Thyroid eye disease

Thyroid eye disease remains one of the most common orbital abnormalities encountered by ophthalmologists. While the maintenance of thyroid function remains of paramount importance to the patient's health, the appearance of the orbit, including the eyelid position and position of the globe, proptosis, remains of paramount importance to the patient. Following stabilization of the condition of the globe in the patient with thyroid eye disease, attention is then focused on the rehabilitation of the thyroid orbit. The etiology, diagnosis, and management of thyroid eye disease are discussed.     

Staples for Intra-Operative Skin Retraction in Hand Surgery

In certain situations staples are a quick and effective method of retracting the skin to give access to the operative site. Staples, once placed, are more reliable and predictable than an assistant with a skin hook. Furthermore, their use frees up the assistant to perform other tasks including further deeper tissue retraction. Staples pinch the skin rather than piercing it and this is especially of value in patients on steroid treatment or with thin skin that may bruise easily. They leave no discernible marks on removal.     

The Tie Retraction Syndrome

Tissue retraction is implicated in the pathogenesis of various ophthalmic disorders. Here we describe the clinical characteristics, epidemiology and pathophysiology of a form of retraction syndrome which – to the best of our knowledge - has not been reported in the ophthalmic literature so far. We have termed this condition - consisting of a slowly progressive pseudovertical shortening of tie length due to a horizontal extension of girth length - the “Tie retraction syndrome” (TRS). Other pathognomonic features include an increased tie tip to belt buckle distance and a prolapse of the subumbilical fat pad (SUFP). The syndrome has a clear male to female preponderance and shows an increasing incidence with age and income before tax. Based on a newly proposed grading scheme we discuss and illustrate the diagnosis as well as the medical and surgical management options of this abundant, but often undiagnosed condition. The authors have no explanation for the apparent lack of awareness for this widely preponderant syndrome and its severe cosmetically disfiguring potential. We thus would like to invite all fellow colleagues with expertise in the field to comment or present their views.     

In Vitro Testing of Elastomeric Modules

Abstract

This study describes the in vitro testing of elastomeric modules. Measurements were first made from study models to establish the clinical distance over which modules are used for canine retraction. From this preliminary study, a typodont, banded with 0·018” × 0·025” standard edgewise brackets, was set up with the canin-molar distance at 28 mm. Modules for canine retraction were then fitted by 11 clinicians. The applied force ranged from 125 to 310 g (221±51 g). A similar, but more extensive study using six different types of modules and two clinician groups (experienced and less experienced clinicians) was then undertaken. Mean force values for different module types ranged from 195±45 g to 318±90 g. There was no statistically significant difference between the force values applied by experienced and less experienced clinicians     

脂肪来源干细胞对兔皮肤组织扩张后回缩率的影响

目的探讨在皮肤组织扩张过程中注射脂肪来源干细胞对扩张皮瓣回缩率的影响。方法取健康新西兰大白兔的脂肪,体外分离、培养并传代脂肪来源干细胞,行免疫细胞化学表面标志物及表皮细胞诱导分化鉴定,并利用EdU染色对脂肪来源干细胞进行标记;20只新西兰大白兔随机分为实验组和对照组,每组各10只;在兔背部埋置-30ml扩张器;实验组在扩张皮下注射1ml脂肪来源干细胞悬液,细胞密度为5×106^／ml;对照组仅注射1ml无血清DMEM培养基;常规组织扩张至预期容量;切取扩张组织,观察切片厚度及组织学变化;计算两组回缩率并作统计学分析;采用免疫组化染色对组织中血管内皮生长因子和内皮细胞特异性标记物（CD31）进行检测。结果与对照组相比,实验组扩张皮瓣回缩率明显降低（P〈0．05）;组织学显示,实验组扩张皮肤厚度大于对照组（P〈0．05）;免疫组化显示,实验组CD31、VEGF表达量增多,毛细血管增生明显。结论脂肪来源干细胞能够促进新生血管生成及皮肤组织再生,很大程度地减少了扩张皮肤组织的回缩率,从而提高了皮肤扩张效率。     

Combined integrin activation and intracellular cAMP cause Rho GTPase dependent growth cone collapse on laminin-1

Cyclic nucleotides regulate the response of both developing and regenerating growth cones to a wide range of guidance molecules through poorly understood mechanisms. It is not clear how cAMP levels are regulated or how they translate into altered growth cone behavior. Here, we show that intracellular cAMP levels are influenced by substrata and integrin receptors. We also show that growth cones require a substratum-specific balance between cAMP levels, integrin function and Rho GTPases to maintain motility and prevent collapse. Embryonic chick dorsal root ganglion neurons plated on different concentrations of laminin extend growth cones at similar speeds, yet have distinct levels of integrin expression, integrin activation and intracellular cAMP levels. Either increasing cAMP signaling or activating integrins enhances the rate of growth cone motility, but only on substrata where these two factors are endogenously low (i.e. low concentrations of laminin). Surprisingly, combining these two positive manipulations induces growth cone collapse and retraction on laminin but not on fibronectin. Collapse and retraction on laminin are Rho and Rac1 GTPase dependent and are associated with internalization of integrins, the primary receptors responsible for adhesion. These observations define a novel pathway through which cAMP influences growth cone motility and establish a link between integrins, cAMP and Rho GTPases in growth cones.     

单个链状橡皮圈弹力结扎牵引尖牙远移的临床观察

目的　比较单个链状橡皮圈弹力结扎与传统的弹力橡皮圈牵引尖牙远中移动的效果。方法　随机选择16例因正畸需要拔除上颌双侧第一双尖牙患者 ,用方丝弓矫治器排齐牙列换上 0 .0 4 6cm(0 .0 18英寸 )的澳丝后 ,以上颌第一磨牙为支抗 ,在患者上颌牙弓的右侧用单个链状橡皮圈弹力结扎 ,左侧用传统正畸弹力橡皮圈牵引尖牙远中移动。比较两种方法牵引尖牙远中移动的速度和支抗丧失的程度。结果　单个链状橡皮圈弹力结扎与传统的弹力橡皮圈牵引尖牙远中移动的速度无显著性差异 (P >0 .0 5 ) ,第一磨牙前移的距离无显著性差异 (P >0 .0 5 )。结论　单个链状橡皮圈弹力结扎可代替传统的弹力橡皮圈用于牵引尖牙远中移动。     

牙槽骨压缩减骨技术整体后移犬上颌6颗前牙初探

目的探讨牙槽骨压缩减骨技术整体后移6颗上颌前牙的效果。方法选择成年Beagle犬1只,拔除两侧尖牙。整体铸造前牙带环,第二、三前磨牙带环单独铸造并用连接杆连接,前牙和两侧前磨牙铸造带环间焊接螺旋压缩器制成压缩装置。于上颌6颗前牙根尖区唇、腭侧行骨皮质切开,黏固压缩装置,以两侧第二、三前磨牙为支抗,调整螺旋压缩器以0.5mm/d的速率后移上颌前牙,共压缩10d,压缩前后取上颌牙模,拍摄牙片及头颅侧位片,摄面像及口内像。结果经过10d压缩,上前牙整体后移4.10mm,未见明显倾斜,牙周膜正常,根尖未见吸收;第二、三前磨牙近中移0.90mm;前牙反。结论以牙为支抗进行牙槽骨压缩减骨能够整体后移6颗上前牙,但支抗牙有向近中移动,要想减少支抗牙的移动,必须加强支抗。     

Modified thin manual Descemet stripping endothelial keratoplasty with air-guided, non-pachymetric donor lenticule dissection: outcomes of graft thickness and complication rate

AIM: To study the different treatment modalities needed in cases of Duane''s Retraction Syndrome. METHODS: This prospective study undergone in more than four years, in Alexandria, included 238 patients of Duane''s Retraction Syndrome, including type I, 162 patients (68%), type II 12 patients (5%) and type III 64 patients (27%). Surgery was indicated in 98 (41%) of them, to eliminate abnormal head posture, deviation of the eye in primary position, severe retraction of the globe or cosmetically unacceptable upshoot with attempted adduction. RESULTS: Type I was the most common and type II was the least. Females were predominant in this study, constituting 125 patients (52.5%), and males 113 patients (47.5%). Left eye was more affected, in 110 patients (46.2%), right eye in 91 patients (38.2%) and bilateral in 37 patients (15.6%). Amblyopia was found in 27 patients (11.3%) and treated in 13 patients under 10 years of age, by patching the normal eye. Ninety eight patients (41%) were operated , the results were most satisfactory and a nomogram is followed in the surgical plan CONCLUSION: The surgical management was needed in less than half of the cases and should be planned for every case individually according to the clinical findings, planned nomogram and modified intraoperatively according to the anatomical findings during surgery.