Healing responses following transverse root fracture: a historical review and case reports showing healing with (a) calcified tissue and (b) dense fibrous connective tissue

Background

The understanding and management of transverse intra‐alveolar root fractures has evolved to its current high level of sophistication and clinical success from foundations laid down by histological studies as early as the mid‐nineteenth century.

Significance

The aim of the review was to highlight those earlier histological reports and studies that have contributed to the current understanding of the biological processes involved in the healing of transverse root fractures. Healing of a transverse root fracture by calcified tissue was demonstrated histologically by Howe in 1926, while Boulger in 1928 showed the two other patterns of root fracture healing, namely the interposition of fibrous connective tissue and the interposition of bone and periodontal ligament around both fractured segments. Other major histological reports around that time came from members of the so‐called ‘The Vienna group of Illinois’, who had a significant influence in the development of oral biology worldwide. Other important reports and an experimental study emanated from Germany and Switzerland in the late 30s and early 40s, followed in the 1950s and early 1960s by histological material principally from Sweden, Denmark, France, the USA and Britain. Jens Andreasen and Erik Hjörting‐Hansen's landmark paper in 1967 included new histological reports and a classification of healing responses following transverse root fractures. The expansion of knowledge related to root fractures since that time has been exponential, with major contributions from Scandinavia and several other countries.

Case reports

Accompanying the historical review are two case reports with histology of root fracture healing by (a) calcified tissue and (b) dense fibrous connective tissue. The role of the pulp and the periodontal ligament in the repair process is described and the clinical significance discussed with particular emphasis to diagnosis and orthodontic management.     

肝上皮样血管内皮瘤1例

上皮样血管内皮瘤(epithelioid hemangioendothelioma,EHE)是一种病因及发病机制不明,累及单个或多个器官的血管源性肿瘤,具有低至中度恶性潜能,呈慢性进行性发展过程.肝脏是EHE受累的常见器官之一.Ishak等[1]在1984年首次报道了肝上皮样血管内皮瘤(hepatic epithelioid hemangioendothelioma,HEHE),此后相关报道逐渐增多.影像学检查是诊断HEHE常用的手段之一,如螺旋X线计算机断层摄影术(CT)、磁共振成像(MRI)、核医学检查等,但存在一定的局限性.我们在此报道1例病史长达17年的HEHE患者的肝脏CT灌注特点及其在HEHE诊断中的价值.     

生脉注射液治疗急性心肌梗死后心源性休克的临床研究

目的研究生脉注射液治疗急性心肌梗死后心源性休克的临床疗效。方法选取2015年6月—2016年8月十堰市太和医院治疗的急性心肌梗死后心源性休克患者164例,随机分为对照组和治疗组,每组各82例,对照组给予常规治疗,治疗组在对照组的基础上静脉滴注生脉注射液,60 m L加入5%葡萄糖溶液250~500 m L,1次/d。两组均连续治疗7 d。治疗后,观察两组患者临床疗效,同时比较血清心肌肌钙蛋白I(c Tn I)、钙调蛋白(Ca M)及其基因表达,心功能指标左心室内压最大上升速率(dp/dtmax)、左心室内压最大下降速率(-dp/dtmax)、左室射血分数(LVEF)、舒张末期室间隔厚度(IVST)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、心脏指数(CI),及肺毛细血管楔压(PCWP)、心率(HR)、收缩压(SBP)、舒张压(DBP)、脉压(PP)和尿量(UV)的变化。结果治疗后,对照组和治疗组总有效率分别为60.97%和74.39%,两组总有效率比较差异有统计学意义(P0.05)。两组c Tn I、Ca M、c Tn I-m RNA和Ca MKII-m RNA均较治疗前显著降低,同组治疗前后差异有统计学意义(P0.05),且治疗组上述指标降低更明显,两组比较差异有统计学意义(P0.05)。两组±dp/dtmax、LVEF和CI均升高、LVEDD增大,IVST和LVESD均缩小(P0.05),且治疗组上述指标改善更明显(P0.05)。两组患者PCWP和HR均降低,SBP和DBP均升高,PP增大,UV增多(P0.05),且治疗组上述指标改善更明显(P0.05)。治疗组并发症中室间隔穿孔、急性肾衰竭和心律失常和死亡率明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论生脉注射液治疗急性心肌梗死后心源性休克疗效显著,纠正急性心肌梗死时心肌"钙超载"现象,明显增强心脏泵血功能,具有一定的临床推广应用价值。     

Sphingosine 1-phosphate receptors in health and disease: mechanistic insights from gene deletion studies and reverse pharmacology

Sphingosine 1-phosphate (S1P) is a bioactive sphingolipid that is critically involved in the embryonic development of the cardiovascular and central nervous systems. In the adult, S1P can produce cytoskeletal re-arrangements in many cell types to regulate immune cell trafficking, vascular homeostasis and cell communication in the central nervous system. S1P is contained in body fluids and tissues at different concentrations, and excessive production of the pleiotropic mediator at inflammatory sites may participate in various pathological conditions. Gene deletion studies and reverse pharmacology (techniques aiming to identify both ligands and function of receptors) provided evidence that many effects of S1P are mediated via five G-protein-coupled S1P receptor subtypes, and novel therapeutic strategies based on interaction with these receptors are being initiated. The prototype S1P receptor modulator, FTY720 (fingolimod), targets four of the five S1P receptor subtypes and may act at several levels to modulate lymphocyte trafficking via lymphocytic and endothelial S1P1 and, perhaps, other inflammatory processes through additional S1P receptor subtypes. A recently completed Phase II clinical trial suggested that the drug may provide an effective treatment of relapsing-remitting multiple sclerosis. FTY720 is currently being evaluated in larger-scale, longer-term, Phase III studies. This review provides an overview on S1P activities and S1P receptor function in health and disease, and summarizes the clinical experience with FTY720 in transplantation and multiple sclerosis.     

O型臂导航引导下经皮椎体成形术治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性

目的 探讨O型臂导航引导下经皮椎体成形术（percutaneous vertebroplasty,PVP）在治疗中段胸椎骨质疏松性椎体压缩骨折的精准性及安全性。方法 2019年12月—2021年8月复旦大学附属浦东医院骨科收治中段胸椎骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture,OVCF）患者15例（15个椎体）,男5例,女10例;年龄70~89岁,平均（76.7±5.8）岁。均采用O型臂导航引导下经单侧穿刺行PVP治疗。主要疗效指标：术中规划路径与实际路径的符合率,微创经皮开路器穿刺成功需要的次数,主要指标用于评价该手术操作的精准性。次要疗效指标包括：记录患者术前、术后2天以及末次随访时视觉模拟（visual analogue scale,VAS）疼痛评分,Oswestry功能障碍指数（Oswestry disability index,ODI）。同时记录患者的手术时间、骨水泥使用量、术中出血量及手术相关并发症发生情况等,测量并记录术前、术后2天及末次随访时伤椎前缘高度,次要指标用于评价该手术方案的临床疗效与安全性。结果 15例患者均顺利完成手术,术中规划路径与实际路径的符合率：优6例,良9例,优良率达100%,所有病例均为1次穿刺成功,无患者出现骨水泥渗漏或严重并发症。平均随访11.7个月。术前、术后2天及末次随访时患者VAS评分分别为7.2±0.7、2.3±0.5和1.9±0.5,患者ODI评分分别为68.1±4.0、23.6±4.3和23.0±4.6,患者伤椎前缘高度分别为（2.4±0.3）cm、（2.7±0.3）cm和（2.6±0.3）cm。术后2天患者VAS评分、ODI评分较术前明显改善（P<0.05）,术后2天及末次随访时患者伤椎前缘高度较术前均增加（P<0.05）。结论 O型臂导航引导下PVP治疗中段胸椎OVCF,可提高手术操作精准度及安全性,在治疗中段胸椎OCVF中可能具有较大的临床应用价值。     

Triple (GGTA1, CMAH,B2M) modified pigs expressing an SLA class Ilow phenotype—Effects on immune status and susceptibility to human immune responses

Porcine xenografts lacking swine leukocyte antigen (SLA) class I are thought to be protected from human T cell responses. We have previously shown that SLA class I deficiency can be achieved in pigs by CRISPR/Cas9‐mediated deletion of β₂‐microglobulin (B2M). Here, we characterized another line of genetically modified pigs in which targeting of the B2M locus did not result in complete absence of B2M and SLA class I but rather in significantly reduced expression levels of both molecules. Residual SLA class I was functionally inert, because no proper differentiation of the CD8⁺ T cell subset was observed in B2M^low pigs. Cells from B2M^low pigs were less capable in triggering proliferation of human peripheral blood mononuclear cells in vitro, which was mainly due to the nonresponsiveness of CD8⁺ T cells. Nevertheless, cytotoxic effector cells developing from unaffected cell populations (eg, CD4⁺ T cells, natural killer cells) lysed targets from both SLA class I⁺ wildtype and SLA class I^low pigs with similar efficiency. These data indicate that the absence of SLA class I is an effective approach to prevent the activation of human CD8⁺ T cells during the induction phase of an anti‐xenograft response. However, cytotoxic activity of cells during the effector phase cannot be controlled by this approach.     

右美沙芬缓释混悬液治疗慢性咽炎所致咳嗽90例的临床观察

目的：研究右美沙芬缓释混悬液治疗成人慢性咽炎所致咳嗽的临床效果。方法：将90例慢性咽炎咳嗽患者随机分为3组,对照组给予万应胶囊治疗,治疗组l给予万应胶囊联合右美沙芬缓释混悬液治疗,治疗组2给予万应胶囊联合右关沙芬缓释混悬液及抗组胺药治疗,疗程均为14d。结果：治疗组1及治疗组2在7d、14d时疗效均优于对照组,差异有统计学意义（P〈O．01）;治疗组2在7d时疗效优于治疗组1,差异有统计学意义（P〈O．01）。结论：右美沙芬缓释混悬液用于成人慢性咽炎所致咳嗽临床效果良好,右关沙芬缓释混悬液联合抗组胺药对成人慢性咽炎所致咳嗽的临床疗效更快、更好。