Hounsfield Units: A new indicator showing maxillary resistance in rapid maxillary expansion cases?

Objective:To determine if density measurements of several maxillary regions in Hounsfield Units (HU) and outcomes of rapid maxillary expansion (RME) are correlated. Is correlation powerful enough to give us direct information about maxillary resistance to RME?Materials and Methods:Twenty-two computed tomographic (CT) scans (14 years) are used in this archive study. Two CT records were collected, one before RME (T₁) and one after 3 months of retention period (T₂). Maxillary measurements were made using dental and skeletal landmarks in first molar and first premolar slides to measure the effects of RME. Density of midpalatal suture (MPSD) and segments of maxillary bone is measured in HU at T₁. Correlation analysis was conducted between density measurements and maxillary variables. Regression analysis was then performed for variables that showed positive correlation.Results:There was no correlation between density and skeletal measurements. Intermolar angle (ImA) in molar slice showed statistically significant correlation with density measurements. The ImA variable showed the highest correlation with MPSD in frontal section (r  =  0.669, P < .01).Conclusions:There is correlation of 32.1–43.3% between density measurements and ImA increase. Our density measurements explain a certain percentage of ImA increase, but density is not the only and definitive indicator of changes after RME.     

Stem cell bioengineering strategies to widen the therapeutic applications of haematopoietic stem/progenitor cells from umbilical cord blood

Umbilical cord blood (UCB) transplantation has observed a significant increase in recent years, due to the unique features of UCB haematopoietic stem/progenitor cells (HSCs) for the treatment of blood‐related disorders. However, the low cell numbers available per UCB unit significantly impairs the widespread use of this source for transplantation of adult patients, resulting in graft failure, delayed engraftment and delayed immune reconstitution. In order to overcome this issue, distinct approaches are now being considered in clinical trials, such as double‐UCB transplantation, intrabone injection or ex vivo expansion. In this article the authors review the current state of the art, future trends and challenges on the ex vivo expansion of UCB HSCs, focusing on culture parameters affecting the yield and quality of the expanded HSC grafts: novel HSC selection schemes prior to cell culture, cytokine/growth factor cocktails, the impact of biochemical factors (e.g. O₂) or the addition of supportive cells, e.g. mesenchymal stem/stromal cell (MSC)‐based feeder layers) were addressed. Importantly, a critical challenge in cellular therapy is still the scalability, reproducibility and control of the expansion process, in order to meet the clinical requirements for therapeutic applications. Efficient design of bioreactor systems and operation modes are now the focus of many bioengineers, integrating the increasing 'know‐how' on HSC biology and physiology, while complying with the GMP standards for the production of cellular products, i.e. through the use of commercially available, highly controlled, disposable technologies. Copyright © 2013 John Wiley & Sons, Ltd.     

皮肤软组织扩张术联合毛囊单位提取技术治疗烧伤后瘢痕性秃发

目的 探讨并分析皮肤软组织扩张术联合毛囊单位提取技术治疗烧伤后瘢痕性秃发的效果.方法 2007年3月至2013年6月共收治48例患者,秃发面积均大于25 cm2.一期手术行扩张器置入,注入额定容量的200％～ 300％;二期手术在注水完成后8周,行局部皮瓣转移修复术;三期手术在皮瓣修复后1年,行瘢痕区单体式毛发移植.结果 经扩张器联合毛发移植后,48例患者瘢痕区毛发生长自然,随访5年,效果满意.三期手术后的毛发形态满意度的VAS评分为(8.2±2.1)分.结论 皮肤软组织扩张术联合毛囊单位提取技术对头部烧伤后瘢痕性秃发修复效果确切.     

综合护理干预在经支气管镜球囊扩张治疗良性气道狭窄中的价值

目的：探讨综合护理干预在良性气道狭窄患者行支气管镜下球囊扩张治疗过程中的应用效果。方法：选取2013年1月至2014年12月在普通病房行支气管镜下球囊扩张治疗良性气道狭窄患者共94例,将2013年1月至2014年2月的住院患者47例作为对照组,选取2014年3月至2014年12月住院患者47例患者作为观察组。对照组患者实施传统护理模式,观察组采取综合护理干预模式。干预20 d后对两组患者不良事件发生率、HAMD评分、气道直径、气促评分及心理抑郁状态等相关指标进行比较。结果：观察组患者不良事件发生率、HAMD评分低于对照组,差异有统计学意义(P<0.05);观察组患者的感染为23.4%,较对照组有明显下降(P<0.05)。观察组患者气道直径(6.12±1.27)、气促评分(0.59±0.71)均较对照组有明显改善差异有统计学意义(P<0.05),干预后观察组患者HAMD评分较对照组患者HAMD评分低,差异具有统计学意义(P<0.05)。结论：实施综合护理模式能有力促进行支气管镜下球囊扩张治疗良性气道狭窄患者的治疗,改善患者抑郁心理。     

外科辅助上颌骨快速扩弓对鼻气道和上颌复合体影响的系统评价

目的 评价外科辅助上颌骨快速扩弓对鼻气道和上颌复合体的影响.材料和方法 我们计算机检索和手动检索以下数据库:PubMed,ISI Web of Knowledge,Ovid,EBSCO Dentistry & Oral Science Source,Cochrane Library and Cochrane Central Register of Controlled Trials (CENTRAL),纳入采用外科辅助上颌骨快速扩弓治疗的研究,要求受试者人数＞10.依据方法学质量评价量表对纳入的文献进行质量评价.结果 初步检索后获得111篇相关的文献,最终对符合纳入标准且方法学质量评价得分较高的4篇文献的4个结果进行Meta分析.结果表明扩弓后,鼻腔后部容积、使用鼻粘膜减充血剂后鼻腔后部最小横截面积、牙弓前后部宽度均增加显著(P＜0.05).结论 从本研究Meta分析中得出结论:随着上颌基骨和牙槽骨的增宽,外科辅助上颌骨快速扩弓增加鼻腔后部最小横截面积并显著增加鼻腔容积,从而减小鼻气道阻力.     

鼻腔扩容技术对中重度阻塞性睡眠呼吸暂停低通气综合征的疗效分析

目的探讨鼻腔扩容技术治疗中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法回顾性分析2008年1月至2011年1月于东莞市石龙人民医院耳鼻喉科经多导睡眠监测确诊的40例中重度OSAHS患者的临床资料,纤维鼻咽镜和上呼吸道三维重建技术确定阻塞位置为鼻、鼻咽和腭咽平面,于内镜下鼻腔扩容鼻腔病变,术后2个月行主观Epworth嗜睡量表(ESS)评分及复查多导睡眠监测各项指标。结果所有患者鼾声指数及ESS评分较术前有明显改善,ESS评分从(14.6±6.2)分下降为(5.4±2.3)分;鼾声指数从(186±90)次/h降至(83±42)次/h,差异均有统计学意义(P<0.01),而呼吸暂停低通气指数(AHI)及最低动脉血氧饱和度(LSa O2)与术前比较差异无统计学意义(P>0.05)。结论鼻腔扩容术可以改善患者主观症状及鼾声指数,但不能改善OSAHS患者的AHI及LSa O2水平,说明对于中重度OSAHS患者仍须行口咽部手术,来达到良好的治疗效果。     

CT混合征与CT血管成像斑点征对急性脑出血血肿扩大的预测价值

目的分析CT混合征与CT血管成像(CTA)斑点征对急性脑出血患者血肿扩大的预测价值。方法回顾性连续纳入2016年3月至2018年12月昆明医科大学第二附属医院脑血管病科收治的急性脑出血患者,发病6 h内进行基线CT及CTA扫描,明确血肿体积、部位、形态及密度(混合征及斑点征),并于发病24 h后复查CT判定是否出现血肿扩大,根据判定结果将符合纳入标准的186例急性脑出血患者分为血肿扩大组(56例)和非血肿扩大组(130例)。收集患者一般临床资料并进行组间比较,对血肿扩大的各影响因素进行Logistic回归分析,计算受试者工作特征(ROC)曲线下面积并比较混合征与斑点征对血肿扩大的预测价值。结果血肿扩大组出现混合征[35.7%(20/56)]、斑点征[44.6%(25/56)]的比例明显高于非血肿扩大组[混合征12.3%(16/130)、斑点征15.4%(20/130)],差异均有统计学意义(χ2值分别为13.738、18.269,均P<0.01);患者入院时存在CT混合征(OR=3.273,95%CI:1.955~5.413)、CTA斑点征(OR=3.207,95%CI:1.275~8.069)及低GCS评分(OR=1.382,95%CI:1.215~1.573)、高血糖(OR=1.281,95%CI:1.088~1.509)、基线血肿体积大(OR=1.118,95%CI:1.023~1.222)、血肿形态不规则(OR=4.530,95%CI:1.297~15.828)均是血肿扩大的独立危险因素。混合征联合斑点征预测血肿扩大的敏感度、特异度、阳性预测值、阴性预测值分别为51.8%、78.5%、50.9%、79.1%,其ROC曲线下面积为0.666(P<0.01),略高于单一斑点征(曲线下面积0.642,P=0.002)及单一混合征(曲线下面积0.617,P=0.011)。结论除血糖、GCS评分、基线血肿体积、血肿形态以外,混合征、斑点征也与血肿扩大相关。混合征联合斑点征预测急性脑出血血肿扩大的能力优于单一征象。