锥形束CT测量单侧后牙正锁髁突的体积和表面积

背景：髁突是下颌骨的生长发育中心,不对称的咬合关系可能会导致其形态的变化。目的：通过锥形束CT测量单侧后牙正锁髁突体积和表面积,观察单侧后牙正锁对髁突形态的影响。方法：从重庆医科大学附属口腔正畸科就诊患者中选取29例成年单侧后牙正锁患者为实验组,同期从门诊检查者中选取32例成年正常咬合为对照组,所有对象均无经正畸治疗史。拍摄锥束CT,用Mimics10.0软件对髁突影像进行三维重建。结果与结论：实验组锁侧髁突表面积和体积均大于非锁侧（P〈0.05）,实验组体积和表面积的不对称性指数明显大于对照组（P〈0.05）。结果证实,单侧后牙正锁患者双侧髁突对称性较差。     

锥形束CT测量单侧后牙正锁髁突的体积和表面积

背景:髁突是下颌骨的生长发育中心,不对称的咬合关系可能会导致其形态的变化。目的:通过锥形束CT测量单侧后牙正锁髁突体积和表面积,观察单侧后牙正锁对髁突形态的影响。方法:从重庆医科大学附属口腔正畸科就诊患者中选取29例成年单侧后牙正锁患者为实验组,同期从门诊检查者中选取32例成年正常咬合为对照组,所有对象均无经正畸治疗史。拍摄锥束CT,用Mimics10.0软件对髁突影像进行三维重建。结果与结论:实验组锁侧髁突表面积和体积均大于非锁侧(P<0.05),实验组体积和表面积的不对称性指数明显大于对照组(P<0.05)。结果证实,单侧后牙正锁患者双侧髁突对称性较差。     

单侧完全性唇腭裂患者下颌骨对称性分析

目的 探讨单侧完全性唇腭裂患者下颌骨两侧垂直向对称性。方法 52名单侧完全性唇腭裂患者作为观察组,52名同龄正常牙合人群作为对照组,两组病例拍摄全景片,对下颌关节高度（CH）,升支高度（RH）及升支关节高度总和（CH+RH）进行测量和分析,所得数据行配对样本T检验和独立样本T检验。结果 单侧完全性唇腭裂患者下颌骨健患侧垂直高度中CH,RH,CH+RH均存在统计学差异(P<0.05),对照组左右侧各项高度测量指标均无统计学差异。组间分析关节高度（CH）及关节升支高度（CH+RH）存在统计学差异(P<0.05)。结论 单侧完全性唇腭裂患者下颌骨健患侧垂直向不对称,且其与正常牙合人群比较存在差异。正常牙合人群下颌骨垂直向左右侧对称。     

成人单侧后牙反[牙合]髁突表面积与体积的CBCT分析

目的探讨应用锥形束CT（CBCT）测量成年单侧后牙反[牙合]髁突的体积与表面积差异。方法选择在重庆医科大学附属口腔医院就诊的单侧后牙反[牙合]成年患者25例为实验组,健康成人正常咬合35例为对照组,拍摄颅颌面CBCT影像,应用Mimics10.0进行髁突的重建与体积和表面积的测量,分析。结果成年单侧后牙反[牙合]患者反侧髁突的体积与表面积明显小于非反侧（P〈0.05）。成年单侧后牙反[牙合]组的不对称性指数也显著高于正常咬合对照组（P〈0.05）。结论成年单侧后牙反[牙合]患者髁突发育不对称,影响颞下颌关节的正常发育,提示单侧后牙反[牙合]患者应尽早矫治。     

两种模拟咬合板对髁突表面应力影响的三维有限元研究

目的分析2种后牙接触咬合板对髁突表面应力的影响，为指导临床实践提供理论基础。方法利用下颌骨三维有限元模型，模拟2种后牙接触咬合板的作用，观察髁状突表面11个区域应力变化情况。结果双侧枢轴咬合板在髁突表面产生的应力，左右侧分布对称；单侧枢轴咬合板在髁突表面产生的应力，左右侧分布不对称。单侧后牙接触的枢轴咬合板，非工作侧髁突表面的最大压应力和Von Mises应力均大于工作侧，而工作侧髁突表面的最大拉应力大于非工作侧。结论在不同咬合板的作用下，髁状突表面应力的分布不同。单侧后牙接触的枢轴咬合板在非工作侧髁突表面产生的负荷大于工作侧。     

锥束CT测量安氏Ⅰ类错牙合人群下颌髁突的体积和表面积

背景:髁突是下颌骨的生长中心,髁突的体积大小对下颌骨的形态有着密切的关系,同时各种关节疾病都会导致髁突形态的变化。目的:通过锥束CT测量年轻安氏Ⅰ类错牙合人群髁突体积和表面积,为中国人髁突体积和表面积提供正常参考值。方法:从重庆医科大学附属口腔医院正畸科就诊患者中选取年龄在18～28岁之间的年轻安氏Ⅰ类错牙合患者70例,男34例,女36例。所取患者脸型左右对称,"↓"开口型,开口度正常,无关节弹响,疼痛等症状。所有患者接受锥束CT检查,通过Mimics10.0对CT片髁突进行三维重建,计算髁突的体积,表面积以及形态指数(体积和表面积之比)。结果与结论:男性髁突体积和表面积均显著大于女性(P<0.01)。左右髁突体积和表面积差异无显著性意义(P>0.05)。左右两侧髁突形态指数和男女髁突形态学指数差异无显著性意义。结果提示脸型对称,无关节症状的安氏Ⅰ类错牙合人群左右髁突基本对称。     

牙齿与颜面不对称畸形的矫治

牙齿与颜面不对称畸形是指由于牙弓或颌骨两侧不对称或因颌位偏斜形成的一种错[牙合]畸形。临床上常表现为单侧后牙反骀，下颌向反[牙合]侧偏斜。单个或多个后牙锁[牙合]，下颌向非锁[牙合]侧偏斜。单个前牙反[牙合]，下颌向反殆向偏斜。这样不仅影响美观，而且影响咬合功能，甚至造成颞下颌关节的损伤。这类患者在临床较常见，对于矫治方案的选择常会困绕正畸医生，追求平衡，稳定，美观是矫治目的。作者自2001年6月至2006年7月对10例成年患者的矫治报道如下。     

髁突运动轨迹描记在(牙合)垫治疗错(牙合)中的应用

目的:探讨安氏Ⅱ类1分类(Ⅱ1)类错(牙合)患者下颌左侧方运动时髁突运动轨迹的特征及其与正常(牙合)之间的差异,并且应用髁突运动轨迹描记法评价(牙合)垫治疗的效果.方法:随机选择正常(牙合)40例(对照组)以及安氏Ⅱ1类错(牙合)患者40例(试验组),其中应用(牙合)垫治疗1个月者10例.应用髁突运动轨迹描记仪记录髁突运动轨迹.采用SAS统计学软件分析比较两组间是否存在统计学差异.结果:试验组左侧方运动中左右侧髁突最大空间位移[(12.19±2.12)mm和(13.36±1.31)mm]均显著大于正常组[(8.89±1.51)mm和(9.87±0.57)mm],P＜0.05,非工作侧水平向和垂直向最大位移量[(3.07±0.64)mm和(8.18±0.51)mm]均显著大于正常组[(1.57±1.02)mm和(6.21±0.42)mm],P＜0.05和0.01;髁突位移5 mm时左右侧矢状髁道倾斜度(sagittal condyle inclination,SCI)分别为(56.94±6.26)°和(60.64±8.04)°,左右侧水平髁道倾斜度(transverse condyle inclination,TCI)分别为(14.39±6.19)°和(15.21±6.89)°;均大于正常组[(45.27±6.53)°、(43.17±4.53)°、(3.01±1.39)°和(2.82±1.32)°,P＜0.05和0.01.而在治疗前后工作侧及非工作侧结果差异无统计学意义(P＞0.05).结论:安氏Ⅱ1类错(牙合)患者下颌侧方运动过程中髁突运动轨迹与正常验有明显差异.验垫治疗在1个月期间并不能明显改善安氏Ⅱ1类错(牙合)患者的错(牙合).     

微型钛板复位内固定治疗下颌骨髁突囊内骨折的效果

目的探讨微型钛板复位内固定治疗下颌骨髁突囊内骨折的临床效果及手术方法。方法对本院2013年3月至2015年3月手术治疗的87例下颌骨髁突囊内骨折患者进行回顾性分析,所有患者均采用微型钛板复位内固定治疗,对比手术前后患侧测量指标与健侧测量指标。结果术后3、6个月87例患者的最大张口度、髁突高度测定值较术前均显著提高(P<0.05),张口偏斜度术后3、6个月较术前显著降低(P<0.05);术前、术后3个月患侧的髁突高度测定值均显著低于健侧(P<0.05),术后6个月两侧髁突高度差异无统计学意义(P>0.05);术后6个月患者的主诉严重程度指数Ai、Di分布均显著优于术前(P<0.05);术后6个月达到完全治愈标准的有50例患者(57.47%)。结论采用微型钛板复位内固定治疗下颌骨髁突囊内骨折临床效果可靠,值得推广。     

美容冠修复成年人前牙错牙合畸形的疗效

目的探讨美容冠修复成年人前牙错牙合畸形的临床疗效。方法 300例（1 460颗牙）前牙错牙合畸形患者中,双牙合前突拥挤者135例,错牙合伴深覆牙合者105例,开牙合（开唇露齿）39例,反牙合（地包天）21例。对上、下牙唇向前突者需内收改向;前牙舌腭侧内倾者需向唇侧外展;牙列拥挤者需近远中减径;伴深覆牙合、开牙合或反牙合者要压低下前牙或后牙的高度,调整牙弓弧度,排齐牙齿,纠正咬合关系。结果 300例患者随访6个月～2年,满意270例（90.0%）,基本满意24例（8.0%）,不满意6例（2.0%）。结论美容冠修复成年人前牙错牙合畸形有较好的疗效,是成年人治疗前牙错牙合畸形较好的选择。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."