Buccal periosteal inversion (BUPI) for defect closure and keratinized gingiva width preservation after tooth extraction – technique modification

IntroductionSeveral techniques and methods have been proposed to cover alveolar bone after tooth extraction when soft tissue is lacking. Some authors recommend soft tissue flap techniques, and others advocate different types of materials for socket covering. In this article, the authors use a modified buccal inversion technique for adequate coverage of the alveolar ridge to ensure its preservation and to minimize soft tissue shrinkage and loss of keratinized gingiva after tooth extraction. This local mucogingival-periosteal plastic procedure was named by the authors the “Buccal Periosteal Inversion technique” or simply BUPI.Materials and MethodsAfter extraction of a fractured, endodontically compromised lower right first molar, the BUPI technique was performed to cover the alveolus. After reflecting the two-sided full-thickness flap, the periosteum was split in the cranial direction. The inverted periosteum is used to provide tension-free defect closure of the postextractional defect. Detailed technique implementation and patient postoperative healing are presented here in detail.ResultsPostoperative evaluation at six weeks was presented with photos showing adequate surgical site healing, no signs of infection or dehiscence, and no crestal shift of the keratinized gingiva.ConclusionThe buccal periosteal inversion (BUPI) technique is a modified technique that allows full socket coverage, avoiding a keratinized gingiva shift in the crestal direction using only the periosteum as a cover material. By inverting the buccal ridge periosteum alone from its normal position, the osteoclastic effect on the buccal bony wall will be eliminated, and this procedure abolishes the need for additional alveolar coverage materials.     

Intrinsic activity and comparative molecular dynamics of buspirone analogues at the 5-HT(1A) receptors

In CNS, the 5-hydroxytryptamine(1A) (5-HT(1A)) receptors exist in two different populations with different behavioural and physiological effects: (1) somatodendritic autoreceptors located pre-synaptically of 5-HT containing neurons and (2) receptors located post-synaptic to 5-HT containing neurons. Clinical studies have shown that 5-HT(1A) partial agonists have anxiolytic properties, while antagonists of pre-synaptical autoreceptors shorten the onset time of selective serotonin reuptake inhibitors (SSRIs). In the present study, the pre- and post-synaptic activity of structural analogues of buspirone was evaluated in animal models. A three dimensional model of the 5-HT(1A) receptor was used to study their interaction modes and helical displacements upon receptor binding. The predicted receptor-ligand interactions indicated similarities in the receptor binding modes for all buspirone analogues, and no clear relationship between receptor contact residues and activity at pre- and post-synaptic receptors. Comparative molecular dynamics (MD) simulations for 650ps indicated that pre-synaptic antagonistic behaviour is connected to large displacements of transmembrane helix (TMH) 7 upon binding, while pre-synaptic agonistic behaviour is connected to large displacements of TMH2 and small displacements of TMH7. Post-synaptic partial agonist behaviour is connected to large displacements of TMH4 and TMH5 upon binding, while post-synaptic antagonists only slightly displace these helices.     

Pathology of pancreatic ductal adenocarcinoma: Facts,challenges and future developments

Despite major improvements concerning its diagnosis and treatment, pancreatic ductal adenocarcinoma (PDAC) remains an aggressive disease with an extremely poor prognosis. Pathology, as interface discipline between basic and clinical medicine, has substantially contributed to the recent developments and has laid the basis for further progress. The definition and classification of precursor lesions of PDAC and their molecular characterization is a fundamental step for the potential identification of biomarkers and the development of imaging methods for early detection. In addition, by integrating findings in humans with the knowledge acquired through the investigation of transgenic mouse models for PDAC, a new model for pancreatic carcinogenesis has been proposed and partially validated in individuals with genetic predisposition for PDAC. The introduction and validation of a standardized system for pathology reporting based on the axial slicing technique has shown that most pancreatic cancer resections are R1 resections and that this is due to inherent anatomical and biological properties of PDAC. This standardized assessment of prognostic relevant parameters represents the basis for the successful conduction of multicentric studies and for the interpretation of their results. Finally, recent studies have shown that distinct molecular subtypes of PDAC exist and are associated with different prognosis and therapy response. The prospective validation of these results and the integration of molecular analyses in a comprehensive pathology report in the context of individualised cancer therapy represent a major challenge for the future.     

生物功能性修复系统应用于下颌低平牙槽嵴的修复效果初探

目的 比较生物功能性修复系统(Bio-functionnal Prothetic System,BPS)和传统方法对下颌低平牙槽嵴修复效果的影响.方法 选择10例口颌系统基本正常,下颌牙槽嵴重度吸收的无牙颌患者,分别采用BPS和传统方法进行全口义齿修复,随机选择戴用顺序,在修复后1、3、6个月后分别对义齿的固位力、咀嚼效能进行测定,并在戴用义齿1个月时进行满意度问卷调查.结果 在修复后1、3、6个月,BPS全口义齿的下颌义齿固位力高于传统全口义齿,差异具有统计学意义(P<0.05);2种全口义齿吸光度值作比较,在各个检测时期,BPS组吸光度值保持稳定,均高于传统全口义齿(P<0.05),传统全口义齿在3个月和6个月后吸光度值有所回升,与第1个月相比具有统计学意义,但仍低于同时期的BPS组(P<0.05);问卷调查显示,BPS组的主观满意度明显高于传统组;6个月后,10位患者均表示BPS全口义齿更舒适,不容易脱落.结论 采用BPS完成的义齿修复应用于下颌低平牙槽嵴的无牙颌患者时,能取得更好的修复效果.     

Verruca plana as a complication of CO2 laser treatment: A case report

Carbon dioxide (CO₂) laser treatment is a common therapeutic modality for many dermatologic conditions. It uses a high energy, infrared beam of light, which selectively targets water-containing tissue resulting in controlled ablative resurfacing. This modality, however, can manifest significant cosmetic side effects. Here we report a case of verruca plana manifesting as a response to CO₂ laser treatment. A 74-year-old female with recent Mohs surgery for a basal cell carcinoma, presented for full-face-fractionated CO₂ treatment to address her surgical scars in addition to treating her mild diffuse actinic damage. Six weeks post treatment, the patient developed erythematous thin plaques over the areas that had been treated. Histology was consistent with verruca plana. Lesions showed mild improvement with topical tretinoin. Verruca plana are benign and typically self-limited; however, they can present a significant cosmetic burden to patients and are an important complication to consider when performing elective cosmetic procedures.     

Periosteal pedicle graft for the treatment of gingival recession: A viable alternative to sub-epithelial connective tissue graft

Treating gingival recessions is important to satisfy the functional and aesthetic needs of the patients. Among various available techniques to treat gingival recessions, the subepithelial connective tissue graft technique is still considered to be the best despite its inherent disadvantages. The recent innovation utilising periosteum as a pedicle graft to treat gingival recession defects has drawn considerable attention and may provide a viable alternative to subepithelial connective tissue graft.     

Q开关Nd:YAG激光联合卡介菌多糖核酸治疗顽固性扁平疣的疗效观察

[目的]观察Q开关Nd:YAG激光联合卡介菌多糖核酸治疗顽固性扁平疣的临床疗效。[方法]采用Q开关Nd:YAG激光(532nm,能量密度1.30～2.33J/cm2)破坏疣体后,30d内隔日肌肉注射卡介菌多糖核酸1ml,随访6月后评价疗效。[结果]23例患者经1～2次激光照射并联合卡介菌多糖核酸治疗后全部痊愈且未复发。[结论]Nd:YAG激光联合卡介菌多糖核酸治疗顽固性扁平疣安全、快速、治愈率高、复发少,值得推广。     

X射线摄影技术数字化研究进展

明确了X射线摄影的概念和重要性,概述了胶片X射线摄影技术、计算机X射线摄影技术、数字化X射线摄影技术以及X射线摄影数字化的研究进展,重点介绍了数字化X射线摄影技术中的非直接数字化X射线摄影技术和直接数字化X射线摄影技术,分析了各种X射线摄影技术之间的差别与优势,指出数字化X射线摄影技术及系统是当今国内医疗仪器行业重要研究课题之一,是医学影像数字化发展的必然趋势。     

扁平式责任大包干在优质护理服务示范工程中的实施体会

目的为了进一步强化落实优质护理服务。方法以患者为中心,结合各科工作实际科学实行"扁平式责任大包干",明确岗位职责,配和绩效考核,高效利用护理人力资源,最大限度挖掘护士潜力。结果通过实行责任大包干前后对照组比较,差异有统计学意义(P<0.5)。结论扁平式责任大包干,配合绩效考核,深化了"优质护理服务示范工程"的实施效果,达到了"六满意"。     

Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies

Columnar cell lesions (CCLs) of the breast are recognized as putative precursor lesions of invasive carcinoma, but their management remains controversial. We therefore conducted a retrospective study on 311 CCLs, diagnosed in 4,164 14-gauge core needle biopsies (CNB): 221 CCLs without atypia (CCL), 69 with atypia (CCL-A), and 21 atypical ductal hyperplasias originating in CCL (ADH-CCL). Two groups were identified: "immediate treatment" group undergoing excision within four months after the CNB diagnosis of CCL (N = 52) and the "wait-and-see" group followed up to 8 years (median 3.5 years, N = 259). In 7 of 31 women (22.5%, 1 CCL, 4 CCL-A, 2 ADH-CCL) who underwent immediate surgical excision and were initially biopsied for microcalcifications, ductal carcinoma in situ (DCIS) was present and in 2/31 women (6.5%, 1 CCL, 1 CCL-A) invasive carcinoma. In 2/21 excisions (9.5%, 1 CCL, 1 CCL-A) initially biopsied for a density, DCIS was present and invasive carcinoma in 5/21 excisions (23.8%, 2 CCL, 3 CCL-A). In the wait-and-see group, 9/259 women (3.5%) developed invasive carcinoma, 6 ipsi, and 3 contralaterally. Progression risks of CCL-A and ADH-CCL were 18% and 22%,versus 2% for CCL without atypia (p < 0.001). In conclusion, CCL-A or ADH-CCL in a CNB were associated with a high risk of DCIS/invasive carcinoma in immediate surgical excision biopsies. The 8-years progression risks for CCL-A and ADH-CCL were around 20%. This illustrates that an atypical CCL in a CNB may signal the presence of concurrent lesions or development of advanced lesions in future and may justify ("mini") surgical excision.