Three-dimensional analysis of the physiological foramen geometry of maxillary and mandibular molars by means of micro-CT

The aim of this study was to investigate the physiological foramen diameter, shape and distance between physiological and anatomical apex of maxillary and mandibular first and second molars. Accurate knowledge of the physiological foramina morphology; thus, inherent mechanical shaping technical hindrances, is decisive when taking the corresponding root canal final preparation decision. The morphological dimensions of a total of 1 727 physiological foramina were investigated by means of micro-computed tomography. Mean narrow and wide (to a high number, oval) diameters of the physiological foramen were 0.24, 0.22 and 0.33 mm and 0.33, 0.31 and 0.42 mm in mesiobuccal (MB), distobuccal (DB) and palatal (P) roots in maxillary first molars; 0.24, 0.22 and 0.33 mm and 0.41, 0.33 and 0.44 in MB, DB, and P roots in maxillary second molars. Mandibular first molars showed mean narrow and wide diameters of 0.24 and 0.30 mm and of 0.39 and 0.46 mm in mesial (M) and distal (D) roots; second mandibular molars showed 0.25 and 0.31 mm and 0.47 mm in M and D roots. The mean distance between the physiological foramina and anatomical apex was 0.82, 0.81 and 1.02 mm and 0.54, 0.43 and 0.63 mm in MB, DB and P roots of the maxillary first and second molars, respectively. A mean distance of 0.95 mm (M) and 1.05 mm (D) in the first and 0.78 mm (M) and 0.81 mm (D) in the second mandibular molars was observed. Based on the results obtained, assumable recommendations for final preparation size of the physiological foramen were calculated. However, when taking into consideration, the resulting standard deviations of marginal errors must be cautiously considered when taking a final decision in clinical endodontic treatment.     

耳鼻咽喉头颈外科医疗纠纷现状分析及防御对策研究

目的 通过分析耳鼻咽喉头颈外科诊疗特点以及医疗纠纷现状,提出针对耳鼻咽喉头颈外科医疗纠纷的防御对策及干预措施.方法 对医务人员和患者医疗纠纷的认识等情况以及既往医疗纠纷病例进行调查分析,提出减少或避免耳鼻咽喉头颈外科医疗纠纷的防御对策,并运用于临床.以2016年全年医疗纠纷数量及患者对医疗满意度等指标为对照组,2017...     

p21、p73及PTEN在头颈部多原发癌中的表达及意义

目的:探讨p21、p73与PTEN在头颈部多原发癌组织中的表达与意义。方法:采用 免疫组织化学方法对30例头颈部多原发癌患者的42份标本、42例头颈部单发癌及30例来源于头颈部的正常上皮组织标本中p21、p73与PTEN蛋白表达进行检测,并将检测结果作统计学分析。结果:p21、p73与PTEN蛋白在头颈部多原发癌组织中阳性表达率分别为69.05％、57.14％和71.43％;在单原发癌组阳性表达率分别为76.19％、40.48％和76.19％;在正常上皮组织中阳性表达率分别为96.66％、13.33％和100.00％。在多原发癌及单发癌组织中p21与PTEN蛋白失表达率以及p73蛋白过表达率均显著高于正常上皮组织（P＜0.05）;三个指标在多原发癌与单发癌组织中的表达差异均无统计学意义。结论:p21与PTEN蛋白失表达以及p73蛋白表达上调,参与头颈部多原发癌和单发癌的形成机制,但还不能认为其在头颈部多原发癌与单发癌形成中的作用有差别。     

The biophysics of nasal airflow

The biophysics of nasal airflow involve the measurement, analysis, and understanding of bulk airflow or momentum transport through the nasal cavity and of the exchange of mass and heat laterally between the air stream and the walls. In both of these areas, optimal progress depends on judicious, combined, and continuous use of physical models, mathematical calculations, and measurements made on human subjects. The progress that has been made to date is both fascinating and encouraging and suggests that great improvement in understanding, diagnosis, and treatment of nasal and upper airway disease will be possible in the future through closer contact and cooperation between clinicians and physical and biological scientists.     

Head and neck ultrasound: why now?

This article provides an overview of ultrasound and the techniques for its use by otolaryngologists in diagnosing and treating neck masses and lesions. Head and neck ultrasound is extremely useful in diagnosing neck masses and lesions and in facilitating many procedures that are commonly performed on the head and neck. Although in the past these studies were generally performed by radiologists, clinicians are now able to perform high-quality ultrasound studies and ultrasound-guided procedures in the head and neck. Given the advanced knowledge of head and neck anatomy and disease processes that otolaryngologists possess, head and neck ultrasound offers a logical and valuable extension of the physical examination. Recent improvements in ultrasound resolution, portability, and affordability have provided an excellent impetus for otolaryngologists to incorporate ultrasound into their office and operative practices.     

Validation of an outcomes instrument for tonsil and adenoid disease

OBJECTIVE: To design and validate a disease-specific health status instrument-the Tonsil and Adenoid Health Status Instrument-for use in children with tonsil and adenoid disease. DESIGN: Prospective psychometric and clinimetric instrument validation in 3 stages. SETTINGS: A tertiary academic pediatric specialty hospital and a tertiary academic hospital, in 2 different cities. PATIENTS/OTHER PARTICIPANTS: Children with tonsil and adenoid disease presenting for evaluation and treatment (n = 224). INTERVENTION/METHOD: Prospective instrument validation. Stage 1 consisted of initial item testing, reduction, and subscale construction; stage 2, reliability and validity testing, factor analysis, and final item reduction; and stage 3, responsiveness analysis. MAIN OUTCOME MEASURES: Test-retest and internal consistency reliability; content, construct, and criterion validity; orthogonal principal components factor analysis; and response sensitivity analysis. RESULTS: Factor analysis and item analysis confirmed 6 distinct subscales measuring different constructs (aspects) of disease-specific health status that are affected by tonsil and adenoid disease: eating and swallowing, airway and breathing, infections, health care utilization, cost of care, and behavior. For each subscale, the Tonsil and Adenoid Health Status Instrument demonstrated excellent test-retest reliability (r = 0.72-0.88) and internal consistency reliability (Cronbach alpha = .73-.87). Content validity was ensured during the design process. Construct validity was demonstrated by means of convergent and divergent validity with a global quality-of-life instrument (the Child Health Questionnaire, version PF28). Criterion validity was also satisfactory. Finally, the instrument was appropriately sensitive, with high standardized response means and effect sizes. CONCLUSIONS: The Tonsil and Adenoid Health Status Instrument is a valid, reliable, and sensitive instrument with 6 distinct subscales. This instrument has significant utility for outcomes research in children with tonsil and adenoid disease.     

抗变态反应药物对季节性变应性鼻炎患者血清特异性IgE及嗜酸粒细胞的影响

目的:探讨炎性递质白三烯和组胺在变应性鼻炎发病机制中的作用,比较白三烯受体拮抗剂和抗组胺药治疗变应性鼻炎的疗效及其机制。方法:将符合入选标准的40例变应性鼻炎患者随机分为两组,分别给予孟鲁司特钠和氯雷他定治疗2周。治疗前、后分别检测患者血清特异性IgE、外周血及鼻腔分泌物中嗜酸粒细胞(EOS),并记录用药后医生和患者对疾病整体状况的评价。结果:治疗后两组患者血清特异性IgE、外周血及鼻腔分泌物中EOS计数均明显下降,与治疗前比较差异有统计学意义(均P<0.05);治疗后两组患者血清特异性IgE、外周血及鼻腔分泌物中EOS计数差异无统计学意义(均P>0.05)。结论:孟鲁司特钠和氯雷他定治疗变应性鼻炎效果相近;组胺和白三烯在病理生理学上均是引起变应性鼻炎的重要炎症递质,两者均是通过影响EOS聚集、活化和减少特异性IgE的形成而发挥作用;白三烯受体拮抗剂是治疗变应性鼻炎的一种新的有效药物。     

头颈部淋巴水肿的诊治进展

头颈部淋巴水肿(HNL)多继发于头颈肿瘤治疗后，症状、体征缺乏特异性，相较于乳腺癌、宫颈癌治疗后继发性淋巴水肿的肿胀程度稍轻。然而，由于头颈部解剖位置的特殊性，其对患者外观、感觉、运动，乃至心理的长期影响较为严重。目前，临床医生对HNL关注较少，缺乏足够的认识，诊治手段及流程尚不规范，且没有完善的诊疗指南用于指导医疗工作，有待学界进一步探究。本文就近年国内外对HNL的诊治进展进行综述，旨在进一步明确HNL的诊治方式。     

Relations between segmental and motor variability in prosodically complex nonword sequences.

PURPOSE: To assess how prosodic prominence and hierarchical foot structure influence segmental and articulatory aspects of speech production, specifically segmental accuracy and variability, and oral movement trajectory variability. METHOD: Thirty individuals participated: 10 young adults, 10 children who are normally developing, and 10 children diagnosed with specific language impairment. Segmental error and segmental variability and movement trajectory variability were compared in low and high prosodic prominence conditions (i.e., strong and weak syllables) and in different prosodic foot structures. RESULTS: Between-participants findings were that both groups of children showed more segmental error and segmental variability and more movement trajectory variability than did adults. A similar within-participant pattern of results was observed for all 3 groups. Prosodic prominence influenced both segmental and motor levels of analysis, with weak syllables produced less accurately and with more lip and jaw movement trajectory variability than strong syllables. However, hierarchical foot structure affected segmental but not motor measures of speech production accuracy and variability. CONCLUSIONS: Motor and segmental variables were not consistently aligned. This pattern of results has clinical implications because inferences about motor variability may not directly follow from observations of segmental variability.     

Differential rates of proliferation and apoptosis in nasal polyps correspond to alterations in DNA spatial distribution and nuclear polarization as observed by confocal microscopy

The study aimed to investigate the expression of p53, Bcl-2 and Ki-67 in relation to the histologic and nuclear qualitative and spatial characteristics of chronic rhinosinusitis with polyposis (CRP). Imprint smears obtained from surgically removed nasal polyps of 20 patients were studied. The polyps were classified according to their histological characteristics as: hyperplasia (simple and pronounced) and squamous metaplasia. The expression of p53, Bcl-2 and Ki-67 was assessed by immunocytochemistry. DNA spatial distribution and nuclear orientation were studied by staining with propidium iodide and examined by confocal microscopy. Positive immunoreaction for p53, Ki-67 and Bcl-2 was observed in 50, 65, and 50% of polyp’s smears, respectively. For each diagnosis, the rates were simple hyperplasia 60, 80 and 30%, pronounced hyperplasia 80, 100 and 40%, metaplasia 0, 0 and 100%, respectively. Abnormal chromatin distribution and nuclear disorientation was observed in three cases of pronounced hyperplasia combined with positive immunoreaction for Ki-67 and p53 and negative immunoreaction for Bcl-2. CRP demonstrated different proliferation and apoptotic rates, according to their histology. Nuclear characteristics observed by confocal microscopy are associated with the immunocytochemical markers of proliferation and apoptosis.     

A ChemoSensory questionnaire for patients treated for cancer of the head and neck

OBJECTIVES: To investigate primary chemosensory issues experienced by patients who undergo treatment for cancer of the head and neck and to develop and assess a ChemoSensory Questionnaire (CSQ). DESIGN: Cross sectional survey for questionnaire development and testing. METHODS: Literature, expert opinion, and focus group methodology were used to identify aspects of smell and taste affecting patients before, during, and after therapy for cancer of the head and neck. A draft instrument was compiled, reviewed, and revised. The revised instrument was administered along with a demographic and clinical form, the SF-12, the Performance Status Survey, and the University of Michigan Head and Neck Quality of Life Questionnaire (HRQOL) to a sample of patients. After item and scale analyses and reductions, a final instrument was assembled. Construct validity and test-retest reliability were assessed. RESULTS: Two hundred six patients were included in the study. The final survey instrument consisted of eight items, four on smell and four on taste. Cronbach's alpha was 0.89 for the smell scale and 0.78 for the taste scale. Correlations with other HRQOL scales ranged from 0.20 to 0.64 for the taste scale and from 0.10 to 0.33 for the smell scale. Good construct validity of the CSQ scores was demonstrated. CONCLUSIONS: Treatment for head and neck cancer negatively impacts smell and taste. A survey instrument was developed to evaluate chemosensory function that is simple to administer and is brief. This instrument will be of value in identifying factors that contribute to chemosensory disturbance and may serve as a guide for planning treatment regimens that minimize such disturbance.     

鼻咽癌EGFL7的表达与肿瘤侵袭转移的关系

目的 观察表皮生长因子样结构域7(EGFL7)在鼻咽癌中的表达,并了解其与微血管密度(MVD)、淋巴管密度(LVD)的相关性,探讨其与鼻咽癌侵袭转移的关系及其可能的机制.方法 采用免疫组化法检测40例鼻咽癌组织(实验组)及20例鼻咽炎(对照组)中的EGFL7的表达;用CD31抗体及D2-40抗体分别检测实验组及对照组的MVD及LVD,并分析EGFL7的表达与肿瘤分级及MVD、LVD三者的相关性.结果 实验组与对照组均有EGFL7的表达,但实验组中EGFL7高表达率高于对照组(P<0.05);实验组中EGFL7的表达与MVD呈正相关,但与LVD相关性不明显;实验组中有淋巴结转移的LVD明显高于无淋巴结转移的(P<0.05);实验组中EGFL7的表达与患者性别、年龄、EB病毒抗体无相关性(P>0.05),与临床分期及有无淋巴结转移有关(P<0.05).结论 EGFL7并不像VEGF家族对血管、淋巴管均有双重作用,它仅表达于血管内皮细胞及鼻咽癌细胞中.EGFL7与鼻咽癌的生长和侵袭转移关系密切,它可能成为反映鼻咽癌转移及预后的标志物之一.     

鼻咽癌血管生成及血小板聚集功能与侵袭转移关系的研究

目的：探讨鼻咽癌（ＮＰＣ） 血管生成及血小板聚集功能与ＮＰＣ 侵袭转移关系,为在分子水平干预肿瘤血管形成,预防ＮＰＣ复发和转移打下基础。方法：采用免疫组织化学Ｓ－ Ｐ法检测了５６ 例ＮＰＣ,２０ 例无瘤鼻咽部石蜡标本组织中的微血管密度（ ＭＶＤ） 及血管内皮细胞生长因子（ＶＥＧＦ） 表达。随访３ 年,ＮＰＣ复发转移１７ 例,无复发或转移３９ 例。结果：复发转移组的血小板聚集率ＭＡＲ,ＭＶＤ 及ＶＥＧＦ的表达较无复发转移的表达高,差异有统计学意义;ＭＶＤ 及ＶＥＧＦ的表达与临床分期相关。结论：ＮＰＣ 血管生成及血小板聚集功能亢进与癌浸润和转移行为密切相关,有可能作为判断肿瘤生物学行为及预后指标,对采用血管生成抑制剂及血小板聚集抑制剂防止ＮＰＣ转移有参考价值。     

同步检测眼性和颈性前庭诱发肌源性电位的可行性研究

目的 探讨同步检测眼性前庭诱发肌源性电位(ocular vestibular-evoked myogenic potential,oVEMP)和颈性前庭诱发肌源性电位(cervical vestibular-evoked myogenic potential,cVEMP)的可行性.方法 对20例正常人及23例梅尼埃病患者分别进行oVEMP和cVEMP同步检测和单独检测,两种检测方式所用仪器和坐姿相同,检测参数设置相同,分别比较两种检测方式下两组对象oVEMP和cVEMP的振幅、潜伏期、波间期及双侧耳不对称比.结果 正常人左、右耳的oVEMP及cVEMP的引出率、振幅、潜伏期、波间期与不对称比在两种形式同步检测与各方式单独检测之间无显著差异;两种方式同步检测时梅尼埃病患者的患耳及对侧耳的oVEMP及cVEMP引出率、振幅、潜伏期、波间期及不对称比与各方式单独检测的结果也无显著差异.结论 对正常人和梅尼埃病患者,oVEMP和cVEMP检测可同步进行,但检测参数应与单独检测时设置一致.     

主观性耳鸣的分期治疗探讨及预后影响因素分析

目的了解主观性耳鸣分期的必要性并分析影响预后的因素。方法将119例(127耳)主观性耳鸣患者随机分为治疗组和对照组,治疗组60例(65耳),根据病程分为急性期24例(25耳)、亚急性期16例(18耳)和慢性期20例(22耳);根据耳鸣匹配检查分为低中频25例(29耳)和高频35例(36耳),低中频耳鸣者采用改善微循环+激素治疗,高频耳鸣者采用离子通道阻滞剂+激素治疗。对照组59例(62耳),其中,急性期21例(23耳)、亚急性期18例(18耳)和慢性期20例(21耳);低中频25例(26耳)和高频34例(36耳);对照组均采用口服盐酸氟桂利嗪治疗。结果治疗组中急性、亚急性及慢性期患者有效率分别为92.0%、61.11%、18.18%;低中频、高频患者的有效率分别为68.96%、50.0%。对照组中急性、亚急性及慢性期患者的有效率分别为56.52%、27.78%、0;低中频、高频患者的有效率分别为42.31%、19.44%。单因素Logistic回归分析表明,性别、年龄、患耳侧别、单双耳患病、耳鸣程度、是否伴高血压、是否伴听力下降耳鸣患者的预后差异无统计学意义,而耳鸣的组别、治疗方法、频率及分期的预后差异有统计学意义。多因素Logistic回归分析表明,耳鸣的频率和分期是影响预后的主要因素。结论低中频耳鸣患者采用改善微循环和激素治疗,高频耳鸣患者采用离子通道阻滞剂和激素治疗,效果明显好于不按耳鸣频率均口服盐酸氟桂利嗪治疗耳鸣的疗效;低中频耳鸣者的预后好于高频耳鸣者;急性期及亚急性期预后较好,慢性期预后较差。有必要对主观性耳鸣患者进行分期并按不同耳鸣频率采用不同治疗方法。     

The impact of cigarette smoking and environmental tobacco smoke on nasal and sinus disease: a review of the literature

Tobacco smoking and exposure to environmental tobacco smoke (ETS) have both been implicated in a number of acute and chronic medical problems including heart and lung disease and several cancers. The impact of tobacco smoke on disorders of the nose and paranasal sinuses is less well understood, although there is growing evidence that such exposure can have a significant impact on nasal and sinus function. A comprehensive review of the literature reveals that tobacco smoking is associated with acute and chronic rhinitis, but may actually be negatively correlated with the development of allergic rhinitis. In those patients with allergies, nasal and sinus symptoms may be exacerbated by tobacco smoking. ETS exposure is associated with acute and chronic nasal symptoms in adults and children, snoring in children and teenagers, and may be associated with an earlier onset and more significant symptoms for individuals with a predisposition to developing allergies. Both primary and environmental tobacco smoke are related to increases in nasal and sinus cancer. Tobacco smoking and ETS are associated with significant nasal and sinus disease and cancer.     

前庭性眩晕疾病患者焦虑和抑郁状况研究

目的 研究临床上常见的四种前庭性眩晕患者的焦虑/抑郁状况及其眩晕残障程度等相关因素并进行分析,为临床诊治四种前庭性眩晕提供依据。 方法 搜集确诊为前庭性眩晕的患者,分别为良性阵发性位置性眩晕(BPPV)、前庭性偏头痛(VM)、梅尼埃病(MD)及前庭神经炎(VN)四种疾病,记录患者的病程、持续时间等一般资料,完善耳科学检查并进行医院焦虑抑郁量表(HAD)、眩晕残障量表(DHI)测定。 结果 纳入前庭性眩晕患者121例,其中BPPV47例,VM31例,MD29例,VN14例,四组患者焦虑/抑郁阳性率分别为BPPV 31.9%、VM 71.0%、MD 75.9%、VN 42.9%;轻度、中度及重度眩晕残障程度分别为BPPV 58.9%、19.8%、21.3%,VM 19.4%、25.8%、54.8%,MD 6.9%、24.1%、69.0%,VN 38.6%、21.4%、40.0%。焦虑与抑郁评分之间线性相关(r=0.570,P<0.05);DHI与HAD评分之间线性相关(r=0.804;P<0.05)。 结论 前庭性眩晕患者存在不同程度的焦虑/抑郁,且焦虑和抑郁有一定的相关性;VM和MD患者焦虑/抑郁的发生率较高;VM、MD及VN患者眩晕残障程度高于BPPV患者。因此在临床上诊治前庭性眩晕疾病的时候要重视患者的焦虑/抑郁状态,特别是VM、MD患者,以便更好的治疗前庭性眩晕。     

Expression of heregulin and ErbB/Her receptors in adult chinchilla cochlear and vestibular sensory epithelium

Immunolabeling of heregulin, a growth factor that enhances cell proliferation in damaged utricles, and one of its binding receptors, ErbB-2, has been briefly described in the P3 rat cochlea and utricle [Zheng et al. (1999) J. Neurocytol. 28, 901-912]. However, little is known about the distribution of heregulin and its three binding receptors in adult animals. Here we describe the immunolabeling patterns for heregulin, ErbB-2, ErbB-3 and ErB-4 in the cochlea, spiral ganglion, utricle and saccule of the adult chinchilla using confocal microscopy. Heregulin immunolabeling was intense along the apical pole of Deiters cells and Hensen cells and along the membrane of supporting cells of the utricle and saccule; light immunolabeling was present in the outer layer of the spiral prominence and cytoplasm of spiral ganglion neurons. In the cochlea, intense to moderate ErbB-2 immunolabeling was evident in the cytoplasm of pillar cells, outer hair cells (OHCs), border cells, stria vascularis and spiral ligament; moderate ErbB-2 immunolabeling was present in the cytoplasm of the hair cell and supporting cell layers of the utricle and saccule. In the cochlea, light ErbB-3 immunolabeling was present in the inner hair cells, OHCs, marginal and intermediate cell layers of the stria vascularis and spiral ganglion neurons; moderate ErbB-3 immunolabeling was present in the cytoplasm of hair cells and supporting cells of the utricle and saccule. In the cochlea, utricle and saccule, ErbB-4 immunolabeling was intense in the nuclei and light to moderate in the cytoplasm and membrane of sensory cells and supporting cells. These results suggest that heregulin acting through ErbB receptors and various receptor complexes may play an important role in cell proliferation and survival in the cochlea and vestibular system.     

鼻咽癌病人放射治疗前后天然杀伤细胞活性、白细胞介素-2水平改变的研究

目的：探讨鼻咽癌(nasopharyngeal carcinoma,NPC)病人放射治疗前后天然杀伤细胞(NK细胞)活性、白细胞介素—2(IL-2)水平的变化和肿瘤复发转移的关系。方法：选择139例首诊的NPC病人为NPC组，45例健康成人为对照组，两组间性别及年龄无显著差异。NPC病人根据肿瘤有无复发转移又分为两组，均予以^60Coγ射线外照射DT68—80Gy，分别检测放疗前和放疗后(36个月内)及对照组的NK细胞活性及IL-2水平，观察肿瘤复发转移的情况。结果：鼻咽癌病人放疗前、后0-30个月内NK细胞活性及IL-2水平动态观察均明显低于正常对照组(P＜0．05)，至放疗30个月后NK细胞活性及IL-2水平恢复近正常水平。肿瘤复发转移者其NK细胞活性及IL-2水平明显低于无复发转移者(P＜0．05)。30个月内肿瘤复发转移率为85．7％(60/70)。结论：NPC病人免疫功能状况与肿瘤复发转移关系密切。动态观察和评价NK细胞活性及IL-2水平对判断NPC是否复发和转移有一定的指导意义。