舌鳞癌侵润和转移的相关病理因素分析及临床意义

为研究舌鳞癌侵润和颈淋巴结转移因素对肿瘤预后的影响，作者对９２例舌鳞癌诸多病理因素经ＳＰＳＳ／ＰＣ＋数据分析软件处理，结果显示：单因素分析，肿瘤侵润方式（ＭＩ）、癌周侵润淋巴细胞密度（ＰＬＩＤ）、Ｔ分期和病理分级与颈淋巴结转移差异有极显著性（Ｐ＜０．００１）。多因素分析只有ＭＩ和ＰＬＩＤ差异有显著性（Ｐ＜０．０１）。在与侵润方式相关的因素分析中，单因素分析、Ｔ分期、病理分级和ＰＬＩＤ与ＭＩ差异有显著性，多因素分析仅Ｔ分期Ｐ＝０．０４５。ＭＩ和ＰＬＩＤ是与颈淋巴结转移相关的重要因素，Ｔ分期与ＭＩ相关。     

口腔鳞癌癌周淋巴管生成与颈淋巴结微转移

目的　探讨口腔鳞癌癌周淋巴管生成与颈淋巴结微转移的关系。方法　对 4 7例口腔鳞癌组织、10例正常口腔黏膜进行酶组织化学染色 ,检测癌周微淋巴管密度 ;对 10例正常淋巴结、4 7例口腔鳞癌患者的 35 5个淋巴结以高分子量细胞角蛋白AE3单抗为抗体的免疫组织化学方法测定。结果　口腔鳞癌癌周淋巴管密度为 (14 0 4± 6 92 )个 / 2 0 0倍视野下 ,显著高于健康对照组 (5 4 8±2 6 2 )个 / 2 0 0倍视野下 (P <0 0 0 1) ;4 7例患者中角蛋白阳性 2 3例 ,阳性率为 4 8 9% (2 3/ 4 7) ;以淋巴微转移阳性、阴性分组 ,阳性组淋巴管密度为 (16 94± 5 4 3)个 / 2 0 0倍视野下 ,阴性组淋巴管密度为 (11 2 6± 5 0 0 )个 / 2 0 0倍视野下 ,阳性组微淋巴管密度显著高于阴性组 (P <0 0 0 1)。结论　癌周淋巴管密度增高在颈淋巴结微转移中起着非常重要的作用。     

口腔鳞癌淋巴结微转移灶检测对分期和预后的影响

目的 :研究口腔鳞癌患者淋巴结微转移灶对预后的影响。方法 :对 3 6例口腔鳞癌患者在常规病理检查阴性的淋巴结 ,运用免疫组化检测细胞角蛋白 (CK)的表达 ,检测微转移灶的存在。分析CK 与生存期的关系。结果 :3 6例患者中 ,CK 和CK-患者的生存期分别为 ( 3 6.76± 6.91)月、( 4 7.47± 11.3 5 )月 (P =0 .0 0 2 )。Logistic回归模型的多因素分析显示 :淋巴结微转移灶的有无、病理分级均可作为独立的预后因素 (P值分别为 0 .0 44和 0 .0 40 ) ,而临床分期并不能作为一项独立的预后因素 (P =0 .2 3 6)。结论 :淋巴结中微转移灶的检测可以补充目前口腔鳞癌的分期方法 ,有微转移灶患者的预后要比无微转移灶者差     

舌鳞癌淋巴管生成与颈淋巴结转移的关系

目的：研究舌鳞癌淋巴管生成及淋巴管密度／淋巴管相对面积（LVD／LVA）与颈淋巴结转移的关系，为术前准确判断颈淋巴结状况提供参考。方法：口腔颌面外科接受舌癌切除及颈淋巴清扫术的标本63例：对HE染色阴性的淋巴结，应用细胞角蛋白CK（AE1／AE3）标记检测微转移，以免疫组织化学检测结果判断淋巴结转移；以LYVE—1作为淋巴管内皮标志物，研究舌癌淋巴管生成参数——淋巴管密度（LVD）和淋巴管面积（LVA）与颈淋巴结转移及其他临床病理变量（年龄、性别、T分类、病理分级、浸润方式）之间的关系。应用SPSS10．0统计软件包对所得数据进行Mann-whitney U检验。结果：应用细胞角蛋白CK（AE1／AE3）标记免疫组化法检测微转移，提高了淋巴结转移的检出率；舌癌实质内未见到LYVE—1^＋的脉管结构，LYVE—1^＋脉管多位于癌周，癌周LVD、LVA与颈淋巴结转移及其他临床病理变量均无关。结论：舌癌癌周淋巴管密度（LVD）、淋巴管面积（LVA）与颈淋巴结转移及其他临床病理变量均无关，不宜作为术前评估淋巴结状况的指标。     

舌鳞癌颈淋巴转移的临床研究

目的：为了探讨舌鳞癌颈巴结转移的规律及临床治疗的关系。方法：对96例舌鳞癌根治性颈清扫标本的转移性淋巴结在颈部的分布进行了回顾性分析。结果：颈部淋巴结转移病理阳性的总发生率52．1％。N0,N1,N2,N3的Ⅳ区、Ⅴ区淋巴结转移率分别为：3．3％,5．0％,30．0％,31．3％。病理证实仅有I区或Ⅱ区淋巴结转移,而无Ⅲ区淋巴结转移时,Ⅳ区、Ⅴ区淋巴结转移率为4．2％,有Ⅲ区淋巴结转移时,Ⅳ区、Ⅴ区淋巴结转移率为57．7％。结论：对于N0和N1的舌鳞癌患者可行肩胛舌骨上清扫,N2和N3的舌鳞癌者应行根治性清扫。行肩胛舌骨上清扫时,行Ⅲ区淋巴结冰冻切片检查,根据结果决定是否同时清扫Ⅳ区、Ⅴ区。     

口腔鳞癌淋巴转移的临床病理危险因素

目的：探讨口腔鳞癌淋巴转移的预告危险因素。方法：随切口腔鳞癌术后４年以上的１９３例患者,用单因素分析、多因素回归分析及显著性检验,观察肿瘤ＴＮ分期、部位、浸润方式、厚度、病理分化、肿瘤细胞有丝分裂数、细胞角化及核分化程度、淋巴细胞浸润等对淋巴结转移和术后淋巴结转移的影响程序。结果：单因素分析肿瘤ＴＮ分期、浸润方式和厚度、淋巴细胞浸润均显著影响颈清扫标本病理确诊淋巴结转移率,多因素分析只有肿瘤浸润方式是显著性因素,并显著影响术后淋巴结转移。结论：肿瘤浸润方式是影响口腔鳞癌淋巴结转移的重要因素。     

舌鳞癌无区域性淋巴结转移患者的颈部处理

目的 评价对于舌鳞癌无区域性淋巴结转移患者造反性颈淋巴清扫的必要性。方法对１３０例舌癌颈淋巴结临床阴性的患者用Ｃｏｘ回归模型（Ｃｏｘ ｒｅｇｒｅｓｓｉｏｎ ｍｏｄｅｒ,Ｃｏｘ模型）多因素分析方法,分析了影响颈部转移的因素,同时比较颈部淋马清扫与否两组的生存效果。结果 原发灶Ｔ分级、治疗方法及放疗与颈淋巴结复发有明显相关意义,是否颈淋巴清扫及其他几个因素则与复发无关,其生存率表明差异无显著性,生存率     

舌鳞状细胞癌区域淋巴结转移危险因素评估

目的　探讨影响舌鳞癌淋巴结转移危险因素在预测颈淋巴结转移中的作用。方法　以106例舌鳞癌患者原始资料为基础,取病灶最大直径、肿瘤细胞分化程度、浸润方式及组织学恶性度分级为危险因素进行统计学分析。结果　原发灶直径及肿瘤细胞分化程度与颈淋巴结转移无明显相关意义;而浸润方式及组织学恶性度分级与颈淋巴结转移有明显相关性。结论　舌鳞癌发生区域淋巴结转移的危险因素是浸润方式及组织学恶性度分级。     

影响舌鳞状细胞癌预后的临床病理因素分析

目的 研究影响舌鳞状细胞癌预后的临床病理因素。方法 以TNM分类,病理分级,淋巴细胞浸润程度,浸润厚度,病理核分裂数,微血管数等指标来研究与舌鳞状细胞癌预后有关的因素。结果 分化程度,淋巴细胞浸润程度,浸润厚度,微血管数,病理核分裂数与区域淋巴结转移无关,肿瘤大小与区域淋巴结转移有关,肿瘤大小,淋巴细胞浸润程度,微血管数等指标与术后复发转移无关,浸润厚度,分化程度,病理核分裂数与术后复发转移有关。结论 对于肿瘤直径大的舌鳞状细胞癌应积极采取颈淋巴结清扫术;分化程度低者易出现术后复发转移;舌鳞状细胞癌浸润厚度超过6mm时,病理核分裂数大于2个／税镜视野时,易出现术后复发转移。     

舌根鳞癌颈淋巴结微转移灶检测对预后的影响

目的:检测舌根鳞癌颈淋巴结的微转移灶,研究其对预后的影响。方法:对50例经病理确诊的舌根鳞癌常规病理检测阴性的淋巴结(pNO),采用免疫组化检测细胞角蛋白(CK)的表达,检测微转移灶的存在。分析CK 与术后复发、生存期的关系。结果:50例患者中,CK 和CK-患者术后复发率分别为42.4％(14／33)和11.8％(2／15)(p<0.05),而其生存期分别为(23.26±5.42)个月和(35.84±6.10)个月(P<0.05)。Logistic回归模型的多因素分析显示:淋巴结微转移灶的有无、病理分化程度均可作为独立的预后因素(P<0.05),而临床分期并不能作为一项独立的预后因素(P>0.5)。结论:舌根鳞癌患者颈淋巴结有微转移灶者,预后比无微转移灶者差。     

Clinical and pathological aspects on some odontogenic tumors

Odontogenic tumors constitute a very diverse group of lesions that reflects the complex processes of odontogenesis. Controversies over their classification/subtyping, terminology and diagnosis have been persisted, which has direct bearings on therapeutic and/or prognostic implications.     

Can you be too old for oral implants? An update on ageing and plasticity in the oro‐facial sensorimotor system

This review focuses on the capacity of the brain for plasticity and the utility and efficacy of oral implants in helping to restore oro‐facial sensorimotor functions, especially in elderly patients. The review first outlines the components of the oro‐facial sensorimotor system which encompasses both oro‐facial tissues and a number of brain regions. One such region is the sensorimotor cortex that controls the activity of the numerous oro‐facial skeletal muscles. These muscles are involved in a number of functions including reflexes and the more complex sensorimotor functions of mastication, swallowing and speech. The review outlines the use by the brain of sensory inputs from oro‐facial receptors in order to provide for exquisite sensorimotor control of the activity of the oro‐facial muscles. It highlights the role in this sensorimotor control played by periodontal mechanoreceptors and their sensory inputs to the brain, and how oral implants in concert with the plastic capacity of the brain may, at least in part, compensate for reduced sensorimotor functioning when teeth are lost. It outlines findings of ageing‐related decrements in oro‐facial sensorimotor functions and control. The changes in oro‐facial tissues and the brain that underlie these ageing‐related functional alterations are also considered, along with adaptive and compensatory processes that utilise the brain's capacity for plasticity. The review also notes the evidence t hat rehabilitation that incorporates adjunctive approaches such as sensorimotor training paradigms in addition to oral prostheses such as implants may enhance these processes and help maintain or facilitate recovery of sensorimotor functioning in the elderly.     

Tumor microenvironment in oral cancer: novel approaches for immunotherapy

Squamous cell carcinoma of the head and neck (SCCHN), which arises from the squamous mucosal epithelium of the oral cavity, pharynx and larynx, is a major health problem in the US and other parts of the world, especially in developing countries.     

牙槽骨再生正畸治疗伴牙槽骨缺损的成人错畸形远期疗效评价

目的：评价牙槽骨再生正畸治疗伴牙槽骨缺损的成人错畸形的远期疗效。方法伴牙槽骨缺损的成人错畸形3例,平均年龄29岁。经正颌-正畸联合会诊制订治疗计划,按照牙槽骨再生正畸及正颌-正畸联合治疗模式,分别进行系统治疗并随访2~3 a。结果3例患者均顺利完成治疗,面型及咬合关系获得良好改善;牙槽骨缺损区正畸牙移动到位且未见医源性牙周并发症,牙槽骨缺损区骨量增加明显且远期效果稳定。结论针对伴牙槽骨缺损的成人患者,牙槽骨再生正畸是一种较为理想的技术。     

伴囊肿的上颌埋伏阻生中切牙早期引流助萌治疗

目的:探讨采用引流助萌的方法对伴囊肿的上颌埋伏阻生中切牙的早期治疗。方法:选取单侧上颌中切牙埋伏阻生、处于替牙早期伴囊肿的患者8例。外科囊肿切除同时对埋伏阻生上颌中切牙引流助萌治疗。治疗前后拍摄CBCT,Dolphin11.0软件测量矫治前后阻生牙及对侧正常同名牙的冠根长度。结果:8例患者的埋伏阻生上颌中切牙平均矫治时间6.7个月。矫治后阻生牙和对侧正常同名牙的冠根长度均有生长。阻生牙冠根长度较对侧正常同名牙明显短(P<0.05)。结论:本研究所采用引流助萌方法为埋伏阻生牙的矫治提供了一个安全、有效的新途径。     

Management of acute open flexor tendon injuries of the hand and wrist: basic sciences,surgical factors and rehabilitation pertinent to optimizing outcome

Flexor tendon injuries to the hand and wrist represent a significant resource burden to the UK NHS. A good understanding of tendon basic science and repair techniques is crucial for the surgeon undertaking their repair and rehabilitation. Furthermore, this is a common topic assessed in the FRCS(Orth) examination. This article will summarize the basic science relating to tendon structure, physiology and injury. Additionally, it will present key surgical and rehabilitation factors relevant to clinical outcomes.     

In vitro calibration and validation of a digital subtraction radiography system using scanned images

OBJECTIVES: To calibrate and validate a digital subtraction radiography system using scanned images for quantification of alveolar bone changes by means of computer-assisted densitometric image analysis (CADIA) in vitro. MATERIALS AND METHODS: Noise levels were determined using 10 standardized periapical radiographs of the same lower molar region in a human dry skull. For validation of the system, radiographs were taken before and after bovine bone particles in measures with increments of 2 mg weighing from 2 to 20 mg were added into each socket of three dry skulls. Radiographs were developed and scanned into a computer with a flatbed scanner. After digitization, the images were subjected to alignment, normalization and subtraction. Appropriate regions of interest (ROIs) were selected and their CADIA values were calculated for the determination of noise levels, and correlations between the CADIA values and the actual bone mass were performed. RESULTS: When the threshold value was 7, the percentage of pixels deviating from the set threshold value was small (0-11.3%). There were statistically significant correlations between the actual bone mass and the CADIA value for anterior sockets (p<0.001, r2=0.89) and posterior sockets (p<0.001, r2=0.9). For pooled data of both anterior and posterior sockets, the correlation was also statistically significant (p<0.001, r2=0.88). CONCLUSIONS: A high and statistically significant correlation between the actual bone mass and CADIA value was obtained, which suggests that the system could be suitable for the detection of small alveolar bone changes.     

Fabrication and characterisation of a novel biomimetic anisotropic ceramic/polymer-infiltrated composite material

Objective

To fabricate and characterise a novel biomimetic composite material consisting of aligned porous ceramic preforms infiltrated with polymer.