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1.
This article outlines a conceptual approach to the reconstruction of jaw deformities associated with abnormalities in the mandibular condyle. The authors describe a hierarchy of reconstruction, emphasizing use of the least invasive and progressing to the most complex and invasive techniques, depending on the nature and severity of the underlying deformity, prior operations, patient age, and stage of growth. Consider joint preservation orthognathic surgical correction, followed by biological techniques for replacement of the condyle, and avoid replacing a functional temporomandibular joint based only on radiographic remodeling and concerns about potential future flare-ups of disease based on anecdotal data.  相似文献   
2.
Rationale:Unilateral cardiogenic pulmonary edema is a rare disease. A common cause is mitral valve and asymmetrical blood regurgitation that is primarily directed toward the upper right pulmonary vein, causing mean capillary pressure to increase on the right side and leading to right pulmonary edema.Patient concerns:A 41-year-old man was diagnosed with pneumonia after presenting with a 2-day history of cough and shortness of breath. Computed tomography indicated right pulmonary edema. He was managed with noninvasive ventilation; however, his condition continued to deteriorate, and he was transferred to the intensive care unit after tracheal intubation.Diagnosis:Acute posterior mitral valve prolapses; unilateral cardiogenic pulmonary edema.Intervention:Emergency mitral valve replacement was performed. During the operation, 2 ruptures of the chordae tendineae in the P2 scallop of the posterior mitral valve were found, and a No. 29 St. Jude mechanical mitral valve was implanted.Outcomes:Cardiotonic and diuretic drugs were administered postoperatively. Tracheal intubation was removed on day 7; the patient was transferred to the general ward on day 11 and discharged on day 23 postoperatively.Lessons:Unilateral cardiogenic pulmonary edema is easily misdiagnosed. Computed tomographic (CT) imaging presentation, brain natriuretic peptide, and cardiac color Doppler ultrasound can assist in determining a differential diagnosis. Early surgical treatment is recommended for patients with acute mitral valve prolapse.  相似文献   
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The philtrum is an important aesthetic structure in the midface. A number of philtrum reconstruction techniques have been advocated for secondary cleft lip revision procedures. Conventional surgical management involves end-to-end orbicularis oris muscle approximation during primary cleft lip repair, often resulting in a flat lip appearance that requires secondary revision surgery at a later stage. A novel modification of the approximation of the orbicularis oris muscle is described that may be implemented with any cleft lip technique in order to create an accentuated philtrum column for a natural looking philtrum. The muscle roll technique results in eversion of the orbicularis oris muscle, successfully recapturing the philtrum column topography. This is achieved by utilizing two inverted horizontal sutures, with an additional philtrum takedown suture placed in the region of the dimple to accentuate the philtrum anatomy and three-dimensional profile. This novel technique in unilateral cleft lip repair addresses philtrum architecture during primary surgery, which may reduce the requirement for secondary surgical intervention. Its application may be particularly suitable in outreach programmes where postoperative follow-up may be compromised.  相似文献   
5.
Sensorimotor adaptation to wedge prisms can alter the balance of attention between left and right space in healthy adults, and improve symptoms of spatial neglect after stroke. Here we asked whether the orienting of spatial attention to visual stimuli is affected by a different form of sensorimotor adaptation that involves physical perturbations of arm movement, rather than distortion of visual feedback. Healthy participants performed a cued discrimination task before and after they made reaching movements to a central target. A velocity‐dependent force field pushed the hand aside during each reach, and required participants to apply compensatory forces toward the opposite side. We used event‐related potentials (ERPs) to determine whether electroencephalography (EEG) responses reflecting orienting (cue‐locked N1) and disengagement (target‐locked P1) of spatial attention are affected by adaptation to force fields. After adaptation, the cue‐locked N1 was relatively larger for stimuli presented in the hemispace corresponding to the direction of compensatory hand force. P1 amplitudes evoked by invalidly cued targets presented on the opposite side were reduced. This suggests that force field adaptation boosted attentional orienting responses toward the side of hand forces, and impeded attentional disengagement from that side, mimicking previously reported effects of prism adaptation. Thus, remapping between motor commands and intended movement direction is sufficient to bias ERPs, reflecting changes in the orienting of spatial attention in the absence of visuo‐spatial distortion or visuo‐proprioceptive mismatch. Findings are relevant to theories of how sensorimotor adaptation can modulate attention, and may open new avenues for treatment of spatial neglect.  相似文献   
6.
《Brain stimulation》2021,14(4):927-937
BackgroundIncreases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT.ObjectiveWe aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields.MethodsA meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT.ResultsData from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (−0.27 (SE: 0.09) per 10%).ConclusionsECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients.  相似文献   
7.
目的:通过与同龄非唇腭裂正常 儿童比较,研究替牙期骨性Ⅲ类单侧完全性唇腭裂(unilateral cleft lip and palate,UCLP)患者上下颌不同位点口周力的特征。 方法:选取替牙期6~12岁UCLP患者20例(男14例,女6例)为UCLP组;同龄正常 儿童21例(男14例,女7例)为对照组。采用口周肌压力采集系统测量每个研究对象息止 位时双侧上下颌中切牙、尖牙或乳尖牙、第一前磨牙或乳磨牙、第一恒磨牙的唇颊、舌腭侧龈缘的口周力。使用SPSS 25.0统计软件对数据进行统计分析。 结果:1.UCLP组上颌口周力裂侧大于非裂侧( P<0.05),下颌口周力两侧无差异( P>0.05)。2. UCLP组上颌口周力大于对照组( P<0.05),两组上颌唇颊侧的口周力均在第一前磨牙/乳磨牙区最大,在中切牙区最小。3. UCLP组下颌唇颊侧口周力小于对照组( P<0.01),下颌中切牙舌侧区UCLP组大于对照组( P<0.05)。4. UCLP组上颌牙弓内外口周力差值大于对照组( P<0.05),下颌差值小于对照组( P<0.01)。 结论:替牙期骨性Ⅲ类UCLP患者口周力较同龄非唇腭裂正常 儿童存在异常。  相似文献   
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9.
《Brain stimulation》2021,14(6):1489-1497
BackgroundThe electrode placement and pulse width for electroconvulsive therapy (ECT) are important treatment parameters associated with ECT related retrograde memory side-effects. Modification of these parameters with right unilateral (RUL) ECT may have utility for further reducing these side-effects.ObjectiveThis study explored use of the frontoparietal (FP) placement for reducing retrograde memory side effects with ECT. We hypothesised that superior retrograde memory outcomes would occur with FP compared to temporoparietal (TP) placement and with ultrabrief (UB: 0.3 ms) compared to brief pulse (BP: 1.0 ms) width ECT.MethodsIn this randomised cross-over, double-blinded study, participants received a single treatment of BP TP, BP FP, UB TP and UB FP ECT. Neuropsychological testing was conducted prior to and immediately following each treatment. Computational modelling was conducted to explore associations between E-fields in regions-of-interest associated with memory.ResultsNine participants completed the study. The FP placement was not superior to TP for retrograde memory outcomes. For both electrode placements UB pulse width was associated with significantly better visual retrograde memory compared to BP (p < .05). With TP ECT, higher E-fields in regions-of-interest were significantly associated with greater visual retrograde memory side-effects (hippocampi: r = −0.77, p = .04; inferior frontal gyri: r = −0.92, p < .01; middle frontal gyri: r = −0.84, p = .02).ConclusionsModification of pulse-width had greater effects than electrode placement for reducing retrograde memory side-effects with RUL ECT. Preliminary findings suggested that higher E-fields may be associated with greater cognitive side-effects with ECT.  相似文献   
10.
目的比较单侧和双侧椎弓根入路经皮穿刺椎体后凸成形术治疗胸腰椎骨质疏松性压缩性骨折的临床效果。方法选取2017年6月-2019年6月本院收治的需要进行经皮椎体后凸形成术治疗胸腰椎压缩性骨折患者55例,按照手术入路不同分单侧入路组(n=29)和双侧入路组(n=26)。比较两组患者手术前后腰背部的疼痛程度;比较两组患者手术时间、术中出血量、骨水泥灌注量以及X线曝光次数;比较术前和术后Cobb角和椎体前缘高度,以及术后并发症情况,包括肺栓塞、骨水泥渗漏和伤椎邻近椎体再骨折。结果 (1)术前腰背部VAS评分比较差异无统计学意义(P> 0.05),术后两组患者VAS评分均有所下降,术后1天、术后3月两组之间VAS评分比较差异无统计学意义(P> 0.05)。(2)单侧入路组的手术时间、术中出血量、骨水泥灌注量及X线曝光次数均低于双侧入路组(P <0.05)。(3)术后均能改善术前患椎Cobb角及增加椎体前缘高度(P <0.05),术后单侧和双侧入路两组数据之间对比差异无统计学意义(P> 0.05)。单侧入路并发症发生率为13.79%,双侧入路组发生骨水泥侧漏6例、伤椎邻近椎体再骨折4例,并发症发生率为38.46%。单侧入路组并发症发生情况明显优于对照组(P <0.05)。结论单侧和双侧椎弓根入路经皮穿刺椎体后凸成形术均可有效缓解患者疼痛,改善病变椎体后凸畸形及恢复椎体高度,但单侧椎弓根入路较双侧可明显缩短手术时间,减少术中出血量、骨水泥灌注量、X线曝光次数以及术后并发症。  相似文献   
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