陶瓷-陶瓷人工髋关节假体在全髋关节置换术中的研究进展

全髋关节置换术（total hip arthroplasty,THA）是治疗髋关节疾病、重新建立关节功能的有效方法,已经在临床上取得了巨大成功。因为陶瓷材料具有生物惰性,使它在髋关节置换手术中可以有效减少因关节界面磨损而引起的人工髋关节松动、下沉等并发症,使陶瓷人工假体成为了人工关节置换术中不可或缺的主要材料。然而关于陶瓷-陶瓷（ ceramic-on-ceramic,COC）人工髋关节置换术后会出现髋关节异响和假体碎裂的问题,引起了关节外科领域学者的广泛关注。该文重点从COC材料在THA中的应用进展、优势及存在的弊端进行综述。     

维生素D对胰岛β细胞功能及胰岛素敏感性的影响

维生素D在维持正常胰岛β细胞功能方面发挥举足轻重的作用。婴幼儿时期维生素D的缺乏可使1型糖尿病的发病率增高,并造成β细胞合成和分泌胰岛素的功能减退。而维生素D的干预则可以延缓和改善这一过程,这可能源于维生素受体(VDR)介导的免疫调节作用。大量研究也揭示了维生素D不足和2型糖尿病之间的内在关联,其对胰岛β细胞功能和胰岛素的敏感性的影响也得到证实,这些效应可能是通过对VDR基因的作用以及对钙磷平衡的影响而介导的,转录因子过氧化酶增殖物活化受体(PPAR)-δ在其中也扮演一定角色。合理使用维生素D有望成为糖尿病预防与治疗的重要手段。     

Sublingual immunotherapy in children. Immunotherapy Committee of the Spanish Society for Clinical Immunology and Pediatric Allergology

Sublingual immunotherapy is currently attracting growing interest because of its ease of administration and, according to previous studies, its infrequent and mild adverse effects. However, at least in children, the efficacy of this therapy has not been completely demonstrated. In addition, the mechanisms of action remain to be elucidated since few studies have been published and the results have been contradictory and sometimes inconclusive. For this reason, we performed a literature review through the MEDLINE database, selecting double-blind studies carried out in children. Only 10 studies meeting these requirements were retrieved. All the studies were performed by European researchers and nine were published in European journals. Efficacy was evaluated by clinical parameters and by reduction in medication use. The results on efficacy are not homogeneous, although most support the utility of this route of administration. Moreover, reports of allergens other than those used in these studies dust mites and grass pollens are lacking. In conclusion, further studies evaluating the efficacy of this therapy in children are required. Among the general population, if the efficacy of sublingual immunotherapy in the treatment of sensitization to hymenoptera venoms were demonstrated, as has been the case with subcutaneous immunotherapy, the utility of this route of administration would be definitively confirmed. Finally, sublingual immunotherapy could be used in children who have shown systemic reactions to subcutaneous immunotherapy or who refuse to undergo injections.     

Managing the high-risk patient: therapeutic approaches in 2002

Populations of patients at high risk of coronary heart disease (CHD) include those with type 2 diabetes and those with heterozygous familial hypercholesterolemia (HeFH). Despite benefits of statin lipid-lowering therapy in reducing CHD risk in diabetic patients, screening for dyslipidemia in such patients is inadequate, and patients frequently fail to achieve recommended low-density lipoprotein goals. Diagnosis of HeFH is also suboptimal, despite the reliability of family lipid screening in confirming clinical diagnosis and utility of screening in identifying other family members who are at risk. Patients with HeFH frequently require large reductions in low-density lipoprotein (LDL) cholesterol to achieve target levels. In both of these populations, statins that produce large reductions in LDL cholesterol offer advantages in achieving lipid-lowering goals and in simplifying medical therapy to reduce CHD risk.     

��ά׮ճ�Ӽ����о���չ

纤维桩因其弹性模量与牙本质相当,且具有美观、操作简便等优点,在临床上得到广泛的应用。目前,国内外对纤维桩粘接技术的研究主要集中在纤维桩的表面处理及粘接树脂等方面。本文将对这些方面的研究进展做一综述。     

�����������ڸ��ܳ�ϴ�о���չ

根管冲洗对根管的消毒和清理起着重要作用,冲洗液可以通过冲洗碎屑、溶解组织和消毒根管系统而提高机械预备的效力。次氯酸钠（NaClO）是目前世界范围内临床上使用最广泛的根管冲洗液之一。本文就NaClO的作用及相应机制、提高使用效率的方法、不良反应、与其他冲洗液联合应用等方面做一综述。     

��������������ػ����о���չ

牙髓再生治疗的一个重要操作步骤是刺破根尖周组织,使血液进入根管内,这将使根尖周的干细胞也同时进入根管,血凝块为干细胞的聚集提供基质和支架;此外,血液内含有丰富的生长因子,可促进干细胞的增殖和分化,对年轻恒牙牙髓再生治疗后根管内硬组织的沉积和牙根的继续发育起到关键作用。本文就牙髓再生治疗相关机制的研究进展做一综述。     

��ǻϸ�������л���ٴ��о���չ

口腔细菌产碱代谢与牙菌斑酸碱平衡、细菌微生态平衡以及龋病的发生、发展密切相关。口腔细菌产碱代谢研究主要集中在尿素代谢、精氨酸代谢、精胺代谢和苹果酸代谢的调控机制及其与龋活跃程度的关系方面,是近年来龋病防治的研究热点。本文着重针对口腔细菌产碱代谢的临床研究做一综述。     

Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors

OBJECTIVES: A subgroup analysis of the Valsartan Heart Failure Trial (Val-HeFT) was performed to evaluate the effects of the angiotensin II receptor blocker, valsartan, in the patients with chronic heart failure (HF) not receiving angiotensin-converting enzyme (ACE) inhibitors. BACKGROUND: The ACE inhibitors reduce mortality and morbidity in patients with HF. Nonetheless, nearly 20% of potentially eligible patients may not be prescribed ACE inhibitors. RESULTS: Val-HeFT was an international, randomized, double-blinded trial that compared valsartan with placebo when added to the prescribed treatment of patients with HF. The two primary end points of the study were all-cause mortality and the composite of all-cause mortality and morbidity (sudden death with resuscitation, hospital admission for HF, or administration of intravenous inotropic or vasodilator drugs for >or=4 h without hospital admission). Of the 5,010 patients enrolled in the trial, 366 (7.3%) were not treated with ACE inhibitors at baseline. The effects of valsartan on the primary and secondary end points of the study were assessed in this subgroup of patients. RESULTS: Both all-cause mortality and combined mortality and morbidity for patients not treated with ACE inhibitors were significantly reduced in the valsartan treatment group compared with the placebo group (17.3% vs. 27.1%, p = 0.017 and 24.9% vs. 42.5%, p < 0.001, respectively). Consistent with the data on clinical events, patients randomized to valsartan showed improvements in physiologic variables, such as ejection fraction, left ventricular internal diameter in diastole, and plasma neurohormone levels. Permanent discontinuation of study treatment because of adverse experiences was comparable between the two groups. CONCLUSIONS: Val-HeFT has provided the first placebo-controlled outcome data demonstrating a favorable effect of an angiotensin receptor blocker on mortality and morbidity in patients with HF not treated with ACE inhibitors. Based on these results, valsartan appears to be an effective therapy in ACE inhibitor-intolerant patients.