平台转换种植体在上颌前牙区的临床应用

目的 评价平台转换种植体在上颌前牙区的应用效果,探讨平台转换技术对种植体周围组织的影响.方法 上颌前牙区单牙种植患者55例共60枚,分为2组,平台转换组25例,共28枚Ankylos系统种植体;平齐对接组30例,共32枚Nobel Replace系统种植体.分别于完成修复后1年和2年,观察种植体周围骨组织情况,计算红色美学得分(pink esthetic score,PES),比较2组种植体边缘骨组织和周围软组织的变化.结果种植体修复1年后,平台转换组种植体边缘骨变化量为(-0.41±0.36)mm,PES为10.43±1.37,平齐对接组种植体边缘骨平均变化量为(-1.77±0.54)mm,PES平均值为9.21±0.97;2年后,平台转换组骨变化量为(-0.55±0.33)mm,PES为10.32±1.21,平齐对接组边缘骨平均变化量为(-1.82±0.61)mm,PES为9.16±0.95.修复后1、2年,2组的种植体周围边缘骨吸收量和PES差异均具有统计学意义.结论 平台转换种植体在上颌美学区单牙种植修复能更有效保留周围骨组织及具有更佳的美学效果.     

Lymphocytic Esophagitis: Assessing Risk Factors and Clinical Outcomes

Digestive Diseases and Sciences - Lymphocytic esophagitis is a rare esophageal condition. Our knowledge of potential risk factors and treatment outcomes of lymphocytic esophagitis is limited. To...     

Airway hyperresponsiveness and bronchial mucosal inflammation in T cell peptide-induced asthmatic reactions in atopic subjects

BACKGROUND: Subjects with allergic asthma develop isolated late asthmatic reactions after inhalation of allergen-derived T cell peptides. Animal experiments have shown that airway hyperresponsiveness (AHR) is CD4+ cell-dependent. It is hypothesised that peptide inhalation produces increases in non-specific AHR and a T cell-dominant bronchial mucosal inflammatory response. METHODS: Bronchoscopy, with bronchial biopsies and bronchoalveolar lavage (BAL), was performed in 24 subjects with cat allergy 6 h after aerosol inhalation of short overlapping peptides derived from Fel d 1, the major cat allergen. Biopsy specimens and BAL fluid were studied using immunohistochemistry and ELISA. RESULTS: Twelve of the 24 subjects developed an isolated late asthmatic reaction without a preceding early (mast cell/histamine-dependent) reaction characteristic of whole allergen inhalation. These responders had significant between-group differences (responders vs non-responders) in the changes (peptide vs diluent) in AHR (p = 0.007) and bronchial mucosal CD3+ (p = 0.005), CD4+ (p = 0.006) and thymus- and activation-regulated chemokine (TARC)+ (p = 0.003) but not CD8+ or CD25+ cells or eosinophils, basophils, mast cells and macrophages. The between-group difference for neutrophils was p = 0.05 but with a non-significant within-group value (peptide vs diluent, responders, p = 0.11). In BAL fluid there was a significant between-group difference in TARC (p = 0.02) but not in histamine, tryptase, basogranulin, C3a or C5a, leukotrienes C(4)/D(4)/E(4), prostaglandins D(2) or F(2alpha). CONCLUSIONS: Direct activation of allergen-specific airway T cells by peptide inhalation in patients with atopic asthma leads to increased AHR with local increases in CD3+ and CD4+ cells and TARC but no significant changes in eosinophils or basophil/mast cell products. These findings support previous animal experiments which showed a CD4+ dependence for AHR.     

Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets

OBJECTIVE: In late 2006, a U.S. Food and Drug Administration advisory committee recommended that the 2004 black box warning regarding suicidality in pediatric patients receiving antidepressants be extended to include young adults. This study examined the relationship between antidepressant treatment and suicide attempts in adult patients in the Veterans Administration health care system. METHOD: The authors analyzed data on 226,866 veterans who received a diagnosis of depression in 2003 or 2004, had at least 6 months of follow-up, and had no history of depression from 2000 to 2002. Suicide attempt rates overall as well as before and after initiation of antidepressant therapy were compared for patients who received selective serotonin reuptake inhibitors (SSRIs), new-generation non-serotonergic-specific (non-SSRI) antidepressants (bupropion, mirtazapine, nefazodone, and venlafaxine), tricyclic antidepressants, or no antidepressant. Age group analyses were also performed. RESULTS: Suicide attempt rates were lower among patients who were treated with antidepressants than among those who were not, with a statistically significant odds ratio for SSRIs and tricyclics. For SSRIs versus no antidepressant, this effect was significant in all adult age groups. Suicide attempt rates were also higher prior to treatment than after the start of treatment, with a significant relative risk for SSRIs and for non-SSRIs. For SSRIs, this effect was seen in all adult age groups and was significant in all but the 18-25 group. CONCLUSIONS: These findings suggest that SSRI treatment has a protective effect in all adult age groups. They do not support the hypothesis that SSRI treatment places patients at greater risk of suicide.     

Effects of chloride flux modulators in an in vitro model of brain edema formation

Brain edema is a serious consequence of hemispheric stroke and traumatic brain injury and contributes significantly to patient mortality. In the present study, we measured water contents in hippocampal slices as an in vitro model of edema formation. Excitotoxic conditions induced by N-methyl-D-aspartate (NMDA, 300 microM), as well as ischemia induced by oxygen-glucose deprivation (OGD), caused cellular edema formation as indicated by an increase of slice water contents. In the presence of furosemide, an inhibitor of the Na,K,Cl-cotransporter, NMDA-induced edema were reduced by 64% while OGD-induced edema were unaffected. The same observation, i.e., reduction of excitotoxic edema formation but no effect on ischemia-induced edema, was made with chloride transport inhibitors such as DIDS and niflumic acid. Under ischemic conditions, modulation of GABAA receptors by bicuculline, a GABA antagonist, or by diazepam, a GABAergic agonist, did not significantly affect edema formation. Further experiments demonstrated that low chloride conditions prevented NMDA-induced, but not OGD-induced, water influx. Omission of calcium ions had no effect. Our results show that NMDA-induced edema formation is highly dependent on chloride influx as it was prevented by low-chloride conditions and by various compounds that interfere with chloride influx. In contrast, OGD-induced edema observed in brain slices was not affected by modulators of chloride fluxes. The results are discussed with reference to ionic changes occurring during tissue ischemia.     

Botulinum toxin A--injection for cervical dystonia

Spasmodic torticollis or cervical dystonia is the commonest focal dystonia. Botulinum toxin-A (BTX-A) was first used in its treatment in 1985. We are reporting our experience of treating 17 patients of cervical dystonia with 29 treatment sessions of BTX-A. The patients consisted of 13 men and four women with a mean age of 44.17 +/- 16.25 years who had tried medical therapy earlier. All patients had a combination of two or more abnormal postures of neck. Both Botox and Dysport were used as per availability. The mean dose of BTX-A in splenius capitus was 283.3 +/- 59.86 U of Dysport and 61.3 +/- 5.16 U of Botox and in sternocleidomastoid it was 210 +/- 53.47 U of Dysport and 46 +/- 18.97 U for Botox. After BTX-A injection, the response was observed after a mean of 9.7 +/- 5.7 days and the mean duration of effect was 15.56 +/- 7.13 weeks. Significant improvement of dystonia (global rating > or = 2) was seen after 25 of 29 treatment sessions (86%) and of pain was seen after four of five patients. Only three treatment sessions were followed by complications (10.4%) of these two had mild dysphagia and one had mild "flu-like" syndrome. We conclude BTX-A is safe and effective treatment of cervical dystonia.     

Myeloid leukemia with promyelocytic features in transgenic mice expressing hCG-NuMA-RARalpha

Acute promyelocytic leukemia (APL) is characterized by the accumulation of abnormal promyelocytes in the bone marrow (BM), and by the presence of a reciprocal chromosomal translocation involving retinoic acid receptor alpha (RARalpha). To date, five RARalpha partner genes have been identified in APL. NuMA-RARalpha was identified in a pediatric case of APL carrying a translocation t(11;17)(q13;q21). Using a construct containing the NuMA-RARalpha fusion gene driven by the human cathepsin G promoter (hCG-NuMA-RARalpha), two transgenic mouse lines were generated. Transgenic mice were observed to have a genetic myeloproliferation (increased granulopoiesis in BM) at an early age, and rapidly developed a myeloproliferative disease-like myeloid leukemia. This leukemia was morphologically and immunophenotypically indistinguishable from human APL, with a penetrance of 100%. The phenotype of transgenic mice was consistent with a blockade of neutrophil differentiation. NuMA-RARalpha is therefore sufficient for disease development in this APL model.     

A single institution experience with concurrent capecitabine and radiation therapy in weak and/or elderly patients with urothelial cancer

PURPOSE: To describe a single institution experience in delivering concurrent capecitabine and radiation in elderly patients with urothelial cancer. METHODS AND MATERIALS: The records of patients with urothelial carcinoma treated with capecitabine and radiation at Wayne State University were reviewed. Capecitabine was administered at a median dose of 1600 mg/m2/day (range, 1200-1800 mg/m2). Concurrent radiation therapy (RT) of 40-45 Gy was delivered to a small pelvic field with a four-field technique, with additional boost to tumor area (total, 54-68.4 Gy). RESULTS: Fourteen patients who were not candidates for cystectomy or cisplatin-based therapy were treated with capecitabine and concurrent radiation therapy. Median age was 80 years (range, 46-88 years). Five patients had a performance status of 3. Nine patients had localized disease, and 5 patients had advanced disease. The most common overall toxicities were fatigue (43%), diarrhea (Grade 2, 14% and Grade 3, 29%), and dehydration (43%), with no Grade 4 or 5 toxicities. Of 14 patients, 3 (20%) required hospitalization for management of toxicities. Seven patients required dose modification, and the therapy was relatively well tolerated. Clinical complete response was seen in 11 of 13 evaluable patients (77%). At a median follow-up of 10.5 months, only 3 of 11 responders had relapsed. CONCLUSION: Concurrent capecitabine and radiation therapy is well-tolerated and demonstrates promising efficacy in urothelial carcinoma, thus offering a tolerable therapeutic option in elderly patients or those with impaired performance status.