Craniofacial malformation caused by premature fusion of cranial suture of infants has a serious impact on their growth. The purpose of skull remodeling surgery for infants with craniosynostosis is to expand the skull and allow the brain to grow properly. There are no standardized treatments for skull remodeling surgery at the present, and the postoperative effect can be hardly assessed reasonably. Children with sagittal craniosynostosis were selected as the research objects. By analyzing the morphological characteristics of the patients, the point cloud registration of the skull distortion region with the ideal skull model was performed, and a plan of skull cutting and remodeling surgery was generated. A finite element model of the infant skull was used to predict the growth trend after remodeling surgery. Finally, an experimental study of surgery simulation was carried out with a child with a typical sagittal craniosynostosis. The evaluation results showed that the repositioning and stitching of bone plates effectively improved the morphology of the abnormal parts of the skull and had a normal growth trend. The child’s preoperative cephalic index was 65.31%, and became 71.50% after 9 months’ growth simulation. The simulation of the skull remodeling provides a reference for surgical plan design. The skull remodeling approach significantly improves postoperative effect, and it could be extended to the generation of cutting and remodeling plans and postoperative evaluations for treatment on other types of craniosynostosis.
Objective To assess the effectiveness of bariatric surgery for obese type 2 diabetes mellitus (T2DM) in Mainland China. Methods Such databases as the Cochrane Central Register of Controlled Trials (Issue 2, 2012), MEDLINE (1990 to February 2012), EMbase (1990 to February 2012), CBM (1990 to February 2012), CNKI (1990 to February 2012), WanFang Data (1999 to February 2012) and VIP (1996 to February 2012) were searched, and the references of the included literature were also retrieved. The studies were screened according to the predefined inclusion and exclusion criteria, the data were extracted, the quality was evaluated, and then the meta-analysis was performed using RevMan 5.2 software. Results A total of 6 controlled before-and-after studies involving 100 patients were included. The overall quality of all literature was as low as grade C. The results of meta-analysis showed that the following indexes after operation obviously decreased than before: 1-month postoperative fasting plasma glucose (MD= –2.27, 95%CI ?4.12 to ?0.42, P=0.02), 6-month postoperative fasting plasma glucose (MD= ?2.73, 95%CI ?2.91 to 2.56, Plt;0.000 01), and 6-month postoperative glycated hemoglobin (SMD= ?1.97, 95%CI ?2.98 to ?0.96, P=0.000 1), and the differences were statistically significant. The sensitivity analysis indicated the results of meta-analysis were credible and stable, but the funnel-plot analysis displayed publication bias might exist in the included studies. Conclusion Current studies show that bariatric surgery is effective for obese T2DM patients in mainland China. However, due to small sample size and low methodological quality of the included studies, its effect has to be proved by high quality, large sample, and long follow-up studies.
Objective To assess the therapeutic effect of gastric bypass on type 2 diabetes mellitus (T2DM) after a one-year treatment in Mainland China. Methods Databases including The Cochrane Central Register of Controlled Trials, MEDLINE, EMbase, CBM and CNKI were searched from inception to February 2012, and the relevant journals and references of articles were also searched to collect randomized controlled trials (RCTs) or before-after self-controlled trials on gastric bypass in treating T2DM in Mainland China. Two reviewers independently screened articles according to the predefined inclusion and exclusion criteria, extracted data, and evaluated quality of the included studies. Then meta-analyses were performed using RevMan 5.1.0. Results A total of 6 before-after self-controlled trials involving 131 patients were finally included. All these trials were graded as low quality. The results of meta-analysis showed that the therapeutic effect of gastric bypass on T2DM after a one-year treatment was good. There were significant reductions in both fasting plasma glucose (1 year: SMD=–2.55, 95%CI –3.40 to –1.69, Plt;0.000 01) and glycosylated hemoglobin (1 year: SMD=–1.98, 95%CI –2.33 to –1.62, Plt;0.000 01); there was no marked change in fasting insulin (SMD=–2.03, 95%CI –4.41 to 0.35, P=0.10). Sensitivity analysis indicated that these results were stable, but funnel-plots indicated possible publication bias existed. Conclusion One year after gastric bypass, T2DM patients in Mainland China get reduced in both fasting plasma glucose and glycosylated hemoglobin, but get no improvement in fasting insulin. However, this conclusion still needs to be further proved by more high-quality and large-scale clinical trials with long-term follow-up because of the limitation of quantity, scale and quality of the included studies.