Surgical planning for restoring velopharyngeal function in velocardiofacial syndrome

Background

Velocardiofacial syndrome (VCFS) is one of the most common multiple anomaly syndromes in humans. Around 70% of the cases show velopharyngeal insufficiency (VPI), as a consequence of cleft palate. VPI is much more frequent due to special abnormal conditions inherent to VCFS including: platybasia, hypotrophy of adenoid, enlarged tonsils, hypotonia and abnormal pharyngeal muscles.

Objective

To evaluate the surgical treatment of VPI in VCFS patients.

Materials and methods

In the Hospital Gea Gonzalez at Mexico City, all cases of VCFS from January 2000 to July December 2007 were studied. All patients subjected to velopharyngeal surgery for correcting VPI were selected. Twenty-nine patients underwent velopharyngeal surgery. All operations were planned according to findings of videonasopharyngoscopy (VNP) and multiview video fluoroscopy (MVF).

Results

Twenty patients underwent pharyngeal flap operations, and 9 patients were operated on with a sphincter pharyngoplasty. After a pharyngeal flap, 17 cases (85%) improved to normal nasal resonance or mild hypernasality. Three flaps showed moderate hypernasality postoperatively. From the 9 sphincter pharyngoplasties, 6 cases (66%) improved to moderate hypernasality. Four patients (33%) persisted with severe hypernasality postoperatively. There were no complications.

Conclusions

Tailor-made pharyngeal flaps seem to be the best option for restoring velopharyngeal function in cases of VPI in VCFS patients. The use of VNP and MVF is useful for planning the operations for VPI, and they are also useful for indicating the removal of tonsils in cases with high risk of obstruction. Moreover, VNP is also useful for preventing damage to the internal carotids which are usually displaced in VCFS patients.     

湖北省7台医用直线加速器调强放射治疗多叶光栅叶片到位精度验证方法研究

目的 用放射性免冲洗胶片测量调强放射治疗（IMRT）多叶光栅（MLC）叶片到位精确度验证方法研究,为IMRT质量控制提供参考依据。方法 选择湖北省7家三甲医院的7台不同型号医用直线加速器,放射治疗计划系统（TPS）计划5条宽度为0.6 cm条状的栅栏,每条状野之间的距离为3.0 cm。用EBT2免冲洗胶片测量5条状野位置、多叶光栅叶片位置偏差和实际宽度。结果 按国际原子能机构（IAEA）要求,胶片测量与TPS计划每条栅栏野多叶光栅条状位置结果应≤±0.5 mm。编号5和编号7的加速器MLC条状野位置偏差分别为0.7和-1.0 mm,不符合IAEA要求。按IAEA要求,胶片测量每对与每条所有多叶光栅叶片平均位置偏差应≤±0.5 mm。7台加速器MLC每对叶片位置偏差均在±0.5 mm内,符合IAEA要求;IAEA要求单对MLC叶片开野宽度与该机器5条条状野平均开野宽度的差值不超过±0.75 mm,7台加速器每对MLC开野宽度与平均值的差值范围为-0.6~0.5 mm,符合要求。所有叶片开野宽度标准偏差应≤0.3 mm,7台加速器标准偏差在0.1~0.2 mm范围内,符合要求。结论 用EBT2免冲洗胶片验证MLC位置精确度方法操作简单、检测精度高,是质量控制（QA）的重要手段之一,适合大范围核查使用。     

氟化钠甘油过敏1例

近年来药物过敏引起的口腔黏膜溃疡越来越多,但氟化钠甘油过敏引起的溃疡却极少见。山东大学千佛山校区医院遇到氟化钠甘油过敏1例,氟化钠甘油治疗后患者口腔黏膜充血水肿明显,颊、腭黏膜有大量红色粟粒状颗粒,3 h后出现吞咽困难,但无呼吸困难,次日出现口腔黏膜大面积溃疡。治疗7 d后患者痊愈,氟化钠敏感试验结果为阳性。     

Detection accuracy of proximal caries by phosphor plate and cone-beam computerized tomography images scanned with different resolutions

This study was carried out to assess whether the spatial resolution has an impact on the detection accuracy of proximal caries in flat panel CBCT (cone beam computerized tomography) images and if the detection accuracy can be improved by flat panel CBCT images scanned with high spatial resolution when compared to digital intraoral images. The CBCT test images of 45 non-restored human permanent teeth were respectively scanned with the ProMax 3D and the DCT Pro scanners at different resolutions. Digital images were obtained with a phosphor plate imaging system Digora Optime. Eight observers evaluated all the test images for carious lesion within the 90 proximal surfaces. With the histological examination serving as the reference standard, observer performances were evaluated by receiver operating characteristic (ROC) curves. The areas under the ROC curves were analyzed with two-way analysis of variance. No significant differences were found among the CBCT images and between CBCT and digital images when only proximal enamel caries was detected (p = 0.989). With respect to the detection of proximal dentinal caries, significant difference was found between CBCT and digital images (p < 0.001) but not among CBCT images. The spatial resolution did not have an impact on the detection accuracy of proximal caries in flat panel CBCT images. The flat panel CBCT images scanned with high spatial resolution did not improve the detection accuracy of proximal enamel caries compared to digital intraoral images. CBCT images scanned with high spatial resolutions could not be used for proximal caries detection.     

近中水平阻生下颌第三磨牙的矫治探索

目的探索保存和利用近中水平阻生下颌第三磨牙的矫治方法,以期保留更多的近中水平阻生的下颌第三磨牙。方法利用自行研制的磨牙胎面正轴装置及磨牙远中正轴装置,配合下颌固定矫治器,对近中水平阻生的下颌第三磨牙进行矫治。结果利用本研究方法对10例11颗近中水平阻生的下颌第三磨牙进行17．26个月矫治,均取得第三磨牙直立、稳定、覆胎覆盖关系正常的预期目标。结论利用磨牙殆面正轴装置及磨牙远中正轴装置,可快速、安全、高效地完成对近中水平阻生下颌第三磨牙的矫治。     

ELBOW JOINT MEDIAL COLLATERAL LIGAMENT INJURY A PRELIMINARY REPORT

The medial collateral Iigament injury of elbow joint may be produced by valgus stre4ss with the arm in extension and abduction or in extension, abduction and slight backward incli- nation The injury presents definite clinical fea- tures If injury is severe, the abnormal passive vajgus movement of elbow joint is at least 30 degrees. Operative technic for repairing the ruptured medial collateral ligament is intro- duced. From the operative findings of traumatic pathologic changes, the rapid recovery of normal function in 10 cases after operation and simp- licity of the operative technic, surgical repair is recommended in severe injury of the medial collateral ligament.     

早期抗病毒治疗对艾滋病患者生存状况的影响

目的 比较不同时间开始抗病毒治疗对艾滋病患者生存状况的影响,并探讨抗病毒治疗最佳时机.方法 利用国家艾滋病抗病毒治疗信息系统,收集2007-2012年河南省加入抗病毒治疗的艾滋病患者基本和随访信息,并按照基线免疫学水平,将所有研究对象分为早期治疗组(基线CD4+T淋巴细胞计数350～500 cell/μl)和常规治疗组(基线CD4+T淋巴细胞计数≤350 cell/μl),采用生存分析方法进行全死因回顾分析.结果 共纳入16 282例艾滋病患者,常规治疗组病死率明显高于早期治疗组(5.78/100人年vs.1.64/100人年),中位生存期低于早期治疗组中位生存期(2.07年vs.3.15年).常规治疗组6年累积生存率低于早期治疗组(77.39％vs.92.10％,x2=156.00,P＜0.01).多因素分析显示,开始治疗时年龄、性别、婚姻状况、感染途径、初始治疗方案和基线症状数为常规治疗组生存时间的影响因素(P＜0.05),开始治疗时的性别、初始治疗方案和基线症状数为早期治疗组生存时间的影响因素(P＜0.05).结论 早期抗病毒治疗可提高河南省接受抗病毒治疗的艾滋病患者生存率,延长其生存时间.     

柴胡解毒汤联合干扰素治疗慢性乙肝的疗效和对细胞因子的影响及机制

目的:观察柴胡解毒汤在治慢性乙型肝炎方面的临床疗效,并借此探讨该方对细胞因子的影响。方法:选取2015年9月至2016年3月重庆三峡高等专科学校附属医院收治的慢性乙型肝炎患者90例,随机分成对照组和观察组,每组45例。对照组采用干扰素注射,1次/d,连续2周后,再改为隔日1次,连用3个月;观察组在使用干扰素基础上采用中药柴胡解毒汤治疗,2次/d,同样治疗14 d后观察2组治疗的临床疗效、肝功能比较、药物不良反应、血清IL-1β、IL-6、5-HT及TNF-α水平的变化、HBs Ag、HBe A、HBV-DNA阴转率等情况。结果:1)治疗后观察组有效率86.67%,对照组有效率68.89%,2组有效率比较,差异有统计学意义(P0.05);2)2组与治疗前比较,肝功能指标均有明显改善,差异有统计学意义(P0.05);治疗后,观察组ALT、AST及TBIL值均明显低于对照组,差异有统计学意义(P0.05);3)不良反应中,对照组出现10例(33.00%),观察组4例(8.80%),观察组不良反应明显低于对照组,差异有统计学意义(P0.05);4)2组患者在治疗前,检测的血清IL-1β、IL-6、5-HT及TNF-α含量比较,差异无统计学意义(P0.05),而组间治疗后比较,观察组明显低于对照组,治疗后,上述指标均较治疗前下降,但观察组下降更明显,差异有统计学意义(P0.05);5)观察组HBs Ag阴转率为24.4%、HBe Ag阴转率为33.3%、HBV-DNA阴转率为48.8%均明显高于对照组,对照组HBs Ag阴转率为15.5%、HBe Ag阴转率为11.1%、HBV-DNA阴转率为28.9%,2组比较差异有统计学意义(P0.05)。结论:柴胡解毒汤在治疗慢性乙肝方面有显著的临床效果,且不良反应较传统干扰素明显降低,值得推广,同时,该药对细胞因子等指标也有明显降低作用,考虑其可能是通过类似机制起作用。