In recent years, laparoscopic surgery and robotic surgery have been widely used, and various intraoperative image navigation systems have also developed rapidly. However, the liver itself has a complex vessel and duct system, which increase the difficulty of liver surgery. The augmented reality image navigation system combines the three-dimensional reconstructed image of the liver with the real liver anatomy, which presents the specific relationship between the tumor location and the surrounding vessels for the surgeon. Compared with other intraoperative image navigation methods, augmented reality has its unique advantages. This paper provides an overview of current advances in registration technology in augmented reality image navigation system, and focuses on its applications in liver surgery, including laparoscopic surgery and robotic surgery. Finally, the technological problems and difficulties still faced at present are summarized, and future directions worth studying in this field are proposed.

ObjectiveThe aim of this study is to investigate change of platelet count in red blood cell （RBC） units at different storage periods and explore the efficiency of platelet removal by leukocyte filter. MethodsA total of 58 RBC units were divided into four groups according to different storage periods： 1 week Group （16）， 2 weeks Group （16）， 3 weeks Group （14） and 4 weeks Group （12）. RBC units in the four groups were filtered through leukocyte filter. The RBC samples before and after filtration were obtained. The platelet count was detected by automatic blood cell counter and the efficiency of platelet removal was calculated. RBC samples before filtration were made into blood cell smears. The blood cell smears were dyed with Wright-Giemsa stain， and the morphology of platelets was observed through a microscope. ResultsThe platelet count in RBC units stored for 1， 2， 3 and 4 weeks was （286.5±62.34）×10⁹/L， （238.0±57.37）×10⁹/L， （193.6±56.21）×10⁹/L and （167.8±24.76）×10⁹/L， respectively. Platelet count in blood stored for 3 weeks （P<0.01） and 4 weeks （P <0.000 1） were significantly lower than those stored for 1 weeks. When observed in the blood smears of RBC units at different storage periods， platelets with normal morphology were distributed in clump and scattered style. The platelet removal rates of the four groups were （80.13±9.06） %， （76.41±10.13） %， （77.78±9.30） % and （70.63±9.39） %， respectively， with no significant difference （P >0.05）. ConclusionsPlatelet count in RBC units decreases gradually as the storage period increases， but most platelets still remain in RBC units of late storage periods （3 weeks and 4 weeks）. The leukocyte filter is able to remove most of the platelets， and the removal efficiency is similar among the groups.

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesize that these effects may improve the quality of recovery (QoR) after open hepatectomy. Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine (CTPVB group) or normal saline (control group). All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was statistically analyzed using Student's t-test. Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study. Compared to the control group, the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores (133.14 ± 12.97 vs. 122.62 ± 14.89, P = 0.002) on postoperative day 7. Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (P < 0.05; P = 0.002), respectively, in the CTPVB group. Conclusion Perioperative CTPVB markably promotes patient's QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.
Anesthetics, Local/therapeutic use* ; Double-Blind Method ; Hepatectomy/adverse effects* ; Humans ; Morphine/therapeutic use* ; Pain Measurement ; Pain, Postoperative/etiology* ; Ultrasonography, Interventional

Objective:To evaluate the effect of indirect anchorage with mini-screw assisted clear aligner on molar distalization.Methods:Twenty-six adult patients [12 males and 14 females, aged 19 to 31 years, mean age (26.4±4.2) years], who were treated in the Department of Orthodontics, the Affiliated Stomatological Hospital of Nanchang University between January 2018 and September 2021, were included. All the patients were treated with clear aligner and mini-screw indirect anchorage to distalize maxillary molars. In the stage of molar distalization, the mini-implants were implanted between the buccal roots of the maxillary first molar and the second premolar, and rigidly connected to the maxillary second premolar as anchorage reenforcement. Until the first molar had distally moved to the designated position, the mini-implants were transferred to the buccal area between the first and the second molars and similar device was connected to the first molar. Cone-beam CT (CBCT) images were taken before the treatment (T0), at the maxillary first molar distally moved to the designated position (T1), and at the anterior teeth alignment finished (T2). The CBCT data were imported into Mimics 20.0 software for three-dimensional reconstruction. After correcting the head position, each reference point was determined in the multi-plane reconstruction view. The bilateral porion, the right orbitale, the nasion, and the anterior nasal spine were selected as reference points to construct the three-dimensional space coordinate system. The positions of the first molar, the second premolar, and the incisor were analyzed three-dimensionally. The three-dimensional position changes of maxillary first molars and maxillary second premolars during the stages of T0-T1, T1-T2, T0-T2, and the mesiodistal and vertical position changes of maxillary central incisors were analyzed. The statistical analysis was carried out using a one-way repeated measures ANOVA.Results:There was a significant difference in the sagittal position changes of the root and crown of the maxillary central incisors among three time points ( F=24.84, P<0.001; F=27.66, P=0.001), but no difference was observed between T0 and T1 ( P>0.05). There was a significant difference in lingual retraction of the maxillary central incisor root [(1.81±0.28) mm] and crown [(2.17±0.42) mm] between T1 and T2 ( P<0.05). A significant difference was noted in the sagittal position changes of the root and crown of the maxillary second premolars among three time points ( F=17.16, P=0.001; F=57.99, P<0.001). However, no statistical difference was detected between T0 and T1 ( P>0.05) and the difference in maxillary second premolar distalization [root (1.95±0.42) mm, crown (2.53±0.33) mm] was observed between T1 and T2 ( P<0.05). There was a statistically significant difference in the sagittal position changes of the root and the crown of the maxillary first molar among three time points ( F=9.37, P=0.002; F=140.26, P<0.001). The difference in the maxillary first molar distalization [crown (3.51±0.30) mm, root (1.98±0.25) mm] between T0 and T1 was significant ( P<0.05). However, no significant difference in the sagittal position of the maxillary first molars was observed between T1 and T2 ( P>0.05). There was a statistically significant difference in the vertical position of the center point of the root in maxillary first molar among three time points ( F=59.06, P<0.001), while (2.28±0.24) mm of intrusion between T0 and T1 was exhibited ( P<0.05). However, no significant difference was found in the vertical position of the maxillary first molars between T1 and T2 ( P>0.05). There was no significant difference in other measurements among three time points ( P>0.05). Conclusions:The effect of indirect anchorage with mini-screw-assisted clear aligner on molar distalization was positive.

OBJECTIVE: To study the expression of multiple negative costimulatory molecules on peripheral blood T cells in patients with acute myeloid leukemia (AML) and its affection on prognosis. METHODS: The peripheral blood samples from patients with newly diagnosed AML, complete remission (CR), and no-remission (NR) were collected, the expression levels PD-1、VISTA and TIM-3 in CD4 and CD8 T cells were detected by flow cytometry , and the clinical data of patients were analyzed. RESULTS: The expression levels of PD-1、VISTA and TIM-3 of CD4 and CD8 T cells in the newly diagnosed AML patients were significantly higher than those in control group (P＜0.05). The expression levels of PD-1、TIM-3 and VISTA of CD4 and CD8 T cells in the CR group were significantly lower than those in newly diagnosed and the NR group (P＜0.05). The TIM-3 expression level positively correlated with VISTA expression level of CD4 and CD8 T cells in newly diagnosed AML patients (r=0.85 and 0.73). The VISTA and PD-1 expression level of CD4 T cells in newly diagnosed AML, NR after first induction chemotherapy and high risk patients significantly increased (P＜0.05), the TIM-3 expression level of CD8 T cells in high risk group significantly increased (P＜0.05), and the VISTA expression level of CD8 T cells in CBFβ-MYH11 mutation-positive group significantly decreased (P＜0.05). CONCLUSION The expression of PD-1、TIM-3 and VISTA in AML peripheral blood T cells may be involved in the immune escape of AML and can be the targets of treatment for acute myeloid leukemia patients.
B7 Antigens ; CD8-Positive T-Lymphocytes ; Flow Cytometry ; Hepatitis A Virus Cellular Receptor 2 ; Humans ; Leukemia, Myeloid, Acute ; Programmed Cell Death 1 Receptor

Objective: To investigage the three-dimensional changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class Ⅲpatients with mandibular deviation using cone-beam CT (CBCT). Methods: Twenty-five skeletal class Ⅲ patients with mandibular deviation were included. The patients (12 males and 13 females, aged 19-25 years, average age 22.4 years) were treated in the Department of Orthodontics, Affiliated Stomatological Hospital, Nanchang University from October 2013 to March 2017. The patients were divided into T1, T2 and T3 groups (T1 group: CBCT taken within 1 week before operation; T2 group: CBCT taken within 1 week after operation; T3 group: CBCT taken 6-8 months after surgery). Three sets of image data of condyles on both sides (deviation side and contralateral side) were obtained. After the DICOM data collection, the software of Mimics 17.0 was used to perform three-dimensional reconstruction and condylar position measurements: the distance from the condylar top (CoT) to the standard horizontal plane (SHP), the middle sagittal plane (MSP) and the sella coronal plane (SCP) (CoT-SHP, CoT-MSP, CoT-SCP); the distance from the condylar center (CoC) to SHP, MSP and SCP (CoC-SHP, CoC-MSP, CoC-SCP); the angle from the condyle cella plane (CCP) to SHP, MSP and SCP (CCP-SHP, CCP-MSP, CCP-SCP); the angle from the condyle sagittal plane (CSP) to SHP, MSP and SCP (CSP-SHP, CSP-MSP, CSP-SCP) and the distance of the anterior, superior, posterior, medial, central and lateral joint space. One-way ANOVA and LSD-t test were used to compare the changes in condylar position at different periods (T1, T2, and T3). Results: Within 1 week before operation on the deviation side, CoT-SHP [(2.5±1.3) mm], CSP-MSP (41.2°±8.4°) and the posterior joint space [(2.0±0.6) mm] were obviously increased (P<0.05), and CoT-SCP [(9.1±3.3) mm], CCP-MSP (78.2°±5.2°) were decreased significantly (P<0.05); on the contralateral side, CoT-MSP [(50.4±3.1) mm], CCP-MSP (80.6°±6.0°), the anterior joint space [(2.2±0.6) mm] and the medial joint space [(2.6±0.6) mm] were obviously increased (P<0.05), and CCP-SCP (11.4°±8.8°) were decreased significantly (P<0.05). Six to eight months after surgery, CoT-SHP [(2.2±1.0) mm] and the posterior joint space [(1.9±0.5) mm] on deviation side and CoT-SCP [(8.4±2.8) mm] on the contralateral side were increased significantly (P<0.05). No significant difference was found in other measurements (P>0.05). Conclusions The condylar position in skeletal class Ⅲ patients with mandibular deviation was asymmetrical. Within 1 week after the operation of BSSRO, the condyle on the deviation side was moved forward, downward and inward. Meanwhile, the condyle on the contralateral side was moved backward and outward. Six to eight months after surgery, the condylar position on both sides was gradually restored to the pre-operative condylar position.

To investigage the three?dimensional changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal classⅢpatients with mandibular deviation using cone?beam CT (CBCT). Methods Twenty?five skeletal class Ⅲ patients with mandibular deviation were included. The patients (12 males and 13 females, aged 19?25 years, average age 22.4 years) were treated in the Department of Orthodontics, Affiliated Stomatological Hospital, Nanchang University from October 2013 to March 2017. The patients were divided into T1, T2 and T3 groups (T1 group: CBCT taken within 1 week before operation; T2 group: CBCT taken within 1 week after operation; T3 group: CBCT taken 6?8 months after surgery). Three sets of image data of condyles on both sides (deviation side and contralateral side) were obtained. After the DICOM data collection, the software of Mimics 17.0 was used to perform three?dimensional reconstruction and condylar position measurements: the distance from the condylar top (CoT) to the standard horizontal plane (SHP), the middle sagittal plane (MSP) and the sella coronal plane (SCP) (CoT?SHP, CoT?MSP, CoT?SCP); the distance from the condylar center (CoC) to SHP, MSP and SCP (CoC?SHP, CoC?MSP, CoC?SCP); the angle from the condyle cella plane (CCP) to SHP, MSP and SCP (CCP?SHP, CCP?MSP, CCP?SCP); the angle from the condyle sagittal plane (CSP) to SHP, MSP and SCP (CSP?SHP, CSP?MSP, CSP?SCP) and the distance of the anterior, superior, posterior, medial, central and lateral joint space. One?way ANOVA and LSD-t test were used to compare the changes in condylar position at different periods (T1, T2, and T3). Results Within 1 week before operation on the deviation side, CoT?SHP [(2.5±1.3) mm], CSP?MSP (41.2°±8.4°) and the posterior joint space [(2.0±0.6) mm] were obviously increased (P<0.05), and CoT?SCP [(9.1±3.3) mm], CCP?MSP (78.2°±5.2°) were decreased significantly (P<0.05); on the contralateral side, CoT?MSP [(50.4±3.1) mm], CCP?MSP (80.6°±6.0°), the anterior joint space [(2.2±0.6) mm] and the medial joint space [(2.6±0.6) mm] were obviously increased (P<0.05), and CCP?SCP (11.4°±8.8°) were decreased significantly (P<0.05). Six to eight months after surgery, CoT?SHP [(2.2± 1.0) mm] and the posterior joint space [(1.9±0.5) mm] on deviation side and CoT?SCP [(8.4±2.8) mm] on the contralateral side were increased significantly (P<0.05). No significant difference was found in other measurements (P>0.05). Conclusions The condylar position in skeletal classⅢpatients with mandibular deviation was asymmetrical. Within 1 week after the operation of BSSRO, the condyle on the deviation side was moved forward, downward and inward. Meanwhile, the condyle on the contralateral side was moved backward and outward. Six to eight months after surgery, the condylar position on both sides was gradually restored to the pre?operative condylar position.

Traditional Chinese medicine(TCM) has been increasingly used in the prevention and treatment of obesity and obesity-related diseases. However, its mechanism of action is not yet clear. In recent years, with the development of high-throughput sequencing technology, scientific researches have found that the disorder of gut microbiota is associated with obesity and other diseases. Furthermore, it has been found that TCM can improve the structure of gut microbiota by increasing probiotics and reducing pathogens, which play an importent role in preventing the development and progression of obesity and other diseases. This article first explores the possible association between intestinal microbiota and obesity. Then, it reviews the traditional Chinese medicine and its role in regulating intestinal microbiota for the prevention and treatment of diseases, including obesity and inflammation, insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, inflammatory bowel disease and other diseases, in theexpectation of new strategies and research direction for treating obesity and relevant diseases, and providing important guidance for further studies in this field in the future.

OBJECTIVETo study the risk factors for elevated serum total bile acid (TBA) in preterm infants.

METHODSA retrospective analysis was performed for the clinical data of 216 preterm infants who were admitted to the neonatal intensive care unit. According to the presence or absence of elevated TBA (TBA >24.8 μmol/L), the preterm infants were divided into elevated TBA group with 53 infants and non-elevated TBA group with 163 infants. A univariate analysis and an unconditional multivariate logistic regression analysis were used to investigate the risk factors for elevated TBA.

RESULTSThe univariate analysis showed that there were significant differences between the elevated TBA group and the non-elevated TBA group in gestational age at birth, birth weight, proportion of small-for-gestational-age infants, proportion of infants undergoing ventilator-assisted ventilation, fasting time, parenteral nutrition time, and incidence of neonatal respiratory failure and sepsis (P<0.05). The unconditional multivariate logistic regression analysis showed that low birth weight (OR=3.84, 95%CI: 1.53-9.64) and neonatal sepsis (OR=2.56, 95%CI: 1.01-6.47) were independent risk factors for elevated TBA in preterm infants.

CONCLUSIONSLow birth weight and neonatal sepsis may lead to elevated TBA in preterm infants.

Bile Acids and Salts ; blood ; Female ; Humans ; Infant, Low Birth Weight ; blood ; Infant, Newborn ; Infant, Premature ; blood ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors ; Sepsis ; blood

OBJECTIVETo analyze the correlation between the hallux valgus angle and arch X-ray parameters change, plantar pressure by measuring the X-ray indexes and foot-pressure indexes in patients with hallux valgus, as well as to study the main cause factors for the pain under the second metatarsal head.

METHODSA retrospective study of 254 patients(477 feet) treated in Wangjing Hospital from January 2012 to June 2013 was performed. The pain under the second metatarsal head and age distribution were recorded. All the patients were divided into two groups according to the second plantar bone pain: pain group and no pain group. The following indexes were measured and compared: HAVA(hallux abductor valgus angle), IMA1-2(the inter-metatarsal angle between the first and second metatarsals), IMA1-5(the inter-metatarsal angle between the first and fifth metatarsals), TAOTMLA (top angle of the medial longitudinal arch), AAOTMLA (anterior angle of the medial longitudinal arch), SMRL (the second metatarsal relative length than the first), and the plantar pressure indicators including TPUM (touch the ground time percentage under the second metatarsal head), PPUM (peak pressure under the second metatarsal head), and IUM(impulse under the second metatarsal head). All the factors were evaluated by Logistic regression analysis.

RESULTSSpearman rank correlation test showed that there were statistical significance in correlation between HAVA and IMA1-2, IMA1-5, TAOTMLA, AAOTMLA, TPUM(<0.05, r=0.647, 0.553, 0.127, -0.165, 0.158). Factors including the HAVA, SMRL and the TPUM were the risks for the pain under the second metatarsal head in patients with hallux valgus(<0.05, ORj=1.030, 1.069, 1.060).

CONCLUSIONSIncrease of the hallux valgus angle causes the collapse of hallux valgus arch, extending the weight bearing time of the second metatarsal and increasing the possibility of the pain under the second metatarsal.