股骨颈骨折合并抑郁老年男性骨密度和骨代谢变化

目的分析老年男性股骨颈骨折合并抑郁患者骨密度和骨代谢生化指标变化，探讨抑郁对骨质疏松骨代谢的影响。 方法选取于北京医院骨科2017年1月至2019年1月住院的老年男性股骨颈骨折患者102例。排除病理性骨折、认知功能障碍等患者。依据老年抑郁量表(GDS)将老年男性股骨颈骨折患者分为抑郁组和对照组。通过测定并比较两组患者的骨密度(BMD)、血清碱性磷酸酶(ALP)、血钙、血磷、25-羟基-维生素D[25(OH)D]、骨钙素(OC)、Ⅰ型原胶原氨基端前肽(P1NP)、血清Ⅰ型胶原羧基末端肽交联β特殊序列(β-CTX)水平，分析抑郁严重程度(GDS评分)与骨密度及骨代谢生化指标的相关性。分类变量的比较采用卡方检验，连续变量的比较采用t检验，两组连续性变量的相关性应用Pearson相关分析。 结果抑郁组患者BMD明显低于对照组(腰椎t ＝5.964、髋部t ＝2.845，P <0.05)。与对照组相比，抑郁组血清25(OH)D水平下降(t ＝3.077，P <0.05)，抑郁组血清OC水平低于对照组(t ＝2.013，P <0.05)，而血清β-CTX水平高于对照组(t ＝2.938，P <0.05)，P1NP水平与对照组差异无统计学意义(t ＝0.684，P >0.05)。抑郁严重程度(GDS评分)与BMD(r＝-0.456，P <0.05)、25(OH)D(r＝-0.546，P <0.05)、OC(r＝-0.215，P <0.05)呈负相关，与P1NP(r＝-0.115，P>0.05)相关性不显著，与β-CTX(r＝0.372，P<0.05)呈正相关。 结论抑郁症患者的骨形成标志物水平降低和骨吸收标志物水平升高，抑郁症是低骨密度和骨折的危险因素。应重视老年抑郁症患者骨代谢指标和25(OH)D的检测，及时进行维生素D的补充和有效的抗骨吸收药物治疗。     

A three-dimensional color-printed system allowing complete modeling of arteriovenous malformations for surgical simulations

To develope a colored realistic AVM model using three-dimensional (3D) printing for surgical planning and research. Raw computed tomography angiography (CTA) and magnetic resonance venography (MRV) data were integrated and used for reconstruction. Each AVM model included the nidus, the feeding arteries, the draining veins, the sinuses, the adjacent principal arteries, and the skull. The models were employed to plan surgical and endovascular treatments. Surgical feedback was obtained using a survey. Five AVM cases were included. The AVMs and the models thereof did not differ significantly in terms of length, width, or height, as measured via magnetic resonance imaging (all p > 0.05). The 3D AVM models were thus accurate. The overall score on the questionnaire survey was >4 point; the model thus aided the planning of interventional surgery. All surgeons were confident that the 3D models reflected the true lesional boundaries. Our 3D-printed intracranial AVM models were accurate, and can be used for preoperative planning and training of residents. The models improved surgeons’ understanding of AVM structure, reducing operative time.     

Objective evaluation of abutment tooth preparation for preformed metal crowns for primary molars in Japanese preclinical training

Evaluation of abutment tooth shape for preformed metal crowns for primary teeth in preclinical training depends on the subjective opinion of the instructor providing the training. Thus, the student's grade will likely vary according to teacher grading. In this study, we explored the potential for objective evaluation by comparing evaluations performed by teaching personnel (teacher grading) of abutment teeth for preformed metal crowns for primary teeth prepared by students at a dental school with evaluation by a three-dimensional (3D) laser morphometric system (system grading). The subjects of the evaluations were 139 abutment teeth for preformed metal crowns for primary teeth that had been prepared by fourth-year students at Asahi University School of Dentistry during preclinical pediatric dentistry training. A tooth prepared by a teacher following instruction criteria was used as the reference tooth, and system grade points were calculated from deductions made for insufficient and excessive cutting. Teacher grade points varied among teachers. We found that teachers prioritized contours of the margin, buccal and lingual sides, and adjacent surfaces in their evaluations. System grading showed that most students carried out insufficient cutting. The mean (SD) teacher and system grade points were 57.7 (9.7) and 75.7 (4.7), respectively, and these grade points were positively correlated (r = 0.500). System grading provides a simple 3D visual assessment of insufficient and excessive cutting that can be used for instructing students.     

Three-dimensional facial volume analysis using algorithm-based personalized aesthetic templates

Three-dimensional stereophotogrammetry is commonly used to assess volumetric changes after facial procedures. A lack of clear landmarks in aesthetic regions complicates the reproduction of selected areas in sequential images. A three-dimensional volumetric analysis was developed based on a personalized aesthetic template. The accuracy and reproducibility of this method were assessed. Six female volunteers were photographed using the 3dMDtrio system according to a clinical protocol, twice at baseline (T1) and twice after 1 year (T2). A styrofoam head was used as control. A standardized aesthetic template was morphed over the baseline images of the volunteers using a coherent point drift algorithm. The resulting personalized template was projected over all sequential images to assess surface area differences, volume differences, and root mean square errors. In 12 well-defined aesthetic areas, mean average surface area and volume differences between the two T1 images ranged from −7.6 mm² to 10.1 mm² and −0.11 cm³ to 0.13 cm³, respectively. T1 root mean square errors ranged between 0.24 mm and 0.62 mm (standard deviation 0.18–0.73 mm). Comparable differences were found between the T2 images. An increase in volume between T1 and T2 was only observed for volunteers who gained in body weight. Personalized aesthetic templates are an accurate and reproducible method to assess changes in aesthetic areas.     

The individual and joint effects of maternal 25(OH)D deficiency and gestational diabetes on infant birth size

Background and aimsTo examine the independent effect of maternal serum 25-hydroxyvitamin D [25(OH)D] deficiency and its joint effect with gestational diabetes mellitus (GDM) on infant birth size.Methods and resultsThis retrospective cohort study was conducted in 15,724 mother-offspring dyads in Beijing, China between 2016 and 2017. Outcomes included infant birth weight Z-score (adjusted for gestational age and sex) and large for gestational age (LGA). Exposures were maternal 25(OH)D concentrations. Linear and logistic regression models were used to assess the associations of exposures with continuous and binary outcomes, respectively. Exposure-outcome associations were not observed when analyzing 25(OH)D concentrations continuously or in quartiles (P > 0.05); however, mothers with severely deficient 25(OH)D concentrations (n = 307) had a decreased risk of LGA compared with those with sufficient 25(OH)D concentrations (≥30.0 ng/mL; n = 5400) (adjusted odds ratio (OR): 0.63; 95% confidence interval (CI): 0.42, 0.93). Compared to mothers with no 25(OH)D deficiency (≥20.0 ng/mL) and no GDM (n = 7975), those with both 25(OH)D deficiency and GDM (n = 1090) had 0.15 (95% CI: 0.09, 0.21) higher infant birth weight Z-score and a higher risk of LGA (OR: 1.29; 95% CI: 1.09, 1.52). Maternal 25(OH)D deficiency and GDM had additive interaction on the risk of LGA (relative risk due to interaction: 0.18).ConclusionMothers with severely deficient 25(OH)D might have a decreased risk of LGA. However, the joint effect of maternal 25(OH)D deficiency and GDM might increase the risk of LGA. Our findings have clinical and public health implications and provide potential directions for future studies.     

Nutrition for pregnancy after metabolic and bariatric surgery: literature review and practical guide

When pregnancy follows metabolic and bariatric surgery (MBS), there are many important considerations related to nutritional status that may impact maternal and infant outcomes. Although evidence-based nutrition guidelines for pregnancy exist for the general population, there are limited practical recommendations that specifically address pregnancy after MBS. A literature search was conducted to investigate outcomes of women with a history of MBS and pregnancy. Search criteria focused on women 18 years of age and older who became pregnant after MBS. Search terms included “laparoscopic sleeve gastrectomy,” “Roux-en-Y gastric bypass,” “laparoscopic adjustable gastric banding,” “biliopancreatic duodenal switch,” and gestation terminology, and they were paired with the nutrition outcomes of interest. A total of 167 publications were identified; 46 articles were included in the final review. Data relating to gestation and fetal weight and nutrition and cardiometabolic data were extracted from the studies. Based on this review, women of childbearing age with a history of MBS should be evaluated and monitored for nutritional status before conception, during pregnancy, and postpartum.