A new approach to define defect extensions of endodontically treated teeth: inter- and intra-examiner reliability

For endodontically treated teeth, there are no standardized measures available to define the extent of loss in tooth substance prior to final restoration. In this study, defect size was classified and the applicability of the classification was tested related to the inter- and intra-examiner reliability. For classification, three parameters were investigated: (i) remaining tooth substance in the vertical dimension (level A-D, aspect I), (ii) remaining tooth substance as regarded horizontally (mm; bucco-lingual and mesio-distal, aspect II), and (iii) size of the orifice (mm; aspect III). Four non-calibrated or (pre-trained) examiners were asked to gauge and classify 20 casts of clinically broken down teeth. The measurements were repeated twice every alternative week giving three separate readings. Inter-examiner reliability was determined at weeks 1, 3 and 5. The intra-examiner reliability was compared between readings 1 and 2, 1 and 3, and 2 and 3. As statistical tests, intra-class correlation (ICC) and Cohen's kappa (weighted) were used at a significance level of P < 0.05. Inter- and intra-examiner reliability for ordinal data (aspect I) revealed, with one exception, 'moderate' to 'very good' evaluations. Inter- and intra-examiner reliability (ICC) of metric data of aspect II and III was primarily 'excellent'. It may be concluded that the newly developed classification could be applied as an appropriate and reproducible method to define defect extension in endodontically treated teeth.     

Temporomandibular clinical exploration in Italian adolescents

Objective: This study investigated the prevalence of the signs and symptoms of temporomandibular disorders (TMD) among Italian adolescents.

Methods: The data were recorded from 567 subjects (246 males and 321 females; age range 11–19 years), grouped according to age and molar class relationship.

Results: Forty-four point one percent of subjects showed at least one sign or symptom of TMD, which were significantly more frequent in the 16–19 year-old group (52.9%) in respect to the 11–15 year-old group (39.8%) (χ ² = 8.78; p = 0.003). Signs and/or symptoms were about 1.6 times more frequent in subjects with Class II/1 malocclusion (χ ² = 13.3, p = 0.0003), mostly for TMJ sounds (χ ² = 1.444; p = 0.036). Myalgia was more frequent in females than in males (χ ² = 3.882; p = 0.049).

Conclusion: TMD signs and/or symptoms among Italian adolescents seem diffused (44.1%). Therefore, all adolescents should be screened thorough medical history and clinical examination.     

两种牙面干燥法对窝沟封闭剂脱落率的影响

比较了使用压缩空气与使用洗耳球热空气干燥牙面对封闭剂脱落率的影响。结果表明：压缩空气干燥牙面较洗耳球热空气干燥牙面，封闭剂完全脱落率低；上颌磨牙远中腭沟、近中沟，差异有高度显著性（Ｐ＜０．０１），下颌磨牙面差异无显著性（Ｐ＜０．０５）。说明使用压缩空气干燥牙面有利于封闭剂的保留，特别对于不易操作的上颌磨牙影响更加明显，而对于能直视、易操作的下颌磨牙，使用洗耳球热空气干燥牙面也能达到较好的效果     

应用ITS1-ITS2区域鉴定口腔念珠菌

目的 :建立快速、准确鉴别念珠菌的方法。方法 :通过CHROMagarCandida培养基显色培养与PCR扩增ITS1 ITS2 区域相结合的方式对 13例口腔念珠菌标本进行细胞及分子水平鉴定 ,并对CHROMagarCandida培养基能否引起念珠菌ITS1 ITS2 区域碱基序列改变问题进行探讨。结果 :13例念珠菌标本分别属于最常见的白色念珠菌、热带念珠菌及光滑念珠菌三种类型 ,并在CHROMagarCandida显色培养基上分别呈现出草绿色 (白色念珠菌 )、蓝灰色 (热带念珠菌 )以及紫红色 (光滑念珠菌 )菌落 ;这三种念珠菌类型在ITS1 ITS2 区域的片断长度或碱基序列上表现出特异性差异。结论 :使用PCR扩增ITS1 ITS2 区域的方法可以对以上三种临床念珠菌进行准确鉴定及种内分型。     

A proposal for a new classification of lesions of exposed tooth surfaces

In the presence of improved methods of identification and treatment of lesions on the exposed surfaces of teeth, it should now be acknowledged that the GV Black "classification of carious cavities" is out of date. This paper describes a new system, proposed in 1997, discussed broadly throughout the profession, and eventually modified. The system has been adopted in several regions around the world as being a useful corollary to the current developing concept of minimal intervention dentistry. It is now desirable to adopt a new approach to the identification and recording of the lesions caused by both caries and non-carious tooth loss. A major advantage arising from its adoption would be that it would encourage the profession to minimise the amount of normal healthy tooth structure that is often sacrificed in pursuit of the cavity designs as suggested by Black. The authors are members of a Project Group of the FDI Science Committee, and this paper explains the concept and offers justification for the adoption of the system.     

脑小血管病患者认知、睡眠和血浆标志物的研究进展

近年来随着神经影像技术的提高与普及,越来越多的脑小血管病被正确识别,脑小血管病在老年人群中已经成为一类常见病。脑小血管病能够引起一系列威胁患者健康的问题,尤其是认知功能损害,但由于疾病早期症状不突出,影像学检查滞后等原因,目前临床仍然缺乏有效的手段尽早识别此类疾病。本文阐述了脑小血管病的影像分型以及其特征性认知功能改变,探讨睡眠和血浆生物标志物与脑小血管病之间的关系,为临床早期鉴别诊断和个体化治疗提供有力依据。     

超声造影结合Bosniak分级在预测肾脏囊性病变良恶性风险分层中的应用价值

目的　探讨参照Bosniak分级CT标准更新版（2019版）的超声造影CT-Bosniak分级标准及超声造影RJ-Bosniak分级标准在预测肾脏囊性病变良恶性中的应用价值。方法　回顾性分析2015年6月至2020年7月在瑞金医院及瑞金医院无锡分院超声科进行超声造影检查的316例患者的347枚肾脏囊性病灶的超声造影声像图。参照2019版Bosniak分级CT标准和瑞金标准分别对超声造影声像图进行Bosniak分级,其中参照CT标准者定义为超声造影CT-Bosniak标准,按照瑞金医院临床实践经验总结所定分级标准定义为超声造影RJ-Bosniak分级标准。所有的入组病例最终由穿刺活检或手术病理学及增强CT或MRI等影像学检查随访证实。采用四格表计算2种超声造影Bosniak分级标准对肾囊性病变良恶性诊断的准确度、灵敏度、特异度等。结果　以手术或穿刺活检所得病理结果及临床最终诊断结果为金标准,347枚肾脏囊性病灶中良性病灶308枚,恶性病灶39枚。以Bosniak III级和IV级为恶性诊断标准,超声造影CT-Bosniak分级正确诊断良、恶性病灶各290个和36个,超声造影RJ- Bosniak分级正确诊断良、恶性病灶各292个和38个,诊断结果与金标准结果均呈高度一致（Kappa值分别为0.74和0.79）,2种分级标准诊断结果之间的准确度、敏感度、特异度、阳性预测值、阴性预测值分别为93.95%(326/347)和95%（330/347）、92.31%（36/39）和97.44%(38/39)、94.15%(290/308)和94.81%(292/308)、66.67%(36/54)和70.37%(38/54)、98.98%(290/293)和99.66%(292/293),差异均无统计学意义,（P>0.05）。347枚病灶中CEUS CT-Bosniak 分级I级198个, II级45个, IIF级50个, III级26个, IV级28个;CEUS RJ-Bosniak分级I级198个, II级28个, IIF级66个, III级28个, IV级27个 。结论　超声造影结合Bosniak分级标准对肾囊性病变良恶性的鉴别诊断有较高的价值。瑞金医院所用的Bosniak分级标准使用简单、有效,值得在临床推广应用。     

茎突综合征与翼钩综合征

手术治疗茎突综合征２４例和翼钩综合征１１例。前者总有效率和治愈率分别为９１．６％和５８．３％，后者为１００％和６３．６％。对两综合征的病因、病理机理、诊断和治疗作了临床比较分析     

速释口服固体制剂人体生物等效性试验豁免药学研究的要求

随着科学认知的不断深入,为缩短药品的批准上市时间,不同药品监管机构相继出台了人体生物等效性豁免的相关法规及技术文件,旨在通过体外研究来替代体内试验。总结和比较国内外相关指导原则对速释口服固体剂型的仿制药药学研究的要求,重点关注存在的差异之处,探讨背后的科学原因,并在最终经国际人用药品注册技术协调委员会协调一致的过程中得到思考和启示,以期增加仿制药被豁免体内试验的成功率、进而降低仿制药的开发成本,但同时亦能保证其质量和疗效与参比制剂一致,真正实现其临床可替代性。     

四川地区抗肿瘤药物风险分级现状及需求研究

目的:了解四川地区抗肿瘤药物风险分级现状及需求,以构建抗肿瘤药物风险提示系统,提高抗肿瘤药物临床应用的安 全性和有效性。方法:采用调查问卷了解四川地区抗肿瘤药物风险分级现状及需求。结果:受访医务人员所在医院的抗肿瘤药 物使用现状:63. 29%存在抗肿瘤药物的超说明书用药,77. 22%有抗肿瘤药物处方前置审核系统,82. 28%为一线医师开具抗肿 瘤药物处方需要上级医师审核,91. 14%为配置静脉用抗肿瘤药物使用生物安全柜,86. 08%为医务人员在配置抗肿瘤药物时穿 戴防护用具,78. 48%为抗肿瘤药物高危标识嵌入电子信息系统,81. 01%有抗肿瘤药物的分级管理制度,81. 01%有抗肿瘤药物 分级管理目录;受访医务人员对抗肿瘤药物的风险因素及风险防范的认知程度一般,而医师、护士和药师对抗肿瘤药物风险点 的风险程度认知有所不同;受访医务人员希望构建抗肿瘤药物风险提示系统并建议了相关影响因素的重要性。结论:四川地区 抗肿瘤药物风险分级现状较好,受访医务人员对肿瘤药物的风险因素及风险防范的认知程度侧重于其工作岗位,强烈要求构建 抗肿瘤药物风险提示系统。