益生菌联合牙周基础治疗对慢性牙周炎患者口腔致病菌的影响

目的 探讨益生菌联合牙周基础治疗对慢性牙周炎患者的治疗效果及其对口腔致病菌的影响。 方法 选取2017年10月至2019年4月我院收治的120例慢性牙周炎患者为研究对象,采用随机数字法将其分为对照组(n=60)及观察组(n=60),对照组采取牙周基础治疗,包括对牙垢面进行清洁、处理咬合创伤、采用生理盐水漱口等及口服阿莫西林胶囊、甲硝唑片,观察组在对照组的基础上口服双歧杆菌三联活菌胶囊,2粒/次,2次/d。治疗4周后,比较2组研究对象探诊深度(probing depth,PD)、牙菌斑指数(dental plaque index,PLI)及牙龈出血指数(bleeding index,BI),评估治疗效果;采用细菌培养的方式观察龈沟液中主要致病菌群变化情况,并记录不良反应发生情况。 结果 治疗后,观察组研究对象PD、PLI及BI均低于对照组(t=2.614,P=0.010;t=2.523,P=0.013;t=5.330,P2=6.775,P=0.009);治疗后,2组研究对象唾液中福赛坦菌、中间普氏菌、牙龈卟啉单胞菌以及伴放线放线杆菌检出率均低于对照组(t=4.174,P=0.041;t=5.783,P=0.016;t=6.009,P=0.014;t=10.231,P=0.001);2组研究对象不良反应发生率差异无统计学意义(χ2=0.086,P=0.769)。 结论 在牙周基础治疗上口服双歧杆菌三联活菌胶囊有利于减轻慢性牙周炎患者牙周症状、抑制口腔致病菌、提高治疗效果。     

Parameters of oxidative stress in saliva from patients with aggressive and chronic periodontitis

Objectives: Free radicals play an important role in the onset and progression of many diseases. The aim of this study was to investigate the contribution of oxidative stress in the pathology of aggressive (AgP) and chronic (CP) periodontitis and its relation with the clinical periodontal status.

Methods: Eighty subjects were divided into two groups: 20 patients with AgP and 20 patients with CP with their 20 corresponding matched controls, based on clinical attachment loss (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). Saliva reactive oxygen species (ROS), lipid peroxidation, and non-enzymatic antioxidant defences were measured by luminol-dependent chemiluminescence assay, as thiobarbituric acid-reactive substances (TBARs) and total radical-trapping antioxidant potential (TRAP), respectively. Pearson's correlation and multivariate analysis were used to determine the relationship between ROS and TBARs and the clinical parameters.

Results: ROS and TBARs were increased in AgP while TRAP was decreased, comparing with CP. In AgP, a strong and positive correlation was observed between ROS and TBARs and they were closely associated with CAL and PPD.

Discussion: In AgP, but not in CP, oxidative stress is a high contributor to periodontal pathology and it is closely associated with the clinical periodontal status.     

Geometry-based pressure drop prediction in mildly diseased human coronary arteries

Pressure drop (△p) estimations in human coronary arteries have several important applications, including determination of appropriate boundary conditions for CFD and estimation of fractional flow reserve (FFR). In this study a △p prediction was made based on geometrical features derived from patient-specific imaging data.     

Rapid detection and quantification of five periodontopathic bacteria by real-time PCR

The quantity of periodontopathic bacteria in plaque samples is an important determinant for understanding the etiologic role of bacteria. The real-time PCR method was used to detect and quantify periodontopathic bacteria, such as Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis, Treponema denticola, and Treponema socranskii, in saliva and subgingival plaque samples. There was good agreement between the results of conventional PCR and real-time PCR methods. Using the LightCycler system we were able to determine the amount of periodontopathic bacteria within an hour. The real-time PCR method was linear for samples containing from 10(3) to more than 10(8) cells (r2 = 0.999). The application of the real-time PCR method should be useful in the rapid detection and quantification of periodontopathic bacteria in clinical samples.     

儿童慢性牙周炎与口腔幽门螺杆菌感染的相关性

目的 探讨慢性牙周炎患儿与其口腔中幽门螺杆菌(Helicobacter pylori, H. pylori)的相关性,为儿童慢性牙周炎的临床治疗提供指导。 方法 分别随机选取2017年5月-2019年5月来我院口腔科就诊的慢性牙周炎患儿和牙周健康的儿童作为观察组(92例)和对照组(92例)。应用PCR技术检测采集的牙菌斑和含漱液样品中的H. pylori,并比较两组儿童口腔H. pylori检出率的差异及龈上、龈下菌斑中的分布情况以及不同程度牙周炎患儿检出率的差异。 结果 观察组患儿口腔中H. pylori的检出率明显高于对照组,两组之间差异有统计学意义(χ2=9.588 1,P2= 58.119 9,P2=19.783 1,P结论 口腔中H. pylori可能在儿童慢性牙周炎致病过程具有一定的促进作用,二者具有相关性。     

Detection and characterization of beta-lactamase genes in subgingival bacteria from patients with refractory periodontitis

Fifty-three beta-lactamase-producing strains of oral bacteria isolated from patients with refractory periodontitis in Norway and USA were screened for the presence of the bla(TEM), bla(SHV), bla(OXA), bla(ampC), bla(cfxA), and bla(cepA/cblA) genes by the polymerase chain reaction (PCR). The PCR products were characterized by direct sequencing of the amplified DNA. Thirty-four of the 53 enzyme-producing strains (64%) were positive in one of the PCR assays. All beta-lactamase-producing Prevotella and Capnocytophaga spp. were CfxA positive. TEM-type beta-lactamases were identified in one strain each of Escherichia coli and Neisseria sp., and one strain of Citrobacter freundii possessed an AmpC-type beta-lactamase. Screening for gene cassettes and genes known to be associated with integrons did not reveal the presence of integrons in these oral bacteria. Sequence analyses showed that most CfxA positive Prevotella and Capnocytophaga isolates from patients with refractory periodontitis harboured variants of the CfxA2 and CfxA3 enzyme. The present study also showed that many different genetic determinants of beta-lactamase production are found in bacteria isolated from refractory periodontitis, many of which remain to be characterized.     

Heterogeneous cholinergic reactions of ringed seal coronary arteries

Coronary blood flow of some seal species is unusual in that it is highly variable in both non-diving and diving conditions and shows intermittent fluctuations, especially during dives when it frequently ceases for brief periods. We sought regulatory mechanisms governing these reactions by studying isometric tension recordings of isolated left circumflex (LC) and left anterior descending (LAD) coronary arteries of ringed seals, Phoca hispida, during reactions to a variety of agents for stimulating or blocking autonomic responses of the vascular smooth muscle. Micromolar acetylcholine (ACh) produced constriction of the small diameter segments of the LAD, but relaxation of the LC and larger segments of LAD. Both constrictions and dilations were prevented by atropine. Small vessel constriction by ACh was prevented by micromolar indomethacin and by a thromboxane receptor antagonist. Large vessel ACh dilations were prevented or reduced by rubbing off the endothelium and by the -arginine analog, -NG-nitro-arginine, an inhibitor of nitric oxide synthesis. We conclude that cholinergic, muscarinic, dilation of ringed seal large coronary arteries is mediated by endothelial-derived relaxing factor (EDRF), whereas ACh constriction of small arteries is mediated by a prostaglandin.     

慢性化脓性中耳炎患者耳道分泌物的病原菌检测及药物敏感性分析

目的 分析慢性化脓性中耳炎（CSOM）患者耳道分泌物的病原菌分布及其药敏情况,为临床合理应用抗菌药物提供参考。方法 收集浙江省立同德医院100例（116耳）CSOM患者耳道分泌物标本进行常规病原菌分离、鉴定及药敏试验。结果 116耳中有97耳培养出病原菌,检出率为83.6%。共检出病原菌103株,其中革兰阳性菌占53.4%（55/103）,革兰阴性菌占41.7%（43/103）,真菌占4.9%（5/103）。金黄色葡萄球菌和表皮葡萄球菌对青霉素和磺胺甲恶唑/甲氧苄啶耐药性较高,对利福平和莫西沙星敏感性较高,对呋喃妥因和万古霉素完全敏感。铜绿假单胞菌和肺炎克雷伯菌对头孢唑啉、氨苄西林、头孢吡肟、头孢曲松、哌拉西林/舒巴坦耐药性均较高,对妥布霉素、氨曲南、哌拉西林/他唑巴坦敏感性较高,对阿米卡星、美罗培南及亚胺培南完全敏感。真菌对氟胞嘧啶、两性霉素B及制霉菌素均敏感,而对酮康唑和氟康唑有一定的耐药性。结论 CSOM患者耳道分泌物中病原菌以金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌及肺炎克雷伯菌为主,这4种病原菌对多数常用抗菌药物有较强的耐药性,治疗时需根据细菌培养及药敏分析结果合理选用抗菌药物。     

Single nucleotide polymorphisms associated with aggressive periodontitis and severe chronic periodontitis in Japanese

Periodontitis is a common inflammatory disease causing destruction of periodontal tissues. It is a multifactor disease involving genetic factors and oral environmental factors. To determine genetic risk factors associated with aggressive periodontitis or severe chronic periodontitis, single nucleotide polymorphisms (SNPs) in multiple candidate genes were investigated in Japanese. We studied 134 patients with aggressive periodontitis, 117 patients with severe chronic periodontitis, and 125 healthy volunteers without periodontitis, under case-control setting, and 310 SNPs in 125 candidate genes were genotyped. Association evaluation by Fisher's exact test (p < 0.01) revealed statistically significant SNPs in multiple genes, not only in inflammatory mediators (IL6ST and PTGDS, associated with aggressive periodontitis; and CTSD, associated with severe chronic periodontitis), but also in structural factors of periodontal tissues (COL4A1, COL1A1, and KRT23, associated with aggressive periodontitis; and HSPG2, COL17A1, and EGF, associated with severe chronic periodontitis). These appear to be good candidates as genetic factors for future study.     

两种龈下刮治和根面平整术对2型糖尿病伴慢性牙周炎疗效的比较

目的:比较一次法龈下刮治和根面平整术(FM-SRP)和常规的四分法龈下刮治和根面平整术(Q-SRP)治疗2型糖尿病伴慢性牙周炎的临床疗效,并观察慢性牙周炎治疗对2型糖尿病患者血糖控制的影响。方法:将48例2型糖尿病伴慢性牙周炎患者随机分为2组:FM-SRP组在l天内完成全口所有象限的刮治和根面平整,Q-SRP组每周进行1个象限的刮治,连续4周完成全口治疗。于治疗前、治疗3个月和6个月时,检测菌斑指数(PLI)、牙周探诊深度(PD)、临床附着水平(CAL)、探诊出血(BOP)及空腹血糖(FPG)与糖化血红蛋白(HbAlc)的变化。结果:有3例患者被剔除。与治疗前相比,2种治疗方式在3个月和6个月时的PLI、PD、CAL和BOP均有显著改善(P<0.05),FPG和HbAlc无显著性改变(P>0.05)。但各项指标的变化在2组间均无显著性差异(P>0.05)。结论:本组资料,FM-SRP和Q-SRP两种方法治疗2型糖尿病伴慢性牙周炎均可达到相同的临床效果,但对2型糖尿病患者血糖控制无明显影响。     

牙周炎伴糖尿病患者HbA1c差异性分析及其与口腔龈下菌群分布的关系

目的探讨牙周炎伴糖尿病患者糖化血红蛋白(HbA1c)水平及其与口腔龈下菌群分布的关系。方法将2018年8月至2019年12月本院牙周病科收治的98例慢性牙周炎患者纳入研究,根据是否合并2型糖尿病将患者分为牙周炎组(n=32)和糖尿病组(n=66)。测定和比较2组患者空腹血糖(FBG)、餐后2小时血糖(2hBG)和HbA1c水平,根据HbA1c水平将患者分为轻度组(HbA1c≤7%)(n=26)、中度组(7%10%)(n=18)。利用牙龈指数评估牙周病变程度。取磨牙探诊深度≥4 mm且存在附着丧失位点处龈下菌斑,鉴定菌种种类并计数。结果糖尿病组患者FBG、2hBG和HbA1c水平显著高于牙周炎组(t=2.878,P=0.005;t=9.119,P<0.001;t=3.371,P=0.001)。不同HbA1c水平牙周病变等级分布差异有统计学意义(t=12.364,P=0.002),HbA1c水平与牙龈损伤程度呈正相关(r=0.769,P=0.002)。糖尿病组患者龈下伴放线放线杆菌和二氧化碳嗜纤维菌检出率显著高于牙周炎组(t=3.873,P=0.049;t=14.061,P<0.001)。患者龈下二氧化碳嗜纤维菌、牙龈卟啉单胞菌、中间普氏菌和变黑普氏菌数量随HbA1c水平升高而增加(t=13.914,P<0.001;t=6.985,P=0.002;t=5.955,P=0.004;t=6.808,P=0.002);HbA1c水平与龈下二氧化碳嗜纤维菌、牙龈卟啉单胞菌、中间普氏菌和变黑普氏菌数量呈正相关(r=0.861,P<0.001;r=0.758,P<0.001;r=0.776,P<0.001;r=0.754,P<0.001)。结论牙周炎伴糖尿病患者牙周病变程度及龈下菌群分布变化与HbA1c水平有关,良好的血糖控制有助于维持慢性牙周炎患者龈下菌群稳态,对糖尿病和牙周病预防与治疗具有积极作用。     

粘接性牙周夹板固定修复在慢性牙周炎患者的临床应用

目的:观察粘接性牙周夹板固定修复治疗慢性牙周炎的临床效果。方法:选择25例(93颗松动患牙)慢性牙周炎患者,记录牙周治疗前、采用粘接性牙周夹板固定修复后即刻、3、6及12个月的牙周状况,包括菌斑指数(PLI)、探针深度(PD)、牙龈出血指数(BOP)、牙龈指数(GI)和附着丧失(AL)的变化;检测牙龈龈沟液中卟啉单胞菌、血链球菌数量的变化;评估患者行固定夹板修复后对美观、舒适、咀嚼、发音等方面的满意度。结果:经牙周夹板固定修复后,各阶段的PLI、PD、GI和AL的指标值与治疗前相比差异均有统计学意义(P0.05),但固定后各阶段之间的牙周临床指标差异无统计学意义(P0.05);牙龈卟啉单胞菌和血链球菌数的数量在固定后各阶段较治疗前均显著减少(P0.05),但固定期间各阶段比较差异不明显(P0.05);固定修复后,各阶段患者的满意度均较高。结论:慢性牙周炎患者经完善的牙周基础治疗后,应用粘接性牙周夹板固定修复,能够有效固定患者松动患牙,恢复其咀嚼功能,有效地控制慢性牙周炎的发展。     

牙周基础治疗对慢性牙周炎伴冠心病患者血清炎症因子、龈下菌群和龈沟液中自噬因子的影响

摘要 目的：观察牙周基础治疗对慢性牙周炎伴冠心病患者血清炎症因子、龈下菌群和龈沟液中自噬因子的影响。方法：选择成都市第三人民医院口腔科2020年3月~2022年2月期间收治的慢性牙周炎伴冠心病患者83例。按照随机数字表法将患者分为对照组（n=41）和研究组（n=42）,对照组接受常规内科维持治疗,研究组在对照组的基础上接受牙周基础治疗。对比两组牙周临床指标、血清炎症因子、龈下菌群、龈沟液中自噬因子的变化情况。结果：治疗3个月后,研究组牙龈指数（GI）、牙周附着丧失（AL）、牙周袋深度（PD）均低于对照组（P<0.05）。治疗3个月后,研究组C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白介素（IL）-1β、IL-6、IL-8、IL-17、IL-18低于对照组,IL-10高于对照组（P<0.05）。治疗3个月后,研究组牙龈卟啉单胞菌、伴放线菌嗜血菌、中间普雷沃菌、福赛斯坦纳菌、齿垢密螺旋体相对含量均低于对照组（P<0.05）。治疗3个月后,研究组微管相关蛋白1轻链3（LC3）、Beclin-1均低于对照组（P<0.05）。结论：牙周基础治疗可有效调节慢性牙周炎伴冠心病患者血清炎症因子水平,改善龈下菌群,降低龈沟液中自噬因子水平。     

口腔H.pylori感染与慢性牙周炎患者龈沟液中细胞因子和MMPs/TIMPs水平的相关性

目的探讨口腔H.pylori感染与慢性牙周炎患者龈沟液中细胞因子及与MMPs/TIMPs水平的相关性。方法选择2017年1月至2019年1月在本院诊断为慢性牙周炎的162例患者作为慢性牙周炎组,根据病情严重程度分为轻度(80例)、中度(59例)、重度(23例);取同期在本院进行常规口腔检查的健康志愿者100例作为正常对照组,对比各组研究对象口腔H.pylori感染率的差异。根据口腔H.pylori感染与否将慢性牙周炎组患者进一步分为H.pylori(+)组(72例)和H.pylori(-)组(90例),对比其血清炎症因子[白介素-1β(IL-1β)、白介素-8(IL-8)、白介素-35(IL-35)、肿瘤坏死因子α(TNF-α)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]和MMPs/TIMPs[基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶组织抑制剂-2(TIMP-2)]水平的差异。结果慢性牙周炎组患者口腔H.pylori阳性率高于正常对照组,且随病情严重程度增加H.pylori阳性率上升(P<0.05)。慢性牙周炎患者中,H.pylori(+)组患者龈沟液中IL-1β、IL-8、IL-35、TNF-α的水平高于H.pylori(-)组;H.pylori(+)组患者龈沟液中MDA的水平高于H.pylori(-)组,SOD的水平低于H.pylori(-)组。H.pylori(+)组患者龈沟液中MMP-3、TIMP-2的水平高于H.pylori(-)组,MMP-3/TIMP-2比值高于H.pylori(-)组(P<0.05)。结论口腔H.pylori感染可能是导致慢性牙周炎患者病情加重的原因之一。     

Measurement of coronary bifurcation angle with coronary CT angiography: A phantom study

PurposeAccurate determination of the bifurcation angle and correlation with plaque buildup may lead to the prediction of coronary artery disease (CAD). This work evaluates two techniques to measure bifurcation angles in 3D space using coronary computed tomography angiography (CCTA).Materials and MethodsNine phantoms were fabricated with different bifurcation angles ranging from 55.3° to 134.5°. General X-ray and CCTA were employed to acquire 2D and 3D images of the bifurcation phantoms, respectively. Multiplanar reformation (MPR) and volume rendering technique (VRT) were used to measure the bifurcation angle between the left anterior descending (LAD) and left circumflex arteries (LCx). The measured angles were compared with the true values to determine the accuracy of each measurement technique. Inter-observer variability was evaluated. The two techniques were further applied on 50 clinical CCTA cases to verify its clinical value.ResultsIn the phantom setting, the mean absolute differences calculated between the true and measured angles by MPR and VRT were 2.4° ± 2.2° and 3.8° ± 2.9°, respectively. Strong correlation was found between the true and measured bifurcation angles. Furthermore, no significant differences were found between the bifurcation angles measured using either technique. In clinical settings, large difference of 12.0° ± 10.6° was found between the two techniques.ConclusionIn the phantom setting, both techniques demonstrated a significant correlation to the true bifurcation angle. Despite the lack of agreement of the two techniques in the clinical context, our findings in phantoms suggest that MPR should be preferred to VRT for the measurement of coronary bifurcation angle by CCTA.     

Colonisation of the oral cavity by periodontopathic bacteria in complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00506.x Colonisation of the oral cavity by periodontopathic bacteria in complete denture wearers Objective: The purpose of this study was to investigate colonisation by periodontopathic bacteria and the sites of colonisation in elderly upper and lower complete denture wearers. We also investigated the relationship between level of oral hygiene and colonisation by periodontopathic bacteria. Materials and methods: Forty edentulous and 37 dentate volunteers participated in this study. Samples were collected from whole saliva, and levels of Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia and Fusobacterium nucleatum were determined by PCR Invader technology. Detection of these species on oral mucosal and denture surfaces was performed by PCR. Fisher’s exact test was used for the statistical analysis. Cluster analysis was employed to investigate trends in the periodontopathic bacteria flora in each sampling area. Results: Detection rates of periodontopathic bacteria in whole saliva were lower under edentulous conditions than under dentulous conditions, except for A. actinomycetemcomitans and F. nucleatum (p < 0.01). Detection rate of F. nucleatum was the highest in all areas. A positive correlation was observed between DNA quantification of P. gingivalis and number of Candida species in saliva. Cluster analysis of the test species identified two clusters. Tongue‐coating status was associated with the detection rate of all periodontopathic bacteria investigated, and denture plaque status was associated with the detection rate of T. denticola and F. nucleatum. Conclusion: Results indicate the presence of periodontopathic bacteria under edentulous conditions and that the status of oral hygiene of the mucosal or denture surfaces affects colonisation by T. denticola and F. nucleatum.     

Undercarboxylated osteocalcin as a biomarker of subclinical atherosclerosis in non-dialysis patients with chronic kidney disease

Background

Studies in recent years have shown that undercarboxylated osteocalcin (uOC) not only maintains bone mineralization, but is also involved in the regulation of atherosclerosis. However, a correlation between uOC and carotid atherosclerosis in non-dialysis patients with chronic kidney disease (CKD) has not been investigated.A total of 240 non-dialysis patients with CKD were included in the study. For these patients, the median estimated glomerular filtration rate (eGFR) was 20.05 (12.43–49.32) ml/min/1.73m². Serum uOC levels were measured using enzyme-linked immunosorbent assay (ELISA). Carotid ultrasonography was performed to assess carotid atherosclerotic plaques and intima–media thickness (IMT) in an attempt to analyze the relationship between uOC level and carotid atherosclerosis.

Results

The uOC levels of non-dialysis patients with CKD were significantly lower than those of healthy controls [28.16 (21.40–45.85) ng/mL vs. 36.42 (28.05–49.28) ng/mL, P < 0.01]. The uOC levels gradually decreased as CKD progressed (P < 0.01). The uOC levels were significantly lower in patients with carotid plaques than in patients without carotid plaques [25.98 (20.14–31.35) ng/mL vs. 31.02 (25.86–36.40) ng/mL, P < 0.01]. uOC level showed significant negative correlation with IMT (r = -0.33, P < 0.01). Logistic regression analysis revealed that after adjustment for various confounding factors, decreased uOC levels were shown to indicate increased possibility of carotid atherosclerotic plaque development in non-dialysis patients with CKD (on every 1 SD decrease in the uOC level, odds ratio 1.70, 95 % confidence interval 1.24–2.98, P < 0.01). Multivariate stepwise regression analysis demonstrated that decreased uOC level (β = -0.163, P < 0.05) was an independent risk factor for increased carotid IMT in non-dialysis patients with CKD.

Conclusion

Serum uOC levels in non-dialysis patients with CKD are significantly lower than those in healthy individuals, and uOC is closely associated with subclinical atherosclerosis in CKD patients.