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Bisphosphonates (BPs), as potent drugs inhibiting bone resorption, have been widely used for treatment of several diseases. In recent years, dentists and oral and maxillofacial surgeons reported continuously increasing cases of bisphosphonate-related osteonecrosis of the jaws (BRONJ). This disease is clinically characterized by exposed bones, formation of sequestrum, pain, and halitosis. Provided that pathogenesis of BRONJ is unclear, effective treatments for this disease are currently unavailable. Thus, prevention plays an important role in the management of BRONJ. This review summarizes research progress on pathogenesis, risk factors, clinical characteristics, treatment, and prevention of this condition.
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Humans , Bisphosphonate-Associated Osteonecrosis of the Jaw , Bone Density Conservation Agents , Bone Resorption , Diphosphonates , Jaw , Risk Factors , Treatment OutcomeABSTRACT
Objective To observe the acarbose combined therapy with sugar pulse phase Ⅰ and phase Ⅱ clinical curative effect of diabetic nephropathy and the effects of oxidative stress on the patients.Methods 188 cases of phase Ⅰ and phase Ⅱ DN patients were selected in hangzhou xixi hospital endocrinology from January 2012 to December 2012,randomly divided into control group and treatment group,94 cases in each groups,the control group given conventional western medicine treatment of diabetic nephropathy,antihypertensive agents using lotensin.Treatment group was treated in the control group on the basis of taking acarbose and sugar pulse tablet.The control group and treatment group a course of eight weeks.Testing for 48 hours patients before and after the urine trace albumin in the urine(UAER)and creatinine ratio(ACR)with urine trace albumin,serum oxide dismutase(SOD),catalase(CAT)and malondialdehyde(MDA).Results The total effective rate was 91.5％in the treatment group,which was significantly higher than that in the control group(68.1％),the total effective rate of the two groups was statistically significant(P<0.05); The levels of UAER and ACR in the treatment group were lower than those in the control group(P<0.05); After treatment,the levels of serum SOD and CAT in the treatment group were higher than those in the control group,the MDA level was lower than that in the control group,the difference was statistically significant(P<0.05); No adverse reactions occurred in the two groups.Conclusion Acarbose combined with Tangmaikang granules in the treatment of DN patients with significant effect,can improve the treatment of diabetic nephropathy,the levels of oxidative stress injury is related to diabetic nephropathy mechanism.
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Objective To evaluate the prognostic value of hyperintense vessel (HV) in patients with acute middle cerebral artery (MCA) occlusion.Methods Seventy-four consecutive patients with first ever stroke(48 male and 26 female,the mean age was (60.7 ± 15.3) years) in the territory of MCA,retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011,were enrolled assubjects.All subjects completed brain MRI,and MRA or DSA indicated proximal MCA occlusion.According to the location and extent of HV,all subjects were classified into 3 groups:without HV,proximal HV and distal HV.Clinical data were obtained and compared among patients with different grades of HV.Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke.Results HV was observed in 49 (66.2％ ) of the 74 enrolled patients.Among patients with HV,7 (9.4％ ) were classified as proximal HV and 42 ( 56.8％ ) as distal HV.Initial NIHSS score ( 11 ( 1 -22) ),10-day NIHSS score ( 13.5(4-25) ),infarction size ( ＞2/3:5 cases(6.8％ ) ),and 90-day mRSscore (3-6 scores:12 cases( 16.2％ )) were significantly lower in patients with distal HV than those without (15(6-25),Z=-3.544;7(0-22),Z=-4.461;20 cases(27.0％),x2 =20.916;27 cases (36.5％),x2 =22.689;all P＜0.01).The NIHSS score decreased from baseline to that on 10 days and the mRS score decreased from 10 days to that on 90 days in patients with distal HV was more than that in patients without distal HV. Multivariate analysis revealed that patients with older age ( OR =1.111,95％ CI 1.036-1.191,P=0.003),high infarction size (OR=3.679,95％ CI 1.35-10.025,P=0.011) worsened outcome,whereas distal HV (P =0.012,OR =0.131,95％ CI 0.027-0.638)improved outcome.Conclusion Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral artery occlusion.
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Objective To investigate the dynamic change of serum high sensitive C-reactive protein (hsCRP) after carotid artery stenting (CAS) and its correlation with in-stent restenosis.Methods The serum hsCRP levels were determined before procedure,at 12 hours,7 days,3 and 6 months after procedure in patients who underwent CAS in the Department of Neurology,Jinling Hospital,Nanjing Their cerebral angiography was reexamined and whether there was in-stent restenosis after 6 months was observed.Results Eighty-four patients treated with CAS were included in the study.Fifteen (24％) had in-stent restenosis after CAS.The stenosis in 3 of them was ＞ 50％,and the stenosis m 12 of them was 30％ to 50％.The serum hs-CRP levels in all patients after procedure were significantly higher than those before treatment (all P ＜ 0.01 ),and they were significantly lower at 6 months after procedure than before treatment (all P ＜0.01).Univariate analysis showed that the proportion of diabetes in the restenosis group was significantly higher than that in the non-restenosis group (P＜0.01).At 7 days (8.83 ± 1.94 mg/L vs.6.77 ± 1.63 mg/L,t =14.398,P=0.044),3 months after procedure (8.26 ± 1.32 mg/L vs.4.58 ± 1.45 mg/L,t =17.569,P =0.008) and 6 months after procedure (7.04 ± i.07 mg/L vs.3.12 ± 1.28 mg/L,t =21.867,P =0.003),the serum hs-CRP levels in the restenosis group were significantly higher than those in the non-restenosis group,and the difference of the serum hs-CRP level (△ hs-CRP) before procedure and at 6 month after procedure was significantly lower than that in the nonrestenosis group (0.85 ± 0.13 mg/L vs.4.89 ± 0.94 mg/L,t =16.987,P =0.000).Multivariate logistic regression analysis showed that /hs-CRP (odds ratio [ OR] 2.392,95％ confidence interval [ CI] 1.538 -3.513; P =0.009) and diabetes (OR 1.840,95％ CI 1.372 -2.241; P =0.023) were the risk factors for instent restenosis.Conclusions The serum hs-CRP level increased significantly at 12 hours after CAS procedure,and then decreased continuously.At 6 months after procedure,the more decrease of the serum hs-CRP level,the lower risk of occurring in-stent restenosis was.
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Objective To investigate the correlation of the lesion pattern of internal border zone infarction (IBZI) with atherosclerosis and outcome.Methods Eighty-one patients with IBZI were retrospectively divided into a simple IBZI group and a mixed IBZI group (combined with other infarct patterns) according to diffusion-weighted imaging (DWI).The clinical characteristics were compared between the 2 groups.And then,the mixed IBZI group was further divided into 3 subgroups:IBZI + pial infarct (PI),IBZI + perforating artery infarct (PAI),and IBZI + PI + PAI.They were compared with the simple IBZI group respectively.Results There were no significant differences in the dinical characteristics,such as age,hypertension,and the numbers of patients with stent implantation between the simple IBZI group and the mixed IBZI group.The proportions of severe stenosis and occlusion of internal carotid artery (ICA) and/or middle cerebral artery (MCA) (P =0.009) and MCA lesions (P =0.032) in the mixed IBZI group were significantly higher.Among the patients with MCA lesions,the severe stenosis in the simple IBZI group was significantly more than that in the mixed IBZI group (P =0.042),while the occlusive lesions in the mixed IBZI group were significantly more than those in the simple IBZI group (P =0.022).The short-term (within 7 days) exacerbation (P =0.039) and poor outcome at 90 days (modified Rankin Scale＞ 3) in the mixed IBZI group (P=0.030) were significantly higher than those in the simple IBZI group.The subgroup analysis showed that the proportions of the short-term exacerbation (P =0.001 ) and poor outcome in patients at 90 days (P =0.010) in the IBZI + PI +PAI subgroup were significantly higher than those in the simple IBZI group.Conclusions The IBZI patients combined with other infarct patterns often exist severe cerebrovascular stenosis and occlusion,and their clinical outcome was poorer.For patients with MCA lesions,the mixed IBZI occurred more in patients with MCA occlusion,and the simple IBZI occurred more in patients with severe MCA stenosis.
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Objective Endoscopy, 24-hour esophageal pH monitoring were used to objectively estimate the extent of gastroesophageal reflux and affecting factor after esophagectomy for cancer. Methods Endoscopy, 24 hour pH monitoring were performed in thirty-nine patients, including 21 undergoing esophagogastrostomy above the aortic arch (group A) and 18 below the aortic arch (group B). Results (1) DeMeeter score of gastroesophageal reflux in group A was significantly higher than that in group B in different postoperative period (P0.05). Conclusion Thoracic anastomosis in the lower thorax is more likely to be followed by gastroesophageal reflux and esophagitis. There is no significant change in extent of gastroesophageal reflux over time.
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<p><b>OBJECTIVE</b>To study a group of patients with abnormalities of esophageal motility in manometric investigation.</p><p><b>METHODS</b>From 1990 to 1999, 14 patients with dysphagia (9), chest pain (3), or both (2) were studied. All patients denied symptoms of heartburn, regurgitation, odynophagia, epigastric discomfort, and investigation failed to show any evidence of ischemic heart disease. A perfused catheter with 4 separate lumens was used and connected to output transducers (Medtronic, PC Polygraf HR).</p><p><b>RESULTS</b>Of the 14 patients, 11 had motor disorders of the esophageal body including simultaneous contractions without normal peristalsis (5), alternative occurrence of simultaneous contractions and normal peristalsis (3), aperistalsis (2) and very low amplitude peristalsis (1). Seven patients were diagnosed with motility disorders of the lower esophageal sphincter including incomplete relaxation or no relaxation on swallowing (6), short relaxation duration (1). Four patients had more than one abnormal manometric findings.</p><p><b>CONCLUSIONS</b>Non-specific esophageal motility disorder is not a real diagnostic entity, but only a group of manometric abnormalities. The relationship between the symptoms of the patients and the manometric findings was analysed. It is uncertain that these disorders have a common etiology. The revision of these abnormalities is difficult because the pathogenesis is unknown.</p>