Objective： To prospectively investigate the value of bone scintigraphy on determining the full extent of tumor involvement in jaw bones and to assess the presence of metastases. Methods： This study had local ethical...Objective： To prospectively investigate the value of bone scintigraphy on determining the full extent of tumor involvement in jaw bones and to assess the presence of metastases. Methods： This study had local ethical committee approval, and all patients gave written informed consent. Thirty seven consecutive patients with primary malignant tumor in jaw bones were recruited for the study. Bone scintigraphy was performed in all patients before surgery to measure the full extent of bony involvement, which was compared with histologic findings. Results： Whole body scan revealed one case with multiple bony metastases. Resection specimens of 36 bone neoplasms were pathologically analyzed to identify type and size of each tumor. The lengths of the tumor involvement in jaw bones defined by bone scintigraphy and pathology were 5.62 ± 1.58 cm, 4.48 ± 1.57 cm, respectively （P 〈 0.05）. The tumor negative margins from removed specimens according to bone scintigraphy were pathologically confirmed. With histologic findings as the standard of reference, the accuracy of bone scintigraphy was 100% （36 of 36 patients） in determining the full extent of tumor involvement in jaw bones. Conclusion： Bone scintigraphy tends to offer specific guidelines in determining the appropriate extent of bone resection while entirely clearing the tumor cells and preserving functions whenever possible and in establishing the bony metastases.展开更多
The growth and enlargement of jaw cysts are associated with raised intracystic pressure and bone resorption surrounding the cysts.The major bone-resorbing cells are the osteoclasts.They are acting under the influence ...The growth and enlargement of jaw cysts are associated with raised intracystic pressure and bone resorption surrounding the cysts.The major bone-resorbing cells are the osteoclasts.They are acting under the influence of local bone-resorbing factors: prostaglandins,proteinases and cytokines.It was found that positive pressure enhanced the expression of IL-1αmRNA and protein in epithelial cells of odontogenic keratocyst,and increased the secretion of matrix metalloproteinase and PGE2 in a co-culture of odontogenic keratocyst fibroblasts and epithelial cells.However,the signal intensities for IL-1α mRNA and protein in the epithelium were significantly decreased after marsupialization which relived intracystic pressure.Experimental study indicated that intermittent negative pressure could promote osteogenesis in human bone marrow-derived stroma cells(BMSCs) in vitro.We propose a hypothesis that bone formation around the cyst of the jaws would be stimulated by intracystic negative pressure.展开更多
A new method for filling bone cavity with a graft of frozen-decalcified-defatted-driedallogeneic (FDDDA) cancellous bone was described.This method was used for the treatment of cavi-ties after the enucleation of jaw c...A new method for filling bone cavity with a graft of frozen-decalcified-defatted-driedallogeneic (FDDDA) cancellous bone was described.This method was used for the treatment of cavi-ties after the enucleation of jaw cysts in 10 patients from December 1985 to February 1990.Thewounds of 9 patients healed by first intension,but wound infection occurred in one case postopera-tively.The 9 patients,besides the patient who suffered from wound infection,were followed up for5 to 56 months,with an average of 41.1 months.Evidence of recurrence with jaw cyst.was not ob-served.展开更多
本文聚焦于应用骨改良药物(bone-modifying agents,BMAs)[双膦酸盐类(bisphosphonates,BPs)药物及地舒单抗]患者发生药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的临床防控问题,结合国内外共识与临床实践,...本文聚焦于应用骨改良药物(bone-modifying agents,BMAs)[双膦酸盐类(bisphosphonates,BPs)药物及地舒单抗]患者发生药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的临床防控问题,结合国内外共识与临床实践,提出一套基于风险分级的全程化防控策略。文章系统分析了诱发MRONJ的三大高危因素(药物因素、全身因素、口腔局部因素),强调不同用药方案(低剂量与高剂量)所致MRONJ的风险差异,并据此构建四层级(R0~R3)的风险分级体系。针对每一层级风险等级,本文详细阐述了相应的口腔筛查重点、预防性干预措施、有创操作(如拔牙)的适应证及围手术期的管理规范,并对高风险(R3)患者的药物假期、影像学评估、微创手术与创口处理策略给出了具体指导。本文旨在推动MRONJ的临床防控从“被动诊治”向“主动预防”的模式转变,为口腔医生在保障患者全身疾病治疗的前提下,科学、有效地降低MRONJ发生率提供系统参考。展开更多
To construct the recombinant adeno-associated virus （rAAV） vector with human bone morphogenetic protein 7 （BMP7） and observe the BMP7 mRNA expression in vitro, BMP7 CDS sequence was cloned into expression plasmid ...To construct the recombinant adeno-associated virus （rAAV） vector with human bone morphogenetic protein 7 （BMP7） and observe the BMP7 mRNA expression in vitro, BMP7 CDS sequence was cloned into expression plasmid pAAV-MCS of AAV Helper Free System. The recombinant plasmid was identified with enzyme digestion and sequencing. The recombinant plasmid, pAAV-RC, pHelper were co-transfected into AAV-293 cells according to the calcium phosphate-based protocol. The viral stock was collected by 4 rounds of freeze/thaw. After purified and concentrated, the recombinant virus titer was determined by dot-blot assay. HEK293 cells were transfected with the recombinant virus at different MOI, and the expression of BMP7 mRNA was detected by RT-PCR. The results showed rAAV-BMP7 was constructed and packaged successfully. The physical particle titer was 2.5×10^11 vector genomes/mL. There was different expression level of BMP7 mRNA after transfecton. These data suggested that recombinant AAV mediated a stable expression of hBMP7 mRNA in 293 cells. The AAV production method may pave the way of an effective strategy for the jaw bone defection around dental implants.展开更多
目的:总结分析接受手术治疗的药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者的临床资料,探讨手术方式等对疾病预后的影响。方法:回顾性分析2013年1月~2024年10月南京市口腔医院收治的173例2~3期MRONJ手...目的:总结分析接受手术治疗的药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者的临床资料,探讨手术方式等对疾病预后的影响。方法:回顾性分析2013年1月~2024年10月南京市口腔医院收治的173例2~3期MRONJ手术患者资料,采用χ^(2)检验和Fisher精确检验比较不同分组及手术方式的预后差异。结果:总计144例治愈,29例复发,总治愈率为83.2%,下颌骨治愈率显著低于上颌骨(P<0.05)。骨管技术(难治型2期)和钛板修复(下颌3期)显著提高治愈率(P<0.05),而上颌3期开窗引流与次全切除术患者预后无差异(P>0.05)。结论:MRONJ发病无明显性别差异,下颌骨较上颌骨手术预后差,骨管技术与重建钛板修复是改善预后的关键。展开更多
目的探索中医药对肿瘤或骨质疏松患者应用抗骨吸收药后所致的药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的疗效。通过构建MRONJ大鼠模型,探究补肾化瘀解毒方对MRONJ的治疗疗效。方法选取36只12周龄的SD大...目的探索中医药对肿瘤或骨质疏松患者应用抗骨吸收药后所致的药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的疗效。通过构建MRONJ大鼠模型,探究补肾化瘀解毒方对MRONJ的治疗疗效。方法选取36只12周龄的SD大鼠,随机分为生理盐水组(negative control,NC)、补肾化瘀解毒方组(Bushen Huayu Jiedu formula,BSHXJDF)和特立帕肽组(Teriparatide,TPTD),每组12只。各组均构建唑来膦酸(zoledronic acid,ZA)联合拔牙诱导的MRONJ大鼠模型。TPTD组、NC组和BSHXJDF组分别对应给予特立帕肽60μg/kg、生理盐水60μg/kg、补肾化瘀解毒方13.33g/kg干预,通过大体观察、组织学检测、口腔颌面锥形束CT(oral and maxillofacial cone beam CT,CBCT)检测,评价补肾化瘀解毒方对MRONJ的治疗效果。结果NC组大鼠伤口愈合不佳,BSHXJDF组和TPTD组伤口几乎愈合、BSHXJDF组愈合效果趋势更佳。生理盐水组MRONJ大鼠模型颌骨坏死,愈合不佳,病理切片可见骨质破坏,结构紊乱。CBCT影像见颌骨创面边缘粗糙,死骨形成。补肾化瘀解毒方组(75.0%)及特立帕肽组(66.7%)见大鼠拔牙创逐渐缩小,大鼠拔牙窝愈合良好;CBCT影像见拔牙创内新骨形成,牙槽骨愈合征象。结论补肾化瘀解毒方治疗MRONJ促进创口愈合及骨重建的治疗效果良好,安全性高。展开更多
Background: The diversity of benign jaw tumours may cause difficulty in a correct diagnosis and insti-tution of an appropriate treatment. Data on the prevalence of these tumours is scarce from the Afri-can continent. ...Background: The diversity of benign jaw tumours may cause difficulty in a correct diagnosis and insti-tution of an appropriate treatment. Data on the prevalence of these tumours is scarce from the Afri-can continent. We present a 19-year audit of benign jaw tumours and tumour-like lesions at a University teaching hospital in Nairobi, Kenya. Methods: Histo-pathological records were retrieved and re-examined from the Department of Oral and Maxillofacial pathology, University of Nairobi from 1992 to 2011. The jaw tumours were classified according to the latest WHO classification. Results: During the 19-year audit, 4257 biopsies were processed of which 597 (14.02%) were jaw tumours within an age range of between 4 to 86 years. There was greater number of odontogenic tumours 417 (69.85%) than the bone related lesions 180 (30.15%). Of the odontogenic tumours, the epithetlial and in the bone related types, the fibro-osseous lesions were frequent. Conclusion: Ameloblastoma and ossifying fibroma were the most frequent tumours reported in this audit. The information regarding the prevalence of these tumours is scarce from the continent and can be useful in early detection and management before they cause facial deformity.展开更多
药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)是指因恶性肿瘤骨转移、骨质疏松等疾病使用抗骨吸收类药物(anti-resorptive,AR)和抗血管生成类药物(anti-angiogenic,AA)等所致的颌骨代谢紊乱及骨坏死类疾病...药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)是指因恶性肿瘤骨转移、骨质疏松等疾病使用抗骨吸收类药物(anti-resorptive,AR)和抗血管生成类药物(anti-angiogenic,AA)等所致的颌骨代谢紊乱及骨坏死类疾病。美国口腔颌面外科医师协会(American Association of Oral and Maxillofacial Surgeons,AAOMS)根据临床表现将MRONJ分成5期,其中,风险期指口服或静脉注射相关药物的患者,颌面部无任何异常症状;0期指没有发现临床可见的颌骨坏死,但是有非特异性的临床表现、影像学变化和症状。目前,0期MRONJ的诊断和治疗方法尚存在不确定性,如何有效预防风险期和0期患者向确立期的MRONJ转化存在争议。本文通过回顾0期MRONJ的诊断方法与治疗现状,分析针对风险期患者实施口腔有创操作的临床实践与研究成果,指出当前研究领域中存在的争议点与不确定性,旨在为未来的科学研究与临床实践提供参考与启示。展开更多
目的观察双侧卵巢切除术联合肌肉注射糖皮质激素对新西兰成年雌兔颌骨骨密度(bone mineral density,BMD)和生物力学的影响,探讨建立新西兰兔颌骨骨质疏松模型的方法。方法将15只5~6月龄新西兰成年雌兔按照随机分配法分为三组:双侧卵巢...目的观察双侧卵巢切除术联合肌肉注射糖皮质激素对新西兰成年雌兔颌骨骨密度(bone mineral density,BMD)和生物力学的影响,探讨建立新西兰兔颌骨骨质疏松模型的方法。方法将15只5~6月龄新西兰成年雌兔按照随机分配法分为三组:双侧卵巢切除术联合生理盐水肌肉注射组5只,为A组;双侧卵巢切除术联合糖皮质激素肌肉注射组5只,为B组;未切除双侧卵巢的假手术组联合生理盐水肌肉注射为对照组5只,为C组。术前及术后每月采用双能X射线骨密度仪进行兔颌骨骨密度测量,检测骨密度的变化。所有动物于手术3个月后检测颌骨生物力学的变化,进行组织染色病理学检查。结果术后3个月,B组新西兰兔下颌骨的BMD值下降29.59%(P<0.05),A组下降13.76%(P>0.05);B组在术后3个月时,下颌骨术后BMD均值小于术前BMD均值减去2SD;与C组相比,B组下颌骨的轴向最大压缩应力降低29.17%(P<0.05),A组下降4.17%(P>0.05);组织形态学观察B组相对于A组、C组,松质骨骨小梁变细,稀疏,数目变少,髓腔扩大,A组较C组变化不明显。结论双侧卵巢切除术联合糖皮质激素肌肉注射3个月可成功建立新西兰兔的颌骨骨质疏松模型。展开更多
文摘Objective： To prospectively investigate the value of bone scintigraphy on determining the full extent of tumor involvement in jaw bones and to assess the presence of metastases. Methods： This study had local ethical committee approval, and all patients gave written informed consent. Thirty seven consecutive patients with primary malignant tumor in jaw bones were recruited for the study. Bone scintigraphy was performed in all patients before surgery to measure the full extent of bony involvement, which was compared with histologic findings. Results： Whole body scan revealed one case with multiple bony metastases. Resection specimens of 36 bone neoplasms were pathologically analyzed to identify type and size of each tumor. The lengths of the tumor involvement in jaw bones defined by bone scintigraphy and pathology were 5.62 ± 1.58 cm, 4.48 ± 1.57 cm, respectively （P 〈 0.05）. The tumor negative margins from removed specimens according to bone scintigraphy were pathologically confirmed. With histologic findings as the standard of reference, the accuracy of bone scintigraphy was 100% （36 of 36 patients） in determining the full extent of tumor involvement in jaw bones. Conclusion： Bone scintigraphy tends to offer specific guidelines in determining the appropriate extent of bone resection while entirely clearing the tumor cells and preserving functions whenever possible and in establishing the bony metastases.
文摘The growth and enlargement of jaw cysts are associated with raised intracystic pressure and bone resorption surrounding the cysts.The major bone-resorbing cells are the osteoclasts.They are acting under the influence of local bone-resorbing factors: prostaglandins,proteinases and cytokines.It was found that positive pressure enhanced the expression of IL-1αmRNA and protein in epithelial cells of odontogenic keratocyst,and increased the secretion of matrix metalloproteinase and PGE2 in a co-culture of odontogenic keratocyst fibroblasts and epithelial cells.However,the signal intensities for IL-1α mRNA and protein in the epithelium were significantly decreased after marsupialization which relived intracystic pressure.Experimental study indicated that intermittent negative pressure could promote osteogenesis in human bone marrow-derived stroma cells(BMSCs) in vitro.We propose a hypothesis that bone formation around the cyst of the jaws would be stimulated by intracystic negative pressure.
文摘A new method for filling bone cavity with a graft of frozen-decalcified-defatted-driedallogeneic (FDDDA) cancellous bone was described.This method was used for the treatment of cavi-ties after the enucleation of jaw cysts in 10 patients from December 1985 to February 1990.Thewounds of 9 patients healed by first intension,but wound infection occurred in one case postopera-tively.The 9 patients,besides the patient who suffered from wound infection,were followed up for5 to 56 months,with an average of 41.1 months.Evidence of recurrence with jaw cyst.was not ob-served.
文摘本文聚焦于应用骨改良药物(bone-modifying agents,BMAs)[双膦酸盐类(bisphosphonates,BPs)药物及地舒单抗]患者发生药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的临床防控问题,结合国内外共识与临床实践,提出一套基于风险分级的全程化防控策略。文章系统分析了诱发MRONJ的三大高危因素(药物因素、全身因素、口腔局部因素),强调不同用药方案(低剂量与高剂量)所致MRONJ的风险差异,并据此构建四层级(R0~R3)的风险分级体系。针对每一层级风险等级,本文详细阐述了相应的口腔筛查重点、预防性干预措施、有创操作(如拔牙)的适应证及围手术期的管理规范,并对高风险(R3)患者的药物假期、影像学评估、微创手术与创口处理策略给出了具体指导。本文旨在推动MRONJ的临床防控从“被动诊治”向“主动预防”的模式转变,为口腔医生在保障患者全身疾病治疗的前提下,科学、有效地降低MRONJ发生率提供系统参考。
基金a grant from National Natural Sciences Foundation of China (No. 30572065/ C03031103)
文摘To construct the recombinant adeno-associated virus （rAAV） vector with human bone morphogenetic protein 7 （BMP7） and observe the BMP7 mRNA expression in vitro, BMP7 CDS sequence was cloned into expression plasmid pAAV-MCS of AAV Helper Free System. The recombinant plasmid was identified with enzyme digestion and sequencing. The recombinant plasmid, pAAV-RC, pHelper were co-transfected into AAV-293 cells according to the calcium phosphate-based protocol. The viral stock was collected by 4 rounds of freeze/thaw. After purified and concentrated, the recombinant virus titer was determined by dot-blot assay. HEK293 cells were transfected with the recombinant virus at different MOI, and the expression of BMP7 mRNA was detected by RT-PCR. The results showed rAAV-BMP7 was constructed and packaged successfully. The physical particle titer was 2.5×10^11 vector genomes/mL. There was different expression level of BMP7 mRNA after transfecton. These data suggested that recombinant AAV mediated a stable expression of hBMP7 mRNA in 293 cells. The AAV production method may pave the way of an effective strategy for the jaw bone defection around dental implants.
文摘目的:总结分析接受手术治疗的药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者的临床资料,探讨手术方式等对疾病预后的影响。方法:回顾性分析2013年1月~2024年10月南京市口腔医院收治的173例2~3期MRONJ手术患者资料,采用χ^(2)检验和Fisher精确检验比较不同分组及手术方式的预后差异。结果:总计144例治愈,29例复发,总治愈率为83.2%,下颌骨治愈率显著低于上颌骨(P<0.05)。骨管技术(难治型2期)和钛板修复(下颌3期)显著提高治愈率(P<0.05),而上颌3期开窗引流与次全切除术患者预后无差异(P>0.05)。结论:MRONJ发病无明显性别差异,下颌骨较上颌骨手术预后差,骨管技术与重建钛板修复是改善预后的关键。
文摘目的探索中医药对肿瘤或骨质疏松患者应用抗骨吸收药后所致的药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的疗效。通过构建MRONJ大鼠模型,探究补肾化瘀解毒方对MRONJ的治疗疗效。方法选取36只12周龄的SD大鼠,随机分为生理盐水组(negative control,NC)、补肾化瘀解毒方组(Bushen Huayu Jiedu formula,BSHXJDF)和特立帕肽组(Teriparatide,TPTD),每组12只。各组均构建唑来膦酸(zoledronic acid,ZA)联合拔牙诱导的MRONJ大鼠模型。TPTD组、NC组和BSHXJDF组分别对应给予特立帕肽60μg/kg、生理盐水60μg/kg、补肾化瘀解毒方13.33g/kg干预,通过大体观察、组织学检测、口腔颌面锥形束CT(oral and maxillofacial cone beam CT,CBCT)检测,评价补肾化瘀解毒方对MRONJ的治疗效果。结果NC组大鼠伤口愈合不佳,BSHXJDF组和TPTD组伤口几乎愈合、BSHXJDF组愈合效果趋势更佳。生理盐水组MRONJ大鼠模型颌骨坏死,愈合不佳,病理切片可见骨质破坏,结构紊乱。CBCT影像见颌骨创面边缘粗糙,死骨形成。补肾化瘀解毒方组(75.0%)及特立帕肽组(66.7%)见大鼠拔牙创逐渐缩小,大鼠拔牙窝愈合良好;CBCT影像见拔牙创内新骨形成,牙槽骨愈合征象。结论补肾化瘀解毒方治疗MRONJ促进创口愈合及骨重建的治疗效果良好,安全性高。
文摘Background: The diversity of benign jaw tumours may cause difficulty in a correct diagnosis and insti-tution of an appropriate treatment. Data on the prevalence of these tumours is scarce from the Afri-can continent. We present a 19-year audit of benign jaw tumours and tumour-like lesions at a University teaching hospital in Nairobi, Kenya. Methods: Histo-pathological records were retrieved and re-examined from the Department of Oral and Maxillofacial pathology, University of Nairobi from 1992 to 2011. The jaw tumours were classified according to the latest WHO classification. Results: During the 19-year audit, 4257 biopsies were processed of which 597 (14.02%) were jaw tumours within an age range of between 4 to 86 years. There was greater number of odontogenic tumours 417 (69.85%) than the bone related lesions 180 (30.15%). Of the odontogenic tumours, the epithetlial and in the bone related types, the fibro-osseous lesions were frequent. Conclusion: Ameloblastoma and ossifying fibroma were the most frequent tumours reported in this audit. The information regarding the prevalence of these tumours is scarce from the continent and can be useful in early detection and management before they cause facial deformity.
文摘药物相关性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)是指因恶性肿瘤骨转移、骨质疏松等疾病使用抗骨吸收类药物(anti-resorptive,AR)和抗血管生成类药物(anti-angiogenic,AA)等所致的颌骨代谢紊乱及骨坏死类疾病。美国口腔颌面外科医师协会(American Association of Oral and Maxillofacial Surgeons,AAOMS)根据临床表现将MRONJ分成5期,其中,风险期指口服或静脉注射相关药物的患者,颌面部无任何异常症状;0期指没有发现临床可见的颌骨坏死,但是有非特异性的临床表现、影像学变化和症状。目前,0期MRONJ的诊断和治疗方法尚存在不确定性,如何有效预防风险期和0期患者向确立期的MRONJ转化存在争议。本文通过回顾0期MRONJ的诊断方法与治疗现状,分析针对风险期患者实施口腔有创操作的临床实践与研究成果,指出当前研究领域中存在的争议点与不确定性,旨在为未来的科学研究与临床实践提供参考与启示。
文摘目的观察双侧卵巢切除术联合肌肉注射糖皮质激素对新西兰成年雌兔颌骨骨密度(bone mineral density,BMD)和生物力学的影响,探讨建立新西兰兔颌骨骨质疏松模型的方法。方法将15只5~6月龄新西兰成年雌兔按照随机分配法分为三组:双侧卵巢切除术联合生理盐水肌肉注射组5只,为A组;双侧卵巢切除术联合糖皮质激素肌肉注射组5只,为B组;未切除双侧卵巢的假手术组联合生理盐水肌肉注射为对照组5只,为C组。术前及术后每月采用双能X射线骨密度仪进行兔颌骨骨密度测量,检测骨密度的变化。所有动物于手术3个月后检测颌骨生物力学的变化,进行组织染色病理学检查。结果术后3个月,B组新西兰兔下颌骨的BMD值下降29.59%(P<0.05),A组下降13.76%(P>0.05);B组在术后3个月时,下颌骨术后BMD均值小于术前BMD均值减去2SD;与C组相比,B组下颌骨的轴向最大压缩应力降低29.17%(P<0.05),A组下降4.17%(P>0.05);组织形态学观察B组相对于A组、C组,松质骨骨小梁变细,稀疏,数目变少,髓腔扩大,A组较C组变化不明显。结论双侧卵巢切除术联合糖皮质激素肌肉注射3个月可成功建立新西兰兔的颌骨骨质疏松模型。
