结合锥形束CT评价两种镍钛器械预备老年人磨牙弯曲根管的效果

目的：比较镍钛器械Twisted Files（TF）和ProTaper在老年人磨牙弯曲根管预备中的临床应用效果。方法：选择2011年8月至2013年8月在我科门诊就诊的有弯曲根管的牙髓炎或根尖周炎的老年患者磨牙90颗,随机分成三组,每组30颗,T组和P组分别采用机用镍钛器械Twisted Files（TF）和ProTaper以冠向下技术预备根管,K组采用手用不锈钢K锉以逐步后退法预备根管,全部患牙均采用冷牙胶侧方加压技术充填。记录三组病例根管预备时间和器械折断数,根据治疗前、中、后的X线片评价根管预备和充填情况,通过锥形束C T记录预备前后距离根尖3mm处根管偏移值。结果：T组、P组均能保持原根管的弯曲和走向,根管预备的锥度和流畅度好,根管充填质量高,T组的偏移量比P组和K组的偏移量小,三组间差异有统计学意义（P〈0.05）。T组的操作时间比P组和K组短,三组间差异有统计学意义（P〈0.05）。预备过程中T组未发生器械折断,P组3例发生器械折断。结论：TF相对与Protaper用于预备老年人磨牙弯曲根管,效率较高,成形效果佳,较安全,更适合于狭窄弯曲的老年根管。     

Apical transportation associated with ProTaper? Universal F1, F2 and F3 instruments in curved canals prepared by undergraduate students

Objective

This study evaluated apical transportation associated with ProTaper^® Universal Fl, F2 and F3 rotary files in curved canais prepared by undergraduate students.

Material and Methods

Twenty mesial roots of mandibular molars with curvatures ranging between 25° and 35° were selected. Mesiobuccal canals were instrumented by twenty students with the ProTaper^® system (Dentsply-Maillefer, Ballaigues, Switzerland) according to the manufacturer''s instructions. Pre-fiaring was performed with Sl and SX files. A #15 K-file was inserted into the root canal up to the working length (WL), and an initial digital radiograph was taken in a buccolingual direction (baseline). Afterwards, the S1, S2, F1, F2, and F3 files were employed up to the WL. Other radiographies were taken in the same orientation of the baseline after the use of the Fl, F2, and F3 files, with each file inserted into the root canal. The radiographic images were overlapped, and the Image J software was used to measure the distance between the rotary files'' ends and the #15 K-file''s end, characterizing the apical transportation. Data were analyzed by Repeated Measure ANOVA and by the SNK post hoc test (P<0.05).

Results

It was verified that file size affected apical transportation significantly (P<0.001). The F3 file showed higher apical transportation than Fl and F2, while between these last files there was no difference.

Conclusion

The undergraduate students produced lower apical transportation in curved canals when they did not use the F3 rotary file.     

两步法根管预备预防根管治疗期间急症的临床研究

目的：旨在探讨两步法根管预备和常规一次根管预备对于根管治疗期间急症的影响效果。方法：选择120例慢性根尖周炎患者,随机分为两组,采用两种方法进行根管预备,观察术后急症的发生率。结果：共19例患牙发生根管治疗诊问急症,其中常规根管预备组15牙（19％）、两步法根管预备组4牙（5．5％）,两组比较有显著性差异（P〈0．05）。两步法根管预备的总有效率为94．5％,常规根管预备组为81％,两组差异显著（P〈0．05）。结论：两步法根管预备可以减少术后肿胀等临床急症,临床应用前景广阔。     

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: A randomised controlled trial

Background

In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans.

Objective

The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences.

Design

A randomised, single-blind controlled trial study design was used.

Settings

This study involved seven hospitals and 10 obstetricians in Taiwan.

Participants

Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n = 155) or control (n = 141) groups.

Methods

The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations.

Results

The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t = 2.48, p = 0.01). The experimental group also showed a higher degree of childbirth control (t = 9.60, p < 0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t = 2.63, p = 0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t = 3.74, p < 0.001) in the experimental group than in the control group.

Conclusions

The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.     

Effects of repetitive multiple freeze-thaw cycles on the biomechanical properties of human flexor digitorum superficialis and flexor pollicis longus tendons

Background

Deep fresh freezing is the most commonly used preservation method for allografts, which is followed by a routine procedure before application—the thawing of the grafts. This work was to explore the biomechanics effects of repetitive freezing–thawing on human tendons.

Methods

Thirty tendons (flexor digitorum superficialis and flexor pollicis longus tendons) were taken from three fresh cadavers. We assigned these tendons into six groups randomly. After the preparation and measurement of cross-sectional area, Fresh Group was tested immediately. The remaining five groups, before biomechanical testing, underwent multiple cycles (1, 2, 3, 5 or 10 cycles) of freezing (− 80 °C for 4 days) and thawing (room temperature for 6 h). Using a material-testing machine, we performed a stress-relaxation test, a creep test and a load to failure test to estimate structural and mechanical properties as well as viscoelastic changes of each group.

Findings

The results of fewer cycles (< 3) of freezing–thawing groups were similar to Fresh Group. The tendons that underwent more than five freezing–thawing cycles demonstrated a significantly smaller ultimate load, stiffness, ultimate stress and Young's modulus. Moreover, the 5 and 10 Cycle Groups showed a significant increase of elongation in creep test and a decrease of load in stress-relaxation test compared with other groups.

Interpretation

Repetitive freezing–thawing (> 5 cycles) declines the structural, mechanical and viscoelastic properties of human tendons. From our results, it is recommended that for deep-frozen preservation of tendon allografts the cycles of freezing–thawing should be less than five times with caution.     

药师参与模式下肠镜检查术前肠道准备的药学服务实践

<正>电子结肠镜检查是诊断和筛查肠道疾病常用、有效的检查方法之一,而进行结肠镜检查的基本条件是清洁良好的肠道准备。虽然近年来肠道清洁剂的商品化和肠道准备方法的标准化不断完善,但仍有约30%的患者肠道准备不充分[1-3]。不充分的肠道准备会导致检查时间延长、操作难度增加、病变检出率降低、漏诊及检查费用增加等。肠道准备的质量多与患者的依从性有关,加强对患者肠道准备相关知识的教育,增强患者对肠道准备方法的认识和理解,可以提高检查前的肠道准备质量[4     

Randomized single blind trial of two low-volume bowel preparations for screening computed tomographic colonography

Background Bowel preparation is an important part of computed tomographic colonography (CTC); we evaluated two small-volume preparations for screening CTC with regard to quality of preparation and patient acceptability.Methods Asymptomatic subjects at average risk for colorectal cancer from a community-based CTC screening program were randomized to bowel preparation comprising magnesium/bisacodyl/picolax or polyethylene glycol (PEG)/picolax. CTC images were evaluated by a blinded investigator for residual feces and fluid; subjects completed a questionnaire regarding acceptability of the preparation.Results In 176 subjects randomized to magnesium/bisacodyl/picolax (n=82) or PEG/picolax (n=94), the former preparation was discontinued because of syncope or presyncope in four (5%) subjects. Another 137 subjects received PEG/picolax without a significant adverse event. There were no other major differences in acceptability of the preparations as reported by subjects. The quality of bowel preparations for reporting CTC was similar.Conciusion For subjects having screening CTC, both small-volume bowel preparations are generally well tolerated and result in minimal fluid and fecal residue; however, the magnesium/bisacodyl/picolax preparation was accompanied by an unacceptable incidence of syncope and is no longer used by us.     

恒康正清行肠道准备的效果研究

[目的]探讨口服恒康正清在结肠镜前行肠道准备的效果。[方法]选择需行结肠镜检查的门诊、住院病人972例,随机分为A组:口服恒康正清358例,B组:口服甘露醇318例,C组:清洁灌肠296例,比较3组病人结肠镜肠道清洁度评定分级。[结果]口服恒康正清方法肠道清洁总有效率,1级率分别为98.9%,81.0%,均占三组之首,经比较差异有统计学意义。[结论]恒康正清清洁肠道,效果显著,不良反应发生率低,操作性强,可作为临床结肠镜肠道准备的一种常规方法。     

杜秘克辅助便秘病人肠道准备的效果观察

目的 探讨对于便秘病人行结肠镜检查前提高肠道清洁度的方法。方法 选取门诊60例便秘病人，随机分为实验组、对照组，两组用同样的时间和方法服用口服洗肠液，并在检查前1日晚进半流食，实验组检查前3d天加用杜秘克30ml，2次/d口服，对照组不服用杜秘克。结果 实验组30例，有效率97％，清洁率90％；对照组30例，有效率80％，清洁率40％。结论 杜秘克对于便秘病人结肠镜检查前的肠道准备有很好的促进作用。     

方格星虫提取物对膜性肾病模型的治疗作用及机制初探

目的:初步探讨方格星虫粗提物(SNP)对膜性肾病(MN)的治疗作用及其可能机制。方法:50只SD大鼠随机分为模型组和对照组,模型组大鼠腹腔一次注入抗FxlA血清建立被动性Heymann肾炎模型,模型建立1周后依24 h尿蛋白排泄量(24 h UPE)随机将Heymann肾炎大鼠分为SNP治疗组和未治疗组,治疗组用SNP灌胃治疗。考马斯亮蓝法每周测定24 h UPE。治疗4周结束后处死大鼠取双肾,光镜、电镜观察肾脏病理改变,RT-PCR法检测肾组织nephrin mRNA和podocin mRNA的表达量。结果:SNP治疗4周后大鼠24 h UPE较未治疗组降低(P<0.05);模型组大鼠肾小球基底膜增厚,上皮下电子致密物沉积,足细胞足突融合等病理改变,SNP治疗组大鼠上述病变较未治疗组减轻,经测定,足细胞足突融合率较未治疗组显著降低(P<0.01);SNP治疗组nephrin mRNA和podocin mRNA表达量较未治疗组升高(P<0.05)。结论:SNP可通过上调膜性肾病大鼠足细胞nephrin和podocin基因表达水平,一定程度上减轻足细胞足突融合,进而减少尿蛋白滤过,可能对人类膜性肾病具有辅助治疗作用。