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??Objective??To study the in vitro biocompatibility of titannium alloy treated with micro-arc oxidation??MAO????in order to provide the theoretical basis for the next application of MAO in the treatment of titanium alloy implants. Methods??The biofilm layer containing hydroxyapatite ??HA?? was formed on the surface of Ti6Al4V by one-step  MAO ??experiment group??. The control groups were the untreated Ti6Al4V and the sandblasted Ti6Al4V. The three groups were co-cultured with osteoblasts to determine the proliferation??alkaline phosphatase ??ALP?? activity and mRNA expression of collagen ?? ??COL-?? and osteocalcin ??OC??. Results??The surface after the treatment was "crater" structure with a large number of HA. The in vitro results of three groups of materials showed that the cell proliferation rate of the Ti6Al4V treated with MAO was higher than that of the other two groups??and the ALP activity and COL-??and OC mRNA expression of cells were higher than those in the other two groups. Conclusion??The biofilm layer formed on the surface of Ti6Al4V by  MAO  has a beneficial effect on the adhesion and proliferation of cells??which promotes the differentiation  and shows good biocompatibility.     

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??Objective    Implant therapy combined with simultaneous guided bone regeneration??GBR??and different soft tissue management was applied to patients to repair their missing maxillary center incisors. This article aims to analyze the effects of hard and soft tissue augmentation quantitatively. Methods    Six patients who accepted implant therapy in combination with simultaneous GBR and different soft tissue management for their single missing maxillary central incisor were screened. They were called for a review visit at 7 to 24 months after final restoration. The clinical periodontal status of the maxillary anterior teeth was examined??and the bone height and thickness at middle labial aspect of implants were measured by CBCT quantitatively. The relationship of gingival zenith position between implants and the control teeth??as well as the papilla height and filling degree of implants were measured quantitatively on the standardized photographs. Pink esthetic score??PES??was applied to evaluate the esthetic effect. Results    All the implants were in stable and healthy periodontal status at the review visit. Vertical and horizontal bone augmentation could be observed on 5 implants. The mean facial bone thickness at 2??4??and 6 mm apical to implant shoulder was??1.7 ± 1.1??mm????2.3 ± 1.1??mm??and??2.2 ± 1.3??mm??respectively. The mean position of gingival zenith of implants was??1.0 ± 0.6??mm more distally??and??0.4 ± 0.8??mm more apically??compared to the control teeth. The mean height??2.8 ± 0.5??mm and filling ??76.9 ± 19.2??% of distal papilla of implants were less than those of mesial papilla??4.2 ± 0.7??mm??and ??89.8 ± 11.1??%. Mean PES was 11.5 ± 1.4. Conclusion    For the patients with bone and soft tissue defect at edentulous areas??implant therapy combined with GBR and different soft tissue management for the missing maxillary center incisors can obtain adequate bone augmentation and harmonious soft tissue profile to the control teeth??and consequently improve esthetic outcomes in a certain degree.     

氢氟酸酸蚀对两种树脂-陶瓷复合材料黏结强度影响研究

目的    研究氢氟酸酸蚀对两种树脂-陶瓷复合材料黏结强度的影响。方法    选择Hyramic和Vita Enamic两种树脂-陶瓷复合材料,每种材料再按照表面处理方式分为未处理组（Hyramic-NT组和Vita Enamic-NT组）以及氢氟酸酸蚀组（Hyramic-HF组和Vita Enamic-HF组）。测量表面处理后的复合材料表面粗糙度,扫描电镜观察表面形貌。使用Multilink N树脂水门汀将组内的复合材料两两黏结,制作微拉伸试件,37℃去离子水中水浴24 h后进行微拉伸强度测试。将粗糙度及微拉伸黏结强度结果采用SPSS 22.0软件进行两因素析因设计资料的方差分析。结果　不同的表面处理方式对微拉伸黏结强度和粗糙度有影响（均P < 0.05）,材料种类对微拉伸黏结强度和粗糙度无明显影响（均P > 0.05)。Hyramic-HF组微拉伸黏结强度高于Hyramic-NT组,但差异无统计学意义（P > 0.05）。Vita Enamic-HF组微拉伸黏结强度明显高于Vita Enamic-NT组,差异有统计学意义（P < 0.05）。粗糙度及扫描电镜结果显示,氢氟酸处理后复合材料的表面形貌有明显改变。结论    氢氟酸酸蚀可提高树脂-陶瓷复合材料与树脂水门汀之间的黏结强度,Vita Enamic比Hyramic更适合氢氟酸酸蚀处理。     

血清脂蛋白磷脂酶A2 和血浆抗凝血酶Ⅲ对2 型糖尿病患者发生缺血性脑卒中风险的评估价值

目的 探讨血清脂蛋白磷脂酶A2 （lipoprotein-associated phospholipase A2,Lp-PLA2）、血浆抗凝血酶Ⅲ（Antithrombin Ⅲ,AT- Ⅲ）在2 型糖尿病患者发生缺血性脑卒中风险评估中的运用价值。方法 选取2018 年7 月~2019 年12 月于成都市郫都区中医医院就诊的84 例伴缺血性脑卒中、无脑卒中以外其他并发症的2 型糖尿病患者作为研究组,另选取84 例无并发症的单纯2 型糖尿病患者作为对照组。采用免疫比浊法于日立7180 生化分析仪上检测血清Lp-PLA2,采用免疫比浊法于积水CP3000 凝血分析仪上进行血浆AT- Ⅲ的检测。运用独立样本t 检验比较研究组与对照组间各检测指标的差异,并观察研究组中各检测指标的异常率,判断血清Lp-PLA2、血浆AT- Ⅲ在2 型糖尿病患者发生缺血性脑卒中风险评估中的运用价值。结果 2 型糖尿病伴缺血性脑卒中患者与单纯2 型糖尿病患者的血清Lp-PLA2 结果分别为229.31±37.92 ng/ml 和101.56±24.32 ng/ml;血浆AT- Ⅲ结果分别为79.43%±14.10% 和100.18%±19.40%。2 型糖尿病伴缺血性脑卒中患者的血清Lp-PLA2 水平显著高于单纯2 型糖尿病患者（t=-25.835,P<0.01）,血浆AT- Ⅲ则显著低于单纯2 型糖尿病患者（t=7.881,P<0.01）,两个检测项目的组间差异均具有统计学意义。2 型糖尿病伴缺血性脑卒中患者中血清Lp-PLA2,血浆AT- Ⅲ和血清Lp-PLA2 联合血浆AT Ⅲ检测指标的异常率分别为82.14%,77.38% 和88.10%;血清Lp-PLA2 异常率较血浆AT- Ⅲ高,而两项同时检测具有更高的异常率。结论 检测血清Lp-PLA2 和血浆AT- Ⅲ对2 型糖尿病患者发生缺血性脑卒中风险的评估具有重要价值。     

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。     

Acoustic neuroma surgery. Results and complications in 348 cases

OBJECTIVES: The aim of this study was to evaluate post-operative complications after acoustic neuroma surgery. METHODS: This was a retrospective study of 348 patients, who had acoustic neuroma surgery between 1984 and 1999. Symptoms, pre-operative evaluation, surgery and post-operative complications were analysed. RESULTS: 174 men and 174 women had an operation. Mean age was 51.8 years (11-78). 31 patients had a grade I tumour, 106 a grade II, 71 a grade III and 140 had a grade IV tumour. 195 patients have been operated through the translabyrinthine approach, 110 through the retrolabyrinthine approach, 42 through the sub-occipital approach, and one through the transcochlear approach. Mortality was 0.85%, 59.2% patients had a post-operative facial paralysis. Most of patients had post-operative dizziness, and 30% still had vestibular disturbances after one year. 9 patients (2.6%) had a cerebrospinal rhinorrhea and 24 patients had a cerebrospinal wound leak (6.9%). 22 patients had post-operative meningitis (6.3%). 2 patients had a cerebello pontine angle haemorrhage, and 3 patients had a brain stem infarct. CONCLUSION: Transpetrous approaches are safe for acoustic neuroma removal and the post-operative complication rate is low. The retrolabyrinthine approach seems to be a good hearing preservative approach, regardless of tumour volume.