A Prosthesis Retention System for Full‐Arch,Fixed, Implant‐Supported Prosthesis

Full‐arch, fixed, implant‐supported prostheses can be designed to be cement‐ or screw‐retained. Both retention mechanisms have a few inherent disadvantages. A fixed attachment system has been introduced to circumvent the disadvantages of both screw and cement retention. This system eliminates the screw access holes and the use of cement. The number of intraoral procedures required is also reduced. The purpose of this article is to report a case using the Locator F‐Tx Attachment System to facilitate fabrication of an esthetic, clinician‐retrievable, full‐arch implant‐supported fixed dental prosthesis.     

Antibiotic concentrations in pus and bone of children with osteomyelitis

Pharmacologic data are presented on 39 children treated for osteomyelitis with one of the following antibiotics: methicillin, dicloxacillin, cephaloridine, or cefazolin. The concentrations of drug in pus and bone were correlated with serum concentrations, with the susceptibilities of Staphylococcus aureus strains isolated from the patients, and with the degree of drug protein-binding. The penetration of the antibiotics into pus and bone was similar for the two penicillins and for the two cephalosporins despite the disparate protein-binding affinities of these drugs. The agents attained concentrations in tissues that were at least several fold, and often more than tenfold, greater than the MIC and MBC values of the S. aureus stains. These data provide a basis for selection of antimicrobial agents for treatment of osteomyelitis.     

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

Purpose

An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants.

Materials and methods

Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases.

Results

Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors.

Conclusions

With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.     

The management of severely comminuted fractures of the femoral shaft, using the external fixator

Fractures of the femoral shaft are often treated by an established method of internal fixation, such as a medullary nail or a plate and screws, to obviate the many disadvantages of traction and prolonged rest in bed. Fractures of the femoral shaft which are severely comminuted and open are usually unsuitable for internal fixation. Between July 1981 and March 1983 we treated seven patients with severely comminuted fractures of the femoral shaft (of which three were open), using the ASIF tubular external fixator system or the Wagner apparatus. The technique of application of the external fixator is important and is described. When correctly applied, the knee's movement was not restricted and few complications were experienced. All the fractures united within 8 months in a good position without shortening, and none required an additional operation. The use of the external fixator in these patients reduced their time in the hospital and facilitated their postoperative rehabilitation by allowing uncomplicated healing of a complicated fracture.     

Genetic determinants of response to aspirin: appraisal of 4 candidate genes

Introduction

Intersubject variability in platelet response to aspirin could be related to genetic factors that regulate platelet enzymes or receptors. This study evaluates the impact of the selected polymorphisms in the COX-1 gene, the CYP5A1 gene, the P2RY1 receptor gene, and the GPIIbIIIa receptor gene on platelet response to aspirin and risk of suffering from major adverse cardiovascular and cerebrovascular events (MACCE).

Materials and methods

192 Caucasian patients with stable coronary artery disease treated with daily aspirin were recruited and followed for 3 years. Platelet aggregation was measured by light transmission aggregometry with arachidonic acid (1.6 mM) and adenosine diphosphate (5, 10 or 20 μM) used as agonists. Genotyping was performed by standard PCR methods.

Results

Arachidonic acid-induced platelet aggregation was unaffected by the COX-1 22C/T and by the Pl^A1/A2 polymorphisms. However, carriers of the 1622 G/G genotype of the P2RY1 gene had significantly higher levels of arachidonic acid-induced platelet aggregation compared with non-carriers (AA 2.0%, AG 2.0% vs. GG 9.0%, p = 0.047). Carrying the 1622 G/G genotype increased the risk of inadequate platelet response to aspirin, defined as arachidonic acid-induced aggregation ≥ 20%, by a factor of 8.5 (1.4 - 53.3, p = 0.022) and the risk of 3-year MACCE by a factor of 7 (1.4 - 34.7, p = 0.017).

Conclusion

The 1622A/G mutation of the P2RY1 gene could contribute to inadequate platelet response to aspirin and is associated with an increased risk of suffering from MACCE.     

Synthesis of the Gln1-facteur thymique serique and its evaluation with human E-rosette bioassay

Synthesis of an analog of facteur thymique serique (FTS) containing a glutaminyl residue in position 1 of the peptide chain is described. Like the original FTS, Gln¹-FTS is able to induce T cell markers on lymphocytes in vitro in a picogram dosage range. The human E-rosette bioassay was adopted for the evaluation of biological activity of Gln¹-FTS. It was also shown that the latter method can be used to evaluate the presence of target cells for FTS activity in peripheral blood lymphocytes in humans.     

Development of a 7 T RF coil system for breast imaging

In ultrahigh‐field MRI, such as 7 T, the signal‐to‐noise ratio (SNR) increases while transmit (Tx) field (B₁⁺) can be degraded due to inhomogeneity and elevated specific absorption rate (SAR). By applying new array coil concepts to both Tx and receive (Rx) coils, the B₁⁺ homogeneity and SNR can be improved. In this study, we developed and tested in vivo a new RF coil system for 7 T breast MRI. An RF coil system composed of an eight‐channel Tx‐only array based on a tic‐tac‐toe design (can be combined to operate in single‐Tx mode) in conjunction with an eight‐channel Rx‐only insert was developed. Characterizations of the B₁⁺ field and associated SAR generated by the developed RF coil system were numerically calculated and empirically measured using an anatomically detailed breast model, phantom and human breasts. In vivo comparisons between 3 T (using standard commercial solutions) and 7 T (using the newly developed coil system) breast imaging were made. At 7 T, about 20% B₁⁺ inhomogeneity (standard deviation over the mean) was measured within the breast tissue for both the RF simulations and 7 T experiments. The addition of the Rx‐only array enhances the SNR by a factor of about three. High‐quality MR images of human breast were acquired in vivo at 7 T. For the in vivo comparisons between 3 T and 7 T, an approximately fourfold increase of SNR was measured with 7 T imaging. The B₁⁺ field distributions in the breast model, phantom and in vivo were in reasonable agreement. High‐quality 7 T in vivo breast MRI was successfully acquired at 0.6 mm isotropic resolution using the newly developed RF coil system.     

Optos 200Tx广角眼底血管造影及其临床应用

广角眼底血管造影是近年来的影像检查新技术,可用于病变范围过大、传统眼底血管造影难以覆盖的患眼,可直观地显示周边部视网膜、脉络膜的血管结构.广角眼底血管造影分为接触式和非接触式两种.近期投入使用的欧堡全景200Tx激光扫描眼底成像系统(Optos 200Tx)是非接触式广角眼底血管造影的代表.它一次即可观察到200°眼底,无需散大瞳孔,且不接触患眼,操作简单、高效而安全,可用于累及周边部眼底的血管性疾病的诊断、鉴别诊断、治疗及随访方案的制定,如糖尿病视网膜病变、视网膜静脉阻塞、视网膜血管炎、葡萄膜炎、眼底肿瘤等.     

Diverse functional coupling of cyclooxygenase 1 and 2 with final prostanoid synthases in liver macrophages

Lipopolysaccharide (LPS) treatment of resident liver macrophages resulted in a coordinated enhanced expression of cytosolic phospholipase A(2) (cPLA(2)), cyclooxygenase (COX)-2 and prostaglandin E(2)-synthase. LPS-pretreated liver macrophages showed a higher release of PGE(2) after zymosan, phorbol ester and A23187, of PGF(2alpha) after zymosan and A23187, whereas the release of thromboxane B(2) and PGD(2) was unchanged. Inhibition of COX-1 and -2 by specific inhibitors (SC560, SC236) inhibited the prostanoid release between 50-80% and 20-40%, respectively, indicating a predominant role for COX-1. In detail (1) the zymosan-induced release of all prostanoids was inhibited to a similar degree by the COX-1 inhibitor (about 70%) and the COX-2 inhibitor (20-30%), (2) PGE(2) release after all stimuli was inhibited to a greater extent by SC560 (70-90%) compared to SC236 (5-30%), (3) the phorbol ester- and A23187-induced release of PGF(2alpha) and PGD(2) was inhibited equally (40-50%) by both inhibitors, (3) TxB(2) release after phorbol ester and A23187 was inhibited by SC560 by 50 and 30%, and by SC236 by 50 and 70%, respectively. cPLA(2), COX-1 and -2, and the final prostanoid synthases were found in different subcellular fractions. These results indicate, that the functional coupling of COX-1 and -2 to final prostanoid synthases depends on the stimulation of the cells.     

Interplay between immune responses to HLA and non-HLA self-antigens in allograft rejection

Recent studies strongly suggest an increasing role for immune responses against self-antigens (Ags) which are not encoded by the major histocompatibility complex in the immunopathogenesis of allograft rejection. Although, improved surgical techniques coupled with improved methods to detect and avoid sensitization against donor human leukocyte antigen (HLA) have improved the immediate and short term function of transplanted organs. However, acute and chronic rejection still remains a vexing problem for the long term function of the transplanted organ. Immediately following organ transplantation, several factors both immune and non immune mechanisms lead to the development of local inflammatory milieu which sets the stage for allograft rejection. Traditionally, development of antibodies (Abs) against mismatched donor HLA have been implicated in the development of Ab mediated rejection. However, recent studies from our laboratory and others have demonstrated that development of humoral and cellular immune responses against non-HLA self-Ags may contribute in the pathogenesis of allograft rejection. There are reports demonstrating that immune responses to self-Ags especially Abs to the self-Ags as well as cellular immune responses especially through IL17 has significant pro-fibrotic properties leading to chronic allograft failure. This review summarizes recent studies demonstrating the role for immune responses to self-Ags in allograft immunity leading to rejection as well as present recent evidence suggesting there is interplay between allo- and autoimmunity leading to allograft dysfunction.