Impact of school sealant programs on oral health among youth and identification of potential barriers to implementation

BackgroundSchool sealant programs (SSPs) increase sealant prevalence among children lacking access to oral health care. SSPs, however, are substantially underused. From 2013 through 2018, the Centers for Disease Control and Prevention funded 18 states for SSP activities in high-need schools (≥ 50% free and reduced-price meal program participation). From 2019 through 2020, the authors assessed SSPs' impact in reducing caries and how states expanded SSPs. The authors also discuss potential barriers to expansion.MethodsFor Aim 1, the authors used a published methodology and SSP baseline screening and 1-year retention data to estimate averted caries over 9 years attributable to SSPs. For Aim 2, the authors used state responses to an online survey, phone interviews, and annual administrative reports.ResultsUsing data for 62,750 children attending 18.6% of high-need schools in 16 states, the authors estimated that 7.5% of sound, unsealed molars would develop caries annually without sealants and placing 4 sealants would prevent caries in 1 molar. Fourteen states reported SSP expansion in high-need schools. The 2 most frequently reported barriers to SSP expansion were levels of funding and policies requiring dentists to be present at assessment or sealant placement.ConclusionsThe authors found that SSPs typically served children at elevated caries risk and reduced caries. In addition, the authors identified funding levels and policies governing supervision of dental hygienists as possible barriers to SSP expansion.Practical ImplicationsIncreasing SSP prevalence could reduce caries. Further research on potential barriers to SSP implementation identified in this study could provide critical information for long-term SSP sustainability.     

采用ART技术封闭恒牙防龋的6年临床效果观察

目的:评价非创伤性充填(ART)技术对恒牙窝沟封闭后,封闭剂保留及新生龋损发生情况。方法:1996年在四川省德阳市4所中学选取12～13岁儿童140名作191个牙ART封闭。采用WHO的ART标准器械,德国ESPE公司生产的高强度玻璃离子材料,对选择的牙面窝沟进行封闭;操作者为经中等口腔专业训练的医生。封闭后每年对ART封闭及牙龋损情况进行评价。结果:封闭后1、2、4、6年的完整保留率分别为75.4%、62.5%、50.0%、34.6%;成功率分别为89.6%、78.8%、68.5%、57.9%。试验后1年没有新生龋牙的发生,试验后2、3年,龋患发生率分别为1.6%、2.8%。试验后4年龋病有明显增加,试验4、5、6年后,龋病发生率分别为8.5%、16.1%、15.0%。结论:ART封闭试验3年的保存率较高、新生龋发生率低;试验6年封闭剂保留率虽然有所降低,但其结果还是令人满意的,预防龋病的效果是显著的。但封闭物脱落3年后,若没有重新修复,新龋患率大幅度上升,作为恒牙龋病防治的措施是适合和可接受的;是一种适合于在学校、社区开展的有效、实用的龋病预防方法。     

Treatment of chronic lip fissures with carbon dioxide laser

Resurfacing of cutaneous tissue with carbon dioxide laser increases the amount and quality of collagen and elastin subepithelially. We used this technique to ablate 12 chronic lip fissures in one woman and 10 men. Five patients' fissures had persisted for durations ranging from several months to seven years; the other six had fissures that split between one and five times annually, and took weeks or months to heal. Ten fissures had re-epithelialised completely six weeks postoperatively, while in two cases the treatment was repeated. At mean long-term follow-up of 70 months (range 44-93) of 11 cases, eight had had no recurrence. One patient, whose fissure had healed at three months was lost to follow-up; one fissure had not improved; one had recurred less severely; and one had split only once, then healed quickly and not recur. Only one patient had postoperative discomfort that required analgesia, and one had a mildly raised scar. This small series shows that this is a successful, safe technique with low morbidity, however, the technology is not always readily available.     

Study of a fissure sealant in mentally retarded Canadian children

The occlusal fissure of 812 permanent and primary posterior teeth of 160 retarded children were sealed with a fluid resin which was polymerized with an ultra-voilet lamp. A half mouth technique was used to evaluate the effectiveness of the sealant in the prevention of fissure caries. The 1st year, the sealant was retained intact on 73 percent of the permanent teeth and on 64 percent of the primary teeth. After 2 years, the sealant was retained intact on 61% of the permanent teeth and on 40% of the primary teeth. The retention of the fissure sealant was better on premolars than molars both in the 1stand in the 2nd year. A single application of the fissure sealant was effective in reducing fissure caries up to 2 years.     

LC3、MMP-14及PD-1在喉癌中的表达及与病理特征和预后的相关性

目的 探讨微管相关蛋白1轻链3（LC3）、基质金属蛋白酶-14（MMP-14）及程序性死亡因子1（PD-1）在喉癌中的表达及与病理特征、预后的相关性。方法 回顾性分析于2016年7月~2018年7月我院收治的36例喉癌患者的临床资料,所有患者均经手术或穿刺活检证实,36份喉癌标本设为观察组,同时选取上述36例喉癌患者手术切除的正常组织作为对照组。分析LC3、MMP-14及PD-1在不同组织中的表达情况,探讨LC3、MMP-14及PD-1表达与病理特征及影响喉癌患者预后生存的因素。结果 喉癌组织及正常组织中的LC3、MMP-14及PD-1阳性表达率比较差异有统计学意义（P＜0.05）。LC3、MMP-14及PD-1的表达与临床分期、淋巴结转移、分化程度有关（P＜0.05）,LC3表达阴性及表达阳性中位生存期分别为（28.65±2.49）个月、（32.92±1.99）个月,MMP-14表达阴性及表达阳性中位生存期分别为（30.46±1.48）个月、（24.48±1.79）个月,PD-1表达阴性及表达阳性中位生存期分别为（25.71±2.04）个月、（19.40±1.63）个月。生存分析显示LC3表达阳性者生存期较长,MMP-14及PD-1表达阴性者生存期较长（P＜0.05）。经非条件多因素Logistic回归模型进一步分析结果显示,临床分期（Ⅲ~Ⅵ期）、有淋巴结转移、高分化、LC3表达阳性、MMP-14表达阳性及PD-1表达阳性为影响喉癌患者预后生存的独立危险因素（P＜0.05）。结论 LC3阴性表达及MMP-14、PD-1阳性表达会增加喉癌患者死亡率,临床分期（Ⅲ~Ⅵ期）、有淋巴结转移、高分化、LC3表达阴性、MMP14表达阳性及PD-1表达阳性为影响喉癌患者预后生存的独立危险因素;LC3、MMP-14、PD-1可作为判断喉癌患者肿瘤进展及预后的标志物。     

小骨窗经侧裂岛叶入路与大骨瓣经颞叶入路血肿清除术治疗基底节高血压脑出血的对比观察

目的探讨小骨窗经侧裂岛叶入路与大骨瓣经颞叶入路血肿清除术治疗基底节高血压脑出血的临床效果。方法选取2017年1月至2019年9月本院收治的60例高血压脑出血患者作为研究对象,随机分为两组,每组30例。对照组采用大骨瓣经颞叶入路血肿清除术治疗,观察组采用小骨窗经侧裂岛叶入路血肿清除术治疗。比较两组手术指标及患者生活能力量表评分(ADL)。结果治疗后,观察组各项手术指标明显优于对照组(P<0.05);观察组生活能力评分显著高于对照组(P<0.05)。结论采用小骨窗经侧裂岛叶入路方法治疗基底节高血压脑出血患者,可明显改善患者各项手术指标,提高患者的生活能力,值得临床推广应用。     

癌因性疲乏对喉癌术后患者生活质量的影响

目的探讨喉癌术后患者癌因性疲乏的发生情况及其对患者生活质量的影响。方法应用一般资料调查表、癌症疲乏量表(CFS)及癌症治疗功能评价系统专用头颈量表(FACT-H&N)中文版对71例喉癌术后患者进行测量。结果喉癌患者术后总疲乏得分为(23.93±7.65)分,其中情感疲乏得分率(55.99%)最高,其次是躯体疲乏(36.87%)和认知疲乏(22.80%);患者的生活质量得分为(70.24±11.51)分,CFS总疲乏得分及各维度得分与FACT-H&N量表总得分呈负相关(P<0.05);将结果进行多元线性回归分析显示,CFS的躯体疲乏维度和情感疲乏维度进入方程(P<0.05),F=14.757(P<0.001),疋=0.398。结论喉癌术后患者的癌因性疲乏较为严重,导致患者生活质量下降,医务工作者应及时发现喉癌术后患者的疲乏情况并给予相应的措施来减轻疲乏状况,从而提高患者的生活质量。     

慢性肛裂手术治疗进展

目的总结目前肛裂手术治疗的研究进展。方法收集近年来国内外关于肛裂的各种手术治疗方式的相关文献并作综述。结果肛裂的手术治疗方法较多,包括闭合式或开放式侧方内括约肌切开术、肛裂切除术、皮瓣成形术及其他手术方式;不同的手术方法各有优缺点,但都存在一定比率的并发症发生率和复发风险。结论对于哪种术式最适合于治疗陈旧性肛裂尚无统一定论。     

四手操作对窝沟封闭术疗效的影响研究

目的:对比分析在窝沟封闭术操作过程中四手操作和医生独立操作对工作效率和疗效的影响。方法:将229名7~9岁儿童458例无龋病的下颌第一恒磨牙随机分为四手操作组和医生独立操作组进行窝沟封闭治疗,1年后复查比较工作效率和封闭剂脱落率,并进行相关统计学分析。结果:两组工作效率和封闭剂脱落率之间存在显著统计学差异。结论:四手操作技术可以缩短患者治疗时间,提高工作效率,降低封闭剂脱落率。     

延髓型重症肌无力喉肌电指标变化的临床价值

目的探讨延髓型重症肌无力患者电视胸腔镜下胸腺扩大切除术（video-assisted thoracoscopic extended thymectomy,VATET）后喉肌电指标测定的临床价值。方法回顾分析2002年6月～2011年7月我科36例延髓型重症肌无力（延髓型组）行VATET的临床资料,对术前后喉肌电指标进行分析,选取同期36例健康受试者作为对照组。结果延髓型组术前喉内肌肌电振幅（210．68±75．42）μV,较对照组（309．40±55．33）μV明显缩窄（t=6．332,P=0．000）;时程（7．68±0．57）ms较对照（5．42±0．34）mB明显延长（t=-20．431,P=0．000）;募集相最大电位（1132．18±467．19）μV较对照组（1675．00±532．85）μV明显缩窄（t=4．596,P=0．000）,术后2组比较仅时程有明显差异（t=6．375,P=0．000）。延髓型组喉内肌群术后肌电振幅（312．91±69．43）μV,较术前（210．68±75．42）μV明显变宽（t=-5．983,P=0．000）;术后时程（6．19±0．64）m8较术前（7．68±0．57）m8明显缩短（t=10．431,P=0．000）;术后募集相最大电位（1557．67±521．45）斗V较术前（1132．18±467．1）μV明显变宽（t=-3．646,P=0．000）;喉外肌仅肌电振幅差异显著[（139．36±74．26）μV vs．（102．75±63．22）μV,t=-2．252,P=0．027]。术后喉肌电图正常的患者疗效有效率89．3％（25／28）,喉肌电图异常的患者疗效有效率37．5％（3／8）,2组比较有统计学差异（χ2=6．891,P=0．009）。结论延髓型重症肌无力患者肌电指标异常,VATET可有效改善各项指标,缓解相关的临床症状。