银杏叶制剂联合地塞米松在老年突聋治疗中对血清炎症指标的影响

目的: 探讨银杏叶制剂联合地塞米松在老年突聋治疗中对血清炎症指标的影响。方法: 按随机数字表法将我院2016年7月-2021年7月收治的102例老年突聋患者分入两组（各51例）。对照组用地塞米松治疗，治疗组加用银杏叶制剂治疗。观察两组治疗前后纯音听阈和血管内皮功能指标[超氧化物歧化酶（SOD）、脂质过氧化物（LPO）、一氧化氮（NO）]、血清炎症指标[肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、白细胞介素-6（IL-6）]，分析其疗效与不良反应。结果: 与对照组比较，治疗组总有效率更高（96.08％vs 82.35％）（χ2=4.993，P=0.025）；两组治疗后各频率点阈值均下降，且相比对照组，治疗组治疗后各频率点阈值更低（P<0.05）；治疗后两组SOD、NO水平均升高，LPO水平降低（P<0.05），且相比对照组，治疗组治疗后SOD、NO水平更高，LPO水平更低（P<0.05）；治疗后两组血清TNF-α、CRP、IL-6水平降低，且相比对照组，治疗组TNF-α、CRP、IL-6水平更低（P<0.05）；治疗组不良反应发生率5.88％，对照组为9.80％，两组比较差异无统计学意义（P=0.543，χ2=0.461）。结论: 银杏叶制剂联合地塞米松治疗老年突聋患者疗效理想，能恢复各频率点听力，安全可靠，推测改善患者血管内皮功能和炎症因子水平是其重要作用机制。     

A customized metal guide for controllable modification of anterior teeth contour prior to minimally invasive preparation

ObjectiveOptimal tooth reduction is a key requirement for aesthetics, function, and the longevity of fixed restorations. Research has demonstrated that controlled and conservative tooth preparation is crucial for the long-term success of adhesive restorations. Different techniques of fabricating reduction guides have been previously reported in literature. The present technical note describes the fabrication technique and clinical application of a customized metal preparation reduction guide.Material and methodPatient presented with tilted maxillary left central incisor. The flared-out part of the tooth was modified prior to veneer restoration preparation. Resin pattern reduction guide was fabricated on the diagnostic cast with a window on the tilted mesial portion of the tooth. After intraoral evaluation, resin pattern guide was casted. Metal reduction guide was place intraorally and reduction was provided on the exposed surface of the tooth. After the removal of the tilted portion, a harmonious arch form allowed the clinician to provide adequate evaluation and preparation for veneer restorations.ResultsThe device demonstrated good practical value, allowing for selective and controlled reduction of tooth structure, and definitive protection of adjacent tooth surfaces from iatrogenic damage. The clinical outcome successfully addressed the patient’s restorative and aesthetic needs, and the veneer was stable 2 years postoperatively.ConclusionUse of a metal guide assists clinicians to provide a more predictable reduction of a desired tooth surface, while decreasing the risk of compromising the other/adjacent tooth surfaces.     

Morphologic Changes of Apical Foramen and Microcrack Formation after Foraminal Enlargement: A Scanning Electron Microscopic and Micro–computed Tomographic Analysis

IntroductionThe aim of the present study was to evaluate the morphologic changes on the apical foramen and the formation of dentinal microcracks after foraminal enlargement in straight and curved root canals using scanning electron microscopic (SEM) and micro–computed tomographic (micro-CT) analyses.MethodsSixty teeth were selected and divided into 2 experimental groups: GI (incisors/straight group, n = 30) and GM (molars/curved group, n = 30). Each group was divided into 2 subgroups (n = 15) according to the analysis performed: SEM or micro-CT analysis. The incisors and mesiobuccal canal of molars were instrumented with Reciproc Blue R25 instruments (VDW, Munich, Germany) using standardized shaping procedures in the apical foramen and 1 mm beyond. The occurrence of foraminal deformation was analyzed by scanning electron microscopy. The z test was used for statistical analysis (P < .05). Micro-CT imaging was used to observe the presence of microcracks in the root apical third. Afterward, pre- and postoperative cross-sectional images were screened to identify the presence of dentinal defects.ResultsThe curvature of the canal did not influence the occurrence of foraminal deformation either for instrumentation in the foramen or for instrumentation beyond the foramen (P > .05). It was also observed that the increase in the working length did not influence the appearance of new deformations in the GI/SEM and GM-SEM groups (P > .05). Qualitative micro-CT analysis showed the presence of dentinal defects in 0.8% (112) and 1.5% (208) of the cross sections of incisors and molars, respectively, from a total of 13,987 slices. All dentinal defects identified in the analysis of any postoperative scans were already present in the corresponding preoperative images. Therefore, no new microcracks were observed after root canal preparation.ConclusionsThe preparation of straight and moderately curved root canals with Reciproc Blue, regardless of the working length, did not influence the occurrence of apical foramen deformations and did not cause the formation of dentinal microcracks.     

Objective evaluation of abutment tooth preparation for preformed metal crowns for primary molars in Japanese preclinical training

Evaluation of abutment tooth shape for preformed metal crowns for primary teeth in preclinical training depends on the subjective opinion of the instructor providing the training. Thus, the student's grade will likely vary according to teacher grading. In this study, we explored the potential for objective evaluation by comparing evaluations performed by teaching personnel (teacher grading) of abutment teeth for preformed metal crowns for primary teeth prepared by students at a dental school with evaluation by a three-dimensional (3D) laser morphometric system (system grading). The subjects of the evaluations were 139 abutment teeth for preformed metal crowns for primary teeth that had been prepared by fourth-year students at Asahi University School of Dentistry during preclinical pediatric dentistry training. A tooth prepared by a teacher following instruction criteria was used as the reference tooth, and system grade points were calculated from deductions made for insufficient and excessive cutting. Teacher grade points varied among teachers. We found that teachers prioritized contours of the margin, buccal and lingual sides, and adjacent surfaces in their evaluations. System grading showed that most students carried out insufficient cutting. The mean (SD) teacher and system grade points were 57.7 (9.7) and 75.7 (4.7), respectively, and these grade points were positively correlated (r = 0.500). System grading provides a simple 3D visual assessment of insufficient and excessive cutting that can be used for instructing students.     

New Ultrasonic Tip Decreases Uninstrumented Surface and Debris in Flattened Canals: A Micro–computed Tomographic Study

IntroductionThe preparation of flattened root canals using reciprocating or rotary nickel-titanium instruments associated with the Flatsonic ultrasonic tip (Helse Ultrasonic, Santa Rosa de Viterbo, SP, Brazil) was evaluated by micro–computed tomographic imaging.MethodsTwenty-four flattened distal canals of mandibular molars with a buccolingual diameter 4 or more times larger than the mesiodistal diameter were selected. The root canals were randomly divided into 2 experimental groups for preparation: a Reciproc Blue (RB; VDW GmbH, Munich, Germany) 40/.06 file in reciprocating motion or ProDesign Logic (PDL; Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil) 40/.01 and 40/.05 files in rotary motion (n = 12). A complementary preparation was performed with the Flatsonic ultrasonic tip for both preparations. Micro–computed tomographic scanning at a resolution of 8.74 μm was performed before and after preparation with the nickel-titanium instruments and after the use of the Flatsonic tip. The percentages of increase in volume, debris, and uninstrumented surface were analyzed. The data obtained were submitted to the paired and unpaired t test, analysis of variance, and the Tukey test (α = 5%).ResultsThe percentage increase in volume, debris, and uninstrumented surface was similar between RB and PDL in the entire root canal (P > .05). The PDL promoted a lower percentage of debris in the cervical third and a lower percentage of increase in volume in the apical third in comparison with RB (P < .05). The Flatsonic decreased debris and uninstrumented surface after PDL preparation in all thirds (P < .05). After preparation with RB, the Flatsonic decreases the debris in the cervical third and the uninstrumented surface in the cervical and middle thirds (P < .05).ConclusionsThe preparation of flattened root canals using RB or PDL produced a high percentage of debris and uninstrumented surface. The Flatsonic ultrasonic tip significantly improved the cleaning of flattened root canals.     

利用聚多巴胺制备丹参注射液缓释制剂的研究

目的:利用聚多巴胺(PDA)对丹参注射液中多成分进行负载,构建丹参注射液(SMI)缓释制剂(PDA-SMI)。方法:建立丹参注射液的原儿茶醛、迷迭香酸和丹酚酸B3种成分的分析方法并进行含量测定;制备PDA,在pH值2.5的条件下对SMI进行负载,制备PDA-SMI;对PDA-SMI体外释放行为进行考察。结果:SMI中原儿茶醛、迷迭香酸、丹酚酸B的浓度分别为0.344、0.214、0.262 mg/mL;PDA-SMI对原儿茶醛、迷迭香酸、丹酚酸B的载药量分别为8.59%,15.90%和20.57%;PDA-SMI中原儿茶醛、迷迭香酸、丹酚酸B体外累计释放率分别为84.05%,77.57%和63.12%。结论:PDA可以负载SMI的多种成分,载药量较高,并具有良好的缓释效应。     

儿童结肠镜术前肠道准备质量的影响因素

目的评估行结肠镜检查术前患儿的肠道准备质量,并探讨其影响因素。方法前瞻性纳入2017年8月1日至2018年3月31日期间行结肠镜检查术的患儿198例。根据Boston肠道准备评分量表(The Boston Bowel Preparation Scale,BBPS)进行肠道准备质量评价,并收集患儿一般资料、肠道准备过程相关情况;采用有序logistic回归分析肠道准备质量的影响因素。结果纳入的198例患儿中,男116例、女82例;平均年龄(8.70±2.87)岁;总BBPS得分为(7.45±1.31)分。肠道准备清洁程度为优104例(52.5%),良74例(37.4%),差20例(10.1%);发生不良反应90例(45.5%)。清洁度优、良、差三组患儿之间便秘史,服药后大便次数,最后一次大便性状,不良反应,服药前、服药期间、服药后运动的差异均有统计学意义(P0.05)。Logistic回归分析发现服药后大便次数少,最后一次大便性状为稀糊状、深黄色或褐色有渣、淡黄水样,服用泻药期间无运动和没有完全服用泻药是降低肠道准备清洁度的独立影响因素(P0.05)。结论临床应早期识别影响肠道准备质量的相关因素,并及时采取相应干预措施,以提高肠道准备质量。