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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.     

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??Clinical application of endoscopic retrograde cholangiopancreatography in the treatment of pancreatic fistula after distal pancreatectomy: A report of 8 cases WU Wen-guang*??ZHANG Wen-jie??GU Jun??et al. *Department of General Surgery??Institute of Biliary Tract Disease??Xinhua Hospital??Affiliated to Shanghai Jiao Tong University School of Medicine??Shanghai 200092??China
Corresponding author??WANG Xue-feng??E-mail??wxxfd@live.cn
Abstract Objective To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of pancreatic fistula after distal pancreatectomy. Methods A retrospective review of 8 cases with ongoing symptoms related to the pancreatic fistula after distal pancreatectomy was conducted from November 2010 to February 2014 at Department of General Surgery and Laboratory of General Surgery??Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Results ERCP was performed and demonstrated clear extravasation of contrast from the main pancreas duct at the site of pancreas transection in all eight cases. Pancreatic duct stents were placed in all patients at a median time of 15.8 days (range??9-26 days)postoperation and the pancreatic fistula resolved in all patients after a median duration of 16.0 days(range??12-25 days) from the index ERCP. Pancreatic duct stent were removed in all patients three months after discharge??and no patient has developed recurrent pancreatic fistula after stent removal. There was no episodes of pancreatitis??perforation??or other complications associated with pancreatic duct stent placement or removal. Conclusion ERCP with pancreatic duct stent may have a beneficial role in the management of patients with pancreatic fistula after distal pancreatectomy and the approach should be considered in patients not responsive to traditional management strategies.     

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。     

替牙期单侧完全性唇腭裂患者下颌骨体积的测量分析

目的　比较替牙期单侧完全性唇腭裂（unilateral complete cleft lip and palate,UCLP）患者裂隙侧与非裂隙侧下颌骨体积的差异,并将两者分别与非唇腭裂（non cleft lip and palate,NCLP）儿童单侧下颌骨体积比较,以研究唇腭裂对下颌骨生长发育的影响。方法　选取2012—2016年于青岛大学附属医院口腔正畸科就诊的替牙期UCLP患者25例作为UCLP组,另选同期就诊的替牙期NCLP儿童25名作为NCLP组。对所有研究对象的头颅部进行锥形束CT（cone-beam CT,CBCT）扫描,获取影像数据,利用Mimics 17.0软件对下颌骨进行三维重建。比较两组双侧的下颌升支、体部及半侧下颌骨体积,并将UCLP组裂隙侧和非裂隙侧的上述测量指标分别与NCLP组进行比较。结果　（1）UCLP组裂隙侧下颌升支体积大于非裂隙侧,差异有统计学意义（t = 2.192,P < 0.05）;而下颌体部及半侧下颌骨的体积比较,差异无统计学意义（均P > 0.05）;NCLP组两侧的下颌升支、体部及半侧下颌骨体积差异均无统计学意义（均P > 0.05）。（2）UCLP组裂隙侧与非裂隙侧的下颌升支体积均小于NCLP组,UCLP组非裂隙侧半侧下颌骨体积小于NCLP组,差异均有统计学意义（t值分别为-2.938、-3.325、-2.023,P < 0.05）。结论　替牙期UCLP患者两侧下颌骨体积存在差异,裂隙侧下颌升支体积大于非裂隙侧,且替牙期UCLP患者下颌骨的生长发育较NCLP儿童差。     

青少年单侧后牙正锁牙合畸形患者双侧髁突在关节窝内位置及其形态变化研究

目的　观察并分析青少年单侧后牙正锁牙合畸形患者的双侧髁突在关节窝内位置及其形态变化。方法　选择2016年8月至2018年8月到南方医科大学口腔医院正畸科就诊的单侧后牙正锁牙合畸形患者35例为观察组,另选择同期就诊的后牙发育正常患者35例作为对照组,所有患者行锥形束CT（CBCT）扫描。分别比较两组患者的双侧关节间隙指标 ［包括关节前间隙（AS）、关节上间隙（SS）、关节后间隙（PS）］测量值及髁突形态指标（包括高度、内外径、前后径、体积、表面积）测量值,并对两组患者间的髁突形态不对称指数进行比较。结果　（1）对照组患者双侧关节间隙各指标（AS、SS、PS）测量值比较,差异均无统计学意义（P＞0.05）;观察组患者双侧关节间隙各指标测量值比较,AS锁牙合侧低于非锁牙合侧、PS锁牙合侧高于非锁牙合侧,差异均有统计学意义（P＜0.05）,而SS两侧差异无统计学意义（P＞0.05）。（2）两组患者双侧髁突形态各指标（高度、内外径、前后径、体积、表面积）测量值比较,差异均无统计学意义（P＞0.05）。（3）观察组患者髁突高度不对称指数明显高于对照组,差异有统计学意义（P＜0.05）,而内外径不对称指数、前后径不对称指数两组患者间比较,差异无统计学意义（P＞0.05）。结论　青少年单侧后牙正锁牙合畸形患者的双侧髁突在关节窝内位置发生改变,锁牙合侧与非锁牙合侧相比更靠前,但髁突形态基本对称,而CBCT能够为患者的锁牙合畸形诊断以及正畸方案提供可靠依据。     

弹性弧形骨钻对小牛椎体骨质疏松模型PVP术中骨 水泥分布的影响

目的探讨自制弹性弧形骨钻在小牛椎体骨质疏松模型上行PVP术的可行性,并观察其对骨水泥分布的影响。方法采用乙二胺四乙酸二钠盐(EDTA-Na2)浸泡法制备小牛体外骨质疏松椎体,将40个骨质疏松椎体随机分为A、B两组,每组各20个椎体行椎体成形术,A组行常规直钻穿刺,B组采用自制弹性弧形骨钻穿刺,弧形方向朝向穿刺对侧,深度达到椎体中前三分之一终止,对两组穿刺骨钻及骨水泥是否达到或越过椎体矢状中线进行统计分析。结果 EDTA-Na2浸泡法脱钙9 d时成功制备出体外骨质疏松椎体,直钻穿刺组钻头达到或越过椎体矢状中线有7个椎体,骨水泥分布达到或越过椎体矢状中线11个;弹性弧形骨钻组穿刺钻头达到或越过椎体矢状中线有18个椎体,骨水泥分布达到或越过椎体矢状中线19个,两组骨钻穿刺效果及骨水泥分布上的差异有统计学意义(P0.05)。A组9个椎体发生骨水泥椎管内渗漏,B组4个椎体发生骨水泥椎管内渗漏,两组间在骨水泥渗漏上无显著性差异(P0.05)。结论采用自制弹性弧形骨钻在小牛骨质疏松模型上可以顺利实施PVP术,且能实现单侧椎弓根穿刺,骨水泥双侧分布的效果。     

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。