腮腺造影用于腮腺疾病的诊断112例分析

目的探讨腮腺造影对腮腺疾病的诊断价值。方法回顾性分析112例139个腺体的腮腺造影影像学特征及诊断结果。结果舍格伦综合征38例、儿童复发性腮腺炎27例、慢性阻塞性腮腺炎29例,其影像学表现符合其各自的特征性表现而得到确诊,良性肥大8例中的2例结合B超检查确诊,腮腺肿瘤10例中有2例结合B超检查定性。结论腮腺造影对腮腺非肿瘤性疾病有诊断价值,腮腺肿瘤应结合病史、化验并配合高频超声等其他手段提高诊断准确率。     

SMAS folded flap and allograft dermal matrix repairing parotid bed following parotidectomy to prevent facial deformity and Frey＇s syndrome

PURPOSE： This study evaluates the outcome of superficial musculoaponeurotic system （SMAS） and allograft dermal matrix （ADM） in preventing facial deformity and Frey＇s syndrome following parotideetomy. METHODS： Forty-six patients with benign parotid tumors were randomly assigned to 4 groups. The control group consisted of 12 patients who underwent a total parotidectomy; The AMD group consisted of 10 patients who underwent a total parotidectomy and underwent intraoperative placement of ADM within the parotid bed; SMAS group consisted of 11 patients who underwent a total parotidectomy and SMAS folded flaps to repair parotid bed; and SMAS plus AMD group consisted of 13 patients who underwent a total parotideetomy and intraoperative placement of ADM to repair parotid bed with SMAS folded flaps. All 46 patients were evaluated via a short questionnaire regarding perception of a facial contour deformity, Frey＇s syndrome, modified Minor＇s starch-Iodine test （MSIT）, and clinical examination. RESULTS： Twelve months of follow-up was conducted after the treatment, the rates of satisfaction with the post-operative facial contour were 33.3% （4/12）,40.0% （4/ 10）,91.9% （10/11） and 100%（13/13） respectively in the control group, AMD group, SMAS group and SMAS plus AMD group, and the difference between the SMAS plus AMD group and the former two groups was statistically significant （P〈 0.05）. The incidences of objective Frey＇s syndrome by MSIT were 50.0 % （6/12）, 20.0% （2/10）, 27.3% （3/11） and 7.7% （1/13） respectively, and the difference between the SMAS plus AMD group and the control groups was statistically significant （P〈0.05）. CONCLUSION： The SMAS folded flap is clinically simple to perform, which can prevent depressed facial deformity. Combination of SMAS folded flap and ADM can reduce the incidence of Frey＇s syndrome in patients undergoing parotidectomy.     

腮腺磁共振造影在舍格伦综合征诊断中的价值

目的：探讨腮腺磁共振造影在舍格伦综合征（SS）诊断中的价值。方法：应用磁共振涎腺成像及磁共振造影（MRS）诊断腮腺表现为主的舍格伦综合征，在选择合理诊断标准的基础上，结合免疫学指标、病理学检查进行诊断。并与腮腺造影结果进行比较。结果：32例最终诊断为SS的25例患者中，23例MRS诊断出现典型的表现，即导管和腺泡不规则的扩张，并能排除腮腺占位性病变。敏感度：92％：特异度：71．4％；准确度：87．5％。伴有自身抗体出现的占68．％：唇腺活检符合SS表现的占72％。18例SS患者MRS与腮腺造影均有阳性表现，15例结果基本相同，占83.3％。结论：MRS能客观地反映舍格伦综合征患者受累腺体的病变情况和程度，是SS诊断和与腮腺肿瘤性疾病鉴别诊断的重要方法之一。     

不同腮腺症状原发性舍格伦综合征的血清学分析

目的:研究不同腮腺症状的原发性舍格伦综合征(primary Sj觟gren’s syndrome,p SS)患者之间的血清学特征的差异性。方法:回顾性研究289名患者,均符合原发性舍格伦综合征(2002年修订的欧美联合诊断标准)。依据患者腮腺的临床特征,将患者分为以下4组:第1组(类肿瘤组)、第2组(感染组)、第3组(肿大组)、第4组(口干组)。对比各组之间的人口统计学和血清学特征。每两组之间结果的统计学分析用t检验,F检验,卡方检验,方差分析。结果:不同的腮腺临床特征的p SS患者具有不同的血清学表型。第1组的血清免疫球蛋白Ig G值是4组中最高的,而补体C4是4组中最低的。第2组的血清免疫球蛋白Ig E值是4组中最高的。第3组的血沉值是4组中最高的。结论 :不同腮腺临床症状的p SS患者具有不同的血清学表型。这可能有助于增进我们对该疾病的认识。     

舍格伦综合征患者腮腺造影追踪观察

作者报告３６例舍格伦综合征Ｘ线追踪观察结果。追踪时间５～７２个月，平均２５个月。参考国际分类标准将患者分为三组：继发组１４例（眼干或（和）口干及结缔组织病）；原发组１４例（口干和眼干）；可能组８例（仅口干或眼干）。追踪结果各组Ｘ线表现：①形态无改变，功能更加迟缓，最早可发生在５个月后；②末梢导管点状扩张（点扩）增多；③点状扩张减少，末梢导管球状扩张（球扩）增多；④点、球、腔扩及阴性涎石；⑤向心性萎缩。本组资料显示：①眼干及结缔组织病继发组、仅眼干的可能组内，对腮腺影响不大，造影改变不明显，无点状扩张，而呈阴性涎石伴管炎改变，要结合临床才能与慢性阻塞性腮腺炎鉴别；②总唾液流率与腮腺造影改变呈负相关关系，总唾液流率低者腮腺造影点扩多，反之亦然。     

儿童难治性腮腺气肿1例报道及文献回顾

目的 探讨腮腺气肿的治疗方法,为临床提供参考。方法 报道1例儿童难治性腮腺气肿,结合文献对腮腺气肿的诊疗进行回顾分析。结果 该例患儿无明显诱因腮腺肿大1个月余,经抗炎治疗、心理干预治疗、物理加压治疗等保守治疗后无效,患儿既往有脑瘫伴癫痫病史,存在非自主性鼓颊行为,考虑为难治性病例。经腮腺导管结扎及腮腺浅叶部分切除术后得到根治。文献回顾表明,腮腺气肿是一种罕见的腮腺肿大,多为口腔内压力增加引起空气经腮腺导管返流入腮腺内所致,其诊断主要依靠间歇性的腮腺肿胀等临床表现及超声、CT、MRI、造影等影像学检查手段。现阶段治疗措施主要包括保守抗炎治疗、物理治疗、心理干预,手术治疗是难治性腮腺气肿的最终治疗手段。结论 腮腺气肿有进一步发展为腮腺炎症的可能,一般采取保守治疗,对于一些重症、复发性以及依从性差的病例,需要进行手术治疗。     

双侧拉杆式口腔矫治器治疗OSAHS前后上气道容积变化及相关因素分析

Objective To investigate the morphologic change of upper airway induced by oral appliance(OA) of double-pull rods in obstructive sleep apnea and hypopnea syndrome(OSAHS) and analyze relevant factors, subsequently investigate treatment mechanism of OA for OSAHS. Methods Nine OSAHS patients (male, 25-43yeas old), diagnosed by polysomnography, successfully treated with OA. After 3 months treatment, each patient received Helical computed tomography in central relation with and without OA respectively. Upper airway structures were reconstructed at threedimension and measured by VG Studio. Results The volume of the upper airway of all 9 patients were increased when patients with OA. A significant negative relationship was found between △volume and BMI(r=-0. 70,P=0. 03). No significant relationship is found between△volume and FH-MP(r=-0. 43,P=0. 25), between△volume and AHI (without OAs)(r=0. 30,P=0. 43), and between△volume and△AHI(r= 0. 39, P=0. 29). Conclusions OSAHS patients can be effectively treated with mandibular advancement devices (MAD), with increased volume of upper airway which is influenced by BMI. The degree of volume increase is not consistent with improvement induced by treatment in patients with OSAHS.     

牙周非手术治疗对2型糖尿病伴牙周炎患者糖代谢及血清白细胞介素6的影响

目的 观察牙周非手术治疗对2型糖尿病伴慢性牙周炎(chronic periodontitis,CP)患者牙周状况、糖代谢及血清白细胞介素6(IL-6)的影响,探讨其可能的影响机制.方法 选取2型糖尿病伴慢性牙周炎(type 2 diabetes mellitus with chronic periodontitis,DMCP组)和不伴有全身系统性疾病的CP患者(CP组)各55例进行牙周非手术治疗,其中DMCP组中糖化血红蛋白(glycated hemoglobin,HbA1c)＜7.00%的患者为血糖控制较好组(A1组),HbAlc≥7.00%的为血糖控制较差组(A2组).在治疗前及治疗后6周、3个月时分别记录全口探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、出血指数(beeding index,BI)和菌斑指数(plaque index,PLI),并检测空腹血糖(fasting plasma glucose,FPG)、HbA1c及血清IL-6水平.结果 DMCP组和CP组PD、AL、BI、PLI和血清IL-6水平在治疗后6周及3个月时均显著降低(P＜0.05),其中DMCP组血清IL-6从(3.47±0.33)ng/L(治疗前)显著降至(3.21±0.66)ng/L(治疗后6周),再降至(3.03±0.54)ng/L(治疗后3个月).DMCP组治疗后3个月HbA1c水平[(6.80±1.21)%]与治疗前[(7.35±1.73)%]相比显著降低(P＜0.05),其中A2组HbA1c水平从治疗前的(8.72±1.51)%显著降至治疗后3个月的(7.59±1.28)%(P＜0.05),而A1组HbA1c水平则无明显变化(P＞0.05).结论 牙周非手术治疗能够降低DMCP患者血清IL-6水平,并在一定程度上改善患者糖代谢状况;该治疗能显著改善血糖控制较差者的糖代谢,而对血糖控制较好者的糖代谢则无明显影响.

Abstract：

Objective To evaluate the effect of non-surgical periodontal therapy on periodontal status, glycemic control and the level of serum interleukin(IL)-6 in type 2 diabetic patients with chronic periodontitis (DMCP). Methods Fifty-five DMCP and 55 systemically healthy patients with chronic periodontitis(CP) were recruited in this study. The diabetes were classified into two groups, the wellcontrolled group [glycated hemoglobin (HbA1c) ＜ 7.00%]and the poorly controlled group (HbA1c ≥7.00%). All subjects received non-surgical periodontal therapy. Periodontal clinical parameters including periodontal probing depth (PD), attachment loss (AL), bleeding index (BI) and plaque index (PLI) were recorded at baseline, 6 weeks and 3 months after the treatment. Fasting plasma glucose(FPG), HbA1c and the concentration of serum IL-6 were measured. Results At 6 weeks and 3 months after treatment, PD,AL, BI, PLI and the concentration of serum IL-6 of both groups significantly reduced(P ＜ 0. 05). The level of IL-6 in diabetic patients reduced significantly from (3.47 ±0.33) ng/L to (3.21 ±0.66) ng/L and to (3.03 ± 0. 54) ng/L. The HbA1c of diabetic patients reduced significantly 3 months after treatment [(6.80±1.21%]compared with the baseline[(7.35 ± 1.73)%, P ＜0.05]. HbA1c of the poorly controlled group reduced significantly(P ＜0. 05), while HbA1c of the well-controlled diabetes did not show any apparent reduction (P ＞ 0. 05). Conclusions Non-surgical periodontal therapy can effectively reduce the concentration of serum IL-6, thereby improving glycemic control in type 2 diabetes patients with chronic periodontitis. However, there was no any significant reduction of HbA1c in the well-controlled diabetes.     

65例恶性成分为非特异性腺癌的涎腺恶性多形性腺瘤临床病理特点

目的 研究分析恶性成分为非特异性腺癌的涎腺恶性多形性腺瘤(malignant pleomorphic adenoma,MPA)的临床病理特点,以期为临床诊断和治疗提供参考.方法 回顾性分析115例原发MPA的临床病理资料,应用统计学软件分析恶性成分为非特异性腺癌和其他组织学类型病例在临床病理特点方面的差异,分析恶性成分为非特异性腺癌病例的临床病理指标与颈淋巴结转移的相关性.结果 恶性成分为非特异性腺癌的65例原发MPA中,男性58例,女性7例;发病年龄23～83岁,平均57岁,50～59岁最好发;发生于大涎腺61例,小涎腺4例;组织学分级为低、中、高度恶性者分别为12、14、39例;非侵袭性、微侵袭性、侵袭性MPA分别为15、13、37例;13例发生颈部淋巴结转移.恶性成分为非特异性腺癌的原发MPA组织学分级与侵袭性呈显著正相关(P＜0.05);侵袭性与TNM分期呈显著正相关(P＜0.05);侵袭性和组织学分级与颈部淋巴结转移之间有显著相关性(P＜0.05).结论 MPA恶性成分组织学类型最常见为非特异性腺癌,组织学分级越高,肿瘤的侵袭性越强;侵袭性癌、组织学分级高度恶性者易发生淋巴结转移.

Abstract：

Objective To analyze the clinicopathologic features of salivary malignant pleomorphic adenoma(MPA)(the subtype of the malignant component was classified as non-specific adenocarcinoma). Methods The clinical and pathological characteristics of 115 salivary gland tumors histologically diagnosed as MPA were analyzed. Results In all the 65 MPA cases, there were 58 male and 7 female patients, and the mean age was 57 years(from 23 to 83). Sixty-one tumors were located in major salivary glands, and 4 in minor. Histologically the malignant components of 39 tumors were high-grade, 14 intermediate-grade, and 12 low-grade. Thirty-seven tumors were invasive carcinoma, 13 minimally invasive, and 15 non-invasive. The high-grade tumors had positive correlation with the invasive carcinomas(P＜0.05). The invasive carcinomas had positive correlation with TNM clinical stage(P＜0.05). The invasive carcinoma and the high-grade tumor had correlation with cervical lymph node metastasis (P＜0.05).Conclusions Non-specific adenocarcinoma are the most common malignant subtype in MPA. The invasive and the high-grade types are more likely to metastasize to cervical lymph node.     

Evidence of the validity of a model of determinants of quality of restorative dental care

A model describing the relationship between self-reported quality of restorative dentistry and dentist characteristics for 119 Montana general dentists is presented. The best predictors formed a significant model explaining 22% of the variance of the quality measure. Results are contrasted with a previous estimation of the model for 102 Washington general practitioners. Evidence for the external validity of the model is presented.     

不同剂型玻璃离子水门汀溶解性比较研究

目的:研究、比较不同剂型玻璃离子水门汀的溶解性和表面微观形态改变,为临床使用提供依据.方法:将3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)及GC玻璃离子水门汀(双糊剂型)分别在人工唾液中浸泡30 d,冷热循环15000次,烘干测重,比较前后质量变化,计算溶解率,并用扫描电镜观察表面微观改变.结果:不同剂型的玻璃离子水门汀溶解率由高到低分别为3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(双糊剂型).3种玻璃离子水门汀经浸泡溶解后,SEM扫描表面微观形态可观察到GE玻璃离子水门汀(双糊剂型)表面形态改变较少,其他2组玻璃离子水门汀表面微观改变较多.结论:双糊剂型玻璃离子水门汀理化性能及溶解率均低于传统水粉剂型,是未来临床修复治疗的的良好选择.     

Evaluation of efficacy of chemiluminescence for diagnosis of leukoplakia

ObjectiveLeukoplakia is the most common potentially malignant disorder preceding oral cancer. Chemiluminescence has been developed as an adjunct to conventional examination for the diagnosis of these potentially malignant disorders. This study was conducted to assess the efficacy of chemiluminescence in the diagnosis of leukoplakia and to compare the results with histopathological examination.Study designA total of 50 patients with leukoplakia were included from the outpatients attending the Department of Oral Medicine and Radiology, Dental Hospital, Bengaluru, Karnataka, India. These patients were subjected to conventional oral examination followed by chemiluminescent examination with Vizilite (Zila, Fort Collins, CO, USA) and biopsy for histopathological confirmation.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of chemiluminescence were 93.75%, 55.56%, 78.95%, and 83.3%, respectively. The overall accuracy of chemiluminescence was 80%. A statistically significant association was observed between histopathology results and chemiluminescence results.ConclusionAlthough it is an easy, safe, minimal time consuming, and noninvasive technique, it has only adjunctive utility and it does not replace biopsy for the diagnosis of leukoplakia.     

Design of clinical trials of traditional therapies of periodontitis

The present paper on the design of clinical trials of periodontal therapy first addresses the issue of the etiology of periodontal disease. It is suggested that most if not all forms of destructive periodontal disease are caused by microorganisms and that there are different forms of disease with different microbial etiologies. The progressive nature of destructive periodontal disease is subsequently discussed and it is emphasized that, in a given patient, periodontal sites which show signs of inflammation and attachment loss may not over a period of several months and years show further sign of attachment loss. The present methods of assessing periodontal disease do not allow us to discriminate between potentially active and inactive sites in untreated patients. The significance and variability of indicators of periodontal disease such as bleeding on probing, probing pocket depth and probing attachment level measurements are discussed. The errors inherent in the various measurements are analyzed and suggestions are presented describing how alterations in any of the above parameters could be identified and presented in a clinical trial. Of concern for the statistical analysis of clinical data of periodontal disease is the definition of the "experimental unit". For a number of years, the "experimental unit" in periodontal trials was the patient. It is clear, however, that different sites within the same individual show different patterns of disease progression and lesion morphology and often respond differently to periodontal therapy. Statistical analyses must consequently be designed which recognize differences in site-to-site infection and lesion morphology within a common host. Until such analyses are available, the investigator should be wary of pooling data within the same individual, since such pooling may obscure meaningful alternatives which may take place in individual periodontal sites. Some goals of periodontal therapy are subsequently identified. 4 goals are discussed more in detail, namely: to establish conditions which will allow the patient to maintain a dentition without further breakdown of the periodontium; to reduce pocket depth to establish an anatomy in the dentogingival region which with proper maintainance care will prevent the re-establishment of the subgingival infection; to gain attachment as a result of treatment; to assess the effect of a certain chemotherapeutic agent on periodontal disease.     

正畸患者切牙影像失真发生情况分析

目的研究正畸患者曲面体层片上的切牙影像失真发生情况，并分析其原因。 方法从中山大学附属口腔医院放射科影像数据库中选取500例正畸患者的曲面体层片和头影测量侧位片，所有曲面体层片均采用咬合杆投照，分别从切牙牙体影像放大、缩小、牙根变短、根尖模糊等评价指标分析上下颌切牙影像失真的发生情况，在头影测量侧位片上测量中切牙根尖-对颌切牙切缘的距离，探讨切牙影像失真发生的原因。采用SPSS 19.0统计软件对所得数据进行统计学检验。 结果500例患者中，切牙牙体影像正常者共417例，切牙牙体影像失真者共83例，影像失真发生率16.6%，其中切牙牙体影像放大17例、牙体影像缩小0例、牙根变短30例，牙根影像变短伴模糊36例。影像失真患者的根尖-切缘距离大于影像正常的患者，差异有统计学意义（F = 5 187.18，P = 0）；影像失真患者的覆盖值大于影像正常的患者，差异有统计学意义（F>477，P = 0）。 结论严重牙颌面畸形如反 、深覆盖是导致曲面体层片的切牙影像失真的主要原因之一。     

Experimental evidence of formation of imines in the course of reduction of hydrazones

The reduction of hydrazones is generally suggested to proceed through a reductive cleavage of the nitrogen–nitrogen bond followed by a reduction of the carbon–nitrogen bond. This sequence of reduction processes is here supported for fluorenone (V) and benzophenone (VI) hydrazones as well as by a comparison of the reduction of fluorenone and benzophenone hydrazonium ions (I,III) with corresponding imines (II,IV). Another proof of the presence of imines as intermediates is the splitting of four-electron waves of hydrazones V and VI and hydrazonium ions I and VIII into two waves at pH < 2. This has been interpreted as due to differences in slopes dE_1/2/dpH and pK_a-values of protonated hydrazine derivatives on one side and corresponding imines on the other. In this pH-range imines formed in reductions of VI and VIII are reduced in a single two-electron wave, those of I and V in two one-electron steps. Fluorenone imine (II) is sufficiently stable to allow recording of time-independent current–voltage curves between pH 6 and 11. In this pH-range the imine (II) is reduced in two one-electron steps. Benzophenone imine (IV) has been found stable between pH 4.6 and 12. At pH 4.6–8 the reduction of the imine IV takes place in a single two-electron step, at pH 8–12 in two one-electron steps. Final proof of the initial cleavage of the N–N bond is presented by comparison with the reduction of nitrones.     

正常青年Monson球面半径的测量研究

目的测量正常青年Monson球面半径。方法选择60名(男30名,女30名)正常青年制取全口印模,应用立体摄影成像的原理与方法对Monson球面半径进行测量和统计学处理。结果Monson球面的半径平均为10.173 cm,大于理论值10.160 cm,差异有显著性(P<0.01);男、女性球面半径差异无显著性。结论本实验所得到的数据可作为全口义齿修复中记录颌位关系的一个参量。     

比色板标准与非标准色标识别差异的初探

目的 测试口腔修复学专业研究生对比色板标准色标与非标准色标颜色识别的差异,评价、分析口腔修复学专业研究生临床实际比色能力,为探讨临床比色教学方法提供客观的基础数据.方法 选择具有1～5年临床工作经验、排除色觉识别障碍、经过色彩学知识培训的口腔修复学专业研究生62名.从比色板A(Lineargnide)的29个标准色标中通过随机数字表抽取7个色标作为标准色标,以比色板B(Vita Bleachadgnide 3D-Master)中的7个色标作为非标准色标,在D55标准光源下,以比色板C(Vita 3D-Master)作为比色工具,对标准色标和非标准色标进行比色测试.计算受试者对两种色标比色的总体准确率;统计比色正确的人数分布,并进行Monte Carlo确切概率法检验;统计比色结果在明度、饱和度、色相上的等级偏差,并进行Wilcoxin符号秩和检验.结果 受试者对标准色标比色的总体正确率为45.9%(199/434),对非标准色标比色的总体正确率为9.0%(39/434);对两种色标比色正确的人数分布的差异有统计学意义(P<0.001);对两种色标比色结果的明度等级偏差[分别为0.2(0.1～0.3)、0.4(0.4～0.5)]、饱和度等级偏差[分别为0.2(0.1～0.4)、0.5(0.4～0.6)]的差异均有统计学意义(P<0.01),色相等级偏差[分别为0.3(0.1～0.4)、0.3(0.1～0.4)]的差异无统计学意义(P=0.079>0.01).结论 口腔修复学专业研究生对比色板非标准色标颜色的识别能力明显低于对标准色标颜色的识别能力.     

Electrodeposition of bilayers of dithiols

We report an electrochemical method to form a bilayer of dithiol. The cyclic voltammogram of the oxidative deposition of an aromatic dithiol on gold from an alkaline aqueous solution reveals two current peaks separated by more than 400 mV. The integrated charge of the oxidative current peak (B) at the most positive potential is twice that of the other oxidative current peak (A). These two oxidative current peaks were characterized by differential capacitance and electrochemical quartz crystal microbalance (EQCM) measurements. A decrease of the capacity by a factor of two, and an increase of the EQCM frequency change by a factor of two were observed when the potential was scanned from a value where only the first oxidative peak (A) is obtained, to a potential where both oxidative current peaks (A and B) are obtained. Infrared spectra show that the aromatic dithiols adsorb vertically at potentials corresponding to the current peak A and they become tilted for potentials corresponding to the current peak B. The simple relationships between the properties of the two oxidative current peaks are found to be compatible with a step-wise oxidative deposition of a bilayer of dithiol.