上、下颌骨的CT影像与断层标本对照研究及临床意义

目的:为牙种植术等临床口腔外科提供解剖学基础.方法:选取成人全牙上、下颌骨标本和志愿者全牙CT重建影像各20例,观察上颌窦下壁的凸起结构和下颌管的走行,测量上颌窦下壁、下颌管上壁至牙根的距离.结果:上颌窦系呈三边形或四边形的锥形腔隙,其下壁常有凸起的骨隔.在标本及影像上的上颌窦下壁至第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根的距离左、右分别为(9.30±2.64)mm和(9.50±2.72)mm、(4.50±1.98)mm和(4.60±1.95)mm、(2.02±0.91) mm和(2.18±0.96)mm、(2.06±1.04) mm和(2.26±1.20)mm、(3.74±1.73)mm和(3.82±1.84)mm.下颌管自牙槽窝下方走行,其舌侧骨板较厚.在标本及影像上的下颌管上壁至第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根的距离左、右分别为(8.36 +2.34) mm和(8.42±2.42)mm、(7.36±2.21)mm和(7.52±2.18)mm、(3.22±1.40)mm和(3.36±1.85)mm、(2.96±1.54)mm和(2.84±1.55)mm、(3.64±1.72) mm和(3.88±1.76)mm.结论:上颌窦、下颌管至牙根的距离测量,对选择适宜长度的牙种植体,避免牙种植体误入上颌窦和损伤下牙槽神经等具有重要意义.     

下颌管的应用解剖及临床意义

目的:为下颌牙种植术等临床口腔外科提供解剖学基础.方法:选取下颌骨标本10例、新鲜下颌骨标本10例和成人全牙下颌骨标本20例,分别暴露出下颌管截面、下牙槽神经血管束和下颌管与下颌后牙牙根.观察下颌管的形态、走行和下牙槽神经、血管的排列关系,用游标卡尺测量下颌后牙牙根尖至下颌管上壁的距离.结果:下颌管呈椭圆形,自磨牙牙根尖舌侧和前磨牙牙根尖颊侧的下方走行;下颌管内的下牙槽血管位于下牙槽神经上方.下颌后牙牙根至下颌管的距离以第2磨牙最近,由近及远依次为第2磨牙、第1磨牙、第3磨牙、第2前磨牙和第1前磨牙;下颌磨牙的远中根至下颌管的距离均较近中根近.第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根至下颌管上壁的最短距离分别为(8.19±0.87) mm(左)和(8.29±0.88) mm(右)、(7.38±0.85) mm、(3.30±0.66) mm、(2.98±0.77) mm(左)和(2.92±0.75) mm(右)、(3.82±0.63) mm(左)和(3.86±0.64) mm(右).结论:下颌管的应用解剖对选择适宜长度的牙种植体,避免牙种植体损伤下牙槽神经等具有重要意义.     

下颌管与下颌后牙的位置关系及临床意义

目的: 为下颌牙种植术等临床口腔外科提供解剖学基础。方法：选取新鲜下颌骨标本10例、成人全牙下颌骨标本18例和20名全牙志愿者,分别暴露出下牙槽神经血管束、下颌管与下颌后牙牙根和CT连续扫描后进行三维重建。观察下牙槽神经、血管的排列关系,用游标卡尺和CT三维重建工作站分别测量下颌后牙牙根至下颌管上壁的距离。结果：下颌管自牙槽窝下方走行,其舌侧骨板较厚;下颌管内的下牙槽血管位于下牙槽神经上方。下颌磨牙的远中根至下颌管的距离均较近中根近。在标本及影像上的第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根至下颌管上壁的距离分别为(8.36±2.34)　mm和(8.42±2.42)mm、(7.36±2.21)mm和(7.52±2.18)mm、(3.22±1.40)mm和(3.36±1.85)mm、(2.96±1.54)mm和(2.84±1.55)mm、(3.64±1.72)mm和(3.88±1.76)mm。结论：（1）下颌后牙至下颌管的距离以第2磨牙最近,由近及远依次为第2磨牙、第1磨牙、第3磨牙、第2前磨牙和第1前磨牙。（2）对选择适宜长度的牙种植体,避免牙种植体损伤下牙槽神经等具有重要意义。     

上颌窦与上颌后牙的位置关系及临床意义

目的为上颌牙种植术等临床口腔外科提供解剖学基础。方法选取新鲜上颌骨标本10例20侧、成人全牙上颌骨标本18例36侧和20名全牙志愿者,分别暴露出上颌窦粘膜、上颌窦与上颌后牙牙根和CT连续扫描后进行三维重建。观察上颌窦的形态及其下壁的骨性和粘膜结构,用游标卡尺和CT三维重建工作站分别测量上颌后牙牙根至上颌窦下壁的距离。结果上颌窦呈三边形或四边形的锥体形腔隙,其下壁常有凸起的骨隔和粘膜隔。上颌磨牙的近中颊根至上颌窦的距离均较舌根、远中颊根近,由近及远依次为近中颊根、舌根和远中颊根。在标本及影像上的第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根至上颌窦下壁的距离分别为(9.30±2.64)mm和(9.50±2.72)mm、(4.50±1.98)mm和(4.60±1.95)mm、(2.02±0.91)mm和(2.18±0.96)mm、(2.06±1.04)mm和(2.26±1.20)mm、(3.74±1.73)mm和(3.82±1.84)mm。结论(1)上颌后牙至上颌窦的距离以第1磨牙最近,由近及远依次为第1磨牙、第2磨牙、第3磨牙、第2前磨牙和第1前磨牙。(2)对选择适宜长度的牙种植体,避免牙种植体误入上颌窦等具有重要意义。     

上颌窦的CT三维重建及其临床意义

目的 为上颌牙种植术等临床口腔外科提供解剖学基础。方法 选取全牙志愿者20名,在螺旋CT机以眦耳线（CML）为基线连续扫描,采用ADW 4.2重建软件的曲面重组技术（CPR）重建上颌窦,观察上颌窦的位置、形态和测量上颌窦下壁至上颌后牙牙根的距离。在Amira 3D重建软件下重建上颌骨及上颌窦的可视化模型,观察半透明上颌骨内上颌窦的位置及其与上颌牙根的关系。结果 上颌窦系一呈三边形或四边形的锥形腔隙,其下壁常有凸起的骨隔。半透明上颌骨可视化模型内的上颌窦可清晰显示其位置、形态及其与上颌牙根的关系。上颌窦下壁至上颌后牙牙根的距离以第一磨牙最近,由近及远依次为第一磨牙、第二磨牙、第三磨牙、第二前磨牙和第一前磨牙。上颌窦下壁至左右侧第一前磨牙、第二前磨牙、第一磨牙、第二磨牙、第三磨牙牙根尖的最短距离分别为（9.58±1.13） mm和（9.64±1.15） mm、（4.54±0.92） mm和（4.60±0.90） mm、（2.13±0.50） mm和（2.21±0.53） mm、（2.19±0.65） mm和（2.27±0.65） mm、（3.94±1.14） mm。结论 上颌窦的3D重建,对指导临床选择适宜长度的牙种植体、避免牙种植体误入上颌窦等并发症具有重要的临床意义。     

下颌管的三维重建及临床意义

目的　为下颌牙种植术等临床口腔外科提供解剖学基础。 方法　选取全牙志愿者20名,在螺旋CT机以眶耳线(OML)为基线连续扫描,采用ADW 4.2重建软件的曲面重组技术(CPR)重建下颌管,观察下颌管的位置、构造和测量下颌后牙牙根至下颌管上壁的距离;在Amira三维重建软件下重建下颌骨及下颌管的可视化模型,观察透明下颌骨内下颌管的走行及其与下颌后牙的关系。 结果　下颌管壁由一薄层骨密质构成,自磨牙牙根尖舌侧和前磨牙牙根尖颊侧的下方走行;透明下颌骨内的下颌管可清晰显示其位置、形态及走行,下颌管与下颌体下缘、牙槽嵴及内、外侧骨板的距离。下颌后牙牙根至下颌管的距离以第2磨牙最近,由近及远依次为第2磨牙、第1磨牙、第3磨牙、第2前磨牙和第1前磨牙;下颌磨牙的远中根至下颌管的距离均较近中根近。第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根至下颌管上壁的最短距离分别为(8.38±1.04) mm(左)和(8.44±1.05) mm(右)、(7.51±0.85) mm、(3.40±　0.65) mm、(2.93±0.61) mm、(3.92±0.63) mm(左)和(3.97±0.63) mm(右)。 结论　下颌管的三维重建对选择适宜长度的牙种植体,避免牙种植体损伤下牙槽神经等具有重要意义。     

比格犬下颌骨微种植体的置入部位和方法*

背景：比格犬下颌骨解剖结构复杂,微种植体置入位置不恰当会造成微种植体周骨量不足和微种植体松脱。 目的：观察比格犬下颌骨相应解剖结构及微种植体的置入部位和方法。 方法：取成年雄性比格犬尸体下颌骨,测量下颌第二双尖牙牙尖至下颌第一磨牙远中颊尖的长度;下颌第二、三、四双尖牙和第一磨牙根分叉度及牙根分叉处距离下颌神经管的垂直高度;于牙槽嵴下4,6 mm处用游标卡尺测量下颌第二、三、四双尖牙和第一磨牙颊舌向牙槽嵴厚度和近远中根的水平距离。 结果与结论：下颌第二双尖牙牙尖至下颌第一磨牙远中颊尖的长度平均为52.70 mm;距离下颌神经管的垂直高度最远的是第一磨牙,最近的是第四双尖牙,根分叉度最大的是第一磨牙,最小的是第四双尖牙。下颌第二、三、四双尖牙和第一磨牙的颊舌向骨质厚度随着距离牙槽嵴顶深度的增加而增加。在距离牙槽嵴顶4,6 mm的深度,下颌第二、三、四双尖牙和第一磨牙近远中根的水平距离均大于5 mm,且随着距离牙槽嵴深度的增加而增加。说明比格犬下颌第二双尖牙至第一磨牙牙槽骨段骨质结构均匀。在距离牙槽嵴顶4~6 mm深度,单颗牙自身近远中牙根之间足以提供微种植体置入所需骨量。     

上牙槽后动脉与上颌窦底、牙槽嵴位置关系的解剖学研究

目的 探讨上牙槽后动脉(PSAA)与上颌窦底、牙槽嵴顶的位置关系,为上颌窦底提升术等临床口腔外科相关手术提供解剖学依据。方法 2015年6—12月,对10%甲醛溶液固定的10侧成人头颅湿标本的PSAA进行解剖,观察PSAA的走行特点。分别以上颌窦底、牙槽嵴顶为参照面分为上颌窦底组、牙槽嵴顶组,以上颌第二、第一磨牙和上颌第二、第一前磨牙为标志点,分别测量PSAA与上颌窦底、牙槽嵴顶的距离。结果 PSAA由上颌动脉进入翼腭窝前发出,沿上颌骨体颞下面下行,发出分支与上牙槽后神经伴行进入牙槽孔;继而在上颌体内或上颌窦黏膜外经过上颌第二磨牙、上颌第一磨牙、上颌第二前磨牙、上颌第一前磨牙的根尖上方呈弓形向前上内走行,并发出分支止于上颌磨牙及前磨牙牙槽突颊侧牙根和黏膜。PSAA在上颌第二磨牙、上颌第一磨牙、上颌第二前磨牙、上颌第一前磨牙处与牙槽嵴顶的平均距离逐渐加大,分别为(15.57±0.53) mm、(16.07±0.30) mm、(18.96±0.43) mm、(21.27±0.61) mm,与上颌窦底的平均距离逐渐加大,分别为(6.68±0.26)mm、(7.26±0.34) mm、(8.54±0.45) mm、(9.81±0.43) mm,差异均有统计学意义(P值均＜0.05)。结论 PSAA在由上颌第二磨牙向上颌第一前磨牙的走行过程中,与上颌窦底和牙槽嵴顶的距离均在上颌第二磨牙处最短,与上颌第一磨牙、上颌第二前磨牙、上颌第一前磨牙的距离逐渐加大,准确测量PSAA在不同标志点与上颌窦底、牙槽嵴顶间的距离,为临床口腔外科相关手术提供可靠的解剖学依据,有助于减少术中PSAA的损伤。     

上颌前牙区即刻种植后骨量变化:水平向吸收是否影响骨结合

背景:目前大量的动物实验和临床研究已证实即刻种植和延期种植同样可获得成功的骨结合,但即刻种植是否能够减少或预防拔牙窝牙槽嵴的生理性骨吸收一直是学者们争论的焦点。目的:利用锥束CT测量评估上颌前牙区即刻种植的近期骨组织变化。方法:选取上颌前牙无法保留适合采取即刻种植的患者18例18颗患牙。于种植当天、6个月、1年行锥束CT检查,分别测量距离种植体肩台4,6,8 mm处牙槽嵴唇侧骨壁的厚度,以及缺失牙牙槽嵴唇颊侧近、远中骨高度。结果与结论:种植后6个月,牙槽嵴唇颊侧骨板近、远中吸收高度分别为(1.83±0.05)mm和(1.50±0.04)mm,距离种植体肩台4,6,8 mm处牙槽嵴唇侧骨板吸收分别为(1.72±0.30)mm,(1.65±0.26)mm,(1.55±0.25)mm;1年后牙槽嵴唇颊侧骨板近、远中吸收高度分别为(0.85±0.04)mm和(0.78±0.05)mm,距离种植体肩台4,6,8 mm处牙槽嵴唇侧水平吸收(0.52±0.20)mm,(0.45±0.16)mm,(0.32±0.15)mm。结果表明即刻种植后唇侧骨壁会发生水平向吸收,但是不影响种植体的骨结合,1年后骨组织吸收基本稳定。     

第二恒磨牙正锁(牙合)畸形相关因素的研究

目的 探讨引发下颌第二磨牙正锁牙台的相关因素,为口腔正畸临床诊断和治疗提供参考.方法 随机抽取800例符合条件的病例作为研究对象.男349例,女451例,平均年龄21.7±3.31 岁,其中45例发生第二磨牙正锁(牙合).测量上颌后段牙弓间隙,下颌后段牙弓间隙,ANB角,上颌第一磨牙区和上颌第二磨牙区的牙槽弓宽度和下颌第一磨牙区和下颌第二磨牙区的牙槽弓宽度,对测量值进行统计分析.结果 第二磨牙正锁牙合的发生率为5.6%,其性别构成差异无显著性(P＞0.05).回归方程:第二磨牙正锁(牙合)=22.974 8+2.025 7×上颌后段牙弓拥挤度+1.537 2×下颌后段牙弓拥挤度+1.007 1×ANB角度+0.378 5×上颌第二磨牙处牙槽弓宽度-0.4897×下颌第二磨牙处牙槽弓宽度.结论 第二磨牙正锁(牙合)与上颌后段牙弓拥挤有显著的相关关系,与下颌后段牙弓拥挤度、ANB角度和上颌第二磨牙处牙槽弓宽度呈正相关关系,与下颌第二磨牙处的牙槽弓宽度呈负相关关系.     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.