腹腔镜技术在腹部手术后并发症诊治中应用价值及评价

随着腹腔镜技术的发展,其手术适应证也不断扩展。腹腔镜技术不仅应用于诊治多种急腹症,目前其在腹部手术术后并发症的诊治中亦进行了初步探索,如术后腹腔内出血、消化道漏、粘连性肠梗阻等,但其在此方向的应用尚不成熟,适宜条件严格,暂不能推荐作为临床常规诊疗手段。须在条件具备的医疗机构由具有丰富腹腔镜手术经验的外科医师在高度选择性的病例中实施并开展相关临床研究。     

激光预处理牙本质对树脂粘结性能影响的研究进展

近年来,为提高牙本质与树脂的粘结性能,国内外学者围绕牙本质表面处理进行了大量的研究。激光技术的快速发展为牙本质的表面处理提供了新思路。该文从树脂水门汀的分类和特点、激光预处理原理、常用激光的种类和特点、激光预处理对牙本质表面形态的影响和对树脂粘结性能的影响五个方面作一简要综述。     

楔状缺损充填治疗的研究进展

临床上治疗楔状缺损的方法主要是充填治疗,而充填治疗后易发生边缘微渗漏、牙本质敏感、充填体脱落、继发龋等问题。目前针对以上问题各种新技术及新材料不断涌现。本文就楔状缺损充填治疗的研究进展作一综述,为口腔临床医生提供借鉴。     

Transcutaneous electroacupuncture alleviates postoperative ileus after gastrectomy: A randomized clinical trial

AIM To investigate the efficacy and safety of transcutaneouselectroacupuncture(TEA) to alleviate postoperative ileus(POI) after gastrectomy.METHODS From April 2014 to February 2017, 63 gastric cancer patients were recruited from the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. After gastrectomy, the patients were randomly allocated to the TEA(n = 33) or control(n = 30) group. The patients in the TEA group received 1 h TEA on Neiguan(ST36) and Zusanli(PC6) twice daily in the morning and afternoon until they passed flatus. The main outcomes were hours to the first flatus or bowel movement, time to nasogastric tube removal, time to liquid and semi-liquid diet, and hospital stay. The secondary outcomes included postoperative symptom assessment and complications.RESULTS Time to first flatus in the TEA group was significantly shorter than in the control group(73.19 ± 15.61 vs 82.82 ± 20.25 h, P = 0.038), especially for open gastrectomy(76.53 ± 14.29 vs 87.23 ± 20.75 h, P = 0.048). Bowel sounds on day 2 in the TEA group were significantly greater than in the control group(2.30 ± 2.61/min vs 1.05 ± 1.26/min, P = 0.017). Time to nasogastric tube removal in the TEA group was earlier than in the control group(4.22 ± 1.01 vs 4.97 ± 1.67 d, P = 0.049), as well as the time to liquid diet(5.0 ± 1.34 vs 5.83 ± 2.10 d, P = 0.039). Hospital stay in the TEA group was significantly shorter than in the control group(8.06 ± 1.75 vs 9.40 ± 3.09 d, P = 0.041). No significant differences in postoperative symptom assessment and complications were found between the groups. There were no severe adverse events related to TEA.CONCLUSION TEA accelerated bowel movements and alleviated POI after open gastrectomy and shortened hospital stay.     

短期内反复内镜治疗难治性食管静脉曲张破裂大出血

目的：探讨食管静脉曲张破裂大出血急诊硬化治疗术后仍持续出血的再次内镜下处理。方法：52例食管静脉曲张破裂大出血首次硬化术后仍出血不止或于1周内再次大出血患者,插入二腔一囊管后牵拉,再次进行硬化或（和）组织黏合剂黏堵治疗。结果：再次硬化治疗41例,黏堵加硬化治疗11例,无效转外科手术1例,死亡2例。急诊止血率为94.2%。发生较重并发症7例。结论：内镜下反复硬化或（和）黏堵治疗是控制难治性食管静脉曲张破裂大出血的首选抢救措施。     

Gum chewing stimulates early return of bowel motility after caesarean section

Objective  To evaluate the efficacy and safety of postoperative gum chewing on the recovery of bowel motility after caesarean section.
Design  A randomised controlled study.
Setting  Faculty of Medicine, Ain Shams University, Egypt.
Population  A total of 200 pregnant women delivered by elective caesarean section (CS) under general anaesthesia.
Methods  Women were randomised into two groups; group A (93 women) who received one stick of sugarless gum for 15 minutes every 2 hours after surgery, and group B (107 women) had traditional management (oral intake of clear fluids allowed after passage of flatus and regular diet with the passage of bowel movement).
Main outcome measures  Time to first hearing of normal intestinal sounds, time to first flatus, time to first bowel movement and length of hospital stay.
Results  The mean duration of surgery was longer in group A (41.3 ± 7.5 versus 38.4 ± 8.1 minutes, P  <   0.05). The mean postoperative time interval to first hearing of normal intestinal sounds (10.9 ± 2.7 versus 15.6 ± 3.7 hours), passage of flatus (17.9 ± 4.6 versus 24.4 ± 7.1 hours), defecation (21.1 ± 4.7 versus 30 ± 8.2 hours) and discharge from the hospital (40.8 ± 10.6 versus 50.5 ± 8.9 hours) were significantly shorter in group A ( P  <   0.001). Severe ileus occurred only in one woman belonging to group B. All patients in group A tolerated gum chewing beginning on the first postoperative day.
Conclusion  Gum chewing after CS is safe, well tolerated, and associated with rapid resumption of intestinal motility and shorter hospital stay; with potential impact on reducing the overall healthcare costs in case of routine implementation.     

Effects of light penetration and smear layer removal on adhesion of post–cores to root canal dentin by self-etching adhesives

ObjectivesThis study investigated the effects of light penetration and removal of smear layer on the adhesive properties of self-etching adhesives to root canal dentin when using fiber posts.MethodsAltogether 54 human incisors and premolars were decoronated, and the roots after preparing the post space were randomly assigned into six groups. Three groups were treated with a light-cured self-etching adhesive and the other three with a dual-cured self-etching adhesive. In a further sub-division, the first group was light-cured with an irradiation unit; the second was light-cured with the irradiation unit and a light-guiding attachment; and the third was light-cured with the irradiation unit and the attachment after removing smear layer by EDTA and NaOCl. Then, a glass-fiber post was luted into the post space by a dual-cured composite. After 24 h, an hourglass-shaped specimen was trimmed and subjected to MTBS testing.ResultsUsing the light-guiding attachment and removing the smear layer reduced the incidence of pre-testing failure significantly from 57.1% to 19.0% (p < 0.05) in the light-cured adhesive groups and from 68.3% to 3.2% (p < 0.01) in the dual-cured adhesive groups. The MTBS in different locations within a post space were in the range from 8.9 to 17.5 MPa in the light-cured group and from 11.2 to 17.2 MPa in the dual-cured group.SignificanceBetter light penetration in post spaces and removal of the smear layer are effective in improving the adhesive properties of self-etching adhesives to root canal dentin when using fiber posts.     

不同材料黏接正畸颊面管的临床效果对比研究

目的探讨GCFuji正畸黏接剂和京津釉质黏接剂黏接磨牙颊面管的临床效果。方法将60例患者随机分为两组,分别使用GCFuji正畸黏接剂和京津釉质黏接剂进行黏接型磨牙颊面管的黏接．对其临床治疗过程中颊面管的脱落率及脱落后牙釉质上的黏接材料残留指数进行观察分析。结果GCFuji正畸黏接剂组的颊面管脱落率略低于京津釉质黏接剂组。但差异无统计学意义（P〉0．05）。两种黏接剂黏接后均显示,上颌第一恒磨牙上的颊面管脱落率最低．而上颌第二恒磨牙的颊面管脱落率最高：两组颊面管脱落后黏接材料牙面残留指数均多数为3．分别占总体分布的55．0％和59.1％。结论黏接黏接型颊面管时使用GCFuji正畸黏接剂和京津釉质黏接剂的黏接效果差别不大：两组颊面管脱落时断裂界面均多数在牙釉质与黏接材料之间。     

Effects of a dental adhesive incorporating antibacterial monomer on the growth,adherence and membrane integrity of Streptococcus mutans

Objectives

This study was attempted to incorporate an antibacterial monomer, methacryloxylethyl cetyl dimethyl ammonium chloride (DMAE-CB), into a commercial dental adhesive and to evaluate the antibacterial activity of the DMAE-CB-incorporated adhesive after being cured against Streptococcus mutans.

Methods

DMAE-CB was incorporated at 3% (w/v) into a clinically used dental adhesive, Single Bond 2. Single Bond 2 without DMAE-CB was served as a negative control; Clearfil Protect Bond, containing an intensively researched antibacterial monomer MDPB, was enrolled as a positive control. The effects of the cured adhesives and their eluents on the growth of S. mutans were determined by film contact test and absorbance measurement, respectively. The effects of the cured adhesives on the adherence and membrane integrity of S. mutans were investigated using confocal laser scanning microscopy (CLSM) in conjunction with fluorescent indicators.

Results

Compared with negative control, the cured DMAE-CB-incorporated dental adhesive and positive control were found to exhibit inhibitory effect on the growth of S. mutans (P < 0.05), whereas their eluents did not show detectable antibacterial activity. Moreover, the fluorescence analysis of CLSM images demonstrated that the cured DMAE-CB-incorporated adhesive and positive control could hamper the adherence of S. mutans and exert detrimental effect on bacterial membrane integrity (P < 0.05).

Conclusions

The incorporation of DMAE-CB can render dental adhesive with contact antibacterial activity after polymerization via influencing the growth, adherence and membrane integrity of S. mutans.     

One-step self-etching adhesive polymerization: Influence of a self-curing activator

Objectives

The objectives of this work were to study the spatially resolved extent of photopolymerization and the final volumetric contraction of the self-etching adhesive Xeno IV (Dentsply/Caulk, Milford, DE, USA) in association with the self-curing agent Aurora (Dentsply/Caulk, Milford, DE, USA), using ¹H Stray-Field magnetic resonance imaging (¹H STRAFI-MRI).

Methods

One-dimensional ¹H STRAFI-MRI images (projections along an axis, profiles) were acquired from the adhesive with and without Aurora, before and after solvent removal. Specimens were observed after the irradiation period recommended by the manufacturers and new profiles were recorded. Extent of polymerization and volumetric contraction were obtained by subtracting the profile of the cured adhesive from the profile of the liquid; the profiles were previously normalized using an external reference signal and the highest magnetization intensity recorded from the cured adhesive, respectively. Data were obtained in the presence of oxygen. Solvent evaporation was measured by gravimetry.

Results

High volumetric contraction was observed for Xeno IV and Xeno IV and Aurora mixture mainly related to solvent evaporation. A drying period favourably influenced the extent of photopolymerization of Xeno IV, which did not increase in the presence of Aurora.

Conclusions

The incorporation of Aurora reduced the extent of polymerization of the one-step adhesive, probably due to the increase in the solvent content of the mixture. It may be that enhancing solvent evaporation is important in order to reach a higher extent of polymerization during the bonding procedure.