Can a community‐based multidisciplinary intervention effectively restore renal function? A non‐randomized clinical trial

There is insufficient evidence in the literature to indicate whether the promotion of lifestyle changes to prevent renal dysfunction and activate regeneration is effective. We examined the effectiveness of a community‐based intervention program on renal restoration using a non‐randomized clinical trial design with a follow‐up period of six months. The training focused on lifestyle changes, including health education and personal consultation with a multidisciplinary health team. Our study included 120 patients with fractional excretion of magnesium levels of > 2%, who were assigned to experimental or control groups. Fractional excretion of magnesium levels were significantly decreased within six months in the experimental group; however, changes in the estimated glomerular filtration rate were not identified in either of the groups. These results suggest that screening of the fractional excretion of magnesium level and the “Healthy Kidney Program” had an effect in preventing chronic kidney disease or restoring kidney function.     

室壁瘤切除左心室成形加冠状动脉旁路移植术的护理配合

目的探讨室壁瘤切除左心室成形加冠状动脉旁路移植术(CABG)中的手术护理配合要点。方法总结58例室壁瘤切除左心室成形加冠状动脉旁路移植术的术中护理过程。结果手术顺利,无并发症及手术意外的发生。结论室壁瘤患者病情重,手术要求高,故周密的准备,密切的配合,是手术成功的关键。     

慢性牙周炎患者应用牙种植修复治疗的效果观察

〔摘 要〕 目的：观察慢性牙周炎患者应用牙种植修复治疗的临床效果。方法：随机选取 2018 年 7 月至 2019 年 7 月于 长沙市口腔医院进行牙种植修复的 82 例患者,按照是否患有慢性牙周炎分为两组,对照组为 41 例无慢性牙周炎患者,观 察组为 41 例患慢性牙周炎患者,比较两组患者治疗后的相关指标、牙槽骨吸收情况和种植成功率。结果：进行牙种植修复 治疗后,对照组患者的龈沟液（PISF）为（0.61 ± 0.19）μL、改良龈沟出血指数（mBI）为（1.14 ± 0.24）、牙种植体周袋 深度（PPD）为（2.45 ± 0.35）mm,均优于观察组,差异具有统计学意义（P ＜ 0.05）;对照组患者的牙槽骨吸收情况半 年后为（0.41 ± 0.24）mm、1 年后为（0.66 ± 0.11）mm,均优于观察组,差异具有统计学意义（P ＜ 0.05）;对照组患者 半年种植成功率为 92.68 %,1 年种植成功率为 90.24 %,均高于观察组的 75.61 %、70.73 %,差异具有统计学意义（P ＜ 0.05）。 结论：牙种植修复是治疗慢性牙周炎患者的有效方式,能够促进牙槽骨吸收,提升种植成功率,但此类患者的治疗效果比 非慢性牙周炎患者低。     

口腔种植修复治疗牙列缺损的效果分析

〔摘 要〕 目的： 评估牙列缺损患者选用口腔种植修复治疗及口腔常规修复治疗的修复效果。方法： 选取长沙市口腔医 院 2018 年 4 月至 2020 年 2 月期间收治的 64 例牙列缺损患者,以抽签方式分为对照组与观察组,各 32 例。观察组采取口 腔种植修复治疗方式,对照组采取口腔常规修复治疗方式,观察比较两组患者的疗效。结果： 观察组患者治疗总有效率为 96.88 %,高于对照组的 78.13 %,差异具有统计学意义（P ＜ 0.05）;观察组患者并发症发生率为 3.13 %,低于对照组的 18.75 %,差异具有统计学意义（P ＜ 0.05）;经修复治疗后,观察组患者在语言功能、固位能力、咀嚼能力、美观程度评 分均优于对照组,差异具有统计学意义（P ＜ 0.05）;观察组患者修复治疗后总满意度为 96.88 %,高于对照组的 75.00 %, 差异具有统计学意义（P ＜ 0.05）。结论： 和口腔常规修复治疗方法相比,为牙列缺损患者选用口腔种植修复治疗方式得 到的修复效果更优一些。     

Insomnia in a chronic musculoskeletal pain with disability population is independent of pain and depression

Background contextInsomnia is frequently experienced by patients suffering from chronic musculoskeletal disorders but is often seen as simply a symptom of pain or depression and not as an independent disorder. Compared with those who experience only chronic pain, patients with both chronic pain and insomnia report higher pain intensity, more depressive symptoms, and greater distress. However, insomnia has not yet been systematically studied in a chronic musculoskeletal pain with disability population.PurposesThis study assessed the prevalence and severity of patient-reported insomnia, as well as the relationship among insomnia, pain intensity, and depressive symptoms, in a chronic musculoskeletal pain with disability population.Study design/settingThis was a retrospective study of prospectively captured data.Patient sampleA consecutive cohort of 326 chronic musculoskeletal pain with disability patients (85% with spinal injuries) entered a functional restoration treatment program. All patients signed a consent form to participate in this protocol.Outcome measuresInsomnia was assessed with the Insomnia Severity Index, a validated patient-report measure of insomnia symptoms. Four patient groups were formed: no clinically significant insomnia (score, 0–7); subthreshold insomnia (score, 8–14); moderate clinical insomnia (score, 15–21); and severe clinical insomnia (score, 22–28). Three patterns of sleep disturbance were also evaluated: early, middle, and late insomnia. Additional validated psychosocial patient-reported data were collected, including the Pain Visual Analog Scale, the Beck Depression Inventory, the Oswestry Disability Index, and the Pain Disability Questionnaire.MethodsPatients completed a standard psychosocial assessment battery on admission to the functional restoration program. The program included a quantitatively directed exercise process in conjunction with a multimodal disability management approach. The four insomnia groups were compared on demographic and psychosocial variables. The shared variances among insomnia, depression, and pain were determined by partial correlational analyses.ResultsThe presence of no clinically significant insomnia, subthreshold insomnia, moderate clinical insomnia, and severe clinical insomnia was found in 5.5%, 21.2%, 39.6%, and 33.7% of the cohort, respectively. More than 70% of patients reported moderate to severe insomnia symptoms, which is a considerably higher prevalence than that found in most patient cohorts studied previously. A stepwise pattern was found, in which severe clinical insomnia patients reported the highest pain, the most severe depressive symptoms, and the greatest disability. The severe clinical insomnia patients also reported a higher number of sleep disturbance types (early, middle, and late insomnia) than the other three groups. In fact, 62.9% of them reported all three disturbance types. Although correlations were found between insomnia and depressive symptoms and between insomnia and pain, the shared variances were small (12.9% and 3.6%, respectively), indicating that depression and pain are separate constructs from insomnia.ConclusionThis research indicates that insomnia is a significant and pervasive problem in a chronic musculoskeletal pain with disability population. Most importantly, although insomnia has traditionally been assumed to be simply a symptom of pain or depression, the findings of the present study reveal that it is a construct relatively independent from both pain and depression. Specific insomnia assessment and treatment is therefore recommended for this chronic musculoskeletal pain with disability population.     

重建喙锁韧带治疗急性肩锁关节脱位的疗效观察

目的探讨重建喙锁韧带治疗急性肩锁关节脱位的手术方法及临床疗效。方法自2010—09--2012—02对28例急性肩锁关节脱位行同种异体肌腱移植结合双带袢钢板重建喙锁韧带术治疗。结果本组获12～29个月。平均17．2个月的随访,肩外形正常,X线复查肩锁关节解剖关系正常。参照Karlsson标准行肩关节功能评定：优25例。良3例。结论应用同种异体肌腱移植结合双带袢钢板重建喙锁韧带治疗肩锁关节脱位,可长期恢复肩锁关节的解剖关系、维持喙锁间隙、术后并发症少,术后配合个性化的康复计划,肩关节功能恢复满意。     

Robot-Assisted Total Knee Arthroplasty Accurately Restores the Joint Line and Mechanical Axis. A Prospective Randomised Study

Robot-assisted Total Knee Arthroplasty (TKA) improves the accuracy and precision of component implantation and mechanical axis (MA) alignment. Joint-line restoration in robot-assisted TKA is not widely described and joint-line deviation of > 5 mm results in mid-flexion instability and poor outcomes. We prospectively randomised 60 patients into two groups: 31 patients (robot-assisted), 29 patients (conventional). No MA outliers (> ± 3° from neutral) or notching was noted in the robot-assisted group as compared with 19.4% (P = 0.049) and 10.3% (P = 0.238) respectively in the conventional group. The robot-assisted group had 3.23% joint-line outliers (> 5 mm) as compared to 20.6% in the conventional group (P = 0.049). Robot-assisted TKA produces similar short-term clinical outcomes when compared to conventional methods with reduction of MA alignment and joint-line deviation outliers.     

New cell therapies in cardiology

Even today, cardiovascular disease remains the leading cause of death globally. Cardiological conditions such as myocardial infarction, ischemic injury and chronic cardiomyopathy result in permanent cardiac tissue damage followed by heart failure. Current therapies primarily aim to trigger the pathological remodeling that occurs after cardiac injury and also to reduce risk factors involved in cardiovascular diseases. Animal model studies over the last decade indicate that the systematic administration of autologous and allogeneic stem cells possesses therapeutic potential to improve overall cardiac functions. This evidence robustly indicates that cardiac tissue has the potential to undergo a systematic repair process. The past few years have also witnessed a splurge in clinical research that particularly aims to explore the regenerative properties of the naive stem cells to restore cardiac functions. The mechanisms involved in stem cell therapy remain unclear. The magnitude of benefit demonstrated in animal models is yet to be completely translated into humans. The future of cardiac research will require tangible synchrony between clinicians and basic scientists to unravel the precise mechanism of stem cell therapy. It is also pivotal to define an ideal cell type and a suitable cell delivery technique that provide maximum benefit, while eliminating the grey areas in translational cardiology research. In this article, the authors review the properties and therapeutic potential of the stem cell plethora reported for cardiac repair and regeneration, recent stem cell therapies, mode of action, their delivery techniques, recent clinical developments and the future for these stem cell therapies in cardiology.     

High-throughput DNA sequence analysis reveals stable engraftment of gut microbiota following transplantation of previously frozen fecal bacteria

Fecal microbiota transplantation (FMT) is becoming a more widely used technology for treatment of recurrent Clostridum difficile infection (CDI). While previous treatments used fresh fecal slurries as a source of microbiota for FMT, we recently reported the successful use of standardized, partially purified and frozen fecal microbiota to treat CDI. Here we report that high-throughput 16S rRNA gene sequencing showed stable engraftment of gut microbiota following FMT using frozen fecal bacteria from a healthy donor. Similar bacterial taxa were found in post-transplantation samples obtained from the recipients and donor samples, but the relative abundance varied considerably between patients and time points. Post FMT samples from patients showed an increase in the abundance of Firmicutes and Bacteroidetes, representing 75–80% of the total sequence reads. Proteobacteria and Actinobacteria were less abundant (< 5%) than that found in patients prior to FMT. Post FMT samples from two patients were very similar to donor samples, with the Bacteroidetes phylum represented by a great abundance of members of the families Bacteroidaceae, Rikenellaceae and Porphyromonadaceae, and were largely comprised of Bacteroides, Alistipes and Parabacteroides genera. Members of the phylum Firmicutes were represented by Ruminococcaceae, Lachnospiraceae, Verrucomicrobiaceae and unclassified Clostridiales and members of the Firmicutes. One patient subsequently received antibiotics for an unrelated infection, resulting in an increase in the number of intestinal Proteobacteria, primarily Enterobacteriaceae. Our results demonstrate that frozen fecal microbiota from a healthy donor can be used to effectively treat recurrent CDI resulting in restoration of the structure of gut microbiota and clearing of Clostridum difficile.     

An interdisciplinary approach to treat crown-root-fractured tooth

Restoration of a crown-root subgingival fractured tooth, especially at anterior aesthetic zones is still a great challenge for restorative dentists. Crown lengthening procedure alone has the disadvantage of high gingival curve of the final restoration, which was not discontinuous to adjacent teeth and thus compromise cosmetic outcomes. The objective of this report is to display a new interdisciplinary approach which combining endodontic root canal treatment, orthodontic extrusion, periodontal crown lengthening surgery and prosthodontic post-core-crown restoration procedures to restore a crown-root subgingival fractured maxillary central incisor and achieved a satisfied cosmetic result. Computer-based spectrophotometer was also used to accurately select colour without objective interference to achieve ideal cosmetic effects.