Using biomimetically mineralized collagen membranes with different surface stiffness to guide regeneration of bone defects

Because guided bone regeneration (GBR) process is pronouncedly affected by the micro‐environment in the defect, the surface stiffness of collagen membranes as a constituent part of the micro‐environment was investigated in this study. The objective of this study was to manufacture biomimetically mineralized collagen membranes with controllable surface stiffness based on biomimetic strategy and to investigate the influences of surface stiffness on GBR process. The characterization and biocompatibility of membranes were examined in vitro. The mechanical properties of membranes were evaluated on macro and micro levels using tensile test and atomic force microscope, respectively. The critical‐size cranial defect model and ectopic osteogenesis were chosen to employ their performances in vivo. The results indicated that the biomimetically mineralized collagen membranes with controllable surface stiffness were manufactured based on the biomimetic theory. The in vitro experiments showed that the mineralized collagen membrane with satisfactory surface stiffness can better promote the adhesion, proliferation, and osteogenic differentiation of mesenchymal stem cells. The membranes can perform excellently in both osteoinduction and osteoconduction, which results in effective manifestations in aspects of ectopic osteogenesis and GBR in vivo. Therefore, this biomimetically mineralized collagen membrane is a promising candidate for GBR treatment in future.     

Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay

The aim of this article is to provide an inventory of the use of contrast‐enhanced ultrasound (CEUS) in relation to percutaneous interventional procedures. The article is structured into a systematic literature review followed by a clinical part relating to percutaneous CEUS‐guided procedures. A literature search identified 3109 records. After abstract screening, 55 articles were analyzed and supplemented with pictorial material to explain the techniques. In conclusion, the best‐evidenced indications for CEUS‐guided interventions are biopsy and ablation of inconspicuous or B‐mode–invisible tumors, intraprocedural ablation control and follow‐up, as well as percutaneous transhepatic cholangiography and drainage procedures.     

中西医结合联合超声引导脓腔冲洗治疗盆腔脓肿临床研究

目的：探讨中西医结合联合超声引导脓腔冲洗治疗盆腔脓肿的临床疗效。方法：将88例盆腔脓肿患者随机分为观察组和对照组,每组各44例。对照组采用中西医结合治疗,观察组在对照组治疗基础上联合使用超声引导脓腔冲洗治疗,观察两组临床疗效。结果：观察组临床疗效优于对照组,差异有统计学意义（P＜0．05）。观察组患者体温恢复正常时间、症状消失时间、住院时间均短于对照组,差异有统计学意义（P＜0．05）。结论：中西医结合联合使用超声引导脓腔冲洗治疗盆腔脓肿疗效可靠,能够缩短患者临床体征消失时间和住院时间。     

CT引导下经皮肝穿刺活检术在不明原因肝功能异常诊断中的临床应用

目的探讨CT引导下经皮肝穿刺活检术在不明原因肝功能异常诊断中的临床应用。方法回顾性分析58例不明原因肝功能异常患者行CT引导下经皮肝穿刺活检术的临床、病理资料,主要观察术后病理诊断率、GS分级诊断率、并发症。结果本组取材成功率100%,手术平均时间11.52 min,取得组织条(1.48±0.50)条,病理诊断率为84.5%(49/58),病理肝炎活动度(G)和肝纤维化程度(S)分级诊断率为72.4%(42/58)。经皮肝穿刺操作未导致肝功能指标数值(ALT、AST、ALP、GGT、TBIL)在短期内显著性增高。8例(13.8%)肝包膜下少量出血,经内科治疗后无进展。结论CT引导下经皮肝穿刺活检术对不明原因肝功能异常的病理及GS分级诊断率高,并发症可控,具有一定的临床应用价值。     

Percutaneous liver biopsy in clinical practice.

Percutaneous liver biopsy (PLB) is the standard procedure for obtaining hepatic tissue for histopathological examination, and remains an essential tool in the diagnosis and management of parenchymal liver diseases. The use of liver biopsy (LB) is increasing with the advent of liver transplantation and the progress being made in antiviral therapeutic agents. While blind percutaneous needle biopsy is the traditional technique, the use of ultrasound (US) guidance has increased considerably. Literatures were reviewed to assess the existing clinical practice of PLB with an emphasis on the technique, the operator, types of biopsy needles, quality of LB specimens and the risk of complications. The best available evidence indicates that the use of ultrasound-guided biopsy (UGB) is superior to blind needle biopsy (BNB). The odds ratios of the controlled studies showed that BNB carried a higher risk for major complications, postbiopsy pain and biopsy failure. Therefore, percutaneous LB under US control is superior to BNB and it is recommended that UGB be considered the standard of care for this important and widely used invasive procedure in the field of clinical hepatology.     

Selective Retreatment and Sinus Lift: An Alternative Approach to Surgically Manage the Palatal Roots of Maxillary Molars

Endodontic microsurgery on the palatal root of maxillary molars presents a clinical challenge because of the root position and approximation from the maxillary sinus floor. Attempting a buccal or a palatal approach to address the root is associated with limited accessibility and visibility as well as the risk of injury to the maxillary sinus membrane and/or the greater palatine nerves and vessels. If all the maxillary molar roots require surgical intervention, two flaps may even be needed, which can make the procedure technically more difficult and lengthier. This case report presents 2 clinical cases in which apicoectomy was needed on the palatal roots of maxillary molars. The treatment includes selective nonsurgical retreatment of the palatal root and obturation using a root repair material followed by a surgical intervention from a buccal approach to treat the buccal roots, sinus lift using piezosurgery, and root resection of the palatal root. The approach was successful in both cases without any untoward events. We monitored the radiographic changes using cone-beam computed tomographic imaging immediately after the surgery and at multiple follow-up appointments. The cone-beam computed tomographic images revealed healing of the periapical disease around all the roots up to 14 and 24 months and apical repositioning of the maxillary sinus floor.     

Guided Endodontics: Use of a Sleeveless Guide System on an Upper Premolar with Pulp Canal Obliteration and Apical Periodontitis

Guided endodontics has been used for the treatment of anterior teeth with a successful outcome. This approach is not only limited to anterior teeth because it can also be used for the treatment of premolars and molars. However, in such cases, space may be a limitation because a long bur has to be used in addition to the guide being placed on top of the teeth. The aim of this case report was to present a novel guided endodontics technique using a sleeveless 3-dimensional–printed guide. This design can reduce vertical space, allowing an open view of the tooth and irrigation during drilling. A 46-year-old female patient consulted the endodontic department with intermittent pain around tooth #5. Tooth #5 presented pain upon percussion and responded negative to a cold test. The initial periapical radiograph revealed an apical radiolucency with pulp canal obliteration. Clinically, there was no sinus tract. The tooth was diagnosed with pulp necrosis and symptomatic apical periodontitis. Guided endodontic treatment was performed with a sleeveless 3-dimensional–printed guide and long neck carbide bur with a head diameter of 1 mm to drill a minimally invasive access cavity up to the root canal. A completely healed apical area of tooth #5 was visible after 1 year on periapical radiographs. This technique seems to be a promising alternative in comparison with the conventional guided endodontic guide design for the negotiation of pulp canal obliteration in cases in which vertical space is limited.     

胰腺癌患者螺旋断层放疗摆位误差分析

目的：通过兆伏级CT（MVCT）在线测量校正胰腺癌患者螺旋断层放疗的摆位误差,确定临床靶区CTV和计划靶区PTV之间的外放距离。方法：2012年5月至12月,21例接受TomoTherapy治疗的胰腺癌患者,每次治疗前均行靶区部位MVCT扫描。并将扫描后的MVCT图像与定位时千伏级CT（kVCT）图像进行配准,分别记录患者左右x、头脚y、腹背z和横断面旋转Roll四个方向的偏差数值,对其误差值进行统计分析。结果：21例患者共行358次MVCT扫描,其摆位误差值在x、y、z和Roll方向分别为：（-0．14±0．60）mm、（-1．21±0．44）mm、（0．69±0．93）mm和（0．02±0．26）。x、y、z方向CTV和PTV之间的外放距离分别为：5．5mm、7．4mm和3．9mm。结论：胰腺癌患者治疗摆位误差较大,Tomotherapy通过在线摆位校正能有效减小摆位误差。临床上建议胰腺癌患者在x、y、z方向上CTV和PTV之间可分别外扩5mm、7mm和4mm,为精确照射提供必要的质量保证。