保留瘢痕组织瓣的耳廓瘢痕疙瘩切除

临床发现耳廓瘢痕疙瘩主要见于穿耳洞后感染，可导致耳廓变形或畸形。目前主要采用手术切除，辅以术后放疗、激素注射和加压等综合治疗。目前尚无规范的治疗手段，疗效各异。我科2009—05—2014—03期间收治15例耳廓瘢痕疙瘩患者，均采用手术切除，部分辅以瘢痕内激素治疗，术后随访6个月～2年，效果良好，现报道如下。     

HSP25 Affects the Proliferation and Differentiation of Rat Dental Follicle Cells

Aim To detect the expression of HSP25 in rat dental follicles both in vivo and vitro, and explore the underlying mechanism of HSP25 on the proliferation and differentiation of rat dental follicle cells （DFCs）. Methodology Immunohistochemistry was performed to detect the expression of HSP25 in mandibles of postnatal rats on days 1, 3, 5, 7, 9 and 11 in vivo. In vitro, the expression of HSP25 in DFCs was detected by an indirect immunofluorescence assay. Thiazolyl blue tetrazolium bromide （MTT） assay, flow cytometry and alkaline phosphatase （ALP） assay were used to identify the time-course effect mediated by different concentrations of recombinant murine HSP25 of 0, 1, 10, 50 and 100 ng/mL on rat DFCs. Results Expression of HSP25 was not detected in dental follicles of the rats until day 5 after birth, but became up-regulated in a time-dependent manner till day 11. HSP25 was detected in the cytoplasm of cultured rat DFCs. No significant difference could be observed in the proliferation of DFCs after stimulation with different concentrations of HSP25 on days 1, 2 and 3 （P〉0.05）. HSP25 at concentrations of 50 ng/mL and 100 ng/mL up-regulated the ALP activity of DFCs on day 9 （P〈0.05）. Conclusion HSP25-immunoreactivity increased chronologically during the development of dental follicles. The protein had no significant effect on cell proliferation but may play a role in cementoblast/osteoblast differentiation of DFCs.     

DAPT Enhances the Apoptosis of Human Tongue Carcinoma Cells

Aim To investigate the effect of DAPT （γ-secretase inhibitor） on the growth of human tongue carcinoma cells and to determine the molecular mechanism to enable the potential application of DAPT to the treatment of tongue carcinoma. Methodology Human tongue carcinoma Tca8113 cells were cultured with DAPT. Cell growth was determined using Indigotic Reduction method. The cell cycle and apoptosis were analyzed by flow cytometry. Real-time PCR and Immuno-Fluorescence （IF） were employed to determine the intracellular expression levels. Results DAPT inhibited the growth of human tongue carcinoma Tca8113 cells by inducing G0-G1 cell cycle arrest and apoptosis, The mRNA levels of Hairy/Enhancer of Split-1 （Hes-1）, a target of Notch activation, were reduced by DAPT in a dose-dependent manner. Coincident with this observation, DAPT induced a dose-dependent promotion of constitutive Caspase-3 in Tca8113 cells. Conclusion DAPT may have a therapeutic value for human tongue carcinoma. Moreover, the effects of DAPT in tumor inhibition may arise partly via the modulation of Notch- 1 and Caspase-3.     

The Effect of Simvastatin on mRNA Expression of Transforming Growth Factor-[H,Bone Morphogenetic Protein-2 and Vascular Endothelial Growth Factor in Tooth Extraction Socket

Aim To determine the effect of local simvastatin application on the mRNA expression level of transforming growth factor-β1 （TGF-β1）, bone morphogenetic protein-2 （BMP-2） and vascular endothelial growth factor （VEGF） in the tooth sockets of rat. Methodology Forty-eight male Wistar rats were randomly divided into experimental and control groups （n=24）. Polylactic acid/polyglycolic acid copolymer carriers, with or without simvastatin, were implanted into extraction sockets of right mandibular incisors. The expression of TGF-β1, BMP-2 and VEGF mRNA was determined by in situ hybridization in the tooth extraction socket at five days, one week, two weeks and four weeks after implantation. Results The fusiform stroma cells in the tooth extraction socket began to express TGF-β1, BMP-2 and VEGF mRNA in both experimental and control groups from one week after tooth extraction until the end of experiment. The expression of TGF-131 and BMP-2 mRNA in the experimental group was significantly up-regulated after one, two and four weeks, and expression of VEGF mRNA was significantly increased after one and two weeks compared with that in the control group. Conclusion The findings indicate that local administration of simvastatin can influence alveolar bone remodeling by regulating the expression of a school of growth factors which are crucial to osteogenesis in the tooth extraction socket.     

Preparing Health Professionals to Provide Care to Individuals with Disabilities

Aim To review the perceptions of dental/medical educators and their students in the United States on the adequacy of didactic and clinical preparation to provide service for individuals with disabilities. Methodology An e-mailed questionnaire with follow-up was sent to 198 deans of dental/medical schools, 1,628 directors of residency programs in nine medical/dental residency programs, 427 medical students in 12 medical schools, and 368 health related organizations, facilities and programs. Results More than half （58%） of the responding deans of medical schools and 50% of the deans of dental schools reported that a curriculum for patients with disabilities was not a high priority at their school. A majority （61%） of deans of medical schools, and 47% of the deans of dental schools, reported that their graduates were competent to treat patients with disabilities. However, majorities of dental/ medical school seniors and graduates expressed inadequate competency in the care of these patients. A majority of the directors of medical/dental residencies indicated a need for additional training for their residents. Conclusion There is need for increased didactic and clinical preparation of dental/medical school graduates in the care of individuals with special health needs. The interest expressed by health profession educators in an effort to develop appropriate curriculum modules provides an opportunity to prepare new graduates for the care of an increasing population of individuals with disabilities.     

国产诺尔康人工耳蜗植入临床分析

人工耳蜗植入（cochlear implantation,CI）是目前临床上针对重度和极重度感音神经性聋的最佳治疗手段。但长期以来由于人工耳蜗产品依赖进口,价格居高不下,很多家庭难以承受,使众多需要行CI的患者不能得到及时有效的治疗。而中国自主品牌诺尔康人工耳蜗的问世,无疑为解决这一问题提供了新选择,并造福更多的国内耳聋患者。本文将对我科诺尔康CI患者进行初步的回顾性研究,为更大范围国产人工的应用提供临床参考。     

过敏性鼻炎患病状况研究

过敏性鼻炎属慢性非感染性疾病,是全球性的健康问题。由于过敏性鼻炎在人群中的患病率较高,分布范围较广,常用描述性研究中的现况研究观察过敏性鼻炎的患病情况。其样本选取的方法多采用抽样调查的方式,随后进行收集信息工作,分问卷调查和临床确诊检查两个步骤。常用问卷有国际儿童哮喘和过敏反应研究问卷和欧共体呼吸健康调查问卷。我国的流行病学研究以局部地区花粉症相关研究做为开端,目前已有部分符合国际流行病学研究规范的数据,初步揭示了成人和儿童在我国中心城市的患病现状。     

变应性鼻炎规范化治疗的临床研究

变应性鼻炎（AR）是临床的一大顽症，发病率高达11％，2001年间世的ARIA指南针对不同类型AR提出了阶梯治疗方案，经过两次修订，2010年最新版的ARIA指南应用了GRADE评价体系，将鼻用糖皮质激素和口服H1受体拮抗剂列为治疗AR的强推荐用药。根据高质量的循证医学证据来治疗AR理应取得不错的疗效，但临床的实际情况不容乐观；近半数患者认为医师与之交流时间过短；     

影像导航辅助鼻内镜教学在鼻科培训教学中的应用

目前鼻内镜是鼻科主要手术方式;而鼻科学由于结构隐蔽,位于腔内,体积小、位置深,与周围重要结构毗邻,手术风险大.对于初学者,进行必要的鼻内镜解剖知识的培训l,是十分必要的;而单纯的内镜教学,初学者往往容易造成对解剖结构知识的模糊。应用影像导航辅助鼻内镜,使得鼻科学的解剖及手术培训教学更为直观、更具吸引力,同时加深了学习者对解剖知识的深入理解。     

我国社会资本举办医疗机构的现状与展望

1为什么需要社会资本举办医疗机构 医药产业链按上下游关系可以分为上游医药制造、中游医药分销、下游医疗服务和终端患者。目前我国的医药制造行业市场化程度较高,竞争充分,整体呈现产能过剩态势：医药分销行业长期受到上下游双重挤压,在产业链中的话语权最小,主要依赖规模效应盈利：医疗服务行业由于较为复杂的制度变迁等因素,长期以来形成了“以药养医”的盈利模式,加上我国医疗资源的相对匮乏和医患信息的不对称,形成了当下医疗服务对上游制药和下游患者双向垄断的格局（图1）。患者看病难、看病贵的问题突出,个人支付比例过大。我国医疗卫生产业链整体处于不平衡状态,但新医改与社会资本进入给医疗服务行业带来了契机。     

耳鼻咽喉医院的连锁发展与民生耳鼻喉医院集团的实践

据不完全统计,全国现有约40多家耳鼻咽喉专科医院,在众多的民营医疗机构中所占的份额还很少,是民营资本不青睐耳鼻咽喉专科还是驾驭不了这个专科？现有的耳鼻咽喉医院发展状况如何？耳鼻咽喉医院适合连锁化发展吗？本文试图通过案例来探究耳鼻咽喉专科发展的若干问题。     

慢性化脓性中耳炎病原菌分布及耐药性分析

近年来由于抗菌药物广泛应用,慢性化脓性中耳炎（chronic suppurative otitis media,CSOM）病原菌构成及对抗菌药物的敏感性发生了改变。为了解本地区情况,指导临床合理用药,对近2年CSOM患者需氧菌培养阳性结果进行回顾性分析,报道如下。     

连续静脉镇痛泵在鼻科术后止痛作用的评估

鼻部手术后由鼻腔填塞带来的痛苦一直是广大患者望而生畏的主要原因，术后疼痛可引起血压升高、鼻腔出血、疼痛性休克等并发症，如何减轻这一痛苦是广大医师一直探讨的问题。     

Treacher Collins综合征基础研究现状

Treacher Collins综合征是以常染色体显性遗传为主要遗传方式的先天颅面畸形。已知致病基因为TCOFl、POLRID、POLRlC。其致病机制可能是基因突变后引起单倍剂量不足而导致成熟核糖体减少,不能满足神经嵴细胞增殖所需,最终导致颅面畸形发生。本文将从分子遗传学、发病机制等方面对该综合征的基础研究现状做一综述。     

复发性耳廓假性囊肿前壁切除加耳廓全层间断褥式缝合术24例疗效分析

我科2009-02-2013-03收治24例（24耳）耳廓假性囊肿治疗后复发的患者,采用耳廓假性囊肿前壁切除加耳廓全层间断褥式缝合术治疗,效果满意,报告如下。     

内镜下经鼻蝶窦垂体瘤切除术患者鼻部相关生存质量研究

垂体瘤是以垂体前叶腺瘤为主的颅内肿瘤,手术治疗是最有效的治疗方法。随着内镜下经鼻蝶窦垂体瘤切除术的发展,经典的显微镜下鼻中隔-蝶窦垂体瘤术式逐渐受到限制;而内镜下经鼻蝶窦垂体瘤切除术因创伤小、并发症少而成为垂体瘤切除的最佳手段〔1-2〕。但经鼻内镜下切除垂体肿瘤时,可能对鼻腔的相关结构如上鼻甲、后组筛房以及蝶窦等进行处理〔1-2〕,这种创伤对于患者鼻部相关的生存质量产生何种程度的影响至今尚缺乏相关性研究。     

Metabolic activity of Streptococcus mutans biofilms and gene expression during exposure to xylitol and sucrose

The objective of the study was to analyse Streptococcus mutans biofilms grown under different dietary conditions by using multifaceted methodological approaches to gain deeper insight into the cariogenic impact of carbohydrates. S. mutans biofilms were generated during a period of 24 h in the following media： Schaedler broth as a control medium containing endogenous glucose, Schaedler broth with an additional 5% sucrose, and Schaedler broth supplemented with 1% xylitol. The confocal laser scanning microscopy（CLSM）-based analyses of the microbial vitality, respiratory activity（5-cyano-2,3-ditolyl tetrazolium chloride, CTC） and production of extracellular polysaccharides（EPS） were performed separately in the inner, middle and outer biofilm layers. In addition to the microbiological sample testing, the glucose/sucrose consumption of the biofilm bacteria was quantified, and the expression of glucosyltransferases and other biofilm-associated genes was investigated. Xylitol exposure did not inhibit the viability of S. mutans biofilms, as monitored by the following experimental parameters： culture growth, vitality, CTC activity and EPS production. However,xylitol exposure caused a difference in gene expression compared to the control. Gtf C was upregulated only in the presence of xylitol.Under xylitol exposure, gtf B was upregulated by a factor of 6, while under sucrose exposure, it was upregulated by a factor of three.Compared with glucose and xylitol, sucrose increased cell vitality in all biofilm layers. In all nutrient media, the intrinsic glucose was almost completely consumed by the cells of the S. mutans biofilm within 24 h. After 24 h of biofilm formation, the multiparametric measurements showed that xylitol in the presence of glucose caused predominantly genotypic differences but did not induce metabolic differences compared to the control. Thus, the availability of dietary carbohydrates in either a pure or combined form seems to affect the cariogenic potential of S. mutans biofilms.     

在教学过程中注重对耳部影像学检查和诊断复杂性与对策的培训

耳部影像学是医学影像学的重要组成部分,在耳科疾病的诊断中具有重要且不可替代的价值。相对于其他系统的影像学来说,由于耳部解剖的复杂性及疾病的特 殊性,针对耳部的影像检查方法更为精细、疾病诊断更加困难。为了激发低年资医师和学生对耳部影像学的学习兴趣,提高学习效率,本文结合文献和个人临床、研究经验,分析耳部影像学检查和诊断的复杂性,并提出相应的解决方案。     

两种激素鼓室灌注治疗重度以上突发性聋的疗效观察

近年来,越来越多的研究聚焦于鼓室内灌注激素治疗突发性聋（sudden deafness,SD）。2010年1月~2013年3月我科对99例重度以上SD患者分别给予全身或鼓室内注射激素治疗,现将治疗结果报道如下。     

诺尔康人工耳蜗残余听力保留技术和术后效果

人工耳蜗自应用以来已成为治疗重度一极重度感音神经性聋的有效方法。随着言语编码技术的进步、手术技术的不断完善及声电联合刺激模式下言语功能优势的体现,人们对人工耳蜗植入（cochlear implantation,CI）的有效性、安全性认识不断提高,CI患者的选择标准也发生着变化,有残余听力的患者亦被列为CI候选者。