数字化根管定位导板在微创牙髓治疗中应用研究进展

随着牙体牙髓治疗技术和理念的不断发展,微创牙髓治疗（minimally invasive endodontics,MIE）理念受到了广泛关注,MIE强调保留更多的牙体组织来提高患牙存留率。在各项数字化技术的联合应用下,MIE有了新思路、新方法。文章从现阶段的数字化根管定位导板在MIE的应用背景、数字化技术、制作方法、临床应用等方面展开综述。     

老年科住院患者抗抑郁药物应用77例分析

目的 探讨老年人应用抗抑郁药的安全性,为老年人合理使用抗抑郁药提供参考。方法 回顾性分析2012年1月至2013年12月北京协和医院院老年示范病房77例65岁以上患者的抗抑郁药物的使用情况、起始剂量及不良反应。结果 经老年医学跨学科团队会诊,77例均服用新型抗抑郁药,其中舍曲林使用率最高,对低体重指数患者更多选择米氮平治疗,伴有慢性疼痛的患者中50%使用5-羟色胺和(或)去甲肾上腺素再摄取抑制剂。70例住院后开始抗抑郁药治疗,72.8%的患者初始给药量从小剂量开始,不良反应发生率为8.6%(6/70)。结论 应结合老年患者特点,以及抗抑郁药的特点、不良反应和药物之间的相互作用来选择适当的抗抑郁药物。     

慢性阻塞性肺疾病合并焦虑抑郁判断及对策

焦虑抑郁是慢性阻塞性肺疾病（COPD）常见的合并症之一,不仅影响患者的疾病严重程度,也是评估患者预后 的重要因素。文章从COPD合并焦虑抑郁的危险因素、临床判断及处置对策进行概述,为临床早期、规范诊治COPD 合并焦虑抑郁提供参考。     

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??Objective    To evaluate the position of maxillary impacted canines and resorption of neighboring incisors with cone beam computed tomography ??CBCT??. Methods    Impacted maxillary canines in sixty-seven patients were selected and scanned by the Planmeca ProMax 3D at Stomatological Hospital of Jilin University from Dec.2015 to Jan.2017. The three-dimensional images were obtained by Invivo 5.4.5 software. Each impacted canine was positioned and the root resorption of adjacent incisors was observed in sagittal??coronal and axial views. Results    In sagittal plane view??except 10 horizontal impacted canines ??12.0%?? and 1 inverted impacted canine ??1.2%????33.7% of impactions were labial??30.1% were palatal??and 22.9% were middle. In coronal plane view??12.0% of the cusp tips of maxillary impacted canines were near the crown of the adjacent incisor??42.2% were near cervical third of the root of the adjacent incisor??24.1% were near middle third of the root of the adjacent incisor??9.6% were near apical third of the root of the adjacent incisor??and 12.0% were near the root tip of the adjacent incisor.In axial plane view??65.1% of impactions were mesial??12.0% of impactions were distal??and 9.6% were middle. About 17.9% lateral incisors had root resorption??and 9.7% central incisors ??13?? had root resorption??the difference being statistical ??P < 0.05??. Conclusion    CBCT is a better way in the diagnosis and analysis of the position and root resorption of maxillary impacted canines??which provides guidance to the treatment.     

三级淋巴结构在结直肠癌中的作用研究进展

肠道作为全身免疫细胞富集的重要器官，肠道免疫微环境改变在结直肠癌的发生发展中发挥重要作用。深入了解结直肠癌进程中肠道免疫微环境的变化是未来探索结直肠癌新型治疗策略的基础。三级淋巴结构（TLS）是近年发现的存在于结直肠癌周围的免疫细胞聚集结构，与次级淋巴器官（SLO）具有类似的表型和功能特征。越来越多的研究证据表明，三级淋巴结构与疾病进程、病人预后及辅助治疗疗效均存在显著相关性。     

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??Early evaluation of imatinib in treatment of gastrointestinal stromal tumor using CT imaging ZHANG Xiao-peng *, TANG Lei, SHEN Lin , et al. *Department of Radiology?? Peking University School of Oncology & Beijing Cancer Hospital, Beijing 100036, China Corresponding author??ZHANG Xiao-peng??E-mail??zxp@bjcancer.org Abstract Objective To compare the value of RECIST and Choi criteria in the evaluation of imatinib in treatment of GIST. Methods The clinical data of 176 cases of GIST treated by imatinib during April 2003 to January 2008 were analyzed retrospectively. Among them??26 cases had medium and short term (2-6months) CT follow-ups were enrolled into the study. CT scans were performed on Siemens plus4 and GE 64-slices MDCT. The size and CT values were measured on axial images. The mean length-diameter and CT values were measured according to RECIST and Choi criteria(≤5/organ, ≤10/case). The change rate of length-diameter and CT values were computed. All patients were divided into good-response group (GoodR) and poor-response group (PoorR) according to RECIST and Choi criteria respectively. The TTP of different groups divided by different criteria using Kaplan-Meier were compared. Results There were 7 cases of good responders and 19 cases of poor responders by RECIST criteria, and the response rate was 27%. There were 19 cases of responders and 7 cases of non-responders by Choi criteria, and the response rate was 73%. The median follow-up was 23.5 months. The median time to progression (TTP) was 17.5 months up to January 2008. There was no statistical significance of TTP between good responder and poor responder groups (P=0.910) according to RECIST criteria, and there was statistical significance of TTP (P=0.000) according to Choi criteria. Conclusion Choi criteria is superior to RECIST criteria in the CT evaluation of GIST treated by imatinib.     

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??Extrahepatic bile duct resection in the treatment of T3,T4 gallbladder carcinoma ZHENG Ya-xin*, ZHONG Ming-an, HU Hai, et al. *Department of General Surgery, Shanghai East Hospital, Tong Ji University, Shanghai 200120,China Corresponding author: ZHENG Ya-xin, E-mail??yxzheng@shmu.edu.cn Abstract Objective To evaluate the clinical significance of extrahepatic bile duct resection ??EBDR??in the treatment of T3,T4 gallbladder carcinoma??GC?? Methods Palliative cholecystectomy (n=8), radical/extended radical resection without EBDR (n=9), and radical/ extended radical resection with EBDR (n=7) were employed performed in 24 patients with T3,T4 GC admitted between January 2004 and December 2006 at Shanghai East Hospital Affiliated to Tong Ji University. Clinicopathologic factors, postoperative complications and survival of the 3 group patients were studied. Results The mean survival of patients after surgery were 4, 6 and 18 months in the 3 groups respectively. There were no significant differences in the proportion of age, sex and postoperative complications among the 3 groups of patients. The 7 patients who underwent radical or extended radical resection with EBDR showed significantly better survival than another two group of patients in whom EBDR was not carried out(P=0.003). Conclusion EBDR is a necessary surgical procedure and is key to the improved survival of patients with T3,T4 GC undergoing radical or extended radical resection.