直接前方入路与后外侧入路全髋关节置换治疗股骨颈骨折的疗效比较及术后髋关节功能的影响因素分析

摘要 目的：比较直接前方入路与后外侧入路全髋关节置换治疗股骨颈骨折的疗效及术后髋关节功能的影响因素分析。方法：选取2019年5月至2021年12月徐州医科大学附属医院收治并行全髋关节置换治疗股骨颈骨折患者96例,按照手术方法的不同分为直接前方入路组（n=48）和后外侧入路组（n=48）。观察两组围术期指标、并发症发生情况,比较两组治疗前后Harris评分、视觉模拟评分法（VAS）。并应用单因素、多因素Logistic回归分析患者术后髋关节功能的影响因素。结果：直接前方入路组下床时间、切口长度、住院时间显著短于后外侧入路组,术中失血量、术后引流量显著低于后外侧入路组,而手术时间显著长于后外侧入路组（P<0.05）。直接前方入路组术后1、3个月Harris评分显著高于后外侧入路组,VAS评分显著低于后外侧入路组（P<0.05）。两组术后并发症发生率比较,无统计学差异（P＞0.05）。两组治疗6个月后髋关节功能优良率比较,差异无统计学意义（P>0.05）。多因素Logistic回归分析结果显示：体质量指数≥24 kg/m²、术后锻炼时间<3 h/d、合并骨质疏松是接受全髋关节置换治疗的股骨颈骨折患者术后髋关节功能不良的危险因素（P＜0.05）。结论：直接前方入路全髋关节置换术较后外侧入路全髋关节置换术短期内优势明显,表现为对患者的创伤更小,术后疼痛程度较轻,有利于患者的髋关节功能恢复。体质量指数≥24 kg/m²、术后锻炼时间<3 h/d、合并骨质疏松是接受全髋关节置换治疗的股骨颈骨折患者术后髋关节功能不良的危险因素。     

Production of urinary tumour necrosis factors and soluble tumour necrosis factor receptors in bladder cancer patients afterbacillus Calmette-Guerin immunotherapy

Intravesical immunotherapy for bladder cancer is the most effective form of tumour immunotherapy. Following repeated instillations of bacillus Calmette-Guérin (BCG) organisms into the bladder large 0quantities of several cytokines are detected in the urine. These cytokines include interleukins IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, tumour necrosis factor α (TNFα), interferon γ (IFNγ) and also soluble intercellular adhesion molecule ICAM-1. In the work reported here we simultaneously quantified urinary levels of TNFα, TNFβ, TNF receptor I and TNF receptor II by enzyme-linked immunosorbent assay (ELISA) techniques and compared this with bioactive levels of TNF. This was undertaken with a limited number of patients throughout a course of six instillations of immuno therapy. Sequential instillations of BCG induced secretion of TNFα and TNFβ into urine. These cytokines were not always secreted simultaneously, perhaps suggesting differential regulation of their synthesis. Maximal concentrations of TNFα were 675 pg/ml and TNFβ 47 pg/ml. High levels of both species of soluble TNF receptor were readily identified in urine. Maximal levels of sTNF-RI were 6200 pg/ml (range from 0) and for sTNF-RII 7800 pg/ml (range from 0). Contrasting with earlier published observations concerning cytokine levels, the concentration of soluble receptor did not increase with repeated instillation. In apparent contrast with the ELISA data, very low levels of bioactive TNF were identified by the L929 bioassay (maximum concentration 1 U/ml) despite the elevated concen t ration of immunoreactive TNF. The large concentrations of soluble TNF receptor in patients’ urine samples could account for the apparently low bioactivity as determined by the L929 cytotoxicity assay. The precise nature of the role of TNF in BCG immunotherapy remains undetermined; however, it is thought that proinflammatory cytokines are in part responsible for the clinical efficacy of this therapeutic approach. Whether other cytokines are antogonised by soluble binding proteins remains to be determined. Furthermore, whether TNF is bioactive in the bladder wall and only neutralised in the urine also requires investigation. Received: 24 August 1994 / Accepted: 17 October 1994     

Construction and characterization of the chimeric monoclonal antibody E48 for therapy of head and neck cancer

Data from an ongoing clinical radioimmunoscintigraphy trial indicate that^99mTc-labeled monoclonal antibody (mAb) E48 is highly capable of selectively targeting squamous cell carcinoma of the head and neck (HNSCC). The percentage of the injected dose per gram of tumor tissue was found to be high, rendering mAbE48 a promising candidate mAb for therapeutic purposes. We now describe the construction of a chimeric (moouse/human) mAb E48 by recombinant DNA technology. The genes encoding the variable domains of the heavy and light chain were cloned and ligated into experession vectors containing the human 1 heavy-chain gene and the human k lightchain gene respectively. Biological properties of the resulting chimeric mAb E48 were compared to the murine form in vitro and in vivo. The reactivities of chimeric (c)mAb and murine (m)mAb E48 with HNSCC, as assessed by immunohistochemical staining as well as immuno-blotting were shown to be similar. The affinity constant appeared to be 0.9×10¹⁰ M^–1 and 1.6×10¹⁰ M^–1 for the mmAb and cmAb respectively. The biodistribution of both antibodies was tested by simultaneous injection into nude mice bearing human HNSCC xenografts. cmAb E48 was found to be cleared more rapidly from the blood than mmAb E48, resulting in a 30% lower tumor uptake but similar tumor to non-tumor ratios, 3 days after injection. Moreover, it was shown that cmAb E48 is highly capable of lysing HNSCC targets in ADCC assays in vitro, whereas the mmAb appeared to be almost incative. These data indicate that cmAb E48 has potential as a targeting agent for the eradication of HNSCC in man.     

Tumour-infiltrating lymphocytes mediate lysis of autologous squamous cell carcinomas of the head and neck

Tumour-infiltrating lymphocytes (TIL) and tumours from six patients with squamous cell carcinomas of the head and neck (SCCHN) were investigated. The six tumours all expressed major histocompatibility complex (MHC) class I antigens both in vivo and as tumor cell lines grown in vitro. In addition, the cancer cells either overexpressed the tumour-suppressor gene product p53 or harboured human papilloma virus 16/18 (HPV). The TIL were expanded in vitro in the presence of interleukin-2, immobilised anti-CD3 mAb and soluble anti-CD28 mAb. Expanded TIL cultures contained both CD4+and CD8+T cells, but generally contained few CD56+CD3-cells of the natural killer (NK) phenotype. CD8+T cells dominated the individual TIL cultures from five of the six patients and showed significant autologous tumour cell lysis. In TIL cultures derived from four of these tumour-reactive TIL cultures, killing could be partially blocked by an anti-MHC class I mAb. TIL cultures reacting with autologous tumour cells also showed strong TCR/CD3-redirected cytotoxicity when assayed against hybridoma cells expressing anti-TCR/CD3 mAb as well as natural-killer(NK)-like activity. A number of TIL cultures devoid of autologous tumour cell lysis were capable of lysing the natural-killer(NK)-sensitive K562 cell line suggesting that the SCCHN cells themselves are resistant to NK-like lysis. In conclusion, TIL cultures from head and neck carcinomas contain T cells which, upon expansion in vitro, can lyse autologous tumour cells in a MHC-class-I-restricted fashion. Thus, the results of the present study document that carcinomas of the head and neck in some patients are infiltrated by cytotoxic T cell precursors potentially capable of rejecting the autologous tumour.     

Development of a surrogate model based on patient weight,bone mass and geometry to predict femoral neck strains and fracture loads

Osteoporosis and related bone fractures are an increasing global burden in our ageing society. Areal bone mineral density assessed through dual energy X-ray absorptiometry (DEXA), the clinically accepted and most used method, is not sufficient to assess fracture risk individually. Finite element (FE) modelling has shown improvements in prediction of fracture risk, better than aBMD from DEXA, but is not practical for widespread clinical use. The aim of this study was to develop an adaptive neural network (ANN)-based surrogate model to predict femoral neck strains and fracture loads obtained from a previously developed population-based FE model. The surrogate model performance was assessed in simulating two loading conditions: the stance phase of gait and a fall.The surrogate model successfully predicted strains estimated by FE (r² = 0.90–0.98 for level gait load case, r² = 0.92–0.96 for the fall load case). Moreover, an ANN model based on three measurements obtainable in clinics (femoral neck length (level gait) or maximum femoral neck diameter (fall), femoral neck bone mass, body weight) was able to give reasonable predictions (r² = 0.84–0.94) for all of the strain metrics and the estimated femoral neck fracture load. Overall, the surrogate model has potential for clinical applications as they are based on simple measures of geometry and bone mass which can be derived from DEXA images, accurately predicting FE model outcomes, with advantages over FE models as they are quicker and easier to perform.     

尿源干细胞对神经源性膀胱大鼠膀胱功能及Notch1、Jagged1蛋白表达的影响

目的:研究尿源干细胞对神经源性膀胱大鼠膀胱功能及Notch1、Jagged1蛋白表达的影响。方法:纳入60只健康雌性清洁SD大鼠作为实验对象,将其按照随机抽签法分为正常对照组、研究组以及损伤组,每组各20只。其中研究组和损伤组大鼠均建立神经源性膀胱模型,研究组在造模成功后予以尿源性干细胞尾静脉注射。28 d后,比较三组大鼠膀胱功能相关指标水平,膀胱湿质量和膀胱湿质量/体质量,Notch1、Jagged1蛋白表达水平。结果:损伤组收缩时间、排尿量、膀胱峰压均低于正常对照组,而研究组收缩时间、排尿量、膀胱峰压均高于损伤组(均P0.05);损伤组膀胱基压高于正常对照组,而研究组膀胱基压低于损伤组(均P0.05)。损伤组膀胱湿质量和膀胱湿质量/体质量均高于正常对照组,而研究组膀胱湿质量和膀胱湿质量/体质量低于损伤组(均P0.05)。损伤组Notch1、Jagged1蛋白表达水平均高于正常对照组,而研究组Notch1、Jagged1蛋白表达水平低于损伤组(均P0.05)。结论:尿源干细胞的应用可显著改善神经源性膀胱大鼠膀胱功能,同时可下调Notch1、Jagged1蛋白表达水平。     

空心钉加内侧支撑钢板与单纯空心钉治疗PauwelsⅢ型股骨颈骨折的疗效比较研究

目的:比较PauwelsⅢ型股骨颈骨折分别经单纯空心钉、空心钉加内侧支撑钢板治疗的临床疗效。方法:回顾性分析2016年3月～2019年2月期间收治的113例PauwelsⅢ型股骨颈骨折患者的临床资料,根据手术方式分为A组(n=55,单纯空心钉内固定治疗)和B组(n=58,空心钉加内侧支撑钢板治疗),比较两组患者围术期指标、髋关节功能、术后疼痛及复位质量,记录两组患者随访期间并发症发生情况。结果:B组术中出血量多于A组,手术时间长于A组(均P0.05);B组骨折愈合时间、完全负重时间短于A组(P0.05)。两组患者术后3个月、术后6个月髋关节Harrris评分呈升高趋势,视觉模拟评分量表(VAS)评分呈下降趋势(P0.05);B组术后3个月、术后6个月髋关节Harrris评分高于A组,VAS评分则低于A组(P0.05)。与术后3 d相比,A组患者术后6个月正位、侧位Garden指数降低(P0.05);B组术后6个月正位、侧位Garden指数评分高于A组(P0.05)。B组并发症发生率低于A组(P0.05)。结论:与单纯空心钉内固定治疗PauwelsⅢ型股骨颈骨折相比,空心钉加内侧支撑钢板虽然术中出血量多,手术时间略长,但其术后恢复效果更佳,且并发症发生率更低,临床应用价值较高。     

Development and evolution of the tetrapod skull–neck boundary

The origin and evolution of the vertebrate skull have been topics of intense study for more than two centuries. Whereas early theories of skull origin, such as the influential vertebral theory, have been largely refuted with respect to the anterior (pre‐otic) region of the skull, the posterior (post‐otic) region is known to be derived from the anteriormost paraxial segments, i.e. the somites. Here we review the morphology and development of the occiput in both living and extinct tetrapods, taking into account revised knowledge of skull development by augmenting historical accounts with recent data. When occipital composition is evaluated relative to its position along the neural axis, and specifically to the hypoglossal nerve complex, much of the apparent interspecific variation in the location of the skull–neck boundary stabilizes in a phylogenetically informative way. Based on this criterion, three distinct conditions are identified in (i) frogs, (ii) salamanders and caecilians, and (iii) amniotes. The position of the posteriormost occipital segment relative to the hypoglossal nerve is key to understanding the evolution of the posterior limit of the skull. By using cranial foramina as osteological proxies of the hypoglossal nerve, a survey of fossil taxa reveals the amniote condition to be present at the base of Tetrapoda. This result challenges traditional theories of cranial evolution, which posit translocation of the occiput to a more posterior location in amniotes relative to lissamphibians (frogs, salamanders, caecilians), and instead supports the largely overlooked hypothesis that the reduced occiput in lissamphibians is secondarily derived. Recent advances in our understanding of the genetic basis of axial patterning and its regulation in amniotes support the hypothesis that the lissamphibian occipital form may have arisen as the product of a homeotic shift in segment fate from an amniote‐like condition.     

Simplification of head and neck volumetric modulated arc therapy patient-specific quality assurance,using a Delta4 PT

Background/AimIn many facilities, intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT) use intensity-modulated beams, formed by a multi-leaf collimator (MLC). In IMRT and VMAT, MLC and linear accelerator errors (both geometric and dose), can significantly affect the doses administered to patients. Therefore, IMRT and VMAT treatment plans must include the use of patient-specific quality assurance (QA) before treatment to confirm dose accuracy.Materials and methodsIn this study, we compared and analyzed the results of dose verification using a multi-dimensional dose verification system Delta4 PT, an ionization chamber dosimeter, and gafchromic film, using data from 52 patients undergoing head and neck VMAT as the test material.ResultBased on the results of the absolute dose verification for the ionization chamber dosimeter and Delta4 PT, taking an axial view, the upper limit of the 95% confidence interval was 3.13%, and the lower limit was −3.67%, indicating good agreement. These results mean that as long as absolute dose verification for the axial view does not deviate from this range, Delta4 PT can be used as an alternative to an ionization chamber dosimeter for absolute dose verification. When we then reviewed dose distribution verification, the pass rate for Delta4 PT was acceptable, and was less varied than that of gafchromic film.ConclusionThis results in that provided the pass rate result for Delta4 PT does not fall below 96%, it can be used as a substitute for gafchromic film in dose distribution verification. These results indicate that patient-specific QA could be simplified.