role,bodily pain,general health,social functioning,emotional role,and mental health were 71.0 ± 9.0,77.3 ± 9.1,73.3 -±9.6,69.6±8.6,71.9±9.9,72.1±12.7,and 73.1±10.5,respectively,which were lower than those in the control group(82.1±10.2,82.4±4.3,86.4±11.3,2.1±7.9,82.8±9.9,83.1±7.7,and 82.2 ±3.6,respectively;all P＜0.05).The scores of SDS and SAS in the presbyacsis group were 53.2± 13.3 and 51.9 ± 11.2,respectively,which were higher than those in the control group(42.5± 10.3 and 43.9± 6.2,respectively;t =10.09 and 7.52,respectively;all P＜0.05).SDS was negatively correlated with general physical and mental health (r =-0.787,P ＜ 0.05;r =-0.743,P ＜ 0.05);SAS was negatively associated with general physical and mental health(r =-0.801,P ＜0.05;r =0.750,P＜0.05,respectively);and SDS was positively correlated with SAS(r =0.958,P ＜0.05).Multiple linear regression analysis showed that concomitant hearing impairment,educational level,marital status,living condition,and sleep condition were positively correlated with SF-36 general health scores;severity of hearing loss and number of comorbidities were negatively associated with general health.However,severity of hearing loss,concomitant hearing impairment,educational level,marital status,and number of comorbidities were positively correlated with SAS and SDS scores;educational level and sleeping were negatively associated with SAS and SDS scores.Conclusions Poor quality of life and high prevalences of depression and anxiety are found in elderly patients with presbycusis,and their influencing factors include severity of hearing loss,concomitant hearing impairment,education level,marital status,sleeping and number of comorbidities.