传统及数字化口腔种植导板的制作及临床应用研究进展

随着口腔种植手术的广泛开展,种植导板在术中的应用不仅有助于术前诊疗计划的设计,还有助于种植体在牙槽骨中的正确定位、成角优化,从而最终达到兼顾功能和美学的术后效果。以修复为导向设计种植导板应用于临床,可相对降低并发症发生的风险。随着椎形束CT(CBCT)的广泛应用,国内外学者在传统种植导板的基础上,结合数字化技术,完成了各种改良式种植导板的制作,由此推进了种植导板的发展。该文对常用的口腔种植导板的分类、优缺点以及计算机辅助外科种植导板进行综述,为临床中种植导板的应用提供参考。     

个体化3D打印种植导板在多牙种植中的临床应用

目的:对3D打印种植导板和传统种植导板在多牙缺失种植中的效果进行观察,并评价患者的满意度.方法:30例(83颗牙)缺牙需种植的患者,用随机数字表法分为传统种植导板组(CIT组,15例,42颗牙)和3D打印种植导板组(TDPIT组,15例,41颗牙),CIT组患者采用传统种植导板,TDPIT组患者采用3D打印种植导板,比较2组患者植入种植体的颈部和尖部偏离值、种植体角度偏离值及角度满意度,术后1年牙周袋探诊深度、骨吸收情况及种植成功率.通过满意度问卷调查,比较2组患者对牙种植效果的满意度.采用SPSS19.0软件包对数据进行统计学分析.结果:TDPIT组种植体颈部和尖部在近远中向、颊舌向和垂直向3个方向的偏离值以及在近远中向和颊舌向2个方向的平均角度偏离值均显著小于CIT组(P＜0.05),且TDPIT组种植体在近远中向和颊舌向2个方向的角度满意度显著高于CIT组(P＜0.05).2组患者术后1年种植体牙周袋探诊深度及骨吸收情况无显著差异(t=1.144,P=0.256;t=1.063,P=0.291).2组患者术后3个月和6个月种植成功率无显著差异(P＞0.05),但术后随访9个月和1年,TDPIT组种植成功率显著高于CIT组(90.48％:100％,x2=4.102,P=0.043).满意度问卷调查显示,TDPIT组患者对种植的满意度显著高于CIT组(86.67％:53.33％,x2=3.968,P=0.046).结论:3D打印种植导板植入的种植体精度、种植成功率和患者满意度优于传统种植导板,适合推广应用.     

虚拟现实技术应用于髋部骨折手术仿真的建立*△

背景:髋部骨折的病情较复杂,临床医师选择适当治疗方案和手术入路的主要依据来源于影像学检查,常难以准确判断空间立体关系. 目的:探讨基于64排螺旋 CT 扫描数据对髋部骨折进行虚拟手术设计的可行性和临床应用价值. 方法:将髋部骨折患者.dicom 格式 CT 数据导入 Mimics 软件,进行图像分割,建立骨折三维模型并进行虚拟复位,将.stl 格式复位模型导入 Imageware12.0,根据钢板放置位置选择合适长度钢板,螺钉固定.并快速成型形成实体与导航模板. 结果与结论:重建三维可视模型可准确反映出骨折特点、骨折移位方向和程度,并可进行任意旋转观察,实现了内固定手术模拟.可见术前应用计算机辅助虚拟现实手术设计可以制定合理的个体化手术方案,有很好的临床应用价值.     

黏着斑微操控在创伤和组织修复中的作用

目的 探讨真皮模板单元-黏着斑微操控制对皮肤成纤维细胞生物学行为影响. 方法 采用微图案方法制作微凸阵列,运用分子自组装在微凸上自组装结构蛋白分子,在自制细胞培养仪模拟皮肤生物力学进行细胞牵拉2周,并行形态学观察和细胞免疫组织化学分析. 结果 细胞牵拉2周后,细胞形态多样、丰满,分泌增加,呈现顺应性.细胞免疫组织化学分析发现,整合素β1、α5表达较对照显著减少,张力蛋白tensin表达显著降低. 结论 通过黏着斑微操控,增生性瘢痕成纤维细胞在形态学及生物学行为上发生改变.     

我国非处方药说明书范本中妊娠期和哺乳期女性用药信息调查分析

目的:评估国家药品监督管理局(NMPA)官网中非处方药说明书范本关于妊娠期和哺乳期女性用药信息标示的完整性和准确性。方法:收集截止到2018年11月11日NMPA官网中,非处方药化学药品说明书范本和非处方药中成药说明书范本,对范本的【禁忌】和【注意事项】中关于妊娠期和哺乳期女性用药信息标示情况进行统计分析。结果:我国非处方药说明书范本对妊娠期和哺乳期女性用药信息的标示情况仍存在较大空缺。非处方药化学药品说明书范本的用药信息标示率低于中成药(P<0.05),但其对妊娠期和哺乳期女性有指导意义的用药信息标示率明显高于中成药(P<0.01);对妊娠期女性有指导意义的用药信息标示率明显高于哺乳期女性(P<0.01)。结论:保障妊娠期和哺乳期女性用药的安全和有效,需要不断完善和规范说明书范本的用药信息,建立妊娠期和哺乳期女性用药信息数据库等措施。     

Three-dimensional facial volume analysis using algorithm-based personalized aesthetic templates

Three-dimensional stereophotogrammetry is commonly used to assess volumetric changes after facial procedures. A lack of clear landmarks in aesthetic regions complicates the reproduction of selected areas in sequential images. A three-dimensional volumetric analysis was developed based on a personalized aesthetic template. The accuracy and reproducibility of this method were assessed. Six female volunteers were photographed using the 3dMDtrio system according to a clinical protocol, twice at baseline (T1) and twice after 1 year (T2). A styrofoam head was used as control. A standardized aesthetic template was morphed over the baseline images of the volunteers using a coherent point drift algorithm. The resulting personalized template was projected over all sequential images to assess surface area differences, volume differences, and root mean square errors. In 12 well-defined aesthetic areas, mean average surface area and volume differences between the two T1 images ranged from −7.6 mm² to 10.1 mm² and −0.11 cm³ to 0.13 cm³, respectively. T1 root mean square errors ranged between 0.24 mm and 0.62 mm (standard deviation 0.18–0.73 mm). Comparable differences were found between the T2 images. An increase in volume between T1 and T2 was only observed for volunteers who gained in body weight. Personalized aesthetic templates are an accurate and reproducible method to assess changes in aesthetic areas.     

Impact of a Structured Reporting Template on Adherence to Prostate Imaging Reporting and Data System Version 2 and on the Diagnostic Performance of Prostate MRI for Clinically Significant Prostate Cancer

PurposeThe aim of this study was to assess the impact of a structured reporting template on adherence to the Prostate Imaging Reporting and Data System (PI-RADS) version 2 lexicon and on the diagnostic performance of prostate MRI to detect clinically significant prostate cancer (CS-PCa).MethodsAn imaging database was searched for consecutive patients who underwent prostate MRI followed by MRI-ultrasound fusion biopsy from October 2015 through October 2017. The initial MRI reporting template used included only subheadings. In July 2016, the template was changed to a standardized PI-RADS-compliant structured template incorporating dropdown menus. Lesion, patient characteristics, pathology, and adherence to the PI-RADS lexicon were extracted from MRI reports and patient charts. Diagnostic performance of prostate MRI to detect CS-PCa using combined ultrasound-MRI fusion and systematic biopsy as a reference standard was assessed.ResultsThree hundred twenty-four lesions in 202 patients (average age, 67 years; average prostate-specific antigen level, 5.9 ng/mL) were analyzed, including 217 MRI peripheral zone (PZ) lesions, 84 MRI non-PZ lesions, and 23 additional PZ lesions found on systematic biopsy but missed on MRI. Thirty-three percent (106 of 324) were CS-PCa. Adherence to the PI-RADS lexicon improved from 32.9% (50 of 152) to 88.4% (152 of 172) (P < .0001) after introduction of the structured template. The sensitivity of prostate MRI for CS-PCa in the PZ increased from 53% to 70% (P = .011). There was no significant change in specificity (60% versus 55%, P = .458).ConclusionsA structured template with dropdown menus incorporating the PI-RADS lexicon and classification rules improves adherence to PI-RADS and may increase the diagnostic performance of prostate MRI for CS-PCa.     

Development of template systems for ligand interactions of CYP3A5 and CYP3A7 and their distinctions from CYP3A4 template

Starting from established CYP3A4 Template (DMPK. 2019, and 2020), CYP3A5 and CYP3A7 Templates have been constructed to be reliable tools for verification of their distinct catalytic properties. A distinct occupancy was observed on CYP3A4-selective ligands, but not on the non-selective ligands, in simulation experiments. These ligands often invade into Bay-1 region during the migration from Entrance to Site of oxidation in simulation experiments. These results offered an idea of the distinct localization of Bay-1 residue on CYP3A5 Template, in which the Bay-1 residue stayed closely to Template border. The idea also accounted for the higher oxidation rates of CYP3A5, than of CYP3A4, of noscapine and schisantherin E through their enhanced sitting-stabilization. Typical CYP3A7 substrates such as zonisamide and retinoic acids took their placements without occupying a left side region of Template for their metabolisms. In turn, the occupancies of the left-side region were inevitably observed among poor ligands of CYP3A7. Altered extent of IJK-Interaction or localization of a specific residue at the left-side would thus explain distinct catalytic properties of CYP3A7 on Template. These data suggest the alteration of each one of Template region, from CYP3A4 Template, led to the distinct catalytic properties of CYP3A5 and CYP3A7 forms.     

Refined CYP2E11 Template7 system to decipher the ligand-interactions

A Template system for a prediction of human CYP2E1-mediated reactions (Drug Metab Rev 2011) has been refined with the introduction of ideas of Trigger-residue and the residue-initiated movement of ligands in the active site. The refined system also includes ideas of bi-molecule binding and angled-placement, which allow to sit diverse types of ligands on Template. With the use of these ideas in common with other Template systems for human CYP1A1, CYP1A2 and CYP3A4 (Drug Metab Pharmacokinet 2016, 2017, 2019, and 2020), 349 reactions of 192 distinct chemicals published as CYP2E1 ligands were examined in the refined system. Verifications of good and poor substrates, regioselectivity and also inhibitory interaction were available faithfully for these ligands from their placements on the refined Template and rules for interaction modes, accompanied with their deciphering information to lead to the judgements. The refined CYP2E1 Template system will thus offer more reliable estimations of human CYP2E1 catalysis toward ligands of diverse structures.