Evaluation of various factors for extraction of teeth in a rural dental college

Aims and objectivesTo investigate the various major and minor reasons for extraction of permanent teeth, taking into consideration various factors such as age, gender, type of teeth being extracted, extent of pathology and non willingness of the patient to save the teeth.Materials and methodsThis study consisted of 1608 patients out of which 840 were males and 768 were females. All these patients had reported to the College of Dental Science & Hospital, Rau, Indore, for extraction of teeth during October 2011 to May 2012. All possible reasons for extraction of teeth were considered and noted down in a preformed chart.ResultsA total of 1790 teeth were extracted in 1608 patients. Males underwent more extractions as compared to females. Middle age group patients of 30–40 years of age had the maximum number of extractions. Dental Caries was the main reason for extraction of teeth.ConclusionDental Caries and Periodontitis still remain the two most important reasons for extraction of teeth. Knowing the etiologic factors will help us treat and prevent them so as to improve the dental health of the general population.     

Current Microsatellite Instability Testing in Management of Colorectal Cancer

Colorectal cancer (CRC) is the third most common cancer worldwide. In the past decade, mismatch repair deficiency (dMMR), manifested as microsatellite instability-high (MSI-H), has been recognized as a distinct mechanism promoting tumorigenesis in 15% of CRCs including 3% Lynch syndrome and 12% sporadic CRCs. As the molecular classifications of CRCs are continuously evolving, MSI-H CRCs appear to be the most homogeneous CRCs with distinct molecular, morphologic, and clinical features. MSI-H CRCs have dMMR causing MSI-H and genetic hypermutation but with diploid chromosomes. Morphologically, MSI-H CRCs appear as poorly differentiated or mucinous adenocarcinoma with characteristic lymphocytic infiltration. Most importantly, MSI-H CRCs have better stage-adjusted survival, do not respond well to standard 5-fluorouracil–based adjuvant chemotherapy, but do respond to immunotherapy. The United States Food and Drug Administration granted accelerated approval to immune checkpoint inhibitors, anti-programmed cell death protein-1 antibodies pembrolizumab and nivolumab, and the combination of nivolumab with anti-CTLA4 antibody ipilimumab for the second-line treatment of patients with stage IV MSI-H CRCs in 2017. There are still ongoing phase III clinical trials evaluating pembrolizumab and anti-programmed death-ligand 1 antibody atezolizumab as the first-line treatment in stage IV MSI-H CRCs and a phase I study on the combination of nivolumab and ipilimumab in patients with early stage CRC. These ongoing clinical studies on immunotherapy may lead to practice-changing results in the management of MSI-H CRCs. The National Comprehensive Cancer Network 2018 guidelines recommended MSI to be tested in all newly diagnosed CRCs. The MSI test will become increasingly vital in guiding adjuvant chemotherapy and immunotherapy in the management of CRCs.     

经鼻胃 / 肠管营养治疗途径

肠内营养是经胃肠道提供代谢需要的营养物质的营养治疗方式。肠内营养治疗途径主要包括口服、管饲（鼻胃管、 鼻肠管）和胃肠造瘘术等。选择合理的肠内营养治疗途径、防治并发症是提供良好营养治疗的重要保证。鼻胃管、鼻肠 管作为临床中最常用的肠内营养治疗途径,满足了医生及患者对肠内营养治疗的需求。鼻胃管、鼻肠管途径具有置管无创、 使用简单、经济、安全等优点,在国内大、中型医院均有应用。本文对经鼻胃管和鼻肠管途径在肠内营养治疗中的应用 背景进行了说明,分析了不同疾病患者应用时的优缺点以及出现的并发症,并且总结比较了鼻胃管饲与鼻肠管饲应用的 适应证、禁忌证以及并发症,对经鼻胃管和鼻肠管途径应用的选择提出了推荐意见。     

恶性肿瘤患者膳食营养处方专家共识

肿瘤患者营养不良和恶液质发生率极高。营养不良可能引起患者治疗耐受性下降,治疗机会减少,并发症增加, 发病率和死亡率增加,住院时间延长,生存期缩短。这些不仅严重影响治疗效果、降低患者生活质量,还造成了巨大的经济损失和社会医疗资源的浪费。营养治疗作为临床治疗及康复的基础手段之一,国内外大量循证医学证据表明,合理、有效地提供营养支持,并不会增加肿瘤复发率或转移率、降低生存率,反而可明显提高肿瘤患者术后营养和免疫状况,减少术后并发症和感染的发生,提高患者救治率、降低病死率,降低药占比及医疗支出,对大部分营养不良肿瘤患者具有积极意义。为了更好地将肿瘤的医学营养治疗理论落实到临床实践,本共识根据国内外现有研究证据,从肿瘤与营养的关系出发,并结合我国膳食现状和特点,对该领域的研究结果进行系统总结,逐一分析膳食营养因素对肿瘤患者的影响,规范肿瘤医学营养治疗原则和步骤,以便临床医师、临床营养专业人员、护士等医疗保健人员应用,更好地为肿瘤患者服务。     

中国新生儿营养支持临床应用指南

推荐意见强度分级 指南参考美国肠内肠外营养学会2000年指南,依据证据等级强度,将推荐意见分为A、B、C三个等级(表1).     

规范化外科营养诊疗示范病房标准

外科手术患者营养不良发生率高，围手术期的禁食禁水、有创操作、手术打击、长期卧床等因素均会导致机体分解代谢增 加、炎症反应加剧、蛋白质稳态失衡，进一步加重营养不良。营养不良不仅影响手术治疗的临床决策，还会增加并发症发生率和病死 率，降低患者的生活质量，影响患者的临床结局。合理、有效、规范的外科营养治疗可以改善患者能量平衡，增加生理储备，加速术后 康复。外科医师对营养治疗的理解尚不充分，存在应用不足与应用过度并存的现象。因此，建立外科营养治疗规范化标准显得尤为 重要。本标准旨在建立完善的外科营养规范化管理体系，推动外科营养治疗的合理应用，在防治营养不良，维护患者医疗安全，提高 患者生活质量，节约医疗费用等方面具有重要意义。希望本标准的发布能够为我国外科营养治疗提供理论指导，为提高我国临床营 养及加速康复外科事业的发展贡献力量。