咬合面无饰瓷氧化锆修复体的3年随访观察

目的:评价咬合面无饰瓷氧化锆后牙单冠的临床效果。方法:本研究选取96例患者的单颗后牙的治疗后全冠修复,96颗后牙全部选择咬合面无饰瓷氧化锆全冠,经过3年随访,对修复体本身、对颌牙釉质磨耗情况以及患者满意度进行临床疗效评价,评价结果采用秩和检验。结果:96例修复体除2例出现修复体脱落现象以外,在修复体抗折性、边缘适合性、邻接关系方面均未发生改变,同时对颌牙磨耗的分级评价未发生显著改变改变,经检验未见统计学差异。结论:无饰面氧化锆后牙单冠进行3年观察能够满足临床治疗需要。     

纤维桩核修复后牙残冠临床疗效观察

目的:观察纤维桩核修复后牙残冠的疗效。方法:应用瑞士康特公司生产的Par a Pos t FI BER LUX玻璃纤维桩核材料成型后牙残冠桩核,辅以氧化锆全瓷冠修复外冠,86例(117颗)后牙于修复后6、12、18、24个月随访评估临床疗效。结果:117颗患牙在修复后随访观察期间,2颗修复体发生崩瓷现象,1颗修复牙并发牙龈炎,2颗患牙发生修复体外冠脱落,1颗修复体发生食物嵌塞;所有修复牙未发现根折、纤维桩核脱落、纤维桩折断及慢性根尖周炎等严重并发症。结论:应用纤维桩核修复后牙残冠能获得良好的近期临床效果。     

纤维桩联合氧化锆全冠修复磨牙大面积缺损的临床评价

目的:评价石英纤维桩联合氧化锆全瓷冠在磨牙大面积缺损修复治疗中的短期临床效果。方法:对28例患者32颗已完善的根管治疗的磨牙残根、残冠,采用石英纤维桩联合氧化锆全瓷冠进行修复。修复后1、6、12个月随访检查,包括修复体完整性、边缘适合性、解剖外形、颜色及牙龈。结果:修复体的完整性好(93.75%),有2例因咬过硬食物崩瓷,边缘适合性及解剖外形良好,修复体颜色与邻牙协调一致(84.37%),纤维桩核及冠均无松动、脱落,X线牙片示纤维桩与根管壁密贴,未见折裂等。结论:石英纤维桩联合氧化锆全瓷冠在磨牙大面积缺损修复治疗中可取得良好的近期临床效果。     

纤维桩联合氧化锆全冠修复磨牙大面积缺损的临床评价

目的:评价石英纤维桩联合氧化锆全瓷冠在磨牙大面积缺损修复治疗中的短期临床效果。方法:对28例患者32颗已完善的根管治疗的磨牙残根、残冠,采用石英纤维桩联合氧化锆全瓷冠进行修复。修复后1、6、12个月随访检查,包括修复体完整性、边缘适合性、解剖外形、颜色及牙龈。结果:修复体的完整性好(93.75%),有2例因咬过硬食物崩瓷,边缘适合性及解剖外形良好,修复体颜色与邻牙协调一致(84.37%),纤维桩核及冠均无松动、脱落,X线牙片示纤维桩与根管壁密贴,未见折裂等。结论:石英纤维桩联合氧化锆全瓷冠在磨牙大面积缺损修复治疗中可取得良好的近期临床效果。     

虚拟(牙合)架在CAD/CAM铣削氧化锆粘接桥中的应用

目的:探讨虚拟(牙合)架在计算机辅助设计与制作(CAD/CAM)铣削氧化锆中的应用,观察其短期修复效果。方法:选取2018年9月-2019年9月南京市口腔医院修复科就诊的单颗前牙缺失并采用氧化锆粘接桥修复的患者为研究对象,使用虚拟(牙合)架辅助设计,3个月、6个月、12个月后按照美国公共卫生协会评价标准观察修复体边缘、颜色、继发龋、松动及脱落情况。结果:共完成12例患者14件氧化锆粘接桥,其中1件修复体6个月内脱落,余修复体边缘、颜色、继发龋、松动及脱落评价均为A级。结论:虚拟(牙合)架可以为CAD/CAM铣削氧化锆粘接桥修复体咬合调整提供帮助,但长期应用效果仍待观察。     

前牙牙体缺损修复的桩核冠材质比较分析

目的:观察比较前牙区牙体缺损修复中采用铸造金属桩联合钴铬烤瓷冠和玻璃纤维桩联合全瓷冠的临床疗效。方法:选取2010年2月~2014年2月我科门诊收治的85例(140颗牙)前牙美学区牙体缺损需行桩核冠修复的患者为研究对象,按照患者选取桩核冠材质的不同分为纤维组和金属组,其中纤维组患者采用玻璃纤维桩联合全瓷冠进行修复(45例,65颗牙),金属组患者采用铸造金属桩联合钴铬烤瓷冠进行修复(40例,75颗牙),随访时间2年,对比两组患牙的修复效果。结果:纤维组修复成功率为96.9%,金属组修复成功率为88.0%,差异有统计学意义(P0.05);修复后2年,纤维组在边缘适合度、修复体完整度、颜色匹配度方面与金属组比较差异有统计学意义(P0.05)。结论:玻璃纤维桩在抗根折能力、美学效果、生物相容性等方面优于铸造金属桩,修复效果良好,值得临床推广应用。     

残冠轴壁剩余量对两种桩核冠修复体抗折性能的影响

目的:评价牙体不同剩余量对镍铬金属和石英纤维两种桩核冠修复体抗折性能的影响。方法:选用6个月内因正畸治疗需要拔除的完整的下颌单根前磨牙60颗,随机分为6组,按照牙体不同轴壁剩余量制造实验模型。分别使用镍铬金属桩核+镍铬全冠修复或石英纤维桩核+镍铬全冠修复,测试最大载荷力值及折裂模式,所有数据使用SPSS软件进行分析。结果:石英纤维桩核冠修复体的抗折载荷与镍铬金属桩核冠修复体间存在显著性差异(P<0.05);石英纤维桩核修复的不同牙体剩余量各组间抗折载荷存在显著性差异(P<0.05);石英纤维桩核冠修复体可修复性折裂发生率大于镍铬金属桩核冠修复体(P<0.05)。结论:石英纤维桩核较镍铬金属桩核能更好地保护剩余牙体组织。使用石英纤维桩核时,牙体剩余量越多,修复体抗折性能越强。     

后牙D型改良粘结桥的临床应用初探

目的评价后牙D型改良粘结桥临床效果。方法收集口腔门诊28例缺失1颗后牙患者,应用D型改良粘结桥修复。修复体粘结后即刻、粘结后6个月和1年观察,对修复体边缘适合性、菌斑指数、牙龈指数等方面进行评价。结果后牙D型改良粘结桥半年后临床复查,基牙2的牙龈指数高于对照牙2(P<0.05)。1年后复查1例(3%)在使用中脱粘,1例(3%)修复体折断,基牙的菌斑指数、牙龈指数与对照牙比较,差异均有统计学意义(P<0.05)。结论后牙D型改良粘结桥作为一种微创伤的固定修复方式,短期临床效果令人满意,长期的牙周维护是必要的。     

国产全解剖形态二氧化锆冠修复磨牙缺损的短期临床效果研究

目的:探讨国产全解剖形态二氧化锆冠在磨牙缺损修复中的短期临床效果。方法:选取磨牙缺损患者80例,随机分为两组。A组:40例,采用国产全解剖形态二氧化锆冠修复;B组:40例,采用进口全解剖形态二氧化锆冠修复,术后3、6、12个月复诊记录修复体完整性、边缘适合性、牙龈炎症、修复体外形及颜色修复效果,另对患者进行主观满意度分析。结果:观察期间,A组有1例患者在术后6个月检出轻度牙龈炎症,两组修复体在术后6、12个月均检出,小部分修复体牙合面染色被不同程度磨耗导致与邻牙有轻度色差;两组修复体在价格因素方面比较有统计学意义(P0.05)。结论:短期观察国产全解剖形态二氧化锆冠用于磨牙缺损的修复效果良好,临床上可根据具体情况选择使用。     

金属烤瓷全冠颈缘修复的临床美学效果评价

目的评价烤瓷全冠颈缘修复的临床美学效果，探讨颈缘变色的原因和预防措施。方法随机选取门诊烤瓷全冠修复2～4年的患者132例，共225件修复体，检查烤瓷冠的颈缘修复效果，对颈缘变色、颈缘密合性及牙龈健康状况的各项指标进行评价。结果53件修复体出现颈缘变色。基牙颈部牙体制备的方式、制备量、烤瓷制作过程及材料的选择与颈缘变色有关。结论正确地选择牙体制备方式，改进烤瓷制作过程，合理地选用基底冠材料，是预防烤瓷冠颈缘变色的关键。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.