中年人上颌前突错 的修复正畸疗效评价

目的　评价修复正畸法对中年人上颌前突错治疗的疗效。方法　应用修复正畸法在短时间内对 18例中年人 (女性 16例 ,男性 2例 ,平均年龄 45 .6岁 )上颌前突进行治疗 ,并以X线头颅侧位定位片分析方法 ,对其疗效进行评价。结果　经过修复正畸法治疗 ,上中切牙长轴明显舌侧倾斜 ,上下中切牙构成角度趋于正常 ,覆、覆盖关系基本接近正常 ;上下唇软组织最前点明显后退 ,侧貌形态显著改善。结论　修复正畸法为不适合正畸治疗的中年人错畸形提供了行之有效的治疗手段。     

Extradural Extranasal Combined Transmaxillary Transsphenoidal Approach to the Cavernous Sinus: A Minimally Invasive Microsurgical Model

The authors have previously described an extradural transmaxillary approach to the anterior compartment of the cavernous sinus. In an effort to expand the surgical access to that area without necessitating a craniotomy or wide transfacial dissection, they present a modification of the transmaxillary approach to the sellar region and cavernous sinus. Methods: The approach was developed on 12 fresh and 12 embalmed cadaveric specimen, and 2 dry skulls. The initial sublabial incision is followed by a maxillotomy to expose the course of the infraorbital nerve (terminal branch of maxillary branch of the trigeminal nerve) on the roof of the maxillary sinus. The route of the infraorbital nerve is traced to the pterygopalatine fossa as a guide to the foramen rotundum. Superomedial drilling of the foramen rotundum is then performed to reveal the contents of the superior orbital fissure. After the nerves are safely identified in the superior orbital fissure, medial enlargement of the window into the cavernous sinus is made possible by drilling the lateral and posterior wall and septum of the sphenoid sinus. Results: The combined transmaxillary transsphenoidal approach offers an excellent exposure of the sellar and infrasellar region. The approach offers clear visualization of the ipsilateral loop of the carotid artery, the pituitary fossa, and the cranial nerves of the ipsilateral cavernous sinus. Mean operative reach is 38 mm from the posterior wall of the maxillary sinus to the ipsilateral carotid loop and 56 mm to the contralateral loop. The width of the operative window is 26 mm at the base within the cavernous sinus. Conclusion: The model offers a minimally invasive approach that avoids the need for craniotomy or violating the nasal cavity. It may be safely employed to access vascular as well as invasive lesions of the sellar and infrasellar region. The approach offers excellent visualization of the ipsilateral intracavernous carotid artery with both proximal and distal control, as well as cranial nerves III, IV, VI, V2, the hypophyseal region, and the medial aspect of the contralateral cavernous sinus.     

Effect of superantigen on ion electrophysiology and permeability in rabbit maxillary sinus epithelia

Objective Superantigens are potent inflammatory stimuli which derive from pathogenic microbes such as bacteria, viruses and protozoa. The aim of this study was to investigate the role of superantigens on the function of rabbit maxillary sinus epithelium. Methods Twenty New Zealand white rabbits were divided into 4 groups. Rabbit sinus mucosa was separated under a surgical microscope and mounted in Ussing chambers to record short circuit current, conductance and permeability to horseradish peroxidase (HRP). Group A was used as normal control. Group B was stimulated with an injection of superantigen into the sinus for 4 hours. The sinus mucosa of Group C was stimulated by the addition of tumor necrosis factor α (TNF-α) into Ussing chambers. Group D sinus mucosa was stimulated by superantigen after pretreatment with anti-TNF-α antibody. Results Superantigen evoked increases in sinus epithelial cell baseline short circuit current, conductance and permeability to HRP stimulated by the addition of TNF-α into Ussing chambers. These were similar to results from superantigen stimulation in vivo. The effect of superantigen on sinus epithelial cells could be blocked by pretreatment with anti-TNF-α antibody. Conclusions Superantigen affected the function of sinus epithelial cells, including the capability of epithelial defensive barrier, which might be mediated by TNF-α.     

Immunotherapeutic targets in non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is one of the most common types of cancer in the world and has a 5-year survival rate of ~20%. Immunotherapies have shown promising results leading to durable responses, however, they are only effective for a subset of patients. To determine the best therapeutic approach, a thorough and in-depth profiling of the tumour microenvironment (TME) is required. The TME is a complex network of cell types that form an interconnected network, promoting tumour cell initiation, growth and dissemination. The stroma, immune cells and endothelial cells that comprise the TME generate a plethora of cytotoxic or cytoprotective signalling pathways. In this review, we discuss immunotherapeutic targets in NSCLC tumours and how the TME may influence patients' response to immunotherapy.     

SETDB1: A perspective into immune cell function and cancer immunotherapy

Oncogene SET Domain Bifurcated 1 (SETDB1)/ESET, an H3K9 methyltransferase, was originally discovered over two decades ago; however, its function in the immune response was not first reported until 2011. SETDB1 immune functions include B cell maturation, T cell activity regulation, and immune escape in cancer cells. In B lymphocytes, SETDB1 mediates the transition from pro-B to pre-B cells and represses endogenous retroviruses (ERV) to encourage B cell lineage differentiation and maturation. SETDB1 alters T cell function by methylating IL-2 and IL-17 promoters and mediating T cell lineage commitment and development. In addition, SETDB1 plays a critical role in ERV silencing within a variety of immune cells, which can indirectly weaken the immune response. Although SETDB1 is critical for normal immune cell function, overexpression in cancer cells negatively impacts immune cell fights against cancer through decreased tumour immunogenicity. Within cancer cells, SETDB1 overexpression represses production and infiltration of antitumour immune cells, mediates immune escape through TE and ERV silencing, represses the type I interferon pathway, and interferes in immune checkpoint blockade (ICB) outcomes by regulation of PD-L1 expression and IFN signalling. In this review, we further discuss the immunological mechanisms of SETDB1 in normal and cancerous cells and its implications in cancer immunotherapy.     

重度蒸汽吸入性损伤犬伤后肿瘤坏死因子水平的改变及其意义

目的研究蒸汽吸人性损伤犬伤后血浆肿瘤坏死因子水平的改变及其与吸入性损伤呼吸循环功能受损程度的关系.方法取犬15条,以蒸汽致重度吸入性损伤,分别于伤前、伤后1h、2h、3h、4h观察有呼气相气道阻力(RE)、心率(HR)、心输出量(CO)、动脉血氧分压(PaO2)、血浆TNF水平;伤后4h致死动物,取肺做病理检查.结果伤后1hTNF、RE升高,HR、CO、PaO2下降;TNF与RE正相关(r=O.965,P<O.01),与CO负相关(r=-0.824,P<O.05).结论严重蒸汽吸入性损伤激发TNF分泌,这是诱发肺损伤及循环系统甚至全身器官功能障碍的重要原因.     

Colour Doppler ultrasound assessment of the inferior vena cava in patients with Wilms' tumour

OBJECTIVE: To assess the diagnostic accuracy of colour flow Doppler ultrasound in diagnosing inferior vena caval (IVC) extension of tumour thrombus in patients with Wilms' tumour. MATERIALS AND METHODS: Over a 3-year period from June 1994 to June 1997, 74 patients with Wilms' tumour were referred to our institution. In this retrospective study we reviewed the preoperative colour flow Doppler ultrasound reports of 64 of these patients and compared the reports with the intra-operative findings in 51 patients who underwent surgery. RESULTS: Vena caval extension of tumour thrombus was present in 12 patients (18.7%) and in six of these patients (9.4%) there was also atrial extension of the tumour. Colour flow Doppler ultrasound correctly diagnosed IVC extension of tumour thrombus in nine patients and correctly predicted the cranial extent of the tumour thrombus in eight patients. CONCLUSION: Colour flow Doppler ultrasound has an overall positive predictive value of 73.4% in assessing IVC patency and correctly diagnosing IVC extension of tumour thrombus, in patients with Wilms' tumour. However, non-diagnostic ultrasound examinations can occur in over 20% of patients.     

Choroid plexus papillomas: Consideration of a surgical series of 33 cases

Summary With the aim of understanding better the behaviour of an uncommon lesion such as the choroid plexus papilloma, we have analysed a surgical series of 33 cases operated on at the Neurosurgical Department, University of Rome La Sapienza, between 1955 and 1992 and have reviewed the relevant literature. Our results support the view that a radical resection of these lesions, which if removed entirely, carry a very good prognosis. The hydro-cephalus should be treated only if persistent.Adjuvant treatment such as radiotherapy and chemotherapy should be reserved for specific cases.     

Experimental and clinical standards,and evolution of lasers in neurosurgery

Summary From initial experiments of ruby, argon and CO₂ lasers on the nervous system so far, dramatic progress was made in delivery systems technology as well as in knowledge of laser-tissue interaction effects and hazards through various animal experiments and clinical experience. Most surgical effects of laser light on neural tissue and the central nervous system (CNS) are thermal lesions. Haemostasis, cutting and vaporization depend on laser emission parameters — wavelength, fluence and mode — and on the exposed tissues optical and thermal properties — water and haemoglobin content, thermal conductivity and specific heat. CO₂ and Nd-YAG lasers have today a large place in the neurosurgical armamentarium, while new laser sources such as high power diode lasers will have one in the near future. Current applications of these lasers derive from their respective characteristics, and include CNS tumour and vascular malformation surgery, and stereotactic neurosurgery. Intracranial, spinal cord and intra-orbital meningiomas are the best lesions for laser use for haemostasis, dissection and tissue vaporization. Resection of acoustic neuromas, pituitary tumours, spinal cord neuromas, intracerebral gliomas and metastases may also benefit from lasers as accurate, haemostatic, non-contact instruments which reduce surgical trauma to the brain and eloquent structures such as brain stem and cranial nerves. Coagulative lasers (1.06 m and 1.32 m Nd-YAG, argon, or diode laser) will find an application for arteriovenous malformations and cavernomas. Any fiberoptic-guided laser will find a use during stereotactic neurosurgical procedures, including image-guided resection of tumours and vascular malformations and endoscopie tumour resection and cysts or entry into a ventricle. Besides these routine applications of lasers, laser interstitial thermotherapy (LITT) and photodynamic therapy (PDT) of brain tumours are still in the experimental stage.The choice of a laser in a neurosurgical operating room implies an evaluation of the laser use (applications, frequency), of the available budget and costs-including purchase, maintenance and staff training-, and material that will be necessary: unit, peripherals, safety devices and measures, training programme.Future applications of lasers in neurosurgery will come from technological advances and refined experimental applications. The availability of new wavelength, tunable, small sized and smart laser units, will enlarge the thermal and non-thermal interactions between laser energy and neural tissue leading to new surgical applications. Tissue photo-ablation, photohynamic therapy using second generation of photosensitizers, updated thermotherapy protocols, are current trends for further use of lasers in neurosurgery.     

Volumetric reconstruction and stereotactic computer assisted resection in intracerebral lesions

Summary Since 1990 112 patients have undergone Stereotactic resection of intra-axial tumoural lesions with volumetric reconstruction, using the Kelly-Goerss system. Stereotactic integration of CT, angiographic and particularly MRI information, together with three-dimensional information of the lesion, provide an innovative evaluation of the most appropriate surgical approach, even for each single patient. The main limitation of this surgical method is in cases where the infiltrating part of the tumour is pre-eminent, while it can allow macroscopically complete resection of well circumscribed lesions, almost independently of their location and volume. Some technical aspects of Stereotactic resection of brain tumours are discussed in the light of our experience.