Three-dimensional periorbital asymmetry assessment of congenital microphthalmia children with a structured light 3D scanning system

Congenital microphthalmia is a rare phenotype characterized by eye growth retardation. Due to the lack of eyeball stimulation, children suffering from congenital microphthalmia always have bony orbital maldevelopment, which leads to facial asymmetry. In the present study, a structured light 3D scanning system was used as a novel method to measure the three-dimensional periorbital asymmetry in children with congenital microphthalmia.Children with unilateral congenital microphthalmia of 0–6 years old were enrolled in the present study. All participants underwent an ultrasound scan to measure the axial length, and accepted the structured light 3D scanning system for their periorbital appearance. The degree of periorbital asymmetry was evaluated using 17 facial landmarks within a three-dimensional cartesian coordinate system (the X-axis represented the horizontal direction, the Y-axis represented the vertical direction, and the Z-axis represented the sagittal direction). Paired student t-test and ANOVA were used in the present study. A three-dimensional periorbital topography was also established to further illustrate the periorbital asymmetry.A total of 67 children were recruited, which included 31 boys and 34 girls. The axial length on the affected side (12.28 ± 3.35 mm) was generally smaller than that on the unaffected side (20.54 ± 1.65 mm, P < 0.001). When grouped by age, the periorbital asymmetry mainly manifested in the Y-axis and Z-axis directions. The unaffected side had a higher orbitale superior (5.09 ± 0.35 vs. 3.02 ± 0.30, P < 0.001) and a lower orbitale inferior (?19.52 ± 0.51 vs. ?16.90 ± 0.53, P < 0.001) in 0–1 year old group. Same performances were also found in the 1–3 and 3–6 age groups. When grouped according to the proportion of axial length on the bilateral sides, seven of the 12 Y-values and all 12 Z-values had statistical differences.The structured Light 3D scanning system may serve as a beneficial complementary tool for computed tomography, in order to better understand the periorbital deformities caused by congenital microphthalmia.     

Assessment of the Fundamental Flexural Guided Wave in Cortical Bone by an Ultrasonic Axial-Transmission Array Transducer

The fundamental flexural guided wave (FFGW), as modeled, for example, by the A0 Lamb mode, is a clinically useful indicator of cortical bone thickness. In the work described in this article, we tested so-called multiridge-based analysis, based on the crazy climber algorithm and short-time Fourier transform, for assessment of the FFGW component recorded by a clinical array transducer featuring a limited number of elements. Methods included numerical finite-element simulations and experiments in bone phantoms and human radius specimens (n = 41). The proposed approach enabled extraction of the FFGW component and determination of its group velocity. This group velocity was in good agreement with theoretical predictions and possessed reasonable sensitivity to cortical width (r² = 0.51, p < 0.001) in the in vitro experiments. It is expected that the proposed approach enables related clinical application. Further work is still needed to analyze in more detail the challenges related to the impact of the overlying soft tissue.     

Tuber-to-Anterior Process Angle (TAPA): A cadaveric study and surgical technique for placing axial calcaneal screws

We describe results of a cadaveric study and an accompanying surgical technique which simplifies posterior-to-anterior axial screw placement into the calcaneus, often utilized during fixation of displaced intra-articular calcaneus fractures or calcaneal osteotomies. By defining the Tuber-to-Anterior Process Angle (TAPA), this technique facilitates axial screw placement, thereby decreasing reliance on intraoperative fluoroscopy and reducing operative time.     

IgA nephropathy associated with axial spondyloarthritis responding to treatment by etanercept: A case report

IntroductionImmunoglobulin A (IgA) nephropathy may be associated with spondyloarthritis (SpA). This association raises the possibility of a common pathogenesis. Tumor necrosis factor alpha (TNFα) blockers showed good efficiency in SpA and may be efficient in IgA nephropathy.Case reportA case of a 28-year-old man diagnosed with axial SpA is reported. The patient’s Bath ankylosing spondylitis disease activity index (BASDAI) was 7 and functional index (BASFI) 9. Laboratory investigations revealed: erythrocyte sedimentation rate (ESR) 38 mm/1st hour, C-reactive protein (CRP) 6 mg/L, serum creatinine 72 μmol/L with a clearance of 108 ml/min; proteinuria 1.55 g/24 h, leucocyturia at 60,000 cells/ml and haematuria 80,000 red cells/ml. The serum IgA level was normal (238.8 mg/dL). Salivary gland and subcutaneous fat biopsies were normal. The renal biopsy showed moderate focal interstitial fibrosis. The glomerular basement membranes were not thickened while the mesangium was slightly thickened. There was no vascular damage. Congo red staining was negative. By immunofluorescent microscopy, there were mesangial deposits of IgA mainly; leading to the diagnosis of IgA nephropathy. Infliximab was initially given with limited efficacy and the patient was switched to etanercept which was effective especially in the osteoarticular symptoms. Leucocyturia, haematuria and proteinuria decreased but did not disappear, and the renal function and blood pressure remained normal. After 2 years there remained a persistent efficacy and good profile of tolerance (BASDAI = 2.2, BASFI = 4, CRP = 2, ESR = 21, proteinurua = 0.5 g/24 h).ConclusionEtanercept may be a potentially effective option for treating IgA nephropathy associated with axial SpA.     

49例老年髋部骨折患者的手术治疗及预后评估研究

目的探讨老年髋部骨折患者的手术治疗效果及预后情况。方法选择我院2017年3月～2018年9月收治的98例患者随机分为观察组(n=49)和对照组(n=49)。对照组患者给予常规保守牵引治疗,观察组给予手术治疗。观察比较两组临床疗效、髋关节功能Harris评分及术后并发症发生情况。结果观察组优良率为89.80%高于对照组的79.59%,但差异无统计学意义(χ2=1.968,P=0.161);两组疗效整体比较,差异有统计学意义(Z=-6.928,P=0.000)。治疗后,两组Harris评分与治疗前比较均显著升高,差异有统计学意义(t=-18.663,P=0.000; t=-15.682,P=0.000);且治疗后观察组Harris评分(88.47±15.84)分显著高于对照组(81.36±12.56)分,差异有统计学意义(t=2.462,P=0.016)。观察组术后并发症发生率4.08%显著低于对照组的16.33%,差异有统计学意义(χ2=4.009,P=0.045)。结论手术治疗老年髋部骨折临床疗效显著,可有效改善患者髋关节功能,减少并发症,提高患者生活自理能力及生活质量,值得推广应用。     

Nocturnal stridor in multiple system atrophy: Video-polysomnography and clinical features

IntroductionNocturnal stridor, a life-threatening condition linked to respiratory failure and sudden death during sleep, is a serious issue in patients with multiple system atrophy (MSA). However, little is known about polysomnographic findings and clinical features of MSA patients with nocturnal stridor. Hence, we investigated video-polysomnography (VPSG) findings and clinical features associated with nocturnal stridor in patients with MSA.MethodsWe retrospectively analyzed the clinical data of patients with MSA (n = 49) who underwent overnight VPSG for the evaluation of sleep-disordered breathing. The presence of nocturnal stridor was confirmed based on overnight VPSG findings. Clinical data, including VPSG findings and clinical features, were compared between MSA patients with and without nocturnal stridor.ResultsNocturnal stridor was present in 31 (63.3%) patients with MSA. Patients with stridor showed significantly higher apnea-hypopnea, respiratory disturbance, and oxygen desaturation indices than those without stridor (P = 0.024, P = 0.049, and P = 0.006, respectively). Patients with stridor had more severe axial motor features, more impaired activities of daily living, and longer disease duration than those without stridor (P = 0.012, P = 0.036, and P = 0.003, respectively). However, there were no significant between-group differences in sex, age at disease onset, MSA subtype, parkinsonian features, cerebellar ataxia, residual urine volume, or systolic and diastolic blood pressure change.ConclusionsMSA with nocturnal stridor is related to higher apnea indices in conjunction with higher O₂ desaturation index, more severe axial motor features, more impaired activities of daily living, and longer disease duration.     

Primary esophageal mucosa‐associated lymphoid tissue lymphoma treated by endoscopic submucosal dissection

Primary esophageal mucosa‐associated lymphoid tissue (MALT) lymphoma is rare. There have been few reports about early primary esophageal MALT lymphoma being treated endoscopically. The clinical profile of primary esophageal MALT lymphoma is currently unclear, so it is important to accumulate more information about early esophageal MALT lymphoma. To achieve early detection of esophageal MALT lymphoma, we need more accurate knowledge and information about the macroscopic and morphological features of this tumor. Endoscopic resection is one of the most effective treatments. With respect to the lateral andvertical margins of the resected specimen, endoscopic submucosal dissection (ESD) may be superior to endoscopic mucosal resection for treating early esophageal MALT lymphoma. Here we report the macroscopic appearance of the tumor which is the first successful case of ESD for early esophageal MALT lymphoma.     

Pallidal stimulation in Parkinson's patients with contraindications to subthalamic target: A 3 years follow-up

IntroductionOver a 3-year period, we monitored the efficacy and safety of deep-brain stimulation of the globus pallidus pars interna in patients with advanced Parkinson's disease whose cognitive, psychiatric impairment and/or dopa-resistant axial motor signs made them ineligible for surgery targeting the subthalamic nucleus.MethodsA total of 25 patients were assessed before surgery, 1 year and 3 years after surgery, on the UPDRS and a neuropsychological battery.ResultsWe noted a significant improvement of 65.9% in the Clinical global self-perceived Improvement by Visual Analog Scale and an improvement of 20.6% in the total UPDRS-III motor score at 3 years in the off-dopa condition compared to before surgery. There was an improvement in the treatment's motor complications, as measured by the UPDRS-IV, with a particularly marked reduction of 50% in the Dyskinesia subscore. Cognitive performances remained stable at 1 year but had fallen by the third year. We interpreted this deterioration as due to disease progression.ConclusionBilateral pallidal stimulation in patients with contraindications to subthalamic surgery therefore seems to be effective over the long term in treating motor symptoms, especially dyskinesias, with good neuropsychological safety.     

牙线牵引辅助在内镜黏膜下剥离术治疗食管早癌及癌前病变中的应用

目的初步探讨牙线在内镜黏膜下剥离术(ESD)治疗食管早癌及癌前病变中的应用价值。方法回顾性分析2015年7月-2016年7月由同一操作者熟练应用ESD方法治疗食管早癌及癌前病变40例,观察组为采用牙线牵引辅助ESD 20例、对照组为传统ESD方法治疗20例,比较手术时间、一次性病变完整切除率、住院时间及术后并发症发生率等方面的差异。结果观察组牙线辅助ESD法平均手术时间、住院时间少于对照组传统ESD术,差异有统计学意义(P0.05);观察组牙线辅助一次性病变完整切除率高于对照组,差异有统计学意义(P0.05);两组均无出现术后大出血和穿孔等并发症,差异无统计学意义(P0.05)。结论牙线牵引辅助应用于ESD术安全、方便、有效,能够缩短手术操作时间,提高一次性完整切除率,缩短住院时间,降低并发症发生率。