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本文通过总结临床经验,从复诊一般检查、牙移动评估、患者依从性评估及监控、矫治器制作与发放、附件监控及邻面去釉的监控等方面,对隐形矫治器复诊时应特别注意的问题进行了深入讨论。同时,本文强调了正畸医生对无托槽隐形矫治技术临床矫治过程进行监控的重要性。     

Effects of Invisalign (G5) with virtual bite ramps for skeletal deep overbite malocclusion correction in adults

ObjectivesTo investigate the skeletal and dentoalveolar effects of Invisalign''s G5 protocol with virtual bite ramps in the treatment of adults with skeletal deep bites.Materials and MethodsThis retrospective study was conducted on consecutively treated adults presenting with skeletal deep bites as defined by the Overbite Depth Indicator (ODI). Subjects were divided into 2 groups: Invisalign group (n = 24) treated with the Invisalign G5 protocol and a full fixed appliance (FFA) group (n = 24) treated with edgewise FFAs and matched to the Invisalign group by ODI, sex, type of malocclusion, and non-extraction treatment. Pretreatment (T₁) and post–comprehensive treatment (T₂) lateral cephalograms were obtained and analyzed.ResultsBoth the Invisalign and FFA groups showed significant changes from T₁ to T₂ in ODI and other skeletal and dentoalveolar measurements. The mean change in ODI was −1.5° (P < .001) for the Invisalign group and −2.0° (P < .001) for the FFA group. The mean decrease in overbite was 1.3 mm (P < .001) and 2.0 mm (P < .001) for the Invisalign and FFA groups, respectively. The mean increase in mandibular plane angle (Sn-GoGn) was 0.65° (P = .003) for the Invisalign group and 1.15° (P < .001) for the FFA group. When the groups were compared with each other, both ODI (P = .03) and overbite (P = .003) were significantly different in addition to other measurements.ConclusionsAlthough FFA treatment had more apparent skeletal changes for deep bite adult patients when compared with Invisalign, both systems were effective in opening deep bites at dentoalveolar and skeletal levels.     

Orthodontic bone screws: A quick update and its promising future

Orthodontic bone screws (OBSs) provide intraoral anchorage by penetrating oral mucosa and seating firmly in basilar bone (BB). Retromolar (prosthetic-type) implants introduced the extra-alveolar (E-A) concept for BB anchorage to move teeth throughout the alveolar process, but the clinical procedures were complex and expensive. Titanium alloy (Ti) miniscrews placed in inter-radicular (I-R) alveolar bone are more convenient and provide some tooth movement potential, but multiple screws are usually required and the devices often interfere with the path of tooth movement. The advantages of BB anchorage and the convenience of miniscrew are combined into the E-A OBS system. These miniscrews are relatively large in diameter (2 mm), and strong (stainless steel), which are placed intraorally in the BB of the infra-zygomatic crest (IZC) and mandibular buccal shelf (MBS). E-A OBSs provide osseous anchorage to retract the dentition and/or rotate either arch. Recovery of impactions is effectively managed with lever arm springs anchored with IZC or MBS bone screws. An emerging frontier is BB anchorage for correcting severe malocclusions with clear aligners. Since the osseous-anchored mechanics are complementary, fixed appliances and clear aligners can be used individually or in tandem to resolve a broad variety of malocclusions. This report summarizes current concepts for conservatively managing complex malocclusions such as severe crowding, skeletal discrepancies, asymmetries and impactions with the OBS system.     

Expression of Opa interacting protein 5 (OIP5) is associated with tumor stage and prognosis of clear cell renal cell carcinoma

Opa interacting protein 5 (OIP5), overexpressed in some types of human cancers, has been reported to be associated with the carcinogenesis of human cancer. However, the biological function and clinical significance of OIP5 in human Clear Cell Renal Cell Carcinoma (CCRCC) remains unknown. In the present study, we found the expression of OIP5 was markedly upregulated in surgical CCRCC specimens and CCRCC cell lines. Immunohistochemical analysis revealed that paraffin-embedded archival CCRCC specimens exhibited higher levels of OIP5 expression than normal renal tissues. Further statistical analysis suggested the upregulation of OIP5 was positively correlated with the Fuhrman grade (P = 0.02), T classification (P = 0.015), N classification (P = 0.018) and clinical stage (P = 0.035). Also, patients with high OIP5 expression dramatically exhibited shorter survival time (P = 0.001). In addition, the OIP5 expression was an independent prognostic marker of overall survival of CCRCC patients in a multivariate analysis (P = 0.008). Experimentally, we demonstrated that silencing OIP5 in CCRCC cell lines by specific siRNA clearly inhibited cell growth. In conclusion, our findings suggested that OIP5 could be a valuable marker of CCRCC progression and prognosis, and a promising therapeutic target for CCRCC.     

Renal tumors with clear cells. A review

The spectrum of primary renal tumors in which clear cells may appear is revisited in this review. The pathologist's viewpoint of this topic is pertinent because not all the tumors with clear cells are carcinomas and not all renal cell carcinomas with clear cells are clear cell renal cell carcinomas. In fact, some of them are distinct entities according to the new WHO classification. The morphological approach is combined with genetics. Renal cell carcinoma related to von Hippel–Lindau disease is reviewed first because many of the genetic disorders underlying this disease are also present in sporadic, conventional renal cell clear cell carcinomas. Subsequently, conventional renal cell clear cell carcinomas, familial, non von Hippel–Lindau-associated renal cell carcinomas, translocation carcinomas, hereditary papillary renal cell carcinomas, carcinomas associated to tuberous sclerosis and to Birt–Hogg–Dubé syndrome, chromophobe renal cell carcinomas, carcinomas associated with end-stage renal disease, and clear cell tubulopapillary carcinomas are reviewed. Finally, epithelioid angiomyolipoma is also considered in this review.     

卵巢透明细胞癌的MRI表现

目的探讨卵巢透明细胞癌的MRI特征。方法回顾性分析9例经手术病理证实的卵巢透明细胞癌的MRI表现。结果 9例均为单侧病变,肿块较大,直径6.5-21.3cm,其中1例为实性肿块,8例为囊实性,囊实性肿块均以囊性成分为主伴多发结节,边缘清晰,肿块实性成分信号均匀,T1WI呈等低信号,T2WI呈高信号,DWI呈高信号,ADC值减低,均值为（0.76±0.12）×10^-3mm^2/s。结论卵巢透明细胞癌MRI表现有一定特征,有助于临床上进行诊断及鉴别诊断。     

透明细胞软骨肉瘤3例临床病理观察

目的 探讨透明细胞软骨肉瘤(CCCS)的临床病理特征、诊断与鉴别诊断.方法 结合临床资料及影像学所见,分析3例CCCS的组织病理学特征并复习相关文献.结果 患者均为女性,年龄23～48岁,平均35.6岁.发病部位分别是鼻中隔、股骨及胫骨.X线显示溶骨性破坏,其内可见斑点状不规则钙化.病变界限清楚,具有薄层硬化边.巨检:灰白色肿瘤组织质软而脆.镜检:肿瘤呈弥漫片层状或模糊的分叶状排列,散在点缀着钙化或骨化灶.病变主要由温和的透明细胞构成,胞质丰富、空泛,边界清楚,核中位,无核沟,可见核仁;一些破骨细胞样巨细胞出现于条索状低级别软骨肉瘤及灶性反应性骨样组织中;其中2例继发动脉瘤样骨囊肿;所有病例核非典型及核分裂罕见.免疫组化:S-100和vimentin(+).1例刮除术后病变复发并发生去分化.结论 CCCS是一种罕见的低度恶性软骨肉瘤的亚型,应与软骨母细胞瘤及转移性透明细胞癌等鉴别.确诊后推荐“大块切除”的外科手术治疗.     

CLEAR CELL SARCOMA KIDNEY: Clinical Features and Outcome

Clear cell sarcoma of kidney (CCSK) is a rare, highly malignant tumor. The clinical features and treatment outcome of 12 patients with CCSK are reported. From 1982 through December 1996, 12 cases of CCSK were seen at the Regional Cancer Centre, Trivandrum, India. Patients were staged according to NWTS III recommendation. They were treated with chemotherapy containing vincristine, actinomycin, and Adriamycin and radiotherapy. The survival curve was calculated by the Kaplan-Meier method. Mass and pain in the abdomen were the presenting symptoms. Male/female ratio was 3:1. Six had stage I, 4 had stage II, and 2 had stage III disease. Of the 12, 10 were evaluable, 6 are alive, and 3 recurred in 9 evaluable. Six patients are alive free of disease 10 to 108 months after diagnosis. The overall survival and disease-free survival of the 10 patients are 64 and 56%. It would appear that combined modality treatment can cure two thirds of children with CCSK. Effective treatment needs to be developed for children who fail after first line treatment.     

透明晶状体摘除治疗高度近视

评价使用超声乳化行透明晶状体摘除和植入折叠人工晶状体治疗高度近视的疗效、预测性和安全性。方法 :对 45例 80只眼行透明角膜切口 ,超声乳化透明晶状体摘除联合折叠人工晶状体植入治疗高度近视。患者年龄 2 5～ 71岁 ,平均 5 5 13± 8 83岁。平均眼轴长度 2 9 45± 2 0 7mm ,平均等效球镜度数 -11 86± 4 73D ,植入人工晶状体屈光度平均值为9 19± 3 80D。随访 6～ 42个月。结果 :术后最佳矫正视力 80只眼均达到或超过术前最佳矫正视力 ;70只眼 (87 5 % )术后裸眼视力达到或超过术前最佳矫正视力 ;44只眼 (5 5 0 % )术后裸眼视力达到 0 5以上 ;术后屈光度平均值为 -1 96± 1 2 8D ,70只眼 (87 5 % )在预矫屈光度±1D内。术中未发生后囊破裂。随访中 11只眼发生后囊混浊 ,未发现视网膜脱离、黄斑囊样水肿等并发症。结论 :透明晶状体摘除治疗高度近视与目前的角膜屈光手术相比 ,可能更适宜于中年以上不愿戴镜和戴镜不能矫治的高度近视眼患者 ,其远期疗效尚需长期随访。     

Pharmacotherapy for treating metastatic clear cell renal cell carcinoma

Introduction: Over the past decade metastatic renal cell carcinoma (RCC) treatment landscape has dramatically evolved from the era of cytokines-based immunotherapy (which benefited very few patients, at the expenses of high toxicities) to the present era of targeted agents and novel immunotherapeutics, greatly improving the prognosis of our patients.

Areas covered: Here we have reviewed the present status of the medical treatment of metastatic RCC. To do this, we interrogated the Medline database, as well as the proceedings of the main Oncological and Urological conferences for the relevant trials coducted so far.

Expert opinion: Despite all the advances made in these relatively few years, further improvements are needed, since none of the available agents proved able to cure even a sigle metastatic RCC patient. In particular, advances are awaited from the results of ongoing trial of combinations of different immune checkpoint inhibitors and of immune checkpoint inhibitors with anti-VEGF/VEGFRs agents. Furthermore, a better understanding of the molecular escape pathways used by the tumor to overcome VEGFR blockade or immune activation will hopefully bring soon to the clinic more active, tailored treatments, to be used in second line and beyond.