Objective:To investigate the effectiveness of probe-based near-infrared autofluorescence imaging (NIRAF) of the parathyroid gland.Methods:A total of 71 patients with thyroid cancer eligible for admission from May 4, 2023 to May 26, 2023 were selected, including 42 patients with thyroid cancer enrolled in the Department of Thyroid (hernia), Department of General Surgery, PLA General Hospital, including 29 females and 13 males, with a median age of 41 years, ranging from 21 to 76 years. A total of 29 patients with thyroid cancer were enrolled in the Department of Thyroid Surgery of Guangzhou First People’s Hospital, including 22 females and 7 males. The median age was 42.5 years, ranging from 24 to 72 years. The follow-up period was 1 month.Results:Among them, 196 suspicious parathyroid tissues were identified by the naked eye, and 207 suspicious parathyroid tissues were identified by probe NIRAF technology. Naked eye identification sensitivity, specificity and accuracy were 84.86%, 56% and 81.89%. The sensitivity, specificity and accuracy of parathyroid tissue identification by probe NIRAF were 92.66%, 80.00% and 90.53%, which were better than that of naked eye identification, and had a good coincidence rate with the results of immunocolloidal gold test or intraoperative freezing pathology (Kappa=0.61, P<0.001) . Conclusion:The probe-based NIRAF technique has a good ability to identify parathyroid tissue.

Objective To study the effects of different types of fluid resuscitation on mesenteric microcirculation and inflammatory factors in rabbits with hemorrhagic shock.Methods The model of hemorrhagic shock rabbits was established by reducing the basic mean arterial pressure by 40%through draining the blood from the common carotid artery.Animals were randomly divided into control group,saline group,lactate Ringer group,acetic acid Ringer group,hydroxyethyl starch group and succinyl gelatin group with 8 animals in each group.Mesenteric microcirculation was monitored with microcirculation monitor.Mean arterial pressure(MAP),heart rate(HR),microvascular perfusion ratio(PPV)and microvascular blood flow index(MFI)were recorded before bleeding(T0),at hemorrhagic shock(T1),at the beginning of fluid resuscitation(T2),at the completion of fluid resuscitation(T3),and at the end of the experiment(T4).The contents of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1)and lactic acid(Lac)were measured at T0,T2 and T4.Results Compared with hydroxyethyl starch group,there were statistically significant differences in T3 MAP(P<0.05),except for succinyl gelatin group,hydroxyethyl starch group had higher MAP at T4 than other groups,the difference was statistically significant(P<0.05).The differences in MAP between experimental control group and other groups were statistically significant at T4(P<0.05).PPV and MFI of hydroxyethyl starch group and succinyl gelatin group were higher than those of normal saline group,lactic acid Ringer group and acetic acid Ringer group at T4(P<0.05),and the lactic acid value of hydroxyethyl starch group at T4 was the lowest,compared with lactic acid Ringer group and normal saline group,the difference was statistically significant(P<0.05).There were statistical significances between all groups and experimental control group at T4(P<0.05).There were no significant differences in TNF-αand IL-1 in T0,T2 and T4 among all groups(P<0.05).Conclusion Hydroxyethyl starch solution and succinyl gelatin solution can improve the microcirculation of rabbits with hemorrhagic shock,but can not improve the level of inflammatory factors.

Objective:To investigate the effect of eyebrow arch augmentation with personalized polyether ether ketone (PEEK) implant assisted by endoscope.Methods:From January 2019 to August 2021, 9 patients with low and flat eyebrow arch requiring eyebrow arch augmentation were treated in the plastic surgery department of the Friendship Plastic Surgery Hospital Affiliated to Nanjing Medical University. The cranial and maxillofacial CT scanning data were obtained before operation, the eyebrow arch elevation range and height were designed according to the patient's requirements, and personalized peek implants were manufactured. During the operation, a small temporal hairline incision was used to accurately separate the implantation cavity of individualized peek implants under the periosteum of the eyebrow arch implantation area with the aid of endoscope. Personalized PEEK implants were implanted under endoscope to make them fully fit with the eyebrow arch bone and fixed with titanium nails. Photos were taken and analyzed before and after operation.Results:All patients were followed up for 3 months to 2 years. Their facial expressions were normal, and there were no motor nerve injury, rejection and iatrogenic infection. The patients were satisfied with the postoperative effect. Compared with before operation, the low level of orbital bone in eyebrow area was improved, and the facial contour was three-dimensional and harmonious.Conclusions:The eyebrow arch augmentation with individualized peek implant assisted by endoscope is safe and effective. It can greatly reshape the upper contour of the face, deepen the upper eyelid fossa and improve the convex eye phenomenon, so as to achieve the cosmetic effect of enhancing the three-dimensional sense of the eyebrow orbital area, which is worthy of clinical application.

Objective:To identify the pathogens isolated in the subperiosteal abscesses from the pediatric patients with acute osteomyelitis and to investigate the characteristics of bacterial drug resistance.Methods:A retrospective study was conducted on children with acute septic osteomyelitis who were hospitalized in the Children's Hospital, Zhejiang University School of Medicine from January 1, 2011 to March 1, 2018. The results of bacterial cultures isolated from the subperiosteal abscesses or bone marrow fluid were collected. The Merier automatic bacterial identification system (i.e., Vitek) was used to identify the bacteria and to assess the drug sensitivity.Results:(1) A total of 104 pediatric patients were included and 60 (57.7%) were male. Sixty-six strains of pathogens were isolated from 65 patients (62.5%). Among them, 53 strains (51.0%) were Staphylococcus aureus; 3 strains were Escherichia coli; 2 strains (1.9%) were Pseudomonas aeruginosa; 2 strains (1.9%) were Streptococcus pneumoniae, 2 strains (1.9%) were Ochrobactrum anthropi, and 4 strains (3.8%) were other bacteria. Pathogens were not found in 39 patients (37.5%). (2) Staphylococcus aureus accounted for 81.5% (53/65) of the pathogen-positive cases. Among them, 23 strains (43.4%) were methicillin-resistant Staphylococcus aureus (MRSA). Aureus-positive children were statistically significantly older ( P=0.028), heavier ( P=0.040) and had higher C-reactive protein (CRP) level ( P=0.038) than the aureus-negative children. (3) All the 53 Staphylococcus aureus strains were resistant to penicillin and 56.6% of them were only sensitive to benzocillin. The resistance rates to compound sulfamethoxazole, tetracycline, clindamycin and erythromycin were 11.3%, 30.2%, 67.9% and 69.8%, respectively. The sensitivity rate of the strains to furantoin was 90.2%. All strains were sensitive to quinupristin/dalfopristin, linezolid, rifampicin, tigecycline, levofloxacin, moxifloxacin, ciprofloxacin and vancomycin. There was 69.8% of the strains resistant to three or more different types of antibiotics. Conclusions:Staphylococcus aureus is the most common pathogen that causes the acute septic osteomyelitis in children, and the resistance rate to Benzocillin is relatively high. Therefore, Benzocillin and Clindamycin, as the traditionally-used drugs, should not be considered as the first choice when empirically using intravenous antibiotics. In the present study, pathogens in 39 patients (37.5%) were not detected in their subperiosteal abscesses or bone marrow fluid, so further effort should be made to investigate the etiology of these patients.

Objective:To evaluate the accuracy and clinical outcomes of two different three-dimensional(3D) printed digital mandibular angle osteotomy templates.Methods:Female patients with a prominent mandibular angle(PMA) admitted to the same surgical team in the Friendship Plastic Surgery Hospital of Nanjing Medical University from March 2019 to July 2020 were selected as the research subjects. They were allocated into Group A and Group B alternately according to the order of admission. Group A was the conventional digital osteotomy template(CDOT) group, and Group B was the novel digital osteotomy template(NDOT) group. All patients underwent cone-beam computed tomography(CBCT) scan and 3D reconstruction before surgery. Preoperative CT data were imported into Mimics 19.0, and personalized mandibular angle osteotomy(MAO) line and digital osteotomy template(DOT) were designed according to patients’ conditions and requirements. In Group A, the DOTs were designed according to the part of mandibular angle to be removed(CDOT). And in Group B, the DOTs were designed according to to the part of reserved mandible(NDOT). The DOTs were created with a 3D printer. All patients were underwent bilateral MAO under the guidance of these DOTs through an intraoral approach. CBCT scan was also performed on all patients within 1 week after surgery, and incision healing, complications and lower facial contouring were observed. The mean time taken for positioning DOT and performing curved osteotomy, the volume of postoperative drainage on one side within 24 hours after surgery, and the deviations between the preoperative design and 3D reconstruction mode lower mandibular margin within 1 week after surgery were compared between the two groups.Results:A total of 20 female patients with PMA were included, including 10 patients in Group A, aged 20-31 years, with an average of 24.3±2.3 years. Group B consisted of 10 patients aged 22-30 years, with an average of 24.6±2.2 years. There was no significant difference in age between 2 groups ( P>0.05). All patients were successfully performed MAO without fracture, massive bleeding, infection and other complications, and the postoperative result were satisfactory. The mean time taken to position the DOT and perform MAO one side in Group A was (18.1±1.0) min, significantly longer than that in Group B (14.2±1.4) min ( P<0.05). The volume of postoperative drainage on one side within 24 hours in Group A and Group B was (107.9±12.5) ml and (112.1±13.8) ml, respectively ( P>0.05). The deviations between preoperative design and postoperative mandibular margin, at the anterior part was (2.7±1.2) mm in Group A, which was significantly larger than that of Group B[(1.6±0.9) mm]( P<0.05), the middle part deviation of Group A and B was (1.9±0.7) mm and (1.8±0.8) mm, respectively ( P>0.05), and the posterior part deviation of Group A was (2.8±1.1) mm, which was significantly higher than that of Group B (1.8±0.8 mm)( P<0.05). Conclusions:DOT assisted MAO can achieve accurate osteotomy and reduce the operative difficulty. The NDOT is easier to be located in the operation with more stable fixation, and the surgical efficiency and accuracy of osteotomy are higher than that of CDOT.

Objective:To evaluate the accuracy and clinical outcomes of two different three-dimensional(3D) printed digital mandibular angle osteotomy templates.Methods:Female patients with a prominent mandibular angle(PMA) admitted to the same surgical team in the Friendship Plastic Surgery Hospital of Nanjing Medical University from March 2019 to July 2020 were selected as the research subjects. They were allocated into Group A and Group B alternately according to the order of admission. Group A was the conventional digital osteotomy template(CDOT) group, and Group B was the novel digital osteotomy template(NDOT) group. All patients underwent cone-beam computed tomography(CBCT) scan and 3D reconstruction before surgery. Preoperative CT data were imported into Mimics 19.0, and personalized mandibular angle osteotomy(MAO) line and digital osteotomy template(DOT) were designed according to patients’ conditions and requirements. In Group A, the DOTs were designed according to the part of mandibular angle to be removed(CDOT). And in Group B, the DOTs were designed according to to the part of reserved mandible(NDOT). The DOTs were created with a 3D printer. All patients were underwent bilateral MAO under the guidance of these DOTs through an intraoral approach. CBCT scan was also performed on all patients within 1 week after surgery, and incision healing, complications and lower facial contouring were observed. The mean time taken for positioning DOT and performing curved osteotomy, the volume of postoperative drainage on one side within 24 hours after surgery, and the deviations between the preoperative design and 3D reconstruction mode lower mandibular margin within 1 week after surgery were compared between the two groups.Results:A total of 20 female patients with PMA were included, including 10 patients in Group A, aged 20-31 years, with an average of 24.3±2.3 years. Group B consisted of 10 patients aged 22-30 years, with an average of 24.6±2.2 years. There was no significant difference in age between 2 groups ( P>0.05). All patients were successfully performed MAO without fracture, massive bleeding, infection and other complications, and the postoperative result were satisfactory. The mean time taken to position the DOT and perform MAO one side in Group A was (18.1±1.0) min, significantly longer than that in Group B (14.2±1.4) min ( P<0.05). The volume of postoperative drainage on one side within 24 hours in Group A and Group B was (107.9±12.5) ml and (112.1±13.8) ml, respectively ( P>0.05). The deviations between preoperative design and postoperative mandibular margin, at the anterior part was (2.7±1.2) mm in Group A, which was significantly larger than that of Group B[(1.6±0.9) mm]( P<0.05), the middle part deviation of Group A and B was (1.9±0.7) mm and (1.8±0.8) mm, respectively ( P>0.05), and the posterior part deviation of Group A was (2.8±1.1) mm, which was significantly higher than that of Group B (1.8±0.8 mm)( P<0.05). Conclusions:DOT assisted MAO can achieve accurate osteotomy and reduce the operative difficulty. The NDOT is easier to be located in the operation with more stable fixation, and the surgical efficiency and accuracy of osteotomy are higher than that of CDOT.

Intracerebral hemorrhage is a kind of nervous system disease with high mortality and disability. By analyzing the clinical variables closely associated with the functional outcome of intracerebral hemorrhage, a scoring scale that can quickly predict the outcome of intracerebral hemorrhage is established, which is helpful to guide clinicians in risk stratification and clinical diagnosis and treatment of patients with intracerebral hemorrhage. At present, more than 10 clinical outcome scoring scales have been developed. This article summarizes these scoring scales of intracerebral hemorrhage in chronological order, and reviews their constituent variables, outcome evaluation value, and follow-up verification.

Objective:To investigate the clinical outcomes of personalized polyetheretherketone (PEEK) implant in the correction of nasolabial fold depression.Methods:A total of 30 patients with nasolabial fold depression (5 males, 25 females, aged 26 to 52 years, mean 36.3 years) admitted to the Affiliated Friendship Plastic Hospital of Nanjing Medical University who want to undergo nasolabial fold augmentation from January 2019 to January 2021. All patients underwent CBCT scan and three-dimensional simulation, the personalized PEEK implant was designed and produced with CAD/CAM technique, the personalized PEEK was implanted during the operation. The patients were followed up for 3-12 months, and the wrinkle score and satisfaction were compared before operation and 3 months and 6 months after operation.Results:The depressions of nasolabial fold were significantly improved in all patients, and there were no complications such as hematoma and infection after operation. During the follow-up, there was no implant displacement or exposure, and the effect was stable and lasting. The scores of wrinkles at 3 months after operation (2.30±0.47) and 6 months after operation (2.17±0.38) were significantly lower than those before operation (4.03±0.67), and the scores of satisfaction were significantly higher than those before operation ( P<0.05). The scores of satisfaction at 3 months after operation (3.97±0.56) and 6 months after operation (4.23±0.57) were significantly higher than those before operation (1.70±0.60). The difference was statistically significant ( P<0.05). Conclusions:3D printing personalized PEEK prosthesis is effective in correcting nasolabial fold depression, and it is safe and stable, so it is recommended for clinical application.

Objective:To investigate the effect of mandibular angle osteotomy on the morphological changes of mandible by using cone beam computed tomography (CBCT) scanning data and three-dimensional cephalometry.Methods:According to included and excluded criteria, the complete CBCT data of 20 female patients (aged 20-35 years with an average age of 25.5 years) from January 2016 to June 2018 who underwent curved mandibular angle osteotomy combined with splitting cortiectomy were selected. Seven items reflecting mandibular morphology before and after surgery were measured respectively. All the data were analyzed by the means of SPSS 12.0; linear correlation analysis and paired t test were used to evaluate the change of andibular morphology.Results:The measurement results of the mandible pre- and post-operative 10 days showed as follows: Go-Go decreased, both sides of Cd-Go, Go-Ri and MR-MA decreased, both sides of Go-Me became longer, both sides of Ar-Go-Me and MP-FH increased. The paired t-test results showed that there was significant difference before and after operation ( P<0.05), but there was no significant difference between the left and right measurement items ( P>0.05). Compared with that in 10 days after operation, the measurement items also changed 6 months after operation. There was no statistical difference between the above measurement items 6 months after surgery and 10 days after surgery ( P>0.05), and no statistical difference between the left and right sides ( P>0.05). Conclusions:The mandibular three-dimensional model which is reconstructed based on CBCT data, not only displays the three-dimensional anatomical structure that cannot be presented on X-ray film visually and comprehensively by means zoom, rotation and other operations, but also precisely and accurately shows the change of the shape of the mandible from the sagittal, coronal and horizontal plane with arbitrary cutting and rotation. The measurement of mandible is more accurate and reliable, and the surgical plan of mandibular angle osteotomy can be accurately planned preoperatively, and the operative effect can be quantitatively evaluated postoperatively.

Objective:To investigate the normal range of exhaled nitric oxide in healthy children aged 6-18 in Jinan.Methods:The healthy school children aged 6-18 in Jinan from October 11 to 26, 2017 were selected for questionnaire survey, physical examination and exhaled nitric oxide test.The levels of mouth exhaled nitric oxide at the flow rate of 50 mL/s (FeNO 50) and mouth exhaled nitric oxide at the flow rate of 200 mL/s(FeNO 200), alveolar nitric oxide (CaNO), and nasal exhaled nitric oxide at the flow rate of 10 mL/s(FnNO 10) were measured by the electroche-mical method.The distributions of FeNO 50, FeNO 200, CaNO and FnNO 10 were analyzed, and their correlations with gender, age, height and body mass index (BMI) were discussed by the multiple linear regression model. Results:A total of 772 healthy children were enrolled in this study, including 364 males and 408 females, with a median age of 12.1(11.8-12.3) years old, a median height of 154.8(153.6-156.0) cm, and a median BMI of 20.3 (20.0-20.6) kg/m 2. The measured values of FeNO 50, FeNO 200, CaNO and FnNO 10 fluctuated in the range of 3.0-168.0 ppb, 2.0-44.0 ppb, 0.5-44.2 ppb and 0-1 253.0 ppb, respectively.FeNO 50, FeNO 200 and CaNO values showed skewed a distribution, and their 95% upper limits were 35.0 ppb, 13.3 ppb and 8.5 ppb, respectively.The geometric mean(95% CI) of FeNO 50 in males (95% CI)[14.6 (13.7-15.5) ppb] was significantly higher than that in females [13.3(12.7-14.0) ppb], and the difference was statistically significant ( Z=1.470, P=0.027). The multiple linear regression results suggested that, FeNO 50 was positively correlated with age and height ( β=0.023, 0.007, respectively, all P<0.05), and negatively correlated with BMI ( β=-0.016, P<0.05). The geometric mean (95% CI) of FeNO 200in males[7.1 (6.8-7.4) ppb] was significantly higher than that in females[6.4 (6.1-6.6) ppb], and the difference was statistically significant( Z=1.747, P=0.004). The multiple linear regression results suggested that, FeNO 200 was positively correlated with height ( β=0.005) and negatively correlated with gender(female β=-1.126) (all P<0.05). There was no significant difference between male and female in CaNO, which had no correlation with gender, age, height and BMI (all P>0.05). FnNO 10 showed a normal distribution, with a mean value of 456.2 ppb, 95% CI of 29.3-863.4 ppb.The geometric mean (95% CI) of FnNO 10 in males [408.7 (377.1-443.0) ppb] was significantly higher than that in females [368.8 (339.0-401.3) ppb], and the difference was statistically significant ( Z=1.722, P=0.005). The multiple linear regression results indicated that FnNO 10 was related to gender ( β=-36.098, P<0.05), and not correlated with age, height and BMI (all P>0.05). Conclusions:The normal ranges of FeNO 50, FeNO 200, CaNO and FnNO 10 in healthy children aged 6-18 in Jinan are 3.0-35.0 ppb, 2.0-13.3 ppb, 0.5~8.5 ppb and 29.3-863.4 ppb, respectively.FeNO 50 is correlated with age, height and BMI.FeNO 200 is correlated with gender and height.CaNO and FnNO 10 are not correlated with age, height or BMI.