地塞米松冠周注射预防下颌阻生第三磨牙拔除后肿胀及张口受限的系统评价

目的 评价地塞米松（DM）冠周注射对下颌阻生第三磨牙拔除术后肿胀及张口受限的预防效果。方法 检索Cochrane图书馆临床随机对照试验库、PUBMED、荷兰医学文摘（EMBASE）和中国生物医学文献数据库;同时手检纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价由2位评价者使用Cochrane系统评价者手册5.0版介绍的偏倚风险评价标准独立完成,同时独立进行数据提取。运用Revman 5.1软件进行Meta分析。结果 共纳入7篇随机对照试验,涉及患者684名,偏倚风险评价显示6个研究为中度偏倚风险,1个研究为高度偏倚风险。Meta分析的结果显示,4～5 mg DM冠周注射能够使患者术后1～2 d内最大张口度大6.77 mm（P=0.02）,同时能够减少51%的中-重度张口受限的发生率（P<0.000 01）,并且在控制面部肿胀方面效果显著（P<0.05）。注射4 mg DM与8 mg DM在各项指标中无显著差别（P>0.05）。结论 选择4～5 mg的DM冠周注射能够较好地控制下颌阻生第三磨牙拔除术后面部肿胀和张口受限,但还需要更多的临床随机对照试验的支持。     

超声器械与手用器械龈下刮治疗效比较的meta分析

目的：通过Meta分析评价超声器械与手用器械龈下刮治比较治疗成人慢性牙周炎的临床疗效。方法：计算机检索PubMed、CochraneLibrary、EMbase、CNKI、CBM、WanFangData等6个电子数据库,查找所有有关超声与手工龈下刮治比较治疗慢性牙周炎的随机对照试验（RCTs）。并追索所有纳入文献的参考文献,文献检索时限均从建库至2012年11月。由2名评价员按照纳入和排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan5．0软件进行Meta分析。结果：最终7个RCT、224例受试者纳入本系统评价。Meta分析结果显示,超声与手工龈下刮治术后3个月复查时探诊深度、附着水平的改变无统计学差异;术后6个月复查时探诊深度、附着水平的改变无统计学差异。结论：现有研究证据表明,在牙周基础治疗过程中,采用超声与手工两种方法进行龈下刮治疗效相似。     

Mental health following traumatic physical injury: An integrative literature review

Aim

To investigate the state of knowledge on the relationship between physical trauma and mental health in patients admitted to hospital with traumatic physical injury.

Background

Adults who sustain traumatic physical injury can experience a range of mental health problems related to the injury and subsequent changes in physical health and function. However early screening and identification of mental health problems after traumatic physical injury is inconsistent and not routine during the hospital admission process for the physically injured patient.

Methods

Integrative review methods were used. Data were sourced for the period 1995–2010 from EMBASE, CINAHL, MEDLINE and PsycINFO and hand searching of key references. Abstracts were screened by 3 researchers against inclusion/exclusion criteria. Forty-one papers met the inclusion criteria. Data were retrieved, appraised for quality, analysed, and synthesised into 5 main categories.

Results

Forty-one primary research papers on the relationship between mental health and traumatic physical injury were reviewed. Studies showed that post-traumatic stress disorder, depression and anxiety were frequent sequelae associated with traumatic physical injury. However, these conditions were poorly identified and treated in the acute hospital phase despite their effect on physical health.

Conclusion

There is limited understanding of the experience of traumatic physical injury, particularly in relation to mental health. Greater translation of research findings to practice is needed in order to promote routine screening, early identification and referral to treatment for mental health problems in this patient group.     

Clinical results after different operative treatment methods of radial head and neck fractures: A systematic review and meta-analysis of clinical outcome

Introduction

There is no consensus on optimal treatment strategy for Mason type II–IV fractures. Most recommendations are based upon experts’ opinion.

Methods

An OVID-based literature search were performed to identify studies on surgical treatment of radial head and neck fracture. Specific focus was placed on extracting data describing clinical efficacy and outcome by using the Mason classification and including elbow function scores.A total of 841 clinical studies were identified describing in total the clinical follow-up of 1264 patients.

Results

For type II radial head and neck fractures the significant best treatment option seems to be ORIF with an overall success rate of 98% by using screws or biodegradable (polylactide) pins.ORIF with a success rate of 92% shows the best results in the treatment of type III fractures and seem to be better than resection and implantation of a prosthesis. For this fracture type the ORIF with screws (96%), biodegradable (polylactide) pins (88%) and plates (83%) showed the best results.In the treatment of type IV fractures similar results could be found with a tendency of the best results after ORIF followed by resection and implantation of a prosthesis.If a prosthesis was implanted, the primary implantation seems to be associated with a better outcome after type III (87%) and IV (82%) fractures compared to the results after a secondary implantation.

Discussion

Recommendations for surgical treatment of radial head and neck fractures according to the Mason classification can now be given with the best available evidence.Level of evidence: IV     

Multicenter retrospective comparative study of laparoscopically assisted and conventional anorectoplasty for male infants with rectoprostatic urethral fistula

Background

Laparoscopically assisted anorectoplasty (LAARP) was expected to achieve better fecal continence than conventional procedures. However, the issue of which approach is better remains controversial. We compared outcomes between the conventional procedure and LAARP in male infants with rectoprostatic urethral fistula.

Methods

Institutes belonging to the Japanese Study Group of Anorectal Anomalies (JSGA) were invited to participate. Subjects were male infants with rectoprostatic urethral fistula treated by the conventional approach (abdominoperineal pull-through and PSARP) or LAARP between 2000 and 2006. Medical charts and operative records were reviewed retrospectively.

Results

Eighty-one patients (conventional: 36, LAARP: 45) were enrolled from 15 centers. In both groups, the mean Kelly score was 5. The total score of the scoring system was newly developed by the Japanese Study Group of Anorectal Anomalies. Follow-up Project (5–15 points) was 10.7 and 12.1 in the conventional group and the LAARP group, respectively (p = 0.07). The incidence of failed rectoanal anastomosis, mucosal prolapse, and anal stenosis was comparable in both groups. Posterior urethral diverticula were detected on cystourethrograms in 7% and 11% (p = 1.0) and on MRI in 0% and 34% (p = 0.02) of the conventional and the LAARP groups, respectively. Overall, 94% of diverticula were asymptomatic.

Conclusions

Fecal continence and complication rates after LAARP were comparable to those observed after the conventional method. Posterior urethral diverticula were detected more frequently after LAARP.     

The management of trauma victims with head injury: a study by the national confidential enquiry into patient outcome and death

Introduction

In 2006 the National Confidential Enquiry into Patient Outcome and Death undertook a large prospective study of trauma care, which revealed several findings pertaining to the management of head injuries in a sample of 493 patients.

Methods

Case note data were collected for all trauma patients admitted to all hospitals accepting emergencies in England, Wales, Northern Ireland and the Channel Islands over a three-month period. Severely injured patients with an injury severity score (ISS) of ≥16 were included in the study. The case notes for these patients were peer reviewed by a multidisciplinary group of clinicians, who rated the overall level of care the patient received.

Results

Of the 795 patients who met the inclusion criteria for the study, 493 were admitted with a head injury. Room for improvement in the level of care was found in a substantial number of patients (265/493). Good practice was found to be highest in high volume centres. The overall head injury management was found to be satisfactory in 84% of cases (319/381).

Conclusions

This study has shown that care for trauma patients with head injury is frequently rated as less than good and suggests potential long-term remedies for the problem, including a reconfiguration of trauma services and better provision of neurocritical care facilities.