碧兰麻应用于牙体牙髓病治疗中的效果分析

目的探讨碧兰麻应用于牙体牙髓病治疗中的效果分析。方法对我院2013-06—2014-01收治确诊的44例牙体牙髓炎患者分别以碧兰麻与利多卡因进行分组治疗,分为观察组和对照组,各22例,对两组患者的麻醉效果和患者对麻醉的满意程度进行观察和问卷分析。结果对两组患者的麻醉效果进行分析,观察组的有效率为90.9%,而对照组为77.3%,差异有统计学意义(χ2=5.939,P0.05)。术后,对两组患者对麻醉效果的满意程度进行分析,其满意率分别为95.5%及72.7%,差异有统计学意义(χ2=4.247,P=0.0390.05)。结论碧兰麻作为口腔局部麻醉剂,其具有效果好且快等优势,值得临床大力推广。     

复方阿替卡因在儿童牙体牙髓无痛治疗中的应用

目的观察复方阿替卡因在儿童牙体牙髓无痛治疗中的应用效果。方法选取接受牙髓无痛治疗的患儿74例,依据随机数表法分为2组,各37例。对照组使用利多卡因进行术前麻醉,观察组使用复方阿替卡因进行术前麻醉,对比2组患儿的麻醉效果、手术期间疼痛程度[视觉模拟评分量表(VAS)评分评定]及术后不良反应(头痛、恶心、切口感染、面部畸形)发生情况。结果观察组麻醉总有效率高于对照组(P<0.05),VAS评分低于、麻醉起效时间短于对照组(均P<0.001);对照组与观察组总体不良反应发生率相比,差异无统计学意义(P>0.05)。结论通过使用复方阿替卡因对牙体牙髓病患儿进行浸润麻醉,可提高麻醉总有效率,降低患儿疼痛感,缩短麻醉起效时间,且不良反应无明显增加。     

碧兰麻在一次性根管治疗中的麻醉效果观察

【目的】观察碧兰麻在一次性根管治疗中的麻醉效果。【方法】200 颗牙齿随机应用碧兰麻及利多卡因(对照组)作浸润或阻滞麻醉,采用标尺VAS法评价麻醉效果。【结果】碧兰麻组有效率为96%,利多卡因组有效率为86%,差异有显著性(P <0.05)。【结论】碧兰麻应用于一次性根管治疗明显优于利多卡因。     

奥硝唑合剂对牙体牙髓病的临床疗效

观察奥硝唑合剂治疗牙体牙髓病的临床效果。抽取门诊收治的142例牙体牙髓病患者为研究对象,采用双盲随机法分为对照组与观察组各71例,对照组行常规治疗,观察组在对照组基础上加入奥硝唑合剂治疗,比较两组临床治疗效果。观察组治疗总有效率、不良反应发生率、VAS疼痛评分等指标明显优于对照组(P0.05)。奥硝唑合剂用于治疗牙体牙髓病疗效确切,有助于减少患者疼痛与不良反应发生率,具有较高实用价值。     

碧兰麻应用于拔牙患者的效果与不良反应观察

目的观察复方盐酸阿替卡因注射液(碧兰麻)在拔牙术中的无痛治疗效果,以及有无不良反应。方法选择门诊常规拔牙患者180例,随机分为观察组90例,使用碧兰麻注射液和压力注射器;对照组90例,使用2%利多卡因注射液和一次性5ml注射器。观察两组注射中疼痛值、手术中麻醉效果和不良反应发生情况。结果观察组注射过程中和手术过程中疼痛程度较对照组均有显著性差异(P<0.001);两组不良反应发生率差异无显著性统计学意义(P>0.05)。结论碧兰麻用于拔牙术有明显的无痛治疗效果,且不良反应与传统麻醉剂基本无差别。     

冠修复+根管填充同步治疗成人隐裂性牙髓病的体会

目的:探讨冠修复与根管填充同步治疗隐裂性牙髓病的临床效果。方法:选取2016年5月~2018年1月我院收治的116例隐裂性牙髓病患者为研究对象,按照随机数字表分为观察组58例(70颗患牙)和对照组58例(74颗患牙)。观察组实施冠修复与根管填充同步治疗,对照组予以传统方案治疗。观察两组患者临床疗效。结果:观察组治疗总有效率显著高于对照组(P0.05);治疗后2周,观察组咬合力水平明显高于对照组,力横向偏移量、闭合时间、干扰率水平均低于对照组(P0.05);治疗后3个月,两组不良反应发生率比较无显著性差异(P0.05)。结论:与传统治疗方法相比较,冠修复与根管填充同步治疗隐裂性牙髓病更易行有效。     

阿替卡因用于活髓后牙牙髓治疗时局部浸润麻醉的效果

目的观察阿替卡因、利多卡因用于活髓后牙牙髓治疗时局部浸润麻醉的效果。方法将152例(191颗牙)活髓后牙须进行牙髓治疗的患者按患病的部位分为2组,上颌患牙(106颗)为A组,下颌患牙(85颗)为B组,2组再分为治疗组和对照组2个亚组,分别注射阿替卡因或利多卡因进行局部浸润麻醉,注射5min后开始进行牙髓治疗。采用VAS法对各组注射时的疼痛程度及麻醉效果进行比较。结果 A、B 2组中治疗组的麻醉成功率分别为98.1%和79.1%,对照组的麻醉成功率分别为81.1%和31.0%,治疗组局部浸润麻醉效果高于对照组(均P<0.05);治疗组注射疼痛程度低于对照组(P<0.05)。A组中治疗组局部浸润麻醉效果高于B组治疗组(P<0.05)。结论阿替卡因局部浸润麻醉效果优于利多卡因,注射疼痛程度低于利多卡因,上颌后牙局部浸润麻醉效果明显优于下颌后牙。     

复方阿替卡因用于老年牙髓病麻醉效果分析

分析复方阿替卡因在老年牙髓病治疗中的临床效果。选择就诊的122例老年牙髓病患者按随机数字表法分为对照组和试验组各61例,对照组注射利多卡因,试验组采用复方阿替卡因进行麻醉,对比分析两组起效时间、临床效果及不良反应。结果 (1)试验组复方阿替卡因麻醉起效时间为(1.8±0.6)min,对照组为(4.7±0.8)min,差异显著(t=4.325,P0.05)。(2)对照组优49例为,优秀率为80.33%;试验组优56例,优秀率为91.80%;试验组优秀率显著高于对照组(P0.05)。(3)对照组出现不良反应6例,不良反应发生率为9.84%;试验组出现不良反应1例,不良反应发生率为1.64%;两组不良反应发生率差异显著(χ~2=4.876,P0.05)。复方阿替卡因在老年牙髓病治疗中麻醉时间较短,临床效果较好,不良反应发生率较低,具有推广应用价值。     

小剂量布比卡因腰麻-硬膜外阻滞麻醉在高龄股骨颈骨折髋关节置换术中的应用效果及对患者应激反应的影响

目的探讨小剂量布比卡因腰麻-硬膜外阻滞麻醉在高龄股骨颈骨折髋关节置换术中的应用效果及对患者应激反应的影响。方法选取2017年2月至2019年1月78例高龄股骨颈骨折患者,均行髋关节置换术,依据麻醉方案不同分组,每组39例。观察组予以小剂量布比卡因腰麻-硬膜外阻滞麻醉,对照组予以全身麻醉。比较两组麻醉起效时间、术后镇痛效果、不良反应发生率及麻醉前、麻醉5、15、20、30 min、术毕平均动脉压(MAP)、心率(HR)水平。结果两组麻醉前、术毕MAP、HR水平比较,差异未见统计学意义(P0.05)。麻醉5、15、20、30 min,观察组MAP、HR水平均高于对照组(P0.05)。观察组麻醉起效时间短于对照组,术后VAS评分低于对照组(P0.05)。观察组不良反应发生率(7.69%,3/39)低于对照组(25.64%,10/39,P0.05)。结论高龄股骨颈骨折患者术中采用小剂量布比卡因腰麻-硬膜外阻滞麻醉,可显著缩短麻醉起效时间,减轻术中应激反应程度,提高术后镇痛效果,且安全性高,值得推广与应用。     

阿替卡因肾上腺素注射液(碧兰麻)对牙髓麻醉效果的临床观察

目的观察用两种阿替卡因肾上腺素注射液（碧兰麻）麻醉方法进行牙髓麻醉的临床效果.方法203颗上下颌前磨牙和磨牙随机分成两组,实验组进行局部浸润麻醉,对照组进行局部浸润麻醉加髓腔注射.观察碧兰麻对开髓拔髓的麻醉效果以及上下颌牙齿对碧兰麻的反应.结果碧兰麻对上颌牙齿的麻醉优于对下颌牙齿的麻醉,差异具有显著性（P＜0.01）.实验组和对照组拔髓术的比较中,实验组优于对照组,下颌牙齿的比较差异具有显著性（P＜0.01）.结论采用碧兰麻局部浸润麻醉加髓腔注射可明显减轻牙髓治疗的疼痛.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

妊娠合并血小板减少症与心、肝、肾脏器损伤

目的探讨妊娠合并血小板减少症伴随重要脏器的损伤情况。方法前瞻性研究我院及北华大学附属医院2004年10月至2005年5月妊娠合并血小板减少症的临床资料，对41例妊娠合并血小板减少症者尿素氮（BUN）、肌酐（CREA）、谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）的测定及妊娠期高血压疾病与血小板计数（PLT），血小板平均体积（MPV）和血小板体积分布宽度（PDW）参数的测定进行对比分析。结果妊娠合并血小板减少症患者心、肝、肾等重要脏器均有不同程度的改变，且随着血小板计数降低，损害程度加剧，差异具有显著性（P〈0．01）。妊娠期高血压疾病，随着疾病程度的加重，血小板计数较正常孕妇明显减少，MPV、PDW明显升高，有显著性差异（P〈0．01）。结论血小板参数是判断疾病的重要参考指标，肝、肾、心脏器损伤程度与血小板计数具有相关性。