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<陳怡睿醫師的部落格> 口腔疾病診察與醫療的溝通平台...

部落格全站分類:醫療保健

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  • 10月 22 週三 200816:03
  • (新聞稿)高燒不退 住院查不出原因 口腔疼痛求診 愛滋感染現形

高燒不退   住院查不出原因
口腔疼痛求診  愛滋感染現形

ㄧ名四十多歲的男性,因為舌頭持續疼痛數個月不癒,到中山醫學大學口腔醫學研究中心求診。經過檢查後發現為口腔黴菌感染,由於患者最近沒有服用任何藥物,因此在口腔診斷後抽血檢查,赫然發現男子為HIV(愛滋病前期)病毒感染者。在醫師仔細詢問過後,男子方才坦承自己有感染的可能,讓站在第一線的醫護工作人員暴露在毫無防備的環境下,引發「醫」場虛驚!
    中山醫學大學口腔研究中心陳怡睿醫師表示,這名男子在去年五月份前來求診,經過診斷發現男子口腔受到黴菌嚴重感染,在治療ㄧ至兩周後男子自行中斷療程,直到去年九月份再回院就診,口腔黴菌狀況仍未見改善,於是請男子接受抽血檢查後,竟發現男子的血液檢體為HIV病毒陽性反應,頓時讓醫師及檢驗單位錯愕不已。在向男子求證後,男子才坦承自己前年11月時曾前往大陸,12月回台後高燒不退而住院,當時檢查不出原因,如今回想起來可能是在大陸時沒有安全的性行為,所以的確有感染HIV病毒的可能,這讓陳怡睿醫師當場傻眼,也讓站在第一線的牙醫等醫護人員為可能的感染捏了ㄧ把冷汗。目前這名男子已轉到感染控制科做進ㄧ步的治療。
    陳怡睿醫師強調,一般口腔黴菌感染的特徵是口腔內出現白斑,嚴重者甚至會由白色轉為紅色;而HIV病毒在口腔的表現為口腔白斑現象更為明顯,甚至會出現疼痛。研究顯示,愛滋病毒是經由親密的性接觸、或經由黏膜直接接觸病人的血液或體液而傳染給他人,建議民眾若有感染的可能性,應主動告知醫師、牙醫師或任何提供照護的人,以避免擴大感染。
    根據了解,口腔診斷主要是透過病人主訴、臨床徵候、病歷、放射線、病理檢驗等,來決定口腔和牙齒疾病,作為治療及預後之依據。診斷的項目包括問診、理學檢查、其他結構性或功能性檢驗等步驟,其中又以問診最為重要。大約七至八成的診斷是在問診中就已經初步建立大概方向,再經由理學檢查和其他檢驗與以確認或排除。因此呼籲民眾若有口腔問題,千萬不要擅自購買成藥處理,最好求助專業的牙醫師進行口腔診斷,才不會誤了病情、嚴重者甚至危及生命。
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  • 個人分類:新聞稿件
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  • 10月 21 週二 200816:25
  • 打鼾~阻塞性睡眠呼吸中止症之牙科療法

打鼾~阻塞性睡眠呼吸中止症之牙科療法
(摘錄自長庚顱顏中心)
打鼾~阻塞性睡眠呼吸中止症是起因於上呼吸道的阻塞,而阻塞的部位大致上是在鼻咽、口咽及喉咽部 ( 常常合併發生 ) ,其中又以口咽部最為常見。一般這類的病人容易產生嗜眠、昏昏欲睡、注意力不集中、記憶力減退、性格改變、心血管疾病。在工作上、家庭中會產生諸多問題。因此所造成的影響不單是家庭問題、社會問題,也是醫療問題。有鑑於此,醫療人員努力尋求解決這方面的問題。
Fujita於1981年發表的懸壅垂咽整型術 ( Uvulopalatopharyngoplasty,簡稱UPPP ) , 為目前公認治療打鼾-阻塞性睡眠呼吸中止症最簡便,有效的手術,只可惜併發症較多,且病人手術後必須忍受疼痛。Sullivan等人又於同年發明鼻腔連續正壓術 ( Nasal Continuous Positive Airway Pressure,簡稱CPAP ) ,其原理是將空氣打入鼻腔,再經由呼吸道至肺部,使阻塞的呼吸道由負壓變為正壓,藉而改善病患呼吸道阻塞及缺氧的情形。效果固然不錯,但因病人的不適應及攜帶不便,反而造成極大困擾。
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  • 個人分類:醫學文獻
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  • 10月 21 週二 200815:58
  • 如何處置孕婦牙科問題?

如何處置孕婦牙科問題?
(Dr.羅文良 主講)
*怎麼辦? 自己看? 轉診?
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  • 個人分類:醫學文獻
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  • 10月 21 週二 200815:31
  • 有沒有辦法在不影響胎兒的情況下拔牙?(懷孕期間的牙科治療概述)

Q: 我目前懷孕27週,牙齒痛到受不了到牙醫看診醫生說蛀得太嚴重了要拔掉,但他不敢幫我拔要我到大醫院去,我打了電話到某醫院詢問牙醫師他也不敢幫我拔 只說最多只能洗一洗牙,日前看了牙醫師上電視有說蛀牙太久沒理它有可能會導致眼睛失明,讓我實在很害怕,我想先詢問貴院牙醫的設備比較齊全,像我這種問題有沒有辦法在不影響胎兒的情況下拔牙?
Ans: 以下針對懷孕期間的牙科治療概述如下:
懷孕期的治療原則上儘可能避開最初期的三個月以及末三個月的中期及後期
--> 懷孕27週,為中三個月至末三個月初期,常規的牙科治療還有期可行性

牙科治療中主要影響胎兒的部份有三: 1.放射線(X光照射) 2.藥物 3.壓力
針對牙齒的部位必須先確認,如果是牙周問題嚴重的牙齒或是明顯可見的牙齒,或許可以避免X光照射,但若是智齒或牙根有彎曲或曾經進行過根管治療的牙齒...就有拍照的必要.主要以局部根尖片為主,身體必須以鉛衣保護,且再懷孕期的第一個三個月內仍應避免照射.
--> 必須先確認您的牙位及口內狀況

藥物的部份主要再避免對胎兒產生危害,目前的局部麻醉用藥(lidocaine...)及部份的消炎(cephamycin...)止痛(panadol; scanol...)藥是具有一定的安全性的.用藥部份以少量有效無傷害為原則,必須和婦產科醫師聯繫討論.
--> 一定得和婦產科醫師討論以確定用藥及身體狀況

懷孕對於身體的壓力以及情緒上的影響是絕對存在的.對於手術等治療的焦慮會造成生命徵象(特別是血壓)的不穩定.另外,在看診過程中,姿勢與時間的控制也非常重要.總之一切以減壓舒適為最高原則.

如果必須拔除牙齒,或評估後發現不拔的影響更大,還有一些方式可以選擇,如鎮靜麻醉等.
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  • 個人分類:問題回應
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  • 10月 21 週二 200814:30
  • Stem Cell的定義及Stem Cell Markers


主題一: Stem Cell的定義
摘錄自: Stem Cell Information (The official National Institutes of Health resource for stem cell research)
I. What are stem cells and why are they important?
Stem cells have two important characteristics that distinguish them from other types of cells. First, they are unspecialized cells that renew themselves for long periods through cell division. The second is that under certain physiologic or experimental conditions, they can be induced to become cells with special functions such as the beating cells of the heart muscle or the insulinproducing cells of the pancreas.
Scientists primarily work with two kinds of stem cells from animals and humans: embryonic stem cells and adult stem cells, which have different functions and characteristics that will be explained in this document. Scientists discovered ways to obtain or derive stem cells from early mouse embryos more than 20 years ago. Many years of detailed study of the biology of mouse stem cells led to the discovery, in 1998, of how to isolate stem cells from human embryos and grow the cells in the laboratory. These are called human embryonic stem cells. The embryos used in these studies were created for infertility purposes through in vitro fertilization procedures and when they were no longer needed for that purpose, they were donated for research with the informed consent of the donor.
Stem cells are important for living organisms for many reasons. In the 3- to 5-day-old embryo, called a blastocyst, stem cells in developing tissues give rise to the multiple specialized cell types that make up the heart, lung, skin, and other tissues. In some adult tissues, such as bone marrow, muscle, and brain, discrete populations of adult stem cells generate replacements for cells that are lost through normal wear and tear, injury, or disease.
It has been hypothesized by scientists that stem cells may, at some point in the future, become the basis for treating diseases such as Parkinson's disease, diabetes, and heart disease.
Scientists want to study stem cells in the laboratory so they can learn about their essential properties and what makes them different from specialized cell types. As scientists learn more about stem cells, it may become possible to use the cells not just in cell-based therapies, but also for screening new drugs and toxins and understanding birth defects. However, as mentioned above, human embryonic stem cells have only been studied since 1998. Therefore, in order to develop such treatments scientists are intensively studying the fundamental properties of stem cells, which include: 1. determining precisely how stem cells remain unspecialized and self renewing for many years; and 2. identifying the signals that cause stem cells to become specialized cells.
II. What are the unique properties of all stem cells?
Stem cells differ from other kinds of cells in the body. All stem cells—regardless of their source—have three general properties: they are capable of dividing and renewing themselves for long periods; they are unspecialized; and they can give rise to specialized cell types.
Scientists are trying to understand two fundamental properties of stem cells that relate to their longterm self-renewal: 1. why can embryonic stem cells proliferate for a year or more in the laboratory without differentiating, but most adult stem cells cannot; and 2. what are the factors in living organisms that normally regulate stem cell proliferation and self-renewal?
Discovering the answers to these questions may make it possible to understand how cell proliferation is regulated during normal embryonic development or during the abnormal cell division that leads to cancer. Importantly, such information would enable scientists to grow embryonic and adult stem cells more efficiently in the laboratory.
Stem cells are unspecialized. One of the fundamental properties of a stem cell is that it does not have any tissue-specific structures that allow it to perform specialized functions. A stem cell cannot work with its neighbors to pump blood through the body (like a heart muscle cell); it cannot carry molecules of oxygen through the bloodstream (like a red blood cell); and it cannot fire electrochemical signals to other cells that allow the body to move or speak (like a nerve cell). However, unspecialized stem cells can give rise to specialized cells, including heart muscle cells, blood cells, or nerve cells.
Stem cells are capable of dividing and renewing themselves for long periods. Unlike muscle cells, blood cells, or nerve cells—which do not normally replicate themselves—stem cells may replicate many times. When cells replicate themselves many times over it is called proliferation. A starting population of stem cells that proliferates for many months in the laboratory can yield millions of cells. If the resulting cells continue to be unspecialized, like the parent stem cells, the cells are said to be capable of long-term self-renewal.
The specific factors and conditions that allow stem cells to remain unspecialized are of great interest to scientists. It has taken scientists many years of trial and error to learn to grow stem cells in the laboratory without them spontaneously differentiating into specific cell types. For example, it took 20 years to learn how to grow human embryonic stem cells in the laboratory following the development of conditions for growing mouse stem cells. Therefore, an important area of research is understanding the signals in a mature organism that cause a stem cell population to proliferate and remain unspecialized until the cells are needed for repair of a specific tissue. Such information is critical for scientists to be able to grow large numbers of unspecialized stem cells in the laboratory for further experimentation.
Stem cells can give rise to specialized cells. When unspecialized stem cells give rise to specialized cells, the process is called differentiation. Scientists are just beginning to understand the signals inside and outside cells that trigger stem cell differentiation. The internal signals are controlled by a cell's genes, which are interspersed across long strands of DNA, and carry coded instructions for all the structures and functions of a cell. The external signals for cell differentiation include chemicals secreted by other cells, physical contact with neighboring cells, and certain molecules in the microenvironment.
Therefore, many questions about stem cell differentiation remain. For example, are the internal and external signals for cell differentiation similar for all kinds of stem cells? Can specific sets of signals be identified that promote differentiation into specific cell types? Addressing these questions is critical because the answers may lead scientists to find new ways of controlling stem cell differentiation in the laboratory, thereby growing cells or tissues that can be used for specific purposes including cell-based therapies.
Adult stem cells typically generate the cell types of the tissue in which they reside. A blood-forming adult stem cell in the bone marrow, for example, normally gives rise to the many types of blood cells such as red blood cells, white blood cells and platelets. Until recently, it had been thought that a blood-forming cell in the bone marrow—which is called a hematopoietic stem cell—could not give rise to the cells of a very different tissue, such as nerve cells in the brain. However, a number of experiments over the last several years have raised the possibility that stem cells from one tissue may be able to give rise to cell types of a completely different tissue, a phenomenon known as plasticity. Examples of such plasticity include blood cells becoming neurons, liver cells that can be made to produce insulin, and hematopoietic stem cells that can develop into heart muscle. Therefore, exploring the possibility of using adult stem cells for cell-based therapies has become a very active area of investigation by researchers.
III. What are embryonic stem cells?
A. What stages of early embryonic development are important for generating embryonic stem cells?
Embryonic stem cells, as their name suggests, are derived from embryos. Specifically, embryonic stem cells are derived from embryos that develop from eggs that have been fertilized in vitro—in an in vitro fertilization clinic—and then donated for research purposes with informed consent of the donors. They are not derived from eggs fertilized in a woman's body. The embryos from which human embryonic stem cells are derived are typically four or five days old and are a hollow microscopic ball of cells called the blastocyst. The blastocyst includes three structures: the trophoblast, which is the layer of cells that surrounds the blastocyst; the blastocoel, which is the hollow cavity inside the blastocyst; and the inner cell mass, which is a group of approximately 30 cells at one end of the blastocoel.
B. How are embryonic stem cells grown in the laboratory?
Growing cells in the laboratory is known as cell culture. Human embryonic stem cells are isolated by transferring the inner cell mass into a plastic laboratory culture dish that contains a nutrient broth known as culture medium. The cells divide and spread over the surface of the dish. The inner surface of the culture dish is typically coated with mouse embryonic skin cells that have been treated so they will not divide. This coating layer of cells is called a feeder layer. The reason for having the mouse cells in the bottom of the culture dish is to give the inner cell mass cells a sticky surface to which they can attach. Also, the feeder cells release nutrients into the culture medium. Recently, scientists have begun to devise ways of growing embryonic stem cells without the mouse feeder cells. This is a significant scientific advancement because of the risk that viruses or other macromolecules in the mouse cells may be transmitted to the human cells.
Over the course of several days, the cells of the inner cell mass proliferate and begin to crowd the culture dish. When this occurs, they are removed gently and plated into several fresh culture dishes. The process of replating the cells is repeated many times and for many months, and is called subculturing. Each cycle of subculturing the cells is referred to as a passage. After six months or more, the original 30 cells of the inner cell mass yield millions of embryonic stem cells. Embryonic stem cells that have proliferated in cell culture for six or more months without differentiating, are pluripotent, and appear genetically normal are referred to as an embryonic stem cell line. Once cell lines are established, or even before that stage, batches of them can be frozen and shipped to other laboratories for further culture and experimentation.
C. What laboratory tests are used to identify embryonic stem cells?
At various points during the process of generating embryonic stem cell lines, scientists test the cells to see whether they exhibit the fundamental properties that make them embryonic stem cells. This process is called characterization.
As yet, scientists who study human embryonic stem cells have not agreed on a standard battery of tests that measure the cells' fundamental properties. Also, scientists acknowledge that many of the tests they do use may not be good indicators of the cells' most important biological properties and functions. Nevertheless, laboratories that grow human embryonic stem cell lines use several kinds of tests. These tests include:
Growing and subculturing the stem cells for many months. This ensures that the cells are capable of long-term self-renewal. Scientists inspect the cultures through a microscope to see that the cells look healthy and remain undifferentiated.
Using specific techniques to determine the presence of surface markers that are found only on undifferentiated cells. Another important test is for the presence of a protein called Oct-4, which undifferentiated cells typically make. Oct-4 is a transcription factor, meaning that it helps turn genes on and off at the right time, which is an important part of the processes of cell differentiation and embryonic development.
Examining the chromosomes under a microscope. This is a method to assess whether the chromosomes are damaged or if the number of chromosomes has changed. It does not detect genetic mutations in the cells.
Determining whether the cells can be subcultured after freezing, thawing, and replating.
Testing whether the human embryonic stem cells are pluripotent by 1) allowing the cells to differentiate spontaneously in cell culture; 2) manipulating the cells so they will differentiate to form specific cell types; or 3) injecting the cells into an immunosuppressed mouse to test for the formation of a benign tumor called a teratoma. Teratomas typically contain a mixture of many differentiated or partly differentiated cell types—an indication that the embryonic stem cells are capable of differentiating into multiple cell types.
D. How are embryonic stem cells stimulated to differentiate?
As long as the embryonic stem cells in culture are grown under certain conditions, they can remain undifferentiated (unspecialized). But if cells are allowed to clump together to form embryoid bodies, they begin to differentiate spontaneously. They can form muscle cells, nerve cells, and many other cell types. Although spontaneous differentiation is a good indication that a culture of embryonic stem cells is healthy, it is not an efficient way to produce cultures of specific cell types.
So, to generate cultures of specific types of differentiated cells—heart muscle cells, blood cells, or nerve cells, for example—scientists try to control the differentiation of embryonic stem cells. They change the chemical composition of the culture medium, alter the surface of the culture dish, or modify the cells by inserting specific genes. Through years of experimentation scientists have established some basic protocols or "recipes" for the directed differentiation of embryonic stem cells into some specific cell types.
If scientists can reliably direct the differentiation of embryonic stem cells into specific cell types, they may be able to use the resulting, differentiated cells to treat certain diseases at some point in the future. Diseases that might be treated by transplanting cells generated from human embryonic stem cells include Parkinson's disease, diabetes, traumatic spinal cord injury, Purkinje cell degeneration, Duchenne's muscular dystrophy, heart disease, and vision and hearing loss.
Stem Cell Basics
IV. What are adult stem cells?
An adult stem cell is an undifferentiated cell found among differentiated cells in a tissue or organ, can renew itself, and can differentiate to yield the major specialized cell types of the tissue or organ.
The primary roles of adult stem cells in a living organism are to maintain and repair the tissue in which they are found. Some scientists now use the term somatic stem cell instead of adult stem cell.
Unlike embryonic stem cells, which are defined by their origin (the inner cell mass of the blastocyst), the origin of adult stem cells in mature tissues is unknown.
Research on adult stem cells has recently generated a great deal of excitement. Scientists have found adult stem cells in many more tissues than they once thought possible. This finding has led scientists to ask whether adult stem cells could be used for transplants. In fact, adult blood forming stem cells from bone marrow have been used in transplants for 30 years. Certain kinds of adult stem cells seem to have the ability to differentiate into a number of different cell types, given the right conditions. If this differentiation of adult stem cells can be controlled in the laboratory, these cells may become the basis of therapies for many serious common diseases.
The history of research on adult stem cells began about 40 years ago. In the 1960s, researchers discovered that the bone marrow contains at least two kinds of stem cells. One population, called hematopoietic stem cells, forms all the types of blood cells in the body. A second population, called bone marrow stromal cells, was discovered a few years later. Stromal cells are a mixed cell population that generates bone, cartilage, fat, and fibrous connective tissue.
Also in the 1960s, scientists who were studying rats discovered two regions of the brain that contained dividing cells, which become nerve cells. Despite these reports, most scientists believed that new nerve cells could not be generated in the adult brain. It was not until the 1990s that scientists agreed that the adult brain does contain stem cells that are able to generate the brain's three major cell types—astrocytes and oligodendrocytes, which are non-neuronal cells, and neurons, or nerve cells.
A. Where are adult stem cells found and what do they normally do?
Adult stem cells have been identified in many organs and tissues. One important point to understand about adult stem cells is that there are a very small number of stem cells in each tissue. Stem cells are thought to reside in a specific area of each tissue where they may remain quiescent (non-dividing) for many years until they are activated by disease or tissue injury. The adult tissues reported to contain stem cells include brain, bone marrow, peripheral blood, blood vessels, skeletal muscle, skin and liver.
Scientists in many laboratories are trying to find ways to grow adult stem cells in cell culture and manipulate them to generate specific cell types so they can be used to treat injury or disease. Some examples of potential treatments include replacing the dopamine-producing cells in the brains of Parkinson's patients, developing insulin-producing cells for type I diabetes and repairing damaged heart muscle following a heart attack with cardiac muscle cells.
B. What tests are used for identifying adult stem cells?
Scientists do not agree on the criteria that should be used to identify and test adult stem cells.
However, they often use one or more of the following three methods: (1) labeling the cells in a living tissue with molecular markers and then determining the specialized cell types they generate; (2) removing the cells from a living animal, labeling them in cell culture, and transplanting them back into another animal to determine whether the cells repopulate their tissue of origin; and (3) isolating the cells, growing them in cell culture, and manipulating them, often by adding growth factors or introducing new genes, to determine what differentiated cells types they can become.
Also, a single adult stem cell should be able to generate a line of genetically identical cells—known as a clone—which then gives rise to all the appropriate differentiated cell types of the tissue. a clone—which then gives rise to all the appropriate differentiated cell types of the tissue. Scientists tend to show either that a stem cell can give rise to a clone of cells in cell culture, or that a purified population of candidate stem cells can repopulate the tissue after transplant into an animal. Recently, by infecting adult stem cells with a virus that gives a unique identifier to each individual cell, scientists have been able to demonstrate that individual adult stem cell clones have the ability to repopulate injured tissues in a living animal.
C. What is known about adult stem cell differentiation?
As indicated above, scientists have reported that adult stem cells occur in many tissues and that they enter normal differentiation pathways to form the specialized cell types of the tissue in which they reside. Adult stem cells may also exhibit the ability to form specialized cell types of other tissues, which is known as transdifferentiation or plasticity.
Normal differentiation pathways of adult stem cells. In a living animal, adult stem cells can divide for a long period and can give rise to mature cell types that have characteristic shapes and specialized structures and functions of a particular tissue. The following are examples of differentiation pathways of adult stem cells.
Hematopoietic stem cells give rise to all the types of blood cells: red blood cells, B lymphocytes, T lymphocytes, natural killer cells, neutrophils, basophils, eosinophils, monocytes, macrophages, and platelets.
Bone marrow stromal cells (mesenchymal stem cells) give rise to a variety of cell types: bone cells (osteocytes), cartilage cells (chondrocytes), fat cells (adipocytes), and other kinds of connective tissue cells such as those in tendons.
Neural stem cells in the brain give rise to its three major cell types: nerve cells (neurons) and two categories of non-neuronal cells—astrocytes and oligodendrocytes.
Epithelial stem cells in the lining of the digestive tract occur in deep crypts and give rise to several cell types: absorptive cells, goblet cells, Paneth cells, and enteroendocrine cells.
Skin stem cells occur in the basal layer of the epidermis and at the base of hair follicles. The epidermal stem cells give rise to keratinocytes, which migrate to the surface of the skin and form a protective layer. The follicular stem cells can give rise to both the hair follicle and to the epidermis.
Adult stem cell plasticity and transdifferentiation. A number of experiments have suggested that certain adult stem cell types are pluripotent. This ability to differentiate into multiple cell types is called plasticity stem cell types are pluripotent. This ability to differentiate into multiple cell types is called plasticity or transdifferentiation. The following list offers examples of adult stem cell plasticity that have been reported during the past few years.
Hematopoietic stem cells may differentiate into: three major types of brain cells (neurons, oligodendrocytes, and astrocytes); skeletal muscle cells; cardiac muscle cells; and liver cells.
Bone marrow stromal cells may differentiate into: cardiac muscle cells and skeletal muscle cells.
Brain stem cells may differentiate into: blood cells and skeletal muscle cells.
Current research is aimed at determining the mechanisms that underlie adult stem cell plasticity. If such mechanisms can be identified and controlled, existing stem cells from a healthy tissue might be induced to repopulate and repair a diseased tissue.
D. What are the key questions about adult stem cells?
Many important questions about adult stem cells remain to be answered. They include:
How many kinds of adult stem cells exist, and in which tissues do they exist?
What are the sources of adult stem cells in the body? Are they "leftover" embryonic stem cells, or do they arise in some other way? Why do they remain in an undifferentiated state when all the cells around them have differentiated?
Do adult stem cells normally exhibit plasticity, or do they only transdifferentiate when scientists manipulate them experimentally? What are the signals that regulate the proliferation and differentiation of stem cells that demonstrate plasticity?
Is it possible to manipulate adult stem cells to enhance their proliferation so that sufficient tissue for transplants can be produced?
Does a single type of stem cell exist—possibly in the bone marrow or circulating in the blood—that can generate the cells of any organ or tissue?
What are the factors that stimulate stem cells to relocate to sites of injury or damage?
V. What are the similarities and differences between embryonic and adult stem cells?
Human embryonic and adult stem cells each have advantages and disadvantages regarding potential use for cell-based regenerative therapies. Of course, adult and embryonic stem cells differ in the number and type of differentiated cells types they can become. Embryonic stem cells can become all cell types of the body because they are pluripotent. Adult stem cells are generally limited to differentiating into different cell types of their tissue of origin. However, some evidence suggests that adult stem cell plasticity may exist, increasing the number of cell types a given adult stem cell can become.
Large numbers of embryonic stem cells can be relatively easily grown in culture, while adult stem cells are rare in mature tissues and methods for expanding their numbers in cell culture have not yet been worked out. This is an important distinction, as large numbers of cells are needed for stem cell replacement therapies.
A potential advantage of using stem cells from an adult is that the patient's own cells could be expanded in culture and then reintroduced into the patient. The use of the patient's own adult stem cells would mean that the cells would not be rejected by the immune system. This represents a significant advantage as immune rejection is a difficult problem that can only be circumvented with immunosuppressive drugs.
Embryonic stem cells from a donor introduced into a patient could cause transplant rejection. However, whether the recipient would reject donor embryonic stem cells has not been determined in human experiments.
主題二: Stem Cell Markers
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  • 10月 20 週一 200802:17
  • 請各位朋友推薦心目中的好牙醫師!

請各位朋友推薦心目中的好牙醫師!
 
近來一直在報章雜誌上看到名醫與良醫的推薦
可是對於牙醫師 卻沒有相關的推薦
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  • 10月 19 週日 200823:09
  • 如何面對口腔顎面外科治療的意外與處置?

如何面對口腔顎面外科治療的意外與處置?
20081019 Dr.夏毅然 新店耕莘醫院 演講課程輯錄 by 陳怡睿
 
常見原因:
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  • 個人分類:醫學文獻
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  • 10月 17 週五 200815:36
  • (新聞稿)牙齒不當美白 小心花錢又傷牙!

牙齒不當美白 小心花錢又傷牙!
 





 



 
醫師:市售美白品良莠不齊,消費者謹慎為上
又到了畢業季,不少即將步入職場的新鮮人為了求職順利而瘋美容,台中市一名二十六歲的應屆畢業生劉同學,為了求得一口潔白牙齒,花費近萬元購買多種美白產 品,如美白橡皮擦、潔牙口香糖、纖維潔牙套、美白貼片等等,不但效果不如預期,有些產品味道甚至讓她噁心反胃!中山醫學大學口腔醫學研究中心保存補綴科主 任楊惠雯醫師表示,目前坊間販售各式各樣的美齒產品,有些並無明確的成分及含量標示,但卻都宣傳能讓牙齒清潔亮白,民眾在自行選購時應特別注意,避免傷害 牙齦而不自知,最好由專業醫療人員進行牙齒美白,安全才有保障。
楊惠雯醫師表示,劉同學因為牙齒不整齊加上顏色偏黃,讓她覺得沒有自信,最近上網買了網友推薦的美齒產品,甚至還委託同學到日本及韓國買了一堆回來,共花 了好幾萬元,結果還是無法擺脫黃板牙。即將畢業季的她,決定到醫院接受牙齒冷光美白,現在讓她笑起來更有自信,也算是送給自己的一份畢業禮物!
楊惠雯醫師說,現在市面上的牙齒美白方法相當多,不過並非人人適合,若不慎使用到藥劑過強的產品,很容易傷害牙齦,或造成牙齒酸痛,想要牙齒美白的民眾, 最好經過專業醫師的診治及評估,且術後的保養更是不可馬虎。目前效果最顯著的牙齒美白術就是冷光美白治療,流程是美白前先以超音波洗牙,去除牙結石及牙菌 斑,並記錄患者美白前的牙齒色階,醫師也會在諮詢過程了解患者對美白的期待,最後才進行最重要的冷光美白。美白過程中會先在患者牙齦塗上一層保護劑,以避 免美白劑傷害到牙齦,接著再將美白藥劑塗抹於牙齒表面,由冷光機照射八至十五分鐘,這樣的步驟會依美白效果不同而重複二至三次,最後再塗上氟膠或專用之去 敏感劑以保護牙齒。
至於美白效果可以維持多久?楊惠雯醫師表示,維持效果長短跟個人飲食習慣有關,一般而言,美白效果可維持2~3年。不過,醫師提醒,任何美白都需要在適當 維護下效果才能持久,像抽煙、嚼檳榔、喝咖啡、茶及可樂等都會造成牙齒染色,另外吃醃漬、沾醬較多的食物也會縮短時效。此外,孕婦、哺乳期的媽媽或12歲 以下之兒童都不適合接受牙齒美白。民眾在選擇牙齒美白方式時,可先與專業醫療人員諮詢討論,在完整的防護措施下進行牙齒美白,才能同時擁有潔白又健康的牙 齒喔!




診間美白/居家美白


 
原理大致相同,差別只在於不同的動能方式和不同的藥劑濃度來驅動此一氧化還原反應。


 
































































診間美白(例如冷光美白)
大約1小時,單次即可完成。
由特定波長的機器驅動反應。 藥劑濃度高(一般介於20%-35%之間)。
效果較為迅速。
居家美白
需時較長(一天一次,一次一小時,至少需時10~14天)。
非由醫師操作的美白,其使用藥劑濃度受限制(通常濃度在5%-15%不等),效果較不明顯。
多建議在診間美白後維持效果使用。
瓷牙貼片/全瓷冠
適用範圍- 
對診間美白藥劑效果不明顯的病人(如嚴重的四環黴素染色)
希望牙齒超級白的人。
合併齒列不整者。
美白牙膏/美白橡皮擦/美白噴砂
作用方式-
藉由物理作用除去牙齒表面的色素沉澱,有點像身體去角質一樣,把牙齒表面的一層污垢搓掉。
只能使牙齒恢復到原來的顏色,並不能使牙齒變白。
噴砂特別是對煙垢,茶垢有非常好的效果。
美白貼片/美白筆












優點 :價格便宜,使用方便。
缺點 : 1. 美白藥劑極容易被口水稀釋掉。
2. 為了避免傷害牙齦(因美白過程中對牙齦沒有任何保護措施),美白藥劑的濃度只有約5.5%,造成美白的效果有限。

美白凝膠
價格便宜。
早、晚1次,連續14天。
含18% Carbamide Peroxide,薄荷清香味。
美白藥劑極容易被口水稀釋掉。
容易傷害牙齦。
美白口香糖
不含美白藥劑
藉由咀嚼口香糖的過程,促進唾液分泌,達到清潔效果。
※居家美白可能產生的問題:
一般而言,沒有放置牙齦保護劑也無吸唾管,可能造成牙齦潰瘍、發炎或誤吞入美白劑之危險。但畢竟濃度不高,並無嚴重或立即性之傷害。
※冷光美白治療流程:
1.於美白前必須先以超音波洗牙,去除牙結石及牙菌斑
2.記錄患者未美白前的牙齒色階,並了解患者對美白的期待
3.先在患者的牙齦塗上一層保護劑,以避免美白劑傷害牙齦
4.將美白藥劑塗抹於牙齒表面,由冷光機照射八至十五分鐘(3.4步驟依美白效果不同而重複二至三次)
5.塗上氟膠或專用之去敏感劑以保護牙齒
※市售美白產品所描述的功效:
1.美白橡皮擦:使用之後牙齒更加潔白;一個月一次可維持牙齒亮白
2.牙齒美白凝膠:早晚1次,連續14天,美白您的牙齒
3.牙齒美白貼片:只要七天搶救黃板牙!牙齒快速白回來!
4.潔牙指套:輕鬆讓牙齒白皙亮麗;特殊極細纖維製成;單DIY使牙齒又白又亮
5.美白牙膏:實驗證明具美白效果;美白效果比一掰牙膏高出百分之九十
6.強力潔齒劑:有效去除牙垢、煙垢、檳榔垢;抗菌、美白、口氣更清新



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  • 個人分類:新聞稿件
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  • 10月 17 週五 200814:59
  • (新聞稿)牙齒美容仍為醫療範圍 需以咬合重建為前提



牙齒美容仍為醫療範圍 需以咬合重建為前提





【中時健康 陳葒冠/台北報導】2008.10.17



以往的牙齒美容,大家只能訂製一成不變的齒型,目前新的客製化星鑽瓷冠美齒雕塑方式,由民眾先挑選齒型,再由醫師量身打造,滿足民眾個人喜好,已在牙醫 及整形界掀起一股新流行風潮。楊丞琳的土撥鼠大門牙,在年輕族群眼中居然是流行個人特色代表,顯見非制式化又可愛討喜的新一波個性牙齒整形風正蘊釀中。


牙醫師呂睿庭表示,民眾選擇客製化星鑽瓷冠美齒雕塑療程,就像到美容院選髮型、到餐廳點菜一樣輕鬆,只要選出特定名人偶像的齒型,醫師就能根據患者的指定,以星鑽瓷冠製作等高、等寬、等比、等色澤的專屬齒模,術後便能擁有指定名人的牙齒特色。


星鑽瓷冠美齒雕塑須依患者牙床骨、牙齦、齒型做三合一統籌規劃,依其高度、寬度及牙齒色澤量身訂做造型,牙材則須選用星鑽瓷冠,因星鑽瓷冠較傳統瓷冠硬度高,適合依照患者臉型及齒質磨製不同比例的齒型,且其透明光度強,仿真度較高,不像傳統假牙給人死板硬實的感覺。


牙醫師陳嘉琪表示星鑽瓷冠美齒雕塑一次解決了牙齒排列不整、先天齒質發育不良、齒型不佳、牙齒斷裂或嚴重蛀牙、牙齒偏黃等五大問題,因此是雕塑牙齒頗佳的選擇。不過,呂睿庭也強調,由於每個人牙齒、臉形狀況不同,要量身打造與偶像一模一樣的齒型,難度也相對提高。


呂睿庭進一步提醒想進行星鑽瓷冠美齒雕塑的民眾,牙齒美容畢竟還是醫療範圍,其前提必定是咬合重建,假如只有美感而忽略健康就失去了醫療的原意。術後仍 需定期回診檢查,平時注意保養清潔,例如:牙線使用、正確的刷牙方式、避免菸酒檳榔等。惟有良好的口腔清潔才能確保牙齒與牙周組織的健康,讓整形後的牙齒 跟原本的牙齒無異,維持的時間才能長久。




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  • 個人分類:新聞稿件
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  • 10月 16 週四 200813:44
  • 年輕人口內長菜花 暑假激增兩成












年輕人口內長菜花 暑假激增兩成



(中央社記者郝雪卿台中市十五日電)台中市一名十八歲的女大學生,發現嘴內長出一粒粒疣狀物,感覺刺痛、搔癢,經醫師檢查後發現 是長「菜花」。中山醫學大學口腔醫學研究中心口腔外科醫師陳怡睿今天表示,暑假期間正是年輕人嘿咻的高峰期,臨床上就發現不少口腔內長菜花的病例,增加比 率約兩成。


陳怡睿指出,這名女大學生原本只是口腔內顎側出現一小顆肉色突起物,原以為是一般火氣大所導致的嘴破,但卻發現漸漸有變硬、變大的趨勢,於是便尋求牙醫師的協助,經診斷後發現是口腔內受到病毒感染而長出「菜花」。


陳怡睿表示,「菜花」是一種透過接觸傳染的病毒引起的,最常發生的感染途徑是男女在發生性關係時,經由口交而傳染至另一方口腔內,通常治療方式是以冷凍治療,雷射切除,或手術切除,只要患者配合持續追蹤治療,不僅可減低復發的機率,大約一至兩週左右就可完全痊癒了。


陳怡睿說,口腔是人體細菌最多的地方,也是最容易受到病毒的感染部位,如果性行為沒有做好安全措施,便很容易被傳染病毒,像舌頭、牙齦、粘膜等都是容易造成 口腔感染病變的地方,他認為,很多病毒都有可能經由口內的血液、傷口進入血液內,所以男女雙方在發生性行為前,記得要做好自我保護,即使口交也要戴保險 套,以避免受到病毒感染。


陳怡睿表示,每年暑假一到,就是年輕人發生性行為的高峰期,不僅公益團體大聲呼籲注意安全性行為,就連牙科醫師都能感受到罹患性病的比率暴增,像口內長菜花的案例就激增兩成。


他提醒,民眾若發現嘴內出現白色顆粒徵狀並感覺搔癢、疼痛等異狀,應先至醫療院所接受專業醫師諮詢,找出病症後再加以診治,以免病症惡化而難以治療。






















罹患菜花注意事項 1.患者在治療菜花期間勿發生性行為,以免導致自己及性伴 侶重複感染菜花。
2.患者及性伴侶應一起接受菜花檢查治療。
3.若口腔若感染菜花,應立即就醫治療,以減低癌變發生的機率。
4.注意個人衛生清潔。
菜花傳染途徑:
1.經由性行為的接觸傳染。
2.公共場所或共用物品傳染,如廁所、三溫暖接觸到菜花患者使用過的物品後,病菌留在指縫中再傳染給自己。
3.母體感染:嬰兒在生產過程中,受到患有菜花的母親感染。

暑假嘿咻高峰期 女大生嘴內長菜花







































轉載 中廣新聞網



台中市一名十八歲的女大學生,發現嘴內長出一粒粒疣狀物,感覺刺痛搔癢,醫師檢查後發現,是得了俗稱菜花的尖形濕疣。中山醫學大學口腔醫學研究中心口腔外科 陳怡睿醫師表示,暑假以來,口腔內長菜花的案例增加許多,呼籲年輕人以更謹慎的態度面對男女性關係,做好保護措施,才不會樂極生悲。


中山醫學大學口腔醫學研究中心陳怡睿醫師指出,這名女大學生因為口腔內側出現一小顆肉色突起物,原以為是火氣大嘴破,卻發現漸漸變硬變大,尋求牙醫師協助, 經診斷後發現是口腔內受到病毒感染而長出菜花,女大學生嚇了一跳。陳怡睿醫師表示,菜花是一種透過接觸傳染的病毒引起的,最常發生的感染途徑是男女在發生 性關係時,經由口交而傳染到另一方口腔內,女大學生坦承確實是性行為造成,經過冷凍治療,雷射切除,再持續追蹤治療,兩週後痊癒,沒有再復發。 陳醫師表示,口腔是人體細菌最多的地方,也是最容易受到病毒的感染部位,如果性行為沒有做好安全措施,便很容易被傳染病毒,像舌頭、牙齦、粘膜等都是容易 造成口腔感染病變的地方,陳怡睿醫師建議,即使口交,也要帶保險套。(口交也要帶保險套)陳怡睿醫師說,暑假是年輕人嘿咻高峰期,口腔內長菜花的案例,目 前增加兩成,暑假結束前可能達到高峰,醫師說,菜花潛伏期約兩週,呼籲年輕男女,發生性行為前,記得要做好自我保護,以避免受到病毒感染。







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  • [22/04/14] 訪客 於文章「口腔蜂窩性組織炎吃藥打針多久會好呢?...」留言:
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  • [19/02/08] 訪客 於文章「(新聞稿)過年期間牙齒痛怎麼辦?...」留言:
    一堆廢話...
  • [19/01/13] 訪客 於文章「齒槽骨炎(alveolar osteit...」留言:
    請問拔牙後的傷口有縫合依然會有機率發生嗎?...
  • [19/01/13] 訪客 於文章「齒槽骨炎(alveolar osteit...」留言:
    請問拔牙後的傷口有縫合依然會有機率發生嗎?...
  • [18/05/17] s280768 於文章「新年快樂!...」留言:
    c0QfD8nq761:1大牌專賣,歐美時尚風格,美麗永無止...
  • [18/03/06] 訪客 於文章「關於顳顎關節的治療......」留言:
    醫師您好,小女24歲,曾在不同診所做過牙齒矯正兩次,臉明顯左...
  • [17/09/23] 訪客 於文章「簡述水平或阻生齒的拔牙過程...」留言:
    請教陳醫師,我今天在一般診所拔了智齒,但牙根斷在裡面(沒有蛀...
  • [17/06/29] BMS病人留言 於文章「新年快樂!...」留言:
    您好!我偶尔在网上看到您的文章,关于灼口综合征BMS。我妈妈...
  • [16/08/05] Charlotte 於文章「新年快樂!...」發表了一則私密留言
  • [16/01/12] julie 於文章「新年快樂!...」發表了一則私密留言

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