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三腔管牵拉支架的制作与应用

Recent Progress of Research and Applications of Fractal and Its Theories in Medicine

Fractal, a mathematics concept, is used to describe an image of self-similarity and scale invariance. Some organisms have been discovered with the fractal characteristics, such as cerebral cortex surface, retinal vessel structure, cardiovascular network, and trabecular bone, etc. It has been preliminarily confirmed that the three-dimensional structure of cells cultured in vitro could be significantly enhanced by bionic fractal surface. Moreover, fractal theory in clinical research will help early diagnosis and treatment of diseases, reducing the patient's pain and suffering. The development process of diseases in the human body can be expressed by the fractal theories parameter. It is of considerable significance to retrospectively review the preparation and application of fractal surface and its diagnostic value in medicine. This paper gives an application of fractal and its theories in the medical science, based on the research achievements in our laboratory.

非体外循环冠状动脉旁路移植术后呼吸功能衰竭的治疗

目的 总结非体外循环冠状动脉旁路移植术（OPCAB）后呼吸功能衰竭的治疗经验。 方法 回顾性分析2006 年6 月至2009 年12 月期间济宁市第一人民医院收治31 例OPCAB 后呼吸功能衰竭患者的临床资料，其中男19 例，女12 例；年龄（62±11）岁。术前临床诊断：稳定型心绞痛9 例，不稳定型心绞痛13 例，急性心肌梗死4例，陈旧性心肌梗死5 例。术前心功能分级（NYHA）Ⅰ级2 例、Ⅱ级11 例、Ⅲ级16 例，Ⅳ级2 例，合并慢性阻塞性肺病患者13 例。术后24 h 内发生呼吸功能不全2 例，48 h 内9 例，72 h 内15 例，72 h 后5 例。术后48 h 因低氧血症不能脱离呼吸机的患者主要采用高呼气末气道正压（PEEP）的方法，拔除气管内插管6 h 后出现呼吸衰竭的患者给予糖皮质激素、利尿剂、呼吸机辅助呼吸，对血流动力学不稳定的患者酌情给予血管活性药物、磷酸二酯酶抑制剂、抗心律失常药物和使用主动脉内球囊反搏等。 结果 31 例患者中29 例痊愈，2 例死亡，其中1 例死于多器官功能衰竭，1 例死于急性呼吸窘迫综合征。术后随访29 例，随访时间6 个月～ 4 年，随访率100%。1 例术后1 年死于脑出血，1 例术后2 年死于食管癌；3 例患者有哮喘发作，1 例患者NYHA Ⅲ～Ⅳ级，2 例轻度活动后有气促症状，其余患者NYHA Ⅰ～Ⅱ级，无心绞痛发作，生活质量明显改善。 结论 对OPCAB 后呼吸功能衰竭患者，积极改善心功能，消除肺间质性水肿，恰当使用呼吸机支持是治疗成功的关键。

The Effect of Allogeneic Canine Cord Blood Mesenchymal Stem Cells Transplantation on Distribution of CD4+T and CD8+T in Infarcted Regions of Hearts.

Objective To study the effect of allogeneic canine cord blood mesenchymal stem cells（cbMSC）transplantation on the distribution of CD4+T and CD8+T in infracted area of hearts. Methods Mononuclear cells of cord blood were isolated by density gradient centrifugation and amplified by adherent culture. 36 adult male dogs were divided into experimental group and control group. Animal models of acute myocardial infarction were established by ligating anterior descending coronary artery. The fourth generations of mesenchymal stem cells (MSC) were transplanted into infarcted area of hearts by left anterior descending coronary artery after 72h induced by 5-aza and transfected by LacZ. The survival of transplanted cells in hearts can be confirmed by βgal expression. CD4+T and CD8+T cells distributed in infarcted area were detected by immunohistochemical staining method. The ImagePlus 5.1 software was used to analyze the images. Results Cells transplanted into infarcted area could survive for a long time. 2, 4, 8 weeks after transplantation, the IOD of CD4+T in experimental group were 44.35±7.03, 19.29±4.11 and 20.27±3.51 respectively, and the CD4+T/CD8+T ratios were 0.63±0.12, 0.51±0.15 and 0.66±0.08. In control group, the IOD of CD4+T at 2, 4, 8 weeks after transplantation were 65.78±10.27, 28.02±2.59, 29.79±6.83, and the CD4+T/CD8+T ratios were 1.28±0.20, 1.34±0.09 and 1.50±0.16. The IOD of CD4+T and CD4+T/CD8+T ratio in experimental group were significantly lower than that in control group. In experimental group the IOD of CD8+T at 2, 4, 8 weeks after transplantation were 69.88±7.84 , 37.80±8.83 and 30.81±7.42, higher than that in control group which were 51.28±10.01, 20.87±4.50 and 19.91±2.87. Conclusion The preliminary results indicated that allogeneic cbMSC transplanted in infarcted area can escape from immune rejection, its mechanism may be associated withdecreasing the amount of CD4+T cells infiltrated in periphery of infarcted area and maintaining CD4+T/CD8+T ratios at a lower level.

Evidence-Based Treatment for a Smoker with Periimplantitis

Objective　To make an evidence-based treatment plan for a smoker with periimplantitis. Methods　Based on the clinical problems raised from the case, we searched The Cochrane Library (Issue 2, 2009), ACP Journal Club (1991 to July 2009), MEDLINE (1950 to July 2009), EMbase (1980 to July 2009) and Chinese Journal Fulltext Database (1994 to July 2009) for guidelines, systematic reviews, meta-analyses and randomized controlled trials (RCTs). The quality of the included studies was assessed. Results　A total of 4 systematic reviews, 8 RCTs were included. The following methods were supported by Level A evidence: (1) Scaling combined with local antibiotics; (2) Guided bone regeneration; (3) Non-surgical debridement with titanium hand-instruments or with an ultrasonic device. Based on the available evidence, we proposed a three-stage therapy plan for the patient: In the first stage, full mouth ultrasonic scaling was performed. The peri-implant pocket was debrided with plastic curettes, and then minocycline gel was applied once a week for four times. The patient was persuaded to maintain oral hygiene and quit smoking. In the second stage, four weeks later, open flap debridement and guided bone regeneration were conducted. In the third stage, long-term care of oral hygiene and dental implants were performed. After 6 months of follow-up, the peri-implant tissues were healthy with no evidence of inflammation, bleeding or suppuration. Conclusion　Based on the approach of evidence-based medicine, we accomplished the treatment of the case with reliable outcomes.

B型超声引导下急诊行铅弹取出术一例

Comparative observation of choroidal osteoma by multimodal fundus imaging methods

ObjectiveTo comparatively observe features of choroidal osteoma by multimodal fundus imaging methods. MethodsThis is a retrospective case study. Sixteen patients (16 eyes) with choroidal osteoma were enrolled in this study. The patients included 6 males (6 eyes) and 10 females (10 eyes), with an average age of (30.5±2.4) years. All patients received examination of best-corrected visual acuity, slit lamp microscope, indirect ophthalmoscopy, fundus color photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA) and spectral domain optical coherence tomography (SD-OCT). The tumors were classified as fresh lesion (clear boundary and rosy tumor with smooth surface) and obsolete lesions (pale and flat tumor with obvious patches). The tumor features of color fundus photography, AF, FFA and SD-OCT were comparatively observed. ResultsThere were 5 fresh lesions and 11 obsolete lesions. Color fundus photography showed the tumor color was orange-red or yellow-white with clear boundary and retinal blood vessels on the surface of the tumor. The color of fresh lesion was rosy. In general, choroidal osteoma shown weak AF, however AF of fresh tumor was slightly stronger than the obsolete tumor, and retinal detachment region showed relatively stronger AF. FFA of fresh tumor indicated uniform intense fluorescence with clear boundary at late stage, much stronger than obsolete tumor. SD-OCT showed mesh-like reflected signal in the choroidal layer, but different from the surrounding choroidal vascular structures. ConclusionsThe tumor color is orange-red or yellow-white in color funds photography, which shown weak AF. FFA showed mottled hyperfluorescence in the early stage and tissue staining at the late stage. SD-OCT showed mesh-like reflected signal in the choroidal layer.

肺韦格纳肉芽肿病一例

Efficacy of light cured composite resin and glass ionomer cement for wedge shaped defect filling: a meta-analysis

Objective To evaluate the efficacy of light cured composite resin and glass ionomer cement for wedge shaped defect filling. Methods PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CNKI, CBM, VIP and WanFang Data were searched from inception to April 5th 2016, to collect randomized controlled trials (RCTs) of light cured composite resin versus glass ionomer cement for wedge shaped defect filling. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. Results A total of 12 studies, involving 3 744 cases of teeth were included. Meta-analysis results showed that there was no significant difference in the two groups on the shedding rate after 2 years (OR=1.19, 95%CI 0.70 to 2.02,P=0.53). But the wear rate of the light cured composite resin group was significantly lower than that of the glass ionomer cement group (Peto OR=0.31, 95%CI 0.22 to 0.44,P<0.000 01). The light cured composite resin group had higher rate of micro leakage or secondary caries rate (OR=1.83, 95%CI 1.11 to 3.01,P=0.02) and incidence of endodontic or periapical lesions (Peto OR=2.84, 95%CI 1.82 to 4.45,P<0.000 01) than the glass ionomer cement group. Conclusion Glass ionomer cement for filling wedge-shaped defects of 2 years after the wear degree is higher than the light cured composite resin, but the occurrence probability of micro leakage or secondary caries and stimulation to pulp are lower than the light cured composite resin. Because of the limitations of the quality of the included studies, the above conclusion still needs to be verified by more high-quality studies.

Efficacy of photodynamic therapy and sodium hypochlorite on the disinfection of Enterococcus faecalis in infected root canal: a meta-analysis

ObjectivesTo systematically review the efficacy of photodynamic therapy (PDT) and sodium hypochlorite (NaClO) for removal of Enterococcus faecalis (E. faecalis) in root canal therapy.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases to collect randomized controlled trials (RCTs) on PDT versus NaClO for removal of E. faecalis from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 17 RCTs were included. The results of meta-analysis showed that, comparing PDT with 5.25%NaClO, there was no significant difference in the remaining colony-forming units (CFUs) of E. faecalis between both groups (MD=0.55, 95%CI −0.72 to 1.83, P=0.40); comparing PDT with 2.5%NaClO, there was no significant difference in the remaining CFUs of E. faecalis between both groups (MD=0.54, 95%CI −0.32 to 1.41, P=0.22).ConclusionsThe current evidence indicates that PDT and NaClO show similar efficacy against the intracanal E. faecalis. Due to the limited quality and quantity of included studies, more high quality studies are required to verify the above conclusions.