Intrapartum fetal surveillance: a physiological approach

Continuous utero-placental circulation, and patent umbilical blood vessels ensure an uninterrupted transfer of oxygen and nutrients to the fetus as well as clearance of metabolic waste products. The onset of labour characterized by progressive and strong uterine contractions poses a threat to fetal oxygenation as a result of collapsing the spiral arterioles traversing the myometrium to supply the placental bed, and repetitive compression of the blood vessels within the umbilical cord. Human fetuses are equipped with compensatory mechanisms to cope with transient interruptions of blood supply during labour. The ability to compensate may be blunted in cases of poor fetal reserves, increased metabolic demand (macrosomia or maternal fever), and due to non-hypoxic pathways (e.g. chorioamniontis or fetal hypovolumia-hypotension syndrome). Intrapartum fetal surveillance involves prompt recognition of the features that signal the onset of fetal decompensation on the cardiotocograph (CTG) to ensure a timely intervention to avoid hypoxic-ischaemic encephalopathy (HIE) or perinatal deaths. This article summarises a ‘physiological approach’ to the interpretation of the CTG which, in places, conflicts with other current UK guidance.     

锥形束CT对儿童上颌前部埋伏多生牙定位的研究

目的评价锥形束CT(cone beam computed tomography,CBCT)及三维重建技术对儿童上颌前部埋伏多生牙定位的价值,为临床提供准确的治疗措施。方法选择2017年6月-2018年9月来本院就诊上颌骨内埋伏牙儿童患者263例行锥形束CT扫描,获取牙体表面三维立体图像及任意平面图像和任意曲面体层图像,从多个角度显示埋伏牙的形态、大小、萌出方向、唇腭侧位置及与邻牙位置的关系。结果263例患儿312颗上颌前部埋伏多生牙252颗位于腭侧,50颗位于唇侧,10颗位于牙槽骨中部;牙冠正向生长77颗,牙冠倒置生长154颗,牙冠横向生长81颗。所有患者顺利完成手术,术前诊断与术中结果完全一致,准确率为100%。结论锥形束CT是精确定位儿童上颌前部埋伏多生牙有效方法,可直接、准确地反映埋伏多生牙的位置,为临床诊断和治疗提供可靠信息。     

无托槽隐形矫治器对牙周炎引起前牙扇形移位的女性患者相关生活质量的影响研究

目的探究无托槽隐形矫治器对牙周炎引起前牙扇形移位的女性患者口腔健康相关生活存质量(OHRQOL)的影响。方法 41例进行成年女性错颌畸形矫治患者,按佩戴矫治器类型不同分为试验组(18例)和对照组(23例)。试验组患者佩戴无托槽隐形矫治器,对照组患者佩戴自锁托槽矫治器,记录附件脱落重粘情况,比较两组患者矫治时长以及不同时间段[矫治开始前(T0)、矫治1个月(T1)、矫治3个月(T2)、矫治6个月(T3)、矫治结束(T4)、矫治结束后3个月(T5)]口腔健康影响程度量表(OHIP-14中文版)评分。结果试验组矫治时长最短42步即84周,最长75步即150周,平均矫治时长(97.52±2.35)周,附件脱落重粘48粒,其中2例重启;对照组矫治时长最短34步即68周,最长74步即148周,平均矫治时长(112.38±3.51)周,因颊面管托槽松动掉落重粘115粒。试验组矫治时长短于对照组,差异具有统计学意义(t=15.437, P=0.000<0.05)。T1时,试验组OHIP-14评分(25.42±4.21)分低于对照组的(35.47±4.02)分,差异具有统计学意义(P<0.05);T0、T2、T3、T4、T5时,两组患者的OHIP-14评分比较,差异均无统计学意义(P>0.05)。结论牙周炎引起前牙扇形移位的女性患者佩戴无托槽隐形矫治器较佩戴固定矫治器有利于缩短矫治时间,及较好的生活质量。     

Evaluation of Biodentine in Pulpotomies of Primary Teeth with Different Stages of Root Resorption Using a Novel Composite Outcome Score

This study aimed to assess the success of pulpotomy in primary molars using Biodentine, new-developed tri-calcium, di-calcium-based silicate cement, at 6 and 12 months. The hypothesis was that stages of root resorption could influence the treatment success. A novel composite score was used based on five clinical and radiographic outcomes: soft-tissue pathology, pain to percussion, pathologic mobility, radiolucency and pathologic root resorption. Patients’ compliance and intraoperative pain experience were recorded using the Frankl scale and the Wong–Baker scale. A total of 22 primary molars, 9 in stage S (stability) and 13 in stage R (resorption) were submitted to pulpotomy using Biodentine and restored with composite resin. The success rate was 92.3% in the R group compared to 100% in the S group at both 6 and 12 months (p = 0.850). There was no statistically significant effect of type of molar, tooth position and type of carious lesions on the composite outcome (all p > 0.05). Overall, 73% of the children experienced no or mild/moderate pain and 77% had a cooperative attitude. Children younger than 7 years old experienced more pain (p = 0.04). Biodentine is a promising biomaterial for pulpotomy of primary teeth regardless of the stage of root resorption.     

Excess salt intake promotes M1 microglia polarization via a p38/MAPK/AR-dependent pathway after cerebral ischemia in mice

A high salt diet (HSD) is among the most important risk factors for many diseases. One mechanism by which HSD aggravates cerebral ischemic injury is independent of blood pressure changes. The direct role of HSD in inflammation after cerebral ischemia is unclear. In this research, after twenty-one days of being fed a high salt diet, permanent focal ischemia was induced in mice via operation. At 12 h and 1, 3 and 5 days postischemia, the effects of HSD on the lesion volume, microglia polarization, aldose reductase (AR) expression, and inflammatory processes were analyzed. We report that in mice, surplus dietary salt promotes inflammation and increases the activation of classical lipopolysaccharide (LPS)-induced microglia/macrophages (M1). This effect depends on the expression of the AR protein in activated microglia after permanent middle cerebral artery ligation (pMCAL) in HSD mice. The administration of either the AR inhibitor Epalrestat or a p38-neutralizing antibody blocked the polarization of microglia and alleviated stroke injury.In conclusion, HSD promotes polarization in pro-inflammatory M1 microglia by upregulating the expression of the AR protein via p38/MAPK, thereby exacerbating the development of ischemia stroke.