慢性牙周炎患者翻瓣术后TNF-a水平和牙周临床指数的变化及意义

目的研究慢性牙周炎患者翻瓣术后TNF-a水平和牙周临床指数的变化及意义。方法选取我院口腔科2012年6月—2013年6月治疗的慢性牙周炎患者80例,按照随机数字表法分为观察组(40例)和对照组(40例)。观察组给予慢性牙周炎翻瓣术治疗,对照组给予慢性牙周炎支持疗法,病变区行龈下刮治和根面平整术,观察两组患者治疗前后血液TNF-a水平和牙周探测深度(PD)、菌斑指数(PLI)、龈钩出血指数(SBI)等牙周临床指标变化情况。结果治疗前两组患者TNF-a、PD、PLI及SBI水平比较差异均无统计学意义(均P0.5);治疗后两组患者TNF-a、PD、PLI及SBI水平均低于治疗前,但仅观察组差异有统计学意义(均P0.05);治疗6周后,观察组患者TNF-a、PD、PLI及SBI水平均低于对照组,差异有统计学意义(均P0.05)。观察组患者治疗前血清TNF-a水平与PD、PLI和SBI之间呈正相关关系(P0.05),治疗后患者血清TNF-a水平与PD、PLI及SBI之间均无显著的相关性(P0.05)。结论慢性牙周炎翻瓣术治疗可以明显降低TNF-a水平,并且改善牙周临床指数,同时TNF-a水平及牙周临床指数的变化可以反映牙周炎的治疗效果和病情变化。     

牙周炎患者病原菌感染状况及RANKL/OPG变化

目的探讨牙周炎患者的病原学状况及核因子κB受体活化因子配体(RANKL)/骨保护素(OPG)变化,为牙周炎的临床预防与治疗提供依据。方法选取130例牙周炎患者作为观察组,另选取体检健康者50名作为对照组。比较2个组受检牙的牙周探诊深度(PD)、附着丧失(AL)、菌斑指数(PLI)和龈沟出血指数(SBI)等指标,分离鉴定病原菌,比较2个组龈沟液RANKL和OPG的差异,分析观察组的临床检查结果与RANKL、OPG的相关性。结果观察组受检牙的PD、AL、PLI和SBI指标高于对照组(P0.05)。观察组牙龈卟啉单胞菌、伴放线放线菌、生痰二氧化碳嗜纤维菌和齿蚀拟杆菌的检出率明显高于对照组(P0.05)。观察组龈沟液中RANKL水平和RANKL/OPG高于对照组,OPG水平低于对照组(P0.05)。观察组OPG水平与PD和AL呈负相关(P0.05),RANKL水平和RANKL/OPG与PD和AL无相关性(P0.05),RANKL水平、OPG水平及RANKL/OPG与PLI和SBI均无相关性(P0.05)。结论牙龈卟啉单胞菌、伴放线放线菌和生痰二氧化碳嗜纤维菌是牙周炎的主要致病菌,RANKL和OPG在牙周炎患者的牙槽骨组织破坏过程中发挥作用。     

全程护理在牙齿洁治术治疗牙周炎患者中的效果研究

目的 观察牙周炎患者行牙齿洁治术治疗期间的护理现状,行全程护理,探讨该模式的临床应用效果.方法 随机数表法将2018年1月—2018年12月期间在我院行牙齿洁治术治疗88例牙周炎患者随机分为对照与研究两组,分别行常规护理与全程护理,对比两组依从性及牙齿状态的差异.结果 研究组依从性总分(89.8±9.3)分,显著高于对照组依从性总分(45.6±8.5)分(P<0.05);两组护理前牙龈指数(GI)、菌斑指数(PLI)、探针深度(PD)、龈沟出血指数(SBI)以及牙周附着水平(AL)状况无差异(P>0.05),护理后28天研究组GI、SBI、PD、PLI及AL状况均优于对照组(P<0.05).结论 接受牙齿洁治术治疗的牙周炎患者围术期中行全程护理,可有效提高其依从性,改善牙齿状况,临床疗效理想,该方式具有较高临床应用价值,值得在临床中推广应用.     

慢性牙周炎患者龈沟液IL-6、TNF-α、MMP-8水平及临床意义

目的探讨慢性牙周炎患者龈沟液中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-8(MMP-8)水平及与牙周指标的相关性,以及牙周基础治疗对其的影响。方法选取2016年5月至2019年5月于安康市人民医院口腔门诊就诊的205例慢性牙周炎患者作为患者组,根据牙周指标分为轻中度组[牙周各大探诊深度(PD)≤5mm,附着丧失(AL)5mm,82例]和重度组(PD≥5mm,AC≥5mm,123例);另外,选取同期牙周健康体检者100例为对照组。收集对照组体检时和患者组牙周基础治疗前后的牙周指标[牙龈沟出血指数(SBI)、菌斑指数(PLI)、PD和AL],检测龈沟液IL-6、TNF-α、MMP-8水平,分析各指标相关性,并观察牙周基础治疗对这些指标的影响。结果对照组、轻中度组、重度组龈沟液IL-6、TNF-α、MMP-8水平依次升高,差异均有统计学意义(P0.05);对照组、轻中度组、重度组患者PD依次升高,差异有统计学意义(P0.05);重度组患者SBI、PLI、AL均高于轻中度组,差异有统计学意义(P0.05);Pearson相关分析显示,患者组治疗前龈沟液IL-6水平与SBI、PLI、PD、AL均呈正相关关系(r=0.623、0.726、0.531、0.573,P0.05);患者组治疗前龈沟液TNF-α水平与SBI、PD呈正相关(r=0.514、0.675,P 0.05);患者组治疗前龈沟液MMP-8水平与PLI、PD、AL呈正相关(r=0.462、0.593、0.534,P0.05);患者组患者龈沟液IL-6、TNF-α、MMP-8水平低于治疗前,差异均有统计学意义(P0.05);牙周基础治疗后,患者组患者龈沟液IL-6、TNF-α、MMP-8水平仍高于对照组,差异有统计学意义(P0.05)。结论牙周炎患者的龈沟液中IL-6、TNF-α、MMP-8水平均出现明显升高,并且与多种牙周炎临床指标具有相关性。龈沟液中这3项指标的水平监测,对于判断牙周炎的严重程度、疗效和预后具有积极的作用。     

牙龈环切辅助牙周炎患牙正畸压低对牙周炎患牙预后的影响

目的探讨牙龈环切辅助牙周炎患牙正畸压低对牙周炎患牙预后的影响。方法选取伴有附着丧失的牙周炎患者86例,按照随机数字表法分为研究组和对照组各43例。所有患者牙周基础治疗后进行正畸治疗。研究组在排齐整平阶段配合牙龈环切治疗,对照组不行牙龈环切。对2组的牙周状况、IL-1β及TNF-α水平、牙根长、牙骨与牙槽嵴顶间距离(CEJAC)、冠根比、牙槽骨吸收比例(ABLR)、复发率等指标变化进行比较。结果 2组治疗前、后的牙周探诊深度(PD)、平均附着丧失(AL)、菌斑指数(PLI)、龈沟出血指数(SBI)、探诊出血(BOP)相比有显著差异(P0.05),且2组治疗后的PD、AL、PLI、SBI、BOP相比有显著差异(P0.05)。研究组治疗后IL-1β、TNF-α水平显著低于治疗前(P0.05),且显著低于对照组治疗后(P0.05)。2组患者治疗前、后牙根长、CEJ-AC、冠根比、ABLR相比有显著差异(P0.05),且2组治疗后牙根长、CEJAC、冠根比、ABLR相比有显著差异(P0.05)。研究组复发率为16.28%,显著低于对照组的41.86%(P0.05)。结论牙龈环切辅助牙周炎患牙正畸压低可有效提高牙周状况,减少炎症因子的释放,提高周围牙槽骨高度和治疗效果。     

派力奥软膏辅助治疗成人重度牙周炎的临床观察

目的:探讨派力奥软膏辅助治疗成人重度牙周炎的临床效果。方法:选取本疾控中心2017年10月～2018年4月收治的64例成人重度牙周炎患者作为研究对象,随机分为实验组和对照组各32例。实验组予以派力奥软膏治疗,对照组予以碘甘油治疗。比较两组不同时间段PLI、SBI、PD、AL。结果:基线时,两组PLI、SBI、PD、AL比较无显著性差异(P0.05);治疗后1个月,实验组SBI、PD、AL明显低于对照组(P0.05);治疗后3个月、6个月,实验组PLI、SBI、PD、AL明显低于对照组(P0.05)。结论:派力奥软膏辅助治疗成人重度牙周炎的效果极佳,值得临床推广。     

牙周联合正畸治疗侵袭性牙周炎患者的疗效 及对牙周临床指数和牙周功能的影响

目的探讨牙周联合正畸治疗侵袭性牙周炎患者的疗效及对牙周临床指数、牙周功能的影响。方法采用回顾性研究的方法,选取2015年6月至2017年12月莱芜市人民医院口腔科收治的98例侵袭性牙周炎患者,按照治疗方法的不同将患者分为对照组和观察组,每组各49例。对照组患者给予基础性牙周治疗,观察组患者给予基础性牙周联合正畸治疗,观察并比较两组患者的临床疗效、治疗前后牙周临床指数的变化及牙周功能等指标。结果对照组的总有效率79. 6%,观察组的临床总有效率91. 8%,观察组患者的临床总有效率高于对照组,差异具有统计学意义(P0. 05)。治疗前,两组患者的出血指数(BI)、牙龈指数(GI)和菌斑指数(PLI)差异无统计学意义(P 0. 05);对照组患者治疗后BI、GI和PLI指数均高于观察组,差异具有统计学意义(P 0. 05)。治疗前,两组患者的牙周探诊深度(PD)和附着丧失水平(AL)差异无统计学意义(P 0. 05);对照组患者治疗后的PD和AL值高于观察组,差异具有统计学意义(P 0. 05)。结论与基础性牙周治疗相比,牙周联合正畸治疗侵袭性牙周炎患者可有效提高其临床疗效,降低侵袭性牙周炎患者的牙周临床指数,改善牙周功能,值得在临床上推广应用。     

葛根芩连汤治疗慢性牙周炎合并动脉粥样硬化的疗效及机制分析

目的探讨葛根芩连汤治疗慢性牙周炎合并动脉粥样硬化的疗效及机制。方法将64例慢性牙周炎合并动脉粥样硬化患者分为两组,每组32例。对照组给予牙周基础治疗。观察组在对照组基础上口服葛根芩连汤。对比两组治疗前后牙周症状、血脂水平、炎性因子的变化。结果治疗后,两组探针深度(PD)、牙周附着水平(AL)、出血指数(SBI)、菌斑指数(PLI)明显降低,差异有统计学意义(P0.05);观察组PD、AL、SBI、PLI明显低于对照组,差异有统计学意义(P0.05)。治疗后两组三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)明显降低,高密度脂蛋白胆固醇(HDL-C)明显升高,差异有统计学意义(P0.05);观察组TG、TC、LDL-C明显低于对照组,HDL-C明显高于对照组,差异有统计学意义(P0.05)。治疗后两组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)明显降低,观察组TNF-α、IL-6、hs-CRP明显低于对照组,差异均有统计学意义(P0.05)。结论葛根芩连汤治疗慢性牙周炎合并动脉粥样硬化的疗效确切,能明显改善患者牙周症状,调节血脂水平,减轻炎性反应。     

基于个案分析的针对性护理对牙周炎患者自我效能及遵医行为的影响

目的探究基于个案分析的针对性护理在牙周炎患者中的应用效果。方法选取郑州大学第一附属医院2021年5月～2022年8月就诊的牙周炎患者102例, 以随机数字表法分为两组, 对照组、观察组各51例。两组均对症治疗, 对照组予以常规护理干预, 观察组在前者基础上予以基于个案分析的针对性护理。对比两组牙周指标〔牙周袋深度(PD)、菌斑指数(PLI)、龈沟出血指数(SBI)〕、遵医行为、焦虑自评量表(SAS)、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)、口腔保健自我效能量表(SESS)评分。结果干预后观察组PD、SBI、PLI均较对照组低(P<0.05);观察组遵医行为优于对照组(P<0.05);干预后与对照组相比, 观察组SESS、WHOQOL-BREF较高, SAS较低(P<0.05)。结论基于个案分析的针对性护理应用于牙周炎患者护理中, 不仅能增强患者自我效能感, 减轻不良情绪, 还能提高遵医行为, 改善牙周健康, 从而提高患者生活质量。     

牙周基础治疗联合抗生素治疗牙周炎合并糖尿病60例疗效观察

目的观察抗生素联合牙周基础治疗对中重度慢性牙周炎合并2型糖尿病患者牙周指数和糖代谢的影响。方法60例中重度慢性牙周炎合并2型糖尿病患者随机分为观察组和对照组各30例。2组糖尿病治疗方案相同,对照组牙周病采取牙周基础治疗,观察组在对照组治疗基础上联合应用抗生素。记录并比较2组治疗前和治疗后3个月牙周探诊深度(probing depth,PD)、菌斑指数(plaque index,PLI)、临床附着丧失(clinic attachment loss,CAL)、出血指数(sulcus bleeding index,SBI)及空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycosylated hemoglobin,HbA_1c)水平。结果 2组治疗前HbA_1c、FPG水平及PD、PLI、SBI、CAL比较差异均无统计学意义(P0.05);对照组治疗后PD[(3.65±0.26)mm]、PLI(1.51±0.33)、SBI(1.79±0.16)及FPG[(7.85±1.25)mmol/L]、HbA1c[(6.96±1.46)%]水平均较治疗前[PD(6.38±0.50)mm、PLI为2.78±0.65、SBI为3.02±0.27、FPG(9.65±1.04)mmol/L、HbA_1c(7.93±1.75)%]降低(P0.05),CAL[(4.43±0.72)mm]与治疗前[(5.09±0.55)mm]比较差异无统计学意义(P0.05);观察组治疗后PD[(3.06±0.34)mm]、PLI(1.13±0.34)、SBI(1.37±0.32)、CAL[(3.73±0.57)mm]、FPG[(6.93±1.20)mmol/L]和HbA_1c[(6.16±1.24)%低于治疗前[PD(6.26±0.48)mm、PLI为2.86±0.61、SBI为3.20±0.39、CAL(4.99±0.48)mm、FPG(9.70±1.43)mmol/L、HbA_1c(7.96±0.97)%](P0.05),且低于对照组治疗后,差异均有统计学意义(P0.05)。结论牙周基础治疗联合抗生素应用可促进中重度慢性牙周炎合并2型糖尿病患者牙周健康,改善糖代谢水平。     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.