Background This multi-center analysis of data from China reviews the management and long-term outcomes of patients with bilateral Wilms tumors(BWT),and explores prognostic risk factors.Methods We retrospectively analy...Background This multi-center analysis of data from China reviews the management and long-term outcomes of patients with bilateral Wilms tumors(BWT),and explores prognostic risk factors.Methods We retrospectively analyzed a cohort of pediatric patients with synchronous BWT treated at 18 pediatric oncology centers in China between 2006 and 2023.The overall survival(OS)and event-free survival(EFS)rates were calculated using Kaplan-Meier methodology.Prognostic risk factors were determined using univariable and multivariable analysis.Results A total of 167 patients with BWT and a median age at diagnosis of 13 months(range 0-78 months)were included in the study.Neoadjuvant chemotherapy was administered to 149 index cases;tumor biopsy was performed before initiating chemotherapy in 70 patients.One hundred and three children underwent bilateral nephron-sparing surgery(NSS)and two hundred fifty-two of the three hundred one kidneys underwent NSS.The four-year OS and EFS rates in the study cohort were 86.5%and 77.8%.After a median follow-up of 50 months,four patients developed renal failure requiring dialysis and a single patient received a kidney transplant 26 months postoperatively.Conclusions Regarding prognostic factors,the results of the multifactor analysis indicate that distant metastasis and positive surgical margins have negative impacts on OS and distant metastasis had a negative effect on EFS.Distant metastasis and positive surgical margins affect the long-term prognosis of BWT.展开更多
Purpose:This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods:Patients with old...Purpose:This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods:Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled.Clinical treatment was classified into 3 phases.In phase I,techniques such as orthognathic surgery,microsurgery,and distraction osteogenesis were employed to reconstruct the correct 3-dimensional(3D)jaw position relationship.In phase II,bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions.In phase III,implant-supported overdentures or fixed dentures were used for occlusal reconstruction.A summary of treatment methods,clinical efficacy evaluation,comparative analysis of imageological examinations,and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects.All data are summarized using the arithmetic mean±standard deviation and compared using independent samplet-tests.Results:In 15 patients with old jaw fractures and dentition defects(an average age of 32 years,ranging from 18 to 53 years),there were 7 cases of malocclusion of single maxillary fracture,6 of malocclusion of single mandible fracture,and 2 of malocclusion of both maxillary and mandible fractures.There were 5 patients with single maxillary dentition defects,2 with single mandibular dentition defects,and 8 with both maxillary and mandibular dentition defects.To reconstruct the correct 3D jaw positional relationship,5 patients underwent Le Fort I osteotomy of the maxilla,3 underwent bilateral sagittal split ramus osteotomy of the mandible,4 underwent open reduction and internal fixation for old jaw fractures,3 underwent temporomandibular joint surgery,and 4 underwent distraction osteogenesis.All patients underwent jawbone augmentation,of whom 4 patients underwent a free composite vascularized bone flap(26.66%)and the remaining patients underwent local alveolar bone augmentation.Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation(73.33%).The 15 patients received 81 implants,of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures.The survival rate of all implants was 93.82%.The final imageological examination of 15 patients confirmed that the malocclusion was corrected,and the clinical treatment ultimately achieved occlusal function reconstruction.The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy,phonetics,aesthetics,and comfort after treatment.Conclusion:Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment,consisting of 3D spatial jaw correction,alveolar bone augmentation and soft tissue augmentation,and implant-supported occlusal reconstruction,achieving satisfactory clinical therapeutic efficacy.展开更多
基金supported by the high-level clinical specialty construction project of public hospital in capital region of Inner Mongolia Autonomous Region(2023SGGZ0038).
文摘Background This multi-center analysis of data from China reviews the management and long-term outcomes of patients with bilateral Wilms tumors(BWT),and explores prognostic risk factors.Methods We retrospectively analyzed a cohort of pediatric patients with synchronous BWT treated at 18 pediatric oncology centers in China between 2006 and 2023.The overall survival(OS)and event-free survival(EFS)rates were calculated using Kaplan-Meier methodology.Prognostic risk factors were determined using univariable and multivariable analysis.Results A total of 167 patients with BWT and a median age at diagnosis of 13 months(range 0-78 months)were included in the study.Neoadjuvant chemotherapy was administered to 149 index cases;tumor biopsy was performed before initiating chemotherapy in 70 patients.One hundred and three children underwent bilateral nephron-sparing surgery(NSS)and two hundred fifty-two of the three hundred one kidneys underwent NSS.The four-year OS and EFS rates in the study cohort were 86.5%and 77.8%.After a median follow-up of 50 months,four patients developed renal failure requiring dialysis and a single patient received a kidney transplant 26 months postoperatively.Conclusions Regarding prognostic factors,the results of the multifactor analysis indicate that distant metastasis and positive surgical margins have negative impacts on OS and distant metastasis had a negative effect on EFS.Distant metastasis and positive surgical margins affect the long-term prognosis of BWT.
基金Project of State Key Laboratory of Military Stomatology(2021ZA07)Shaanxi Provincial Key Research and Development Program(2023-YBSF-291)The Science and Technology Project of Xi'an City(22YXYJ0116).
文摘Purpose:This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods:Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled.Clinical treatment was classified into 3 phases.In phase I,techniques such as orthognathic surgery,microsurgery,and distraction osteogenesis were employed to reconstruct the correct 3-dimensional(3D)jaw position relationship.In phase II,bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions.In phase III,implant-supported overdentures or fixed dentures were used for occlusal reconstruction.A summary of treatment methods,clinical efficacy evaluation,comparative analysis of imageological examinations,and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects.All data are summarized using the arithmetic mean±standard deviation and compared using independent samplet-tests.Results:In 15 patients with old jaw fractures and dentition defects(an average age of 32 years,ranging from 18 to 53 years),there were 7 cases of malocclusion of single maxillary fracture,6 of malocclusion of single mandible fracture,and 2 of malocclusion of both maxillary and mandible fractures.There were 5 patients with single maxillary dentition defects,2 with single mandibular dentition defects,and 8 with both maxillary and mandibular dentition defects.To reconstruct the correct 3D jaw positional relationship,5 patients underwent Le Fort I osteotomy of the maxilla,3 underwent bilateral sagittal split ramus osteotomy of the mandible,4 underwent open reduction and internal fixation for old jaw fractures,3 underwent temporomandibular joint surgery,and 4 underwent distraction osteogenesis.All patients underwent jawbone augmentation,of whom 4 patients underwent a free composite vascularized bone flap(26.66%)and the remaining patients underwent local alveolar bone augmentation.Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation(73.33%).The 15 patients received 81 implants,of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures.The survival rate of all implants was 93.82%.The final imageological examination of 15 patients confirmed that the malocclusion was corrected,and the clinical treatment ultimately achieved occlusal function reconstruction.The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy,phonetics,aesthetics,and comfort after treatment.Conclusion:Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment,consisting of 3D spatial jaw correction,alveolar bone augmentation and soft tissue augmentation,and implant-supported occlusal reconstruction,achieving satisfactory clinical therapeutic efficacy.
