MCI的情志病机及疏肝法干预的可行性探讨＊

轻度认知障碍（Mild cognition impairment， MCI）是尚未达到阿尔兹海默病（Alzheimer’s disease， AD）的诊断标准且可逆转为正常脑老化状态的最佳窗口期。情志异常、肝失疏泄（肝失疏泄日久致肝郁）已被证实为MCI的重要情志病机，且“长期负性情绪积累肝失疏泄致衰加速脑老化”的科学假说已在本课题组前期研究中得到初步证实，疏肝法干预肝郁型MCI患者疗效显著，但以上作用机制尚未得到完全阐述。因此本研究系统总结了中医学对MCI的认识，长期情绪不调肝失疏泄对MCI的影响及可能机制，疏肝解郁方药及其成分改善肝郁型MCI的可行性，并提出使用无束缚性设计的眼动技术以探索疏肝法改善肝郁型MCI的可行性，为MCI的中医药干预及其神经机制探讨提供新思路，为中医情志衰老学说增添新内涵。     

段迎喜“升脾”学术思想探微

脾胃之气的充足和清气的正常升发对人体生命活动具有决定意义,饮食、劳倦、情志、外感对脾胃的损伤往往影响中焦脾胃清阳的生成及升发,脾胃病以本虚为主,多由虚致实,虚实兼有,病机关键为升降失常,脾气不升。肝对人体气机具有升宣调畅作用,脾气的升清有赖于肝气升发促进。在补中益气的同时,要补肝益气。同时,肾精气充盈,元气方能充沛,肾阳又主气化,肾精不封、肾气不固者必致肾气下陷。治疗须温肾壮阳、升阳举陷。脾胃中气不足,气机郁滞而化火,并脾之清气下流而生泄泻,相火乘其土位更加耗伤中焦清阳之气。段老师特别注重脾气生长、升发,只有清阳升发,脾气上升,元气才能充沛,阴火才会收敛潜藏。治疗时运用辛甘之药以补益中气,借升阳风药以助肝胆之用,补其中而升其阳,升浮变通,使生长之气健旺。段老师善于运用甘温之品,温补中气,升发清阳。     

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。     

探讨微型种植体支抗对青少年口腔正畸的效果

目的探讨微型种植体支抗治疗青少年口腔正畸的临床效果。方法纳入襄阳市中医医院口腔科100例青少年口腔正畸治疗患者。随机数字表分组,传统正畸疗法组对就诊青少年口腔正畸患者根据以往的常规治疗方法进行正畸治疗,微型种植体支抗治疗组则采用的是微型种植体支抗进行口腔的正畸干预。比对两组疗效;患者对牙齿矫正后外观的满意度评分;施治前后患者磨牙出现移位的距离、上中切牙倾角以及凸距的差值;牙齿松动发生比例。结果微型种植体支抗治疗组疗效、患者对牙齿矫正后外观的满意度评分、磨牙出现移位的距离、上中切牙倾角以及凸距的差值相比传统正畸疗法组有优势,P<0.05。微型种植体支抗治疗组牙齿松动发生比例低于传统正畸疗法组,P<0.05。结论对于需要进行正畸治疗的患者而言,在治疗过程,选择微型种植体支抗治疗可获得良好的效果,其进行正畸治疗的效果更为满意且不良情况出现率更少。     

Talon cusp in the temporary dentition of a patient with Kabuki syndrome: Case report with a two‐year follow‐up

The presence of dental abnormalities in the same individual may be related to syndromic cases and occur through associated systemic changes. Kabuki syndrome presents well‐defined systemic changes, but its clinical characteristics related to the oral cavity have not been fully explained. This study aimed to report the dental changes in a child diagnosed with Kabuki syndrome. A male brown patient aged 2 years and 7 months, accompanied by his mother to the dental visit, they main complaint was the presented of an additional tooth behind upper right central incisor. Anamnesis, intra‐ and extraoral examinations, and dental X‐rays were performed, revealing a talon cusp. Considering the dental clinical findings, the patient was referred to a medical geneticist who additionally requested cardiological and genetic examinations, which established the Kabuki syndrome. The caregivers were advised that the talon cusp would not cause any injury to the natural exfoliation of the tooth and that oral hygiene should be performed carefully. Abnormalities in the oral cavity and developmental delay may be associated with a potential undiagnosed syndrome. The medical evaluation becomes decisive for investigation, diagnosis, and final conduct of the case.     

Comparative evaluation of periodontal ligament fibroblasts stored in different types of milk: effects on viability and biosynthesis of collagen

Milk remains one of the most frequently recommended solutions for storage of avulsed teeth because it can maintain cell viability and is easily accessible. However, some negative effects of milk on avulsed teeth have been reported, just as the effects of milk on the long‐term functions of cells are not clear. This study aimed to evaluate the effects of different types of milk on the viability, proliferation, and functions of periodontal ligament fibroblasts (PDLF)s in vitro. Human PDLFs were culture‐medium depleted for 5 min and stored in Hanks’ balanced salt solution (HBSS), whole cow's milk, low‐fat cow's milk, or almond milk for 1 h at 25°C. Cell viability and proliferation were assessed using MTT assays. Expression of the genes encoding type I collagen and its modifying enzymes were analyzed using real‐time PCR. Collagen matrix production was evaluated using Picrosirius red polarization. Our results showed the overall efficiency of low‐fat cow's milk in maintaining the viability and proliferation of PDLFs, and in enhancing the process of collagen production. Almond milk storage resulted in the highest rate of PDLF proliferation, and comparable collagen biosynthesis ability to the control. Therefore, besides low‐fat cow's milk, almond milk may potentially be an alternative tooth‐storage medium for PDLF preservation and PDL tissue regeneration.     

Prognosis and complications of mature teeth after lateral luxation: A systematic review

BackgroundDental trauma injuries are frequent in children and adolescents and can result in a sequela of future complications. Lateral luxation injuries are diagnosed when a tooth becomes displaced in a position other than axial and is often associated with alveolar bone fracture. Although the tooth is not immediately lost, pulp canal obliteration or pulpal necrosis can occur. The objective of this systematic review was to gather existing data on lateral luxation injuries to mature teeth to evaluate their overall prognosis and reported complications.Types of Studies ReviewedThe authors conducted a systematic search of the literature using MEDLINE, PubMed, Embase, and Cochrane databases in February 2019. They hand searched reference lists to identify additional literature. The authors included prospective and retrospective observational studies in the search. They screened a total of 291 articles, downloaded 28 articles, and included 4 articles in the study.ResultsThe most frequent complication reported for mature teeth with lateral luxation was pulpal necrosis (44.2%). Less frequent findings included surface resorption (14.0%), inflammatory resorption (8.5%), pulp canal obliteration (8.1%), and replacement resorption (0.9%). The included studies were cohort studies, which resulted in great heterogeneity, and the authors could not attempt a meta-analysis.Conclusions and Practical ImplicationsA large number of permanent teeth that experience lateral luxation are at risk of developing pulpal necrosis and other complications. Careful follow-up is required for these patients to treat complications as early as possible. Furthermore, the authors of this systematic review emphasize the importance of consistent reporting of dental trauma outcomes.