重组牛碱性成纤维细胞生长因子凝胶预防阻生牙拔牙后并发症的疗效

目的探讨重组牛碱性成纤维细胞生长因子凝胶预防阻生牙拔牙后并发症的临床疗效。方法将172例阻生牙患者按随机数字表法分为观察组和对照组,每组86例。2组均行阻生牙拔除术。拔牙术后,观察组采用重组牛碱性成纤维细胞生长因子凝胶治疗,同时采用无菌棉球止血;对照组采用无菌棉球止血。对2组术后并发症(出血、感染和干槽症)发生率进行比较。结果观察组术后无出血率明显高于对照组,明显出血、少量出血及感染、干槽症发生率均明显低于对照组(P<0.05或P<0.01)。结论重组牛碱性成纤维细胞生长因子凝胶预防阻生牙拔牙后并发症的效果显著,可作为阻生牙拔除后预防并发症的简便、有效方法。 更多还原     

米诺环素在下颌阻生牙拔除后干槽症预防中的应用

目的将米诺环素放入下颌阻生牙拔除后牙槽窝,评价其预防干槽症的效果。方法选择韶关学院医学院附属医院口腔门诊拔除下颌阻生牙的患者126例,随机分成两组,试验组在拔除阻生牙后放入米诺环素,对照组不放任何材料任其自行愈合,1周后复诊观察干槽症的发生情况。结果试验组有1例干槽症发生,对照组有8例干槽症发生,两组干槽症发生率的差异有统计学意义(P0.05)。结论复杂阻生牙拔除术,由于创伤大、操作时间长,在牙槽窝放入米诺环素可预防干槽症的发生。     

HEAL-ALL组织补片在拔牙后干槽症预防中的应用

背景：口腔组织补片是将异体组织经过脱细胞处理后的一种细胞外基质,具有组织相容性好、来源充分、易操作的特性,在口腔颌面外科领域应用广泛。目的：将HEAL-ALL（海奥）口腔组织补片植入下颌阻生牙拔除后牙槽窝,评价其预防干槽症的效果。方法：选择中山大学附属第一医院口腔外科门诊拔除下颌阻生牙的患者80例,随机分成2组,试验组在拔除阻生牙后放入HEAL-ALL（海奥）组织补片,对照组不放任何材料任其自行愈合,1周后复诊观察干槽症的发生情况。结果与结论：试验组无干槽症发生,对照组有6例干槽症发生,两组干槽症发生率的差异有显著性性意义（P〈0.05）。提示对于复杂阻生牙拔除,损伤大、操作时间长的患者,为了预防其干槽症的发生,建议术后采用组织补片填入牙槽窝的方法。     

重组人碱性成纤维细胞生长因子对牙科创面止血及伤口修复愈合的影响

探讨重组人碱性成纤维细胞生长因子(rh-b FGF)治疗牙科创面止血及伤口修复愈合的效果。选取拔牙的阻生牙患者100例,采用数字随机法均分为观察组与对照组各50例,两组均行阻生牙拔除术,对照组给予无菌棉球止血,观察组给予重组人碱性成纤维细胞生长因子治疗,对比两组创面止血及伤口修复愈合情况。观察组止血时间显著短于对照组(P0.05),感染、干槽症发生率显著低于对照组,两组比较差异具有统计学意义(P0.05);观察组治疗1、3、7d伤口修复愈合率显著高于对照组,两组比较差异具有统计学意义(P0.05)。重组人碱性成纤维细胞生长因子在拔牙后止血效果较好,且能预防感染、干槽症发生,加快拔牙伤口愈合。     

HEAL-ALL组织补片在拔牙后干槽症预防中的应用

背景:口腔组织补片是将异体组织经过脱细胞处理后的一种细胞外基质,具有组织相容性好、来源充分、易操作的特性,在口腔颌面外科领域应用广泛。目的:将HEAL-ALL(海奥)口腔组织补片植入下颌阻生牙拔除后牙槽窝,评价其预防干槽症的效果。方法:选择中山大学附属第一医院口腔外科门诊拔除下颌阻生牙的患者80例,随机分成2组,试验组在拔除阻生牙后放入HEAL-ALL(海奥)组织补片,对照组不放任何材料任其自行愈合,1周后复诊观察干槽症的发生情况。结果与结论:试验组无干槽症发生,对照组有6例干槽症发生,两组干槽症发生率的差异有显著性性意义(P<0.05)。提示对于复杂阻生牙拔除,损伤大、操作时间长的患者,为了预防其干槽症的发生,建议术后采用组织补片填入牙槽窝的方法。     

组织补片植入预防下颌阻生牙拔除术后并发症的临床研究——附45例报道

目的:评价组织补片植入对下颌阻生牙拔除术后并发症的预防作用.方法:选择90例需行下颌阻生牙拔除术患者,随机分为观察组与对照组各45例,观察组在阻生牙拔除后植入HEAL-ALL口腔组织补片,对照组按常规处理,4d后复查两组面部局部肿胀、张口受限、拔牙后出血、干槽症的发生情况.结果:术后观察组、对照组分别有3例(7％)、18例(40％)出现张口受限、面部局部肿胀,对照组有7例(16％)发生干槽症,观察组无患者发生干槽症,两组患者均无一例发生拔牙后出血.观察组术后张口受限、面部局部肿胀以及干槽症的发生率均明显低于对照组(P＜0.05或0.01).结论:组织补片植入对下颌阻生牙拔除术后并发症有一定预防作用.     

下颌阻生牙拔牙应用甲硝唑碘仿明胶海绵预防干槽症的效果分析

目的观察下颌阻生牙拔牙应用甲硝唑碘仿明胶海绵预防干槽症的效果。方法选择拔除下颌阻生牙患者900例作为研究对象,按照随机分组方式分为A组320例、B组280例、C组300例,A组拔牙后拔牙窝内放入甲硝唑碘仿明胶海绵,B组拔牙后拔牙窝内放入碘仿明胶海绵,C组拔牙后拔牙窝内不放任何填塞物。术后第3、第7d观察干槽症等并发症发生情况。结果 A组干槽症发生率为1.56%,并发症发生率为6.88%;B组分别为5.36%、14.65%;C组分别为15%、35%。A组干槽症发病率及并发症发生率均低于B组和C组,差异有统计学意义(P0.05),B组干槽症发病率及并发症发生率均高于C组,差异有统计学意义(P0.05)。A组肿胀时间及疼痛时间均少于B组、C组,差异有统计学意义(P0.05);B组肿胀时间及疼痛时间少于C组,差异有统计学意义(P0.05)。结论下颌阻生牙拔牙术后牙槽窝填塞明胶海绵能有效预防干槽症等并发症的发生,其中使用甲硝唑碘仿明胶海绵效果最佳,碘仿明胶海绵效果其次,且甲硝唑碘仿明胶海绵能有效减少拔牙后肿胀时间及疼痛时间。     

碱性成纤维细胞生长因子对阻生齿干槽症发生的预防实验

目的：研究下颌阻生齿拔除后应用碱性成纤维细胞生长因子(bFGF)对拔牙后干槽症发病的预防作用。方法：采用随机数字表法分组，双盲试验的临床流行病学方法，观察拔牙后即刻应用bFGF组与应用安慰剂组干槽症的发病率比较。结果：应用bFGF组拔牙后干槽症的发病率1．61％，明显少于对照组发病率13．11％(P&;lt;0．05，x^2=5．998)。结论：下颌阻生齿拔牙后局部应用bFGF对干槽症的发病有预防作用。     

重组人碱性成纤维细胞生长因子复合胶原海绵的制备及其在齿槽外科的应用

目的观察重组人碱性成纤维细胞生长因子复合胶原海绵对牙科创面止血及伤口修复愈合的影响。方法实验于2003-01/2004-03在暨南大学医学院附属广州市红十字会医院创伤研究所和口腔科完成。首先用Ⅰ型胶原蛋白、碱性成纤维细胞生长因子与壳聚糖配制成混合物,冷冻干燥成复合胶原海绵备用。收治60例错牙合畸型患者需行牙齿对称减数进行正畸治疗,共计对称拔除双尖牙212颗、磨牙14颗。左侧为实验组牙槽窝置入复合胶原海绵,右侧为对照组置入医用明胶海绵。记录拔牙创面止血时间,观察术后2,7d拔牙面创愈合情况。结果60例236颗牙拔除后的止血时间,实验组(45.9±12.8)s,对照组(89.0±16.4)s。实验组2d拔牙创面愈合78例(66%)、7d拔牙创面愈合117例(98%);对照组2d拔牙创面愈合25例(21%)、7d拔牙创面愈合95例(79%)。实验组创面愈合均好于对照组。结论重组人碱性成纤维细胞生长因子复合胶原海绵的止血效果和促进创面愈合作用明显优于明胶海绵。     

碱性成纤维细胞生长因子对阻生齿干槽症发生的预防实验

目的:研究下颌阻生齿拔除后应用碱性成纤维细胞生长因子(bFGF)对拔牙后干槽症发病的预防作用。方法:采用随机数字表法分组,双盲试验的临床流行病学方法,观察拔牙后即刻应用bFGF组与应用安慰剂组干槽症的发病率比较。结果:应用bFGF组拔牙后干槽症的发病率1.61%,明显少于对照组发病率13.11%(P<0.05,χ2=5.998)。结论:下颌阻生齿拔牙后局部应用bFGF对干槽症的发病有预防作用。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.