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2024 Vol. 54, No. 6
Published: 2024-06-25
431
Picosecond laser-induced different patterned surface modification of dental zirconia ceramics and its effect on bonding properties
ZHOU Qiaozhen, CHEN Rui, LUO Yixuan, ZHU Li, WANG Siqian, LIU Zhucheng, MA Jianfeng
DOI: 10.3969/j.issn.2095-9400.2024.06.001
Objective: To compare the effects of different patterned picosecond laser scanning on the surface treatment of zirconia by evaluating the bonding strength with self-adhesive resin cement. Methods: 160 sintered zirconia ceramic specimens were randomly divided into 8 study groups and treated as follows. Blank control (group A); Sandblasting control (group B); Picosecond laser treatment groups (group C-H), according to the different patterned picosecond laser scanning on the surface treatment of zirconia, divided to the following groups:picosecond laser honeycomb scanning (group C); honeycomb scanning with picosecond laser after alumina sandblasting (group D); picosecond laser transverse linear scanning (group E); picosecond laser transverse linear scanning after alumina sandblasting (group F); picosecond laser trellis scanning (group G); picosecond laser grid scanning after alumina sandblasting (group H). Scanning electron microscope was used to observe the microstructure of the samples, atomic force microscope was used to measure the surface roughness, X-ray diffractometer was used to observe the transformation of crystal phase composition on the surface, the electronic universal testing machine was used to measure the three-point bending strength and the shear bond strength (SBS) of zirconia samples and self-adhesive adhesive resin cement, the optical microscope was used to observe the fracture surface to judge the fracture mode. All data were analyzed by SPSS 26.0 software. Results: After picosecond laser scanning on the surface of zirconia ceramic, the honeycomb shape, parallel and equal spacing horizontal line pattern and criss-crossing and equal spacing tic-tac-toe pattern can be obtained. Different roughness was obtained, group F showed the largest roughness, which was 14.92 μm. Laser surface treatment does not lead to surface crystal phase transformation. The shear bond strength increased obviously after picosecond laser patterning treatment (P<0.05).The bonding strength of group C was the highest (26.86±1.53)MPa, which was about 7.4 times of group A. The fracture mode changed from complete bond failure of group A and group B to cohesive failure and mixed failure.The lowest flexural strength of the zirconia ceramic after laser treatment still met the requirements of clinical application. Conclusion: Patterning the surface of zirconia with picosecond lasers can improve the shear bond strength between zirconia and the resin cement, which is a promising surface modification method for zirconia.
2024 Vol. 54 (6): 431-437,445 [
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438
Latent class analysis of caregiver burden in parents of children with autism
JIANG Sisi, TAO Jingrui, WU Yanhong, CEN Yibeini, HUANG Liqiang, DONG Chaoqun.
DOI: 10.3969/j.issn.2095-9400.2024.06.002
Objective: To explore the latent classes of caregiver burden in parents of children with autism and analyze the differences in demography and family resilience. Methods: Parents of children with autism who were trained in 5 autism rehabilitation institutions in Wenzhou and Ningbo cities of Zhejiang province from June to August in 2021 were selected by convenience sampling method. Basic information questionnaire, family resilience assessment scale and Zarit caregiver burden interview were used for investigation. Latent class analysis was used to explore the latent classes of caregiver burden in parents of children with autism. Univariate analysis and ordinal and multinominal logistic regression were used to identify the predictors of the latent classes.Results: A total of 260 returned questionnaires (out of the 280) were valid, with an effective response rate of 92.86%. The caregiver burden among parents of children with autism could be divided into 3 latent classes,i.e., low-burden group (35.8%), medium-burden group (41.5%), and high-burden group (22.7%). Ordinal and multinominal Logistic regression outputs demonstrated that parents who were older (OR=1.050, 95%CI=0.009-0.089, P=0.016), had 3-6 h (OR=2.098, 95%CI=0.188-1.294, P=0.009) and >6 h (OR=2.667, 95%CI=0.211-1.752, P=0.013) rehabilitation training and bore >60% percentage of rehabilitation costs (OR=2.886, 95%CI=0.158-1.963, P=0.021) tended to be in the high-burden group, while parents who had higher scores of family resilience were less likely to be in the high-burden group (OR=0.954, 95%CI=-0.062-0.031, P<0.001).Conclusion: The caregiver burden in parents of children with autism are heterogeneous and can be divides into 3 latent classes. The caregivers of older age, with longer rehabilitation training, higher rehabilitation costs and lower family resilience had higher caregiver burden. Medical staff should pay attention to those caregivers with older age and higher rehabilitation training input, and try to help families build positive belief and develop coping skills to overcome adversity so as to reduce caregiver burden.
2024 Vol. 54 (6): 438-445 [
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446
Effect of transcutaneous electrical acupoint stimulation on immunity and clinical prognosis of patients with lumbar disc herniation
QIAN Xuwen, LI Guoyan, LIU Guokai, TANG Wenqian, LI Chuntian
DOI: 10.3969/j.issn.2095-9400.2024.06.003
Objective: To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the immune balance, postoperative infection and clinical prognosis in patients with lumbar disc herniation undergoing open spine surgery. Methods: A total of 112 patients who met the inclusion criteria were selected as the research subjects, who were divided as a simple general anesthesia group (control group) and an electrical acupoint stimulation combined with general anesthesia group (experimental group) according to the computergenerated random table, with 56 cases in each. The serum indexes (IL-2, TNF-α, IFN-γ, IL-4, IL-6, IL-10, TGF-β,IL-17), BIS value and postoperative complications (incision infection, nausea and vomiting) were observed before anesthesia (T0), tracheal intubation (T1), skin incision (T2), insertion of the first pedicle screw (T3), the end of operation (T4), the first day after operation (T5) and the second day after operation (T6) to explore the effect of TEAS on the immune balance and clinical prognosis in patients undergoing open spine surgery. Results:Compared with T0, IL-17 levels in the control group increased more at T4 time point (P<0.05); TGF-β level in both groups increased at T2, T4, T5, T6 time points (P<0.05). Compared with the control group, IL-2 level in the experimental group was significantly lower at T4 and T6 time points (P<0.01); the level of IL-4 in the experimental group was significantly higher at T3 and T4 time points (P<0.05); the level of IFN-γ in the experimental group was significantly lower at T1 and T5 time points (P<0.05); the level of IL-17 in the experimental group was significantly lower at T4 (P<0.05); TGF-β levels were significantly increased at T3 (P<0.01). The incision infection rate of the experimental group (1, 1.7%) was lower than that of the control group (5, 8.9%), with statistical difference (P<0.05). The incidence of postoperative nausea and vomiting in the experimental group (8, 14%) was lower than that in the control group (24, 43%), with sighificant difference (P<0.05); The BIS value of the experimental group was higher than that of the control group at the end of operation, showing statistical difference between the two groups (P<0.05). Conclusion: The application of TEAS during peri-operation can improve the patients’ immune balance, reduce the inflammatory reaction, increase the anti-inflammatory response, thus reducing the occurrence of postoperative infection. Meanwhile, it can shorten the recovery time and significantly reduce postoperative complications such as nausea and vomiting.
2024 Vol. 54 (6): 446-451 [
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452
Correlation between serum neuron-specific enolase and cognitive dysfunction after acute stroke
WANG Hong, WANG Liuqing, WANG Zhen, ZHANG Rongwen, LEI Chenli, LUAN Xiaoqian
DOI: 10.3969/j.issn.2095-9400.2024.06.004
Objective: To explore the relationship between cognitive impairment in the acute stage of ischemic stroke and the levels of serum neuron-specific enolase (NSE) at admission. Methods: Subjects with acute ischemic stroke (AIS) were screened from the First Affiliated Hospital of Wenzhou Medical University from July 2017 to January 2023. Their cognition status was assessed by the Mini-Mental State Examination (MMSE) within the first month after stroke. Blood samples were obtained in the morning for measuring the levels of NSE, which were divided into four quartiles: Q1:≤11.00 ng/mL, Q2: >11.00-13.50 ng/mL, Q3: >13.50-17.00 ng/mL, and Q4: >17.00 ng/mL. To investigate the relationship between NSE and PSCI, binary logistic regression analysis was conducted. Additionally, a restricted cubic spline (RCS) model was employed to further investigate the connection between NSE and cognitive impairment in the acute stage of ischemic stroke.Results: The serum NSE levels were significantly higher in the PSCI group (P<0.05). With confounders adjusted,the risk of developing cognitive impairment was significantly higher for patients in the Q1, Q2 and Q4 quartiles compared with those in the Q3 quartile (P<0.05 for all). Additionally, the restricted cubic spline (RCS) model indicated that the risk of cognitive impairment in the acute stage of ischemic stroke escalated markedly with the increase of serum NSE levels once they surpassed the threshold of 17.69 ng/mL. Conclusion: Higher serum NSE levels were associated with cognitive impairment after stroke, which might aid in the early identification of highrisk patients and facilitate timely intervention.
2024 Vol. 54 (6): 452-457 [
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458
Predicting the risk of postoperative cervical lymph node metastasis in papillary thyroid carcinoma: A composite model based on ultrasound and clinical indicators
HE Lei, XIONG Bing, LUO Yinli, CHEN Shunping
DOI: 10.3969/j.issn.2095-9400.2024.06.005
Objective: To explore the predictive value of preoperative ultrasonographic features combined with clinical indices for the risk of cervical lymph node metastasis after surgery for papillary thyroid carcinoma (PTC). Methods: A retrospective collection of 43 patients with cervical lymph node metastasis of PTC confirmed by pathology after a second surgery at the First Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2020 was included in as the metastasis group. Meanwhile, 89 patients who had undergone initial PTC surgery from January 2013 to December 2014 and were followed up for at least 8 years without recurrence of cervical lymph nodes were collected as the non-metastasis group. Patients were randomly sampled in a 7:3 ratio into a training set (n=92) and a validation set (n=40). In the training set, a predictive model was constructed through univariate and multivariate logistic regression analyses and visualized with nomograms. The model was validated using the validation set, and its efficacy and clinical value were assessed by ROC curve and decision curve analysis (DCA). Results: Statistically significant differences were observed between the metastasis and nonmetastasis groups in terms of surgical methods, intraoperative lymph node metastasis, thyroid nodule location,echogenicity, maximum diameter of thyroid nodules, ultrasonographic indication of lymph node enlargement,lymph node long-to-short axis ratio, and lymph node blood flow characteristics (all P<0.05). Multivariate logistic regression analysis identified the method of surgery (OR=0.332, 95%CI=0.134-0.828, P=0.018), intraoperative lymph node metastasis (OR=2.978, 95%CI=1.112-7.953, P=0.03), thyroid nodule location (middle vs. lower pole,OR=6.624, 95%CI=1.986-22.095, P=0.002) and maximum diameter of thyroid nodules (OR=1.064, 95%CI=1.002-1.130, P=0.042) as independent predictors of cervical lymph node metastasis after surgery. The model exhibited an area under the curve (AUC) of 0.872 (95%CI=0.795-0.949) in the training set and an AUC of 0.863 (95%CI=0.749-0.976) in the validation set, with DCA showing a net benefit in predicting the risk of postoperative PTC cervical lymph node metastasis at a threshold probability of 0.1 to 0.7. Conclusion: Based on preoperative ultrasonographic characteristics and clinical pathological indices, the constructed model effectively forecasts the risk of cervical lymph node metastasis after PTC surgery, offering valuable guidance for clinical decisionmaking.
2024 Vol. 54 (6): 458-464 [
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Changes of pelvic floor three-dimensional ultrasound indicators in patients with postpartum stress urinary incontinence
WU Liqun, ZHAO Huiyan, GAO Jie, YAO Rui, XU Qun.
DOI: 10.3969/j.issn.2095-9400.2024.06.006
Objective: To investigate the changes and risk factors of pelvic floor three-dimensional ultrasound parameters in patients with postpartum stress urinary incontinence 6-8 weeks after delivery. Methods: A total of 96 cases of postpartum patients from Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2021 to January 2024 were selected and assigned into two groups: observation group (52 cases) with stress urinary incontinence and control group (44 cases) without stress urinary incontinence. Threedimensional ultrasound indexes of pelvic floor were compared between two groups. Meaningful indicators were analyzed by logistic regression analysis. Results: The findings showed that the observation group was higher than the control group (P<0.05) in the bladder neck funnel formation rate, bladder neck descent (BND), levatorani hiatus area (LHA) under the state of being at rest, LHA under valsalva state, LHA variation (△LHA), levator hiatus length (LH-L) under two states and LH-L variation (△LH-L). Logistic regression analysis showed that the bladder neck funnel formation rate (OR=10.714, 95%CI=2.269-50.603, P=0.003) and △LH-L (OR=1.013,95%CI=0.897-1.145, P=0.031) were influencing factors of SUI. Conclusion: In patients of singleton primipara with SUI, the formation of bladder neck funnel, increased △LH-L are risk factors for postpartum SUI.
2024 Vol. 54 (6): 465-470 [
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Accuracy analysis of a novel digital post-core impression method
ZHENG Ruibin, YE Zengqi, ZHU Li,YANG Zhengyu
DOI: 10.3969/j.issn.2095-9400.2024.06.007
Objective: To analyze the accuracy of a novel post and core impression by best-fit alignment technique. Methods: A maxillary left canine tooth of standard dental model was prepared for post and core restoration, which was scanned using Micro-CT to establish 3D reconstruction data. Then 8 digital impressions were taken by oral scanner and 8 silicone rubber impressions were taken by desk scanner to get digital models,which were matched by software to obtain 8 three-dimensional data. The accuracy of the new digital post-core impression method is analyzed by measuring and comparing the root-mean-square of each overlapping model.Results: The trueness of the novel technique was (91.100±12.475)μm, with the precision being (91.354±21.422) μm respectively. The accuracy and repetition deviation values of the crown group were smaller than those of the root group. The accuracy and repetition deviation values of the root apical 1/3 group were greater than those in other groups (P<0.05). Conclusion: The accuracy of the novel technique is acceptable in clinical applications.The accuracy of the novel technique varies in different part, with the crown part higher than the root part, and the root apical 1/3 group lower than other groups.
2024 Vol. 54 (6): 471-476 [
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477
Application of modified tracheoglossostomy in patients with difficult tracheotomy
YE Fan, FANG Xiaobi,XIA Zhigang, WU Cong, LIN Renyu, LI He
DOI: 10.3969/j.issn.2095-9400.2024.06.008
Objective: To study the application value of modified tracheotomy in patients with difficult tracheotomy. Methods: A retrospective study was conducted on 42 patients with difficult tracheotomy who underwent tracheotomy at the First Affiliated Hospital of Wenzhou Medical University between November 2016 and December 2021. They were divided into temporary tracheotomy group (25 cases) and modified tracheoglossostomy group (17 cases) according to different methods of gas incision. The first postoperative tube replacement time, blood volume, postoperative complications, decision time and operation time were analyzed.Results: Compared with the temporary tracheotomy group, the modified tracheoglossostomy group had significant advantages in the first postoperative tube replacement time and blood flow volume (P<0.05). Compared with the temporary tracheostomy group, the modified tracheoglossostomy group significantly shortened the surgical decision time (P<0.05). There was no significant difference in operation time between the two groups (P>0.05).There was 1 case of subcutaneous emphysema complications in the modified tracheoglossostomy group, and in the temporary tracheostomy group there were 2 local infections, 3 accidental extubations and 1 balloon rupture.Conclusion: Modified tracheoglossostomy has certain advantages over temporary conventional tracheostomy in terms of postoperative complications and outcomes.
2024 Vol. 54 (6): 477-481 [
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Xp11.2 translocation/TFE3 fusion-associated renal cell carcinoma in children: Diagnosis and treatment of 5 cases
LIU Miaoqing, ZHOU Pingjiang, XU Lei, CHEN Congde, LI Zhongrong
DOI: 10.3969/j.issn.2095-9400.2024.06.009
Objective: To summarize the clinical characteristics of pediatric renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion for the better understanding of its features. Methods: A retrospective analysis was conducted on the data of 5 children diagnosed with Xp11.2 translocation/TFE3 gene fusion-associated renal cell carcinoma treated in the Second Affiliated Hospital of Wenzhou Medical University from January 2015 to December 2023, combined with a literature review to analyze its clinical characteristics. Results: Of the 5 cases, 1 was male and 4 females, with the onset age ranging from 5 to 15 years old and a median age of 11 years.Tumors were located in the left kidney in 2 cases and in the right kidney in 3 cases. Initial symptoms included gross hematuria in 1 case, abdominal distension in another, incidental findings during physical examinations in 2 cases, and post-exercise lumbar and abdominal pain in 1 case. Four children underwent radical nephrectomy,and one received partial nephrectomy. No complications occurred in any of the surgeries. Postoperative immunohistochemical staining showed TFE3 positive in all children. One child was lost to follow-up after surgery,and the remaining 4 were followed up for 3 months up to 6.5 years. One child died two years after receiving sunitinib targeted therapy postoperatively, while the remaining three did not receive chemotherapy or targeted therapy and had no recurrence or metastasis after surgery. Conclusion: Although pediatric renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion is rare, it has a relatively good prognosis. Imaging for identifying lesion locations has limited specificity; its diagnosis relies mainly on immunohistochemistry. Radical nephrectomy serves as an effective primary treatment option.
2024 Vol. 54 (6): 482-486 [
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CT and clinicopathological features of primary pulmonary artery sarcoma
CHEN Li, LIN Yizi,ZHANG Peigui, XIA Ruike, CHENG Weipeng, LI Jun, WANG Jianshu, GAO Yuantong
DOI: 10.3969/j.issn.2095-9400.2024.06.010
Objective: To analyze the CT and pathological features of primary pulmonary artery sarcoma (PPAS). Methods: Retrospective analysis was conducted on CT images and pathological data from 13 cases of PPAS. CT scans focused on observing the location, extent, shape, density, invasion and metastasis of surrounding tissues. Pathological manifestations of the tumor were also analyzed to identify potential characteristics. Results:In 12 cases, the main body of the tumor was located in the main pulmonary artery pulmonary artery trunk, while in 1 case it was found in the pulmonary artery trunk. Tumor involvement was observed in the pulmonary lobar branches of the pulmonary artery in 9 cases. In 13 cases, PPAS indicated significant localized thickening of the pulmonary arteries, with complete or partial filling defects in corresponding areas of the main pulmonary artery and proximal pulmonary artery. These defects presented as cast, polypoid, or nodular changes. The inner wall boundary of the diseased segment of the pulmonary artery appeared unclear. There were 5 cases that showed lesion invasion outside the arterial wall, penetrating the vascular wall and forming a mass within the mediastinal.One case revealed invasion of the main left pulmonary vein, forming a polypoid mass shadow. Furthermore, one case exhibited secondary solitary nodular metastasis in the left upper lobe of the lung. On plain scanning, the tumor appeared uneven or slightly lower in density, with uneven enhancement observed in the arterial phase,continuous enhancement in the venous phase, and reduced enhancement in the delayed phase after enhancement.Multiple small and patchy exudative solid lesions were observed in 4 cases, including 1 case with cavity. Mild pericardial effusion was detected in 2 cases, along with mild pleural effusion. Microscope examination revealed tumor cells were predominantly irregular vascular cavities and spindle cells. Some areas exhibited mucinous changes, necrosis, and large nuclei atypia. Immunophenotype: tumor cells showed diffused positivity for Vimentin,and positivity for CD34 and CD31. Conclusion: PPAS mostly invades the main pulmonary artery, as well as the left and right pulmonary artery trunks, with involvement of more than 2 sites commonly observed. The lesions are mostly cast-like, polypoid, or nodular, exhibiting uneven density on plain scans and uneven enhancement on enhanced scans. The tumor exhibits strong invasiveness. The tumor cells showed diffused positive for Vimentin,while CD34 and CD31 are positive. These findings can aid in the recognition and diagnosis of PPAS.
2024 Vol. 54 (6): 487-491 [
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Meta-analysis of autologous soft tissue replacement materials in the treatment of natural tooth gingival recession
CAI Zhibin, HE Kuifang, DENG Hui
DOI: 10.3969/j.issn.2095-9400.2024.06.014
Objective: To systematically evaluate and compare from the perspective of clinical indicators the efficacy of autologous soft tissue replacement materials and connective tissue grafts combined with coronal reduction flap technology in the treatment of natural tooth gingival recession. Methods: Computer retrieval of randomized controlled trials using autologous soft tissue replacement materials or connective tissue grafts (CTGs) for the treatment of gingival recession from databases such as PubMed, EMBASE, Web of Science, VIP,Wanfang, and CNKI, with a search period from January 2013 to December 2023. Results: Totally 14 randomized controlled studies were included, with 1 117 sites of gingival recession. Meta-analysis showed that at 6 months after surgery, CTG was more effective in reducing gingival recession compared with xenogeneic collagen matrix (XCM), but was not significantly different from platelet rich fibrin (PRF) or decellularized dermal matrix (ADM).Compared with PRF, ADM, and XCM, CTG had a more significant increase in keratinized gingival width.There was no statistical difference in the root coverage index; PRF and XCM significantly reduced postoperative pain in patients. Conclusion: Research has shown that there is no significant difference in the effectiveness of autologous soft tissue replacement materials compared with CTG in treating gingival recession, but the former can relieve postoperative pain in patients.
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The effect of internship at the student’s hometown on the occupational identity of order-oriented medical students free of charge with rural background
FENG Anting, JI Bingyan, YU Sicheng, HUANG Di, WU Huilei
DOI: 10.3969/j.issn.2095-9400.2024.06.015
Objective: To explore the differences and influencing factors of occupational identity among order-oriented charge-free rural medical students before and after their internship in their location of origin.Methods: The Occupational Identity Scale was used to conduct pre-test & post-test on 208 students of 2019 majoring in general medicine in Wenzhou Medical University. Occupational identity of the target students before and after the internship was tested by paired t-test, and the influence of different factors on the occupational identity was tested by the independent sample t-test. Results: Rural order-oriented free medical students had a moderate to high level of occupational identity, and after internships in their hometowns, the overall level of professional identity improved, showing a significant positive correlation among the dimensions of occupational identity (P<0.05). Before and after the internship, their occupational commitment level was at the end of the occupational identity level, and taking postgraduate entrance exam was an important factor to reduce their occupational commitment. Students with grassroots community practice had higher occupational identity than those without the same experience (P<0.05). Gender, place of origin, and target work location have no significant impact on the occupational identity of rural order-oriented free medical students (P>0.05). Conclusion: Collaboration between schools and local governments should be made to encourage internship for rural order-oriented free medical students in their hometowns, increase opportunities for grassroots community practice, and strengthen the hometown awareness and local emotions in the whole educational process, thus enhancing their occupational identity.
2024 Vol. 54 (6): 508-513 [
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Issues in quality improvement of short-time peer review in medical journals of sub-discipline
JIANG Suqiong, WU Feiying, JI Weihong, WU Xixi, XIE Haohuang.
DOI: 10.3969/j.issn.2095-9400.2024.06.016
Peer review is a key step to control the quality of manuscripts in academic journals, which has a significant impact on the time lag of publication cycle. In order to meet the need to develop specialized differentiation of medical disciplines, medical journals of subordinate subject are gradually expanding. However,there’d no guarantee for the quality of peer review. Taking an example of medical journals of sub-discipline,based on literature research and personal experience, this paper analyzes the problems and causes in the peer review process and then puts forward specific measures to improve the review quality and ensure the review efficiency under the short-time requirement.
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