美学区软组织水平和骨水平植体周围骨丧失和牙龈生物型的分析

目的: 植体周围一定程度的骨丧失可能会给牙种植治疗的美观效果带来不利影响。这种情况可能更容易影响软组织水平（Tissue-Level, TL）设计,因此,当强调形态的美观自然性时,骨组织水平（Bone-Level, BL）设计可能更有优势。除了植体的设计,牙龈生物型也被认为是维持牙槽骨稳定的重要因素。本研究拟针对具有不同牙龈生物型的患者,在其美学区域行软组织水平和骨水平牙种植治疗,探究其骨丧失的程度。材料和方法: 对41位患者行20个TL和22个BL种植治疗,术后即刻、术后随访对这42个位点行口内影像学检查;运用计算机技术行牙槽骨高度测量分析;运用TRAN法鉴定患者的牙龈生物型。结果: TL组平均4.9年的存留期里,厚龈型的12颗植体周围平均骨丧失0.21mm（SD：0.43mm）;薄龈型的8颗植体周围平均骨丧失0.05mm（SD：0.47mm;P=0.31）。BL组平均1.9年的存留期里,厚龈型的14颗植体周围骨丧失为-0.03mm（SD：0.38mm）,薄龈型的8颗植体周围骨丧失为+0.09mm（SD：0.32mm;P=0.84）。结论: 分析得到的数据发现,牙槽骨高度的变化与种植设计或是牙龈生物型并无直接相关性。然而在选择种植设计之前,评价软组织的厚度是有利的,其中BL种植设计更能获得自然的外形。为实现以上评价目的,TRAN法是最快速、简易的方法。     

Implementing an Innovative Cardiac Assist System in a Nonuniversity Hospital—Feasibility,Complications, and First Results

To evaluate the feasibility of implementing a cardiac assist system in a nonuniversity hospital we analyzed 18 consecutive patients treated with venoarterial membrane oxygenation. The system was used electively in 5/18 (27.8%) patients during high‐risk interventions. Thirteen patients (72.2%) were treated in emergency situations. The extracorporal system could be initiated successfully in all patients. Periprocedural complications were hemolysis in 3/18 (16.7%), disseminated intravascular coagulation in 2/18 (11.1%), cerebral ischemia in 1/18 (5.6%), and local infection in 2/18 (11.1%) patients. None of these led to a discontinuation of the therapy. All electively treated patients were successfully weaned from the extracorporeal system. In 9/13 (69.2%) emergency patients the system was removed successfully. The 60‐day survival rate of the emergency patients was 53.8% (7/13). Our experience confirms that an innovative extracorporeal circulatory support system can be implemented in a nonuniversity hospital at a tolerable risk and a low complication and high procedural success rate.     

Acute Limited Intimal Tears of the Thoracic Aorta

Background

Limited intimal tears (LITs) of the aorta (Class 3 dissection variant) are the least common form of aortic pathology in patients presenting with acute aortic syndrome (AAS). LITs are difficult to detect on imaging and may be underappreciated.

Long-term effect of combined vitamins E and C on coronary and peripheral endothelial function

OBJECTIVES: We tested whether long-term administration of antioxidant vitamins C and E improves coronary and brachial artery endothelial function in patients with coronary artery disease (CAD). BACKGROUND: Endothelial function is a sensitive indicator of vascular health. Oxidant stress and oxidized low-density lipoprotein (LDL) impair endothelial function by reducing nitric oxide bioavailability in the artery wall. METHODS: We randomly assigned 30 subjects with CAD to combined vitamin E (800 IU per day) and C (1000 mg per day) or to placebos in a double-blind trial. Coronary artery endothelial function was measured as the change in coronary artery diameter to acetylcholine infusions (n = 18 patients), and brachial artery endothelial function was assessed by flow-mediated dilation (n = 25 patients) at baseline and six months. Plasma markers of oxidant stress (oxidized LDL and autoantibodies) were also measured. RESULTS: Plasma alpha-tocopherol (p < 0.001) and ascorbic acid (p < 0.02) increased with active therapy. Compared to placebo, there was no improvement in coronary and brachial endothelial vasomotor function over six months. Although vitamins C and E tended to reduce F2-isoprostanes (p = 0.065), they failed to alter oxidized LDL or autoantibodies to oxidized LDL. CONCLUSIONS: Long-term oral vitamins C and E do not improve key mechanisms in the biology of atherosclerosis or endothelial dysfunction, or reduce LDL oxidation in vivo.