Acta Academiae Medicinae Sinica

Literatures have demonstrated the association between oral diseases and systemic diseases. For example,periodontitis is associated with coronary heart disease,diabetes,preterm low birth weight,and gastritis. Therefore,more relevant research on the relationship between oral diseases and systemic diseases should be carried out.

Root canal therapy is currently the most effective treatment for pulpal and periapical diseases. With the innovation of endodontic therories and techniques,the concept of contemporary root canal therapy has been established and promoted gradually. Advances in endodontic technology,instruments,and materials have increased the safety and clinical success rate of root canal therapy. This article reviews the recent theoretical research and clinical practices of contemporary root canal therapy.

Objective To analyze the correlation between the phenotype and genotype of tooth agenesis using the tooth agenesis code (TAC) and the traditional descriptor for missing teeth. Methods Patients with isolated hypodontia caused by PAX9 or MSX1 mutation reported before May 2007 were enrolled. The teeth missing rate and TAC code were recorded. The missing teeth patterns caused by the two mutations were compared. Results The teeth missing rates in each teeth positions were significantly different between maxillary and mandibular except maxillary central incisor,lateral incisor and mandibular canine,first molar (P<0.05,P<0.001). MSX1 gene mutation often led to the loss of maxillary first premolar,maxillary second premolar,and mandibular second premolar,while PAX9 gene mutation often led to the loss of the first,second,and third molars. The results were similar when analyzed either by TAC code analysis or by traditional descriptor. Conclusions PAX9 and MSX1 gene mutation can cause different phenotypes of tooth agenesis. The TAC code can be used in the analysis of the correlation between phenotype and genotype of the missing teeth patients.

Objective To evaluate the effect of sustained release of recombinant rat insulin-like growth factor-1(rrIGF-1) from poly (lactide-CO-glycolide) (PLGA) microspheres on bone formation in the peri-implant areas in Goto-Kakizaki rats with type 2 diabetes. Methods Type 2 diabetes models were successfully established in 20 male Goto-Kakizaki rats,which were then randomly divided into treatment group (sustained release of rrIGF-1 from PLGA microspheres were loaded on the peri-implant areas,n=10) and diabetic group (loaded with isodose placebo from PLGA microspheres,n=10). Another ten male SD rats served as control group (did not sustain any loading). Titanium implants were inserted into the tibias of 30 diabetic and normal animals. Four,5,and 8 weeks after implantation,local blood samples around the implants were obtained for the determination of serum osteocalcin (OCN),serum bone specific alkaline phosphatase (B-ALP),and serum procollagen I carboxyterminal propeptide (PICP) with enzyme linked immunosorbent assays. Results Four weeks after implantation,OCN,B-ALP,and PICP were significantly lower in both treatment group and diabetic group than in control group(both P<0.05). Five weeks after implantation,serum OCN and B-ALP levels of the diabetic group were significantly lower than those of the other two groups (all P<0.05). Serum PICP levels of both diabetic group and treatment group were significantly lower than that of control group(both P<0.05). The OCN level in the trealment group was significantly higher in the post-operative 5th week than in the post-operative 4th week,while the PICP levels in the diabetic group were significantly lower than those in the treatment group and control group in the post-operative 8th week (both P<0.05). Conclusion Sustained release of rrIGF-1 from PLGA microspheres loaded on the local peri-implant areas can promote bone formation in the peri-implant areas in Goto-Kakizaki rats with type 2 diabetes.

Objective To explore the effect of combination of pulsed CO2 laser irradiation and diammine silver fluoride treatment on the ultrastructure of dentine. Methods Each extracted molars was made into four identical dentinal specimens,which were randomly divided into 4 groups according to the treatment methods: A,control group; B,pulsed CO2 laser irradiation; C,coated with 38%Ag(NH3)2F; and D,laser irradiation plus fluoride. Scanning electron microscope (SEM) analysis was performed. Results As shown by SEM,group A showed clear dentinal tubuli,group B showed melted surface without dentinal tubule openings,group C showed thicker melted layer without dentinal tubule openings,and group D showed the thickest melted and recrystalized layer on dentine surface. Conclusions Both pulsed CO2 laser irradiation and 38%Ag(NH3)2F treatment can seal dentinal tubule. The combination of these two techniques can form a synergistic effect.

Objective To compare the influences of gold alloy metal crown and Ni-Cr alloy metal crown on ginigival health. Methods Totally 20 patients requiring one metal crown restoration were divided into the gold alloy metal crown group (n=9) and Ni-Cr alloy metal crown group (n=11). The contra-lateral homonymy natural healthy teeth served as controls. Before the tooth preparation and 6 months after crown placement,the weight of gingival crevicular fluid (GCF) of each tooth (included the test teeth and the control teeth) was measured,and the probing depth and the sulcus bleeding index of each tooth were also recorded. Results In the gold alloy metal crown group,the weight of GCF detected before the tooth preparation was significantly larger than that detected 6 months after restoration (P<0.05). In the Ni-Cr alloy metal crown group,the sulcus bleeding index recorded 6 months after restoration was significantly larger than that recorded before the tooth preparation (P<0.05). The other experimental indicators were not significantly different before and after restoration. Conclusion The gold alloy metal crowns will not cause obvious harm to the periodontal tissues of the abutments shortly after restoration,while the Ni-Cr alloy metal crowns may increase the risk of sulcus bleeding.

Objective To evaluate the attention shift effect produced by a video-audio eyewear in pediatric dentistry. Methods Totally 40 children aged 4-7 years were equally randomized into fissure sealant group(group S) and caries filling group(group F). A self-control comparison method was used in each group: each child took two visits to finish the whole study,they received the dental treatment either with normal method(SC,FC) or with attention shift by wearing the video-audio eyewear (SI,FI) for each visit. The degree of pain,accomplishment of treatment,and co-operation were analyzed and compared. Results All children were successfully managed in the whole course. The pain scores were not significantly different between SC group and SI group or between FC group and FI group (P＞0.05),while the Frankl scores were significantly different between SC group and SI group (P=0.04) and between FC group and FI group (P=0.03). Houpt scores were significantly different between SC group and SI group (P=0.04),but not between FC group and FI group (P=0.85). Most children (90% in group S) and (85% in group F) expressed the willingness to receive the video-audio eyewear if they were asked to do so again. Conclusions The video-audio eyewear provides satisfactory attention shift for children during dental treatment and increases their cooperation. However,it has little effect on pain relieving.

Objective To observe the influence of three types of dental ceramic alloys on magnetic resonance imaging (MRI). Methods Ni-Cr alloy,Co-Cr alloy,and Ti alloy were elaborated into three crowns with the same shape and size by computer aided design,computer aided manufacturing device. Afterwards we fixed the crown in the mouth of a volunteer at the same location separately. Then we scanned them with MRI. The extents of artifacts were compared. Results All these alloys caused MR artifacts. The extent of the artifact of Co-Cr alloy was larger than those of Ni-Cr alloy and Ti alloy under MRI. Conclusion Ti alloy has the smallest influence on MRI than Ni-Cr alloy and Co-Cr alloy.

Objective To investigate the situation of gingival bleeding in patients with untreated gingivitis. Methods Totally 444 patients with untreated gingivitis were enrolled in one district located in Beijing. The gingival bleeding,except the third morlars,was evaluated using the gingival bleeding index (GBI). Results The sites of GBI=1 were 8.15±7.17 in males and 5.65±5.65 in females (P=0.0003). The sites of GBI=2 were 33.48±21.65 among subjects aged 35-50 years and 24.31±18.15 among subjects aged 18-29 years (P=0.03). The first left mandible molars had the highest GBI,while the right maxillary incisors got the lowest GBI. The posterior teeth,the lingual surface,and the proximal region had more sites than the anterior teeth,the buccal surface,and the central region on GBI=1,GBI=2 and total sites（P<0.05）. Conclusion The severity of gingival bleeding is associated with age and gender,and tends to be site-specific.

Objective To construct mouse Zinc-α2-glycoprotein (mZAG) eucaryotic expression plasmid and identify its expression in 3T3-L1 preadipocytes. Methods The total RNA from mouse liver tissue was extracted. The reverse-transcript(RT)-PCR method was used to amplify the complete domain sequence of mZAG,and the confirmed PCR products was inserted into expression plasmid by DNA ligation. The mZAG expression plasmids with various concentrations (0,0.4,0.8,and 1.6 μg) were transfectd into 3T3-L1 preadipocytes,and ZAG expression in mRNA and protein level was determined by real-time fluorescence quantitative PCR and Western blot,respectively. Results DNA sequencing confirmed the right sequence of mZAG expression plasmid pcDNA3.1(-)-mZAG. After the mZAG expression plasmid with different concentrations were transfected into 3T3-L1 preadipocytes,mZAG mRNA level significantly increased and reached 2.58 folds (P=0.002),3.67 folds (P=0.000） and 5.19 folds (P=0.001) of that in the control group (no mZAG transfection). mZAG protein level also significantly increased and reached 2.75 folds of that in the control group (P=0.017). Treating 3T3-L1 cells with small interferencing RNA (siRNA) sequence siRNA1 and siRNA4 resulted in a decrease of mZAG mRNA to 49% and 41% of those in the contro1 group(no siRNA sequence trasfection) (P=0.002,P=0.000)and a decrease of mZAG protein to 55% and 62% of that in the contro1 group (P=0.004,P=0.025). Conclusions mZAG expression plasmid pcDNA3.1(-)-mZAG was successfully established in this study. This plasimd can be well expressed in 3T3-L1 preadipocytes. siRNA1 and siRNA4 can effectively inhibit the expression of mZAG in these cells.

Objective To summarize the sonographic features of primary non-Hodgkin's lymphoma of the breast using the Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) and explore the value of ultrasonography in the preoperative diagnosis. Methods The clinical data of 11 patients with primary non-Hodgkins lymphoma of the breast were retrospectively reviewed. BI-RADS-US grading was performed for each lesion. Results Totally 13 lesions were detected in 11 patients. Single lesion at one side was detected in 9 patients (81.8%). Circumscribed (n=7,53.8%) or microlobulated lesions (n=5,38.5%),parallel orientation (n=10,76.9%),and oval masses (n=8,61.5%) were also observed on sonography. The echo pattern of the mass was hypoechoic in 10 lesions (76.9%),hyperechoic in 1 lesion,and complex echoic in 2 lesions. No mass had speculated margins or calcifications. Ipsilateral axillary lymph node involvements were noted in 6 patients. Conclusions Most primary non-Hodgkins lymphomas of the breast present as single hypoechoic masses with circumscribed or microlobulated margins and parallel orientation on sonography. BI-RADS-US,combined with the analyses of multiple signs,is feasible for the pre-surgical diagnosis.

Objective To investigate the effects of Qihong capsule (QH) on HeLa cells infected by coxsackievirus B3 (CVB3) in vitro and its potential antiviral mechanism. Methods HeLa cells were infected by CVB3 in vitro. XTT assay and plaque inhibition assay were performed to determine the 50 % effective dose,(ED50),50 % inhibitory concentration (IC50),and 50% cytotoxity concentration (CC50) of QH and the control drug,ribavirin. The total therapeutic index (TI) was calculated. Anti-viral time-course experiments were performed to compare the anti-viral effects at different time points. The inhibitory effects of QH on the attachment and penetration of CVB3 were also observed. Results XTT assay and plaque inhibition assay showed that the ED50 and IC50 were (7.16±0.80) mg/L and (2.63±0.50) mg/L in QH group and (4.35±0.40) mg/L and (1.92±0.30) mg/L in ribavirin group,respectively. CC50 was 16-fold higher in QH group than in ribavirin group ［QH: (1 648±219) mg/L vs. Ribavirin: (103±14) mg/L］. Time-course studies demonstrated that antiviral effect of QH was mainly found 0-4 hours after infection. QH effectively blocked the attachment and penetration of CVB3 into cells. Conclusion By inhibiting the attachment and penetration of CVB3,QH can effectively inhibit the invasion of virus in vitro with low toxicity.

Objective To evaluate the diagnostic values of four risk of malignancy indices (RMI) for malignant adnexal masses. Methods The data of 223 women with adnexal masses admitted to the Department of Obstetrics and Gynecology of Peking Union Medical College Hospital for surgical exploration between June 2008 and December 2008 were retrospectively analyzed. The sensitivity,specificity,positive predictive value and negative predictive value of RMI1,RMI2,RMI3,and RMI4 in the diagnosis of malignant adnexal masses were calculated. Results When the cutoff levels of RMI1,RMI2,RMI3 were set at 200 and RMI4 at 450,the sensitivities for diagnosing malignant adnexal masses ranged 59.0%-67.2%,the specificities ranged 94.4%-96.9 %,the positive predictive values ranged 82.0%-87.8%,and the negative predictive values ranged 90.9%-92.6%. The Youdens indexes (YI) of RMI1,RMI2,RMI3,and RMI4 were 0.559,0.606,0.576,and 0.559,respectively. RMI2 was significantly different from RMI1 (P=0.000),RMI3 (P=0.008),and RMI4 (P=0.000) in terms of diagnostic efficiency. RMI1,RMI2,RMI3,and RMI4 at a cutoff level of 75.6、88.6、79.1,177.2 respectively,according to ROC curves,yielded sensitivities of 77.8%-82.5%,specificities of 84.6%-90.1%,positive predictive values of 69.0%-75.4%,and negative predictive values of 90.9%-92.6%; the relevant YI of RMI1,RMI2,RMI3,and RMI4 were 0.635,0.665,0.651 and 0.705,respectively. Under this cutoff level,the difference between RMI1,RMI2,RMI3,and RMI4 in diagnosing malignancy had no statistic significant. The primary histological types arising false negative were early stage epithelial ovarian cancer and non-epithelial ovarian cancer. The primary histological types arising false positive were endometriosis masses and degenerative sex cord-stromal tumor. Conclusions RMIs are useful indices for the differentiation between benign and malignant pelvic diseases. Meanwhile,their cutoff levels for Chinese populations need further study.

Objective To compare the hemodynamic responses to orotracheal intubation using a Shikani Optical Stylet (SOS) laryngoscope or a Macintosh direct laryngoscope (MDLS). Methods Totally 41 patients with American Society of Anesthesiologists （ASA） physical status Ⅰ-Ⅱ,aged 20-60 years and scheduled for elective surgery under general anesthesia requiring orotracheal intubation,were randomly allocated to either the SOS group (n=21) or MDLS group (n=20). After an intravenous anesthetic induction,the orotracheal intubation was performed using a SOS laryngoscope or a MDLS. Blood pressure and heart rate (HR) were recorded before and after anesthetic induction,immediately after intubation,and 5 minutes after intubation. Rate pressure product（RPP）were calculated. Results Blood pressures and RPP in both two groups significantly decreased after anesthetic induction (P<0.05) while blood pressures,HR,and RPP significantly increased after orotracheal intubation (P<0.05). HR in both groups after intubation were significantly higher than the pre-induction level (P<0.05),and such an increase lasted for 3 min. HR immediately after intubation was also significantly higher in MDLS group than in SOS group (P<0.05); however,such difference was not observed in other time points (P>0.05). In the MDLS group,when compared with the occurrence time required for the maximum values of systolic blood pressure (SBP),the occurrence time required for the maximum values of HR after the start of intubation and success of intubation during the observation were significantly delayed (P<0.05). Compared with the MDLS group,the occurrence time required for the maximum values of SBP after the start of intubation and the success of intubation were significantly delayed in the SOS group (P<0.05). The incidences of SBP more than 130% of baseline value and RPP more than 22 000 were not significantly differently(P>0.05). Also,the intubation time was not significantly different (P>0.05). Conclusion The hemodynamic responses to orotracheal intubation is milder in SOS laryngoscope than in MDLS.

Objective To investigate the relationship among oxygen concentration,quorum sensing system,type Ⅲ secretion system,and biofilm production of Pseudomonas aeruginosa. Methods A total of 23 clinical strains of Pseudomonas aeruginosa were cultured at different levels of environmental oxygen for three days. Then biofilm mass and alginate were quantified. The expression levels of LasI and RhlI were detected by real time polymerase chain reaction (PCR). The secretion of exoenzyme S was examined by Western blot. Results Both the biofilm mass (R=0.455,P=0.000) and alginate (R=0.367,P=0.000) were positively correlated with oxygen concentration. Real time PCR showed that the expression levels of LasI and RhlI were not significantly correlated with oxygen concentration (R=0.025,P=0.794; R=-0.044,P=0.653),the production of biofilm (R=0.001,P=0.990; R=0.011,P=0.909),or alginate(R=0.029,P=0.770; R=0.193,P=0.064). Western blot showed that the optimal oxygen concentration range for exoenzyme S secretion of Pseudomonas aeruginosa ranged 10% to 30%. Conclusions Hyperoxia can promote the production of biofilm and alginate by Pseudomonas aeruginosa. Las/Rhl system may not participate in biofilm production at the early stage due to the low bacteria amount. The increased production of biofilm may inhibit the expression of Type Ⅲ Secretion system and thus inhibit bacterial virulence.

Objective To evaluate the value of the combination of methotrexate(MTX) injection through hysteroscopic tubal catheterization and mifepristone per os in the conservative treatment of tubal pregnancy. Methods Forty patients who met the criteria of conservative treatment were enrolled in this study and received the combined therapy of MTX 50 mg/d injection through hysteroscopic tubal catheterization and oral mifepristone 100mg/d for 5 days. Results Of these 40 patients,38 (95.0%) were cured. The human chorionic gonadotropin decreased to normal level within 3-48 days. The masses disappeared within 16-65 days. The menstruation returned normal within 28-42 days. No obvious side effect was observed. Of 30 patients who underwent hydrotubation through hysteroscopy three months later,12 patients were unobstructed,2 patients were completely obstructed,and 16 patients were partially obstructed. Five patients had full-term deliveries up to this report. Conclusion The combination of MTX injection through hysteroscopic tubal catheterization and mifepristone per os is safe and effective for early tubal pregnancy.

Objective To explore the effectiveness of a combined therapy using two types of peginterferon (PEG-IFN) and ribavirin in treating chronic hepatitis C virus (HCV) genotypes 1b/6a infections. Methods The clinical data of 171 patients with chronic HCV genotypes 1b/6a infection in Common Hospital Centre S. Januario,Macau SAR,China,were retrospectively analyzed. Of these patients,145 (84.8%) were infected with HCV genotype 1b and 26 (15.2%) with HCV genotype 6a. Patients were divided into two groups based on drug therapies: PEG-IFN-2b group (n=140),in which patients were treated with PEG-IFN-2b 1.5 g/kg QW plus ribavirin 800-1 200 mg/d and PEG-IFN-2a group (n=31),in which patients were treated with PEG-IFN-2a 180g QW plus ribavirin 800-1 200 mg/d. Patients was treated for 48 weeks and then followed up for 24 weeks. Results All patients completed their therapies. The rates of early viral response (EVR) and sustained virologic response (SVR) were 78.95% and 69.59%,respectively . The two groups were not significantly different in terms of EVR（P=0.091),end of treatment virological response (ETVR) (P=0.542),SVR （P=0.079）,relapse (P=0.497). And the two HCV genotypes patients were not significantly different in terms of EVR (P=0.268),ETVR (P=0.276),SVR (P=0.479),and relapse (P=1.000). Conclusions PEG-IFN combined with ribavirin can achieve high viral response in treating chronic hepatitis C. PEG-IFN-2a and PEG-IFN-2b basically are similarly effective in treating HCV genotype 1b or 6a infections.

Objective To assess the patency and complications of the polytetrafluoroethylene (PTFE) graft for hemodialysis access and to summarize the experiences in the treatment of graft occlusions. Methods The clinical data of 30 patients who underwent forearm PTFE graft for hemodialysis access from March 2003 to December 2008 in our hospital were retrospectively analyzed. Results Patients were followed up for (28.7±17.6) months (range: 8-78 months).The peri-operative mortality was zero. Primary patency rate was 70.0% at Year 1 and 56.7% at Year 2. Accumulative secondary patency rate was 90.0% and 80.0%,respectively at Year 1 and Year 2. Postoperative complications included graft thrombosis (n=13,43.3%),venous anastomosis stenosis (n=1,3.3%),graft infection (n=2,6.7%),and edema of the forearm (n=10,33.3%). Totally 24 graft revisions were performed,including thrombectomy (12 times),thrombectomy and venous anastomosis plasty with artificial patch (4 times),arterial and venous anastomosis plasty with patch (2 times),venous anastomosis angioplasty with a balloon (2 times),new graft hemodialysis access construction in the contralateral arm (1 case),and graft removal (3 cases). Conclusions PTFE graft is an important backup hemodialysis access in urinemic patients. Proper revision according to different cause of graft occlusions can prolong the service time of the graft.

Objective To evaluate the lumber plexus blockade as anesthesia technique for hip fracture repair in elderly patients. Methods We retrospectively analyzed the peri-operative data of 87 hip fracture patients,aged 70 years or older,who underwent surgical repair at our hospital between 2003 and 2006. Patients were divided into three groups according the anesthesia techniques applied: general anesthesia (GA) group (n=21),epidural anesthesia (EA) group (n=37),and lumber plexus blockade (LPB) group (n=29). Results The peri-operative data were comparable among thee three groups,except that intra-operative the dosage of fentanyl was significantly lower in LPB group compared with in GA group(P＜0.05),and the blood urea nitrogen 1 day after surgery was significantly increased in GA group(P＜0.05). Conclusion Lumber plexus blockade combined with small-dose intravenous anesthesia is an optional anesthetic technique for elderly patients undergoing hip fracture repair.

Objective To summarize the diagnosis and treatment of pulmonary thromboembolism (PTE) in post-operative neurosurgical patients. Methods We retrospectively analyzed the clinical data of 7 patients who experienced pulmonary thromboembolism after neurosurgical operations in our department from October 2009 to March 2010. Results Of these 7 patients,6 were confirmed with computed tomographic pulmonary angiography (CTPA) and 1 was diagnosed according to the clinical manifestations and other diagnostic examinations. All the patients were treated initially with low-dose heparin or low-molecular-weight heparin and then with warfarin. Two patients were implanted with permanent inferior vena cava filters before anticoagulation. One received anticoagulant therapy and died of respiratory failure due to pulmonary embolism on the fourth post-operative day. Six patients were discharged after significant improvement. Conclusions Many risk factors may cause PTE peri-operatively. Post-operative CTPA may be indicated. Anticoagulation and other management strategies may be applied to improve the outcome.

Objective To summarize the clinical features and analyze the serologic test results of latent syphilis. Methods The clinical data of 601 patients with latent syphilis who were treated in the sexually transmitted disease centre of Peking Union Medical College Hospital between January 2001 and November 2007 were retrospectively analyzed. Results Of the 601 cases of latent syphilis,there were 174 cases of early latent syphilis(EL),170 cases of late latent syphilis(LL),and 257 cases of unknown latent syphilis. Male to female ratio was 0.74:1（256 males and 345 females,respectively). Patients aged 20-39 years accounted for the largest proportion. Non-marital sexual intercourse was the main route of infection. Forty-six patients (7.65%) were co-infected with other sexually transmitted diseases. A total of 251 cases of latent syphilis (41.76%) were confirmed when the patients were receiving tests for other sexually transmitted diseases or suspected sexually transmitted diseases. Of the 601 patients with EL,LL and unknown latency,the proportion of serum rapid plasma reagin(RPR) titers higher than or equal to 8 were 72.99% (127/174),52.94% (90/170),and 60.31%(155/257),respectively. Compared with the early syphilis,serological negative conversion rate was significantly lower after treatment for l2 months in the early latent syphilis patients (P=0.044). Conclusion Education and awareness raising on syphilis should be strengthened to lower the prevalence of latent syphilis.

Objective To evaluate the effect of micronutrients on the immune status of human immunodeficiency virus (HIV)-positive individuals. Methods Totally 102 HIV-positive individuals were randomly divided into supplementation group (received micronutrients supplement) and control group (received placebo). Physical examinations were performed at baseline and at the end of the trial. Immune status were determined in both two groups. Results Age,height,weight,and sex ratio were not significantly different between two groups (all P>0.05). Baseline CD3+,CD4+,and CD8+ T lymphocytes and IgA,IgG,IgM,C3 levels were not significantly different between two groups (all P>0.05),while the levels of CD3+,CD4+,and CD8+ T lymphocytes and IgA,IgG,IgM,C3 were significantly higher in supplementation group than in control group(all P＜0.05). Conclusion Supplementation of micronutrients can improve the immune status of HIV-positives individuals.

Asthma,often begins in childhood,can affect dental health. In return,dental treatment and dental anxiety can lead to an acute asthmatic attack. This article reviews the potential influence of asthma on dental treatment and dental medications and specifically describes the modes of dental conscious sedation in asthmatic patients.