Pediatric malocclusion is common in dentistry.Some children with malocclusion combined with obstruc-tive sleep apnea-hypopnea syndrome(OSAHS)often fail to receive appropriate treatment due to a lack of multidisci-plinary diagnosis and treatment.It can cause abnormal ventilation during sleep,affecting the central nervous system and cardiovascular development and even causing neurological and behavioral problems.Pediatric OSAHS is caused by the narrowing of the upper respiratory tract,characterized by specific facial bone characteristics and neuromuscular factors and correlated with malocclusion.Due to its diverse clinical manifestations and etiology,the diagnosis and treatment of pediatric OSAHS require an interdisciplinary,personalized,and specialized approach.Questionnaires and physical ex-aminations can be used for preliminary screening.Moreover,children's stomatology and otorhinolaryngology examina-tions are the basis for disease diagnosis.Polysomnography(PSG)is currently the direct diagnostic method.There are var-ious treatment methods for OSAHS in children,and for OSAHS caused by adenoid tonsil hypertrophy,adenoidectomy and tonsillectomy are the main treatments.Othodontic treatment including mandibular advancement and rapid maxillary expansion et al is also effective for OSAHS in children with malocclusion.Currently,there is limited research on the cor-relation between childhood malocclusion and OSAHS,and multidisciplinary combination therapy may improve the cure rate,but there is a lack of sufficient evidence.In the future,the pathogenesis of OSAHS should be further elucidated,and research on multidisciplinary combination therapy should be promoted to achieve early intervention and treatment for potential and existing patients.

Objective:To investigate the clinical effect of nanofat transplantation combined with CO 2 fractional laser in the treatment of depressed facial scars. Methods:Through a retrospective study, a total of 27 patients with depressed facial scars who got admitted to the plastic surgery department of our hospital from January 2016 to June 2018 were recruited for autologous nanofat transplantation and carbon dioxide fractional laser treatment in combination to treat moderate to severe depressed facial scars. The treatment was carried out as follows: autologous nanofat transplantation was performed, the depressed scar was subcutaneously separated with a 26 G needle, and injected with the autologous nanofat 0.5-1.0 ml/cm 2. After 3 months, the fractional CO 2 laser treatment was performed for a total of 2 times, with an interval of 3 months each time. Before and six months after treatment, patients and surgeons used the Patient and Observer Scar Assessment Scale (POSAS) to evaluate each aspect of scar. The total score for each item was 1-10 points. According to the total POSAS scores of patients and doctors, the degree of improvement of depressed scars was classified and evaluated. Grade 1: invalid, total score reduction ≤ 5 points; grade 2: mildly effective, total score reduction> 5 points and ≤ 10 points; grade 3, effective, total score reduction> 10 points and ≤ 20 points; grade 4, markedly effective, total score reduction> 20 points. Using SPSS 23.0 to do t-test on the data before and after treatment. P<0.05 indicates that the difference is statistically significant. Results:A total of 27 patients were enrolled, including 16 males and 11 females, aged (29.1±7.9) years old. Before and after six months of treatment, the difference between the scores of the patients on all indicators of scar was statistically significant ( P<0.05); the difference between the doctor’s scores was statistically significant ( P<0.01). The total scores of post-total POSAS were (43.7±10.8) and (23.3±3.2) points respectively, the difference was statistically significant ( P<0.01). After six months of treatment, the degree of pain, itching, color, hardness, thickness (depression), elasticity, tension of the depressed scar were significantly improved. Among them, there was 1 case of second-level improvement, 14 cases of third-level improvement, and 12 cases of fourth-level improvement. The total effective rate reached 96.3% (26/27). None of the 27 patients had lumps or cord-like indurations on the filling parts of the face. No embolism, infection, hematoma and other complications occurred after nanofat transplantation in all patients. Skin flushing, burning, edema, pain and other symptoms occurred early after the fractional CO 2 laser treatment, and no hyperpigmentation occurred in the 6-month follow-up after a treatment cycle. Conclusions:The combination of nanofat transplantation technology and carbon dioxide fractional CO 2 laser can produce a significant effect on improving depressed scar, reducing treatment period, rendering a simple operation with few complications.

Objective:To investigate the clinical effect of nanofat transplantation combined with CO 2 fractional laser in the treatment of depressed facial scars. Methods:Through a retrospective study, a total of 27 patients with depressed facial scars who got admitted to the plastic surgery department of our hospital from January 2016 to June 2018 were recruited for autologous nanofat transplantation and carbon dioxide fractional laser treatment in combination to treat moderate to severe depressed facial scars. The treatment was carried out as follows: autologous nanofat transplantation was performed, the depressed scar was subcutaneously separated with a 26 G needle, and injected with the autologous nanofat 0.5-1.0 ml/cm 2. After 3 months, the fractional CO 2 laser treatment was performed for a total of 2 times, with an interval of 3 months each time. Before and six months after treatment, patients and surgeons used the Patient and Observer Scar Assessment Scale (POSAS) to evaluate each aspect of scar. The total score for each item was 1-10 points. According to the total POSAS scores of patients and doctors, the degree of improvement of depressed scars was classified and evaluated. Grade 1: invalid, total score reduction ≤ 5 points; grade 2: mildly effective, total score reduction> 5 points and ≤ 10 points; grade 3, effective, total score reduction> 10 points and ≤ 20 points; grade 4, markedly effective, total score reduction> 20 points. Using SPSS 23.0 to do t-test on the data before and after treatment. P<0.05 indicates that the difference is statistically significant. Results:A total of 27 patients were enrolled, including 16 males and 11 females, aged (29.1±7.9) years old. Before and after six months of treatment, the difference between the scores of the patients on all indicators of scar was statistically significant ( P<0.05); the difference between the doctor’s scores was statistically significant ( P<0.01). The total scores of post-total POSAS were (43.7±10.8) and (23.3±3.2) points respectively, the difference was statistically significant ( P<0.01). After six months of treatment, the degree of pain, itching, color, hardness, thickness (depression), elasticity, tension of the depressed scar were significantly improved. Among them, there was 1 case of second-level improvement, 14 cases of third-level improvement, and 12 cases of fourth-level improvement. The total effective rate reached 96.3% (26/27). None of the 27 patients had lumps or cord-like indurations on the filling parts of the face. No embolism, infection, hematoma and other complications occurred after nanofat transplantation in all patients. Skin flushing, burning, edema, pain and other symptoms occurred early after the fractional CO 2 laser treatment, and no hyperpigmentation occurred in the 6-month follow-up after a treatment cycle. Conclusions:The combination of nanofat transplantation technology and carbon dioxide fractional CO 2 laser can produce a significant effect on improving depressed scar, reducing treatment period, rendering a simple operation with few complications.

Objective:To investigate the efficacy of treatment of bromhidrosis by cutting off the apocrine glands under direct vision combined with micro electrocoagulation.Methods:From January 2017 to December 2017, 25 patients (50 sides) with axillary osmidrosis admitted to the First People’s Hospital of Yuhang District were treated with direct vision cutting and micro electrocoagulation to destroy the apocrine sweat glands, including 13 males and 12 females, aged 14-38 years, with an average age of 23 years. According to Young-Jin Park′s criteria for judging axillary osmidrosis, 21 cases were classified as grade 3 and 4 cases as grade 2. After tumescent anesthesia, the subcutaneous apocrine sweat glands, fat and hair follicles were cut off under direct vision. The subdermal vascular network was preserved, and the basement was destroyed one by one by using high-frequency electrocoagulation mode. After the operation, the evaluation was conducted according to the criteria for judging axillary osmidrosis formulated by Young-Jin Park.Results:The symptoms of axillary osmidrosis reached the standard of cure in 24 patients after operation, 1 case failed to reach the cure standard. Among the patients who reached the standard, there were 2 cases of necrosis of the skin flap and 1 case of hematoma after operation unilaterally, which were given actively dressing change, secondary debridement, suturing and hematoma removal, The follow-up period was 6 months to 1 year. During the follow-up period, 24 cases were cured, including 21 cases of grade one and 3 cases of grade zero. The treatment effect was stable.Conclusions:The treatment of axillary osmidrosis by cutting off the apocrine sweat glands under direct vision combined with micro electrocoagulation, exposing the apocrine sweat glands as much as possible, effectively removing the apocrine sweat glands and hair follicles, and reducing the recurrence rate of axillary osmidrosis. It is a simple, safe and effective treatment technology for axillary osmidrosis.

Objective:To investigate the efficacy of treatment of bromhidrosis by cutting off the apocrine glands under direct vision combined with micro electrocoagulation.Methods:From January 2017 to December 2017, 25 patients (50 sides) with axillary osmidrosis admitted to the First People’s Hospital of Yuhang District were treated with direct vision cutting and micro electrocoagulation to destroy the apocrine sweat glands, including 13 males and 12 females, aged 14-38 years, with an average age of 23 years. According to Young-Jin Park′s criteria for judging axillary osmidrosis, 21 cases were classified as grade 3 and 4 cases as grade 2. After tumescent anesthesia, the subcutaneous apocrine sweat glands, fat and hair follicles were cut off under direct vision. The subdermal vascular network was preserved, and the basement was destroyed one by one by using high-frequency electrocoagulation mode. After the operation, the evaluation was conducted according to the criteria for judging axillary osmidrosis formulated by Young-Jin Park.Results:The symptoms of axillary osmidrosis reached the standard of cure in 24 patients after operation, 1 case failed to reach the cure standard. Among the patients who reached the standard, there were 2 cases of necrosis of the skin flap and 1 case of hematoma after operation unilaterally, which were given actively dressing change, secondary debridement, suturing and hematoma removal, The follow-up period was 6 months to 1 year. During the follow-up period, 24 cases were cured, including 21 cases of grade one and 3 cases of grade zero. The treatment effect was stable.Conclusions:The treatment of axillary osmidrosis by cutting off the apocrine sweat glands under direct vision combined with micro electrocoagulation, exposing the apocrine sweat glands as much as possible, effectively removing the apocrine sweat glands and hair follicles, and reducing the recurrence rate of axillary osmidrosis. It is a simple, safe and effective treatment technology for axillary osmidrosis.

Objective: To assess the value of detecting multiple rearrangements of MLL gene in children with acute mononuclear leukemia (AML). Methods: Eighty six children with AML were analyzed by fluorescence in situ hybridization (FISH), chromosomal karyotyping and multiplex reverse transcription-PCR (RT-PCR). Results: Cross signals were detected by FISH in 26 cases, and 30.2% were detected with MLL gene rearrangements. R-band karyotyping analysis revealed 14 translocations with breakages involving 11q23 and 5 other aberrations, which yielded an overall detection rate of 22.1%. Multiple RT-PCR has detected 12 fusion genes produced by the MLL translocation, which yielded a detection rate of 14.0%. A significant difference was found in the detection rate of the three methods (P<0.05). Conclusion Combined use of FISH, chromosomal karyotyping and multiplex RT-PCR can improve the detection of MLL gene rearrangements and provide important clues for clinical diagnosis, treatment and prognosis of AML.

Objective: To evaluate the safety and efficacy of microneedle radiofrequency for minimally invasive interventional treatment of bromhidrosis. Methods: From March 2016 to June 2017, Thirty-one bromhidrosis patients were treated with microneedle radiofrequency equipment (Bodytite armpits). Clinical follow up was then evaluated with Park standard. Results: Six to twelve months after surgery (average 8.58 months), malodor were totally eliminated in thirty patients. One patient with residual malodor was cured by second operation. There were no significant scars in all patients. Five patients were observed with mild pigmentation. Conclusions The microneedle radiofrequency treatment is a simple, efficient and safe method for minimally invasive interventional treatment of bromhidrosi.

Objective: To evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS) for left-sided pancreatic adenocarcinoma. Methods: Clinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old(47-68 years old). Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017. Results: All patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes(180-445 minutes), and the blood loss was 150 ml(50-500 ml). The medium first flatus time and diet resumption time were 3.0 days(1-5 days) and 3.5 days(1-7 days) respectively.The medium postoperative hospital stay was 9 days(4-18 days). Morbidity occurred in 8 patients with gastric empty delay(n=1), bleeding(n=1), fluid collection(n=3). There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis. Conclusion Lap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.

Objective To evaluate the safety and feasible of adjacent organ resection during laparoscopic pancreaticoduodenectomy(LPD),and summary the surgical strategies.Methods Clinical data of 15 adjacent organ resections combined with LPD from March 2013 to September 2017 were reviewed.There were 10 male and 5 female patients aging from 20 to 86 years,and the body mass index ranged from 19.6 to 34.5 kg/m2.Two patients had previous abdominal surgical history.Two patients underwent preoperative chemotherapy.Results The resected adjacent organs included liver (n =4),stomach (n =3),colon(n =6),right kidney with embolectomy and vasoplastic of inferior vena cava (n =1),and spleen artery aneurysms(n =1).The operative time ranged from 280 to 450 minutes,and the blood loss ranged from 100 to 450 ml.The total complication rate was 5/15 and no one died in 90 days after surgery.The postoperative hospital stay ranged from 10 to 42 days with medium 18 days.The pathology included adenocarcinoma of stomach and duodenum (n =1),gastric cancer invading pancreas or duodenum (n=2),ampullary adenocarcinoma with left hepatolithiasis(n=1),ampullary adenocarcinoma with a benign lesion in left liver (n =1),ampullary adenocarcinoma with single liver metastasis (n =1),ampullary adenocarcinoma(n =1),pancreatic intraductal papillary mucinous neoplasm with splenic artery aneurysms (n=1),pancreatic neuroendocrine neoplasm with colon cancer (n =1),distal common bile duct adenocarcinoma involving righ hepatic duct (n =1),pancreatic neuroendocrine neoplasm invading inferior vena cava and right renal vein(n=1),duodenal adnocarcinoma(n =1),duodenal ewing's sarcoma(n =1),duodenal intesititialoma (n =2).The follow-up was from 3 to 40 months with the medium survival of 17.5 months.Conclusions The oncological outcomes of PD combined with adjacent organ resection is acceptable.Surgical treatment for those patients with periampullary neoplasma and adjacent organ lesions should be aggressive.

Objective To evaluate the safety and feasible of adjacent organ resection during laparoscopic pancreaticoduodenectomy(LPD),and summary the surgical strategies.Methods Clinical data of 15 adjacent organ resections combined with LPD from March 2013 to September 2017 were reviewed.There were 10 male and 5 female patients aging from 20 to 86 years,and the body mass index ranged from 19.6 to 34.5 kg/m2.Two patients had previous abdominal surgical history.Two patients underwent preoperative chemotherapy.Results The resected adjacent organs included liver (n =4),stomach (n =3),colon(n =6),right kidney with embolectomy and vasoplastic of inferior vena cava (n =1),and spleen artery aneurysms(n =1).The operative time ranged from 280 to 450 minutes,and the blood loss ranged from 100 to 450 ml.The total complication rate was 5/15 and no one died in 90 days after surgery.The postoperative hospital stay ranged from 10 to 42 days with medium 18 days.The pathology included adenocarcinoma of stomach and duodenum (n =1),gastric cancer invading pancreas or duodenum (n=2),ampullary adenocarcinoma with left hepatolithiasis(n=1),ampullary adenocarcinoma with a benign lesion in left liver (n =1),ampullary adenocarcinoma with single liver metastasis (n =1),ampullary adenocarcinoma(n =1),pancreatic intraductal papillary mucinous neoplasm with splenic artery aneurysms (n=1),pancreatic neuroendocrine neoplasm with colon cancer (n =1),distal common bile duct adenocarcinoma involving righ hepatic duct (n =1),pancreatic neuroendocrine neoplasm invading inferior vena cava and right renal vein(n=1),duodenal adnocarcinoma(n =1),duodenal ewing's sarcoma(n =1),duodenal intesititialoma (n =2).The follow-up was from 3 to 40 months with the medium survival of 17.5 months.Conclusions The oncological outcomes of PD combined with adjacent organ resection is acceptable.Surgical treatment for those patients with periampullary neoplasma and adjacent organ lesions should be aggressive.