降低垂直距离在老年全口义齿修复中的应用

目的:观察适当降低垂直距离对老年人全口义齿修复效果的影响。方法:采用传统法和降低3mm垂直距离法,为40例老年患者分别制作完成2副全口义齿。适应3个月后,测定咀嚼效能和压痛点。采用SAS6.04软件包对数据进行统计学分析。结果:降低3mm垂直距离制作的全口义齿咀嚼效能与传统法比较,无显著差异(P>0.05),但压痛点显著少于传统法(P<0.05)。结论:降低3mm垂直距离法是临床上可行的老年人全口义齿修复方法。     

Influence of procedural variations during the laboratory phase of complete denture fabrication on patient satisfaction and denture quality

Objectives

To compare subjective and objective outcomes of complete dentures fabricated with standard clinical protocols, but omitted selected steps during the laboratory phase.

Materials and methods

Forty-three edentulous patients (mean age 58.1 years, SD 9.9, range 35–78), were consecutively recruited and randomly assigned to one of four groups according to selected variations of laboratory steps: Group 1 (n = 10), omission of secondary casts obtained from impressions in border moulded custom trays; Group 2 (n = 10), omission of secondary casts and face-bow articulator mounting; Group 3 (n = 10), omission of face-bow mounting; Group 4 (n = 13), no steps omitted (control). Clinical procedures for all groups were identical, and performed by senior dental students under supervision of prosthodontists, all of whom were blinded to the Group. At 1-, 4- and 12-weeks after delivery, patients rated their overall satisfaction, as well as a range of functional factors using visual analogue scales. An independent blinded prosthodontist similarly rated four domains of denture quality at the 1-week follow-up.

Results

No significant differences were noted among the groups in all aspects of patients’ assessments at all the time points (P > 0.1). There were no significant differences in prosthodontists’ ratings of denture quality in any of the domains examined (P > 0.1).

Conclusion

Selected omissions of steps (face-bow mounting and/or secondary casts) during the laboratory phase of complete denture fabrication has only a minor role, if any, in subjective and objective outcomes, contrasting with the common belief that such omissions will adversely affect outcomes.

Clinical significance

General practitioners provide most complete dentures. Many do not follow all the procedures they were taught at dental school. Our finding that omitting frequently advocated steps made no difference to patient satisfaction or to denture quality suggests that cost-effectiveness through simplifications be considered in practice and in education.     

Influence of high expansion dental stone used as investing medium on the changes in occlusal vertical dimension of complete dentures

Problem statementDespite advances in materials and techniques, complete dentures made of acrylic resin experience an increase in the occlusal vertical dimension (OVD) during processing. Many factors that affect the OVD of complete dentures are known. However, no study has examined the effect of using high-expansion dental stone (type V) as an investing material on the OVD.PurposeThis study investigated the effects of using a high-expansion dental stone as an investing material on changes in the OVD of complete dentures.Material and methodsTwenty sets of simulated upper and lower dentures were processed by the compression molding technique. Specimens were equally divided into 2 groups. In the dental stone type III (DST III) group, the lower, middle, and upper parts of a flask were filled with DST III. In the dental stone type V (DST V) group, the procedure was the same as in the DST III group, except that the middle layer was made of high-expansion DST V. Changes in the OVD were measured before and after denture processing. Collected data were analyzed with t-test statistics. Differences were considered statistically significant at the 95% confidence level.ResultsBoth groups showed a small increase in the OVD as a result of processing, but the OVD increase was significantly less in the DST V group compared to the DST III group.ConclusionHigh-expansion DST V can be recommended as an investing material to reduce the increase in the OVD that may occur while processing complete dentures.     

Residual ridge resorption, lower denture stability and subjective complaints among edentulous individuals

Residual ridge resorption in the mandible after tooth loss may lead to worsening of complete denture stability and to various subjective complaints. The aim was to evaluate the association between radiologically assessed residual ridge resorption in the mandible, clinically assessed stability of lower complete denture and subjective complaints among elderly denture wearers. The study population consisted of 326 (115 men and 211 women) edentulous subjects aged 60-78years, all of whom were wearing complete dentures in the mandible. Data on subjective complaints were obtained from questionnaires and interviews. Denture stability was assessed clinically. Residual ridge resorption was analysed from panoramic radiographs. The results showed that women were significantly more often satisfied with their lower dentures and reported fewer problems with eating than men. They also had significantly more often residual ridge resorption than men. Among women, residual ridge resorption was significantly associated with poor chewing ability, low satisfaction with dentures and poor denture stability. Among men, residual ridge resorption did not associate with subjective complaints or denture stability. Poor satisfaction with dentures associated significantly with poor denture stability in both genders. In conclusion, these results highlight the importance of denture maintenance treatment. As the extent of residual ridge resorption in the mandible was the most important factor that increased dissatisfaction with lower complete dentures, it is also important to inhibit the progression of resorption by preventing tooth loss or by using implant-retained dentures.     

不同类型雄激素不敏感综合征性腺肿瘤临床分析

目的:探讨完全型雄激素不敏感综合征(CAIS)与不完全型雄激素不敏感综合征(IAIS)患者的性腺肿瘤发生情况及临床特征,以进一步提高对该病的认知水平与诊治。方法:回顾性分析2001年1月至2015年3月北京协和医院妇产科收治的雄激素不敏感综合征(AIS)78例患者的临床资料及性腺病理检查结果。结果:78例AIS患者中,CAIS 52例,IAIS 26例。共14例(17.9%,14/78)患者存在性腺肿瘤,年龄14~33岁,肿瘤类型包括:性腺母细胞瘤(2例)、支持细胞腺瘤(8例)、精原细胞瘤(1例)、无性细胞瘤(1例)和性索肿瘤(1例)、左侧性腺精原细胞瘤及右侧支持细胞腺瘤(1例)。发生肿瘤的性腺位于腹盆腔9例,腹股沟管5例。14例性腺肿瘤患者诊断为CAIS12例和IAIS 2例,其性腺肿瘤的发生率分别为23.1%和7.7%,差异有统计学意义(P0.05)。结论:AIS患者性腺易发生肿瘤,非阴囊内部位的性腺易发生性腺肿瘤。CAIS的性腺肿瘤发生率较高。     

腹腔镜下右半结肠全系膜切除术

患者为老年男性,临床分期为c T4N0M0,术后病理分期为p T4aN1M0。采用"四步法":1.沿肠系膜上静脉走向充分显露肠系膜上静脉,整块清除外科干淋巴结、胰头前及第6组淋巴结,进入并分离胰十二指肠前间隙。2.进一步扩大胰十二指肠前间隙并游离右肾前间隙至右结肠旁沟,沿此间隙游离升结肠及回盲部后方。3.切开回结肠反折腹膜及升结肠侧腹膜。4.切除右侧大网膜、第6组淋巴结,切开肝结肠韧带。腹腔镜下操作完成。     

前扣带皮层区域磷酸激酶Czeta在弗氏安全佐剂致炎性痛大鼠情绪反应中的作用

目的 观察CFA致炎性痛模型大鼠的情绪反应,探讨前扣带皮层（ACC）磷酸激酶Czeta（PKCzeta）与炎性痛大鼠情绪反应的关系。方法 24只清洁级雄性SD大鼠随机分为空白对照组和模型对照组。足底皮下注射弗氏完全佐剂建立慢性炎性痛模型。动态观察各组大鼠造模前（base）、造模后3、7、14、21和28 d的体重和痛阈变化;观察造模后14、21、28 d所有大鼠在高架O迷宫中的总运动距离、开放臂运动距离、开放臂进入次数和开放臂停留时间百分比。观察造模后14、29 d所有大鼠在旷场中的总运动距离、中央象限运动距离、中央象限进入次数和中央象限停留时间。采用免疫印迹法检测造模后14 d和29 d健侧和患侧ACC区域PKCzeta蛋白表达。结果 各个时间点两组大鼠体重差异无显著性（P>0.05）。造模前,两组大鼠痛阈差异无显著性（P>0.05）;造模后1 d,模型对照组大鼠痛阈显著降低（P<0.05）,且在整个实验过程中均显著低于空白对照组（P<0.05）。与空白对照组比较,模型对照组大鼠于模后28 d开放臂运动距离和开放臂停留时间百分比显著减少（P<0.05）,于模后29 d中央象限运动距离和中央象限进入次数明显减少（P<0.05）。造模后29 d,模型对照组大鼠患侧ACC区域PKCzeta蛋白表达明显多于空白对照组（P<0.05）。且开放臂运动距离、开放臂停留时间百分比、中央象限运动距离、中央象限进入次数与患侧PKCzeta蛋白表达变化呈负相关。结论 CFA诱导的慢性炎性痛大鼠可出现异常情绪行为;慢性炎性痛情绪样行为可能与ACC区域PKCzeta的高表达相关。     

完整结肠系膜切除术与传统根治术治疗结肠癌的效果比较

目的比较完整结肠系膜切除术（CME）与传统根治术治疗结肠癌的临床效果。方法选取92例结肠癌患者,根据治疗方法将其分为观察组（CME治疗）与对照组（传统根治术治疗）,各46例。比较两组的手术时间,术中出血量,术后排气时间、并发症发生情况;随访1年,比较两组的复发率。结果两组的手术时间差异无统计学意义（P〉0.05）,观察组的术中出血量显著少于对照组,术后排气时间显著短于对照组（P〈0.05）;观察组的淋巴结清除数显著多于对照组（P〈0.05）;观察组的术后并发症发生率为6.52%,显著低于对照组的17.39%（P〈0.05）;观察组的1年复发率为2.17%,显著低于对照组的13.04%（P〈0.05）。结论相对于传统根治术,对结肠癌患者采用CME治疗能更好地清除淋巴结,且术后并发症较少,复发率较低,值得推广。     

Can molecular insights guide treatment of AML evolved from MPNs?

Leukemic transformation of myeloproliferative neoplasms (MPNs) is associated with dismal outcomes. The genetic complexity of leukemic transformation of MPNs is being deciphered and will likely result in targeted therapy approaches. Ongoing trials are investigating the efficacy of emerging treatments for this high-risk patient population. This review has outlined recent progress in the understanding and treatment of leukemia arising from MPNs.     

剖宫产瘢痕妊娠患者甲氨蝶呤胎囊注射联合B超监测下清宫术的疗效分析

目的 探究甲氨蝶呤胎囊注射联合B超监测下清宫术治疗剖宫产瘢痕妊娠患者的临床效果。方法 回顾性分析2014年10月至2017年10月安钢总医院收治的87例剖宫产瘢痕妊娠患者临床资料,按治疗方案不同分为对照组（n=43）与试验组（n=44）。对照组患者单纯采取甲氨蝶呤胎囊注射治疗,试验组患者采取甲氨蝶呤胎囊注射联合B超监测下清宫术治疗。对比两组患者的临床效果、月经恢复时间、包块消失时间、血人绒毛膜促性腺激素（HCG）转阴时间、阴道出血时间、住院时间及治疗前、治疗后2个月生活质量评分（SF-36）。结果 试验组治疗后总有效率（88.64%）高于对照组（67.44%）,差异有统计学意义（P<0.05）;与对照组相比,试验组包块消失时间、血HCG转阴时间、阴道出血时间、住院时间均较短,差异有统计学意义（P<0.05）;两组患者治疗后2个月SF-36评分均提高,且试验组提高水平高于对照组,差异有统计学意义（P<0.05）。结论 剖宫产瘢痕妊娠患者予以甲氨蝶呤胎囊注射联合B超监测下清宫术治疗可明显改善临床效果,缩短患者恢复时间,改善患者生活质量。