以粘接固位为基础的后牙冠方修复是一种更加保守且生存率高的修复方式,目前己被广泛应用.该文以多数学者提出的基牙预备原则和研究为基础,结合实际临床操作病例,从患牙的术前分析、去除龋坏组织、剩余牙体组织分析和抗力形预备、修复空间预备、即刻牙本质封闭和洞形优化设计这些临床操作步骤来介召后牙大面积缺损粘接间接修复牙体预备的规范化操作过程.

Medical disputes have a negative impact on doctors, patients, medical institutions, and society. Due to various reasons, tense doctor-patient relationships and even medical disputes often occur in the standardized training for stomatological residents. Consequently, preventing stomatological residents from medical disputes should not be underestimated. Lack of working experience,poor communication ability, insufficient knowledge of laws and regulations, low quality of medical care, and frequent change of departments are the main reasons for the occurrence of medical disputes in the standardized training for stomatological residents. Medical disputes will not only damage the learning and working enthusiasm of stomatological residents, but also affect the normal working environment and order of medical units. Therefore, it is necessary to prevent medical disputes from occurring in the standardized training for stomatological residents. Based on the present situation and necessity, this paper focused on the detailed preventive strategy of medical disputes in the standardized training for stomatological residents, such as strengthening supervision and management, emphasizing clinical teaching, improving legal accomplishment, cultivating crisis consciousness, paying attention to doctor-patient communication, and taking advantage of the advanced teaching method. It provides some references for improving the quality of standardized training for stomatological residents.

Objective:To compare the efficacy and prognosis of three kinds of operation for stage Ⅰ-Ⅱ breast cancer.Methods:The data of 127 patients with breast cancer who underwent surgical treatment from March 2013 to March 2018 were retrospectively analyzed. They were divided into three groups according to the operation types：endoscopic group（40 cases underwent single hole endoscopic breast conserving surgery），traditional group（44 cases underwent traditional open breast conserving surgery），and radical resection group（43 cases underwent open total mastectomy）. SPSS 23.0 statistical analysis software was used，and the operation-related indicators were expressed as（xˉ±s），and single-factor analysis of variance was used among multiple groups；the count data such as complications and metastasis rate were expressed as rates，and χ2 test was used for comparison；P < 0.05 was considered statistically significant.Results:Operation time：traditional group < radical group < endoscopic group（P < 0.05）；Intraoperative bleeding，number of lymph node dissections，length of hospital stay and total incidence of complications：endoscopic group < traditional group < radical group（P < 0.05）；The excellent and good rate of breast beauty：endoscopic group > traditional group > radical mastectomy group（P < 0.05）；There was no significant difference in local recurrence rate and metastasis rate among the three groups（P > 0.05）.Conclusion:Endoscopic breast-conserving surgery，traditional open breast-conserving surgery and modified radical mastectomy have similar efficacy in the treatment of stage Ⅰ to Ⅱ breast cancer，and there is no significant difference in the risk of mid and long term recurrence and metastasis. However，endoscopic breast-conserving surgery has certain advantages in breast aesthetics and postoperative recovery.

目的 探讨乳腺癌术后接受ac-T方案化疗患者放疗开始时间对预后的影响.方法 研究纳入2019年1月至2020年1月间本院收治的乳腺癌患者120例,所有患者均采用手术治疗,术后均行ac-T方案化疗和辅助放疗,回顾性分析患者的临床资料,依据患者手术治疗到放疗的间隔时间(SRI)将120例患者分为对照组和研究组,其中对照组患者54例,SRI在3个月以上,研究组患者66例SRI在3个月以内,比较2组局部复发、远处转移和预后的差异.结果 研究组并发症发生率22.73％、局部复发率10.61％、远处转移发生率9.09％,分别与对照组18.52％、9.26％和7.41％对比差异均无统计学意义(P＞0.05);研究组无进展生存期时长(24.05±5.37)个月明显长于对照组(18.69±5.13)个月;对照组和研究组手术前生活质量评分差异无统计学意义(P＞0.05);术后6个月,研究组5个领域的生活质量评分均高于对照组,差异有统计学意义(P＜0.05).结论 乳腺癌术后接受ac-T方案化疗的患者越早行术后放疗越有助于延长患者的无进展生存期,提高患者的生活质量,临床效果更加显著.

目的:探讨与分析血清胃蛋白酶原(PG)、多富含亮氨酸重复单位的G蛋白偶联受体4(LGR4)与胃癌患者腹腔镜D2根治术(LD2RS)预后相关性.方法:2021年1月到2021年12月选择在本院进行诊治的胃癌患者210例作为胃癌组,同期选择在本院进行体检的健康者210例作为对照组.检测两组人群的血清血清PG、LGR4含量,调查患者预后并进行相关性分析.结果:胃癌组的血清PG Ⅰ含量低于对照组,血清LGR4、PG Ⅱ含量高于对照组(P＜0.05).平均手术时间154.98±19.43 min;平均术中出血量148.62±15.83 mL;平均术后肠功能恢复时间2.51±0.29 d;平均术后肛门排气时间2.79±0.16 d;平均术后下床活动时间2.33±0.15 d;平均术后住院时间9.28±0.29 d.术后14 d发生并发症24例,占比11.4％.胃癌组所有患者随访至今,平均随访时间为17.38±2.15个月,预后发生转移23例,占比11.0％;复发14例,占比6.7％.Spearsman分析显示胃癌患者预后转移、复发与血清PG Ⅰ、PG Ⅱ、LGR4含量存在相关性(P＜0.05).多因素logistic回归显示血清PG Ⅰ、PG Ⅱ、LGR4为导致患者预后复发、转移的重要因素(P＜0.05).结论:腹腔镜D2根治术治疗胃癌具有很好的安全性与微创性,但是预后复发率与转移率依然比较高,血清PG、LGR4与胃癌患者腹腔镜D2根治术预后存在相关性,也是导致预后复发与转移的重要因素.

目的 探讨指压法治疗甲状腺癌术后轻中度颈部淋巴漏的临床效果.方法 选取2015年5月至2019年5月于我院行甲状腺癌颈部淋巴结清扫的2468例患者作为研究对象,其中12例发生术后左侧颈部淋巴漏.分析局部指压法治疗淋巴漏患者的临床效果;观察治疗前、后颈部引流液的量及性状,以及颈部引流管的拔除时间.结果 12例患者接受指压法治疗后均顺利拔管并痊愈出院.患者治疗后颈部引流量持续减少,治疗第4天拔除引流管,且无因复发再次住院的患者.结论 指压法治疗甲状腺癌术后轻中度颈部淋巴漏的临床效果显著,且安全性高.

目的 优化硬镜用于取石保胆手术治疗胆囊结石的流程,探索更加微创的保胆手术方式.方法 选择我科收治的2334例行硬镜取石保胆手术的患者为研究对象,统计患者手术类型、不同术式的临床相关指标及并发症发生情况.结果 单孔组的手术时间、术中出血量、住院时间、胃肠功能恢复时间及术后积液引流量均优于两孔组及三孔组,且两孔组优于三孔组(P<0.05).单孔组的局部感染发生率显著低于三孔组(P<0.05).结论 单孔法操作简单,对腹腔内干扰及创伤最小,患者术后恢复相对更快,更加符合微创理念.

Objective:To know the harmfulness of the occult thyroid cancer,and discuss treatment mode of the oc-cult thyroid cancer in further.Methods:To report a case of a patient with occult thyroid cancer associated with multi-ple bone metastases in our department,with recent literature review,summarize the diagnosis,treatment and prognosis of occult thyroid cancer.Results:Although occult thyroid cancer belongs to thyroid microcarcinoma according to tumor size classification,diagnosis is relatively difficult,prognosis was still affected by many factors.Conclusion:Regardless of tumor size,harmfulness are be reckoned,even occult thyroid carcinoma,fully detailed assessment lesions and sys-temic situation is critical.

目的：探讨胆囊收缩功能低下（超声测量法胆囊收缩率<30%）的胆囊结石患者行取石保胆术后胆囊收缩功能的改变情况，综合判断该手术对此类患者的疗效。方法：回顾性分析2009 年12 月—2015 年5 月在唐都医院普通外科行取石保胆术的69 例胆囊收缩功能低下胆囊结石患者临床及随访资料。结果：69 例患者均行腹腔镜辅助取石保胆术。术后随访1~4 年，1 例（1.4%）复发，其他效果均满意；69 例患者术后胆囊收缩率较术前明显升高[（42.48±8.70）% vs.（14.46±9.78）%]；分组分析显示，不同数目、不同部位结石患者胆囊收缩率均较术前明显改善（均P<0.05）。结论：对于胆囊收缩功能低下的部分胆囊结石患者行取石保胆术可以获得较满意的效果。

目的:探讨肾透明细胞癌组织中MAPK9表达及其与肾透明细胞癌主要临床病理特征之间的关系,分析MAPK9对索拉非尼靶向治疗疗效的关系.方法:回顾分析2006年5月-2013年10月经病理确诊的32例肾透明细胞癌转移患者的MAPK9的表达情况.所有患者术后均服用索拉菲尼并随访;同时选取10例距肿瘤3 cm癌旁正常肾组织作为对照.对比分析肾透明细胞癌患者与对照组MAPK9的阳性表达率,分析MAPK9阳性表达与疗效的相关性,并分析MAPK9阳性表达与生存率之间的关系.结果:肾透明细胞癌组MAPK9阳性表达21例(65.6％),较正常对照组2例(20.0％)有显著性差异(P＜0.01).TNMⅠ ～Ⅱ期MAPK9阳性表达12例(85.7％),较TNMⅢ～Ⅳ期10例(55.6％)有显著性差异(P＜0.05);核分级1～2级MAPK9阳性表达18例(81.8％),较3～4级4例(40.0％)有显著性差异(P＜0.05).MAPK9阳性表达患者与阴性表达患者疗效有显著性差异(P＜0.05).MAPK9阳性患者PFS为(646±103)d,较阴性患者PFS为(502±89)d,有显著性差异(P＜0.05).MAPK9阳性患者OS为(866± 75)d,较阴性患者OS为(657±62)d,有显著性差异(P＜0.01).结论:MAPK9在肾透明细胞癌中高表达,与肿瘤的临床TNM分期、病理分级相关.MAPK9阳性表达患者其靶向治疗疗效越好,提示MAPK9可能是一个预测索拉菲尼靶向治疗肾透明细胞癌疗效的潜在因子.

目的 回顾性总结使用硬质胆囊镜(硬镜)进行保胆手术治疗胆囊结石的经验与体会,并制定胆囊结石分级分期治疗策略(唐都经验/标准).方法 对该科2009年12月～2012年12月441例行硬镜取石保胆术患者进行回顾性分析.结果 441例胆囊结石患者均行手术治疗,其中11例失访,失访率为2.4％.6例患者出现术后并发症,其中胆囊结石复发2例(0.47％),胆囊周围积液3例(0.7％),胆漏1例(0.23％),其余424例效果均满意.结论 取石保胆术是一种尚有争议,但逐渐被认可的手术治疗方式,可以成为治疗胆囊结石的主要治疗方法.笔者制定的“GUW”胆囊结石分级分期治疗策略(唐都经验/标准)有望成为这一治疗方式的评价体系标准.

BACKGROUND:Cell transplantation for disease treatment is one of interesting topics.To find a better source of seed cells and a more efficient amplification method is the basis for clinical application.OBJECTIVE:To determine whether the RhoA gene silencing in fetal liver stem cells can optimize liver stem cell cultures.METHODS:Fetal liver stem cells were in vitro cultured and were transfected by small interfering RNA(siRNA) to knock down the expression of RhoA.Then the cells were randomly divided into three groups.In the group A,fetal liver stem cells were non-treated.In the group B,fetal liver stem cells were transfected with randomly sequenced siRNA.In the group C,fetal liver stem cells were transfected with siRNA.RhoA gene and protein expression prior to and after transfection was detected by RT-PCR and western blot methods,respectively.Cellular proliferation was determined by MTT assay.The cell cycle was analyzed by flow cytometry.RESULTS AND CONCLUSION:Compared with groups A,B,the expression of RhoA gene and protein in the group C was significantly decreased(P < 0.05),the cell growth speed was significantly increased,cells in the G0/G1 phase of the cell cycle were decreased,and cells in the S phase were increased(P < 0.05).These findings suggest that the RhoA gene silencing can promote the proliferation of fetal liver stem cells and optimize the culture of fetal liver stem cells.

AIM:To investigate the effect of ligustrazine in alleviating inflammation and inhibiting the activation of NF-κB in rats after liver trauma. METHODS:Sixty rats which underwent 2/3 hepatectomy were randomly and equally divided into three groups.Group A was intraperitoneally injected with normal saline,and groups B and C were injected with PDTC and ligustrazine, respectively.The general status of the rats was observed,and changes in serum levels of aminotransferases were measured.Hepatic pathological changes were examined,and the activation of NF-κB was investigated by Western blot. RESULTS:Cellular swelling was milder in group C than in group A.Serum levels of ALT at 6 and 10 h after the operation were significantly lower in group C than in group A(6 h:488.9 U/L±59.2 U/L vs 651.6±65.3 U/L;10 h:670.0 U/L±73.4 U/L vs 930.0 U/L±62.9 U/L;both P < 0.05). Serum levels of AST at 6 and 10 h were also significantly lower in group C than in group A(6 h: 1113.1 U/L±138.7 U/L vs 1315.0 U/L±111.0 U/L; 10 h:1388.2 U/L + 209.6 U/L vs 1728.4 U/L±87.3 U/L;both P < 0.05).The levels of activated NF-κB in group C(0.78±0.04,0.75±0.07) were lower than those in group A(both were 1),higher than those in group B(0.68±0.09,0.66±0.04) at 2 and 10 h(all P < 0.05),but were comparable to that in group B at 6 h(0.71±0.07 vs 0.64±0.09,P > 0.05). CONCLUSION:Ligustrazine protects the post-traumatic liver tissue possibly by inhibiting the activation of NF-κB.