下颌KennedyⅡ类牙列缺损冠外附着体义齿的三维有限元分析——基牙数目对支持组织应力分布的影响

目的：探讨不同基牙数目下,下颌单侧游离端缺损冠外附着体义齿修复支持组织的应力分布情况。方法：建立下颌KennedyⅡ类牙列缺损冠外附着体义齿修复的三维有限元模型,分析在垂直向和侧向载荷作用下采用不同基牙数目时,基牙牙周组织及缺牙区牙槽嵴的Von Mises应力分布。结果：不同载荷方向,末端基牙均受到较大的非轴向应力,应力主要集中在牙颈部,缺牙区牙槽嵴的应力较大。单侧基牙数由1个增加到2个时,远中基牙牙周的应力略有减小,但当基牙数目从2个增加至3个时,垂直向和颊舌向加载时末端基牙牙周膜和牙槽骨的应力均有明显下降,但在舌颊向加载时,第二前磨牙各部位的应力没有明显下降,部分牙颈部的应力反而有所增加。结论：在下颌单侧游离端缺损修复中,冠外附着体义齿支持组织应力的减小与基牙数目的增加不完全成比例,在临床上应根据具体情况确定联合基牙的数目。     

Antibacterial treatment needed for severe early childhood caries

OBJECTIVES: To assess the effects of a single 10% povidone iodine application as an adjunct to extensive surgical procedures in the clinical treatment of children with early childhood caries. METHODS: Twenty-two children scheduled for dental treatment under general anesthesia were randomized into either an intervention group (10% povidone iodine), or a control group (phosphate buffered saline). Either povidone iodine or phosphate buffered saline was applied to teeth and soft tissues after prophylaxis and all operative dental procedures, followed by 1.23% acidulated phosphate fluoride gel. Saliva samples taken at baseline, and after 1 hour, 3 weeks and 3 months were assayed for mutans streptococci, lactobacilli and total viable bacteria. Caries lesions were recorded at baseline and at one year. RESULTS: Mutans streptococci and lactobacilli levels in the povidone iodine group were significantly reduced relative to baseline at 1 hour, 3 weeks and 3 months. At one year at least 60% of subjects had new caries lesions in each group, and there was no significant difference in caries increment between the two groups. CONCLUSIONS: Even prophylaxis, fluoride gel application and complete surgical treatment of caries at baseline were insufficient to prevent new caries in over 60% of the patients in these high caries risk infants. Although the one-time treatment with povidone iodine reduced mutans streptococci and lactobacilli levels for up to 3 months this therapy failed to additionally reduce future caries formation over one year, indicating that repeated antibacterial treatments will be needed to control high levels of cariogenic bacteria.     

Ⅰ类洞树脂充填中不同调和比例基底材料的三维有限元应力分析

目的分析树脂充填中采用不同调和比例的基底材料垫底盖髓时，其对牙体和修复体受力可能造成的影响。方法测定调和比例分别为1∶1、3∶4、4∶3的玻璃离子Vitrebond及化学固化氢氧化钙Dycal弹性模量及泊松比，采用Micro- CT扫描离体牙标本，建立下颌第一磨牙Ⅰ类洞的三维有限元模型，模拟不同调和比例的基底材料垫底盖髓，复合树脂充填，生理性力作用下对牙体、修复体进行应力分析。结果不同调和比例的Vitrebond和Dycal的弹性模量不同。在生理性力作用下，Vitrebond或Dycal调和比例不同时，其对牙体、修复体所受应力的大小及分布影响不大。与Vitrebond垫底相比，Dycal垫底时牙体的峰值应力及高应力区面积均较大。结论人为改变双组份基底材料的理想调和比例会影响材料部分机械性能，但其对牙体、充填体、垫底材料的应力分布影响不大。为避免应力集中，在深龋治疗中应尽量使用弹性模量与牙本质或修复体相接近的基底材料。     

口腔颌面癌瘤的颈淋巴结转移及颈淋巴清扫术的临床研究

目的 探讨口腔颌面癌瘤颈淋巴结转移的部分规律及其与颈淋巴清扫术间的关系。方法 对250例行颈淋巴清扫联合根治术的口腔颌面癌病例进行回顾性研究。结果 口腔颌面癌颈淋巴结转移率为18．8％，其中鳞癌的颈淋巴结转移率为23．4％，腺上皮源性癌颈淋巴结转移率为9．6％，颈淋巴结转移临床诊断与病理诊断符合率为58．4％，漏诊率为9．1％。结论 鳞状上皮细胞癌比腺上皮源性癌更易发生颈淋巴结转移；临床诊断阳性的颈淋巴结应实施颈淋巴清扫术，对N0期颈淋巴结应采取适时监测，当其转为阳性时可再行手术治疗。     

青年心肌致密化不全合并心力衰竭1例并文献复习

目的 系统回顾心肌致密化不全(NVM)的疾病特点及诊治要点,并总结该病的治疗经验.方法 回顾性分析2020年4月2—18日及9月2—7日该院心内科入院收治的1例NVM合并心律失常、心力衰竭及血栓栓塞等多种并发症的青年患者的诊治经过,并系统随访11个月,观察患者预后.结果 积极控制并纠正心律失常后患者心脏结构及功能呈现可逆性改善.结论 NVM是临床较为罕见的先天性心肌病.其临床表现多样而不典型,可出现包括心律失常、心力衰竭、血栓栓塞等多种不良事件,甚至可出现心源性猝死等恶性后果.临床医师需加强对该病的认识,为及时确诊并合理治疗提供可能.     

载脂蛋白E基因多态性与面肌痉挛发病率的相关性研究

目的:研究载脂蛋白E基因(apolipoprotein E gene,APOE)多态性与面肌痉挛发病率是否存在关联.方法:收集重庆医科大学附属第一医院94例面肌痉挛患者(面肌组)和73例正常人(对照组)的临床资料,采用限制性片段长度多态性聚合酶链反应(cleaved amplification polymorphism sequence-tagged sites,CAPs)检测所有人员的APOE基因型,分别计算出面肌组和对照组3种APOE等位基因,即APOEs2、APOEε3和APOEε4的分布情况,进行统计学分析其分布是否存在差异.结果:面肌组APOEε4等位基因频率为15.43％,明显高于对照组的6.85％;同时,面肌组的APOEε4等位基因携带者所占比例为29.79％,也明显高于对照组的13.70％,2组之间差异具有统计学意义(P--0.014).结论:APOE基因多态性可能与面肌痉挛的发病率有关,其中APOEε4等位基因携带者可能更容易罹患面肌痉挛.     

肺磨玻璃结节的CT征象与组织学类型相关性分析

目的 探讨肺磨玻璃结节(ground glass nodule,GGN)的CT征象与其组织学类型的相关性,为临床制定应对策略提供影像学依据.方法 收集2013年7月至2019年12月北京中医医院平谷医院经手术病理证实的136例GGN患者的CT检查资料,其中浸润前病变(不典型腺瘤样增生和原位腺癌)40例、腺癌(微浸润癌、浸润性腺癌、浸润性黏液腺癌)96例,比较两组GGN的CT征象,分析不同病理类型GGN间的差异.结果 浸润前病变组GGN以纯磨玻璃结节为主(80％),腺癌组以混合磨玻璃结节为主(60.4％),两组间病灶密度、毛刺征、分叶征、空气支气管征、胸膜凹陷征、有无血管穿行征象比较,差异均有统计学意义(P＜0.05).腺癌组病灶大小平均(0.97±0.48)cm,明显大于浸润前病变组的(0.76±0.34)cm,差异有统计学意义(t =-2.485,P＜0.05).二元logistic回归分析显示,GGN的密度和血管穿行征象是预测肺腺癌的重要因素.结论 肺纯磨玻璃结节常提示浸润前病变,而混合磨玻璃结节伴血管穿行常提示浸润病变.     

补阳还五汤促进脑缺血大鼠脑组织微结构重塑的作用

目的 研究补阳还五汤改善脑缺血大鼠脑血流灌注、促进轴突生长及微结构重塑的药理作用及机制.方法 线栓法制备右侧大脑中动脉栓塞脑缺血大鼠模型.将雄性SD大鼠随机分为假手术组、模型组和补阳还五汤组(16.1 g/kg),连续灌胃15 d后取材并检测指标.T2加权成像检测脑梗死体积;动脉自旋标记检测损伤脑区的血流灌注;弥散张量成像检测损伤脑区的超微结构.HE染色观察损伤脑区的病理损伤;免疫荧光染色法检测淀粉样前体蛋白(APP)、神经轴突生长抑制因子(NogoA)和神经轴突生长抑制因子受体(NgR)的蛋白表达,RT-PCR法检测生长相关蛋白-43(GAP-43)、NogoA和NgR的基因水平,以评价脑缺血大鼠轴突的生长及损伤情况.结果 MRI结果显示,与模型组比较,补阳还五汤组大鼠的脑梗死体积减小(P<0.05),梗死核心及周围皮层的血流灌注增加(P<0.05),梗死灶周围皮层的超微结构改善.HE染色结果显示,补阳还五汤组大鼠较模型组皮层正常形态神经细胞数量增加,异常形态神经细胞数量减少(P<0.01或P<0.05),水肿程度减轻,神经纤维致密性提高.免疫荧光染色结果显示,补阳还五汤组大鼠较模型组梗死灶周围皮层及内囊APP、NogoA蛋白的阳性表达降低(P<0.05或P<0.01),内囊NgR蛋白阳性表达降低(P<0.05).RT-PCR结果显示,补阳还五汤可下调梗死灶周围皮层NogoA、NgR基因表达水平(P<0.05或P<0.01).结论 补阳还五汤能够有效减小脑缺血大鼠的梗死体积,改善脑血流灌注和脑组织微结构,减轻神经细胞损伤,促进轴突生长及微结构重塑.     

Effects of Liancao-Xieli capsule on intestinal mucosal inflammatory factors and TLR4/PI3K/Akt/mTOR signaling pathway in mice with ulcerative colitis

Objective: To observe the effect of Liancao-Xieli capsule on intestinal mucosal inflammatory factors and TLR4/PI3K/Akt/mTOR signaling pathway in mice with ulcerative colitis (UC); Methods: 40 male C57BL/6 mice were randomly divided into the control group, model group, Liancao-Xieli group and mesalazine group, with 10 mice in each group. In addition to the control group, the remaining three groups of mice were induced by 3％ dextran sulfate sodium (DSS) to induce acute UC model. During the modeling period, mice in each group were given corresponding drugs and normal saline by gavage. At the end of the experiment, HE staining was used to observe the pathological changes of colonic tissue in each group, and ELISA was used to detect the inflammatory factors (TNF-α, IL-6, IL-1β, IL-8, IL-17, and INF-γ) in serum and colonic tissue. The expression levels of TLR4/PI3K/Akt/mTOR signaling pathway related proteins were also detected by Western blot; Results: Compared with the model group, Liancao-Xieli capsule could significantly increase the colon length and decrease the score of colon histopathology in UC mice (P<0.01). In addition, the levels of TNF-α, IL-6, IL-1β, IL-8, IL-17, and INF-γ were significantly reduced in serum and colon tissue, and the expressions of TLR4, PI3K, p-Akt and p-mTOR were significantly down-regulated in Liancao-Xieyi group when compared with the model group (P<0.01).While the expressions of Akt and mTOR were not significantly affected in Liancao-Xieyi group (P>0.05); Conclusion: Liancao-Xieli capsule can reduce the secretion of inflammatory factors, improve the intestinal mucosal damage and inflammatory response in UC by inhibiting the activation of TLR4/PI3K/Akt/mTOR signaling pathway.     

甲状腺全切除术在甲状腺癌外科治疗中的影响效果分析

目的 分析在甲状腺癌外科治疗中实施甲状腺全切除术的临床效果.方法 选取本院2017年1月至2020年1月收治的甲状腺癌患者124例,按照随机数字法分为参照组和研究组,每组62例.参照组采用甲状腺次全切除手术,研究组采用甲状腺全切除术.比较两组治疗效果、手术时间、术中出血量、住院时间及并发症发生率.结果 研究组治疗总有效率为96.77％,高于参照组的87.09％,差异有统计学意义(P<0.05).研究组术中出血量少于对照组,手术时间、住院时间均短于参照组,差异有统计学意义(P<0.05).研究组并发症发生率为3.23％,低于参照组的19.35％,差异有统计学意义(P<0.05).研究组总满意率为91.93％,高于参照组的70.97％,差异有统计学意义(P<0.05).结论 在甲状腺癌外科治疗中实施甲状腺全切除术效果更理想,患者术中出血量较少,手术时间、住院时间较短,且安全性较高,值得临床推广运用.