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To investigate the efficacy of all-arthroscopic glenoid bone augmentation surgery using the iliac crest autograft procedure. Furthermore, we sought to compare the clinical and radiographic outcomes of using screw versus button fixation, in patients with recurrent anterior shoulder instability. Between 2015 and 2019, 134 shoulders with persistent instability were surgically treated with an arthroscopically placed autologous iliac crest bone graft transfer procedure. Preoperative and postoperative clinical follow-up data were evaluated using the range of motion, and the Walch–Duplay, American Shoulder and Elbow Society, and Rowe scores. Radiologic assessment on 3-dimensional computed tomography scans was performed preoperatively, immediately after surgery, as well as postoperatively, at 3 months, 6 months, 1 year, and at the final follow-up stage. Graft positions, healing, and resorption were evaluated from postoperative images. This study included 102 patients who underwent arthroscopic iliac crest bone grafting procedure with 2 screws fixation (n = 37; group 1) and 2 button fixation (n = 65; group 2). The mean follow-up period was 37 months. There were no significant differences between groups in terms of clinical scores, shoulder motion range, graft healing, or graft positions on computed tomography scans (P >.05). In group 1, 1 patient showed mechanical irritation and persistent pain around the screw insertion site, being treated through the arthroscopic removal of the screws. The average postoperative bony resorption percentages were 20.3% and 11.2% at 6 months, and 32.4% and 19.3% at 12 months, in group 1 and group 2, respectively. A statistically significant difference was detected between the two groups (P <.05). In the arthroscopic iliac crest bone grafting procedure for the treatment of chronic osseous anterior shoulder instability, excellent functional results were obtained after both button fixation and screw fixation techniques. In addition, less graft resorption and no hardware-related complications were detected with suture button fixation technique. Level III, retrospective comparative therapeutic trial. [ABSTRACT FROM AUTHOR]

Background: Normal skin flora and suboptimal skin antisepsis are the primary drivers of healthcare-associated infections (HAIs). Antimicrobial persistence of preoperative skin preparation is necessary to limit microorganisms on the skin and help minimize their entry into an incision or device-insertion site after application.Aim: To assess the antimicrobial persistence of two preoperative skin preparation solutions.Methods: A randomized, single-centre, partially blinded, clinical study was conducted in 103 healthy volunteers to evaluate the persistent antimicrobial properties of BD ChloraPrep™ (2% w/v chlorhexidine gluconate [CHG] + 70% v/v isopropyl alcohol [IPA]) and BD PurPrep™ (8.3% w/w povidone-iodine [PVPI] + 72.5% w/w IPA) skin preparations out to 7 days and 96 h, respectively, on abdomen and groin testing sites. An additional 32 healthy volunteers participated in a neutralization procedure to ensure that the study recovery solution was non-toxic to microorganisms, and a spore-recovery procedure to demonstrate that microorganisms could be successfully recovered from the PVP-I+IPA film-forming product.Findings: Both CHG+IPA and PVP-I+IPA produced a mean bacterial log10 reduction >2 and >3 on the abdomen and groin, respectively, 10 min after application. CHG+IPA maintained antimicrobial persistence out to 7 days post application, whereas PVP-I+IPA maintained antimicrobial persistence out to 96 h post application, the longest time-point selected for this product.Conclusion: CHG+IPA and PVP-I+IPA were both found to be effective, persistent antiseptic skin preparations. Overall, skin irritation was uncommon, and only one adverse event occurred following product application, which was not considered product-related but was considered procedure-related. [ABSTRACT FROM AUTHOR]

• Analysis of antiseptic solutions using in vitro and in vivo studies • Evaluation of antimicrobial activity, clinical efficacy, and adhesive strength • PVP-I+IPA and Iodine Povacrylex+IPA are both effective skin preparation solutions Healthcare-associated infections (HAIs) are a persistent clinical challenge caused primarily by bacteria on the skin. Proper utilization of optimized antiseptic skin preparation solutions helps reduce the prevalence and impact of HAIs by decreasing patient skin microorganisms preoperatively. The purpose of this study was to evaluate the efficacy of 2 antimicrobial solutions containing iodine and isopropyl alcohol (IPA): Povidone iodine (PVP-I) with IPA (ie, PVP-I+IPA, PurPrep) and Iodine Povacrylex+IPA (DuraPrep). The antimicrobial activity of the test solutions was evaluated in vitro by determinations of minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) against 1105 diverse microbial isolates and a time-kill assay to evaluate efficacy against 120 strains of Gram-positive and Gram-negative bacteria and yeasts. Peel tests were performed between skin samples treated with test solutions and representative drape/dressing materials to determine effects of test solutions on the biomechanical adhesion properties. Finally, an Institutional Review Board (IRB)-approved, randomized, controlled, single-center, partially blinded in vivo study was performed to assess the immediate and persistent antimicrobial activity of the test solutions on the abdomen and groin. Both PVP-I+IPA and Iodine Povacrylex+IPA solutions demonstrated broad-spectrum antimicrobial activity with MIC and MBC at less than 1% of the full-strength concentration of each product against a wide variety of microorganisms. In the time-kill tests, both solutions were able to successfully reduce all microbial populations by 99.99% (ie, 4 log 10) at the contact times of 30 seconds, 2 minutes and 10 minutes. The 2 solutions showed relatively similar adhesion results when tested with 3 representative operating room materials. Both PVP-I+IPA and Iodine Povacrylex+IPA met the expected Food and Drug Administration (FDA) efficacy requirements at 10 minutes and 6 hours post-treatment for both anatomic sites (ie, groin, and abdomen) in the clinical study, with no safety issues or adverse events. Analysis of the in vitro antimicrobial activity, biomechanical adhesive strength, and in vivo efficacy of PVP-I+IPA demonstrated similar results compared to Iodine Povacrylex+IPA. Both products were efficacious at reducing or eliminating a wide range of clinically-relevant microorganisms in lab-based and clinical settings, supporting their use as antiseptic skin preparation solutions to reduce bacteria on the skin that can cause infection. [ABSTRACT FROM AUTHOR]

• IL-1beta, IL-2, IL-5, CD40L and HGF were elevated simultaneously in both AIS and hemorrhagic stroke patients. • IL-2R, IL-10, IL-16, MIP-3alpha and MMP-1 were differentially expressed in AIS patients compared to control group. • IL-6, IL-7, IL-20, IL-21, BAFF, BLC, IFN-alpha, MIP-1alpha and TRAIL were uniquely varied in hemorrhagic stroke patients compared to control group. • IL-6 and TNF-beta were found to be key cytokines among the 65 inflammatory factors to distinguish cerebral hemorrhage from cerebral ischemia. Sufficient understanding of the systemic inflammatory response after stroke will make the therapeutic strategy targeting inflammation more feasible. Here, we aimed to identify the globally alterations of circulating cytokines in super-acute ischemic stroke (AIS). A broad panel of 65 cytokines was measured in the plasma of twenty-eight AIS patients within 6 h after stroke onset (n = 28), cerebral hemorrhagic patients (n = 28) and healthy controls (n = 18). The diagnostic power of the candidate cytokines and their relationship with the number of lymphocytes and neutrophils were analyzed by receiver operating characteristic (ROC) and spearman rank correlation respectively. The expression level of plasma IL-1beta, IL-2, IL-2R, IL-5, IL-10, CD40L, HGF, MIP-3alpha and MMP-1 were obviously up-regulated, while IL-16 was down-regulated in AIS patients compared to healthy controls. Among them, IL-2R, IL-10, IL-16, MIP-3alpha, and MMP-1 were specially altered in AIS patients, while IL-1beta, IL-2, IL-5, CD40L and HGF were elevated simultaneously in AIS and hemorrhagic stroke patients. Interestingly, IL-6 and TNF-beta were found to be key facytors among the 65 cytokines to distinguish hemorrhage from ischemia. Furthermore, IL-1beta, IL-16, CD40L and HGF were obviously correlated with the number of lymphocytes, and IL-1beta and IL-16 were significantly associated with the number of neutrophils in AIS patients. These results suggest that lymphocytes and neutrophils associated inflammation may play a pivotal role in AIS. Importantly, except for some mutual pathological processes, AIS and hemorrhage had their own distinctive pathogenesis, and transformation of this knowledge to further research may provide novel treatment strategy for AIS. [ABSTRACT FROM AUTHOR]

• CLA, IPCC inventory, and Input-Output Model account for CCEs from older population. • Dynamic trend of CCEs of the elderly per person in China is analyzed. • Random effects model is integrated to regression to explore influencing factors. • Mitigation strategies related to elderly CCEs are proposed for different actors. Climate change and population aging are inevitably the two most significant global challenges. Senior population growth in China is accompanied by an increase in consumption-induced carbon emissions (CCEs). The study's contribution of a deeper understanding of the intertemporal relationship between senior characteristics and multi-category CCEs provides the theoretical foundation for the formulation of mitigation strategies. This study utilizes panel data obtained from the China Health and Retirement Longitudinal Study (CHARLS) surveys in 2013, 2015, and 2018 to compute the per capita CCEs for elderly adults across eight major consumption categories. It also exposes the dynamic influences of individual characteristics on CCEs by estimating the mixed effects model. Based on the findings, accommodation, transportation and communication, and food comprise the top three categories of CCEs. Furthermore, seniors' consumption preferences have gradually drifted from basic necessities to pleasurable experiences and healthcare services. Notably, seniors' characteristics (e.g., income, health, education, marital status, residential type, and the degree of urbanization) exert distinctively dynamic impacts on each type of CCEs over time. In pursuit of a greener aging society, this study proposes various implementation strategies for mitigating CCEs among different actors (the government, community, manufacturers, and older individuals) in light of the captured intricate mechanism. [ABSTRACT FROM AUTHOR]

[Display omitted] • New degraded products of limonoid were isolated from the root bark of Dictamnus dasycarpus. • The A/B ring degraded biogenetic pathway of limonoid was firstly hypothesized. • Broadened NMR spectra and self-aggregation of hydroxyl acids were studied. • Compounds 1 – 3 significantly inhibited OA-induced lipid accumulation in HepG2 cells. Five degraded products of limonoid, including two previously undescribed compounds (1 , 3) and one pair of new natural products (4i , 4ii), were isolated from the root bark of Dictamnus dasycarpus Turcz. Their structures were elucidated by extensively spectroscopic methods (NMR, MS, ECD, etc), as well as quantum chemical calculations. The broadening NMR lines, along with the relaxation time and DOSY experiment revealed the self-aggregation of 1 in chloroform through H-bond between –COO H and – O H, which provided additional evidence to distinguish acid and ester/lactone in structure elucidation. Compounds 1 – 3 attenuated oleic acid-induced lipid accumulation in HepG2 cells significantly, with inhibition rates of 19.8%, 23.6%, and 13.5% at 10 μM, much stronger than fenofibrate, affording a novel scaffold for drug discovery against fatty liver disease. [ABSTRACT FROM AUTHOR]

Air balancing is a key technology for improving indoor environmental quality and reducing ventilation system energy consumption. Existing air balancing methods just considered damper angles and fan control voltages, combined as single constraint strategy to balance air. Fan power, as the direct parameter affecting system electricity consumption, has not been included in air balancing modelling. On the other hand, single constraint strategy makes current methods inflexible to maintain airflow accuracy and energy efficiency together. This paper proposes a novel air balancing energy-saving model with multiple constraint control strategy. Damper angle, fan control voltage, and fan power are combined by an improved perceptron model. It is aimed at minimizing ventilation system energy consumption, by achieving optimal airflow accuracy and energy conservation. The proposed improved perceptron under multiple constraints (IPMC) method is validated on the experimental system with 5 terminals, air balancing relative errors within 6.0 %. Compared with the current high-precision and energy-saving methods in references, IPMC reduces energy consumption by 12.0 % and 7.6 %, respectively, with improved airflow prediction accuracy. The proposed air balancing method has three innovation: 1) Constrained by the fan power, the IPMC method improves ventilation energy efficiency; 2) Independent and flexible constraints enable more accurate airflow control; 3) Integrated by an improved perceptron, multiple constraints consider airflow prediction accuracy and energy conservation at the same time. This method is expected to better satisfy airflow demand and reduce effectively energy consumption of ventilation system, thus improving building ventilation energy utilization efficiency without losing thermal comfort and indoor air quality. • The novel method considers airflow accuracy and energy conservation at the same time. • Fan power, damper angle and fan voltage are combined as multiple constraints. • Flexible multiple parameter adjustment is achieved by an improved perceptron. • The energy consumption is reduced by 12.0 % compared with the typical reference. [ABSTRACT FROM AUTHOR]

DNA methylation of promoter regions is often associated with epigenetic silencing of gene expression, and DNA methyltransferase (DNMTs) has been used to suppress gene expression. In order to explore the synergistic roles of two methyltransferase members Dnmt3a and Dnmt1, we constructed expression plasmid that could express a recombinant DNMTs consisting of the C‐terminal domains of both Dnmt3a and Dnmt1 fused to a zinc finger domain which binds to the PD‐L1 promoter of human prostate cancer cells (DU145). Programmed death ligand 1 (PD‐L1, B7‐H1, CD‐274) is a transmembrane protein widely expressed on antigen‐presenting and other immune cells. The interaction of PD‐L1 with its receptor PD‐1 is considered an 'immune checkpoint' for possible cancer therapy. DU145 cells treated with the Dnmt3aC‐1C plasmid showed significantly reduced expression of PD‐L1 as compared to Dnmt3aC or Dnmt1C alone. Our results show that the fusion of Dnmt1 improves the methylation activity of Dnmt3a and enhances its biological functions. This combinatorial strategy can be used to better control PD‐L1 expression to support cytotoxic T lymphocytes (CTL) response against tumors. [ABSTRACT FROM AUTHOR]

Background: Increasing studies have shown that the use of laryngeal mask airways (LMAs) improved the perioperative respiratory adverse events (PRAEs) in children. However, the results of some of these studies still remained controversial as their sample sizes were small. A systematic review and meta-analysis was designed to evaluate the impact of LMAs in decreasing PRAEs in children.Methods: We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to May 29, 2018 to identify relevant randomized controlled trials (RCTs) which analyzed and evaluated the impact of LMAs in decreasing PRAEs in children. Participants were randomly assigned to receive LMAs (the intervention group) or other airways (the control group). We studied PRAEs which included breath apnea, laryngospasm, desaturation, cough, fever, pulmonary rales and pulmonary infection. Risk ratio (RR) with 95% confidence intervals (CIs) were estimated to compare the outcomes of the groups. We also performed subgroup analysis and sensitivity analysis to evaluate the impact of LMAs on further decreasing PRAEs. Two reviewers assessed the trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in the Review Manager 5.2.Results: Twelve RCTs (N = 1577 participants) were identified. Comparing with other airways, significant reduction were found in the overall PRAEs (RR 0.52, 95% CI 0.39-0.70; P < 0.0001), major PRAEs (RR 0.47, 95% CI 0.29-0.79; P = 0.004) as well as minor PRAEs (RR 0.57, 95% CI 0.45-0.74; P < 0.0001) in patients managed with LMAs. When compared with endotracheal tubes (ETTs), LMAs also significantly reduced PRAEs. Further analysis also found that LMAs reduced the incidences of postoperative cough (RR 0.44, 95% CI 0.31-0.63; P < 0.00001), pulmonary rales (RR 0.62, 95% CI 0.44-0.87; P = 0.006) and infections (RR 0.28, 95% CI 0.13-0.61; P = 0.001) in children.Conclusions: LMAs reduced the incidences of many PRAEs in children and should be used as one of anaesthesia methods for children. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to characterize subchondral bone remodeling by using magnetic resonance imaging (MRI) and histopathologic assessment of temporomandibular joint osteoarthritis (TMJOA) and to analyze the correlations between them.Study Design: The retrospective study was based on 153 joints of 100 patients. These patients had undergone MRI and had been diagnosed with temporomandibular joint internal derangement Wilkes stage IV-V, followed by the failure of conservative or arthroscopic/anchorage treatment. We evaluated and compared 136 joints based on MRI and histopathologic observation. According to the modified Osteoarthritis Research Society International system and the Diagnostic Criteria for Temporomandibular Disorders system, the scores of histopathology and MRI were compared by using kappa categorical agreement analysis.Results: MRI showed subchondral bone changes in 153 joints, 136 of which had been subjected to surgical treatment and histopathologic assessment. Statistical tests revealed substantial agreement between MRI and histopathology (κ value: 0.779).Conclusions: MRI is an effective technique to evaluate the pathologic changes of TMJOA. Our histopathologic grading criteria contributed to the clarification of the occurrence and developmental process of TMJOA. Therefore, the evidence of MRI should be seen as a reference standard for the choice of nonsurgical or surgical therapy in the management of TMJOA. [ABSTRACT FROM AUTHOR]

Cyanobacteria blooms caused by water eutrophication are an urgent problem worldwide, and the frequency and scale of blooms with filamentous cyanobacteria are increasing continuously as the intensification of global warming. Plant secondary metabolite p -coumaric acid (p -CA) has biological properties such as scavenging free radicals, anti-inflammation, anti-tumor, and antibacterial, and have allelopathic effects on terrestrial plants, but its allelopathy on algae is less studied. In this study, the low concentration of p -CA (113 mg/L) can promote the growth of Limnothrix sp., while the high concentration (>127 mg/L) can significantly inhibit algae growth in a dose-dependent manner, reaching 99.55 % inhibition rate at the concentration of 153 mg/L. About 150 mg/L p -CA led to the destruction of algae cell structure, leakage of intracellular material, reduced photosynthetic pigments and protein content, inhibited photosynthesis, and stressed antioxidant system. Untargeted metabolomic analysis showed that 189 metabolites of Limnothrix sp. were significantly differentially expressed under the treatment of p -CA, and the metabolic pathways related to antioxidant stress and cell membranes were disrupted. In general, the above results indicate that p -CA is an effective allelochemical for inhibiting the growth of Limnothrix sp. and provide a new idea for the development of p -CA as a botanical agent for the control of cyanobacterial bloom. [Display omitted] • p -coumaric acid can strongly inhibit the growth of Limnothrix sp. • p -coumaric acid leads to sever and irreversible cell membrane damages. • p -coumaric acid causes oxidative stresses and reduces the photosynthetic activity. • p -coumaric acid results in the changes of cell metabolic pathways. [ABSTRACT FROM AUTHOR]

Solid carbon source (SCS)-based denitrification is a promising technique for nitrogen removal from sewage. However, a sustainable and effective supply of carbon sources, crucial to denitrification performance, has always been challenging. This study developed four synthetic SCSs: biochar (BC), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), PHBV loaded on biochar (BCP), and PHBV loaded on biochar-supported nanoscale zero-valent iron (BCPF), to examine their denitrification efficiency enhancement. Insufficient carbon sources caused low nitrate removal (<45%) in the BC reactor during the entire experiment. At the biofilm formation stage (influent nitrate: 40 mg L-1), the relatively higher nitrate removal in biochar-based SCS reactors than in the P reactor in the first 4 h indicated that the biochar's rapid release of carbon sources played a priming role in denitrification. Then, the subsequent sharp decrease in nitrate removal revealed the biochar's unsustainable release of carbon sources for the denitrifiers. Similar to the P reactor, the nitrate removal in BCP and BCPF reactors gradually increased after 12 h until the 48 h mark, where the high nitrate removal efficiency was stabilized (P: 79.93%−93.74%, BCP: 86.90%−100%, and BCPF: 91.68%−100%), except in the BC reactor. Evidently, the decomposed products from PHBV provided sustainable carbon sources for the denitrifiers. Compared with the P reactor in the continuous running stage, BCP and (especially) BCPF reactors exhibited excellent resistance to load impact. Here, PHBV supplied sustainable carbon sources and electron donors for denitrification, while nZVI served as extra electron donors. The biochar dominantly provided habitats for denitrifiers and functioned as an electron mediator. [Display omitted] • A novel SCSs was synthesized by loading PHBV on biochar-supported nZVI. • BCPF had the excellent denitrification performance and resistance to load impact. • Biochar provided habitats for denitrifiers and served as electron mediator. • PHBV provided the sustainable carbon sources and electron donors for denitrifiers. [ABSTRACT FROM AUTHOR]

This study prepared surface-modified biochar, including acid washing biochar (HBC) and biochar supported with nanoscale zero-valent iron (nZVI-HBC). The surface-modified biochar was added to sulfamethoxazole (SMX)-contaminated soil with and without earthworms to examine the effects of surface-modified biochar and/or earthworms (Eisenia fetida) on the levels of SMX and its relevant genes (sul 1, sul 2, and intI 1) in the soil. Additionally, the joint toxicity of these exogenous substances on earthworms was investigated. The results showed that although earthworms significantly enhanced the dissipation of SMX in the soils with and without HBC, this effect was not observed in the soil with nZVI-HBC. Among all treatments, nZVI-HBC most effectively accelerated SMX dissipation in the soil, regardless of coexisting earthworms. However, the presence of earthworms significantly increased the total relative abundances of sul 1, sul 2, and intI 1 in the soil. A reasonable explanation for this is the shift in the bacterial community composition rather than the residual level of SMX. When earthworms coexisted, the richness of Proteobacteria evidently increased, which was the main host of the above genes. Both HBC and nZVI-HBC decreased these genes in the soil with earthworms, which was mainly due to the decrease in host genera from Proteobacteria, Actinobacteria, and Gemmatimonadetes. Although there was toxicity of single-surface-modified biochar or SMX on earthworms, the synergistic interaction of surface-modified biochar and SMX resulted in the most serious histopathological changes in earthworms and their highest superoxide dismutase activity. • Earthworms enhanced sulfamethoxazole (SMX) dissipation in soil without and with HBC. • nZVI-HBC most effectively decreased SMX in soil regardless of coexisting earthworms. • Earthworms increased the total relative abundance of sul 1, sul 2 and intI 1 in soil. • Earthworms increased Proteobacteria that was mainly antibiotic resistance host in soil. • Joint toxicity of modified biochar and SMX to earthworms was stronger than single one. [ABSTRACT FROM AUTHOR]

Purpose To establish a goat model for traumatic temporomandibular joint (TMJ) and describe the gross appearance and histopathologic changes for the prognostic comparison of different types of TMJ trauma. Materials and Methods According to clinical traumatic types, 16 adult goats were randomly divided into 4 groups based on outcome of surgical induction: 1) disc displacement without reduction (DD), 2) condylar cartilage defect (CCD), 3) DD plus CCD, and 4) control. TMJs were removed and observed 2 weeks and 1 month after the operation. These specimens were compared and evaluated based on gross appearance and histopathologic observations with hematoxylin and eosin and toluidine blue stains. The histopathologic score of condylar cartilage was observed and compared across the 4 groups using SPSS 17.0 software. Result Three traumatic TMJ goat models were successfully established. At 2 weeks and 1 month after surgical induction, the DD group showed slightly irregular cartilage compared with the C group, with disordered cartilage composition, little angiogenesis, and proteoglycan degradation. The CCD group showed fibrous adhesion between the condyle and the disc without reparative cartilage tissues; the remaining cartilage was normal in composition and proteoglycan content. The DD + CCD group showed fibrous adhesions and irregular condylar cartilage with disordered cartilage composition and decreased matrix proteoglycans. The scores of cartilage degeneration among the 4 groups showed significant differences at 2 weeks and 1 month (DD + CCD > DD > CCD; P < .05). Conclusion Among the 3 traumatic TMJ models, DD plus CCD can cause osteoarthritis (OA) and adhesions in the joint, DD can cause only OA, and CCD with the disc in normal position merely affects the remnant cartilage. [ABSTRACT FROM AUTHOR]

Highlights: [•] Two new components have been isolated from Anemarrhena asphodeloides Bge. [•] The isolated components were evaluated for their antiplatelet aggregative activity. [•] The structures were elucidated by spectroscopic data and CD analysis. [Copyright &y& Elsevier]

Abstract: Our aim was to describe the effects of soft tissue injury to the temporomandibular joint (TMJ), to analyse possible reasons for it, and to evaluate the results of treatment. Eight patients (12 joints) who developed disorders of the TMJ after trauma to the mandible without fracture of the condyle were treated in our department from 2009 to 2010. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to check the condition of the joint. Five patients had their joints explored to relieve pain and improve mouth opening. MRI showed all 12 joints had displaced discs. CT showed that the surface of the condylar bone was “intact” immediately after injury but destroyed later in 8 joints. Exploration showed fibrous ankylosis in 5, osteoarthritis with intra-articular adhesions in 2, and internal derangement in 1. Four were treated by costochondral graft (CCG) with 7 symptomatic joints. The disc was repositioned in 1 case with 1 affected joint. The mean maximal incision opening at follow-up were significantly better than the one before treatment (mean 34 compared with 23mm, p =0.02). Pain in the TMJ was relieved by operation in all patients so treated. The other 3 patients (4 joints) had no treatment because their symptoms were minor and mouth opening was not restricted. Soft tissue injuries of the TMJ can potentially lead to internal derangement, osteoarthrosis, and possibly fibrous ankylosis, which should be considered during follow-up. Displacement of the disc and damage to the condylar cartilage seem to be the causes of these complications. Surgical management is effective in the short term. [Copyright &y& Elsevier]

Abstract: Our aim was to investigate the role of retention of the condylar cartilage in open reduction and internal fixation (ORIF) of intracapsular condylar fractures (ICFs) in growing goats by three-dimensional computed tomographic (CT) analysis. Twelve goats 6 months old were randomly divided into three groups. ICFs were created bilaterally in mandibular condyles and treated with ORIF. On the one side (n =4) the condylar cartilage was removed, and on the other side (n =4) it was retained. Condyles in the control group (n =4) were untouched. CT scans were taken immediately postoperatively, and 3 and 6 months later. The heights of the rami among the three groups were compared, There were significant reductions in the height of rami in the group from which the cartilage had been removed 3 and 6 months postoperatively compared with controls, but no significant differences between control group and the group in which it had been retained. We conclude that retaining condylar cartilage in the ORIF for ICF of growing goats has no harmful effect on condylar growth, but removal can limit growth. [Copyright &y& Elsevier]

Purpose: We report a surgical method for the treatment of traumatic temporomandibular joint (TMJ) ankylosis with a medially displaced residual condyle and compare the long-term results with those obtained using different interpositional materials. Patients and Methods: From 2001 to 2009, 60 patients and 82 joints diagnosed with traumatic TMJ ankylosis with a medially displaced residual condyle were included in the present study. Lateral arthroplasty (LAP) was performed, and either the masseter muscle flap (MMF) or the temporalis myofascial flap (TMF) was used as interpositional material to fill the lateral space. The long-term results of these treatments were compared by performing postoperative computed tomography scans and clinical follow-up examinations. Results: Of the 82 joints, 22 were treated with LAP, 28 with LAP and MMF, and 32 with LAP and TMF. Of the 60 patients, 38 (48 joints) participated in long-term follow-up (from 1 to 4 yr). Of the 11 joints treated with LAP, 4 (36.4%) developed reankylosis. Of the 17 joints treated with LAP and MMF, 3 (17.6%) developed reankylosis, and none of the 20 joints treated with LAP and TMF developed reankylosis. Compared with LAP alone, LAP with TMF significantly improved the maximal incisal opening during long-term follow-up. Conclusion: LAP can preserve the residual TMJ structure. The TMF is a reliable interpositional material in LAP for the prevention of reankylosis. [ABSTRACT FROM AUTHOR]

Objective: This article studies the classification of traumatic temporomandibular joint (TMJ) ankylosis based on coronal computed tomographic (CT) scan and presents our treatment experience in the TMJ division of Shanghai Ninth People''s Hospital. Patients and Methods: From 2001 to 2009, 130 patients diagnosed with TMJ ankylosis were treated in the TMJ division. Among them, 84 patients with 124 joint injuries caused by trauma were treated first by our group of surgeons and were included in this study. All of them had CT scans, especially coronal reconstruction through the TMJ area before and after surgery. A new classification based on the coronal CT scan was proposed: type A1 is fibrous ankylosis without bony fusion of the joint; type A2 is ankylosis with bony fusion on the lateral side of the joint, while the residual condyle fragment is bigger than 0.5 of the condylar head in the medial side; type A3 is similar to A2 but the residual condylar fragment is smaller than 0.5 of the condylar head; type A4 is ankylosis with complete bony fusion of the joint. Our treatment protocol for type A1 ankylosis is fibrous tissue release or condylar head resection with costochondral graft (CCG) and temporalis myofascial flap (TMF). For type A2 and A3 ankylosis, the lateral bony fusion is resected, while the intact residual condylar fragment, displaced medially, is retained. We call it “lateral arthroplasty” (LAP). TMF or masseter muscle flap (MMF) is used as a barrier in the lateral gap between the TMJ fossa and the stump of the mandibular ramus. If the medial condylar fragment in type A3 ankylosis is too small to bear the load, it is resected with the bony mass. The joint is then reconstructed with CCG and TMF or MMF. For type A4 ankylosis, the bony fusion is completely removed and the joint is reconstructed with CCG and TMF or MMF. The result of the treatment was evaluated by CT scan and clinical follow-up. Results: Among the 124 ankylotic joints, there were 14 type A1 ankylosis (11.3%); 43 type A2 ankylosis (34.7%); 46 type A3 ankylosis (37.1%); and 21 type A4 ankylosis (16.9%). Part of type A1, and all of type A2 and A3 ankylosis had the residual condylar head displaced medially, which accounted for 75% (93/124) of the TMJ ankylosis. Eighty-two joints (66.1%) had LAP treatment; 33 joints (26.6%) had CCG joint reconstruction; and 3 joints (2.4%) had TMJ fibrous tissue release. In our case, 1 joint (0.8%) had condylectomy and TMF; 3 joints (2.4%) with fibrous ankylosis had mouth opening treatment; and 2 joints had gap arthroplasty (1.6%). Forty-eight patients with 68 joints had long follow-ups from 10 months to 4 years. Among them, 4 of 17 joints reconstructed with CCG had reankylosis (23.5%), and 7 of 48 joints treated with LAP had reankylosis (14.6%). Conclusions: The new classification of TMJ ankylosis based on coronal CT scan is valuable in guiding clinical treatment. LAP with TMF is a good way to treat traumatic TMJ ankylosis when the medially displaced condylar head and disc are intact. CCG with TMF has a good result for type A4 ankylosis. [Copyright &y& Elsevier]

Osteochondroma with secondary synovial chondromatosis is rare in the temporomandibular joint (TMJ), so we retrospectively reviewed 210 such patients who presented to our hospital from 2001-2013. The final sample included 3 patients with secondary synovial chondromatosis (mean (SD) age 40 (??) years), all of whom had symptoms of disorders of the TMJ. Condylar neoplasms and loose bodies were found during operation. Histopathological examination showed a bony growth capped with hyaline cartilage and clustering chondrocytes, with partial calcification and ossification of the loose bodies, and primary osteochondroma with secondary synovial chondromatosis was diagnosed. There were no recurrences during a follow-up that ranged from 3 months to 5 years. The presence of loose calcified bodies in osteochondroma is a possible sign of secondary synovial chondromatosis. [ABSTRACT FROM AUTHOR]