[Influencing factors of protein energy wasting in maintenance hemodialysis patients]

Objective: To analyze the influencing factors of protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods: A multicenter cross-sectional study was conducted in eleven hemodialysis centers of Guizhou province between June and August 2018. Clinical data, physical parameters, body composition data and laboratory values of MHD patients were collected. Analysis of variance was used to assess the impact of the indicators on the prevalence of PEW. Factor analysis was carried out after further classifing the factors into several common factors, and logistic regression was used to analyze the impact of common factors on PEW. Results: The results of univariate analysis showed that somatic cell mass, lean weight, fat content, body mass index (BMI), grip strength, leg circumference, hip circumference, waist circumference, midpoint circumference of upper arm, triceps skin fold thickness, hemoglobin, albumin, prealbumin, serum calcium, phosphorus, serum magnesium, creatinine, parathyroid hormone were the influential factors of PEW (all P<0.05). Factor analysis indicated that the above indicators can be classified into five common factors. Logistic regression model showed that with the increase of the prevalence of PEW, the scores of common factors decreased, the absolute value of regression coefficient beta in sequence, was common factor 2 (β=-2.258, P<0.001), common factor 4 (β=-1.589, P<0.001), common factor 1 (β=-1.144, P=0.001) and common factor 3 (β=-0.740, P=0.016). Conclusion: The reduction of fat content, anemia, hypoproteinemia, disorder of calcium and phosphorus metabolism were important factors influencing PEW.

[Research and development of digital design and fabrication of complete denture]

Removable complete denture are still the primary prosthetic solution for edentulous patients. Functional pressure impression obtaining, jaw relation recording, personalized balance occlusion and highly precise fabrication of denture are difficult. The digital restoration technique represented by intraoral three-dimensional scanning and three-dimensional (3D) printing compensates for the shortages of the manual techniques, but there are still many limitations in the application of complete dentures. At present, a few computer aided design and computer aided manufacture (CAD/CAM) complete denture systems have been developed both domestically and abroad, and these system are mainly focused on the digital design and manufacture of denture, and are seldom used for the recording of impression and jaw relation. This review is based on the main clinical procedures of the traditional complete denture restoration, elaborating the research and application status of digital technique in each steps, in order to provide reference for clinical application.

[Quantitative evaluation of printing accuracy and tissue surface adaptation of mandibular complete denture polylactic acid pattern fabricated by fused deposition modeling technology]

Objective: To quantitatively evaluate the adaptation of polylactic acid (PLA) pattern of mandibular complete denture fabricated by fused deposition modeling (FDM) technology. Methods: A mandibular complete denture digital model was designed through a complete denture design software based on a pair of standard maxillomandibular edentulous plaster model and their occlusion bases. Ten PLA mandibular complete dentures were printed with a FDM machine. The dentures were scanned with and without the plaster model using a three-dimensional (3D) scanner. In Geomagic software, the scanning data of printed dentures were registered to its computer aided design (CAD) data, and the printing error was analyzed using the multipoint registration command. For quantitatively evaluating the adaptation of the denture, the data of plaster model and PLA denture were registered to the whole data of denture located in the plaster model using the best-fit alignment command, the 3D deviation of the plaster model and tissue surface of the denture represent the space between them. The overall area was separated into three parts: primary stress-bearing area, secondary stress-bearing area and border seal area, and the average deviations of these three parts were measured. The values were analyzed using analysis of variance. Results: Compared with the CAD data, the printing error was (0.013±0.004) mm. The overall 3D deviation between PLA denture and plaster model was (0.164±0.033) mm, in which the primary stress-bearing area was (0.165± 0.045) mm, the secondary stress-bearing area was (0.153 ± 0.027) mm, the border seal area was (0.186 ± 0.043) mm. These showed a good fit in the majority parts of the FDM denture to the plaster model. No statistically significant difference was observed between the three areas (F=1.857, P=0.175>0.05). Conclusions: Combined with the 3D scanning, CAD and FDM technology, a FDM 3D printing process of complete denture for injection moulding can be established. As a result, high efficiency and low cost can be used to print out the complete denture, to lay the basis for further clinical applications.

[Postoperative computed tomography: study of 10 cases on reactive ring-enhancement in brain]

This paper presents 10 cases with CT appearances of postoperative reactive ring-enhancement in the brain, which were not reported in our country. The mechanisms and differential diagnosis of postoperative ring-enhancement are discussed with reports in the literature. The ring-enhancement at surgical margin is the reactive change of the brain traumatized by operation and related to postoperative pathological processes such as breakdown of blood-brain barrier, vascular granulation and luxury perfusion. This paper demonstrates that reactive ring-enhancement appears as early as 2-4 wk and may last as long as 7 wk after operation. It disappears gradually in 7 wk and cannot exist over 3 mon after operation. In the first 3 mon after operation, peripheral enhancement around the surgical site may be operative reaction, or residual tumor and cerebral abscess. The presence of ring-enhancement beyond 3 mon should be viewed as evidence of pathological process other than postoperative change. This paper emphasizes that ring-enhancement at margin of the surgical site with fine clinical manifestations in the early postoperative period is probably normal postoperative reaction. Close follow-up enhanced CT scan proves to be an effective measure to avoid misdiagnosis and unnecessary reexploration.

[Diagnostic evaluation of coronal CT scan in skull and brain diseases]

Coronal computed tomography findings in 30 cases of skull and brain diseases, including glioma 6 cases, meningioma 4 cases, acoustic neurinoma 3 cases, intraorbital tumor 3 cases, paranasal sinus tumor 3 cases, pituitary adenoma 2 cases, craniopharyngioma 2 cases, nasopharyngeal carcinoma 2 cases, empty sella 1 case, subdural hematoma 1 case, infarction 1 case, subarachnoid cyst 1 case, and metastasis 1 case are reported. The results show that as an adjunct to the axial computed tomography coronal CT scan provides valuable additional diagnostic informations. Coronal CT methods are also discussed.

[Surgical treatment of primary pulmonary cryptococcal granuloma--report of 4 cases]

Primary pulmonary cryptococcal granuloma is not common in Sichuan. The diagnosis of this disease is difficult to make because the patient has no characteristic symptoms and the chest X-ray findings of the mass are not easily differentiated from carcinoma of the lung. The incidence of this disease is apparently increasing. Pulmonary cryptococcosis may be disseminated hematogenously to the meninges and cryptococcal meningitis is very difficult to treat. If the pulmonary lesion is localized, the patient's general condition is good with no evidence of systemic lupus erythematosis, diabetes, leukemia or lymphoma, partial resection of the lung is indicated. But, if the patient has a history of recent cryptococcal meningitis, surgery must be deferred. Four cases of primary pulmonary cryptococcal granuloma have been treated surgically supplemented with medical therapy in the First Affiliated Hospital from 1986 to 1987. Follow-up of more than one year showed good results in each case.