Objective : To investigate the effectiveness of an extraoral guide plate system targeting the superior and inferior heads of the lateral pterygoid muscle in improving the accuracy of injection therapy for anterior disc displacement (ADD) of the temporomandibular joint (TMJ) with lateral pterygoid myalgia, and to provide a reference for precise clinical treatment. Methods: With approval from the institutional medical ethics committee and informed consent from patients, spiral CT scans were performed on seven patients with ADD accompanied or not accompanied by lateral pterygoid myalgia to acquire craniofacial data. Mimics 21.0 software was used to reconstruct three-dimensional craniofacial structures, identify attachment points of the superior and inferior heads of the lateral pterygoid muscle, and design dual injection paths along with a retention system. Personalized templates were fabricated using digital light procession-based 3D printing. Under the guide plate, a single targeted injection of 20 U of botulinum toxin type A (BTX-A) was administered into both the superior and/or inferior heads of the lateral pterygoid muscle. Immediate postoperative CT scans were conducted to compare actual needle placement with preoperative plans. Pain was assessed using the visual analogue scale (VAS) at 3 days and 1, 2, and 4 weeks postoperatively. Joint clicking was recorded at 2 and 4 weeks, and complications were monitored throughout the duration of the study. Results : A total of 15 sites in 7 patients were injected into the upper / lower head of the lateral pterygoid muscle under the guidance of the guide plate. Under the guide plate, all of the injections achieved an angular deviation within 2.5° (superior head: 2.49° ± 0.17°, inferior head: 2.31° ± 0.16°) and a needle tip positional deviation within 2 mm [superior head: (1.96 ± 0.25) mm, inferior head: (1.65 ± 0.21) mm]. The significant pain improvement rate (defined as ≥3-point reduction in VAS score) increased from 60% (9/15) at day 3 to 85% (13/15) at 2 weeks post-operation, stabilizing at 86.7% (13/15) at 4 weeks post-operation. Joint clicking improvement rates reached 72% (11/15) at 2 weeks post-operation and 75% (11/15) at 4 weeks post-operation. Regarding safety, only one case of injection site swelling and one case of transient paresthesia were observed; both resolved spontaneously within a short period of time. No neurovascular injury events occurred. Conclusion CT-guided guide plate achieves precise targeting design to minimize injection errors in the lateral pterygoid muscle. This technology is effective and safe, and it can provide an anatomically specific and operationally versatile targeted therapy for temporomandibular disorders.

Ménière's disease （MD） is an inner ear disease characterized by vertigo， tinnitus， hearing loss， and ear stuffiness. Modern therapies such as drugs， surgery， and vestibular function rehabilitation have limited effects in relieving the symptoms and reducing the recurrence. Traditional Chinese medicine （TCM） can alleviate the symptoms of MD with simple operation and mild adverse reactions while emphasizing psychological adjustment. The TCM treatment of MD is individualized depending on different stages and pathogenic factors. The internal treatment mainly targets phlegm， dampness， water， wind， fire， deficiency， and blood stasis. External interventions include acupuncture and moxibustion. This paper reviewed the published articles about the treatment of MD with TCM. In recent five years， the published studies were mainly clinical trials and experience discussion （or case reports）， and few reports of fundamental research were published. In these studies， the Western medicine diagnosis of MD mostly refers to the Diagnostic Basis and Efficacy Evaluation of Ménière's Disease （Guiyang， 2006） and the Guidelines for Diagnosis and Treatment of Ménière's Disease （2017）， while the TCM diagnosis mostly refers to the Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine issued by the National Administration of TCM in 1994. The efficacy was mostly evaluated based on clinical efficacy， scales， syndrome scores， pure tone audiometry， etc.， while caboratory indexes were rarely used. The available clinical studies about the treatment of MD with TCM generally have low quality of evidence and single intervention means. In the future， the research on the treatment of MD with TCM can be improved by standardizing the research program， improving the quality of evidence， exploring more intervention methods， and strengthening basic research.

Objective:To explore the demand and mode of palliative care for emergency dying patients by analyzing the case data of emergency death and cardiopulmonary resuscitation.Methods:The data of 776 cases of emergency clinical death and cardiopulmonary resuscitation in the Second Affiliated Hospital of Soochow University from 2017 to 2020 were retrospectively analyzed.Results:A total of 687 patients were included with (70.38 ± 16.57) years old, and 49.8% (342/687) of them were 75 years old and above; among them, 36.0% (247/687) patients or their families chose not to give cardiopulmonary resuscitation (DNR) in the last stage of their lives,and 63.2%(156/247) of DNR patients were 75 years old and above. The top four etiology of DNR were cerebral hemorrhage, respiratory failure, multiple organ dysfunction syndrome and out of hospital cardiac and respiratory arrest.After successful cardiopulmonary resuscitation, 37.5% (45/120) of the patients' family members chose to give up treatment again. The median stay time of DNR patients in the emergency room was 738.7 minutes.Conclusions:The patients who choosed DNR were mainly 75 years old and above, with cerebral hemorrhage, respiratory failure, multiple organ failure and cardiac and respiratory arrest. The detention of these patients in the emergency room increases the congestion of the emergency room, and at the same time, they can not get a peaceful palliative care environment. It is suggested that emergency medical staff should strengthen the awareness and improve the ability of palliative care. A relative independent area and corresponding soothing palliative treatment and nursing should be given to the DNR patients.

Objective To investigate the changes of B type natriuretic peptide(BNP) and interleukin(IL)-33 levels and their clinical diagnostic values in different heart function classification of patients with heart failure.MethodsFrom January 2016 to January 2017,286 patients with heart failure in our hospital were selected as the heart failure group,while 106 healthy people were selected as the control group.The heart failure group was divided into New York Heart Association(NYHA)Ⅰ(n=76), NYHA Ⅱ(n=129), NYHA Ⅲ(n=61) and NYHA Ⅳ(n=20) according to the NYHA heart function classification criteria.The BNP and IL-33 levels were compared between heart failure group and control group,as so as the different heart function classification groups.And analyzed the factors related to heart failure by single factor and multivariate logistic regression.The diagnostic value of BNP and IL-33 in heart failure were analyzed by receiver operating characteristic(ROC) curve.ResultsThe level of BNP in heart failure group was significantly higher than that in control group(P<0.05),while IL-33 level was significantly lower than that in control group (P<0.05).The BNP levels in heart function classification groups had significant difference(P<0.05),but there was no significant difference in IL-33 level among them.Univariate analysis showed that both BNP and IL-33 were associated factors of heart failure, but multivariate logistic analysis showed that only BNP was an independent factor of heart failure.ROC curve showed that the area under the curve(AUC) of heart failure diagnosed of BNP was bigger than that of IL-33,the difference was statistically significant (P<0.05).ConclusionBNP and IL-33 can both effectively diagnose heart failure, but BNP is more diagnostic value.Besides, BNP can effectively reflect the cardiac function, the degree of disease and prognosis, witch can more scientifically guide the clinical treatment.

OBJECTIVETo investigate the differences in body composition between Crohn's disease(CD) patients and healthy subjects as well as the characteristics of human body composition in various types of CD.

METHODSA total of 57 CD patients were prospectively selected from the Sixth Affiliated Hospital of Sun Yat-sen University as the study group, while 51 healthy subjects as the control group. Protein content, mineral content, fat content, lean body mass, waist circumference, and hip circumference in the two groups were measured by body composition analyzer. Characteristics of CD at different location and different disease activity index were investigated as well.

RESULTSIntracellular fluid, extracellular fluid, weight, protein content, fat content, lean body mass, muscle weight, body fat ratio, waist hip ratio, body weight ratio, arm muscle circumference, arm circumference, quality of cells, BMI and basal metabolic rate in CD patients were significantly lower than those in control group(all P<0.05). Proportion of protein-deficiency patients and fat-deficiency patients were 66.7% and 47.4% respectively. Protein content, fat content, and lean body mass in ileocolic CD patients were lower than those with small bowel and colonic CD(all P<0.05). Protein content, fat content, lean body mass in patients with high disease activity index were lower than those in patients with low and medium index, but higher basal metablic rate was found in the former group(all P<0.05).

CONCLUSIONSThe human body composition in patients with CD are different from healthy people. Disease location and disease activity index have an impact on protein content, fat content, and lean body mass.

Objective To investigate the differences in body composition between Crohn′s disease (CD) patients and healthy subjects as well as the characteristics of human body composition in various types of CD. Methods A total of 57 CD patients were prospectively selected from the Sixth Affiliated Hospital of Sun Yat-sen University as the study group, while 51 healthy subjects as the control group. Protein content, mineral content, fat content, lean body mass, waist circumference, and hip circumference in the two groups were measured by body composition analyzer. Characteristics of CD at different location and different disease activity index were investigated as well. Results Intracellular fluid, extracellular fluid, weight, protein content, fat content, lean body mass, muscle weight, body fat ratio, waist hip ratio, body weight ratio, arm muscle circumference, arm circumference, quality of cells, BMI and basal metabolic rate in CD patients were significantly lower than those in control group (all P<0.05). Proportion of protein-deficiency patients and fat-deficiency patients were 66.7% and 47.4% respectively. Protein content, fat content, and lean body mass in ileocolic CD patients were lower than those with small bowel and colonic CD (all P<0.05). Protein content, fat content, lean body mass in patients with high disease activity index were lower than those in patients with low and medium index, but higher basal metablic rate was found in the former group (all P<0.05). Conclusions The human body composition in patients with CD are different from healthy people. Disease location and disease activity index have an impact on protein content, fat content, and lean body mass.

Objective To investigate the differences in body composition between Crohn′s disease (CD) patients and healthy subjects as well as the characteristics of human body composition in various types of CD. Methods A total of 57 CD patients were prospectively selected from the Sixth Affiliated Hospital of Sun Yat-sen University as the study group, while 51 healthy subjects as the control group. Protein content, mineral content, fat content, lean body mass, waist circumference, and hip circumference in the two groups were measured by body composition analyzer. Characteristics of CD at different location and different disease activity index were investigated as well. Results Intracellular fluid, extracellular fluid, weight, protein content, fat content, lean body mass, muscle weight, body fat ratio, waist hip ratio, body weight ratio, arm muscle circumference, arm circumference, quality of cells, BMI and basal metabolic rate in CD patients were significantly lower than those in control group (all P<0.05). Proportion of protein-deficiency patients and fat-deficiency patients were 66.7% and 47.4% respectively. Protein content, fat content, and lean body mass in ileocolic CD patients were lower than those with small bowel and colonic CD (all P<0.05). Protein content, fat content, lean body mass in patients with high disease activity index were lower than those in patients with low and medium index, but higher basal metablic rate was found in the former group (all P<0.05). Conclusions The human body composition in patients with CD are different from healthy people. Disease location and disease activity index have an impact on protein content, fat content, and lean body mass.