Population‐based Assessment of Familial Inheritance and Neurologic Comorbidities among Patients with an Isolated Atrial Septal Defect

Background. Interatrial shunts, caused by either atrial septal defect (ASD) or patent foramen ovale, have been reported to have a familial association. We sought to examine the familial risk of isolated interatrial shunt and explore associated comorbidities of stroke, transient ischemic attack (TIA), and migraine using a population database. Methods. The Utah Population Database is linked to inpatient and outpatient records from the University of Utah Health Science Center. Patients with an interatrial shunt were identified, and those with any other form of congenital heart disease or an inheritable syndrome associated with ASD were excluded. Of the 9452 individuals diagnosed with isolated interatrial shunt, 6179 (65%) had sufficient familial and follow‐up data for analysis. Five age/gender matched controls were randomly selected per case. Cases and their relatives were compared with controls to assess the relative risk for each comorbid condition. Results. Relatives of interatrial shunt cases had an increased risk for interatrial shunt: siblings relative risk (RR) 6.98 (95% confidence interval [CI] 5.75–8.48; P < 1.0 × 10^?16), first‐degree RR 5.64 (95% CI 4.76–6.68; P < 1.0 × 10^?16), and second‐degree RR 1.75 (95% CI 1.32–2.32; P= 0.0001). Patients with interatrial shunt were more likely to have a comorbid condition compared with controls (RR 21.3, 95% CI 17.1–26.5; P < 1.0 × 10^?16). First‐degree relatives of cases had an increased risk of TIA (RR 1.70, 95% CI 1.18–2.45; P= 0.0045), but no increase risk of stroke or migraine compared with controls. Conclusions. There is a strong familial inheritance pattern for isolated interatrial shunt, with significantly higher risk of interatrial shunt among affected patients' siblings, first‐, and second‐degree relatives. Relatives of affected individuals also had a higher risk of TIA, a trend toward an increased risk for stroke, but no increased risk of migraine headache.     

Sudden Cardiac Arrest Due to Subtotal Absence of Left‐sided Pericardium—Case Report and Review of the Literature

Congenital absence of the pericardium is a very rare cardiac malformation, usually diagnosed fortuitously on autopsy or surgery. Symptoms related to these abnormalities are usually benign, and fatalities reported in the literature are almost exclusively secondary to herniation of the heart through a partial defect. We present the unusual case of a 44‐year‐old woman admitted for sudden cardiac arrest. Initial evaluation suggested acute anterior myocardial infarction, but further investigation ruled out coronary heart disease. No arrhythmia could be initiated on electrophysiological study, and absence of most of the left pericardium was confirmed by cardiac magnetic resonance imaging. After the exclusion of common etiologies such as idiopathic ventricular fibrillation, transient great vessel torsion due to hypermobility of the heart with secondary malignant arrhythmia was considered to be the most likely mechanism for the sudden cardiac arrest. A review of the available literature on clinical presentation, diagnostic tools, and therapeutic options is also presented.     

n-HA／PA66人工骨板引导修复腭部软组织缺损的动物实验研究

目的:观察纳米羟基磷灰石/聚酰胺(n-HA/PA66)复合人工骨板对羊腭部软组织缺损的引导修复作用。方法:将12只羊分为实验与空白对照两组,于羊硬腭中份做18.0mm×14.0mm矩形黏骨膜缺损和15.0mm×13.0mm矩形骨缺损,实验组在缺损处植入人工骨板封闭骨质缺损,空白对照组不做任何修复。术后通过大体、病理切片观察黏骨膜组织生长情况和新生组织结构。结果:实验组黏骨膜组织沿人工骨表面爬行生长,于6周内完全关闭软组织缺损;空白对照组软硬组织未能自行愈合。结论:n-HA/PA66人工骨板可引导羊腭部黏骨膜沿其生长,自行修复一定大小的软组织缺损,而达到腭部软组织缺损修复重建的目的。     

BMSCs／PLGA复合物修复山羊下颌髁突骨软骨缺损的实验研究

目的：观察利用BMSCs／PLGA复合物修复山羊下颌髁突骨软骨缺损的可行性及效果。方法：选取36只成年健康山羊,一侧关节制备3mm直径、5mm深的髁突表面骨软骨缺损,根据植入物不同分为BMSCs／PLGA复合物组、PLGA组及空白组,另一侧关节作为正常对照组。分别在术后6周和24周后处死每组6只动物,标本进行大体及组织学检查比较。结果：术后24周时空白组下颌髁突骨软骨缺损未能自发修复;植入PI。GA组的缺损表面虽有软骨形成,但连续性有中断;植入BMSCs／PLGA组的修复效果最佳,表面软骨接近正常纤维软骨。组织学评分结果也显示BMscs／PLGA组明显优于材料组和空白组。结论：BMSCs／PLGA复合物可以作为一种修复下颌髁突骨软骨缺损的新的有效方法。     

低强度脉冲超声波联合引导组织再生术促进牙周骨开窗缺损修复的动物实验

目的 探讨低强度脉冲超声波(low intensity pulsed ultrasound,LIPUS)联合引导组织再生术(guided tissue regeneration,GTR)对Beagle犬尖牙牙周骨开窗缺损的修复效应.方法 构建4只Beagle犬尖牙颊侧区根中1/3处牙周骨开窗缺损模型.将4只Beagle犬的16颗双侧上、下颌尖牙(实验牙)按简单随机法平均分配为4组:①实验1组,LIPUS(60 mW/cm2,20 min/d)处理+GTR+牙周骨质缺损组;②实验2组,LIPUS(60 mW/cm2,20 min/d)处理+牙周骨质缺损组;③实验3组,GTR+牙周骨质缺损组;④空白对照组,牙周骨质缺损组.实验共进行28 d.每14天分别测量各组处理前后实验牙牙龈表面温度,并行Wilcoxon符号秩和检验.4周后观察脱钙骨组织切片,分析各组尖牙牙周骨开窗缺损的组织学修复效果.结果 临床观察各组实验牙牙周均愈合良好.各组处理前后的牙龈表面温度差值[M(Q)]分别为:实验1组:0.225(0.463)℃;实验2组:0.265(0.133)℃;实验3组:0.09(0.115)℃;空白对照组:-0.175(0.370)℃,实验1、2组每次处理前后温度变化差异均有统计学意义(P值均为0.027).脱钙骨组织切片观察显示实验1组骨缺损内充满团状新生骨组织,成骨细胞增生活跃,骨胶原较成熟,Masson染色红染明显;实验3组新生牙骨质、牙槽骨较实验2组和空白对照组多,新生骨胶原成熟度不高,Masson染色呈红蓝相间;实验2组新生骨胶原成熟度较实验3组和空白对照组高,Masson染色红染明显;空白对照组可见少量新生牙骨质沿切迹处生长,新生骨胶原不成熟,Masson染色呈红蓝相间.结论 LIPUS具有促进牙周骨开窗缺损修复的潜能,LIPUS与GTR结合可能更利于牙周组织缺损的修复.

Abstract：

Objective To evaluate the effects of low intensity pulsed ultrasound(LIPUS)combined with guided tissue regeneration(GTR) for the repair of the periodontal fenestration defect at the canines in Beagle dogs. Methods Four Beagle dogs were used for establishing the periodontal fenestration defect. Sixteen canines of four Beagle dogs were simple randomly assigned into experimental group 1[LIPUS(60 mW/cm2,20 min/d)irradiation + GTR + the periodontal fenestration defect], experimental group 2[LIPUS(60 mW/cm2,20 min/d)irradiation + the periodontal fenestration defect], experimental group 3(GTR+ the periodontal fenestration defect) and control group(the periodontal fenestration defect). Experiments conducted 28 d. The temperature of the gingive′s surface of each group was tested every 14 days(analyzed by Wilcoxon rank sum test with SPSS 13.0). The demineralized bone tissue slices of the periodontal fenestration were obtained for histologic staining after 4 weeks treatment. Results Clinically all the treatment groups healed well. The change of gingive′s surface temperature[M(Q)] before and after LIPUS irradiating were:0.225(0.463)℃(experimental group 1),0.265(0.133)℃ (experimental group 2),0.090(0.115)℃(experimental group 3);-0.175(0.370)℃(control group). The P value of experimental group 1 and 2 with pre-and post-treatment each time were both 0.027. Histology of the demineralized bone tissue revealed that in experimental group 1, the bone defect was filled with fresh bone-like tissues, proliferatively active osteoblasts and newly formed cementum-like tissues along the defect surface. In experimental group 3, there were more new cementum-and bone-like tissues than in experimental group 2 and control group. In experimental group 2,the new bone collagen was more mature than in experimental group 3 and control group. In control group,there was less growth of new cementum along the notch, and the new bone collagen was immature. Conclusions LIPUS combined with GTR may have the potential of promoting the repair of periodontal fenestration defect.     

Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction

Our aim was to use the deep circumflex iliac artery (DCIA) flap together with a costochondral graft as a safe and reliable bone flap for routine reconstruction of the mandibular body and the temporomandibular joint (TMJ). Five patients with benign tumours of the mandible had segmental mandibulectomy including the condyle, and this was reconstructed in one stage using the DCIA combined with a constochondral graft. The rib was inserted into the iliac crest as a whole transplant, and fixed to the proximal stump of the mandible with a prebent reconstruction plate according to a computer-aided design. The grafts healed uneventfully, and dental implants were inserted in 4 cases. During the 2-year follow-up these patients had good mandibular function, including mouth opening, force of bite, and occlusion. The radiographs showed good bony consolidation between the graft and the stump of the mandible and function of the TMJ.A DCIA flap combined with a costochondral graft is a safe and reliable way to provide not only a large bulk of bone to suit the mandible, but also good function of the TMJ in the absence of radiotherapy.     

Cardiac MR imaging reveals L-type transposition of the great vessels and failing right heart

L-type transposition of the great vessels is a rare congenital heart disease in which both the great arteries and the ventricular chambers are reversed. Because this condition preserves a physiologic circulatory pathway, it can be challenging to diagnose in infants with no concurrent cardiac abnormalities. Early detection is essential, however, because these patients will eventually experience severe complications, as the structural right ventricle is unable to function long-term in the systemic position. We report a rare case of L-type transposition of the great vessels in a 32-year-old male who presented in adulthood with tachycardia and palpitations. The initial echocardiogram was inconclusive. Further imaging (cardiac MRI & transesophageal echocardiogram) revealed the inverted anatomy due to the presence of key morphological features, such as the malposed great vessels along with the moderator band and prominent trabeculae within the right ventricle, which was functioning systemically.     

Implementation of 3D Printing in Medical Care for Preoperative Planning of Complex Ventricular Septal Defect

Three-dimensional (3D) modeling and printing in medicine have emerged to encompass every aspect of medical applications. This ranges from education, illustration, and treatment, as well as patient care whether for purposes of diagnosis or treatment and surgical planning. In the past few decades, these novel tools have shown promising utility to help radiologists and the medical team to improve quality of patient care and outcomes via 3D printing application and utilization. This workflow will be illustrated through a ventricular septal defect (VSD) case at which 3D analysis was critical in the assessment and treatment planning of the patient’s underlying medical condition.     

自发性脑脊液耳漏4例临床分析

目的探讨自发性脑脊液耳漏的临床特点及治疗。方法回顾性分析2015年7月—2016年12月手术治疗的4例自发性脑脊液耳漏患者的临床病例资料,4例患者均有细菌性脑膜炎病史,2例为内耳畸形（内耳不完全分隔Ⅰ型）,漏点均位于镫骨足板;行耳后切口鼓室探查术,术中见镫骨足板缺损有清亮液体涌出,去除镫骨及砧骨,以颞肌筋膜、耳廓软骨及纤维蛋白胶封堵前庭窗。另2例漏点位于后颅窝硬脑膜,其中1例位于弓状隆起至总角水平,1例位于圆窗至外耳道下壁水平;此2例患者均行完壁式乳突开放术,显露后颅窝骨质缺损处,可见脑脊液流出,以颞肌筋膜、耳廓软骨、乳突皮质骨骨粉及纤维蛋白胶封堵缺损。结果4例患者术后随访23~39个月,脑脊液耳漏及脑膜炎均无复发。结论自发性脑脊液耳漏发病率低,容易漏诊、误诊,以致脑膜炎反复发作。听力下降伴脑膜炎的患者应高度怀疑自发性脑脊液耳漏的可能。