慢性牙周炎附着丧失程度与改良固相BANA试验的关系

目的：初步探讨慢性牙周炎活动期病人改良固相BANA试验结果与附着丧失程度的关系,为临床牙周病活动期的诊断提供依据。方法：记录慢性牙周炎活动期病人附着丧失程度,并采集龈下菌斑标本进行改良固相BANA试验。结果：附着丧失程度不同所对应的改良固相BANA试验结果的差异有统计学意义,经Spearman秩相关检验r=0.7439,P〈0.05。结论：附着丧失程度与改良固相BANA试验结果呈正相关。改良固相BANA试验为临床牙周病活动期的诊断提供了更简洁、快速的客观参考指标。     

Toxicity evaluation of root canal sealers in vitro

AIM: To compare the toxicity of methacrylate resin-based root canal sealers with sealers based on epoxy resin and silicone by two-well established cell culture methods. METHODOLOGY: Specimens of AH Plus, EndoREZ, RoekoSeal and Epiphany were prepared for direct contact in the Millipore filter diffusion test and as extracts in the MTT assay. Mouse fibroblasts (L929) were used as toxicity targets. Differences in cytotoxicity between fresh and set specimens and between the extracts of root canal sealers were determined by t-test (P < 0.05). RESULTS: In the filter diffusion test, freshly mixed Epiphany and AH Plus were rated severely toxic and RoekoSeal and EndoREZ nontoxic. When set, Epiphany was moderately toxic, whereas AH Plus, RoekoSeal and EndoREZ were nontoxic. Epiphany was significantly more toxic than RoekoSeal and EndoREZ (P < 0.05). In the MTT assay with set specimens, Epiphany was rated severely toxic; AH Plus and RoekoSeal slightly toxic; and EndoREZ nontoxic. Epiphany was significantly more toxic than the other three materials in this test (P < 0.001). CONCLUSION: The multi-methacrylate resin-based (Epiphany) root canal sealer was significantly more toxic to L-929 cells than the silicone-based Roeko Seal and the single methacrylate-based EndoREZ root canal sealers. AH Plus showed intermediate toxicity.     

电子纤维鼻咽喉镜对腭咽环扎术疗效的评价

目的 应用电子纤维鼻咽喉镜观察腭咽环扎术后患者腭咽闭合功能，评价该手术的远期疗效。方法 选择腭咽环扎术后16年的腭裂患者23例，用电子纤维鼻咽喉镜观察患者在吞咽和发音时的咽侧壁、咽后壁、软腭的运动情况。结果 电子纤维鼻咽喉镜系统直接观察到发音时咽侧壁的运动及软腭的上、下、前、后运动，软腭与咽后壁的关系，软腭长度及在矢状面上提升的高度。结论 腭咽环扎术能有效地改善腭咽闭合功能；电子纤维鼻咽喉镜可直接观察到腭咽部的运动情况，是评价术后腭咽闭合功能的有效方法。     

Early loading of machined-surface Brånemark implants in completely edentulous mandibles: healed bone versus fresh extraction sites

Background: Restoration of edentulous mandibles with dental implants installed with a two‐stage or one‐stage surgical approach, yet with delayed loading, is a predictable and successful treatment. Purpose: The present prospective study evaluated the success up to 3 years of function of nonroughened machined‐surface Brånemark System implants (Nobel Biocare AB, Gothenburg, Sweden) loaded early or immediately with a fixed 12‐unit bridge. Materials and Methods: In total, 184 implants were installed in 36 patients:30 with healed bone and 6 with some remaining teeth, which were extracted simultaneously with implant installation. The provisional or final prostheses were installed 0 to 52 (mean 18.2) days later. Results: Thirteen of 184 (7.1%) implants failed within 3 months of loading in 5 of 36 (13.9%) patients:1 of 153 implants (0.7%) failed in healed bone, and 12 of 31 (39%) failed in fresh extraction sites. This consequently meant a loss of 3 of 36 (8.3%) prostheses, all in the extraction group. No implants were lost during 3 years of functional loading (16 patients, 75 implants). The average marginal bone level measured initially and after 1, 2, and 3 years was 0.8 mm (SD = 0.5), 1.0 mm (SD = 0.4), 1.1 mm (SD = 0.3), and 1.4 mm (SD = 0.5), respectively. Conclusions: Four to six Brånemark implants with nonroughened machined titanium surfaces can be loaded early or immediately with cross‐arch restorations in healed mandibulary bone, but this cannot be recommended for fresh extraction sites.     

Periodontal considerations for functional utilization of a retained root after furcation management

Abstract The rationale for periodontal treatment in this case was that inflammatory perio-dontal disease can be arrested by creating a dento-gingival anatomy which is accessible for daily plaque removal techniques and that hypermobility per se does not mandate splinting to adjacent, less mobile teeth. These principles were applied to the management of a maxillary molar with advanced furcation involvement. In order to resolve the furcation problem it was necessary to amputate the palatal and disto-buccal root which resulted in retention of the mesio-buccal root. Although this retained root was hypermobile, this was not reason in itself to justify splinting. Splinting would be necessary only if the mobility interfered with masticatory function or increased progressively. Since this would not be known until the behavior of the tooth was observed in function, the root was restored as an independent unit. The occlusion was designed so that the crown had no premature contacts in the retruded or intercuspal positions and no non-working side contacts in lateral excursion. The margins of the crown were kept supragingival. In the weeks following crown placement, no increase in mobility occurred although the tooth was in full masticatory Function. One year later there had been no change in the mobility status. It was concluded that the retained mesio-buccal root which had reduced periodontal support and a degree of hyper-mobility was capable of independent function. No periodontal breakdown occurred due to this mobility. Furthermore, efficient removal of plaque prevented recurrence of inflammatory periodontal disease and, in the presence of this plaque control, root caries did not develop after placing the crown margins in a supragingival location.     

胫骨假体的不同后倾角度对内侧间室单髁置换术后膝关节功能的影响

目的: 研究分析胫骨假体在矢状面上的位置对牛津(Oxford)单髁置换术后膝关节功能的影响。方法: 回顾性分析2016年1月1日至2020年5月31于北京大学第一医院骨科行膝关节内侧间室单髁置换术的患者。依据术后胫骨假体后倾角度(posterior tibial slope,PTS), 将患者分为PTS标准组(PTS≥3°且PTS<8°)及PTS异常组(PTS<3°或PTS≥8°)。患者随访至少12个月,比较两组病例术后膝关节协会临床评分(Knee Society Clinical Score,KSS-C)、膝关节协会功能评分(Knee Society Functional Score,KSS-F)及膝关节活动范围,并评估手术前后PTS变化值与术后KSS-C评分、KSS-F评分及膝关节活动范围的相关性。结果: 共纳入72例患者(82膝),其中PTS标准组51例患者(58膝)、PTS异常组21例患者(24膝),所有患者均完成随访,中位随访时间23.6个月。两组病例的一般资料(性别、年龄、体重指数)、术前膝关节活动范围、术前KSS-C评分及KSS-F评分差异无统计学意义(P>0.01)。术后12个月随访时,所有病例在膝关节活动范围、KSS-C评分及KSS-F评分上均较术前显著改善(P<0.01)。两组病例在术后KSS-C评分上差异有统计学意义[PTS标准组(88.76±2.79)vs. PTS异常组(84.42±3.35),P<0.01],但在术后KSS-F评分、膝关节活动范围上差异无统计学意义(P>0.01)。另外,手术前后PTS的变化值与术后KSS-C评分(r=-0.034,95%CI:-0.247 ~ 0.186,P=0.759)、KSS-F评分(r=-0.014,95%CI:-0.238 ~ 0.198,P=0.901)及膝关节活动范围(r=0.045,95%CI:-0.214 ~ 0.302,P=0.686)无相关性。结论: 膝关节单髁置换术中采用3°~<8°的PTS可以使患者获得更好的术后功能,术中应避免胫骨假体PTS的过度增大或减小。     

新型冠状病毒肺炎患者的静脉血栓栓塞症风险评估与抗凝治疗

目的评估新型冠状病毒肺炎(简称新冠肺炎)患者的静脉血栓栓塞症(VTE)风险与药物性抗凝治疗。方法收集并分析2020年2月9日至2020年3月29日期间收治于武汉同济医院光谷院区的新型冠状病毒肺炎患者的临床资料、血凝常规等资料。每位患者在入院24 h内进行Padua评分。分析患者Padua评分与患者疾病严重程度和28天预后的关系。结果共收集分析102例新冠肺炎确诊患者的临床资料。重型组的Padua评分高于普通型组(2.5±1.0比2.1±0.4,P=0.201),但无统计学差异。危重型组的Padua评分(6.2±1.1比2.5±1.0,P<0.001)、抗凝比例(52.6%比7.1%,P<0.001)、死亡率(57.8%比4.3%,P<0.001)均明显升高于重型患者,其凝血酶原时间、活化部分凝血活酶时间、D-二聚体较重型组也明显升高。以Padua评分4分为界,分为VTE高风险组(≥4分)和VTE低风险组(<4分)。VTE高风险组的死亡率、活化部分凝血活酶时间、D-二聚体、纤维蛋白原均明显高于VTE低风险组。在VTE高风险组中,抗凝比例明显高于VTE低风险组(41.7%比6.4%,P<0.001),但仍仅有41.7%。VTE高风险患者中,抗凝者的死亡率低于未抗凝治疗者(30%比42.8%,P=0.52),但差异无统计学意义。结论重型和危重型的新冠肺炎患者VTE风险明显升高,对于这类VTE高风险患者进行预防性抗凝治疗可能降低死亡率,但仍需要更多循证医学证据。     

丁苯酞联合马来酸桂哌齐特对急性脑梗死患者脑血流及神经功能相关指标水平的影响

目的观察丁苯酞软胶囊联合马来酸桂哌齐特注射液对急性脑梗死患者脑血流、神经功能及炎性指标等的影响。方法选取2017年3月—2018年3月海南省干部疗养院/海南省老年病医院内科收治急性脑梗死患者100例,按照随机数字表法分为对照组和观察组,各50例。对照组给予马来酸桂哌齐特注射液治疗,观察组在此基础上给予丁苯酞软胶囊治疗。比较2组治疗效果;检测2组患者治疗前及治疗后14 d大脑中动脉(MCA)、大脑前动脉(ACA)血流速度及神经生长因子(NGF)、神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、星形胶质源性蛋白(S100-β)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、白介素-10(IL-10)、单核细胞趋化蛋白-1(MCP-1)水平,并比较ADL评分、NIHSS评分及治疗过程中不良反应。结果治疗后,观察组患者治疗总有效率显著高于对照组(96.00%vs.80.00%,χ²/P=6.061/0.014);2组患者治疗后MCA、ACA血流速度,血清NGF、BDNF、IL-10水平,ADL评分均高于治疗前,NSE、S100-β、TNF-α、CRP、MCP-1水平,NIHSS评分均低于治疗前(P<0.05);观察组患者治疗后MCA、ACA血流水平,血清NGF、BDNF、IL-10水平,ADL评分均高于对照组(t/P=4.450/0.001,4.317/0.001,3.315/0.001,10.420/0.001,6.274/0.001,7.507/0.001),NSE、S100-β、TNF-α、CRP、MCP-1水平,NIHSS评分均低于对照组(t/P=7.963/0.001,5.212/0.001,13.450/0.001,14.840/0.001,11.650/0.001,6.385/0.001)。结论丁苯酞软胶囊联合马来酸桂哌齐特注射液治疗急性脑梗死患者效果显著,能改善脑血流动力,通过调控NGF、NSE、BDNF水平,促进患者脑神经功能恢复,抑制炎性反应,达到治疗目的。     

内源性大麻素抗肺纤维化的作用研究进展

肺纤维化作为临床常见的呼吸系统危重症,病因及发病机制复杂,最终导致呼吸衰竭,严重影响患者的生活质量。在肺组织、支气管平滑肌细胞、内皮细胞存在内源性大麻素和相应的大麻素受体,内源性大麻素与大麻素受体结合后可能通过磷脂酰肌醇-3激酶/蛋白激酶(PI3K/Akt)信号通路和TGF-β₁/Smad3信号通路参与调节免疫反应,抑制炎性细胞分泌细胞因子,减轻炎性反应,并且抑制血管内皮生长因子、基质金属蛋白酶等表达,抑制基底膜增生,发挥抗纤维化作用。文章就内源性大麻素在抗肺纤维化中的作用进行综述。     

重组人脑利钠肽联合呋塞米对急性心肌梗死患者血清MMP-2、GDF-15、CYR61水平的影响

目的观察重组人脑利钠肽(rhBNP)联合呋塞米对急性心肌梗死患者的治疗效果及对血清基质金属蛋白酶2(MMP-2)、生长分化因子15(GDF-15)、富含半胱氨酸蛋白61(CYR61)水平的影响。方法选取2018年11月—2019年11月湖南省人民医院/湖南师范大学附属第一医院心内科收治急性心肌梗死患者105例,随机数字表法分为呋塞米组52例、联合组53例,2组患者均给予常规治疗,呋塞米组加用呋塞米治疗,联合组加用呋塞米及rhBNP,治疗5 d后,比较2组患者治疗效果,治疗前后心功能、血清T淋巴细胞亚群水平、肌钙蛋白I(cTnI)、高敏肌钙蛋白I(hs-TNI)、高敏C反应蛋白(hs-CRP)、白介素-8(IL-8)、IL-17、MMP-2、GDF-15、CYR61水平。结果联合组患者治疗总有效率高于呋塞米组(88.68%vs.73.08%,χ~2/P=4.144/0.042)。治疗后联合组心排出量(CO)、LVEF、CD4~+、CD3~+水平高于呋塞米组(t/P=2.883/0.005、3.560/0.001、5.634/0.001、4.720/0.001),LVPWd、CD8~+、cTnI、hs-TNI、hs-CRP、IL-8、IL-17、MMP-2、GDF-15、CYR61水平低于呋塞米组(t/P=5.032/0.001、5.822/0.001、11.320/0.001、3.559/0.001、9.660/0.001、3.472/0.001、8.862/0.001、6.978/0.001、17.440/0.001、6.085/0.001)。结论 rhBNP联合呋塞米治疗急性心肌梗死具有一定疗效,能够改善患者心功能,减轻心肌损伤、炎性反应,提升患者免疫功能,调控血清MMP-2、GDF-15、CYR61水平,治疗效果显著。