Complete Denture Occlusion: An Evidence‐Based Approach

Purpose : This study involved an extensive search for randomized controlled clinical trials comparing bilateral balanced and canine‐guided dentures, and questioned whether a bilateral balanced occlusion is imperative for successful denture treatment. Materials and Methods : Studies were identified by searching electronic databases (PubMed/MEDLINE, ISI Web of Science, LILACS, and BBD). The keywords “denture” and “occlusion” were used. The minimum inclusion requirements were (1) randomized controlled trials with patients of any age wearing both maxillary and mandibular conventional complete dentures (CDs), (2) comparison between bilateral balanced and canine‐guided dentures, and (3) assessment of masticatory function and/or patients’ satisfaction. Results : The search resulted in the identification of 5166 articles. Subsequently, 5156 articles were excluded on the basis of title and abstract. By the end of the search phase, seven randomized controlled trials were considered eligible. Conclusions : Current scientific evidence suggests that bilateral balanced occlusion is not imperative for successful treatment with conventional CDs in average patients. More studies are necessary to identify if specific clinical conditions may benefit from a balanced occlusion.     

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儿童错[牙合]畸形的早期矫治是指预防、诱导和阻断错[牙合]畸形的发生、发展,达到儿童颅面[牙合]功能与美观的协调与平衡。儿童错[牙合]畸形早期矫治概念提倡的是早期和及时,并且贯穿于乳牙列期、混合牙列早期和晚期、恒牙列期等各个颅面[牙合]的发育时期。儿童错[牙合]畸形的早期矫治遵循早期和阶段性的原则,通过预防错[牙合]]的发生、辅助治疗与错[牙合]畸形形成有关的口腔疾病及牙外伤、纠正口腔不良习惯、诱导牙萌出建[牙合]、治疗牙发育不良造成的咬合紊乱、阻断能造成功能和健康损害的咬合障碍、矫正面颌发育不调的骨性畸形,以达到颅面[牙合]的美观及功能完美协调发展和儿童心理的健康发育。儿童错[牙合]畸形的早期矫治应用活动矫治、功能矫治及固定矫治等技术,选择最佳的治疗时机矫正错[牙合],以达到临床阻断和预防的最大治疗效果,并简化错[牙合]的矫治,最终减轻患儿的治疗负担。儿童错[牙合]畸形的早期矫治是儿童口腔医学和口腔正畸学的重要内容,是现代儿童口腔医学和口腔正畸学发展的潮流和方向。     

探讨甲状腺小结节的径线特征及其对结节定性诊断的价值

目的探讨甲状腺小结节(结节长径≤10 mm)的径线特征及其与结节良、恶性的关系,提高高频超声对甲状腺小结节定性诊断的准确性。方法对病理诊断的353例患者的665个甲状腺小结节(结节长径≤10 mm)的前后径与横径进行分析比较,观察超声声像图特征。结果恶性结节对于前后径≥横径的敏感性及特异性都很高(93.6%、97.4%),良、恶性结节相比有显著差异性(P<0.05);不规则边界、不完整晕环、微钙化、穿入血流,恶性结节的敏感性及阳性预测值都很低;恶性结节对于低回声的敏感性高(89.2%),特异性低(19.1%)。结论根据小结节的径线特征利于甲状腺微小癌的早期诊断。     

两种剂量他汀对冠脉粥样硬化斑块的作用及其疗效和安全性

目的应用血管内超声(IVUS)比较大剂量和常规剂量阿托伐他汀对初发不稳定心绞痛患者冠状动脉临界病变粥样硬化斑块的作用,并观察两种剂量阿托伐他汀的临床疗效和安全性。方法经冠状动脉造影(CAG)显示狭窄程度在50%～70%的临界病变的冠心病初发不稳定心绞痛患者100例,每位患者均行IVUS检查并选取1处狭窄为50%～70%的粥样斑块病变为靶病变,随机分为阿托伐他汀80 mg/d的大剂量治疗组和阿托伐他汀20mg/d的常规剂量对照组,9个月后再次行CAG和IVUS,比较治疗前后斑块体积、管腔体积和血管体积的变化。结果 100例均完成了临床随访,62例完成了整个服药过程及CAG和IVUS复查。结果显示,9个月后对照组斑块体积增大(P<0.05),治疗组未见明显变化(P>0.05)。结论大剂量阿托伐他汀可遏制初发不稳定心绞痛患者冠脉临界病变粥样硬化斑块的进展。     

Endoscopic ultrasound-guided elastography in the nodal staging of oesophageal cancer

AIM: To assess quantitative endoscopic ultrasound (EUS)-guided elastography in the nodal staging of oesophago-gastric cancers.METHODS: This was a single tertiary centre study assessing 50 patients with established oesophago-gastric cancer undergoing EUS-guided fine needle aspiration biopsy (FNAB) of lymph nodes between July 2007 and July 2009. EUS-guided elastography of lymph nodes was performed before EUS-FNAB. Standard EUS characteristics were also described. Cytological determination of whether a lymph node was malignant or benign was used as the gold standard for this study. Comparisons of elastography and standard EUS characteristics were made between the cytologically benign and malignant nodes. The main outcome measure was the accuracy of elastography in differentiating between benign and malignant lymph nodes in oesophageal cancers.RESULTS: EUS elastography and FNAB were performed on 53 lymph nodes. Cytological malignancy was found in 23 nodes, one was indeterminate, one was found to be a gastrointestinal stromal tumor and 25 of the nodes were negative for malignancy. On 3 occasions insufficient material was obtained for analysis. The area under the curve for the receiver operating characteristic curve for elastography strain ratio was 0.87 (P < 0.0001). Elastography strain ratio had a sensitivity 83%, specificity 96%, positive predictive value 95%, and negative predictive value 86% for distinguishing between malignant and benign nodes. The overall accuracy of elastography strain ratio was 90%. Elastography was more sensitive and specific in determining malignant nodal disease than standard EUS criteria.CONCLUSION: EUS elastography is a promising modality that may complement standard EUS and help guide EUS-FNAB during staging of upper gastrointestinal tract cancer.     

Update of endoscopy in liver disease: more than just treating varices

The management of complications in liver disease is often complex and challenging. Endoscopy has undergone a period of rapid expansion with numerous novel and specialized endoscopic modalities that are of increasing value in the investigation and management of the patient with liver disease. In this review, relevant literature search and expert opinions have been used to provide a brief overview and update of the current endoscopic management of patients with liver disease and portal hypertension. The main areas covered are safety of endoscopy in patients with liver disease, the use of standard endoscopy for the treatment of varices and the role of new endoscopic modalities such as endoscopic ultrasound, esophageal capsule, argon plasma coagulation, spyglass and endomicroscopy in the investigation and treatment of liver-related gastrointestinal and biliary pathology. It is clear that the role of the endoscopy in liver disease is well beyond that of just treating varices. As the technology in endoscopy expands, so does the role of the endoscopist in liver disease.     

Asymptomatic pancreatic lesions: New insights and clinical implications

Despite great efforts in experimental and clinical research, the prognosis of pancreatic cancer (PC) has not changed significantly for decades. Detection of pre-invasive lesions or early-stage PC with small resectable cancers in asymptomatic individuals remains one of the most promising approaches to substantially improve the overall outcome of PC. Therefore, screening programs have been proposed to identify curable lesions especially in individuals with a familial or genetic predisposition for PC. In this regard, Canto et al recently contributed an important article comparing computed tomography, magnetic resonance imaging, and endoscopic ultrasound for the screening of 216 asymptomatic high-risk individuals (HRI). Pancreatic lesions were detected in 92 of 216 asymptomatic HRI (42.6%). The high diagnostic yield in this study raises several questions that need to be answered of which two will be discussed in detail in this commentary: First: which imaging test should be performed? Second and most importantly: what are we doing with incidentally detected pancreatic lesions? Which ones can be observed and which ones need to be resected?