Distraction spinal cord injury is caused by some degree of distraction or longitudinal tension on the spinal cord and commonly occurs in patients who undergo corrective operation for severe spinal deformity.With the i...Distraction spinal cord injury is caused by some degree of distraction or longitudinal tension on the spinal cord and commonly occurs in patients who undergo corrective operation for severe spinal deformity.With the increased degree and duration of distraction,spinal cord injuries become more serious in terms of their neurophysiology,histology,and behavior.Very few studies have been published on the specific characteristics of distraction spinal cord injury.In this study,we systematically review 22 related studies involving animal models of distraction spinal cord injury,focusing particularly on the neurophysiological,histological,and behavioral characteristics of this disease.In addition,we summarize the mechanisms underlying primary and secondary injuries caused by distraction spinal cord injury and clarify the effects of different degrees and durations of distraction on the primary injuries associated with spinal cord injury.We provide new concepts for the establishment of a model of distraction spinal cord injury and related basic research,and provide reference guidelines for the clinical diagnosis and treatment of this disease.展开更多
Limited research has explored roadside advertisements’ effects on road user behavior in Middle Eastern countries. This study aims to understand distraction perceptions, including advertisements, their impact on behav...Limited research has explored roadside advertisements’ effects on road user behavior in Middle Eastern countries. This study aims to understand distraction perceptions, including advertisements, their impact on behavior, and potential influences from advertisement type, in-vehicle distraction, and country factors (reflecting culture and environment). A standardized questionnaire was administered in Jordan and Kuwait, complemented by observations across three segment types: roadside advertisements, commercial signs, and road signs as control segments. Descriptive and inferential statistics were used. Results indicated a significant disparity in distraction perception between the two groups. Advertisement presence influenced Kuwaiti but not Jordanian behavior. Behavior varied by advertisement type in Jordan, not Kuwait, and in-vehicle distraction did not impact driver behavior. The study suggests explicitly revising advertising policies with a traffic safety focus. Overall, the study contributes insights into road user perceptions and behaviors, highlighting the complex interplay of distractions and advertising on road safety. Further research is required to validate these findings and shape road safety regulations.展开更多
Objective: skeletal advancement in order to improve the airway dimensions is known as one of the most effective surgical theraphy for treating obstructive sleep apnea (OSA). Distraction osteogenesis (DO) can be a bett...Objective: skeletal advancement in order to improve the airway dimensions is known as one of the most effective surgical theraphy for treating obstructive sleep apnea (OSA). Distraction osteogenesis (DO) can be a better treatment alternative in some selected cases similar to our patient. Using custom made distractors can make this technique more safe and successful. Study Design: Surgically assisted rapid palatal expansion (SARPE), bilateral intraoral mandibular distraction osteogenesis (MDO) and orthodontic treatment were tried to a 20-year-old OSA patient with orthognathic anomaly. For mandibular distraction, custom made distractors were used. Results: The initial AHI of the patient was 23.3. At the end of the treatment it decreased to 8.7. Conclusions: Distraction osteogenesis could be a better alternative than the conventional orthognathic surgery in this kind of selected patients. Customization of the distraction devices can contribute to making this procedure safer and more successful.展开更多
Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is s...Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.展开更多
Objective: To apply trifocal distraction osteogenesis in canine model of skull segmental defects and to provide reference for clinical treatment. Methods: Six labrador dogs were selected in this study and divided into...Objective: To apply trifocal distraction osteogenesis in canine model of skull segmental defects and to provide reference for clinical treatment. Methods: Six labrador dogs were selected in this study and divided into observation group and control group randomly. Each group contained 3 dogs. Skull segmental defects models were established by surgery, and dogs in bservation group received trifocal distraction osteogenesis treatment. Bone density was observed and compared between two groups during treatment. Results: There were no significant difference in bone density between two groups on th 1st day ( P>0.05). The bone density of observation group on the 30th day, and 60th day were higher than that of control group ( P<0.01). Conclusions: Trifocal distraction osteogenesis has significant clinical effect, and it would be widely used in clinical treatment.展开更多
Post-traumatic osteoarthritis(PTOA)is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 ...Post-traumatic osteoarthritis(PTOA)is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 joints in the foot and the ankle.Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented.The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle,subtalar,first metatarsophalangeal,and second tarsometatarsal joints,and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty.Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle.Additionally,the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint,and can prolong the need for further,more aggressive surgical interventions such as fusion or arthroplasty.展开更多
The objective of the present study was to investigate our novel methods for the repair of massive cartilage defects by joint distraction and motion using an external fixator. In this study, we used a rabbit model of m...The objective of the present study was to investigate our novel methods for the repair of massive cartilage defects by joint distraction and motion using an external fixator. In this study, we used a rabbit model of massive articular cartilage defect in order to evaluate the effectiveness of using joint distraction and motion with a ring-type external fixator. This external fixator has a hinged joint with a center of rotation along the femoral transepicondylar axis, which allows the knee joint to freely flex and extend. Mesenchymal cells from bone marrow, induced by spongialization, were differentiated into mature chondrocytes and formed hyaline-like cartilage as a result of joint distraction and movement. The transplantation of autologous cells expanded from bone-marrow-derived mesenchymal cells, concentrated autologous bone marrow aspirate, and concentrated autologous peripheral blood cells were all effective in promoting cartilage repair. The quality of the cartilage after long-term joint distraction for 6 months was inferior to that after 12 weeks. In general, weight bearing on the regenerated cartilage promoted cartilage repair, although this effect differed based on when gradual weight bearing was begun. Specifically, gradual weight bearing beginning at 9 weeks produced superior results to that beginning at 6 weeks. Our methods provide an optimal environment for cartilage regeneration.展开更多
Background Dental implants have been widely used in the last few decades.However,patients with insufficient bone height need reconstructive surgeries before implant insertion.Distraction implant(Dl)has been invented t...Background Dental implants have been widely used in the last few decades.However,patients with insufficient bone height need reconstructive surgeries before implant insertion.Distraction implant(Dl)has been invented to simplify the treatment procedure,but the shortcomings of Dl have limited its clinical use.We introduced biodegradable polyester to a novel Dl,called biodegradable interference distraction implant(BIDI).The purpose of this study was to assess the radiological,histological,and biomechanical properties of BIDI in animal models.Methods BIDIs were manufactured and inserted into the atrophied mandibles of 6 dogs.展开更多
BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with reg...BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with regard to the technique:How to accurately achieve a safe surgical margin,and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis.Epiphyseal distraction was applied to separate the epiphysis and metaphysis,and this provided a safe surgical margin.The massive bone defect was reconstructed with a custom-made antibioticloaded polymethyl methacrylate(PMMA)construct combined with a free nonvascularized fibular graft.Six months after surgery,bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography(CT)examination.Moreover,considerable callus formation was found around the PMMA construct.After 28 mo of follow-up,there was no sign of recurrence or metastasis.The patient could walk without any aid and carry out her daily life activities satisfactorily.CONCLUSION In cases of osteosarcoma without epiphysis involvement,epiphyseal distraction can be easily applied to obtain a safe margin.Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture,less time-consuming to place,and less likely to get infected,while also ensuring bone union.Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.展开更多
Objective To investigate the histological changes of rapid tooth movement in dogs treated by resistance reduction and distraction osteogenesis,aiming to establish an animal model and further to reveal the remodeling m...Objective To investigate the histological changes of rapid tooth movement in dogs treated by resistance reduction and distraction osteogenesis,aiming to establish an animal model and further to reveal the remodeling mechanism of rapid tooth movement. Methods A total of 8 local hybrid dogs were selected as subjects for this study. The second pre-molar was extracted on both sides. The experimental side underwent alvelor surgery for resistance reduction and a home-made tooth-borne intraoral distraction device was installed for rapid tooth movement,while for the other side (control side) only tooth-borne intraoral distraction device was used for rapid tooth movement. The longest active force-delivery span was 2 weeks,followed by 6-week retention. The distance between the moved tooth and anchor unit was recorded weekly,and radiography was performed for each side before and after distraction. The surrounding tissues including periodontal ligament and alveolar bone were sectioned for histological analysis. Results The average distance of tooth movement was 3.55mm on the experimental side and 1.11mm on the control side. The rate of tooth movement was notably higher (P<0.01) and no significant apical root resorption was detected by X-ray on the experimental side. The active alvelor bone remodeling was found on the tension and pressure sides. However,there was no significant difference between the experimental side and the control side after the retention period. Conclusion The rate of orthodontic tooth movement can be accelerated through resistance reduction and periodontal distraction without any unfavorable effects but at minimal anchorage loss.展开更多
AIM: To investigate the reliability of a modified threedimensional distraction test(3D-DT) and three-dimensional pinch test(3D-PT) for assessing lower eyelid tension(LET).METHODS: A cross-sectional study was conducted...AIM: To investigate the reliability of a modified threedimensional distraction test(3D-DT) and three-dimensional pinch test(3D-PT) for assessing lower eyelid tension(LET).METHODS: A cross-sectional study was conducted among 97 volunteer s including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each par ticipant, including two photographs obtained in a neutral position(NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT.RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively;technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively;and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients(ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1;the ICCs of all the measurements obtained in all the positions(NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80.CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre-and postoperative clinical evaluation.展开更多
BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy ...BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.展开更多
Background: Children who undergo a day case surgery experience high levels of preoperative anxiety. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long term ...Background: Children who undergo a day case surgery experience high levels of preoperative anxiety. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long term postoperative complications. Recently, video distraction intervention has been evaluated for its anxiolytic effects in preoperative children. Aim: The aim of this integrative review was to demonstrate the varying methodological approaches utilized to evaluate the effectiveness of a video distraction intervention in reducing preoperative anxiety in children undergoing day case surgery. Methods: A total of 8 articles, meeting the inclusion criteria, were evaluated and included. Findings: The eight studies investigating the effect of video distraction on children preoperative anxiety concluded that video distraction was significant in controlling children preoperative anxiety. Four of the eight studies (50%), investigated video distraction effectiveness against pharmacological comparisons and demonstrated superior or equal anxiolytic effect of video distraction on different points along the surgical continuum. Three of the eight studies compared video distraction against parental presences and video distraction showed superior anxiolytic effect. Three of the eight studies evaluated the effect of video distraction on anesthesia induction compliance and emergence delirium. A significant effect on anesthesia induction was demonstrated while non-significant effect on emergence delirium was documented. Conclusion: Video distraction is a safe, time and cost effective non pharmacological anxiolytic intervention. It can be provided by nurses to control children high level of anxiety before surgery and during anesthesia induction.展开更多
Facial asymmetry can be acquired or congenital. Patients with facial asymmetry are not always functionally disturbed by the malfunction but are usually very much disturbed by their external appearance. Depending on th...Facial asymmetry can be acquired or congenital. Patients with facial asymmetry are not always functionally disturbed by the malfunction but are usually very much disturbed by their external appearance. Depending on the degree of asymmetry and deformation, the surgical procedure may vary in complexity and extent. The extent of surgery can range from a genioplasty procedure to bimaxillary osteotomy, concomitant with augmentation surgery, genioplasty and craniofacial implants along with mandibular distraction. In severe cases, the soft tissue structures on the affected side may constitute an incredible resistance to stretching and can make the surgery considerably more difficult and liable to relapse. Here we represent a case of post ankylotic facial asymmetry with occlusal cant which was treated by bimaxillary distraction osteogenesis. Simultaneous mandibular and maxillary distraction corrected the facial asymmetry without disturbing the pre-existing compensated dental occlusion, and so there was no need for prolonged and difficult orthodontic treatment.展开更多
With the aim of improving parameter identification and, eventually, evaluating driver distraction with changes in gaze direction, we applied a genetic algorithm (GA) method to identify parameters for an existing vesti...With the aim of improving parameter identification and, eventually, evaluating driver distraction with changes in gaze direction, we applied a genetic algorithm (GA) method to identify parameters for an existing vestibulo-ocular reflex (VOR) model. By changing the initial inputs to the GA and fixing two parameters pertaining to the horizontal direction, we achieved improved parameter identification with a lower mean-square error. The influence of driver distraction on eye movement with changes in gaze direction was evaluated from the difference between the predicted and observed VOR in the vertical axis. When a driver was given an additional mental workload, the mean-square error between the measured and simulated values was bigger than that in the absence of the mental workload. This confirmed the relationship between driver distraction and eye movement in the vertical direction. We hope that this method can be applied in evaluating driver distraction.展开更多
The purpose of this study was to compare the dentoalveolar changes produced when using two different intraoperative surgical procedures for maxillary distraction osteogenesis. Eight patients were assigned into two gro...The purpose of this study was to compare the dentoalveolar changes produced when using two different intraoperative surgical procedures for maxillary distraction osteogenesis. Eight patients were assigned into two groups according to the surgical procedure: down-fracture (DF, n = 6) vs non-down-fracture (NDF, n = 2). Lateral cephalograms and 3-D models before and after maxillary distraction were analyzed. The Mann-Whitney U test was used to compare the differences in the amounts of advancement and dento-alveolar changes between the DF and NDF groups. The significance level was established at 0.05. Although a significantly greater amount of maxillary movement was observed in the DF group (10.0 mm ± 2.2) than in the NDF group (5.9 mm ± 2.3), significantly greater arch length (8.7 mm ± 5.2) and arch width changes (6.0 mm ± 1.0) were observed in the NDF group than in the DF group, (arch lengths 3.0 mm ± 1.1 and arch width changes 3.2 mm ± 2.0). A significantly greater amount of dental anchorage loss was observed in the NDF group. The use of the NDF procedure resulted in greater amounts of dental anchorage loss than resulted from the DF procedures when tooth-borne devices were used during maxillary distraction osteogenesis. The type of surgical procedure might play an important role in the amount and direction of the dental changes.展开更多
Background: Distraction Osteogenesis is popular for long bones. And nowadays it has found its role in facial bone deficiency treatments. Purpose: We used our special designed Distractor for advancement of Maxillary de...Background: Distraction Osteogenesis is popular for long bones. And nowadays it has found its role in facial bone deficiency treatments. Purpose: We used our special designed Distractor for advancement of Maxillary deficiencies in cleft lip and palate patients. The purpose of this paper is to compare the treatment of hypoplastic, posteriorly retruded maxillary of cleft palate patients using distraction osteogenesis vs. Le fort I orthognathic surgery for length of advancement, stability and relapse, growth after distraction and soft tissue expansion and soft tissue profile changes. Meterial & Methods: In group A only Le fort I and surgical maxillary advancement sometimes with bone graft were done. In group B we used our special Distractor for Distraction Osteogenesis and advancement of the Maxillary bone. Demographic data, length of retrusion of maxilla, time length of treatment, length of advancement and relapse, SNA and SNB angles were measured and included in the study. The results were compared in each group before and after advancement and between both groups. The rate of distraction was 0.5 mm twice per day to achieve normal occlusion with 2 mm overcorrection more than calculated measures. The devices removed after 10 weeks as latency period. Results: The SNA increased at the end of distraction (p < 0.001), with no significant relapse indicating stability at 1 year after treatment. The total length of advancement in group A was 17 ± 4 mm and in group B was 20 ± 3 mm. The difference between before and after measurements in each group was significant (p = 0.002, p = 0.003 respectively). The mean length of relapse in group A was 3 ± 1 mm and in group B was 1 mm. Discussion: For the deformities and retrusions less than 7 - 8 mm, the Orthognatic surgery is the treatment of choice, however for more retrusions (>10 mm) we recommend Distraction Osteogenesis, and it preferred to start it soon in younger ages.展开更多
Purpose: To measure the upper airway changes associated with maxillary distraction osteogenesis in cleft lip and palate patients in the immediate post operative period and 12 months later. Materials and Methods: Seven...Purpose: To measure the upper airway changes associated with maxillary distraction osteogenesis in cleft lip and palate patients in the immediate post operative period and 12 months later. Materials and Methods: Seven patients with repaired cleft lip and palate (CLP) presented with severe maxillary hypoplasia. They were examined initially at T1 predistraction phase. Records taken included radiographs (orthopantograms OPG, lateral cephalometric, posteroanterior). Cephalometric analysis was done to evaluate the upper airway. Mean age is 17 years and the reverse overjet > 6 mm. They underwent maxillary Le Fort I distraction using external rigid distracters (RED). Cephalometric analysis to evaluate the upper airway was repeated at the end of the consolidation phase T2 and twelve months after distractor removal T3. Results: The range of maxillary advancement was between 8 - 15 mm (mean 9 mm). The anteroposterior distance of the superior velopharynx (PPS) and middle velopharynx (SPPS) increased at T2. A small amount of reduction in these values was recorded at T3. The inferior velopharynx (MPS) and the oropharynx (IPS, EPS) showed minimum increase in anteroposterior distance in only two patients at T2 and no change at T3. Conclusion: All seven patients showed clinical improvement in the upper airway and an increase in the upper airway values on lateral cephalometric radiographs.展开更多
Objective To study the ultrastructure and Ca/P clement spectrometry of distraction osteogenesis(DO) for reconstruction of cleft palate(CP),so as to explore the osteogenesis and remodeling of new bone in situ.Methods 2...Objective To study the ultrastructure and Ca/P clement spectrometry of distraction osteogenesis(DO) for reconstruction of cleft palate(CP),so as to explore the osteogenesis and remodeling of new bone in situ.Methods 23 rhesus macaques展开更多
Objective To study three - dimensional finite element analysis for external midface distraction after different osteotomy in patients with cleft lip and palate ( Clp) . Methods Three - dimensional Fem models of Le Fo...Objective To study three - dimensional finite element analysis for external midface distraction after different osteotomy in patients with cleft lip and palate ( Clp) . Methods Three - dimensional Fem models of Le Fort Ⅰ,Ⅱand Ⅲ,osteotomy in Clp patients were estabolished. External midface distraction were simulated. An anteriorly and inferiorly directed 900 g force was展开更多
基金supported by the National Natural Science Foundation of China,No.81772421(to YH).
文摘Distraction spinal cord injury is caused by some degree of distraction or longitudinal tension on the spinal cord and commonly occurs in patients who undergo corrective operation for severe spinal deformity.With the increased degree and duration of distraction,spinal cord injuries become more serious in terms of their neurophysiology,histology,and behavior.Very few studies have been published on the specific characteristics of distraction spinal cord injury.In this study,we systematically review 22 related studies involving animal models of distraction spinal cord injury,focusing particularly on the neurophysiological,histological,and behavioral characteristics of this disease.In addition,we summarize the mechanisms underlying primary and secondary injuries caused by distraction spinal cord injury and clarify the effects of different degrees and durations of distraction on the primary injuries associated with spinal cord injury.We provide new concepts for the establishment of a model of distraction spinal cord injury and related basic research,and provide reference guidelines for the clinical diagnosis and treatment of this disease.
文摘Limited research has explored roadside advertisements’ effects on road user behavior in Middle Eastern countries. This study aims to understand distraction perceptions, including advertisements, their impact on behavior, and potential influences from advertisement type, in-vehicle distraction, and country factors (reflecting culture and environment). A standardized questionnaire was administered in Jordan and Kuwait, complemented by observations across three segment types: roadside advertisements, commercial signs, and road signs as control segments. Descriptive and inferential statistics were used. Results indicated a significant disparity in distraction perception between the two groups. Advertisement presence influenced Kuwaiti but not Jordanian behavior. Behavior varied by advertisement type in Jordan, not Kuwait, and in-vehicle distraction did not impact driver behavior. The study suggests explicitly revising advertising policies with a traffic safety focus. Overall, the study contributes insights into road user perceptions and behaviors, highlighting the complex interplay of distractions and advertising on road safety. Further research is required to validate these findings and shape road safety regulations.
文摘Objective: skeletal advancement in order to improve the airway dimensions is known as one of the most effective surgical theraphy for treating obstructive sleep apnea (OSA). Distraction osteogenesis (DO) can be a better treatment alternative in some selected cases similar to our patient. Using custom made distractors can make this technique more safe and successful. Study Design: Surgically assisted rapid palatal expansion (SARPE), bilateral intraoral mandibular distraction osteogenesis (MDO) and orthodontic treatment were tried to a 20-year-old OSA patient with orthognathic anomaly. For mandibular distraction, custom made distractors were used. Results: The initial AHI of the patient was 23.3. At the end of the treatment it decreased to 8.7. Conclusions: Distraction osteogenesis could be a better alternative than the conventional orthognathic surgery in this kind of selected patients. Customization of the distraction devices can contribute to making this procedure safer and more successful.
文摘Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.
基金supported by Shanghai Municipal Science and Technology Commission, International Cooperation Projects (No. 10410702100)
文摘Objective: To apply trifocal distraction osteogenesis in canine model of skull segmental defects and to provide reference for clinical treatment. Methods: Six labrador dogs were selected in this study and divided into observation group and control group randomly. Each group contained 3 dogs. Skull segmental defects models were established by surgery, and dogs in bservation group received trifocal distraction osteogenesis treatment. Bone density was observed and compared between two groups during treatment. Results: There were no significant difference in bone density between two groups on th 1st day ( P>0.05). The bone density of observation group on the 30th day, and 60th day were higher than that of control group ( P<0.01). Conclusions: Trifocal distraction osteogenesis has significant clinical effect, and it would be widely used in clinical treatment.
文摘Post-traumatic osteoarthritis(PTOA)is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 joints in the foot and the ankle.Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented.The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle,subtalar,first metatarsophalangeal,and second tarsometatarsal joints,and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty.Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle.Additionally,the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint,and can prolong the need for further,more aggressive surgical interventions such as fusion or arthroplasty.
文摘The objective of the present study was to investigate our novel methods for the repair of massive cartilage defects by joint distraction and motion using an external fixator. In this study, we used a rabbit model of massive articular cartilage defect in order to evaluate the effectiveness of using joint distraction and motion with a ring-type external fixator. This external fixator has a hinged joint with a center of rotation along the femoral transepicondylar axis, which allows the knee joint to freely flex and extend. Mesenchymal cells from bone marrow, induced by spongialization, were differentiated into mature chondrocytes and formed hyaline-like cartilage as a result of joint distraction and movement. The transplantation of autologous cells expanded from bone-marrow-derived mesenchymal cells, concentrated autologous bone marrow aspirate, and concentrated autologous peripheral blood cells were all effective in promoting cartilage repair. The quality of the cartilage after long-term joint distraction for 6 months was inferior to that after 12 weeks. In general, weight bearing on the regenerated cartilage promoted cartilage repair, although this effect differed based on when gradual weight bearing was begun. Specifically, gradual weight bearing beginning at 9 weeks produced superior results to that beginning at 6 weeks. Our methods provide an optimal environment for cartilage regeneration.
基金supported by the National Natural Science Foundation of China(No. 30900284,No.31100668,and No.31070873)
文摘Background Dental implants have been widely used in the last few decades.However,patients with insufficient bone height need reconstructive surgeries before implant insertion.Distraction implant(Dl)has been invented to simplify the treatment procedure,but the shortcomings of Dl have limited its clinical use.We introduced biodegradable polyester to a novel Dl,called biodegradable interference distraction implant(BIDI).The purpose of this study was to assess the radiological,histological,and biomechanical properties of BIDI in animal models.Methods BIDIs were manufactured and inserted into the atrophied mandibles of 6 dogs.
基金Supported by National Natural Science Foundation of China,No.81301671
文摘BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with regard to the technique:How to accurately achieve a safe surgical margin,and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis.Epiphyseal distraction was applied to separate the epiphysis and metaphysis,and this provided a safe surgical margin.The massive bone defect was reconstructed with a custom-made antibioticloaded polymethyl methacrylate(PMMA)construct combined with a free nonvascularized fibular graft.Six months after surgery,bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography(CT)examination.Moreover,considerable callus formation was found around the PMMA construct.After 28 mo of follow-up,there was no sign of recurrence or metastasis.The patient could walk without any aid and carry out her daily life activities satisfactorily.CONCLUSION In cases of osteosarcoma without epiphysis involvement,epiphyseal distraction can be easily applied to obtain a safe margin.Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture,less time-consuming to place,and less likely to get infected,while also ensuring bone union.Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.
基金supported by the Traditional Chinese Medicine Research Fund of the Administration of Traditional ChineseMedicine of Shaanxi Province (jc34)
文摘Objective To investigate the histological changes of rapid tooth movement in dogs treated by resistance reduction and distraction osteogenesis,aiming to establish an animal model and further to reveal the remodeling mechanism of rapid tooth movement. Methods A total of 8 local hybrid dogs were selected as subjects for this study. The second pre-molar was extracted on both sides. The experimental side underwent alvelor surgery for resistance reduction and a home-made tooth-borne intraoral distraction device was installed for rapid tooth movement,while for the other side (control side) only tooth-borne intraoral distraction device was used for rapid tooth movement. The longest active force-delivery span was 2 weeks,followed by 6-week retention. The distance between the moved tooth and anchor unit was recorded weekly,and radiography was performed for each side before and after distraction. The surrounding tissues including periodontal ligament and alveolar bone were sectioned for histological analysis. Results The average distance of tooth movement was 3.55mm on the experimental side and 1.11mm on the control side. The rate of tooth movement was notably higher (P<0.01) and no significant apical root resorption was detected by X-ray on the experimental side. The active alvelor bone remodeling was found on the tension and pressure sides. However,there was no significant difference between the experimental side and the control side after the retention period. Conclusion The rate of orthodontic tooth movement can be accelerated through resistance reduction and periodontal distraction without any unfavorable effects but at minimal anchorage loss.
基金Supported by the Project of National Key Research and Development (No.2018YFC1106103)Chongqing Science and Health Joint Medical Research Project-Youth Project (No.2022QNXM016)The Fundamental Research Funds for the Central Universities (No.2021FZZX005-15)。
文摘AIM: To investigate the reliability of a modified threedimensional distraction test(3D-DT) and three-dimensional pinch test(3D-PT) for assessing lower eyelid tension(LET).METHODS: A cross-sectional study was conducted among 97 volunteer s including 97 eyelids with no history of trauma, tumor, or reconstructive surgeries. Six three-dimensional photographs were acquired for each par ticipant, including two photographs obtained in a neutral position(NP), two using a modified 3D-DT with a 15.9-grammes stainless steel eyelid hook performed, and two using 3D-PT.RESULTS: The mean absolute differences between NP, 3D-DT, and 3D-PT measurements varied between 0.07 and 7.42, 0.10 and 13.10, and 0.07 and 15.97, respectively;technical error of measurement varied between 0.05 and 7.81, 0.09 and 10.19, and 0.07 and 12.47, respectively;and relative error measurements varied between 0.10% and 11.50%, 0.16% and 30.51%, and 0.11% and 38.75%, respectively. For intra-rater reliability, the intraclass correlation coefficients(ICCs) were more than 0.80 in seven out of eight measurements obtained in the NP and 3D-DT, whereas those obtained in the 3D-PT were as low as less than 0.30 by rater 1;the ICCs of all the measurements obtained in all the positions(NP, 3D-DT, and 3D-PT) were more than 0.80 by rater 2. For inter-rater reliability six out of eight NP and 3D-DT measurements had an ICC greater than 0.80, whereas those of 3D-PT measurements were less than 0.30. For intra-method reliability, the ICCs of all the NP measurements were more than 0.87, whereas those of the six 3D-DT measurements and four 3D-PT measurements were more than 0.80.CONCLUSION: Our study results prove that the modified 3D-DT, which involves the use of an eyelid hook, can be a highly reliable method for evaluating LET. Furthermore, this novel and simple method may be utilized as the basis for further investigation and routine pre-and postoperative clinical evaluation.
文摘BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.
文摘Background: Children who undergo a day case surgery experience high levels of preoperative anxiety. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long term postoperative complications. Recently, video distraction intervention has been evaluated for its anxiolytic effects in preoperative children. Aim: The aim of this integrative review was to demonstrate the varying methodological approaches utilized to evaluate the effectiveness of a video distraction intervention in reducing preoperative anxiety in children undergoing day case surgery. Methods: A total of 8 articles, meeting the inclusion criteria, were evaluated and included. Findings: The eight studies investigating the effect of video distraction on children preoperative anxiety concluded that video distraction was significant in controlling children preoperative anxiety. Four of the eight studies (50%), investigated video distraction effectiveness against pharmacological comparisons and demonstrated superior or equal anxiolytic effect of video distraction on different points along the surgical continuum. Three of the eight studies compared video distraction against parental presences and video distraction showed superior anxiolytic effect. Three of the eight studies evaluated the effect of video distraction on anesthesia induction compliance and emergence delirium. A significant effect on anesthesia induction was demonstrated while non-significant effect on emergence delirium was documented. Conclusion: Video distraction is a safe, time and cost effective non pharmacological anxiolytic intervention. It can be provided by nurses to control children high level of anxiety before surgery and during anesthesia induction.
文摘Facial asymmetry can be acquired or congenital. Patients with facial asymmetry are not always functionally disturbed by the malfunction but are usually very much disturbed by their external appearance. Depending on the degree of asymmetry and deformation, the surgical procedure may vary in complexity and extent. The extent of surgery can range from a genioplasty procedure to bimaxillary osteotomy, concomitant with augmentation surgery, genioplasty and craniofacial implants along with mandibular distraction. In severe cases, the soft tissue structures on the affected side may constitute an incredible resistance to stretching and can make the surgery considerably more difficult and liable to relapse. Here we represent a case of post ankylotic facial asymmetry with occlusal cant which was treated by bimaxillary distraction osteogenesis. Simultaneous mandibular and maxillary distraction corrected the facial asymmetry without disturbing the pre-existing compensated dental occlusion, and so there was no need for prolonged and difficult orthodontic treatment.
文摘With the aim of improving parameter identification and, eventually, evaluating driver distraction with changes in gaze direction, we applied a genetic algorithm (GA) method to identify parameters for an existing vestibulo-ocular reflex (VOR) model. By changing the initial inputs to the GA and fixing two parameters pertaining to the horizontal direction, we achieved improved parameter identification with a lower mean-square error. The influence of driver distraction on eye movement with changes in gaze direction was evaluated from the difference between the predicted and observed VOR in the vertical axis. When a driver was given an additional mental workload, the mean-square error between the measured and simulated values was bigger than that in the absence of the mental workload. This confirmed the relationship between driver distraction and eye movement in the vertical direction. We hope that this method can be applied in evaluating driver distraction.
文摘The purpose of this study was to compare the dentoalveolar changes produced when using two different intraoperative surgical procedures for maxillary distraction osteogenesis. Eight patients were assigned into two groups according to the surgical procedure: down-fracture (DF, n = 6) vs non-down-fracture (NDF, n = 2). Lateral cephalograms and 3-D models before and after maxillary distraction were analyzed. The Mann-Whitney U test was used to compare the differences in the amounts of advancement and dento-alveolar changes between the DF and NDF groups. The significance level was established at 0.05. Although a significantly greater amount of maxillary movement was observed in the DF group (10.0 mm ± 2.2) than in the NDF group (5.9 mm ± 2.3), significantly greater arch length (8.7 mm ± 5.2) and arch width changes (6.0 mm ± 1.0) were observed in the NDF group than in the DF group, (arch lengths 3.0 mm ± 1.1 and arch width changes 3.2 mm ± 2.0). A significantly greater amount of dental anchorage loss was observed in the NDF group. The use of the NDF procedure resulted in greater amounts of dental anchorage loss than resulted from the DF procedures when tooth-borne devices were used during maxillary distraction osteogenesis. The type of surgical procedure might play an important role in the amount and direction of the dental changes.
文摘Background: Distraction Osteogenesis is popular for long bones. And nowadays it has found its role in facial bone deficiency treatments. Purpose: We used our special designed Distractor for advancement of Maxillary deficiencies in cleft lip and palate patients. The purpose of this paper is to compare the treatment of hypoplastic, posteriorly retruded maxillary of cleft palate patients using distraction osteogenesis vs. Le fort I orthognathic surgery for length of advancement, stability and relapse, growth after distraction and soft tissue expansion and soft tissue profile changes. Meterial & Methods: In group A only Le fort I and surgical maxillary advancement sometimes with bone graft were done. In group B we used our special Distractor for Distraction Osteogenesis and advancement of the Maxillary bone. Demographic data, length of retrusion of maxilla, time length of treatment, length of advancement and relapse, SNA and SNB angles were measured and included in the study. The results were compared in each group before and after advancement and between both groups. The rate of distraction was 0.5 mm twice per day to achieve normal occlusion with 2 mm overcorrection more than calculated measures. The devices removed after 10 weeks as latency period. Results: The SNA increased at the end of distraction (p < 0.001), with no significant relapse indicating stability at 1 year after treatment. The total length of advancement in group A was 17 ± 4 mm and in group B was 20 ± 3 mm. The difference between before and after measurements in each group was significant (p = 0.002, p = 0.003 respectively). The mean length of relapse in group A was 3 ± 1 mm and in group B was 1 mm. Discussion: For the deformities and retrusions less than 7 - 8 mm, the Orthognatic surgery is the treatment of choice, however for more retrusions (>10 mm) we recommend Distraction Osteogenesis, and it preferred to start it soon in younger ages.
文摘Purpose: To measure the upper airway changes associated with maxillary distraction osteogenesis in cleft lip and palate patients in the immediate post operative period and 12 months later. Materials and Methods: Seven patients with repaired cleft lip and palate (CLP) presented with severe maxillary hypoplasia. They were examined initially at T1 predistraction phase. Records taken included radiographs (orthopantograms OPG, lateral cephalometric, posteroanterior). Cephalometric analysis was done to evaluate the upper airway. Mean age is 17 years and the reverse overjet > 6 mm. They underwent maxillary Le Fort I distraction using external rigid distracters (RED). Cephalometric analysis to evaluate the upper airway was repeated at the end of the consolidation phase T2 and twelve months after distractor removal T3. Results: The range of maxillary advancement was between 8 - 15 mm (mean 9 mm). The anteroposterior distance of the superior velopharynx (PPS) and middle velopharynx (SPPS) increased at T2. A small amount of reduction in these values was recorded at T3. The inferior velopharynx (MPS) and the oropharynx (IPS, EPS) showed minimum increase in anteroposterior distance in only two patients at T2 and no change at T3. Conclusion: All seven patients showed clinical improvement in the upper airway and an increase in the upper airway values on lateral cephalometric radiographs.
文摘Objective To study the ultrastructure and Ca/P clement spectrometry of distraction osteogenesis(DO) for reconstruction of cleft palate(CP),so as to explore the osteogenesis and remodeling of new bone in situ.Methods 23 rhesus macaques
文摘Objective To study three - dimensional finite element analysis for external midface distraction after different osteotomy in patients with cleft lip and palate ( Clp) . Methods Three - dimensional Fem models of Le Fort Ⅰ,Ⅱand Ⅲ,osteotomy in Clp patients were estabolished. External midface distraction were simulated. An anteriorly and inferiorly directed 900 g force was
