没食子口含液对牙周临床指标及口气的影响

目的:评价使用没食子口含液对牙周临床指标和口气的影响.方法:采用随机对照单盲试验的方法,选择2008年10月至2009年9月就诊于北京大学口腔医院牙周科门诊的菌斑性龈炎或轻、中度慢性牙周炎患者70例,随机分为仅使用没食子口含液口含2周的试验组和没有任何辅助用药的对照组,两组在基线时都接受了相同的口腔卫生指导,基线及2周时分别测定并记录口气指标[包括感官值(organoleptic score,OS)、口腔挥发性硫化物(volatile sulphur compounds,VSCs)水平、舌苔面积(area of tongue coating,Ta)、舌苔厚度(thickness of tongue coating,Tt)]和牙周指标[包括菌斑指数(plaque index,PⅡ)、探诊深度(probing depth,PD)、牙龈出血指数(bleeding index,BI)和色素指数(staining index,SI)].结果:2周后,两组牙周临床指标除了SI外都有显著改善(P<0.001),且试验组治疗后PⅡ的改善程度明显优于对照组,差异有统计学意义(P<0.05);2周后试验组的OS值和Tt以及对照组的0S值均降低(P<0.05),虽然试验组的口腔VSCs降低程度、OS值和Tt的改善程度有高于对照组的趋势,但差异并无统计学意义(P>0.05).结论:对于未治疗的菌斑性龈炎及轻、中度慢性牙周炎患者,没食子口含液有显著的菌斑抑制作用,但在改善121气方面较单纯刷牙不具有优势.     

牙周维护治疗在保持牙周长期疗效中的作用

目的:评估牙周维护治疗在保持牙周治疗长期疗效中的作用.方法:对在北京大学口腔医院接受过牙周基础治疗的慢性牙周炎患者进行回顾研究,其中未接受维护治疗者22例,接受维护治疗者17例.临床检查包括牙周探诊深度(probing depth,PD)、牙龈出血指数(bleeding index,BI)、缺失牙数,并拍摄全口根尖片评价牙槽骨高度(骨根比值).未维护治疗组的初诊和最后一次复诊的间隔时间平均为5.09年,维护治疗组平均为7.53年.比较初诊和最后一次复诊的上述各项临床指标.结果:未维护治疗组每人每年缺牙0.28颗,显著高于维护治疗组(0.09颗);复诊与初诊相比,未维护治疗组的PD值差异无统计学意义(4.13 mm vs.4.03 mm,P>0.05),而维护治疗组的PD值明显降低(4.02 mm vs.3.03 mm,P<0.05);未维护治疗组的牙槽骨骨根比由初诊时的59.15%下降到复诊时的54.76%,平均每年下降0.86%(P<0.05),而维护治疗组的牙槽骨骨根比复诊与初诊相比差异无统计学意义(60.51% vs.60.09%,P>0.05).结论:牙周维护治疗不仅可以降低年缺失牙率、PD、BI,而且能明显减缓牙槽骨的进一步吸收,确保了基础治疗后效果的长期稳定.     

伴牙周炎的代谢综合征者动脉硬化早期指标的检测

目的:探索慢性牙周炎(chronic periodontifis,CP)和代谢综合征(metabolic syndrome,MS)对动脉粥样硬化的协同作用.方法:口腔门诊就诊的CP患者59人,由内科医师依据病史、物理和血清检测结果,按照MS最新诊断标准分组,其中MS组26人,非MS对照组33人.同一名牙周医师记录口内缺失牙,存留牙近中颊和远中舌2个位点菌斑指数、出血指数、探诊深度和附着丧失(attachment loss,AL).彩色多普勒超声分别检测双侧颈总动脉内中膜厚度(intima-media thickness,IMT)和血流介导的血管舒张反应(flow-mediated dilatation,FMD),以这两项反映动脉粥样硬化早期血管改变.结果:MS组的AL显著高于对照组[(2.91±1.84)眠(1.97±1.74)mm,P=0.03],MS组颈动脉IMT及粥样斑块检出率高于对照组,左侧差异达到统计学意义[左侧IMT(1.00±0.45) vs.(0.80±0.26)mm,P=0.04,右侧IMT(0.87±0.44) vs.(0.78±0.31)mm,P=0.23;左侧斑块检出率34.62% vs.9.09%,P=0.02,右侧斑块检出率19.23% vs.9.09%,P=0.26].MS组FMD较对照组差,经检验差异有统计学意义[(7.67±5.06) vs.(11.82±7.00),P=0.02).随着全身情况和CP程度加重,IMT呈增加趋势,FMD呈降低趋势,但差异无统计学意义.多因素分析显示调整性别、吸烟后,年龄是影响颈动脉IMT的重要因素(OR=0.016,95%C/0.01～0.02,P<0.01),在调整性别、年龄和吸烟因素后,CP程度(OR=-2.67,95%C/-4.70～-0.62,P=0.01)和患MS(OR=-3.36,95%C/-6.61～-0.10,P=0.04)均是影响FMD的重要因素.结论:CP和MS可能协同影响FMD,从而对动脉粥样硬化病变的发生起作用.     

多发性骨髓瘤患者基质细胞衍生因子-1α、CD44v6表达的研究

目的 探讨基质细胞衍生因子-1α(SDF-1α)、CD44v6(一种变异的CD44受体)在多发性骨髓瘤(MM)中的表达水平及其与病情进展的关系.方法 用酶联免疫吸附试验(ELISA)检测24例MM患者[14例初发和复发MM患者(初发和复发MM组),10例病情稳定MM患者(病情稳定MM组)]和15位健康骨髓移植供者或非肿瘤良性贫血患者(对照组)的骨髓单个核细胞(MNC)和骨髓基质细胞(BMSC)培养上清的SDF-1 α、CD44v6水平.结果 初发和复发MM组MNC培养上清的SDF-1α、CD44v6表达水平[(7232.41±2644.97)pg/ml和(34.34±13.20)ng/ml]显著高于病情稳定MM组[(2315.49±748.29)pg/ml和(15.69±5.28)ng/m1](t=6.25、t=7.82;均P＜0.05)和对照组[(1149.52±636.06)pg/ml和(4.85±3.62)ng/ml](t=4.60、t=7.61;均P＜0.05).病情稳定MM组SDF-1α、CD44v6水平显著高于对照绀(t=2.99、t=4.87;均P＜0.05).9例初发和复发MM组的BMSC与人类骨髓瘤细胞系细胞U266加入rhIL-6进行混合培养后,SDF-1 α水平[(6180.25±5925.38)pg/ml]显著高于5例对照组BMSC[(1021.13±358.65)pg/ml]和9例初发和复发MM组[(1004.07±727.36)pg/ml](t=2.66、t=2.42;均P＜0.05).而其他BMSC各组问的SDF-1α水平差异无统计学意义(P＞0.05).SDF-1 α与CD44v6两者表达水平呈正相关(r=0.51,P=0.03).结论 SDF-1 α、CD44v6水平升高与MM的病情进展或发病有关,也可能与MM的肿瘤浸润过程有关;而这些体内过程可能需骨髓瘤细胞和BMSC与IL-6、SDF-1α和CD44v6等因素协同完成.     

生物玻璃在龈下刮治和根面平整中的疗效评价

目的:研究龈下刮治和根面平整后局部应用生物玻璃对牙周临床指标及患者敏感症状的影响.方法:共纳入慢性牙周炎患者60名,采用双盲设计,随机将患者分为粉膏组(生物玻璃粉剂与生物玻璃膏剂)、粉剂组(生物玻璃粉剂与安慰膏剂)、膏剂组(安慰粉剂与生物玻璃膏剂)和对照组(粉剂与膏剂均为安慰剂).刮治后牙周袋内应用粉剂,6周内以膏剂刷牙.刮治后1、2、3周以及6周时,检测冷刺激敏感度;刮治后6周及3个月时,记录牙龈出血指数(bleeding index,BI)、探诊深度(probing depth,PD)和临床附着丧失(clinical attachment loss,CAL).结果:生物玻璃粉剂与膏剂的应用对刮治后1、2、3周的牙本质敏感度均有明显的缓解作用.刮治后6周,对照组的牙本质敏感状况也基本消失,各组间差异不再有统计学意义;刮治后6周,应用生物玻璃粉剂或膏剂组的BI值均有明显降低;应用生物玻璃粉剂组在刮治后6周时的PD和CAL.值均小于未应用组,且应用生物玻璃粉剂或膏剂对刮治后3个月的CAL水平均有一定改善作用.结论:牙周刮治后的牙本质敏感在6周内多可自行缓解,而生物玻璃粉剂和含有7%生物玻璃的膏剂均可有效降低敏感的发生率和敏感程度;生物玻璃同时还具有明显的抗炎作用,可有效降低BI,改善PD和CAL.     

治伤散巴布剂在冠脉介入诊治术后前臂皮下瘀斑中的应用

目的 探讨治伤散巴布剂减轻冠状动脉介入术后前臂皮下瘀斑的效果.方法 随机将40例冠脉介入诊治术后前臂皮下形成瘀斑的患者分成2组,对照组18例采用传统的50%MgSO4湿敷法,实验组22例采用治伤散巴布剂敷贴法.比较2组皮下瘀斑消退效果及疼痛程度.结果 实验组疼痛程度显著低于对照组,皮下瘀斑消退时间显著短于对照组,差异均有统计学意义(P＜0.05).结论 治伤散巴布剂能有效消除冠脉介入术后前臂皮下瘀斑并减轻疼痛.     

社区护理干预提高脑梗死患者生存质量的效果观察

目的 探讨提高出院的脑梗死患者生活质量的社区护理干预方法.方法 以80例出院脑梗死患者为研究对象,随机分为干预组与对照组各40例,干预组在出院后对患者进行定期电话回访及评估家属对患者的照顾水平,对照组给予常规出院指导.结果 干预组患者的生活质量评分明显高于对照组,2组比较差异有统计学意义(P＜0.05),2组患者在遵医行为和家属对患者照护知识的知晓率方面差异有统计学意义(P＜0.05).结论 社区护理干预提高了脑梗死患者的生活质量,而且对提高患者家属的照护水平具有重要的作用,值得在社区健康服务中心中进一步推广.     

中医辨证治疗58例Ⅱ型糖尿病的临床疗效分析

目的:临床评价Ⅱ型糖尿病中医辨证论治的诊疗方案,验证中医的证候诊断价值以及其临床效果.方法:将确诊是Ⅱ型糖尿病的58例病人随机分成中医治疗组与西医治疗组,评价二组的疗效.结果:治疗后二组的空腹和餐后2h血糖,以及血脂、糖化血红蛋白、证候积分差异显著(P<0.05).结论:Ⅱ型糖尿病中医治疗有较好疗效.     

难治性淋巴瘤患者外周血T淋巴细胞亚群与自然杀伤细胞活性的检测及其临床意义

目的 探讨外周血T淋巴细胞亚群及自然杀伤(NK)细胞活性水平与难治性淋巴瘤的相关性.方法 采用流式细胞术(FCM)检测60例初治淋巴瘤患者化疗前外周血T淋巴细胞亚群水平与NK细胞的活性,化疗后随访分为难治组30例、有效组30例,以20名健康者为健康对照组.结果 淋巴瘤患者组化疗前外周血CD+4、CD+4/CD+8、NK细胞数比健康对照组低(30.17±8.63与46.52±1.39,t=12.218,P＜0.05;0.86±0.45与1.64±0.05,t=11.225,P＜0.05;12.39±7.08与19.29±0.84,t=6.365,P＜0.05),CD+3、CD+8细胞数比健康对照组高(76.14±10.71与70.48±1.44,t=-3.439,P＜0.05;40.28±14.03与28.35±0.73,t=-5.625,P＜0.05).难治组化疗前外周血CD+4、CD+4/CD+8、NK细胞数比有效组低(27.70±7.81与33.13±8.82,t=2.163,P=0.036;0.67±0.27与1.10±0.52,t=3.272,P=0.003;9.87±6.60与15.40±6.58,t=2.771,P=0.008),而CD+3、CD+8细胞数比有效组高(79.67±8.18与71.91±12.00,t=-2.540,P=0.015;44.70±13.99与34.98±12.41,t=-2.416,P=0.020).结论 淋巴瘤初治患者化疗前外周血T淋巴细胞亚群水平及NK细胞活性的检测,对判断、预测容易转归为难治的患者可能有一定的参考价值.     

延续护理在出院2型糖尿病患者血糖控制中的应用

目的 探讨延续护理对出院2型糖尿病患者血糖控制的影响.方法 将86例出院2型糖尿病患者随机分成实验组和对照组各43例,实验组由教育护士提供出院后延续护理,对照组接受常规出院教育.观察干预后2组患者的空腹血糖、餐后2h血糖和糖化血红蛋白(HbAlc)3个代谢指标值及自护行为能力改变情况.结果 干预后实验组空腹血糖、餐后2h血糖和HbAlc控制方面优于对照组,差异具有统计学意义(P＜0.05).2组自护行为能力比较,各项差异均具有统计学意义(P＜0.01).结论 延续护理能够改善出院2型糖尿病患者血糖控制情况,提高患者的自护行为能力,利于患者采取健康促进行为.     

Esthetic periodontal therapy

Esthetic periodontal therapy is a challenging treatment modality. A thorough understanding of the biological principles and technology assists in achieving superior results. However, the key to effective therapy is diagnosis. Only after proper diagnosis can the appropriate integration of soft- and hard- tissue reparative procedures lead to a definitive treatment. Definitive treatment helps to maintain the results. This article outlines the importance of diagnosis and proposes procedures for soft- and hard-tissue reconstructions in esthetic.     

Treatment paradigms in periodontal disease

The prevailing treatment paradigm in periodontal disease relies on debriding the tooth surfaces to keep the bacterial load below the level that triggers tissue loss. When debridement cannot be easily accomplished because of deep pocketing, access surgery is recommended. The debridement approach that involves access surgery is successful in 80% to 85% of patients. Patients who do not respond are often treated with systemic antibiotics. This paradigm, which is based on the nonspecific plaque hypothesis, is labor-intensive and relies on antibiotics only as a last resort. This nonspecific treatment paradigm is in contrast with the specific plaque hypothesis, which states that a limited number of bacterial species are specifically involved in most forms of periodontal disease. Some studies have significantly associated anaerobic bacteria with advanced forms of periodontal disease. These observations led us to hypothesize that most forms of periodontal disease are anaerobic infections, which can be treated by antimicrobials such as metronidazole or clindamycin. Three double-blind studies have shown that 1 to 2 weeks of unsupervised use of metronidazole-plus-debridement was significantly better than placebo-plus-debridement in reducing the need for periodontal surgery. These findings suggest that treatments based on the specific plaque hypothesis give clinicians and patients a choice regarding treatment options in periodontal disease.     

Compliance with supportive periodontal therapy

CONCLUSIONS: Bronchobiliary fistula is an in frequent manifestation of common bile duct obstruction. The slowly progressive narrowing of the common duct by the fibrosis of chronic pancreatitis is an even more rare mechanism of such fistula formation with only two cases having been reported previously. A third case of bronchobiliary fistula caused by chronic pancreatitis is presented and its successful management is discussed. BACKGROUND: A 54-yr-old male with known chronic pancreatitis presented with a cough productive of copious amounts of bile and with pulmonary infiltrates. METHODS: Diagnosis of bronchobiliary fistula was made based on HIDA scan and confirmed by operative cholangiogram. RESULTS: Successful correction of this fistula was accomplished by operative closure of the fistulous tract and diversion of the narrowed bile duct by hepaticojejunal bypass.     

Statistical issues in periodontal research

In the past 10 to 12 years, there have been several statistical issues identified in periodontal research which require and have generated non-standard or new statistical approaches. The purpose of this paper is to give an overview of these issues and approaches. Three general categories of issues are described: (i) statistical methods for detecting when disease progression occurs, and biological theories and corresponding statistical models which attempt to describe how the disease progresses; (ii) design issues in studies of therapeutic efficacy; and (iii) analytic issues arising from periodontal data analysis.     

Mucogingival orthodontic and periodontal problems

Di-n-butyltin diacetate (DBTA) has been shown previously to cause malformations such as cleft mandible, ankyloglossia and fused ribs in rat foetuses after oral treatment of dams on day 8 of gestation. In this study, effects of pretreatment with carbon tetrachloride (CCl4) on the teratogenic activity of DBTA were examined in Wistar rats. Pregnant rats were pretreated sc with CCl4 (0.5 ml/kg) on days 6 and 7 of gestation and were treated orally with DBTA on day 8 of gestation at doses of 0, 4.5, 10 or 22 mg/kg. Caesarean sections were performed on day 20 of gestation, and foetuses were examined for external and skeletal anomalies. Pretreatment with CCl4 enhanced the incidence of external and skeletal malformations caused by DBTA. Concentrations of di-n-butyltin in embryos, maternal liver and maternal blood on day 9 of gestation were increased by CCl4 pretreatment, which inhibited the activity of maternal hepatic microsomal drug-metabolizing enzymes. These results suggest that there is little probability that metabolites of DBTA make a critical contribution to the teratogenicity of DBTA.