MACRO-LOCK石英纤维桩的修复效果及安全性评价*

背景：在桩核的设计选择中,石英纤维桩因其良好的理化性能被认为是金属桩的良好替代品。 目的：评价MACRO-LOCK石英纤维桩树脂核全冠修复残根、残冠的临床疗效和安全性。 方法：将大面积前牙牙体缺损患者随机分为2组：石英纤维桩组患牙行完善的根管治疗后,利用MACRO-LOCK石英纤维桩、ULPDENT树脂黏接剂,PULPDENT双固化树脂核材料恢复桩核,以全瓷冠或贵金属烤瓷全冠修复。对照组患牙行传统的铸造金属桩核冠修复。随诊6个月及3年时的修复效果。 结果与结论：与对照组相比,石英纤维桩组RTD-MACOK POST石英纤维桩修复后随访3年仅1例发生桩核脱落,1例出现纤维桩折断,未出现根折现象,3年随访的成功率较高(P < 0.05)。结果证实,MACRO-LOCK石英纤维桩修复残根、残冠可获得良好的远期修复效果,安全性较好。     

5000/高强度玻璃纤维复合树脂桩核与IPS E.Max全瓷冠修复前牙缺损的临床效果观察

目的：研究Parapost Fiber Lux高强度玻璃纤维复合树脂桩核系统与IPS E.Max全瓷冠对前牙缺损修复的临床效果。方法：对80例患者,118例牙体缺损的前牙行完善的根管治疗后,用高强度玻璃纤维复合树脂桩核与IPS E.Max全瓷冠进行修复。结果：经过6—24个月后的临床随访观察,全瓷冠的固位良好,无发现根折或者桩折断,边缘密合,美观逼真自然。结论：高强度玻璃纤维复合树脂桩核系统与IPS E.Max全瓷冠对前牙缺损修复具有比较理想的临床效果。     

纤维桩的性能及其修复残根残冠的黏结固位

摘要目的：探讨预成金属桩、铸造金属桩、陶瓷桩、纤维桩等材料在临床应用中的优缺点,评价纤维桩的机械性能、美学性能以及材料的生物相容性。方法：以“纤维桩,桩核修复,口腔材料,粘固材料,黏结剂”为中文关键词;以“fiber post, post-core restoration, dental materials, cement material, binder”为英文关键词,采用计算机检索1990-01/2008-10相关文章。纳入与纤维桩在残根残冠修复中的应用研究相关文章;排除重复研究或Meta分析类文章。以24篇文献为主重点讨论了纤维桩的机械性能、生物相容性以及纤维桩的黏接固位。组织工程血管材料的种类及其性能。结果：鉴于传统的金属桩容易导致根折的发生、易腐蚀、同时存在美学性能和生物相容性的问题,纤维桩与传统的金属桩相比,纤维桩的强度、硬度、美学性能、抗腐蚀、抗疲劳性能以及生物相容性均比较优越。而且,纤维桩可以通过树脂类黏接剂与根管牙本质之间达到很高的黏接强度,这可以延长修复体的使用寿命,并能减少根折的发生,有利于牙齿的保存和失败后的再修复。同时纤维桩质量更轻是金属桩的很好替代品。而且在修复失败后,纤维桩更易取出,使得再修复容易进行。纤维桩和树脂类核的联合使用,可以使最终的修复体更加接近天然牙的本来结构。 结论：纤维桩具有合适的弹性模量,良好的美容修复效果,黏结效果可靠,易鉴别、易去除,修复成功率高,操作简便,是一种新型、理想的美观桩核材料,值得在临床上广泛推广应用。关键词：纤维桩;桩核修复;口腔材料;粘固材料;黏结剂     

上颌中切牙全瓷冠纤维桩与复合树脂核在两种边界条件下的应力分析

摘要 背景：以往应用三维有限元对桩核修复体的研究中,对在不同边界条件下的应力分析报道较少。 目的：应用三维有限元法分析两种边界条件下,上颌中切牙全瓷冠纤维复合树脂桩核修复后的应力变化。 方法：使用三维螺旋CT,对受试者上颌中切牙进行连续扫描,并输入Mimics10.01软件中,建立两组相同的三维有限元模型。分别定义两组的边界条件为摩擦关系和全约束关系。在有限元分析软件Abaqus中,分析两种边界条件下全瓷冠、剩余牙本质和玻璃纤维桩的Von Mises应力及最大主应力。 结果与结论：全瓷冠、剩余牙本质在摩擦关系下的应力峰值明显增高;纤维桩在两种边界关系下的应力峰值相差甚小;两种边界关系下各部分组织的应力分布基本相同;提示边界条件不会改变原有组织的应力分布,但其对应力峰值影响较大,纤维桩不会降低剩余牙本质的应力峰值。     

玻璃纤维桩核与镍铬合金桩核修复牙组织抗折裂强度的体外实验★

目的：传统桩核材料由于自身的局限性已不能满足临床需要，新型玻璃纤维桩核的强度有待证实。比较玻璃纤维桩核和镍铬合金桩核系统修复离体牙咀嚼抗折裂强度。 方法：实验于2006-11/2007-09在辽宁医学院附属第二医院口腔实验室完成。选择因牙周病拔出的6个月以内的上颌中切牙40颗，患者对治疗及实验均知情同意，并自愿捐献。40颗离体牙按随机数字表法分为两组，玻璃纤维桩核系统组和镍铬合金桩核系统组，每组20个。行常规根管治疗后截除牙冠，分别用玻璃纤维桩核系统和镍铬合金桩核系统进行桩核及烤瓷冠恢复外形，包埋于底座后在INSTRON测试仪上进行抗折裂强度的测试，记录试件折裂时测试机上的读数以及试件折裂的模式。 结果：①玻璃纤维桩核系统修复的牙体折裂时的负荷值高于镍铬合金桩核系统[分别为（1.29±0.46）kN，（0.93±0.58）kN]。②牙体组织折裂后可再次修复玻璃纤维桩核系统组18个，镍铬合金桩核系统组5个，玻璃纤维桩核系统的牙体组织折裂后可再次修复的可能性高于镍铬合金桩核系统修复的牙齿，差异性有显著性意义（P < 0.01）；牙体组织折裂后不可再次修复玻璃纤维桩核系统组2个，镍铬合金桩核系统组15个。 结论：玻璃纤维桩核系统修复离体牙咀嚼抗折裂强度优于镍铬合金桩核系统。     

三维有限元分析前牙薄弱根管重塑后的桩核冠修复

背景：目前对于薄弱根管重塑后桩核修复的研究多为复合树脂重塑后金属桩核修复,纤维桩核修复研究较少。 目的：采用三维有限元方法对薄弱根管重塑后应用不同材料桩核修复的牙本质内应力分布情况进行分析。 方法：利用螺旋CT扫描正常上颌中切牙,获得BMP位图后,应用Adobe Photoshop Matlab 7.0软件建立正常牙、薄弱根管及薄弱根管重塑模型,将数据输入Ansys 11.0中形成三维有限元模型。模拟临床正常咬合对模型进行加载,分析石英纤维桩核冠、玻璃纤维桩核冠、铸造镍铬合金桩核冠修复正常根管、薄弱根管、重塑后薄弱根管3种状态根管的牙本质、桩核及重塑体内的应力分布情况。 结果与结论：薄弱根管重塑后桩核冠修复整个牙根的Von mises应力可下降到正常根管水平,且应力分布情况也与正常根管相似。纤维桩核修复不会明显改变高应力区的分布,与桩修复前牙根的应力分布相同;铸造镍铬合金桩核修复不会明显改变高应力区的分布,但与桩修复前牙根的应力分布不同,使薄弱根管牙根颈部唇侧牙本质的Von mises应力峰值明显升高,重塑根管后有所下降,但仍高于正常根管。提示用弹性模量和牙本质接近的修复材料重塑薄弱根管,可以降低牙本质及桩内的应力,有利于薄弱根管残根的保存治疗。纤维桩较铸造镍铬合金桩更适于残根的桩核冠修复。     

单纤维肌电图结合疲劳试验对重症肌无力的诊断价值

目的对重症肌无力(MG)患者行单纤维肌电图(SFEMG)检测及疲劳试验,探讨两者结合对重症肌无力的诊断意义。方法选择53例MG患者进行试验。均在下午15点~16点选取小指展肌、三角肌进行SFEMG检测,休息10min后,进行疲劳试验5min,休息2min后再进行SFEMG检测记录相关数据进行分析。结果 53例患者中,单纯SFEMG检查正常者20例(33.73%),异常者33例(62.26%),其中颤抖延长者有34例(64.15%),阻滞者28例(52.83%)。疲劳试验后,SFEMG检查正常者3例(5.66%),异常者50例(94.34%),其中颤抖延长者有48例(90.57%),阻滞者43例(81.13%)。疲劳试验前后两者数据相比,差异有统计学意义(P<0.05)。结论 SFEMG结合疲劳试验可明显提高MG患者的阳性诊断率,尤其对于静息状态下SFEMG检测正常的MG患者更有效,能在检测中很好的减少伪差,减小患者重复检查的痛苦,并对记录结果的分析有很高的参考价值。     

纤维桩核修复3种上切牙牙冠缺损类型的有限元应力对比*

挑选1颗牙体完好无损,解剖值符合国内牙体解剖平均数据的成人离体上中切牙。使用牙科专用锥形束CT扫描,图像处理并根据牙冠和牙本质肩领的不同缺损量逆向建立3种不同缺损类型的牙体-纤维桩核-全瓷冠的三维有限元模型。模型1：牙冠横行缺损,存在2 mm的完整牙本质肩领;模型2：牙冠近远中斜行缺损,牙本质肩领部分缺失;模型3：牙冠横行缺损,牙本质肩领完全缺失。用ABAQUS软件进行三维有限元分析,对比加载后3个模型的应力分布状态。牙本质肩领不完整的牙冠近远中向斜行缺损时,与牙本质肩领完整牙齿的应力分布情况接近,但粘接剂和纤维桩上的应力峰值明显低于无牙本质肩领的牙齿模型。提示纤维树脂桩核修复牙本质肩领完整的牙冠横行缺损效果最佳;牙本质肩领部分缺失的牙冠近远中斜行缺损仍可以使用纤维树脂桩核修复体;纤维桩核修复无牙本质肩领的牙冠横行缺损时,脱落、折断的可能性增大。     

玻璃纤维桩与Ni-Cr合金桩核在前牙桩拆除后再修复中的比较**

摘要：对比观察玻璃纤维桩与Ni-Cr合金桩核在前牙桩拆除后再修复中的应用效果。选取89例共103颗拆除桩后需要再修复的前牙，分别用玻璃纤维桩（54颗）和Ni-Cr合金桩（49颗）作桩核修复，患者两年后复诊，观察修复效果。其中玻璃纤维桩组有3例出现中度牙龈炎性反应，2例桩核折断，1例桩脱落；Ni-Cr合金桩核组有8例和6例分别出现牙龈中、重度反应，6例出现边缘色泽改变，7例出现根折，5例出现桩核脱落。结果表明玻璃纤维桩比铸造金属桩更适合应用于前牙的再次修复，但不能完全代替Ni-Cr合金桩。     

多个玻璃纤维桩树脂核修复磨牙残冠

背景：由于铸造金属桩核弹性模量大,修复磨牙残冠残根时易造成根尖部根折,难以取出、生物相容性差等缺点。 目的：评价多个玻璃纤维桩修复磨牙残冠的临床效果。 方法：选择26例31颗磨牙残冠,经完善根管治疗后,选择两至三个根管制作玻璃纤维桩树脂核,然后进行氧化锆全瓷冠修复,随访观察治疗效果。 结果与结论：随访12~24个月,3颗全瓷冠出现颜色偏差,因后牙对美观影响不大,患者未提出异议;1颗冠崩瓷而重做外冠,1颗冠因邻接关系不良导致食物嵌塞而重做外冠,1颗冠因牙合龈距离低,聚合度过大冠脱落,经增加辅助固位型后重做外冠,重做外冠观察半年以上未见异常。其余病例修复体外形良好,边缘密合,X射线检查桩与根管密贴,无桩或根折,根尖根周牙槽骨无吸收影像。表明多纤维桩树脂核技术修复磨牙残冠能够获得良好的近期临床效果。     

金铂合金烤瓷冠对牙周组织的影响

背景：金属烤瓷冠的修复材料种类很多,每种材料的性能及对牙周组织细胞毒性影响均不相同。 目的：观察金铂合金烤瓷冠修复后对牙周组织的影响。 方法：选择2009-06/2010-01采用金铂合金烤瓷冠进行上颌切牙修复患者21例(26颗牙),以患牙对侧的同名健康牙为对照牙。烤瓷冠戴入6~8个月后复诊。 结果与结论：修复体边缘的深度及密合度均符合临床要求,修复后患牙的菌斑指数和龈沟液内血管内皮生长因子、肿瘤坏死因子α水平与对照牙比较,差异无显著性意义(P > 0.05),但患牙探诊深度、龈沟内出血指数及龈沟液量明显高于对照牙,差异有显著性意义(P < 0.05)。说明金铂合金烤瓷冠对患牙牙周组织有一定的不良影响。     

Fatigue in patients with diabetes: A review

Objective

Fatigue is a common and distressing complaint among people with diabetes and likely to hinder the ability to perform daily diabetes self-management tasks. A review of the literature about diabetes-related fatigue was conducted with an eye toward creating a framework for beginning to conduct more focused studies on this subject.

Methods

A literature search containing the terms diabetes, fatigue, tiredness, and symptoms was conducted to search for literature that addressed diabetes-related fatigue.

Results

Diabetes presents many potential pathways for fatigue, but focused studies on this symptom are rare. Furthermore, research on diabetes-related fatigue is limited by fatigue's nonspecific symptoms and because fatigue researchers have yet to agree on standardized definition, measurement, or diagnostic criteria. Additionally, few diabetes randomized clinical trials included measurement of patient-reported outcomes, such as symptoms or health-related quality of life in their study designs, although one that did provided some meaningful finding that symptom-focused education improved self-management practices, Hb_A1c levels, quality of life, and symptom distress.

Conclusion

There is a need to standardize the definition, measurement, and diagnostic criteria of fatigue in diabetes. We present a model that can guide focused studies on fatigue in diabetes. The model capitalizes on the multidimensional phenomena (physiological, psychological, and lifestyle) associated with fatigue in diabetes.     

Repetitive transcranial magnetic stimulation in treatment of post polio syndrome

Background

Post polio syndrome is a rare disease that occurs decades after polio virus infection. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness in drug resistant depression. Possibly it can be helpful in therapy of other neurological diseases including post polio syndrome.

帕金森病患者疲劳与睡眠障碍的研究

目的调查帕金森病(Parkinson’s disease,PD)患者中疲劳和睡眠障碍的患病率,研究疲劳和睡眠障碍的危险因素及相关性。方法采用疲劳严重度量表(FSS)和匹兹堡睡眠质量指数量表(PSQI)对363例PD患者的疲劳及睡眠状况进行评价。FSS4界定为疲劳,PSQI≥7界定为睡眠障碍。同时,采用统一帕金森病评分量表(UPDRS)及HoehnYahr评价运动障碍及严重程度,美国国立精神卫生研究所流行病学研究中心编制的抑郁量表(CESD)评价抑郁,阿尔茨海默病评定量表(ADAS-Cog)评价认知,36条目简化医疗结局调查问卷(SF-36)评价生活质量。结果 363例PD患者61.7%存在疲劳,55.1%存在睡眠障碍。其中,136例(37.5%)疲劳与睡眠障碍共存,87例(24%)仅存在疲劳,63例(17%)仅存在睡眠障碍。单因素方差分析显示,疲劳组与对照组比较UPDRS第3部分评分、左旋多巴制剂等效剂量(LDE)、CESD分值均显著升高(均P0.001);睡眠障碍组与对照组比较UPDRS第3部分评分、LDE、CESD分值均无显著差异(均P0.05)。多参数Logistic回归显示,UPDRS第3部分评分和CESD分值能预测疲劳的发生,而LDE未被引入疲劳预测模型。与之相反,UPDRS第3部分评分、LDE、CESD分值均不能预测睡眠障碍的发生。结论疲劳和睡眠障碍是PD常见的非运动症状。二者在临床上有所重叠,但危险因素不同,疲劳和睡眠障碍是PD独立的非运动症状。     

创伤后应激障碍发生自杀的研究进展

随着近年来对创伤后应激障碍（PTSD）的关注越来越多,目前认为PTSD患者自杀率远远高于普通人群,因此,早期识别自杀并干预将具有重大的医学和社会意义。现从PTSD发生自杀的流行病学、影响因素、生物学机制及干预几个方面进行综述。     

Fatigue in patients with lupus is not associated with disturbances in cerebral blood flow as detected by SPECT

Abstract Objectives Fatigue is a common complaint in patients with systemic lupus erythematosus (SLE). We investigated whether focal or general disturbances of cerebral blood flow (CBF), as assessed by SPECT, were associated with the presence of fatigue in an unselected group of SLE patients. Methods Fifty-six patients were included. Mean age was 47.5 years (±12.7), mean disease duration 14.7 years (±8.9), and disease activity measured by SLE disease activity index (SLEDAI) was 5.7 (±5.4). Fatigue was assessed by the Fatigue Severity Scale (FSS) and CBF by Tc-99m-hexamethyl propylamine oxime (HMPAO)-SPECT. The images were read and processed quantitatively by a computer program using the primary visual cortex as reference region and > 15% CBF deviation as definition of abnormality. Results The mean FSS score was 4.6 (±1.8). SPECT revealed focal CBF disturbances in 17 patients (30.4 %). Generalized symmetrical CBF reductions were present in 32 patients (57.1 %). There were no significant associations between CBF disturbances in any region of the brain and the degree of fatigue. Conclusions Fatigue in SLE patients is not related to focal or general CBF disturbances. Therefore, factors that do not influence blood flow seem responsible for the fatigue phenomenon.     

Fatigue in patients with sarcoidosis, compared with the general population

Objective

Fatigue is a significant symptom in sarcoidosis patients. The causes for this symptom are unclear. The aims of this study were to analyze age and gender differences in fatigue, compared with the general population, and to test the psychometric properties of two questionnaires measuring fatigue in sarcoidosis.

Method

A sample of 1197 patients diagnosed with sarcoidosis was examined in Germany with the Fatigue Assessment Scale (FAS) and the Multidimensional Fatigue Inventory (MFI).

Results

The percentages of patients exceeding the fatigue cut-offs were 70% (FAS) and 68% (MFI), respectively. While in the general population there is a nearly linear age trend (high fatigue scores with increasing age), among the patients there is only a very slight and nonlinear age trend. Female patients are more affected by fatigue than male patients, but this relationship is also true in the general population. Both questionnaires (FAS and MFI) are equally suited to test fatigue; their psychometric properties are good. They should not be replaced with a single question concerning tiredness.

Conclusion

The comparison to norm data is highly recommended for the evaluation of age and gender differences. Compared with the general population, young sarcoidosis patients are especially affected by fatigue.     

Children and adolescents with Chronic Fatigue Syndrome in non-specialist settings

Abstract Background Adolescents with Chronic Fatigue Syndrome (CFS) seen in specialist centres have substantial psychological and functional impairment. Beliefs about activity levels may be important in the development of CFS. Method The aim was to investigate psychological and functional impairment, and beliefs in children and adolescents with CFS recruited from non-specialist services. A total of 30 such individuals participated, and 30 young people with Inflammatory Bowel Disease (IBD) formed the comparison group. Results Emotional symptoms and disorder were high in both groups. In all, 50% of those with CFS and 30% with IBD reached the threshold for emotional disorder according to the Strengths and Difficulties Questionnaire (SDQ) parent report, although this difference did not reach statistical significance. Participants with CFS scored statistically significantly higher on measures of functional impairment, including school non-attendance, compared to those with IBD. According to questionnaire responses, those with CFS were statistically significantly more likely to favour rest rather than exercise compared to those with IBD. Comparison of parental beliefs did not show such a difference. Conclusions These young people with CFS were at high risk of psychiatric disorder. They were substantially disabled when compared to individuals with a known chronic illness. Also, as a group, they were characterised by a preference for rest rather than exercise.