数字化修复结合牙周手术解决复杂前牙美学缺陷

目的： 针对伴有牙周软组织形态不良的复杂前牙美学缺陷病例,探索一种全程数字化修复的治疗流程,为解决复杂前牙美学诊疗问题提供新思路。方法： 选取复杂前牙美学缺陷的患者12例,通过口内和面部三维扫描获取牙列和面部三维数据并进行配准,在计算机辅助设计( computer-aided design,CAD) 软件中进行两种美学设计（仅考虑“白色美学”、综合考虑“粉白美学”）, 结合数码摄影得到相应的彩色三维数字化修复效果模拟图。以患者评分为标准评价两种美学设计,并由患者自主选择,针对选择后一种设计的患者,三维打印其诊断模型并制作导板指导牙周手术,后续采用数字化方法完成前牙美学修复。结果： 患者针对基于口内和面部三维扫描及数码摄影的两种数字化美学设计进行评价,综合考虑“粉白美学”设计的患者满意度更高（P<0.05）,且更多患者（66.7%）选择牙周手术改善软组织形态后再行修复;将该设计通过三维打印制作诊断模型及导板指导牙周手术,实现了数字化设计向最终手术效果的转移;后续数字化方法制作最终修复体,实现全程数字化。结论： 通过数字化美学分析和设计,修复效果预测,三维打印诊断模型制作导板指导牙周手术,并用数字化方法完成前牙美学修复诊疗流程的方法可行,临床显著提高医生、患者、技师相互间的沟通效率,体现了多学科联合治疗复杂前牙美学诊疗问题的优势。     

全身麻醉复合腰硬联合麻醉对腹腔镜手术患者术后的影响

目的 通过研究探讨全身麻醉复合腰硬联合麻醉对腹腔镜手术患者术后疼痛程度与麻醉复苏时间的影响,为该手术的麻醉方法选择提供可依靠的依据。方法 选取医院从2019年1月—2020年10月在医院进行腹腔镜手术的患者98例,随机分成两组。其中对照组采用丙泊酚与瑞芬太尼靶控静脉麻醉,观察组患者则在对照组基础上复合使用腰硬联合麻醉的方法进行麻醉,对比两组患者手术后的疼痛程度（visual analogue scale,VAS）评分、苏醒质量以及两组患者手术前后的简易精神状态评价量表（minimental state examination,MMSE）评分、警觉-镇静评分（the observer’s assessment of alertness/sedation scale,OAAS）。结果 两组患者经过相应的麻醉手术后在拔管时间、苏醒时间的数据上差异无统计学意义（P> 0.05）;而观察组患者在自主恢复呼吸时间以及定向力恢复时间上明显的短于对照组患者,与对照组患者具有差异,差异有统计学意义（P <0.05）;两组患者的拔管1 h、3 h MMSE评分、VAS评分、警觉-镇静评分（OA...     

108例药物流产后阴道出血的超声诊断分析

目的 探讨药物流产后阴道出血的原因，对临床治疗提供依据。方法 对108例停经时间≤49d，尿β-HCG阳性，经超声检查为宫内妊娠，试行药物流产后出血≥14d的患者作为观察对象。结果 108例药物流产后出血的患者中73例经病理检查证实为不全流产占67．59％。结论 药物流产后长时间出血的患者中，最主要原因为不全流产，其次为子宫内膜炎。     

国产支架型人工血管的实验研究与临床应用

目的研究和开发国产支架型人工血管经腔内治疗动脉疾病.方法1993年6月至1999年8月,用北京地区杂种狗24条,分别制作了腹主动脉瘤(8条)、降胸主动脉瘤(6条)、升主动脉瘤(4条)、主动脉弓瘤(4条)和动静脉瘘(2条)模型,用自制的支架型人工血管置入.置于腹主动脉的支架是编织式镍钛合金记忆金属,长3cm,直径8cm;胸主动脉支架是联体不锈钢“Z“型支架,长3cm,直径2cm.覆膜均为国产超薄涤纶人工血管.临床应用20例,男17例,女3例.主动脉夹层11例,肾下腹主动脉瘤7例和创伤性动静脉瘘2例.结果17条狗术后存活,分别于2、4、8周获取标本,支架型人工血管通畅良好,无血栓形成.临床病例中,有1例腹主动脉瘤并发肾功能不全,于术后20天血液透析中死于心肌梗塞,其余病人均被成功治疗.随访2个月至5年,除1例夹层动脉瘤术后3个月支架移位外,所有病人恢复良好.结论自制的支架型人工血管费用低,操作简便,应用前景可观.     

The Role of Invasive Therapies in Elderly Patients with Acute Myocardial Infarction

INTRODUCTION:

In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge.

METHODS:

We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were ≥70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models.

RESULTS:

By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG.

CONCLUSION:

Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.     

Development and evaluation of a presurgical preparation program

Three presurgical preparation programs were developed and evaluated in an Australian hospital utilizing an additive component design. The component basic to all three preparation programs was modeling. This technique was compared with the additional components of teaching child coping skills and parent coping skills via videotape. Subjects were 28 children between the ages of 4 and 13 years who were scheduled for elective surgery. Anxiety of both the children and parents was assessed by self-report and behavior observation. Results indicated that there was no further anxiety reduction by the addition of child and parent coping skills. Results are discussed in terms of the viability of teaching coping skills via videotape particularly to parents. Methodological difficulties associated with research in this area are examined.     

A prospective study of the incidence, time of appearance and significance of anti-paternal lymphocytotoxic antibodies in human pregnancy

The incidence and natural history of serum anti-paternal cytotoxic antibody (APCA) in normal pregnancy and spontaneous abortion was investigated prospectively in 306 women (64 primigravidae and 242 multigravidae), in order to establish whether serum APCA is a useful screening test in the diagnosis, treatment and prognosis for patients with recurrent pregnancy loss. Pre-pregnancy, serial pregnancy and post delivery serum samples were tested against partner's lymphocytes, using a microdroplet lymphocytotoxicity assay. The incidence of serum APCA in the 256 pregnancies successfully completed was 32%, compared with 10% amongst the 50 pregnancies ending in spontaneous abortion. The lower incidence of positive APCA tests in unsuccessful pregnancies was explained by our finding that positive APCA tests are related to the gestational age of the pregnancy and are rarely demonstrable before 28 weeks gestation. Since APCA usually disappears between pregnancies, its usefulness as a diagnostic test for immunotherapy against recurrent abortion should be questioned.     

The influence of in-vitro development upon post-thaw survival and implantation of cryopreserved human blastocysts

Blastocysts from 198 patients were frozen using glycerol ascryoprotectant. No difference in the post-thaw survival of blastocystsor implantation rates was found between 177 patients (122 transfers)with all surplus embryos cultured to blastocysts before freezingand 20 patients (12 transfers) whose embryos were consideredunsuitable for freezing during cleavage and were then frozenas blastocysts. Nineteen pregnancies were achieved, of whichsix aborted. Pre-freezing morphology was similar in blastocystsof patients in groups 1 and 2 and did not relate to their survivalafter cryopreservation. A significantly lower proportion withsuspected damage after thawing was present among patients becomingpregnant after transfers of single blastocysts (P < 0.01)and implanting embryos were in general more expanded at thetime of transfer. No differences were detected between blastocystsresulting in normal development and those leading to abortion.The developmental consequences of damage to human blastocystsare discussed.     

Surgical and survival outcomes of laparoscopic staging surgery for patients with stage I ovarian cancer

Objective

To assess the feasibility and survival outcomes of laparoscopic staging for patients with stage I ovarian cancer.

Understanding the Legal Essentials of a Bowel Injury Lawsuit in Minimally Invasive Gynecologic Surgery

Bowel injury is a known inherent complication of minimally invasive gynecologic surgery; however, it does not automatically signify medical malpractice. Plaintiff attorneys representing patients seeking legal recourse from a bowel injury typically allege claims of intraoperative negligence, delay in diagnosis, or lack of informed consent in an effort to circumvent the assertion that it is a known inherent complication. In addition, damage awards in bowel injury lawsuits can easily exceed the amount covered by the policy limits of a medical malpractice insurance plan, leaving the gynecologist financially responsible for the difference. Therefore, it is crucial to understand when it may be appropriate to consent to a settlement offer, which can relieve the gynecologist from financial liability for amounts awarded above the medical malpractice policy limits. The purpose of this medical-legal review is to make minimally invasive gynecologic surgeons more aware of the legal strategies used by plaintiff attorneys representing patients who have incurred bowel injuries, and how to limit liability in lawsuits.