Objective:To explore an applicative value of a 5-type precise diagnostic technique in integrated precise repair and reconstruction of digit-tip injuries.Methods:From March 2012 to June 2022, 45 digit-tip injuries (38 patients, with an average age of 33 years old) were classified under microscope on the basis of effectiveness of blood vessels remained in the severed tissue. Among the injured digits, there were 15 thumbs, 9 index fingers, 16 middle fingers, 4 ring fingers and 1 little finger. The diagnosis was categorised into 5 types according to involvement of blood vessels: Type I, injury of proper palmar digital artery (10 digits) ; Type II, injury of small artery (5 digits) ; Type Ⅲ, injury of whole vein (4 digits) ; Type IV, injury of superficial palmar arch (4 digits) ; and Type V, vessels missing (22 digits). The timing and therapeutic method of surgery were selected based on the precise classification of 5 types of diagnosis: (1) For type Ⅰ-Ⅳ injuries, 16 patients (23 digits) received in situ tissue replantation after emergency classification. Of which, type Ⅰ-Ⅱ injuries received conventional replantation, type Ⅲ injuries had replantation with arterialised vein, and type IV injuries received replantation with artery-vein shunt. (2) For the type V injuries, 22 patients (22 digits), staged and categorised flap reconstruction with toe flaps were performed. Of which, 7 were performed in emergency surgery, 12 in subemergency surgery and 3 in elective surgery. Based on the severity of defects, small tissue flaps of toe were used in reconstruction of type V injuries and following toe flaps were employed: 9 hallux nail flaps, 3 hallux nail flaps (for reconstruction of distal phalanx), 5 hallux fibular flaps, 3 hallux abdominal flaps and 2 compound tissue flaps with nail bed of the second toe. The sizes of the 45 replanted/transferred tissues flaps were 1.0 cm×0.6 cm×0.4 cm-2.2 cm×1.5 cm×0.8 cm. Donor sites directly sutured. Medical APP was applied in the rehabilitation exercises. Functions of digits were assessed by scheduled follow-ups at outpatient clinic and via remote medical APP to evaluate the clinical efficacy.Results:All small tissue blocks and (or) tissue flaps survived after replantation and (or) flap reconstruction of 45 injured digits. Postoperative follow-up lasted for 6 months to 7 years, with 36 months in average. The appearances of the reconstructed digit-tips were close to normal digits, with TPD at 3-7 mm. According to the Michigan Hand Outcomes Questionnaire (MHQ), 32 patients (37 digits) were in excellent, 5 patients (7 digits) in good, and 1 patient (1 digit) in poor, with 97.78% of excellent and good rate.Conclusion:Five-type precise diagnostic technique is the key to the integrated and precise reconstruction of digit-tip injuries. This method has been clinically validated and achieved realistic recovery from the injured digits.

Objective:To evaluate the three-dimensional soft tissue changes at nasolabial region of female patients with maxillary protrusion after orthognathic surgery with maxillary setback.Methods:Peking University School and Hospital of Stomatology admitted 88 female patients with maxillary protrusion, aged 18-42 years old, with an average age of 28.2 years old. The segmental Le Fort Ⅰ osteotomies were performed in all patients with extraction of maxillary first premolars to create space for maxillary setback. The patients with maxillary protrusion and mandibular retraction received bilateral sagittal split ramus osteotomy(BSSRO)to move mandibular body, while the patients with bimaxillary protrusion received subapical osteotomy. 3dMD photos were taken preoperative 1-3 days and at least 6 months after operation to obtain three-dimensional facial images. The postoperative soft tissue changes of three-dimensional landmarks, line space and angles were measured with the use of Geomagic Studio 2013, and three-dimensional deviation analysis was applied. Paired t test was performed on the measured results. P<0.05 was considered statistically significant. Results:The distance of the subnasale in sagittal direction in patients with maxillary protrusion was (-10.90±18.60) mm preoperatively, (-10.05±18.62) mm ( t=-7.66, P<0.001)postoperatively, and setback of (0.85±1.00) mm; Labrale superius was (-15.18±18.67) mm preoperatively, (-11.92±18.9) mm postoperatively, and setback of (3.26±1.40) mm. Preoperative nasal width was (37.32±2.32) mm, postoperative for (38.08±2.32) mm ( t=-4.85, P<0.001)and increased by (0.76±1.47) mm.The lip width was (49.17±3.54) mm before surgery and (47.68±3.74) mm ( t=5.77, P<0.001)after surgery ( t=5.77, P<0.001), decreased by (1.49±2.42) mm. Philtrum length was (15.20±2.32) mm preoperatively and (15.78±2.17) mm ( t=-4.70, P<0.001)postoperatively, increased by (0.58±1.16) mm; The nasolabial angle was 101.98°±9.34° before surgery and 109.05°±8.59° ( t=-12.36, P<0.001)after surgery, increased by 6.99°±5.35°. The three-dimensional deviation analysis result showed that the soft tissue in the parasnasal area was moved forward (1.54±0.73) mm. Conclusions:3dMD can reflect the three-dimensional soft tissues changes after orthognathic surgery directly and accurately. After maxillary setback, the nasal base and upper lip of patients were significantly retrograded, and the paranasal area appeared forward, accompanied by increase in the nasolabial angle, lengthening of the philtrum length, vermillion length decrease, increase in nasal width and decrease in lip width.

Objective:To evaluate the three-dimensional soft tissue changes at nasolabial region of female patients with maxillary protrusion after orthognathic surgery with maxillary setback.Methods:Peking University School and Hospital of Stomatology admitted 88 female patients with maxillary protrusion, aged 18-42 years old, with an average age of 28.2 years old. The segmental Le Fort Ⅰ osteotomies were performed in all patients with extraction of maxillary first premolars to create space for maxillary setback. The patients with maxillary protrusion and mandibular retraction received bilateral sagittal split ramus osteotomy(BSSRO)to move mandibular body, while the patients with bimaxillary protrusion received subapical osteotomy. 3dMD photos were taken preoperative 1-3 days and at least 6 months after operation to obtain three-dimensional facial images. The postoperative soft tissue changes of three-dimensional landmarks, line space and angles were measured with the use of Geomagic Studio 2013, and three-dimensional deviation analysis was applied. Paired t test was performed on the measured results. P<0.05 was considered statistically significant. Results:The distance of the subnasale in sagittal direction in patients with maxillary protrusion was (-10.90±18.60) mm preoperatively, (-10.05±18.62) mm ( t=-7.66, P<0.001)postoperatively, and setback of (0.85±1.00) mm; Labrale superius was (-15.18±18.67) mm preoperatively, (-11.92±18.9) mm postoperatively, and setback of (3.26±1.40) mm. Preoperative nasal width was (37.32±2.32) mm, postoperative for (38.08±2.32) mm ( t=-4.85, P<0.001)and increased by (0.76±1.47) mm.The lip width was (49.17±3.54) mm before surgery and (47.68±3.74) mm ( t=5.77, P<0.001)after surgery ( t=5.77, P<0.001), decreased by (1.49±2.42) mm. Philtrum length was (15.20±2.32) mm preoperatively and (15.78±2.17) mm ( t=-4.70, P<0.001)postoperatively, increased by (0.58±1.16) mm; The nasolabial angle was 101.98°±9.34° before surgery and 109.05°±8.59° ( t=-12.36, P<0.001)after surgery, increased by 6.99°±5.35°. The three-dimensional deviation analysis result showed that the soft tissue in the parasnasal area was moved forward (1.54±0.73) mm. Conclusions:3dMD can reflect the three-dimensional soft tissues changes after orthognathic surgery directly and accurately. After maxillary setback, the nasal base and upper lip of patients were significantly retrograded, and the paranasal area appeared forward, accompanied by increase in the nasolabial angle, lengthening of the philtrum length, vermillion length decrease, increase in nasal width and decrease in lip width.

BACKGROUND:Stem cel transplantation has gained considerable support recently. It provides new opportunities for treating diabetic neurogenic bladder. OBJECTIVE:To summarize the research progress in bone marrow mesenchymal stem cel s (BMSCs)transplantation in the treatment of diabetic neurogenic bladder. METHODS:The first author retrieved Sciencedirect, PubMed, Embase, Wangfang and CNKI databases, for relevant articles of BMSCs transplantation in the treatment of diabetic neurogenic bladder, published from 2000 to 2016. The key words were“bone marrow mesenchymal stem cel s, diabetic neurogenic bladder, differentiation, transplantation”in Chinese and English, respectively. RESULTS AND CONCLUSION:In patients with diabetic neurogenic bladder, the transplantation of BMSCs may provide safer and longer-lasting outcomes by repairing the damaged bladder and urethra. And it can produce various bioactive substances, which wil have nutritional paracrine effects on the bladder microenvironment, including anti-inflammation, promoting cel proliferation and improving cel survival. On the one hand, the BMSCs have the ability to migrate to the injury site via the blood circulation. On the other hand, BMSCs can produce various growth factors, as wel as the cytokines that can inhibit the inflammatory response. While the current clinical studies are lacking, its efficacy and safety needs further verification.

Aim To study the analgesic effect of geraniol on neuropathic pain and to explore the possible mechanism.Method A neuropathic pain rat model of Spared Nerve Injury(SNI) was established to measure changes in the threshold of paw withdrawal before and after i.p.administration of geraniol.Patch clamp whole-cell recording was performed to measure activity of sodium channels using ipsilateral L3/L4/L5 dorsal root ganglion(DRG) cells isolated from the SNI rats.In addition, HEK 293 cells expressing hNav1.7 and hTRPA1 channels were used for measuring the changes in channel activities with or without geraniol by whole-cell patch clamp.Results Geraniol had a fast analgesic effect on hypersensitivity of mechanical pain in the SNI model.It significantly inhibited sodium channels on DRGs isolated from SNI rats and hNav1.7 but not hTRPA1 channels expressed by HEK293 cells.However, high concentrations of geraniol facilitated the activation of HTRPA1 channel stimulated by AITC.Conclusion Geraniol may abirritate hypersensitivity of mechanical pain in the SNI model by specifically inhibiting Nav1.7 channel activity on the DRG cells.

Objective:To evaluate the surgical corrective results of maxillary hypoplasia in patients with cleft lip and palate withtranspalatal modified Le Fort Ⅰ osteotomy.Methods:In the study,1 1 patients (4 women,and 7 men)with maxillary hypoplasia secondary to cleft lip and palate underwent transpalatal modified Le Fort Ⅰ osteotomy at Peking University School of Stomatology from Jan.201 2 to Dec.201 3, with the mean age of 21 years (from 1 8 to 27 years),Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty were performed simultaneously in 9 of them for better appearance and functional occlu-sion.Lateral cephalometric radiographs were taken and traced before surgery,immediately after surgery and 6 months after surgery.The position of subspinale (A)on horizontal direction,the angle of sella-na-sion-subsipmale (SNA)and the angle of sella-nasion-supramental (SNB)were collected and analyzed to evaluate the results.Results:All the patients were uneventful with transpalatal modified Le Fort Ⅰosteotomy.All of them had a better profile and a satisfactory occlusionafter operation.The position of A was moved forward (6.6 ±1 .1 )mm on average in horizontal direction when surgery was completed,and maintained (6.0 ±1 .2)mm on average 6 months after surgery.The average of SNA was 75.9°±2.8° before surgery,81 .6°±8.6°immediately after surgery,and maintained 81 .0°±2.6°6 months after sur-gery.The average of SNB was 82.6°±3.7°before surgery,78.0°±2.4°immediately after surgery,and maintained 78.5°±2.4°6 months after surgery.Conclusion:The maxillary hypoplasia in cleft lip and palate patients can be successfully corrected with transpalatal modified Le Fort Ⅰ osteotomy and the func-tional occlusion can be achieved simultaneously.The effect of deformity correction was satisfactory. Transpalatal modified Le Fort Ⅰ osteotomy can move maxilla more sufficiently,especially applicable for the patient with severe palatal scars preoperatively.

Objective To quantitatively analyze the changes of facial symmetry and temporomandibular joint structure at different periods after intraoral condylectomy combined with orthognathic surgery,and to evaluate the long-term stability after the operation.Methods Spiral CT data of 10 cases treated by intraoral condylectomy combined with orthognathic surgery were collected,and then reconstructed by ProPlan software.Mark points were drawn on the 3D-images reconstructed immediately after the operation,and 6 months and 12 months after the operation.The measurements parameters included condylar axis angle in three dimensions,condylar-glenoid relative position and condylar facial morphology related indicators.The results were statistically analyzed by the consistency test and the variance of repeated measurement data.Results The facial asymmetry of the patients was corrected after operation,the height of the affected mandibular ascending ramus(T1:[67.81±6.95] mm,T2:[64.49±6.24] mm,T3:[63.05±7.07] mm) as well as the degree of pogonion deviation decreased(T1:[2.79±4.93] mm,T2:[0.37±4.20] mm,T3:[0.33 ± 3.97] mm) (P＜0.05).But the tilt angle of the occlusion plane and the degree of mandibular height asymmetry had no significant difference between all the post-operative periods(P＞0.05).The post-operative 3D changes of the position and shape of the resected and its contralateral condylar showed that the bilateralcondylar axis angle in the horizontal plane gradually grew after operation(affected condyle:71.95°±7.47°,74.73°±8.44°,76.56°±5.22°;control condyle:72.60°±5.56°,76.00°±5.30°,77.19°±6.20° and had significant difference between all the post-operative periods)(P＜0.05),the condyle moved slowly upward on both sides (superior space on the affected side:[8.78±4.38] mm,[4.11±2.49] mm,[3.27±1.96] mm;on the control side:[3.63t1.49] mm,[2.52±1.19] mm,[2.38±1.11] mm)(P＜0.05),and moved inward only on the affected side(P＜0.05).All the above changes slowed down over time,and the disc-condyle-fossa relative position tended to be stable over time as well.The condyle diameter on the inside-outside direction gradually decreased on the affected side(T1:[14.98±2.39] mm,T2:[14.04±2.68] mm,T3:[13.74±2.89] mm)(P＜0.05),and the surface morphology,of the resected condyle was similar to the normal side.There were also some condylar surface morphological changes on the control side,but no statistical significance was found between different periods after the peration(P＞0.05).Conclusions The intraoral condylectomy combined with orthognathic surgery can eliminate condylar lesions effectively and correct the facial asymmetry caused by condylar benign tumor and hyperplasia.The facial symmetry can be maintained well after the operation,and the post-operative condylar morphology changes tended to be stable six months after the operation.

Objective To establish a computer-aided surgical simulation procedure based on the natural head position(NHP) for orthognathic surgery and to access the effect for correcting facial asymmetry for skeletal Class Ⅲ deformity. Methods Thirty-five patients(male: 14 and female: 21, mean age: [21.5 ± 2.3] years) of skeletal Class Ⅲ deformity with facial asymmetry were included and divided into virtual group (16 patients) and control group(19 patients). The computer-aided surgical simulation procedure was used in the virtual group and the intermediate and final splints were fabricated using the rapid protyping technique. The traditional model surgery based on plaster casts was used in control group, and the splints were handmade. To evaluate the symmetry, three-dimensional(3D) photos were taken for all the patients before operation and 6 months after operation using the 3dMD face imaging system. Coordinate system was built based on mirror-original alignment method on the 3D photo. Thirteen soft tissue landmarks were marked on each 3D photo. The asymmetry index(AI) of those soft tissue landmarks was calculated. Results There was no significant difference in the AI values between the two groups before surgery. Sixth month after operation, the mean AI values in the virtual group were (0.81 ± 0.50) mm for subnasale, (1.01 ± 0.80) mm for labiale superius, (1.94 ± 1.30) mm for crista philtri, (1.60 ± 1.20) mm for pogonion and (5.68 ± 2.25) mm for gonion. The mean AI values in the control group were (1.49 ± 1.10) mm for subnasale, (1.79 ± 1.33) mm for labiale superius, (3.52±2.50) mm for crista philtri, (2.79±2.08) mm for pogonion and (8.43±3.94) mm for gonion and those indexes were significantly different between the two groups(P<0.05). There was no significant difference in the AI values of the pronasale, alare, labiale inferius and cheilion between the two groups sixth month after operation. Conclusions The introduced procedure of the virtual design based on the estimated NHP could more effectively correct the asymmetry deformity for the skeletal ClassⅢpatients.

Objective:To investigate the effect of segmental Le FortⅠosteotomy and bilateral sagittal split ramus osteotomy ( BSSRO ) on the condyle position in skeletal class Ⅲ malocclusion patients . Methods:In this retrospective study , 19 patients with skeletal class Ⅲmalocclusion who met the inclu-sion criteria were enrolled .All the patients underwent the segmental Le FortⅠ osteotomy and BSSRO . Cone beam computed tomography ( CBCT) scans were performed in the following phases:T1:within one week before the surgeries;T2:within one week post-surgery;T3:three months post-surgery;T4:6 to 14 months post-surgery .The posterior spaces , anterior spaces and the superior spaces of the bilateral tem-poromandibular joints were measured according to the Kamelchuk method respectively .The fossa ratios of the condyle and the distribution of the condyle positions related to the glenoid fossa ( anterior , concentric and posterior position ) were calculated .The results were analyzed statistically .Results:The posterior space , the anterior space and the superior space of bilateral temporomandibular joints in T 2 phase [ right:(2.78 ±1.23) mm, (2.47 ±0.89) mm, (3.07 ±0.85) mm; left: (2.93 ±0.83) mm, (2.69 ± 1.14) mm, (3.44 ±1.16) mm] showed significantly larger spaces than those in T 1 phase [right:(1.81 ±0.95) mm, (1.65 ±0.55) mm, (2.13 ±0.52) mm;left:(2.12 ±1.05) mm, (1.79 ±0.59) mm, (2.15 ±0.93) mm],in T3 phase [right:(2.08 ±1.25) mm, (1.79 ±0.68) mm, (1.80 ±0.76) mm;left: (2.05 ±0.75) mm, (1.99 ±0.94) mm, (2.14 ±0.71) mm] and in T4 phase [right:(1.94 ±0.77) mm, (1.81 ±0.69) mm, (2.05 ±0.69) mm;left:(1.89 ±0.69) mm, (1.80 ±0.61) mm, (2.19 ±0.75) mm], P<0.05.No significant differences were observed among T 1,T3 and T4 pha-ses in the terms of the joint spaces of both sides ( P >0.05).The fossa ratio and the condyle position related to the glenoid fossa had no significant difference in all the four phases (P>0.05).The results suggested that the condyle moved downward in T 2 phase and changed to the original pre-surgery position in T3 phase, then keot stable in T4 phase.Conclusion:Segmental Le FortⅠ osteotomy and BSSRO caused significant and transient changes of the condyle position in skeletal class Ⅲmalocclusion patients . However , the condyle tended to move back to the original pre-surgery position and might keep stable .

Objective: To investigate the effect of icariin on the proliferation, differentiation, and the mRNA expressions of Cbfαl, BMP2, BMP4 of rat osteoblasts. Methods: Primary rat osteoblastic cells were obtained by sequentia collagenase/trypsin enzyme digestion from calvarial bones of new born ( within 24 h) SD rats and were identified by Alkaline phosphatase and alizarin red staining. The passage 3-5cells were treated with icariin at the concentration of 0 mol/L, 10~(-8)mol/L, 10~(-7)mol/L, 10~(-6)mol/L,10~(-5)mol/L, 10~(-4)mol/L for 24 h, 48 h, 72 h, and the proliferation of the cells was measured by CCK-8assay. The proliferation index was detected by Flow Cytometry and the activity of alkaline phosphatase was determined by p-Nitrophenyl phosphate (pNPP) method after being treated with icariin at the concentration mentioned above for 48 h. The total cellular RNA was extracted 48 h after being treated with icariin at the concentration of 10~(-6)mol/L, and the expressions of Cbfα1, BMP2, BMP4 mRNA were examined by real-time PCR. Results: Icariin showed no effect on the proliferation of osteoblasts, but improved ALP activity. The Cbfα1, BMP2, BMP4 mRNA were significantly upregulated after icariin treatment. Conclusion: Icariin could promote the differentiation ability of rat osteoblasts through upregulating the Cbfα1, BMP2, BMP4 mRNA expressions.