Background: Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. Objective: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. Design: Descriptive cross-sectional study. Setting: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. Results: Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.
Objective PMMA bone cement leads to the development of local thrombi. Our study found that ES-PMMA bone cement, a novel material, can reduce local thrombosis. We used a simple and reproducible animal model to confirm the reduction in local thrombosis and preliminarily explored the associated molecular mechanism. Methods New Zealand rabbits, which were used to model thrombosis using extracorporeal carotid artery shunts, were divided into the following three groups, with 10 rabbits in each group: the sham group, PMMA group and ES-PMMA group. Four hours after modelling, experimental samples were collected, and the degree of thrombosis was compared between the groups. The expression of thrombomodulin in endothelial cells was quantified in vascular tissues samples. Results Thrombosis was observed in the PMMA group and ES-PMMA group but not in the sham group. The thrombosis weight was 0.00732 ± 0.00089 g/cm in the PMMA group and 0.00554 ± 0.00077 g/cm in the ES-PMMA group (P < 0.001). Quantitative real-time polymerase chain reaction (RT–qPCR) and Western blotting revealed that the expression of CD40, which can regulate thrombosis in vascular endothelial cells, was significantly lower in the ES-PMMA group than in the PMMA group. Conclusion Compared with PMMA bone cement, ES-PMMA bone cement can reduce local thrombosis by decreasing the expression of the thrombus-associated regulatory protein CD40 in vascular endothelial cells.
Background The objective of this study was to evaluate the efficacy of locking plates versus interlocking intramedullary nails in the treatment of proximal humerus fractures to provide clinical data support and theoretical guidance. Methods Patients with proximal humerus fracture from the Third hospital of Shijiazhuang city and Third hospital of Hebei medical university and from January 2017 to June 2019 were selected, included and divided into the locking plate group and the interlocking intramedullary nail group according to the intervention received. Information pertaining to the perioperative period (operation time, hospital stay, blood loss, etc.) of patients in both groups was collected. VAS pain scores, shoulder activity Constant-Murley scores and postoperative complications were documented. The perioperative data of the two groups were compared, and P < 0.05 was considered statistically significant. Results A total of 64 patients were enrolled, including 36 patients in the locking plate group, with a mean age of 61.3 ± 13.9 years, while the mean age of the interlocking intramedullary nail group was 65.6 ± 11.2 years. There was no statistical difference in gender, affected side, injury mechanism and Neer classification between the two groups (P > 0.05). However, the average operation time of the locking plate group was shorter than that of the interlocking nail group (84.9 ± 11.7 vs. 102.6 ± 22.1 min, P = 0.00), and the intraoperative blood loss of the locking plate group (137.4 ± 16.8 ml) was higher than that of the interlocking nail group (72.5 ± 10.5 ml, P = 0.00). There was no significant difference in the VAS score and Constant-Murley score between these two groups at the final follow-up. Conclusion Interlocking intramedullary nails are more minimally invasive than locking plates, but fracture reduction and fixation take longer. There was no significant difference in pain and shoulder function scores between the two internal fixation strategies for the treatment of proximal humerus fracture.
Objective: To demonstrate, in a simple and reproducible animal model, that ordinary high viscosity bone cements develop local thrombi; To reduce the occurrence of thrombus in joint arthroplasty, we develop a new material, enoxaparin sodium high viscosity bone cement, to reduce local thrombosis and preliminarily explored the molecular mechanism by which it reduced local thrombus occurrence compared with ordinary high viscosity bone cement. Methods: We used New Zealand rabbits to establish two groups of animal models: ordinary high viscosity bone cement group and new enoxaparin sodium high viscosity bone cement group on the basis of carotid artery vein extracorporeal shunt. There were 3 rabbits in each group. The experimental samples were collected 4 hours after modeling, and the amount of thrombosis between the two groups was compared, The collected vascular tissue samples were quantitatively detected for endothelial cell related thrombomodulin.Results: we successfully established the animal model on the basis of arteriovenous shunt in New Zealand rabbits. We found that both ordinary high viscosity bone cement and new enoxaparin sodium high viscosity bone cement could form thrombosis. The weight of thrombosis in ordinary high viscosity bone cement group was 0.00706 ± 0.00136g/cm, The weight of thrombosis in the new enoxaparin sodium high viscosity bone cement group was 0.00551 ± 0.00115g/cm. The amount of thrombosis in the new enoxaparin sodium high viscosity bone cement group was significantly reduced. We detected by RT qPCR and Western blot that the expression of CD40, a related protein that can regulate thrombosis in vascular endothelial cells, was significantly lower in the new enoxaparin sodium high viscosity bone cement group than that in the normal high viscosity bone cement group.Conclusion: We confirm that the new enoxaparin sodium high viscosity bone cement forms less thrombus than common high viscosity bone cement and preliminarily elucidate that the molecular mechanism by which this new material reduces thrombus formation is to decrease the expression of thrombus associated regulatory protein CD40 in vascular endothelial cells.
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