细胞内抗原免疫金银染色技术的改进

为解决细胞内抗原应用免疫金银法染色时背景过重的问题,建立了甘氨酸二次阻断的处理方法,效果较好。     

海芋散在复治肺结核中的作用初探

目的探讨经炮制海芋散在复治肺结核中的作用。方法把102例多治病人随机分成两组。采用WHO推荐的复治方案3H3R3Z3E3／6H3R3E3为对照组（51例），将用复治方案3H3R3Z3E3／6H3R3E3，加口服经炮制海芋散作为治疗组（51例），对病例的症状体征、病灶吸收情况、空洞吸收和闭合情况、痰菌阴转情况及不良反应发生的情况进行观察研究。结果症状体征改变情况治疗组总有效率为96．0％，对照组为66．7％（P〈0．01）；病灶吸收情况治疗组为96．1％，对照组为64．7％，治疗组明显高于对照组（P〈0．01）：空洞吸收或闭合治疗组为98．0％，对照组为68．6％，治疗组明显高于对照组（P〈0．01）；痰菌阴转情况治疗组为94．1％。对照组为70．5％，治疗组明显高于对照组（P〈0．05）；不良反应发生情况治疗组为25．1％，对照组为52．2％．治疗组显著低于对照组（P〈0．01）。结论加服用经炮制海芋散联合抗痨化疗组合药物治疗复治肺结核的疗效优于单纯用抗痨化疗组合药的化疗方案，且可减轻抗痨化学药物的不良反应，作用肯定，值得在临床中进一步探讨研究。     

La risoluzione delle complessità nei ritrattamenti

ObjectivesThe aim of this study is to describe the main causes and prevalence of endodontic therapy failures, to promote a diagnostic and prognostic work-up suited to the relevant pathology evolution degree and to suggest appropriate clinical strategies to achieve the expected results.Materials and methodsThrough an extensive review of recent literature, combined with an accurate analysis of clinical cases and epidemiological investigation, it was possible to gather and evaluate the necessary information and data for providing clinical dictates on the solution of endodontic retreatment problems.ResultsThe success percentage of endodontic retreatments is quite variable, ranging from 60% to 85% of treated cases. Such percentage is strongly dependent on two critical variables: the preoperative condition of periapical tissues and the previously provided treatment. A chronic apical periodontitis subjected to inadequate therapy leading to the structural alteration of dental elements, is indeed a crucial factor affecting the retreatment prognosis.ConclusionsAll retreatment procedures should be preceded by an accurate case analysis. Adverse anatomical conditions and periapical bone lesions may predict an unfavorable prognosis and should be taken into great consideration. However, in all other clinical conditions, high success rates can be achieved, ensuring a long-term survival of dental elements.     

�����������о��½�չ

??Root canal therapy is the general treatment for endodontic and periapical disease. However??the failure of the therapy still exists. Then root canal retreatment becomes an effective way to increase the conservation rate of those teeth. The aim of retreatment is to eliminate the infected site. The success rate of retreatment is related to many kinds of factors. With the development of implant technology and endodontic surgery??the indications of retreatment have changed. Besides??Niti instruments??ultrasonic and laser technology have improved the efficiency of the retreatment.     

Evaluation of the angiographic outcomes after clipping of intracranial aneurysms: determination of predisposing factors for occurrence of aneurysm remnants

ABSTRACT

Objectives: Aneurysm remnants after microsurgical clipping have a risk of regrowth and rupture and have not been validated in the era of three-dimensional angiography. Therefore, this study aimed to evaluate the angiographic outcome using three-dimensional rotational images and determine the predictors for remnants after microsurgical clipping.

Methods: Between January 2014 and May 2017, 139 aneurysms in 106 patients who were treated with microsurgical clipping, were eligible for this study. For the determination of aneurysm remnants after microsurgical clipping, the angiographic outcomes were evaluated using follow-up digital subtraction angiography within 7 days for unruptured aneurysms or within 2 weeks for ruptured aneurysms. According to the Sindou classification, the aneurysm remnants were dichotomized, and subgroup analysis was performed to identify the predictors of aneurysm remnants after clipping with various imaging parameters and clinical information.

Results: The overall rate of aneurysm remnants was 29.5% (41/139), in which retreatments were needed in 6.5% (9/139). The neck size and maximum diameter of aneurysms were independent predisposing factors for the aneurysm remnants that need retreatment (OR: 2.30; p < 0.001; OR: 1.38; p < 0.001, respectively).

Conclusions: This study demonstrated a low incidence of aneurysm remnants after microsurgical clipping which need to retreatment. However, selective postoperative angiography could provide us clear information of surgical result and evidence for long-term follow-up for some aneurysms with larger neck size (>5.7 mm) and maximum diameter (>7.1 mm).     

再治疗根管粪肠球菌毒力因子gelE表达与临床表现的关系研究

目的:比较再治疗根管内粪肠球菌(enterococcus faecalis)毒力因子gelE表达情况,分析gelE表达与临床表现的关系。方法:采集临床需要根管再治疗病例的根管内细菌样本53例,利用Real Time Quantitative PCR技术来检测gelE的表达情况。统计学分析gelE表达与患者临床表现之间的关系。结果:再治疗根管内粪肠球菌毒力因子gelE在有临床症状或体征和有根尖暗影的病例中表达增强(P<0.05)。结论:再治疗根管内粪肠球菌毒力因子gelE的表达增强与临床症状或体征的出现有关系。     

Selective Retreatment and Sinus Lift: An Alternative Approach to Surgically Manage the Palatal Roots of Maxillary Molars

Endodontic microsurgery on the palatal root of maxillary molars presents a clinical challenge because of the root position and approximation from the maxillary sinus floor. Attempting a buccal or a palatal approach to address the root is associated with limited accessibility and visibility as well as the risk of injury to the maxillary sinus membrane and/or the greater palatine nerves and vessels. If all the maxillary molar roots require surgical intervention, two flaps may even be needed, which can make the procedure technically more difficult and lengthier. This case report presents 2 clinical cases in which apicoectomy was needed on the palatal roots of maxillary molars. The treatment includes selective nonsurgical retreatment of the palatal root and obturation using a root repair material followed by a surgical intervention from a buccal approach to treat the buccal roots, sinus lift using piezosurgery, and root resection of the palatal root. The approach was successful in both cases without any untoward events. We monitored the radiographic changes using cone-beam computed tomographic imaging immediately after the surgery and at multiple follow-up appointments. The cone-beam computed tomographic images revealed healing of the periapical disease around all the roots up to 14 and 24 months and apical repositioning of the maxillary sinus floor.     

Long-term Success and Survival of Endodontic Microsurgery

IntroductionHealed rates of endodontic microsurgery (EMS) may decrease over time, but research on the long-term outcomes is scarce. The aims of this retrospective cohort study were to evaluate the 5- to 9-year healed and survival rates of EMS, to identify associations between prognostic factors and healing status, and to compare the short-term (1- to 2-year) with long-term (5- to 9-year) outcomes.MethodsOne hundred fifty-one eligible patients (166 teeth) who underwent EMS in 2007–2010 were invited for a follow-up examination. Eighty-three patients (94 teeth) participated in the study. Survival status and reasons for extraction of all teeth were determined, and survival rates were calculated by Kaplan-Meier analyses. Outcomes were determined on the basis of clinical and radiographic findings and associated with potential prognostic variables via multivariate Cox regression analyses.ResultsThirty-two teeth were extracted: 6 because of endodontic failure, 20 for unrelated reasons, and 6 for unknown reasons. Outcomes were categorized as healed and not healed. Multivariate analysis revealed that adjusted hazard ratio for failure was 5.95 times higher (95% confidence interval, 1.54–22.91) for teeth treated with intermediate restorative material than with mineral trioxide aggregate and 3.38 times higher (95% confidence interval, 1.05–10.9) for teeth with no known history of nonsurgical retreatment. Teeth classified as healed in the 1- to 2-year review mostly remained healed at 5- to 9-year review (45/48 teeth); those with uncertain healing had varied outcomes at long-term review.ConclusionsEMS results in high long-term healed (78.3%, 72/92 teeth) and survival (95.2%) rates. Root-end filling material and nonsurgical retreatment before EMS may influence the long-term outcome.     

Retreatment of multiple failing maxillary implants after full arch rehabilitation: a retrospective,observational cohort study

The aim of this study was to assess implant retreatment in a group of patients whose maxillary implants were all failing after full arch rehabilitation. Treatment involved implant removal, augmentation, and placement of an overdenture supported by four to six implants. All consecutive patients referred between 2008 and 2018, following multiple late implant failures in the rehabilitated maxilla, were included in the study. Seventy implants in 15 patients were evaluated at 3.3 ± 2.5 years (range 1.1–8.6 years) after loading. Implant survival, complications, clinical parameters, marginal bone loss, and patient-related outcome measures were recorded at the time of evaluation. Overall implant survival was 95.7%. Three implant failures occurred within the first year of function. Marginal bone loss was 0.32 ± 0.46 mm; pocket probing depth was 4.55 ± 1.59 mm. Plaque, calculus, inflammation, and bleeding were hardly seen (median index score 0). Patients scored their satisfaction with their overdentures as high (mean overall score 8.7 ± 1.2, maximum 10). Chewing soft and tough food was scored as ‘good’ and hard food as ‘moderate’. The mean Oral Health Impact Profile score was 29.5 ± 33.3. It can be concluded that the replacement of multiple failing implants in an edentulous maxilla after bone augmentation is a safe and predictable treatment procedure when applied as an implant-supported overdenture.