牙周组织再生结合骨皮质切开术对骨性Ⅲ类错[牙合]牙龈厚度影响的数字化评估

目的通过口内扫描技术初步探索并建立一种评价软组织改变的方法,评估牙周组织再生结合骨皮质切开术对骨性Ⅲ类错[牙合]骨嵴顶冠方牙龈厚度的影响。方法纳入2018年1月至2019年3月于北京大学口腔医学院·口腔医院正畸科和口腔颌面外科转诊至牙周科、全身和牙周健康、需行正畸-正颌联合治疗的骨性Ⅲ类错[牙合]畸形患者22例,其中男性4例,女性18例,年龄(24.0±4.5)岁(19~35岁);观测前牙共112颗,其中上颌前牙46颗,下颌前牙66颗。在前牙去代偿正畸移动前行牙周组织再生结合骨皮质切开术,观察探诊深度、出血指数、角化龈宽度,比较术前及术后6个月的差异。术前与术后6个月通过口内扫描技术直接获取患者上下颌前牙区数字化模型,在分析软件中构建软组织形态测量模型,并定量分析牙冠正中测量矢状面上龈缘根方1和2 mm处牙龈厚度的变化。结果22例患者手术前后探诊深度、出血指数差异均无统计学意义(P>0.05);术后6个月角化龈宽度从术前的(4.22±1.43)mm显著增加至(5.18±2.32)mm(P<0.05)。术后6个月上颌、下颌前牙龈缘根方1和2 mm处牙龈厚度与术前相比均显著增加(P<0.05);其中上颌前牙龈缘根方1和2 mm处牙龈厚度增加量分别为(0.68±0.56)和(1.00±0.69)mm;下颌前牙龈缘根方1和2 mm处牙龈厚度增加量分别为(0.38±0.42)和(0.58±0.45)mm;且上颌牙龈厚度增加量均显著大于下颌(P<0.01)。结论基于口内扫描技术进行软组织形态变化的定量评价方法切实可行。在骨性Ⅲ类错[牙合]正畸-正颌联合治疗中牙周组织再生结合骨皮质切开术不但能增加角化龈宽度,而且可增加骨嵴顶冠方牙龈组织厚度。     

合理情绪疗法对骨性Ⅲ类错颌畸形患者术前心理状况的影响

目的探讨合理情绪疗法对骨性Ⅲ类错颌畸形患者术前心理状况的影响。方法将40例骨性Ⅲ类错颌畸形患者随机分为观察组和对照组各20例。对照组给予口腔科术前常规护理,实验组在此基础上应用合理情绪疗法进行心理干预,分为心理诊断阶段、领悟阶段、修通阶段、再教育阶段4个阶段采取相应的干预措施。干预前和干预后即刻采用症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行评估。结果干预后观察组SCL-90改善幅度显著优于对照组,HAMA评分显著低于对照组(均P0.05)。结论合理情绪疗法能够明显改善骨性Ⅲ类错颌畸形患者术前焦虑程度,让患者更积极参与治疗。     

Overview of high-risk HPV's 16 and 18 infected cervical cancer: Pathogenesis to prevention

As general, the Human papillomavirus (HPV) causes the most sexually transmitted diseases. Among well categorized 80 types, the high-risk types HPV's 16 and 18 are highly involved in 70% of cervical cancer. The virulence of HPV is mainly exhibited by E5, E6 and E7 encoded oncoproteins that cause low to high-grade cervical lesions (CIN-1, 2, 3), leading to form 99.7% of squamous cell and 89% of adenocarcinomas cervical cancer worldwide. This study mainly encircles the major role of E5, E6 and E7 oncoproteins in HPV 16 and 18. Further discussed the uprising of significant biomarkers and their cellular process in different stages of cervical cancer with current prevention and treatment regimens. Hence, this integration will evoke novel markers, potential vaccination and various treatments approaches with special reference for HPV16 and 18 infected cervical cancers.     

多轴锁定钢板内固定结合关节镜技术治疗高能量Pilon骨折

目的观察多轴锁定钢板内固定结合关节镜技术辅助治疗高能量Pilon骨折的疗效。方法自2010-02—2013-04诊治高能量Ruedi-AllgowerⅢ型Pilon骨折22例,利用CT三维重建骨折的形态及关节面情况,术中采用关节镜辅助观察胫距关节面并协助复位,然后用多轴锁定钢板固定胫骨远端碎骨折块。通过分析末次随访的踝关节影像学形态测量结果和踝关节功能Mazur评分评定术后疗效。结果 22例均获得随访10~24个月,平均13.3个月。骨折均获得愈合,愈合时间7~19周,平均11.4周。1例出现皮肤坏死,行转移皮瓣修复,其余无深部感染、骨折不愈合、钢板外露等并发症。末次随访时均行踝关节CT检查,仅1例CT显示胫骨远端关节面欠平整,但暂无骨性关节炎表现。疗效根据踝关节功能Mazur评分评定:优(92分)15例,良(87~92分)4例,可(65~86分)3例。结论多轴锁定钢板内固定结合关节镜技术治疗Ruedi-AllgowerⅢ型Pilon骨折具有手术创伤小、固定可靠、可早期功能锻炼、术后踝关节功能恢复好的优点。     

芪藿复方合剂联合西药治疗糖尿病肾病Ⅲ期临床研究

目的观察芪藿复方合剂治疗脾肾气虚型早期糖尿病肾病(diabetic nephropathy,DN)Ⅲ期的临床疗效。方法将60例脾肾气虚型DNⅢ期患者随机分为治疗组和对照组,每组30例。对照组给予降血糖、降血压等对症处理,治疗组加用芪藿复方合剂治疗,疗程3个月。观察两组治疗前后24h尿微量蛋白(urinary microalbumin,UmAlb)、24h尿微量蛋白排泄率(urinary albumin excretion rate,UAER)、血清肌酐(serum creatinine,SCr)、血尿素氮(blood urine nitrogen,BUN)、空腹血糖(fasting blood glucose,FBG)、总胆固醇(total cholesterol,TC)、三酰甘油(triglycerides,TG)、C反应蛋白(C-reactive protein,CRP)及中医证候积分的变化。结果治疗组临床疗效显著优于对照组(P<0.05),治疗组总有效率显著高于对照组(83.3%vs 60.0%,P<0.05);治疗组在降低中医证候积分、FBG、TC、TG、CRP、SCr、24hUmAlb和24h UAER方面显著优于对照组。结论芪藿复方合剂对DN有一定的干预作用,可延缓DN的发展。     

高危型人乳头瘤病毒阴性/不典型鳞状细胞和低度鳞状上皮内病变患者的随访观察

目的分析高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)阴性的不典型鳞状细胞(atypical squamous cells undetermined significance,ASCUS)和低度鳞状上皮内病变(low squamous intraepithelial lesion,LSIL)患者的随访结果,探讨HR-HPV阴性的ASCUS和LSIL患者的合理处理方法。方法回顾性分析2010年1月1日至2012年12月31日期间,就诊于首都医科大学附属北京朝阳医院妇科门诊,HR-HPV阴性、宫颈液基细胞学为ASCUS和LSIL的356例患者的病理资料,对HR-HPV阴性的ASCUS和LSIL经阴道镜及宫颈活检排除高级别病变的306例患者定期进行HR-HPV随访。HR-HPV检测采用杂交检测法2代(hybird capture-Ⅱ,HC-Ⅱ)。结果 HR-HPV阴性/ASCUS和LSIL患者宫颈上皮内瘤变(cervical intraepithelial lesions,CIN)-Ⅲ及以上病变发病率分别为7.9%和9.1%。HR-HPV阳性/ASCUS和LSIL患者CIN-Ⅲ及以上病变发病率分别是22.9%和17.9%。HRHPV阳性的ASCUS和LSIL患者CIN-Ⅲ及以上病变发病率明显高于HR-HPV阴性患者,差异具有统计学意义(P=0.000)。HRHPV阳性对ASCUS及LSIL患者宫颈高级别病变的阴性预测值分别为87.13%和84.42%。HR-HPV阴性/ASCUS和LSIL患者CIN-Ⅱ及以上病变检出率是14.3%。不同年龄段的HR-HPV阴性/ASCUS和LSIL的患者,宫颈高级别病变患者的发生率不同,差异具有统计学意义(P<0.05)。30~39岁妇女宫颈高级别病变的发生率最高(18.2%)。结论 HR-HPV阴性的ASCUS和LSIL患者发生CIN-Ⅲ及以上病变分别是7.9%和9.1%,CIN-Ⅱ及以上病变达14.3%,30~39岁的HR-HPV阴性/ASCUS和LSIL患者宫颈高级别病变发生率达18%,建议对于HR-HPV阴性的ASCUS和LSIL患者应行阴道镜检查可疑病变部位活检。     

Diagnostic Algorithm to Reflect Regressive Changes of Human Papilloma Virus in Tissue Biopsies

Purpose

Landmark indicators have not yet to be developed to detect the regression of cervical intraepithelial neoplasia (CIN). We propose that quantitative viral load and indicative histological criteria can be used to differentiate between atypical squamous cells of undetermined significance (ASCUS) and a CIN of grade 1.

Materials and Methods

We collected 115 tissue biopsies from women who tested positive for the human papilloma virus (HPV). Nine morphological parameters including nuclear size, perinuclear halo, hyperchromasia, typical koilocyte (TK), abortive koilocyte (AK), bi-/multi-nucleation, keratohyaline granules, inflammation, and dyskeratosis were examined for each case. Correlation analyses, cumulative logistic regression, and binary logistic regression were used to determine optimal cut-off values of HPV copy numbers. The parameters TK, perinuclear halo, multi-nucleation, and nuclear size were significantly correlated quantitatively to HPV copy number.

Results

An HPV loading number of 58.9 and AK number of 20 were optimal to discriminate between negative and subtle findings in biopsies. An HPV loading number of 271.49 and AK of 20 were optimal for discriminating between equivocal changes and obvious koilocytosis.

Conclusion

We propose that a squamous epithelial lesion with AK of >20 and quantitative HPV copy number between 58.9-271.49 represents a new spectrum of subtle pathological findings, characterized by AK in ASCUS. This can be described as a distinct entity and called "regressing koilocytosis".     

Molecular fixative enables expression microarray analysis of microdissected clinical cervical specimens

Formalin-fixed tissue has been a mainstay of clinical pathology laboratories, but formalin alters many biomolecules, including nucleic acids and proteins. Meanwhile, frozen tissues contain better-preserved biomolecules, but tissue morphology is affected, limiting their diagnostic utility. Molecular fixatives promise to bridge this gap by simultaneously preserving morphology and biomolecules, enabling clinical diagnosis and molecular analyses on the same specimen. While previous reports have broadly evaluated the use of molecular fixative in various human tissues, we present here the first detailed assessment of the applicability of molecular fixative to both routine histopathological diagnosis and molecular analysis of cervical tissues. Ten specimens excised via the loop electrosurgical excision procedure, which removes conical tissue samples from the cervix, were cut into alternating pieces preserved in either formalin or molecular fixative. Cervical specimens preserved in molecular fixative were easily interpretable, despite featuring more eosinophilic cytoplasm and more recognizable chromatin texture than formalin-fixed specimens. Immunohistochemical staining patterns of p16 and Ki-67 were similar between fixatives, although Ki-67 staining was stronger in the molecular fixative specimens. The RNA of molecular fixative specimens from seven cases representing various dysplasia grades was assessed for utility in expression microarray analysis. Cluster analysis and scatter plots of duplicate samples suggest that data of sufficient quality can be obtained from as little as 50 ng of RNA from molecular fixative samples. Taken together, our results show that molecular fixative may be a more versatile substitute for formalin, simultaneously preserving tissue morphology for clinical diagnosis and biomolecules for immunohistochemistry and gene expression analysis.     

两种方法治疗垂直不稳定型股骨颈骨折的近期疗效对比

目的评价单纯空心螺钉与3枚空心钉加内侧支撑钢板两种方式处理股骨颈Pauwels Ⅲ型骨折的近期治疗效果。方法选取锦州地区55例股骨颈Pauwels Ⅲ型骨折患者,随机分为空心加压螺钉组30例（A组）,3枚空心螺钉+支撑钢板组25例（B组）。记录术后髋关节Harris评分,对比各项手术指标、愈合时间、复位质量、股骨头坏死与骨不连等并发症的发生情况。结果A组手术时间（68.73±4.91）min,低于B组（110.76±5.85）min;A组术中出血量（69.47±5.15）mL,低于B组（110.92±10.10）mL;A组的骨折愈合时间（5.03±0.47）个月,高于B组（4.37±0.56）个月;差异均有统计学意义（P<0.05）。两组内固定失效和复位情况的对比,B组优于A组（P<0.05）;在股骨头坏死和骨折不愈合方面的比较,A组高于B组（P>0.05）。术后第1、3个月的Harris分值,A组为（70.67±1.88）分、（74.83±3.69）分,低于B组（71.60±1.78）分、（76.60±3.10）分,差异无统计学意义（P>0.05）;术后第6、12个月的Harris分值,A组为（78.97±1.88）分、（88.17±3.36）分,低于B组（80.08±1.93）分、（92.04±3.72）分,差异有统计学意义（P<0.05）。结论采用空心钉+支撑钢板治疗骨折线较垂直的股骨颈Pauwels Ⅲ型骨折的效果优于单纯3枚空心钉,拥有骨折复位质量好、更加牢靠的固定、有效抵抗垂直剪切力、缩短愈合时间,患髋功能恢复好等优点。