舌正中岛状瓣修复口底缺损

目的：总结应用舌正中岛状瓣修复口底缺损的经验。方法：5例中小型口底缺损患者采用舌正中岛状瓣修复重建。在舌背正中部位制备舌肌黏膜瓣,通过切开舌尖或舌组织隧道以岛状瓣的方式转移修复口底缺损。结果：5例患者术后舌瓣均成活良好,无舌瓣坏死,1例术后一侧舌尖部分坏死。术后随访3-6个月,患者发音及吞咽功能无明显异常。结论：舌正中岛状瓣是一种修复中小型口底缺损的好方法。     

Factors Affecting Survival and Usefulness of Implants Placed in Vascularized Free Composite Grafts Used in Post–Head and Neck Cancer Reconstruction

Background: Bone‐containing vascularized grafts have been used successfully to reconstruct post‐cancer surgical defects. Dental implants can be placed in these bone‐containing grafts to allow implant‐supported prosthodontic reconstruction of these patients. Purpose: The aim of this study was to evaluate the survival of dental implants used in the rehabilitation of subjects treated with bone‐containing vascularized grafts to compare usability of implants placed at the time of reconstruction and after healing. Materials and Methods: A cross‐sectional study was undertaken to examine survival rates of implants placed in vascularized bone‐containing grafts either immediately at the time of surgical reconstruction or after 3 months healing. Other factors such as graft type, whether radiation therapy was given, and implant type were recorded. Results: A total of 41 patients had 145 implants placed in 47 vascularized bone‐containing flaps. Increased failure rate of implants was seen in immediately placed implants. There was also a significant increase in the number of osseointegrated implants that were prosthodontically unusable or sub‐optimally placed in the immediate placement group. Radiation therapy was associated with a significant increase in failure rate. Modern implant surfaces appeared to perform better than machined/turned surfaces. Graft donor site did not influence implant survival. Conclusion: This study demonstrated the difficulties encountered with immediate placement of dental implants at the time of post‐cancer reconstructive surgery.     

光棒引导经鼻插管在张口困难患者中临床应用

目的:探讨光棒引导经鼻气管插管在张口困难患者中应用的可行性.方法:选择82例口腔颌面外科张口困难(张口度＜2.5 cm)患者,在快诱导麻醉下由光棒引导经鼻气管插管.记录患者麻醉诱导前后、插管过程中和插管后的SBP、DBP和HR.记录插管成功时的插管次数、插管时间及术后24 h并发症发生率.结果:82例患者中,53例(64.6％)一次性插管成功,29例(35.4％)经2～3次插管成功.插管操作时间(75.4-±26.4)s.与诱导前相比,插管时的BP和HR差异无显著性.术后随访2例有轻微咽部不适,1例主诉咽喉疼痛.结论:光棒引导经鼻气管插管对血流动力学影响轻微,口咽部损伤小,成功率高,在张口困难患者中值得推广应用.     

手足口病病原体核酸在患者不同样本中的分布

目的探讨手足口病患者不同样本病毒检出率差异,为手足口病检测样本的选择和疫情控制提供一定依据。方法用实时荧光定量PCR技术,通过一步法RT-PCR扩增对55例临床确诊为手足口病住院患儿的咽拭、肛拭、血液和尿液样本进行肠道病毒71型（EV71）和柯萨奇病毒A16型（CoxA16） PCR-荧光探针核酸检测。结果本组患者咽拭样本阳性37例（67.3%）,肛拭样本阳性34例（61.8%）,差异无统计学意义（χ2=0.8,P＞0.05）;血液样本阳性13例（23.6%）,尿液样本阳性9例（16.4%）,差异无统计学意义（χ2=2.25,P＞0.05）;血液、尿液样本阳性率同咽拭样本比较,差异均具有统计学意义（χ2分别为22.0和26.0,P均＜0.005）;肛拭、咽拭均阳性的33例样本中有9例肛拭样本的循环阈值（CT）小于咽拭,占24.2%（9/33）。结论为获得病原学依据,应对咽拭阴性的患者可进行肛拭样本检测。在疫情防控中,对手足口病患儿血液、尿液可能造成的感染应引起重视。     

653例手足口病并神经系统损害患者的早期临床表现及脑脊液分析

目的分析手足口病并神经系统损害的早期临床表现及脑脊液特点,为手足口病并神经系统损害的早期诊断提供依据。方法回顾性分析本院2232例手足口病中合并神经系统损害653例的年龄分布、早期临床表现、病原体及脑脊液改变特点。结果653例多发于6个月～3岁,病原体以肠道病毒71型为主,早期表现多有持续发热、易惊、肢体抖动、嗜睡、易激惹、呕吐、头痛或头晕、肢体无力、抽搐等表现,脑脊液有程度不同的氯化物降低、白细胞或蛋白增高。结论手足口病合并神经系统损害常在早期就存在不同的非特异性临床表现和脑脊液改变,应引起重视,及时予以诊断和治疗。     

Cost-effectiveness analysis of burning mouth syndrome therapy

Hens MJ, Alonso‐Ferreira V, Villaverde‐Hueso A, Abaitua I, Posada de la Paz M. Cost‐effectiveness analysis of burning mouth syndrome therapy. Community Dent Oral Epidemiol 2012; 40: 185–192. © 2011 John Wiley & Sons A/S Abstract – Objective: To study the cost‐effectiveness of four alternative treatments for burning mouth syndrome (BMS). Methods: A cost‐effectiveness analysis was conducted from a healthcare payer perspective of four therapy strategies (amisulpride, paroxetine, sertraline and topical clonazepam), using a decision‐tree model that incorporated direct healthcare costs and probabilities associated with the possible events and outcomes. Average cost‐effectiveness and incremental cost‐effectiveness ratios were calculated. Sensitivity analyses included the costs of brand name and generic drugs in five European countries (France, Italy, the Netherlands, Spain and UK), as well as two scenarios with different treatment length. Results: Of the drugs analysed, topical clonazepam proved to be the most cost‐effective therapy. Although generic proved more efficient than brand name drugs, they displayed no advantage over brand name topical clonazepam. The Netherlands was the country with the highest overall drug efficiency. Sensitivity analyses highlighted the robustness of the model, because topical clonazepam proved to be the most efficient therapy under all the different scenarios. Conclusions: Topical clonazepam, which previous analyses of clinical evidence have shown to be the drug of choice for BMS, also proved to be the most cost‐effective of the drugs analysed for this condition.     

手足口病患儿血清硫化氢及白细胞介素-6水平改变的研究

目的：研究手足口病(hand,foot and mouth disease,HFMD)患儿血清硫化氢(hydrogen sulfide,H2 S)与白细胞介素(interleukin,IL)-6水平改变的意义。方法选择在我院住院治疗的92例HFMD 患儿为研究对象,根据病情,选择其中48例为重症 HFMD 组,44例为普通 HFMD 组,选择同期健康儿童46例为健康对照组。分别检测其血清 H2 S 及 IL-6水平。结果急性期：重症 HFMD 组与普通 HFMD 组血清 H2 S [(21.72±7.52)μmol /L、(31.86±8.41)μmol /L]水平均明显降低,IL-6[(131.33±17.82)ng /L、(95.48±15.07)ng /L]水平明显升高,与健康对照组[H2 S (55.76±7.80)μmol /L,IL-6(61.31±13.43)ng /L]比较差异有统计学意义(P ﹤0.01);重症 HFMD 组与普通HFMD 组比较差异有统计学意义(P ﹤0.01)。恢复期：重症 HFMD 组血清 H2 S[(34.54±13.21)μmol /L]水平仍低于健康对照组,IL-6[(92.73±15.25)ng /L]水平仍高于健康对照组,差异有统计学意义(P ﹤0.01)。相关性分析显示：重症 HFMD 组与普通 HFMD 组血清 H2 S 与 IL-6水平之间均呈显著负相关(r ＝-0.31,P ﹤0.01;r ＝-0.45,P ﹤0.01)。结论 HFMD 患儿血清 H2 S 和 IL-6水平发生了改变,并且可作为重症 HFMD 患儿早期诊断的指标之一。