PICU重症坏死性筋膜炎诊治分析

目的分析重症坏死性筋膜炎（necrotizing fasciitis,NF）临床特点及诊断治疗要点。方法回顾性分析安徽省儿童医院PICU2007年1月至2013年9月14例NF患儿临床体征、辅助检查、治疗及预后。结果14例患儿中,男8例,女6例,年龄（15．86±10．48）个月,住院天数（29．07±16．30）d,热程（10．64±5．64）d,清创次数（3．07±1．33）次;均有脓毒性休克,5例有多脏器功能衰竭。发病部位：臀部5例,下肢4例,背部2例,会阴部2例,颈部1例;血培养：6例金黄色葡萄球菌（1例耐甲氧西林金黄色葡萄球菌）,4例铜绿假单胞菌,3例培养未见明显细菌生长,1例咽峡炎群链球菌。CT均见皮肤及皮下组织水肿,筋膜增厚,11例见软组织气体影。组织活检均确诊为NF;病初表现不典型以局部组织红肿为主,随病情进展患处皮肤苍白伴血疱,后颜色逐渐发紫发黑,部分患儿有皮下握雪感,切开后见筋膜大片苍白坏死;均行切开引流（5例行封闭负压引流持续吸引）、彻底清创、有效抗生素治疗、胶体支持治疗;1期愈合7例（50．00％,7／14）,2期植皮4例（28．57％,4／14）,死亡3例（21．43％,3／14）;随访2年,6例患儿有局部肢体活动受限。结论NF病情危重,常见于会阴部、腹部及四肢,易导致脓毒性休克,多脏器功能衰竭,革兰阴性杆菌感染临床症状极危重,病死率高。NF需尽早确诊,强有力抗生素使用,积极广泛、彻底地外科清创,充分引流,加强支持对症处理可降低病死率。     

Esthetic comparison of white-spot lesion treatment modalities using spectrometry and fluorescence

Objective:To compare the esthetic improvements of white-spot lesions (WSLs) treated by fluoride, casein phosphopeptide amorphous calcium phosphate (CPP-ACP), or resin infiltration.Materials and Methods:WSLs were created on human enamel and randomly assigned to four groups: NaF (500 ppm), CPP-ACP, resin infiltration (Icon), or distilled deionized water (DDW; control group). The color change (ΔE) of each specimen was measured with a Crystaleye spectrophotometer, and fluorescence loss (ΔQ) was measured by quantitative light-induced fluorescence (QLF), at different time points after treatment: baseline (0 weeks), 2 weeks, 4 weeks, and 6 weeks.Results:The ΔE and ΔQ baseline values for the four groups before the treatments did not differ significantly. Icon treatment improved the WSL color significantly and gave the lowest ΔE (2.9 ± 1.2 on average) compared with other treatments (P < .01). The Icon treatment also resulted in a significant change in the ΔQ of WSLs compared with baseline (P < .01). In the NaF and CPP-ACP treatment groups, ΔQ showed significant recovery compared with the baseline values only after 4 weeks after treatment (P < .05).Conclusions:Resin infiltration is more effective than NaF or CPP-ACP in providing esthetic improvement of WSLs.     

Erk1/2 signalling is involved in the differentiation of periodontal ligament stem cells to Schwann cells in dog

Periodontal ligament stem cells (PDLSCs) show a multi-differentiation potential, however, the mechanism of its neural differentiation is still unclear. We aim to explore the potential role of Erk1/2 signalling pathway in the differentiation of PDLSCs to Schwann cells (SCs).     

Angiotensin II induces mitochondrial dysfunction and promotes apoptosis via JNK signalling pathway in primary mouse calvaria osteoblast

Objectives

This present study was designed to investigate the effects of Angiotensin II on mitochondrial functions, ROS generation and c-jun N-terminal kinases (JNK) signalling pathway-mediated cell apoptosis in mouse calvaria osteoblasts.

Methods

Calvaria osteoblast were isolated and cultured. The cells were separated into two groups—control and treated groups—where the latter was stimulated with angiotensin II (Ang II). Mitochondrial reactive oxygen species (ROS) and superoxide production were measured. Intracellular ATP levels were also detected. The cell proliferation rate was determined for the two groups. Protein production such as Anti-Bax, Bcl-2, COX IV and activation of c-jun N-terminal kinases signal (JNK) pathway was measured by enzyme-linked immunosorbent assay (ELISA) methods and Western blotting in this study.

Results

Ang II treated cells showed significantly higher levels of superoxide production compared to the control group (p < 0.05). Conversely, Ang II induced inhibitory effects on mitochondrial respiratory enzyme complexes, cause membrane potential dissipation, ATP loss and promote ROS generation, cell apoptosis in cultured osteoblasts. In addition, JNK phosphorylations were involved in activating the mitochondria-dependent apoptotic pathway following Ang II stimulation, as pre-treatment of JNK-specific inhibitor SP600125 could rescue osteoblast cells from apoptosis by enhancing the anti-apoptotic protein Bcl-2 expressions, suppressing the translocation of Bax from cytosol into mitochondria, blocking cytochrome C release and caspase-3 activation.

Conclusions

Ang II stimulates osteoblast apoptosis via suppression of the mitochondrial respiratory enzymes, membrane potential and cellular ATP productions. Clinical application with Ang II-stimulated osteoblast could be used for modelling or bone resorption in the oral region.     

The variation of cancellous bones at lumbar vertebra,femoral neck,mandibular angle and rib in ovariectomized sheep

This study aimed to compare the variation of cancellous bones at four skeletal sites: lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep. Sixteen adult sheep were randomly divided into two groups: eight sheep were ovariectomized served as experimental group; the other eight untreated sheep were served as control group. Bone mineral density was assessed by dual-energy X-ray absorptiometry on lumbar vertebrae at baseline and twelve months after ovariectomy. After 12 months, lumbar vertebrae L3 and L4, femoral necks, mandibular angles and the fourth ribs were harvested for micro-CT scanning, histological analysis and biomechanical test. The results showed that bone mineral density of lumbar vertebra decreased significantly in twelfth month (p < 0.05). The results of micro-CT showed that the bone volume/total volume decreased by 45.6%, 36.1% 21.3% and 18.7% in lumbar vertebrae, femoral necks, mandibular angles and ribs in experimental group (p < 0.05) respectively. The trabecular number showed the same downtrend (p < 0.05). Histological analysis showed trabecular area/tissue area decreased by 32.1%, 23.2% and 20.7% in lumbar vertebrae, femoral necks and mandibular angles respectively (p < 0.05), but no significant difference in ribs. Specimens elastic modulus from lumbar vertebra, femoral neck and mandibular angle were 952 ± 76 MPa (628 ± 70 MPa), 961 ± 173 MPa (610 ± 72 MPa) and 595 ± 60 MPa (444 ± 31 MPa) in control group (experimental group) respectively. These datum indicated that the sensibility of cancellous bones to oestrogen deficiency in ovariectomized sheep was site-specific on a pattern as follows: lumbar vertebra, femoral neck, mandibular angle and rib.     

Cyclosporine A Inhibits Apoptosis of Rat Gingival Epithelium

Background: The use of cyclosporine A (CsA) induces hyperplasia of the gingival epithelium in a site‐specific response manner, but the molecular mechanism via which the lesion occurs is unclear. The present research aims to investigate the site‐specific effect of CsA on the apoptosis of gingival epithelium associated with gingival hyperplasia. Methods: Forty Wistar rats were divided into CsA‐treated and non‐treated groups. Paraffin‐embedded sections of mandibular first molars were selected for hematoxylin and eosin staining, immunohistochemistry analyses of bcl‐2 and caspase‐3, and the staining of terminal deoxynucleotidyl transfer‐mediated dUTP nick‐end labeling (TUNEL). The area of the whole gingival epithelium and the length of rete pegs were measured, and the number of bcl‐2‐ and caspase‐3‐positive cells in the longest rete peg were counted. The analysis of variance for factorial designs and Fisher least significant difference test for post hoc analysis were used to determine the significance levels. Results: In CsA‐treated rats, bcl‐2 expression was significantly upregulated, whereas caspase‐3 expression was downregulated, along with a reduced number of TUNEL‐positive cells. The site‐specific distribution of bcl‐2 was consistent with the site‐specific hyperplasia of the gingival epithelium in CsA‐treated rats. Conclusions: CsA inhibited gingival epithelial apoptosis via the mitochondrial pathway and common pathway. The antiapoptotic protein bcl‐2 might play a critical role in the pathogenesis of the site‐specific hyperplasia of gingival epithelium induced by CsA. There were mechanistic differences in the regulation of apoptosis for cells in the attached gingival epithelium, free gingival epithelium, and junctional epithelium.     

Association Between Periodontitis Needing Surgical Treatment and Subsequent Diabetes Risk: A Population‐Based Cohort Study

Background: It is well known that patients with diabetes have higher extent and severity of periodontitis, but the backward relationship is little investigated. The relationship between periodontitis needing dental surgery and subsequent type 2 diabetes mellitus (DMT2) in those individuals without diabetes was assessed. Methods: This is a retrospective cohort study using data from the national health insurance system of Taiwan. The periodontitis cohort involved 22,299 patients, excluding those with diabetes already or those diagnosed with diabetes within 1 year from baseline. Each study participant was randomly frequency matched by age, sex, and index year with one individual from the general population without periodontitis. Cox proportional hazards regression analysis was used to estimate the influence of periodontitis on the risk of diabetes. Results: The mean follow‐up period is 5.47 ± 3.54 years. Overall, the subsequent incidence of DMT2 was 1.24‐fold higher in the periodontitis cohort than in the control cohort, with an adjusted hazard ratio of 1.19 (95% confidence interval = 1.10 to 1.29) after controlling for sex, age, and comorbidities. Conclusions: This is the largest nation‐based study examining the risk of diabetes in Asian patients with periodontitis. Those patients with periodontitis needing dental surgery have increased risk of future diabetes within 2 years compared with those participants with periodontitis not requiring dental surgery.