功能神经外科的进展

功能神经外科是神经外科的一个新的分支,已广泛应用于功能性疾病如运动障碍病、癫痫、疼痛和精神障碍疾病的治疗。近年来,神经电生理学、神经影像学以及新的植入材料的进展,使功能神经外科的疗效和安全性有了很大的提高。目前功能神经外科领域所采用的新技术及临床应用方面有诸多的新进展。     

Reference distributions for complement proteins C3 and C4: a comparison of a large cohort to the world's literature

The lack of credible reference materials and satisfactory methods for quantifying serum levels has limited the bedside use of complement protein (C3 and C4) measurements. However, great technological strides have been made in the last few years. The remaining barrier to a more relevant and cost-effective use of serum protein data for diagnosis and prognosis is the availability of reliable reference intervals from birth to old age for both males and females. Fifty-one publications reporting reference intervals were identified that meet the criteria used in our prior four studies, and these were analyzed statistically. Previous small studies with constrained age ranges agree, on average, with our larger series of life-long reference ranges. This meta-analysis provides support for our reference ranges and places them in the context of previous publications.     

Morgagni hernia repair in children over two decades: Institutional experience,systematic review,and meta-analysis of 296 patients

Background/Purpose

Morgagni diaphragmatic hernia (MH) is rare. We report our experience based on routine patch use in MH repair to curb recurrence. A systematic review and meta-analysis were performed to study the recurrence and complications associated with minimally invasive surgery and the use of patch.

Neurosurgery of epilepsy,movement disorders and pain

Functional neurosurgery involves the surgical management of a wide range of neurological diseases with the aim of treating conditions such as movement disorders, spasticity, epilepsy and intractable pain. Functional neurosurgery began with ablative surgical techniques involving destruction of neural structures responsible for the aberrant neural pathways/networks causing pathology. In more recent years there has been a move away from the creation of permanent destructive lesions towards modulation of the neural networks utilizing neuromodulation. Neuromodulation therapies include invasive (e.g. deep brain stimulators, cortical stimulators, vagal nerve stimulators and spinal cord stimulators) and non-invasive (e.g. transcranial magnetic stimulation) approaches that involve the application of electrical stimulation to drive or inhibit neural function within a circuit. Most implantable neuromodulation systems include three primary components: stimulating electrode(s) with contacts at the tip through which electricity is delivered; an implantable pulse generator (IPG) that serves as a signal generator/battery pack; and the extension cable(s) to subcutaneously connect the electrode(s) to the IPG. In this article we primarily focus on the current role of neuromodulation in treating movement disorders, epilepsy and pain, and also consider emerging and evolving applications.     

Integrated Care Management of Patients With Atrial Fibrillation and Risk of Cardiovascular Events: The ABC (Atrial fibrillation Better Care) Pathway in the ATHERO-AF Study Cohort

ObjectiveTo investigate the impact on cardiovascular events (CVEs) in a real-world population of patients with atrial fibrillation (AF) by implementing the Atrial fibrillation Better Care (ABC: A, Avoid stroke with anticoagulation; B, better symptom management; C, Cardiovascular and comorbidity risk management) pathway.Patients and MethodsThis prospective single-center cohort study included 907 consecutive patients with nonvalvular AF on vitamin K antagonists from February 2008 to December 2016. The A, B, and C groups were defined as follows: “A” by a Time in Therapeutic Range ≥65%; “B” by a European Heart Rhythm Association (EHRA) symptom scale I-II, and “C” as optimized cardiovascular comorbidity management. Primary end point was a composite outcome of CVEs.ResultsDuring a median follow-up of 36.9 months (interquartile range [IQR] 20.0-57.5; 3022 patient-years), 118 CVEs occurred (3.9% per year; 95% confidence interval [CI], 3.2-4.7). Symptomatic patients (EHRA III-IV) had a higher risk of CVEs compared with those in EHRA I (hazard ratio [HR], 2.73, 95% CI, 1.61-4.63, P<.001). Optimally managed patients in the ABC group (n=198) had a lower risk of CVEs (1.8 [95% CI, 0.9-3.0] vs 4.5% [95% CI, 3.7-5.5] per year, P=.001) compared with those presenting with at least 1 suboptimal ABC factor (HR, 0.40, 95% CI, 0.22-0.74, P=.003). This association was evident using multivariate Cox proportional regression analysis (HR, 0.44, 95% CI, 0.24-0.80, P=.007).ConclusionIntegrated care management according to the ABC pathway resulted in a significantly lower rate of CVEs, suggesting a clear benefit of a holistic approach to optimize the management of patients with AF.Trial Registrationclinicaltrials.gov Identifier: NCT01882114     

Periodontally accelerated osteogenic orthodontics with platelet-rich fibrin in an adult patient with periodontal disease: A case report and review of literature

BACKGROUNDIn the clinical scenario, adult patients with periodontal diseases and dental malformation, characterized by dental crowding in lower anterior teeth with the thin biotype, often require orthodontic treatment. This case report aimed to evaluate the clinical and radiographic outcomes of periodontally accelerated osteogenic orthodontics (PAOO) combined with autologous platelet-rich fibrin (PRF) in an adult patient with class I malocclusion along with dental crowding, a thin periodontal biotype, and buccal plate deficiency.CASE SUMMARYA 32-year-old female complaining of dental crowding and gingival bleeding was referred to the orthodontic clinic. The patient underwent periodontal risk assessment prior to orthodontic treatment. She was diagnosed with a high risk of gingival recession due to dental crowding, root prominence, loss of buccal plates, and a thin gingival tissue biotype. The treatment regimen included PAOO combined with autologous PRF for alveolar augmentation and interproximal enamel reduction for moderate dental crowding. Clinically, PAOO-assisted orthodontic tooth movement in this case showed enhanced periodontium remodeling. Radiographic outcomes also showed statistically significant improvements (P < 0.01) in the mandibular buccal alveolar bone. CONCLUSIONThis case report suggests the combination of autologous PRF with PAOO to enhance bone augmentation and long-term tissue support in adult orthodontic patients with periodontal disease.