上颌快速扩弓联合前方牵引对替牙期骨性Ⅲ类错牙合畸形的矫治疗效

目的 通过锥形束断层扫描技术(cone beam computed tomography, CBCT)研究评价上颌快速扩弓联合前方牵引对替牙期骨性Ⅲ类错牙合横向不足的治疗效果。方法 选择替牙期骨性Ⅲ类错牙合患儿19例,平均(8.47±0.70)岁。分别于上颌快速扩弓联合前方牵引治疗前(T₁)及扩弓结束3个月后(T₂)拍摄CBCT,测量上颌第一磨牙倾斜度、上颌前磨牙段及第一磨牙牙冠宽度、牙槽突宽度、上颌基骨宽度、牙槽嵴高度、第二前磨牙牙胚在牙槽骨中的位置等,比较治疗前后各测量项目的差异。结果 从T₁到T₂阶段,上颌第一前磨牙牙冠宽度增加(2.37±3.47)mm (P=0.008),第二乳磨牙牙冠宽度增加量中位数为3.37 mm (P=0.009),第一磨牙牙冠宽度增加(2.60±2.53)mm (P<0.001),上颌第一前磨牙、第二乳磨牙、第一磨牙对应牙槽突宽度分别增加(1.63±2.45)mm (P=0.010)、(2.12±2.59)mm (P=0.002)、(1.98±2.10)mm ...     

自锁托槽和传统结扎托槽对拔牙矫治效果的比较

目的使用自锁托槽和传统结扎托槽进行拔牙矫治,比较两种托槽治疗前后磨牙支抗丧失和上切牙位置变化的情况,评价两种托槽系统的临床效果。方法选择52例需要拔除4个第一双尖牙矫治的病例,分为传统结扎托槽组(CB组)25例和自锁托槽组(SLB组)27例。在治疗前后头颅侧位定位片上分别测量、比较矢状向第一磨牙前移量、上颌中切牙内收量,垂直向上颌第一磨牙和上颌中切牙位置的变化及上颌中切牙冠转矩的变化。采用t检验进行统计学分析。结果CB组和SLB组矢状向上颌第一磨牙前移量分别为(2.90±1.58),( 2.26±0.92)mm; 矢状向上颌中切牙内收量分别为(2.99±1.44),(3.45±1.88)mm; 垂直向上颌第一磨牙移动量伸长分别为(0.18±0.94),(0.49±1.38)mm; 垂直向上颌中切牙移动量伸长分别为(0.17±1.56),(0.64±1.24)mm; 上颌中切牙冠转矩变化舌倾分别为(4.76±3.93)°,(4.62±2.15)°。两组病例所有测量项目治疗前后的变化比较,差别无统计学意义(P>0.05)。结论使用传统结扎托槽和自锁托槽进行拔除上颌第一双尖牙矫治后,无论时矢状向还是垂直向的磨牙支抗保护和前牙内收效果差别均无统计学意义,低摩擦力的自锁托槽并不能获得更好的临床效果。     

成人上中切牙迟萌2例

上颌恒中切牙在生长发育过程中，易受到外伤、疾病、局部多生牙、乳牙滞留等因素的干扰而致埋伏、祖生、近前、发育仅形，发育不良等．然而，成年后埋伏之恒中切牙迟前实国罕见，现将所见之2例病例报告如下．例1，陈某，女，犯岁，自达近几月来自觉上颌州部位租槽粘肿胀，助之质硬，同时伴有川处修复体松动、脱落，州牙冠渐8．检查：11牙冠萌出1／4左右，朵白质发育正常，川牙冠呈近中倾斜，局部牙龄粘膜路红肿，ZI残根，X－ray显示：1呀冠为低拥状态，很尖路温状、川牙槽突处牙周膜呈楔状包统牙预牙历腔科大，牙根长度姑短，州牙冠位立正…     

锥形束CT在上颌尖牙埋伏病因机制中的应用

目的:利用三维锥形束CT技术研究上颌尖牙唇侧和腭侧埋伏的病因学机制?方法:选取262例有上颌尖牙埋伏和262例无尖牙埋伏的患者为研究对象,其中前者分为唇侧埋伏组和腭侧埋伏组,在治疗前均接受CBCT扫描?在单盲条件下对CBCT数据进行分析,以获取牙齿?牙弓和颌骨的定性和定量资料?采用 SPSS13.0 软件包对测量结果进行统计学分析?结果:腭侧埋伏组侧切牙牙冠的近远中宽度显著小于其他组(P < 0.001)?唇侧埋伏组的上牙弓前段宽度和上颌骨宽度都显著小于对照组(P < 0.001)?腭侧埋伏组中锥形侧切牙和唇侧埋伏组中切牙埋伏的发生率均显著提高(P < 0.001)?唇侧埋伏组和腭侧埋伏组尖牙牙尖所处的部位分别位于侧切牙长轴的近中和远中?结论:中国人群上颌尖牙唇侧埋伏阻生主要与上颌前部牙弓和颌骨宽度不足以及切牙埋伏有关,而上颌尖牙腭侧埋伏主要与相邻侧切牙过小或缺失有关?上尖牙萌出路径受上述局部因素作用而产生变化导致不同方位的埋伏阻生?     

第二恒磨牙生长萌出位置和发育阶段与不同矢状骨面型的相关性研究

目的通过评价11岁牙龄儿童不同矢状骨面型患者第二恒磨牙的萌出位置和发育阶段,分析其与不同矢状骨面型的相关关系。方法选取牙龄11岁错畸形患者74例(根据Becker牙龄评价标准确定牙龄)。根据患者矫治前数字头颅侧位X线片,测量3组患者的SNA角、SNB角、ANB角以及APDI值,依据测量值将其分为骨性Ⅰ类组、下颌骨骨性Ⅱ类组和上颌骨骨性Ⅲ类组。同时根据头颅侧位X线片和数字化曲面断层X线片,测量第二磨牙的萌出高度、角度和发育阶段。采用SPSS16.0软件包进行统计学分析,P<0.05差异具有统计学意义。结果 11岁牙龄儿童在不同矢状骨面型中,上下颌第二恒磨牙萌出高度、角度和发育阶段均未见显著差异(P>0.05);PP长度与上颌第二恒磨牙的萌出高度及发育阶段呈正相关性(P<0.01),与萌出角度呈负相关性(P<0.05);GM长度与上下颌第二恒磨牙的发育阶段呈正相关性(P<0.01),但与下颌第二磨牙的萌出高度和角度无相关性(P>0.05)。结论通过11岁牙龄组的第二恒磨牙萌出高度、角度、发育阶段与不同矢状骨面型相关性分析可推断,11岁牙龄组儿童上颌骨长度越长,上颌第二磨牙萌出高度越高,萌出角度越小,发育时间越早;下颌体长度越长,上下颌第二磨牙发育越早。     

锥形束CT应用于上颌埋伏尖牙正畸牵引手术开窗定位中的价值研究

目的:探讨锥形束CT应用于上颌埋伏尖牙正畸牵引手术开窗定位中的应用价值。方法:对25例(26颗)上颌埋伏尖牙正畸牵引术患者采用锥形束CT扫描,记录上颌埋伏尖牙牙冠位置、发育情况,尖牙整体位置及与相邻切牙情况;采用上颌埋伏尖牙正畸牵引术进行牵引导萌。结果:埋伏尖牙的牙冠位置、尖牙发育及整体位置、相邻切牙情况与锥形束CT影像特征相符。经过锥形束CT定位及正畸牵引术治疗,26颗上颌尖牙形态良好,牙髓活力正常,无邻牙牙根吸收情况。结论:锥形束CT能够对上颌埋伏尖牙进行精确定位,确保正畸牵引手术的顺利进行。     

锥形束CT在儿童上颌前部埋伏多生牙定位中的应用

目的探讨锥形束CT技术在儿童上颌前部埋伏多生牙中的诊治应用价值。方法对在门诊常规X线检查中发现的埋伏多生牙病例,行锥形束CT扫描,分析判断埋伏牙的位置,确定手术进路,然后拔除。结果锥形束CT结果显示：16例患者20颗上颌前部埋伏多生牙,13颗位于腭侧,5颗位于唇侧,2颗位于牙槽骨中部,与术中所见一致。锥形束CT可以准确显示上颌前部埋伏多生牙的数量、牙冠牙根形态、唇腭侧位置、萌出方向及与邻牙关系。结论锥形束CT技术的应用是精确定位儿童上颌前部埋伏多生牙有效方法。     

皮质骨切开术对正畸牙齿矢状方向移动方式及幅度的影响

目的 探讨皮质骨切开术对正畸牙齿矢状方向移动方式及幅度的影响。方法 选择2019年3月至2020年2月在南京市浦口区中医院进行治疗的82例错颌畸形患者,采用随机数字表法分为研究组和对照组,每组41例。对照组接受常规正畸治疗,观察组接受皮质骨切开术辅助正畸治疗。对比两组患者术前1周正畸时间（排齐时间、关闭间隙时间及总时间）、上颌中切牙切缘中点至水平面距离（U1I-HP距）、上颌中切牙切缘中点至冠状面距离（U1I-CP距）、上颌中切牙牙根尖点至水平面距离减少量（U1R-HP距）及上颌中切牙牙根尖点至冠状面距离减少量（U1R-CP距）。对比两组患者上颌中切牙、上颌第一磨牙矢状方向移动距离。对比两组患者不同时刻（术前及术后1周、4周、8周）角化龈宽度。结果 两组患者排齐时间对比,差异无统计学意义（P＞0.05）,研究组关闭间隙时间及总时间短于对照组（P＜0.05）。两组患者U1I-HP距、U1R-HP距对比,差异均无统计学意义（P＞0.05）,研究组U1I-CP距、U1R-CP距均高于对照组（P＜0.05）。两组患者上颌中切牙、上颌第一磨牙矢状方向移动距离对比,差异均无统计学意义（P＞0.05）。两组患者角化龈宽度时间对比差异有统计学意义（P＜0.05）;与术前相比,两组患者术后1周角化龈宽度均增加（P＜0.05）;术后4、8周角化龈宽度与术前对比,差异均无统计学意义（P＞0.05）;两组患者角化龈宽度组间及交互效应对比,差异则均无统计学意义（P＞0.05）。结论 相比常规正畸治疗,皮质骨切开术辅助正畸治疗可缩短正畸治疗术前正畸时间,促进畸牙移动,且对术前正畸过程中牙齿矢状方向移动模式及术区角化龈宽度无明显影响。     

口腔颌面锥形束CT在上颌窦提升牙种植术中的临床应用

目的 观察锥形束CT在评估上颌后牙缺牙区牙槽嵴高度、宽度及指导上颌窦提升牙种植术中的应用,并评价其效果.方法 23例行牙种植术患者在术前均拍摄锥形束CT,测量和观察上颌后牙缺牙区牙槽嵴高度、宽度及上颌窦的形态,完成上颌窦提升和牙种植术,术后定期随访观察.结果 牙种植术前经锥形束CT测量设计,手术均按术前设计完成了上颌窦的提升和牙种植体的精确植入,短期疗效满意.结论 锥形束CT应用于上颌窦提升牙种植术前测量设计,可以达到规避手术风险、减少手术并发症、指导上颌窦提升和牙种植术、提高手术成功率的作用,值得临床推广.     

年轻女性骨性Ⅱ类错上前牙牙槽骨厚度CBCT测定

目的 了解年轻女性骨性Ⅱ类错上前牙牙槽骨厚度的特点,及其与骨性Ⅰ类错上前牙牙槽骨厚度差异。方法 选取年轻女性骨性Ⅱ类、Ⅰ类错锥形束CT(CBCT)影像各30例,以上颌腭平面为水平基准平面,分别作右上前牙的矢状向切面,测量唇舌侧牙槽骨厚度。结果 Ⅱ类组上颌中切牙、侧切牙舌侧牙槽骨厚度在根尖、根中水平均小于Ⅰ类组(t=1.47~2.69,P<0.05);Ⅱ类组上颌尖牙舌侧牙槽骨厚度在根中水平小于Ⅰ类组(t=3.45,P<0.01)。Ⅱ类组上前牙牙槽骨最薄处均位于唇侧根中水平,最厚处均位于舌侧根尖水平。结论 骨性Ⅱ类错与骨性Ⅰ类错上前牙牙槽骨牙槽骨厚度有一定差异,且骨性Ⅱ类错内收治疗的风险更大,内收治疗时应谨慎设计。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.