肺脏超声评价儿童重症肺炎疗效的应用分析

目的:探讨肺脏超声（LUS）评价儿童重症肺炎（SP）疗效的应用价值。方法:选取142例儿童SP患者，回顾性根据临床疗效判断标准分为治愈组75例、好转组49例、无效组18例。分别于入院时、入院第7天和第15天对所有患儿行LUS及X线片检查，观察3组患儿肺部征象，并进行LUS评分。入院第15天时，采用临床肺部感染评分（CPIS）评估3组肺部感染情况，采用血气分析仪检测肺泡-动脉氧分压差（A-aDO2）及氧合指数（OI）水平，采用Pearson相关系数分析入院第15天LUS评分与CPIS、A-aDO2和OI的关系。结果:入院第7天和第15天治愈组患儿LUS评分、坐位B线数和平卧位B线数均少于好转组和无效组（P<0.05）。治愈组患儿胸膜线异常和A线消失率低于好转组和无效组（P<0.05）。治愈组患儿入院时和入院第7天胸腔积液LUS检出率高于X线片（P<0.05），无效组患儿入院时和入院第15天LUS胸腔积液检出率高于X线片（P＜0.05）。治愈组患儿CPIS和A-aDO2水平低于好转组和无效组（P<0.05），OI水平高于好转组和无效组（P<0.05）。Pearson相关性分析结果显示，入院第15天LUS评分与CPIS和A-aDO2呈正相关（P<0.05），与OI呈负相关（P<0.05）。结论:LUS及LUS评分能够有效评估儿童SP的临床疗效，且胸腔积液检出率更高，具有较高的临床应用价值。 【关键词】肺脏超声；儿童；重症肺炎；肺脏超声评分；临床疗效     

临床路径在可摘局部义齿修复游离端牙列缺失患者中的应用价值

摘要:目的 研究临床路径在可摘局部义齿修复游离端牙列缺失患者中的应用价值。方法 选择 130 例肯氏 Ⅰ、 Ⅱ类牙列缺损患者, 按口腔内余留牙和牙槽嵴黏膜条件相近、 肯氏分类及亚类相同的 2 例为一对, 分为 65 对, 均分为临床路径组和传统修复组。比较 2 组的适应期调改次数, 适应期结束后咀嚼是否有力, 咀嚼时游离端基托是否存在肉眼可见活动度、 基牙龋坏、 基齿松动和食物嵌塞情况。结果 临床路径组在适应期调改次数低于传统方法组［1.0 （1.0, 2.0） 次 vs. 3.0 （2.0, 4.0） 次］; 适应期结束后调改后咀嚼有力的比例 （93.85% vs. 76.96%） 高于传统方法组, 出现肉眼可见动度 （0 vs. 15.38%）、 基牙龋坏 （1.54% vs. 13.85%）、 基牙松动 （0 vs. 12.31%） 及食物嵌塞 （1.54% vs. 15.38%）比例均低于传统方法组 （均 P＜0.05）。结论 临床路径可以提高可摘局部义齿的固位和稳定, 遵循临床路径方法制作可摘局部义齿能够减小功能状态下义齿的不稳定性, 具有良好的推广前景。     

Radiographic examination of ectopically erupting maxillary canines

This study analyzes the need for and possibility of obtaining further information from different radiographic procedures in 125 children with potential ectopic eruption of the maxillary canines. After clinical examination of 3,000 10 to 15-year-old children, it was found that 7% needed radiographic examinations for determination of the canine position. Eighty-four children (2.8%), with a total of 125 potential ectopically erupting maxillary canines diagnosed clinically and by means of periapical radiographs, were selected and a stepwise extended radiographic diagnostic procedure was used. Most canines in ectopic eruption were positioned palatally; the positions could be assessed with sufficient accuracy from conventional periapical films in 92% of the cases. Only in 37% of the cases, however, could the lateral incisor be projected free from the ectopic canine by the intraoral technique. The lamina dura of the lateral incisor facing the canine was often found to be interrupted. For 29% of the ectopic canines, the lateral incisors could neither be projected free nor judged free from resorptions and a supplementary polytomographic investigation was believed to be necessary. The number of resorbed teeth was doubled by polytomography and altogether 12.5% of the ectopic canines caused resorptions. A stepwise radiographic procedure including polytomography is described and recommended in cases of ectopic eruption of maxillary canines for determining the correct position and ruling out or confirming resorptions on incisors, thereby optimizing the orthodontic treatment planning.     

In situ localization of tenascin mRNA in developing mouse teeth

Tenascin is a large extracellular-matrix glycoprotein found in developing connective tissue. A cDNA probe to mouse tenascin, mTN2, was used to determine the cellular origins of this molecule in the murine tooth germ by in situ hybridization. At embryonic day 19, a hybridization signal significantly greater than background was detected with mTN2 in the subodontoblastic layer of the dental mesenchyme and in the inner enamel epithelium of the enamel organ. At postnatal day 1, a signal was detected over pre-odontoblasts and the strata intermedium and externum. No tenascin mRNA was detected in odontoblasts or the stellate reticulum at either age, and hybridization in ameloblasts was not significantly greater than background at postnatal day 1. Thus, much of the tenascin found throughout developing teeth appears to be synthesized by pre-odontoblasts and the inner enamel epithelium, the two populations of cells destined to generate mineralized matrix.     

Stimulation by carrageenan of arachidonate 12-lipoxygenase activity in dog gingival tissue

At 4 h after injection of carrageenan into the gingiva, the 12-lipoxygenase activity of the gingival homogenate was markedly increased. Activity in the cytosol and microsomal fractions was markedly increased when assessed as the specific activity based on nmol/min/mg of protein, and in the cytosol fraction as the percentage distribution of total activity. The 12-lipoxygenase activity in the homogenate from carrageenan-treated gingiva was not affected by either EDTA or calcium ion, or a combination of the two. 12-lipoxygenase activity in both carrageenan-treated and untreated gingiva was inhibited dose-dependently by AA861, a striking difference from its effect on platelet 12-lipoxygenase. There was a marked increase of 12-lipoxygenase activity in experimentally inflamed gingiva compared to the non-inflamed gingiva.     

In vivo and in vitro study of the effects of chlorpromazine on tooth mineralization in rats and mice

The effects of chlorpromazine (CPZ) on tooth mineralization were examined using incisor dentine in adult rats and cultured tooth germs of mandibular first molars dissected from mouse embryos. CPZ (10, 50 and 250 mg/kg, s.c.) substantially inhibited dentine mineralization as evaluated by contact microradiographs. Plasma calcium and phosphorus concentrations were not decreased by CPZ (10 and 50 mg/kg). Physicochemical effects were not involved in the action of CPZ on the mineralization. In vitro experiments showed that CPZ (1 and 10 μM) inhibited mineralization and alkaline phosphatase (ALP) activity in the tooth germs. As CPZ has the properties of a calmodulin antagonist, the calmodulin antagonists W-7 and W-5 were also examined. Both inhibited mineralization and ALP activity in tooth germs; W-5 had less effect than W-7. These in vivo and in vitro findings suggest that CPZ inhibited cell-mediated mineralization in dentine without affecting the calciumdashregulating system and physicochemical mineral deposition. In addition, calmodulin could be involved in cell-mediated mineralization.     

Immunohistochemical localization of very late activation integrins in healthy and diseased human gingiva

The β1-integrins (VLA family) are cellular adhesion molecules (CAM) that play a major role in cell-cell and cell-matrix interactions. The expression pattern of CAM was studied in 5 clinically normal volunteers with healthy gingiva and in 18 patients with clinically different stages of periodontitis. In healthy human gingiva α2. α3 and α6 integrin chains were found in a characteristic distribution, showing a broad continuous expression on the junctional and sulcular epithelium sites. The expression of these integrins was demonstrated primarily on the basal cell layers and in some cells of the stratum spinosum. Inflammatory stages of periodontitis revealed further upregulation of α2, α3 and α6 integrins into the junctional and sulcular epithelial cells, which correlated with the stage of the periodontitis and the extent of the cellular infiltration. α4 and α6 were found to be the predominant β1 integrin chains on inflammatory cells. The amount of δ4 and ş6 positive infiltrative cells increased with the number of inflammatory cells. VCAM-1. the corresponding cell-cell ligand of VLA-4 (α4) was present on the majority of subepithelial vessels in all stages of gingivitis and periodontitis. The α5 subunit was expressed on both endothelium and gingival connective tissue cells. Samples from advanced periodontitis cases showed a higher number of a5 positive mononuclear cells. In comparison to normal epidermis, a human gingival epithelial cells express higher levels of integrins. This expression is further upregulated in advanced stages of periodontitis, indicating changes of the β1 integrin organization.     

Effects of benzo(a)pyrene and nicotine on prostaglandin synthesis in buccal pouch and submandibular glands of the Syrian hamster

Adult male Syrian hamsters were treated by swabbing the apex of the buccal pouch with corn oil (control, C), 1 mM benzo(a)pyrene (BP), nicotine (NC), or BP + NC in corn oil, twice daily, 5 days a week. After a 4-week treatment, the pouches and submandibular glands were dissected and used for the determination of endogenous prostaglandin (PG) production and studies on in vitro PG synthesis. Of the three PGs analysed (PGE₂, PGF₂ and 6-keto-PGF₁), PGE₂ was predominant in the pouch and the glands. BP or NC alone had only a weak effect on PG synthesis in both tissues. However, the combination of BP and NC had a synergistic effect, causing diminished PG synthesis in both tissues. In buccal pouch, BP + NC significantly decreased the concentrations of endogenous PGE₂ and PGF₂ (PGE₂: 0.669 + 0.254 versus 1.698 + 0.460, PGF₂: 0.273 ± 0.090 versus 0.625 ± 0.272 ng/g tissue; BP + NC versus C; mean ± SD, n = 5, p < 0.05). Similarly significant results were also found for in vitro PG synthesis (PGE₂: 0.541 ± 0.249 versus 1.399 ± 0.340, PGF₂: 1.045 ± 0.428 versus 2.133 ± 0.510 ng/g tissue; BP + NC versus C; mean ± SD, n = 5, p < 0.05). In submandibular glands, BP + NC significantly diminished the concentration of endogenous PGE₂ (1.183 ± 0.175 versus 2.379 ± 0.488 ng/g tissue; BP + NC versus C; mean ± SD, n = 5, p < 0.05). The synthesis of 6-keto-PGF₁ in both tissues, and the synthesis of PGF₂ in submandibular gland, were slightly decreased with all treatments.     

Mineralized nodule formation by cultures of human dental pulp-derived fibroblasts

Pulp fibroblasts were isolated from human deciduous and supernumerary teeth and cultured in vitro. With continued culture in normal tissue-culture medium, six pulp fibroblast strains formed cell nodules after 10–15 days. By electron microscopy the nodules had matrix vesicles, and needle-shaped crystals associated with a dense network of collagen fibrils. The crystalline material exhibited a pattern consistent with hydroxyapatite when nodules were examined by X-ray diffractometry. Furthermore, the cells showed high levels of alkaline phosphatase activity, which could be increased more than seven-fold by the addition of 1,25(OH)₂D₃ (5 × 10⁻⁹−5 × 10⁻⁸M). In addition to the production of type I collagen, these cells also synthesized fibronectin and osteonectin. The formation of mineralized tissue nodules by pulp cells in vitro provides a useful system for study of the pathological calcification of pulp tissues.     

不同年龄层高脂血症患者个体化护理的血脂控制

【摘要】 目的 探讨不同年龄层高脂血症患者实施个体化护理对其血脂控制的临床效果。 方法 选取2015年1月～2019年12月我院收治的高脂血症患者480例作为研究对象,按照不同年龄层划分为青中年组(18～59岁)240例和老年组(≥60岁)240例。两个不同年龄层组又随机分为中青年观察与对照亚组及老年观察与对照亚组,每组各120例。两个年龄层对照组患者均接受传统护理。青中年观察组患者均联合实施协同护理模式干预,老年观察组均联合实施指导监督个体化护理方式干预,比较各组临床效果。 结果 两组不同年龄层患者干预前相关不良生活方式、生化指标无明显差异(P＞0.05)。接受个体化护理干预后,不同年龄层观察亚组患者相关不良生活方式及血脂水平较干预前均得以明显改善(P＜0.05),且明显优于其对照亚组(P＜0.05);各对照亚组干预前后相关指标无明显差异(P＞0.05)。 结论 针对不同年龄层高脂血症患者实施个体化护理干预,可有效改善患者不良生活习惯,有助于控制血脂水平,改善患者预后。