Long-term clinical performance of flapless implant surgery compared to the conventional approach with flap elevation: A systematic review and meta-analysis

BACKGROUND The conventional implant approach involves flap elevation,which may result in increased soft tissue and bone loss and postoperative morbidity.The flapless surgical technique,aided by three-dimensional medical imaging equipment,is regarded as a possible alternative to the conventional approach to alleviate the above issues.Several studies have been performed regarding the role of flapless implant surgery.However,the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.AIM To compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.METHODS PubMed,EMBASE,Cochrane Central Register of Controlled Trials,and grey literature databases were searched from inception to 23 September 2019.Randomised controlled trials(RCTs)and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were included.Meta-analyses were conducted to estimate the odds ratios(ORs)or mean differences(MDs)and their 95%confidence intervals(CIs)between the long-term implant survival rate,marginal bone loss,and complication rate of the flapless and conventional groups.Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.RESULTS Ten articles,including four RCTs and six cohort studies,satisfied the eligibility criteria and nine of them were included in the meta-analysis.There was no significant difference between the long-term implant survival rate[OR=1.30,95%CI(0.37,4.54),P=0.68],marginal bone loss[MD=0.01,95%CI(-0.42,0.44),P=0.97],and complication rate[OR=1.44,95%CI(0.77,2.68),P=0.25]after flapless implant surgery and the conventional approach.Moreover,subgroup analyses revealed that there was no statistically significant difference between the implant survival rate[guided:OR=1.52,95%CI(0.19,12.35),P=0.70];free-hand:n=1,could not be estimated,marginal bone loss[guided:MD=0.22,95%CI(-0.14,0.59),P=0.23;free-hand:MD=-0.27,95%CI(-1.10,0.57),P=0.53],or complication rate[guided:OR=1.16,95%CI(0.52,2.63),P=0.71;free-hand:OR=1.75,95%CI(0.66,4.63),P=0.26]in the flapless and conventional groups either with use of the surgical guide or by the free-hand method.CONCLUSION The flapless surgery and conventional approach had comparable clinical performance over three years or more.The guided or free-hand technique does not significantly affect the long-term outcomes of flapless surgery.     

迟缓青霉素过敏反应高热休克1例

患者,女,38岁,教师。既往健康,因患上呼吸道感染1周,来院就诊,青霉素皮试(-),加入5%葡萄糖注射液500m l静脉滴注。上午11时静脉滴注结束,当日无不良反应及不适,下午正常生活。第2日上午继续静脉点滴青霉素800万U。批号、方法同前。11∶30静脉滴注结束,身体无不适。未用其他任何药物。13∶30在家中出现心悸、气短、胸闷、寒战、高热、脉搏细数。查体:体温40.3℃,心率124次/分,呼吸12次/分,血压测不清。急性痛苦病容,神志恍惚,烦躁不安,强迫体位,寒战,高热,张口呼吸,呼吸极度困难,带有喘鸣音,语音微弱,吐字不清,全身皮肤苍白,双眼球上翻,颈静…     

运用心理知识做好门诊医患纠纷协调工作

随着人们对医疗服务需求的日益增长以及法律意识和维权观念的不断增强,医患纠纷呈不断上升趋势.门诊是医院的一个"大窗口",人员流动性大,病人需经过挂号、看病、划价、取药、检查等许多过程,身心极易疲惫,情绪会变得烦躁、易怒,很容易与医务人员发生冲突,因此门诊是医患纠纷易发场所.所以运用心理知识做好门诊医患纠纷协调工作显得尤为重要.     

泌尿系结石患者的饮食管理

泌尿系结石的形成与食物的组成有关。根据文献报道，能影响泌尿系结石形成的食物成分有蛋白质、脂肪（胆固醇、鱼油、多不饱和脂肪酸）、糖类、嘌呤、草酸、矿物质（钙、镁、钠等）、维生素（A、B6、D、C、K）、蔬菜（菠菜）、磁化水、乳制品、液体、微量元素等。改变饮食习惯或进行饮食控制，有助于预防结石复发。     

全膝人工关节股骨假体屈曲对疗效的影响:1年随访结果

背景:对于全膝人工关节置换术的股骨假体屈曲问题,多数人认为不能或不太影响膝关节术后功能,仅仅是术后X射线片令人不甚满意,因此尚未引起人们足够的重视.目的:回顾分78例123膝全膝人工关节置换术股骨假体屈曲对随访疗效的影响.设计:分组对比观察.单位:中国中医科学院望京医院骨关节一科.对象:选择2001-10/2004-06在中国中医科学院望京医院关节一科行全膝人工关节置换者78例123膝,其中发生股骨假体不同程度屈曲15例17膝(13.8%),男5例,女10例,年龄47～81岁:未发生屈曲63例106膝(86.2%),男22例,女41例,年龄47～79岁.方法:回顾性分析方法比较股骨假体屈曲组和非屈曲组手术前后HSS(HSS knee rating score)评分、膝关节活动范围和屈曲挛缩畸形,并测量屈曲角和屈曲距离,股骨假体屈曲对置换效果的影响.主要观察指标:①股骨假体屈曲的测量结果.②患者膝关节HSS评分和活动度.③患者屈曲挛缩畸形例数及角度.④不良事件及副反应.结果:患者获随访1年以上.①17膝股骨假体屈曲角为7°～19°,平均为11.3°;股骨假体屈曲距离为2～4 mm,平均为2.6 mm.②术前屈曲组与非屈曲组患者HSS评分和膝关节活动范围差异均无显著性(P＞0.05),但术后屈曲组低于非屈曲组(P≤0.01);术后均高于术前(P=0.02或P＜0.01).③屈曲组术后屈曲挛缩例数和角度多于和大于非屈曲组(P＜0.01),两组术后屈曲挛缩均有改善(屈曲组P＜0.05,非屈曲组P＜0.01).④非屈曲组并发右股深静脉血栓1例,骨化性肌炎1例;屈曲组并发髌骨假体撞击征1膝.结论:本组资料证明,股骨假体屈曲对全膝人工关节置换效果的影响是增加术后膝关节屈曲挛缩的发生率,造成伸膝功能障碍.     

Laparoscopic repair of complete intrathoracic stomach with iron deficiency anemia:A case report

BACKGROUND Giant paraesophageal hiatal hernias(HH)are very infrequent,and their spectrum of clinical manifestations is large.Giant HH mainly occurs in elderly patients,and its relationship with anemia has been reported.For the surgical treatment of large HH,Nissen fundoplication is the most common antireflux procedure,and the reinforcement of HH repair with a patch(either synthetic or biologic)is still debatable.CASE SUMMARY We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia.After performing a series of tests and diagnostic approaches,results showed a complete intrathoracic stomach associated with severe iron deficiency anemia.The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication.Postoperatively,reflux symptoms were markedly relieved,and the imaging study showed complete reduction of the hernia sac.More importantly,anemia was resolved,and hemoglobin,serum iron and ferritin level were returned to the normal range.The patient kept regular follow-up appointments and remained in a satisfactory condition.CONCLUSION This case report highlights the relationship between large HH and iron deficiency anemia.For the surgical treatment of large HH,laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.     

Rare anaplastic sarcoma of the kidney:A case report

BACKGROUND Anaplastic sarcoma of the kidney(ASK)is a rare and newly recognized renal neoplasm.The tumor usually is extensive and cystic,characterized by pleomorphic spindle cells with marked atypia and associated with multinucleated cells.To date,only 27 cases have been reported in the literature.The authors present an additional case and summarize the relevant knowledge in the literature.CASE SUMMARY A 27-year-old previously healthy woman presented with a palpable mass over the abdomen and right flank soreness for one year.After the computed tomography study,the patient underwent right radical nephrectomy obtaining a 1680-g tumor with a size of 18.4 cm×14.5 cm×11 cm.The tumor is chiefly composed of anaplastic spindle cells with marked nuclear atypia admixed with multinucleated cells.Immunohistochemical evaluation of tumor cells exhibited diffuse positivity for CD56,p53,and vimentin,and focally positive for desmin.The diagnosis of ASK was established.Unfortunately,a local tumor recurrence followed by a distant metastasis developed within months.The patient died 26 months after the initial surgery.Comparing to the previously 27 cases of ASK,the current case had a relatively worse prognosis,which might be potentially associated with older patient age,larger tumor size,and the lack of en-bloc resection of adjacent organs during the initial radical nephrectomy.CONCLUSION This case points out the featured pathological findings for diagnosing ASK and suggests more aggressive management for patients with ASK.     

柳硼酊巧治灰指甲

灰指甲是由皮肤真菌侵犯甲板所致的一类疾病,多表现为甲板失去光泽、增厚变形,因变脆而破裂、缺失,病甲呈灰白、污黄色,临床多见,且顽固难治.笔者用柳硼酊(由本院药剂科配制)治疗该病5例,均治愈.现将此方法介绍如下.     

纳米级阳离子聚合物优化转染siRNA的研究

背景:转染是基因研究最关键的始动环节,高效安全的基因转染试剂是基因研究的热点问题.纳米级材料表面活性强,易于表面修饰,膜通透性高,如何将物质纳米化应用于基因转染尚在探索之中.目的:观察不同分子质量、结脂度的纳米级阳离子聚合物的转染效率,筛选低毒、高效的优化转染试剂.设计:对照实验.单位:南方医科大学基因研究所.方法:实验于2006-03/2007-06在南方医科大学基因工程研究所实验室完成.以脂质体为阳性对照,将9种不同分子质量、结脂度的纳米级阳离子聚合物聚乳酸聚乙醇酸、壳聚糖-聚己内酯、聚乙烯亚胺-聚乙二醇,包裹FITC标记的以bcl-2基因为靶标的siRNA(0.2 nmol/L),转入无血清培养的白血病细胞株K562,于转染后6 h后补加20%胎牛血清培养基.MTT法测定24,48,72 h后细胞增殖状况,荧光显微镜检测转染48 h后各纳米材料转染效率,流式细胞仪检测白血病细胞株K562细胞Bcl-2蛋白的表达和凋亡率.结果:①荧光显微镜结果:不同材料的纳米级颗粒,其转染效率有统计学差异(P < 0.05),同种材料的纳米结构因其结脂度不同,其转染效率也有统计学差异(P < 0.05).②MTT结果:表明细胞增殖率与转染率正相关.③流式细胞仪结果表明:转染siRNA引起的靶基因表达抑制以及细胞凋亡率与转染效率正相关.结论:分子质量为1 800/2 000,脂结合力为29%的纳米级聚乙烯亚胺-聚乙二醇颗粒,为低毒、高效的转染试剂.     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

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.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.