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OBJECTIVE To investigate the effects of esketamine combined with dexmedetomidine used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome. METHODS Totally 60 patients with obstructive sleep apnea syndrome were randomly divided into control group and observation group ，with 30 cases in each group. Anesthesia induction scheme of control group included loading dose of dexmedetomidine 1 μg/kg，pumped for 10 min，maintained at 1 μg（/ kg·h），and intravenous administration of propofol at a constant rate of 3 mg（/ kg·h）until the patient snored. That of observation group included same administration route and dose of dexmedetomidine as control group ，intravenous administration of esketamine 1 mg/kg at a constant rate of 0.5 mg/（kg·h）until the patient snored. Sleep endoscopy was performed when the bispectral index （BIS）was lower than 75 and the alert /sedation（OAA/S）score was higher than 1. The vital signs ，BIS and OAA/S scores of patients in awake state （T0），10 min load dose of dexmedetomidine infusion （T1），at the time of examination （T2）and at the end of examination （T3） were recorded ，as well as the patient ’s medication （including the one-time success rate of examination ，the number of additional drugs due to physical movement during examination ），and the occurrence of adverse events after medication. RESULTS In the comparison between groups ，the pulse oxygen saturation （SpO2）and BIS of patients in the observation group were significantly higher than those in the control group at T1，T2 and T3；the heart rates and mean arterial pressures （MAP）at T2 and T3 were significantly lower than those in the control group ；and the OAA/S score at T1 and T2 were significantly higher than those in the control group （P＜0.05）. Comparison within the group ，the heart rates at T1，T2 and T3 in the observation group were significantly lower than those at T0，and the MAP at T2 and T3 were significantly lower than that at T1（P＜0.05）；in control group ，compared with T0，SpO2 decreased significantly at T1，T2 and T3，heart rate decreased significantly at T1，and MAP increased significantly at T2（P＜0.05）. Sixty patients successfully completed drug-induced sleep endoscopy after medication. The one-time success rate of examination in the observation group was significantly higher （No.191460443） than control group （P＜0.05），and the number of additional drugs due to physical movement during examination was significantly less than control group （P＜0.05）. There was no significant difference in the incidence of adverse events between 2 groups（P＞0.05）. CONCLUSIONS Esketamine combined with dexmedetomidine has less respiratory inhibition and less effect on hypoxia hemodynamics in patients with obstructive sleep apnea syndrome. It has less intervention times in the process of sleep endoscopy ，and has more advantages than propofol.
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Olfactory dysfunction is defined as decrease or loss of smell perception.This review systematically summarizes classification, etiology and diagnosis progress of olfactory dysfunction, and focuses on advancement in management of olfactory dysfunction, including pharmaceutical remedy, surgical treatment as well as olfactory training.Glucocorticoids play an important role in the treatment of olfactory dysfunction. Sodium citrate, vitamin A, and nonspecific phosphodiesterase inhibitors (theophylline, pentoxifylline) are promising drugs.Endoscopic paranasal sinuses surgery can improve the olfactory dysfunction caused by chronic sinusitis to some extent.Olfactory training has been proven to be effective for a variety of causes of olfactory dysfunction.
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Objective To explore a novel strategy to repair traumatic soft tissue defects in the head and face by tissue expansion in the early stage.Methods Eighteen patients with traumatic soft tissue defects were treated with thorough debridement leaving the wound unclosed or simply closed with thin split-thickness scalp skin grafting,and adjacent expander implantation in the early stage and expanded flap transposition in the second stage.Results There were 11 male patients and 7 female patients ranging in age from 3.5 to 40 years [mean,(19.4±12.2) years],with average 15 months follow-up (range,3-67 months).The average expansion time was 74.3 days (range,53-96 days).The total of 18 patients with 22 expanders were treated with satisfactory results.All the flaps survived and the skin color,texture and contour well matched to those of the peripheral tissue.Only one complication of infection happened in the 18 cases (5.56％) and total 22 expanders (4.55％),which was similar to the rate reported in the literature.There were no any other complications related to the expander.Conclusions Debridement and tissue expansion in the early stage have been proved a more effective strategy to repair traumatic soft tissue defects in the head and face,which can not only achieve satisfactory color,unbulky and well matched texture similar to normal,but also can avoid unnecessary donor site injuries and does not increase the infection rate of tissue expansion.
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Objective To investigate the role of bone marrow-derived mesenchymal stem cells (BMSCs) compounded with bioprotein gel (Bg) in repair of knee articular cartilage defects of rabbits.Methods Bilateral femoral condylar cartilage defect models (3.5 mm in diameter and 3 mm in depth) were established in 36 healthy New Zealand rabbits.Animals were divided into three groups of 12 rabbits each according to the random number table:BMSCs-Bg group,Bg group and blank control group.Effect of repair was evaluated by anatomic observation and histological examination at 4,8,12 and 16 weeks after operation and by articular cartilage histological hemi-quantitative scoring system.Results Hyaline-like cartilage was noted in BMSCs-Bg group at 4 weeks postoperatively,got close to the normal at 8 and 12 weeks and showed no disintegration at 16 weeks.Only fibrous tissue or fibrocartilage was observed in other 2 groups.In BMSCs-Bg group histology scores were (4.5 ± 0.1) points,(4.9 ± 0.1) points,(5.5 ± 0.1) points,and (6.2 ± 0.1) points respectively at 4,8,12 and 16 weeks,higher than those in other 2 groups (P ＜ 0.05).Besides,the histology scores were higher in Bg group than in blank control group but the differences were insignificant.Conclusion BMSCs-Bg compound can well repair the articular cartilage defect in a short-term period,when Bg contributes to cartilage generation as a good cell carrier.
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Objective To study the feasibility and rehabilitation outcomes of one -stage cochlear implantation (CI) in profound deaf children with secretory otitis media (SOM ) .Methods A total of 11 profound deaf children with soal receired one -soage unilateral cochlear implantation with a follow -up period from 13~60 months .In-flamed mucosa in the mastoid as well as exudates were removed radical1y at the time of implantation for adequate drainage of the middle ear .After the sugery ,the patients were followed up and the hearing and rehabilitating out-comes were eveluated .Results All 11 patients were successfully operated with 8 cases in the right ear and 3 cases in the left ear .Among them ,7 cases were nucleus 24 CA ,1 case losa clarion AB 90 K ,2 cases were medel combi 40+and 1 case was pulsar .All patients were successfully operated .No infectious complications occurred .No recurrence of secretory otitis media was observed .After initial stimulation and post regular fitting ,the status of the implant-able devices were all stable .All the implantees had satisfied hearing and entered normal kindergartens or schools . Conclusion Profound deaf pediatric patients with SOM are not an absolute contraindication for CI .With sufticient pre-operation preparontion ,proper trentment and nursing .Cochlear implantation should be condnote as early as possible better rehabilitation performance .
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Objective To compare complication,nutritional status and quality of life between total gastrectomy and jejuna interposition after proximal radical gastrectomy in patients with advanced proximal gastric carcinoma.Methods Eighty-five patients with proximal stomach cancer were enrolled from Jan.2002 to Dec.2008,total gastrectomy group(Control group) had 40 cases,jejuna interposition after proximal radical gastrectomy(Experimental group) included 45 cases.Nutritional status,incidence of reflux esophagitis and cholecystolithiasis,5-year survival rate,quality of life were investigated.Results There was no significant difference in 5-year survival rate between two groups(P ＞ 0.05).Incidence of reflux esophagitis in Experimental group was significantly lower than that in Control group(P =0.042).Incidence of cholecystolithiasis in Experimental group was significantly lower than that in Control group (P =0.038).Hemoglobin,albumin,vitamin B12 and ferritin in Experimental group were significantly higher than those in Control group[(142.2 ±8.6) vs (128.4 ±8.4),(41.3 ±5.8) vs (35.9 ±3.8),(271.5 ± 49.7) vs (184.5 ± 24.6),(220.2 ± 59.7) vs (170.2 ± 27.6),P =0.036,0.024,0.032,0.026].Diet and labor in Experimental group were better than those in Control group (P =0.042,0.048).Conclusion Jejuna interposition after proximal radical gastrectomy decrease incidences of reflux esophagitis and cholecystolithiasis,improve nutritional status and quality of life.
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Objective To investigate the influence of the fish oil fatty acid (rich in ω-3 polyunsaturated fatty acids ) acting on the cellular immune and inflammatory response of perioperative patients of gastrointestinal tumors .Methods 79 gastrointestinal tumors patients who took total parenteral nutrition (TPN)after operation are divided into 2 groups randomly(collected from July 2010 to June 2012) .39 patients in study group are supplied with fish oil fatty acid within 24 h after operation and 7 d in total .40 pa-tients in the control group are supplied with ordinary long chain fat emulsion within 24 h after operation ,7 d as a course .The per-centage and the ratio of T lymphocyte subsets(CD3 ,CD4 ,CD8) ,monocyte human leukocyte antigen DR(HLA-DR) expression(per-centage) and the number of monocytes of 2 groups were test by blood test at 1st and 8th day after operation .Results The ratio of CD3、CD4、CD8、CD4/CD8 ,monocyte(HLA-DR) expression(percentage) and the number of monocytes in the study group were sig-nificantly higher than that of control group after received fish oil fat emulsion (P0 .05) .However ,compared with their results shown that they all had obvious difference respectively by a eight-day observation(P0 .05) .Conclusion Given the fat emulsion of fish oil which is rich in ω-3 poly-unsaturated fatty acid can significantly improve the cellular immune function of postoperative patients and release the inflammatory response after operation in patients of gastrointestinal tumors .
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Objective To investigate neuroimaging and its correlation with clinical aspects of cerebral palsy (CP).Methods A retrospective study of 295 children with CP was conducted.Magnetic resonance imaging (MRI),the gross motor function classification system (GMFCS) and intelligence testing were administered,and any correlations among these measures was analysed.Results Among the 295 cases,257 presented abnormal MRIs (87.1％) due to brain maldevelopment (n =11),periventricular leukomalacia (PVL) (n =173),cortical/subcortical lesions (n =17),basal ganglia lesions (n =26),cerebellar maldevelopment (n =11) or others lesions (n =19).Thirty-nine presented with normal MRIs.About 26％ were rated at GMFCS level 1,18％ at level 2,17％ at level 3,19％ at level 4 and 20％ at level 5.Almost 82％ of the children presented with brain maldevelopment and 84.4％ with PVL-induced spastic bilateral paralysis.In 41％ of the children with cortical or subcortical lesions,induced spastic hemiplegia was observed,whereas 47％ had induced spastic bilateral paralysis.In 77％ of the children with basal ganglia lesions induced involuntary movement was observed,and all of those with maldevelopment of the cerebellum were ataxic.Most of those with spastic hemiplegic,bilateral paralysis,involuntary movement and ataxia were on GMFCS levels 1 or 2,with only 3.7％,33.5％,64.1％ and 46.2％ respectively on GMFCS level 4 or 5.Among those in whom the MRI revealed brain maldevelopment,9.1％ were on GMFCS level 1 or 2.The corresponding percentage for PVL was 43.9％,for cortical or subcortical lesions 58.8％,for basal ganglia lesions 19.2％ and for cerebellar maldevelopment 27.3％.The balance in each category were on GMFCS level 4 or 5.Epilepsy was most common in the children with brain maldevelopment (36.4％) or cortical or subcortical lesions (41.2％).Mental retardation was most common in cases of brain maldevelopment (45.5％),cortical or subcortical lesions (41.2％) or cerebellum maldevelopment (36.4％).The incidence of epilepsy and mental retardation was higher among the children on levels 4 and 5 than on levels 1 and 2.Conclusions Neuroimaging correlates significantly with the type of CP and GMFCS level.Epilepsy and mental retardation are most common in children with brain maldevelopment or lesions.The incidence of epilepsy and mental retardation is higher among children rated at GMFCS level 4 or 5 than among those on levels 1and 2.
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@# Visual dysfunction is a common complication in cerebral palsy, including low visual acuity, refractive errors, strabismus, abnormal visual field, absent stereopsis, abnormal fundoscopic fingdings and nystagmus, etc. Low visual acuity is reported in almost three-quarters of patients.The incidence of strabismus is 39%～50% and nystagmus is 9.5%. Periventricular leukomalacia, introventricular hemorrhage and low birth weight are risk factors of visual dysfunctions in cerebral palsy.
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@#ObjectiveTo determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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@#Objective To determine the correlation between the risk factors of cerebral palsy and gestational age of live born infants. MethodsThe gestational age, the risk factors of cerebral palsy and clinical features of 478 children with cerebral palsy were analyzed retrospectively. ResultsFetal distress, threatened abortion, non-infectious diseases during pregnancy, hypoxic-ischemic encephalopathy, neonatal convulsion, infection of newborn, intracranial hemorrhage and haemolysis did not correlated with the gestational age of children with cerebral palsy (P>0.05). Brain malformation, maternal infection, aspiration pneumonia, neonatal asphyxia and hyperbilirubinemia negatively correlated with the gestational age (P<0.05). The incidence of spasmo-diplegia was significantly different between preterm and term infant (P<0.05). ConclusionThe morbidity of cerebral palsy associated with the merging development malformation, maternal infection, aspiration pneumonia, neonatal asphyxia or hyperbilirubinemia increased as the gestational age declined. The spasmo-diplegia more happened in the preterm infants than in the term ones.
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Objective To study the clinical features of visual dysfunction in children with cerebral palsy (CP) and related factors. Methods Between 2006 and 2009, one hundred and sixty-three children (aged 4 to 108months, mean age 29.05 ± 20.51 months) with CP at Qingdao's Rehabilitation Center for Disabled Children were enrolled into this study, including 117 boys and 46 girls. All the children were retrospectively reviewed for perinatal risk factors. Ophthalmologists examined their visual parameters, including refraction, visual acuity, eye position and movement, and fundoscopy. Results Among the 163 children, 61 had visual dysfunctions, an occurrence rate of 37.4%. They included refractive errors in 39 (23.9%) , strabismus in 50 (30.7%) , abnormal eye movement in 26(15.9%) , and abnormal fundoscopic findings in 13 (7.9%). Thirty-seven children's visual acuity was examined,and 19 of them (51.4%) had low visual acuity. Patients who showed periventicular leukomalacia (PVL) or lesions in the occipital lobe on MRI examination had a high incidence of visual dysfunction. Preterm and low birth-weight were risk factors for visual dysfunction in these CP children. Conclusions Visual dysfuntion is a common complication in CP children. Early ophthalmological assessment and intervention are important for CP children.
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OBJECTIVE@#To explore the clinical characteristics of infectious mononucleosis (IM) in adults.@*METHOD@#Medical records of 50 adult IM patients admitted in hospital were analyzed retrospectively.@*RESULT@#Diagnosis delayed group contained 16 patients (32% of total patients) and was significantly different from the diagnosis in-time group in typical symptoms, signs and laboratory findings of IM.@*CONCLUSION@#The clinical manifestations of adult IM are rather complicated and nonspecific to diagnosis. History collection and physical examination in detail are helpful for early diagnosis.
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Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Diagnóstico Diferencial , Erros de Diagnóstico , Mononucleose Infecciosa , Diagnóstico , Estudos RetrospectivosRESUMO
Objective To investigate the relationship between the expression of inhibition of apoptosis proteins like p53,survivin,bcl-2 and chemosensitivities in gastrointestinal tract carcinomas.Methods The expression of p53,survivin and bcl-2 were determined immunohjstochemically,and the chemosenisitivities to 9 drugs was measured by MTT assay in 84 tissue specimens of gastrointestinal carcinomas.Resuits Positive immunostainning for p53,survivin and bcl-2 were found in 64%,89%and 61%of cases.respectively.Correlation existed between the expression of Sllrvivin and bcl-2(r=0.3027,P＜0.05).In terms of relationship between expression of p53,survivin or bcl-2 and inhibition rates of tumor cells.the inhibition rates to PTX and DDP in p53 strong expression group were lower than those in weak group(t=2.1282,P:0.0363;t=3.8850,P=0.0002).When survivin expressed strongly,the inhibition rates for VCR and DDP decreased significantly(t=2.1693,P=0.0329;t=2.0247,P=0.0046),while that for OXA increased(t=-2.9070,P:0.0047).here were lower tumor inhibition rates for 5-FU.VCR,eADM and OXA in bcl-2 strong expression group than those in weak group(t=2.1483～3.2330,P=0.0347～0.0018,respectively).Conclusions The extent of the expression of P53.survivin or bcl-2 in gastrointestinal carcinomas was associated with the chemosensitivities of some drugs.In assessing the influence of p53,survivin or bcl-2 on durg resistance,many factors and mechanisms should be considered.
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Objective To investigate the relationship between expression of P-glycoprotein (P-gp), glutathione S-transferase-π (GST-π) and chemosensitivities in lymph node metastases (LNMs) of gastrointestinal carcinomas. Methods Tumor chemosesitivities to 9 drugs was measured by MTT assay, and the expression of P-gp and GST-π were determined immunohistochemically in primary tumor (PT) and LNMs of gastrointestinal carcinomas in 54 patients. Results The P-gp expression was detected in 22% cases (k= -0.0133, P =0.8698) for beth PT and LNMs, and of GST-π in 50% (k =0. 1137, P= 0. 1496). Expression of P-gp and GST-π in LNMs were stronger eompared with PT (Z = -3. 0448, Z = -2. 1178, both P <0. 05). The inhibition rates of LNMs cells for VCR, OPT, OXA, DDP and MTX were lower than those to PT (all P < 0. 05), but for VP-16 it was higher (P < 0. 05). In PT, there were negative correlation between expression of P-gp and inhibition rates of tumor cells for 5-FU, VCR and PTX respectively (r = -0. 4142 ～ -0. 5712, all P <0. 05), and GST-π for 5-FU, VCR, OPT and PTX as well (r = -0. 3927 ～ -0. 4951, all P <0. 05). In LNMs, negative correlation between expression of P-gp and inhibition rates of tumor cells for VP-16, PTX and eADM were found statistically (r = - 0. 3802 ～ - 0. 4624, all P < 0. 05), and also GST-π for 5-FU, VCR and DDP (r = - 0. 3996 ～ - 0. 5345, all P < 0. 05). Conclusions The LNMs of gastrointestinal carcinomas are heterogeneous with respect to expression of mdr-related factors and response to chemotherapy, and more resistant than the PT for chemotherapeutants. Effective adjuvant chemotherapy in gastrointestinal cancers depends on targeting the metastatic component of the tumor.
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@#Objective To investigate the relationship between magnetic resonance imaging(MRI) and the type of cerebral palsy (CP) and gestational age at birth.MethodsThe MRI and clinical data of 224 CP children with spastic type were analyzed retrospectively.ResultsAmong these children, 27 cases had spastic hemiplegia, 149 had spastic diplegia, and 48 had spastic tetraplegia. 201 cases (89.7%) had abnormal MRI result. The abnormal rate of MRI in spastic hemiplegia, diplegia and tetraplegia were 100%, 87.2% and 91.7%, respectively. Periventricular leukomalacia (PVL) was observed mostly in children with spastic diplegia, other types of brain lesions were uncommon. In spastic tetraplegia the lesions were more varied. Three predominated types of MRI abnormalities were: PVL (45.8%), term-type brain injuries (20.8%) and congenital brain abnormalies (18.8%). Unilateral lesions were observed mostly in children with hemiplegia spastic diplegia born at term who showed unilateral motor disorder and upper extremity were heavier than lower extremity. Unilateral and bilateral PVL were observed in children with hemiplegia spastic diplegia born at preterm who showed lower extremity were heavier than upper extremity. Of 152 cases with PVL, 108 cases (71.1%) were preterm infants and 44 cases (28.9%) were term infants. Of 22 cases with term-type brain injuries, 20 cases (90.9%) were term infants. PVL was most observed in preterm brain injuries and was observed most in preterm children but was also in term children. Term-type brain injuries (border-zone infarct, basal ganglia-thalamic lesion, subcortical leukomalacia, and multicystic encephalomalacia) were observed most in term and rare in preterm children.ConclusionThe MRI findings in CP show a good correlation with type of CP and gestational age.
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Objective To compare the clinical performance of the self-etching and the phosphoric acid etching adhesive system for restoration of non-carious Class V restorations for a period of two years.Methods There were 37 patients with at least one pairs of similar-sized non-carious cervical lesions participated in the study.120 restorations were placed by one operator,of which 60 with phosphoric acid etching adhesive system(Spectrum TPH,Prime& Bond)and 60 with self-etch(Clearfil AP-X,SE Bond).The restorations were evaluated by ?2 statistics at the baseline,6th,12th and 24th month according to the modified Ryge"s USPHS criteria.Results At two years,106 teeth were reviewed in 33 patients.The retention rates for self-etching adhesive system were 89% and for phosphoric acid etching adhesive system 77%.The percentage of the retention rates of both adhesive systems was not found to be different when calculating the failure rates.No cases in both adhesive systems showed slight marginal discoloration problems.Some cases for each adhesive system had slight color change after the same period.Conclusions The performance of both adhesive systems is excellent during this two-year clinical trial.The self-etch adhesive system exhibites slightly better coloar match than the phosphoric acid etching system.