双源CTA在蝶骨嵴脑膜瘤术前检查的应用价值

目的探讨双源CTA在蝶骨嵴脑膜瘤术前检查的应用价值。方法选取2009年1月至2016年3月在本院治疗的蝶骨嵴脑膜瘤患者23例,对双源CTA检查结果进行分析,重建肿瘤和颅底血管及骨质图像。结果 CTA图像可清晰显示Willis动脉环,容积再现法图像立体感强,对于肿瘤与周围血管结构毗邻三维立体关系显示效果最好,可以提供直观的观察,清晰显示肿瘤与周围大血管间的空间关系,但成像有时受到颅底骨质影响,部分血管细节显示不清;在瘤体大小和瘤颈宽度测量方面,最大密度投影(MIP)、多平面重建(MPR)、容积再现(VR)和数字减影血管造影(DSA)成像技术之间差异无统计学意义(P=0.672和0.728,P0.05);在瘤体形态和瘤体三维关系方面,DSA图像评分低于VR和MIP(P0.05),瘤体光滑度方面,VR图像评分高于MIP和DSA(P0.05),在显示级别方面,DSA图像评分高于VR和MIP(P0.05),总体质量方面,VR、MIP和DSA图像评分差异有统计学意义(P0.05),其中VR图像评分最高,MIP次之。结论双源CTA在蝶骨嵴脑膜瘤术前检查中,可提供脑膜瘤血供情况以及与毗邻血管的三维空间关系,为蝶骨嵴脑膜瘤手术方案提供指导意见。     

Anatomy of the breast

This contribution discusses the basic anatomy of the breast.     

心房颤动患者左房形态解剖学的CT成像特点研究

目的:利用CT三维成像技术研究心房颤动(房颤)患者左房结构的形态学特点。方法:利用西门子16层螺旋CT作36例房颤患者[23例男性,年龄(51±12岁)]与21例非房颤患者[12例男性,年龄(46±11)岁]的心脏扫描,研究左心房的结构形态学特点并作对比分析。结果:房颤组与非房颤组相比左心房容积和左心耳较大,差异有统计学意义;二者的左心耳位置、左心耳-肺静脉脊(房颤组:长2·8±0·5,宽0·4±0·1;非房颤组:长2·7±0·4,宽0·4±0·1)和左心房顶部的形态学特点无明显差异;房颤组肺静脉开口异常率高达17%,非房颤组为10%,2组相比较差异无统计学意义。结论:房颤患者有着较大的左心房和左心耳,在左心耳位置、左心耳-肺静脉脊、左心房顶部和肺静脉开口等特殊解剖结构上与非房颤患者无差别。这些发现对减少射频消融术并发症及改进手术方法等方面能提供有用信息。     

内侧型蝶骨嵴脑膜瘤的微创外科手术治疗

目的:探讨内侧型蝶骨嵴脑膜瘤的微创外科治疗策略及方法。方法:回顾分析23例内侧型蝶骨嵴脑膜瘤病例的临床资料、微创外科治疗及手术过程、疗效及预后情况。结果:所有病例通过微创神经外科手术切除。simpsonⅠ、Ⅱ级切除20例,Ⅲ级3例。出现动眼神经麻痹2例,尿崩2例,视力恶化1例,轻瘫3例,肌力术后1个月均恢复,脑血管痉挛并脑梗死1例,无死亡病例。结论:个体化的术前评估,微创外科手术技术的应用能提高肿瘤的全切率及疗效,在切除肿瘤的同时尽可能保护患者的神经功能。     

显微手术治疗蝶骨嵴脑膜瘤30例分析

目的：探讨显微手术治疗蝶骨嵴脑膜瘤的临床疗效。方法：回顾性总结分析30例蝶骨嵴脑膜瘤的临床资料。结果：本组病例均在显微镜下行肿瘤切除,全切除26例,次全切除4例,无死亡病例。结论：显微手术是保留重要神经和血管的关键,可使大多数压疮获得肿瘤全切,可显著提高蝶骨嵴脑膜瘤的疗效。     

Stress distribution prevents ischaemia and bone resorption in residual ridge

Objective

Intensive mechanical stress and/or inflammation are known to induce alveolar bone resorption. This study investigated whether a distribution of mechanical stress would reduce residual ridge resorption or improve ischaemia.

Design

Thirty rats were divided into six experimental groups (n = 5). The control group received no intentional stimulation, but rats in the experimental groups wore denture stimulators made of acrylic resin or a soft lining material. The stimulator transmitted masticatory pressure to the rats’ palates for four weeks. The four types of soft lining materials investigated in this study dispersed the applied pressure, with compressive stress ranging from 20.8 to 90.8 kPa. Volumes of blood flow and bone resorption of denture foundations were measured every week for 4 weeks. Statistical evaluation of these results was performed using two-way ANOVA and Holm-Sidak test within 5% error limits.

Results

Non-viscoelastic material clearly induced bone resorption and ischaemia of denture foundations, while viscoelastic materials reduced these phenomena to different extents according to their viscoelastic properties. Ischaemia in the alveolar ridge preceded residual ridge resorption, because the amount of residual ridge resorption and blood flow rate showed a simple linear regression.

Conclusion

Animal model of this study suggested that a distribution or reduction of mechanical stress could improve blood flow and decrease alveolar ridge resorption.     

膳食因素与城市居民血脂水平关系的岭回归分析

[目的]探讨不同膳食因素与血清总三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）以及极低密度脂蛋白胆固醇（VLDL-C）的关系。[方法]采用横断面调查的方法,于2007年4月序贯收集成都363医院户籍为成都市的健康体检人员为研究对象,其中女性105人,年龄（49．52±14．88）岁;男性110人,年龄（42．75±15．19）岁。采用问卷方式收集被调查者一般状况、生活行为方式（每天体力活动量,包括工作、锻炼以及家务劳动等;吸烟、饮酒等不良嗜好;性格及精神紧张状况）;膳食调查采用半定量膳食调查表（包括膳食摄入量及频次等信息）。血清血脂水平采用氧化酶法进行检测。血脂浓度和膳食因素及部分生活习惯进行Spearman相关分析;为控制多重共线性,采用岭回归（ridge regression）法分析膳食因素与不同血脂测量指标之间的相关关系。[结果]Spearman相关分析得出高脂肉类、禽肉类、腌制食品与TG正相关（r=0．117、0．193、0．180,P〈0．01）;与HDL—C成负相关（r=-0．167～r=-0．311,P〈0．01）;与VLDL—C成正相关（r=0．164～r=0．235,P〈0．02）。植物油和水果与TG成负相关（r=-0．138,-0．141,P〈0．05）;与VLDL—C成负相关（r=-0．145,P=0．033;r=-0．139,P=0．042）。水果与HDL-C成正相关（r=0．147,P=0．031）。进一步岭回归分析得出高脂肉类、禽肉类、油炸食品以及男性、吸烟等因素与HDL-C呈负相关（β=-0．129、-0．154、-0．092、-0．062、-0．068）;水果与HDL-C呈正相关（β=0．070）;禽肉类、饮酒等因素与VLDL-C呈正相关（β=0．086,0．185）,植物油、水果与VLDL-C呈负相关（β=-0．110,-0．070）。[结论]该人群膳食因素主要影响血清TG、HDL-C和VLDL-C的水平;饮酒、肉食类食物是血脂水平高的危险因素;不饱和脂肪酸     

Radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning: one-year results of a randomized controlled trial

The objective of this study was to perform a comparative evaluation of the radiographic outcomes of lateral sinus floor elevation with and without bone window repositioning (BLSFE and LSFE, respectively) when applied concomitantly with implant placement. A randomized controlled clinical trial was conducted between February 1, 2016 and May 1, 2017 including 26 individuals with at least one missing tooth. Participants were randomized 1:1 to undergo BLSFE (10 participants, 16 implants) or LSFE (13 participants, 19 implants). Bovine-derived xenograft was used in both groups and the implants were inserted concomitantly. In the BLSFE group, the antrostomy was covered with a repositioned bone window and then with a concentrated growth factors (CGF) membrane. In the LSFE group, the antrostomy was covered with a CGF membrane. Panoramic radiographs were taken before surgery (T0), immediately postoperative (T1), and at 12 months postoperative (6 months after loading) (T2). Marginal bone loss (MBL), apical bone gain, augmented alveolar bone height, and intra-sinus bone augmentation were evaluated on panoramic radiographs at T2. A linear regression analysis with generalized estimating equation models was performed. The implant survival rate was 100% at 1 year after implant surgery. The residual alveolar bone height at T0 was comparable in the BLSFE and LSFE groups (3.58 ± 1.49 mm vs 4.12 ± 1.61, P = 0.32), as was the alveolar bone height at T1 (13.61 ± 1.82 mm vs 12.38 ± 1.82 mm, P = 0.06). At T2_, significantly higher alveolar bone height, intra-sinus bone augmentation, and apical bone gain, and lower distal MBL were observed in the BLSFE group when compared to the LSFE group, with adjusting for covariates (β = 2.44, 95% CI 1.42–3.46, P < 0.0001; β = 2.38, 95% CI 1.35–3.41, P < 0.0001; β = 2.33, 95% CI 1.23–3.42, P < 0.0001; and β = ?0.43, 95% CI ?0.83 to ?0.02, P = 0.038, respectively). No significant difference was observed for mesial MBL or apical bone resorption at T2. Lateral sinus floor elevation with bone window repositioning may result in higher bone augmentation after 1 year than the traditional approach. Further research is needed to elucidate the effect of lateral sinus floor elevation with bone window repositioning.     

Harvesting anterior iliac crest or calvarial bone grafts to augment severely resorbed edentulous jaws: a systematic review and meta-analysis of patient-reported outcomes

The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) ? 0.13, 95% confidence interval (CI) ? 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD ?2.32, 95% CI ?5.20 to 0.55, P = 0.113; late postoperative: MD ?0.01, 95% CI ?0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28–100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.