Lenke 1型青少年特发性脊柱侧凸患者不同上端融合椎对术后双肩平衡的影响

【摘要】 目的：探讨不同上端融合椎对术前双肩水平的Lenke 1型青少年特发性脊柱侧凸（adolescent idiopath?鄄ic scoliosis,AIS）患者术后双肩平衡的影响。方法：选取2006年6月~2009年6月在我院行后路主胸弯融合术并有2年以上完整影像学随访资料的32例Lenke 1型AIS患者。所有患者术前均表现为双肩水平,其中男6例,女26例,手术时年龄13~19岁,平均14.9岁,上胸弯Cobb角平均为23.7°±8.0°（10°~36°）,主胸弯Cobb角平均47.5°±6.9°（40°~62°）。按照上端融合椎不同将AIS患者分为两组：A组,上端融合椎为T3,19例;B组,上端融合椎为T4,13例。A组患者的手术时年龄、Risser征、上胸弯及主胸弯柔韧度与B组比较均无统计学差异（P>0.05）。采用方差分析比较两组患者术前、术后1年和末次随访时的上胸弯及主胸弯Cobb角、顶椎及躯干偏移距离、影像学肩关节高度差（radiographic shoulder height, RSH）、喙突高度差（CPH）和锁骨角（CA）。结果：A组随访时间2~4.5年,平均3.6±1.3年;B组随访时间2~4.8年,平均3.1±2.1年,两组比较无统计学差异（P>0.05）。术前、术后1年和末次随访时,A组患者的上胸弯Cobb角、主胸弯Cobb角、顶椎及躯干偏移距离、RSH、CPH及CA与B组比较均无统计学差异（P>0.05）。A、B两组患者术后1年和末次随访时的上胸弯Cobb角、主胸弯Cobb角、顶椎及躯干偏移距离、RSH、CPH、CA分别与术前比较均有显著性改善（P<0.05）;末次随访时,两组患者的上胸弯Cobb角及RSH、CPH、CA较术后1年均显著减小（P<0.05）,均获得较满意的双肩平衡。结论：对于术前双肩水平的Lenke 1型AIS患者,上端融合椎为T3或T4对重建术后双肩平衡的疗效无明显差别;对此类患者上端融合至T4即可获得良好的矫形效果和满意的双肩平衡。     

Conversion of Fused Hip to Total Hip Arthroplasty: Long-Term Clinical and Radiological Outcomes

BackgroundDespite promising results at the mid-term followup, several aspects of conversion of the fused hip to total hip arthroplasty (THA) remain controversial. The aim of this study was to evaluate clinical and radiological outcomes with a minimum 5-year followup in patients who underwent conversion of the fused hip to THA.MethodsFifty-seven patients (59 hips) were evaluated. The Harris Hip Score (HHS), range of motion (ROM), and the Visual Analogue Scale (VAS) were used to assess hip function and low back pain. Subjective satisfaction with surgery and the presence of the Trendelenburg sign was also evaluated. Radiological assessment was performed pre- and postoperatively to evaluate loosening and heterotopic ossification (HO).ResultsAfter a mean followup of 13.0 ± 6.2 years, HHS and VAS significantly improved from 46.0 ± 16.7 to 80.8 ± 18.8 and from 4.4 ± 1.5 to 2.1 ± 1.4 (both P < .001), respectively. Twenty-three patients (40.4%) had a positive Trendelenburg sign, and HOs were found in 29 cases (49.1%). An overall 29.8% complication rate was noted. Smoking habits and rheumatoid arthritis were predictive of Trendelenburg sign (P = .046 and P = .038, respectively). Implant survival rate as the end point was 98.7 ± 1.3% at 5 years, 92.4 ± 3.3% at 10 years, 82.1 ± 5.7% at 15 years, and 73.4 ± 8.0% at 20 and 25 years. A worse cumulative implant survival rate was noted in patients who underwent previous hip surgery, defined as any hip operation before fusion (P = .005).ConclusionConversion of the fused hip to hip arthroplasty provides high levels of hip functionality and satisfaction with surgery at long-term followup. An implant survival rate higher than 70% can be expected 25 years postoperatively.     

一种交叉异位融合肾新亚型及其诊治

目的:观察一种交叉异位融合肾新亚型的发病情况,探讨其临床分型、诊断与治疗以及发病机制。方法:回顾性分析1例交叉异位融合肾合并髂血管后巨输尿管异位开口和胸椎侧弯患者的临床资料,包括患者的病史资料、影像资料和手术探查交叉异位融合肾的术中所见,然后进行文献复习。结果:文献复习证实这可能是交叉异位融合肾的一种新亚型,交叉异位融合肾合并髂血管后异位输尿管在以前的文献中也从未见报道,患者的异位输尿结石并感染通过手术治愈。结论:男性的异位输尿管开口更为隐蔽,需要联合多种方法进行诊断。     

Ceramic on ceramic hip arthroplasty in fused hips

Background:Most literature in the field of total hip arthroplasty (THA) for fused hips, until date has reported the results of using metal on polyethylene and ceramic on polyethylene bearings. Results of THA using ceramic on ceramic (CoC) bearings in fused hips have not been published in literature. This study reports the results of cementless THA using CoC articulation perfomed in fused hips.Results:Mean Harris hip score improved from 42.4 to 84.2 and mean leg lengthening of 36.6 mm was achieved. In the average 5.4 years (range 2.8-9.1 years) followup there were no cases with osteolysis around acetabular cup and femoral stem. In this study, there was no case of ceramic fracture. There was one case of squeaking.Conclusion:This study suggests that cementless THA performed for fused hips with CoC bearings can provide good early clinical results.     

金沉积烤瓷冠的临床评价

目的：评价金沉积烤瓷冠临床修复效果。方法：选择金沉积烤瓷冠、贵金属烤瓷冠、镍铬合金烤瓷冠各50颗牙,观察修复体颜色、牙龈染色、边缘适合性、牙周组织健康状况、瓷裂、瓷崩等情况。结果：对临床修复病例进行6个月至1年的随访观察,在颜色、牙龈染色、牙周组织健康方面金沉积烤瓷冠与贵金属烤瓷冠差异无显著性（P〉0.05）,明显优于镍铬合金烤瓷冠（P〈0.01）;在边缘适合性方面,金沉积烤瓷冠优于贵金属烤瓷冠（P〈0.05）,明显优于镍铬合金烤瓷冠（P〈0.01）,三者在瓷崩瓷裂方面差异无显著性。结论：在烤瓷修复体中金沉积烤瓷冠是良好的修复体。     

Familial inheritance of crossed fused renal ectopia

A family with dominant inheritance of a rare renal malformation is reported. The father and one son had left crossed fused ectopic and dysplastic kidneys and another son had a horseshoe kidney and vesicoureteral reflux. We discuss various potential pathogenetic mechanisms and propose that a defect in the timing of the proper reciprocal induction of the ureteric bud and the metanephric blastema is involved. Received: 30 June 2000 / Revised: 7 November 2000 / Accepted: 8 November 2000     

镍铬合金上不同厚度瓷覆盖后唾液中镍铬元素含量分析

目的本实验研究被遮色瓷覆盖后镍铬合金在唾液中是否容易被腐蚀，不同厚度瓷层覆盖后的镍铬合金是否会影响唾液中的镍铬金属离子的含量，为金属材料在临床中的应用提供理论依据。方法以牙科铸造用镍铬合金为研究对象，将33个铸造好的镍铬合金试件，经预氧化处理后，随机选用3个试件作为对照组，其余的按照遮色瓷层的烧结厚度不同分成10个组，分别分装在33个盛有人工唾液的试剂瓶中，在37℃的恒温箱内静置90天后，测定各试剂瓶中的镍铬离子含量，同时使用SPSS12．0统计软件包对各实验组和对照组进行比较，分析其间的差别。结果1．被遮色瓷覆盖后的镍铬合金仍然有镍铬离子析出，但随着瓷层厚度的逐渐增厚，其离子含量在逐渐减小。2．各实验组镍铬离子浓度与对照组间进行比较均无统计学意义（P〉0．05）。结论①被遮色瓷覆盖后的镍铬合金在人工唾液中仍然容易发生电化学腐蚀，析出金属离子。②在临床厚度范围的遮色瓷层对镍铬合金在唾液环境中不具保护性。     

Blocking PD-1/PD-L1 by an ADCC enhanced anti-B7-H3/PD-1 fusion protein engages immune activation and cytotoxicity

Antibody therapy based on PD-1/PD-L1 blocking or ADCC effector has produced significant clinical benefit for cancer patients. We generated a novel anti-B7-H3 antibody (07B) and engineered the Fc fragment to enhance ADCC. To improve efficacy and tumor selectivity, we developed anti-B7-H3/PD-1 bispecific fusion proteins that simultaneously engaged tumor associate marker B7-H3 and immune suppressing ligand PD-L1 as well as enhanced ADCC to promote potent and highly selective tumor killing. Fusion proteins were designed by fusing human PD-1 extra domain to 07B in four different formats and showed good binding capacity to both targets. Indeed, the affinity of fusion proteins to B7-H3 is over 10,000 fold higher compared to that of the analogous PD-L1 and the blocking of fusion proteins to PD-L1 was worse but it greatly enhanced when bound to B7-H3, thus achieving directly PD-L1-blockade to B7-H3-expressing tumor cells. Importantly, IL-2 production was enhanced by fusion proteins from staphylococcal enterotoxin B (SEB) stimulated PBMC. Similarly, cytokines induced by fusion proteins was enhanced when co-cultured with stimulated CD8⁺ T cells and B7-H3/PD-L1 transfected raji cells. Additionally, fusion proteins improved activation to CD16a by Fc modification and delivered selective cytotoxicity to B7-H3 expressing tumor cells. In conclusion, fusion proteins blocked the PD-1/PD-L1 signal pathway and significantly increased potency of ADCC in a B7-H3-directed manner, thereby selectively activating CD8⁺ T cells and enhancing natural killing towards tumor. This novel fusion protein with its unique targeting preference may be useful to enhance efficacy and safety of immunotherapy for B7-H3-overexpressing malignancies.     

Formulation of 3D Printed Tablet for Rapid Drug Release by Fused Deposition Modeling: Screening Polymers for Drug Release,Drug-Polymer Miscibility and Printability

The primary aim of this study was to identify pharmaceutically acceptable amorphous polymers for producing 3D printed tablets of a model drug, haloperidol, for rapid release by fused deposition modeling. Filaments for 3D printing were prepared by hot melt extrusion at 150°C with 10% and 20% w/w of haloperidol using Kollidon^® VA64, Kollicoat^® IR, Affinsiol^?15 cP, and HPMCAS either individually or as binary blends (Kollidon^® VA64 + Affinisol^? 15 cP, 1:1; Kollidon^® VA64 + HPMCAS, 1:1). Dissolution of crushed extrudates was studied at pH 2 and 6.8, and formulations demonstrating rapid dissolution rates were then analyzed for drug-polymer, polymer-polymer and drug-polymer-polymer miscibility by film casting. Polymer-polymer (1:1) and drug-polymer-polymer (1:5:5 and 2:5:5) mixtures were found to be miscible. Tablets with 100% and 60% infill were printed using MakerBot printer at 210°C, and dissolution tests of tablets were conducted at pH 2 and 6.8. Extruded filaments of Kollidon^® VA64-Affinisol^? 15 cP mixtures were flexible and had optimum mechanical strength for 3D printing. Tablets containing 10% drug with 60% and 100% infill showed complete drug release at pH 2 in 45 and 120 min, respectively. Relatively high dissolution rates were also observed at pH 6.8. The 1:1-mixture of Kollidon^® VA64 and Affinisol^?15 cP was thus identified as a suitable polymer system for 3D printing and rapid drug release.