Objective:To explore the early clinical effect of synchronous total and unicompartmental knee arthroplasty in the treatment of bilateral knee osteoarthritis in the same patient.Methods:From January 2018 to December 2020, 16 patients with bilateral knee osteoarthritis who underwent total and unicompartmental knee arthroplasty at the same time were analyzed retrospectively. The operation time, tourniquet time, hospitalization time and blood transfusion rate were recorded. The hip-knee-ankle (HKA) angle and lower limb length of patients after bilateral surgery were compared, and the leg length discrepancy (LLD) was calculated. Knee society score-function (KSS-f), Oxford knee score (OKS), EuroQol Five Dimensions Questionnaire (EQ-5D) and Forgotten joint score (FJS) at 2 years after operation were counted, and Knee society score-clinic (KSS-c) on both sides were recorded.Results:All patients were followed up for an average of (34.81±6.01) months. The average operation time was (118.63±5.54) minutes, the total tourniquet time was (84.88±5.63) minutes, and the hospital stay was (7.25±1.65) days. No patient needed blood transfusion. The HKA angle and lower limb length on TKA side were similar to those on UKA side, with no significant difference. The change of HKA on TKA side was (7.25±4.33)°, and that on UKA side was (4.17±4.20)°. The change of HKA angle on TKA side was more significant (Z=2.275, P=0.023). The length variation of lower limb on TKA side was (12.66±6.29)mm, while that on UKA side was (5.30±3.05)mm. The length of lower limb on TKA side increased more, with a statistically significant difference (Z=3.103, P=0.002). Two years after operation, the KSS-f score was (82.63±4.70) points, the OKS score was (17.31±3.70) points, the KSS-c score on the TKA side was (78.94±7.41) points, and the UKA side was (83.88±5.77) points, both of which were significantly higher than those before operation (P<0.001). The FJS score was (69.81±4.64), and the EO-5D score was (73.88±8.21). None of the patients had occurred complications, as pulmonary embolism, symptomatic deep vein thrombosis, knee stiffness, joint infection, and the progression of reserved compartmental osteoarthritis.Conclusions:At the same time, one side of TKA and the other side of UKA are effective methods for the treatment of knee osteoarthritis, which can achieve satisfactory clinical effects, and will not lead to differences in the length of lower limbs after surgery.

目的 探讨胫骨髁外翻截骨术(TCVO)治疗陈旧性内侧胫骨平台骨折并发创伤性膝关节炎(TKOA)的早期临床疗效.方法 回顾性分析2016年6月至2021年6月于苏州市立医院关节外科接受TCVO手术治疗陈旧性内侧胫骨平台骨折并发TKOA的18例患者的术前及术后相关临床资料,所有患膝均为陈旧性内侧胫骨平台骨折保守治疗后畸形愈合并发膝内翻TKOA.患者发生胫骨平台骨折至TCVO手术治疗的时间为49～171个月,平均(111.1±33.8)个月;患膝内翻角度为6.81°～14.49°,平均10.95.±2.62°;关节线会聚角(JLCA)为3.58°～8.12°,平均5.95°±1.42°.所有患者于术前及术后3个月拍摄站立位双下肢全长X线片、膝关节正侧位X线片并测量患膝内翻角度、胫骨近端内侧角(MPTA)、JLCA、胫骨平台后倾角(PTS),评估术前、术后下肢力线以及膝关节对合状态的变化情况.依据术前及术后3、12个月的患膝关节活动度(ROM)、疼痛视觉模拟评分(VAS)、西安大略与麦克马斯特大学(WOMAC)骨关节炎指数、膝关节损伤与骨关节炎评分(KOOS)评估早期临床疗效.结果 18例患者均获得随访,随访时间为14～65个月,平均随访(27.4±14.4)个月.术后3个月时,患膝内翻角、JLCA均较术前显著降低,差异均具有统计学意义(P＜0.05);MPTA与术前相比有显著提升,差异有统计学意义(P＜0.05);PTS与术前相比差异无统计学意义(P＞0.05).术后3、12个月时,患膝关节ROM、VAS、WOMAC、KOOS评分均较术前有显著好转,差异均具有统计学意义(P＜0.05).结论 采用TCVO治疗陈旧性内侧胫骨平台骨折并发TKOA可以取得良好的早期临床疗效,有效矫正膝关节内翻畸形,缓解膝关节疼痛及改善膝关节功能.

目的 探讨NNN-链接模式干预应用于髋膝置换患者中的效果.方法 选择2020年1月至2021年1月该院收治的骨性关节炎人工髋膝关节置换术患者112例,随机分为两组,各56例.对照组实施常规干预,观察组实施NNN-链接模式干预.对比两组干预前后自我感受负担水平、髋关节功能、膝关节功能、膝关节主动活动度、膝关节被动活动度、疼痛程度、生活质量变化.结果 观察组干预2周后身体因素、情感因素、经济因素评分均低于对照组(P<0.05);观察组干预2周后髋关节功能评分、膝关节功能评分、膝关节主动活动度、膝关节被动活动度评分均高于对照组(P<0.05);观察组干预2周后疼痛程度轻于对照组(P<0.05);观察组干预2周后生活质量各项评分均高于对照组(P<0.05).结论 NNN-链接模式干预应用于骨性关节炎人工髋膝关节置换术患者可减轻患者自我感受负担,促进髋膝关节功能恢复,减轻疼痛程度,改善生活质量.

目的 探讨不稳定型骨盆骨折合并多发伤患者干预中引入损伤控制理论的效果.方法 选择2019年10月—2020年10月医院收治的不稳定型骨盆骨折合并多发伤患者104例,按照组间基本特征均衡可比的原则分为对照组和观察组,各52例.对照组行常规干预及护理,观察组在此基础上引入损伤控制理论干预并在护理中严格落实损伤控制理论.比较两组骨折复位质量、手术情况、术后功能恢复效果、并发症发生率及病死率.结果 观察组骨折复位效果优于对照组(P<0.05);观察组入院距确定性手术时间、确定性手术时长、体温恢复时间、骨折愈合时间均短于对照组(P<0.05),术中出血量、输血量少于对照组(P<0.05);观察组术后功能恢复优于对照组(P<0.05);观察组术后并发症发生率低于对照组(P<0.05).结论 不稳定型骨盆骨折合并多发伤患者干预中引入损伤控制理论可改善患者手术情况,促进骨折复位及术后功能恢复,减少并发症和死亡发生.

目的:探讨全膝关节置换术后康复锻炼专案改善方案的临床应用效果.方法:选择2019年1月—2021年1月我院收治的全膝关节置换术病人118例,随机分为两组,各59例.对照组行常规康复锻炼,观察组在此基础上引入专案改善方案.比较两组术后康复情况、住院时间、术后膝关节活动能力、膝关节功能评分、日常生活活动能力评分、并发症发生率.结果:观察组实现直腿抬高时间、实现屈膝90°时间、初次下床活动时间、住院时间分别为(32.06±10.07)h、(23.29±5.71)h、(21.74±4.58)h、(4.15±0.95)d,对照组实现直腿抬高时间、实现屈膝90°时间、初次下床活动时间、住院时间分别为(43.61±9.58)h、(34.15±9.38)h、(51.37±8.09)h、(6.16±0.92)d,两组比较差异均有统计学意义(P<0.001);观察组术后第5天最大屈曲度、借助步行器行走距离大于对照组(P<0.001);观察组术后第7天、术后1个月膝关节评分、日常生活活动能力评分均高于对照组(P<0.001);观察组术后并发症发生率低于对照组(8.47％与37.29％,P<0.001).结论:全膝关节置换术后病人康复锻炼中引入专案改善方案可促进病人膝关节功能恢复,提高日常生活能力,降低并发症发生率,缩短住院时间.

单髁置换术(UKA)是指治疗单一间室膝骨关节炎(KOA)的一种微创手术,因其具有手术切口小、术中出血少、术后恢复快等优势,逐渐成为膝骨关节炎阶梯化治疗中的重要环节.临床上应用的UKA假体主要有活动平台(MB)和固定平台(FB)两种,MB-UKA可使膝关节的运动更接近自然生物力学且磨损率低,但易发生垫片脱位及假体撞击等并发症.FB-UKA较稳定,无脱位风险,并发症少但磨损率高.目前国内外文献对两者的孰优孰劣尚未形成统一的标准.本文就MB-UKA和FB-UKA的最新临床应用进展进行综述.

With the development of the knee-preservation concept and surgical techniques, lateral unicompartmental knee arthroplasty (UKA) has become an effective method for the lateral compartment osteoarthritis of the knee.The incidence of knee osteoarthritis is low in the lateral compartment, which is different from the medial compartment in anatomical and kinematic characteristics. These two factors increase the challenge of lateral UKA, so the clinical efficacy of lateral UKA has been controversial. With the improvement and renewal of treatment concepts, surgical techniques and prosthesis design, the clinical effect of lateral UKA and the survival rate of the prosthesis have been continuously optimized. This article aims to summarize the characteristics of lateral compartment knee osteoarthritis, clinical efficacy, prosthesis selection, reasons for revision, future application and prospects, combined with relevant literature in recent years, to review the current progress of lateral UKA.

目的 探讨下泪小管断裂的鼻侧断端寻找方法及手术吻合技巧,选择合适的泪管支撑管提高下泪小管断裂吻合术的成功率.方法 采用回顾性病例分析方法,选取无锡市人民医院2014年6月至2018年6月下泪小管断裂患者70例(70只眼).术中显微镜下寻找下泪小管鼻侧断端,Ⅰ期行泪道硅胶管环形置管吻合下泪小管,观察其临床治疗效果及并发症发生率.结果 70例(70只眼)下泪小管断裂中70例术中全部成功吻合.术后58只眼治愈,占82.9％;11只眼好转,占15.7％;1只眼未愈,占1.4％,总有效率达98.6％.结论 泪道硅胶管环形置管吻合手术治疗下泪小管断裂是一种简便易行的下泪小管断裂吻合方法.

目的 比较固定平台单髁置换术(unicompartmental knee arthroplasty,UKA)和全膝关节置换术(total knee arthroplasty,TKA)治疗外侧间室膝关节骨关节炎的早期临床疗效.方法 回顾性分析2018年1月至2020年2月我院关节外科行外侧UKA或TKA手术治疗的41例外侧间室膝关节骨关节炎患者,按手术方式分为外侧UKA组和TKA组.根据性别、年龄和身体质量指数(bodymassindex,BMI)进行1 ︰ 1配对设计研究,成功配对14对,其中男性5对,女性9对.UKA组患者平均年龄为(69.13±9.09)岁,BMI(26.28±3.04)kg/m2,TKA组患者平均年龄为(68.06±8.07)岁,BMI(25.13±3.18)kg/m2.两组患者年龄和BMI差异无统计学意义(P＞0.05).比较两组手术时间、术后1 d血红蛋白下降比、术后3 d的疼痛视觉模拟评分(visual analogue scale,VAS)和住院时间,术后1个月、3个月、6个月和1年的膝关节协会评分(knee society score,KSS)、Oxford膝关节评分(Oxford knee score,OKS)和膝关节活动度(range of motion,ROM)及术后1年的人工关节遗忘评分(forgotten joint scores,FJS).结果 患者均获随访,随访时间12～35个月,平均(22.83±7.66)个月.两组术前VAS、KSS临床评分、KSS功能评分、OKS及ROM差异无统计学意义(P＞0.05).相比TKA组,UKA组手术时间和住院时间更少,术后1 d血红蛋白下降比更小,术后3 d VAS更低,差异均有统计学意义(P＜0.05).术后1个月、3个月和6个月,UKA组KSS临床评分、KSS功能评分、OKS和ROM均优于TKA组(P＜0.05);术后1年,两组KSS临床评分、KSS功能评分、OKS和ROM接近,差异无统计学意义(P＞0.05).术后1年,UKA组的FJS高于TKA组,差异有统计学意义(P＜0.05).随访期间,两组患者均未出现假体松动和垫片脱位等假体相关并发症.结论 对于外侧间室膝关节骨关节炎患者,外侧UKA与TKA均能够有效缓解患者疼痛,改善膝关节功能.相较于TKA,外侧UKA具有创伤小、恢复快、本体感觉好等优点.

目的:分析牙源性上颌窦炎(odontogenic maxillary sinusitis,OMS)锥形束CT(cone-beam computed tomography,CBCT)图像的影像学特征.方法:收集196例OMS患者的CBCT数据,利用专用软件NNT重建和观察,对导致OMS的病因进行分析,包括病原牙/牙根的根尖周病或牙周病与上颌窦底(maxillary sinus floor,MSF)的关系、根管治疗质量、MSF的完整性、窦内黏膜增厚等,测量最大黏膜厚度和最小MSF厚度.结果:根尖周病是窦内黏膜增厚最重要的危险因素.上颌磨牙导致的OMS是前磨牙的5.21倍,且上颌第一磨牙(maxillary first molar,MFM)明显高于第二磨牙.MFM的近颊根(23.37％)和腭根(20.31％)与OMS关系最密切;MSF破坏后黏膜增厚更明显(P＜0.05).根管治疗不完善与OMS最相关,尤其是根管清理不到位(35.25％)和根管遗漏(31.15％).在遗漏根管中,44.74％为MFM的近颊根第二根管.结论:完善的根管治疗并有效控制根尖感染、保护MSF的完整性是减少OMS发生的重要因素.

目的 通过比较平行和分角线投照数字根尖片(digital periapical radiographs,DPR)测量种植体长度和直径的准确性,为DPR评价种植体周围骨组织水平提供参考.方法 160名患者210颗种植体,按随机数字表法分为平行投照组(80例患者,98颗种植体)和分角线投照组(80例患者,112颗种植体),术后即刻拍摄DPR.利用软件SOPRO Imaging 2.20盲法测量DPR上种植体的直径和长度,然后与种植体实际值比较,利用SPSS软件进行两元方差分析和LSD多重比较,评价两种投照DPR测量的准确性.结果 平行投照DPR测量直径和长度与种植体实际值的差值分别为(0.14±0.10)mm、(0.20±0.15)mm,水平和垂直放大倍率分别为1.58％、2.13％;分角线投照DPR测量直径和长度与种植体实际值的差值分别为(0.37±0.22)mm、(1.04±0.47)mm,水平和垂直放大倍率分别为3.90％、10.65％.平行投照DPR测量种植体长度和直径的准确性均优于分角线投照DPR(P<0.05).结论 平行投照DPR能更准确地测量种植体的直径和长度,提示利用平行投照DPR能更准确地评价种植体周围的骨组织水平.

目的 探讨肌少症对老年患者髋部骨折术后近期及远期死亡率的影响.方法 2014年2月至2017年2月,共93例符合纳入及排除标准的老年髋部骨折患者纳入本研究.利用胸部CT测量T12椎体(T12)椎弓根水平肌肉组织的横截面积.以T12椎弓根水平肌肉横截面积除以患者身高平方计算得到骨骼肌指数(SMI).采用T12水平SMI截断值:42.6 cm2/m2(男性)和30.6 cm2/m2(女性),将患者分为肌少症组及非肌少症组,随访两组患者术后生存时间.采用Kaplan Meier分析两组患者的生存曲线,使用卡方检验对比两组在术后6个月和12个月的生存率差异.采用Cox比例风险模型分析肌少症、骨折类型(手术类型)、年龄、性别及ASA等级等多变量因素对髋部骨折术后死亡率的影响.结果 肌少症组患者共45例,非肌少症组患者共48例.肌少症组4例患者在术后6个月内死亡,死亡率为9.8％,非肌少症组3例患者在术后6个月内死亡,死亡率为8.3％,组间术后6个月死亡率差异无统计学意义(c2=0.008,P=0.929).肌少症组19例患者在术后24个月内死亡,死亡率为42.2％,非肌少症组10例患者在术后24个月内死亡,死亡率为18.8％,组间术后24个月死亡率差异具有统计学意义(c2=6.081,P=0.014).Cox比例风险模型分析结果为:患有肌少症及患者年龄和术后24个月死亡率显著相关(HR=2.015,95％CI:2.690,20.904,P=0.000;HR=0.062,95％CI:1.004,1.128,P=0.036),患有肌少症及年龄较大的患者,术后24个月死亡率越高,而骨折类型(手术类型)、性别及ASA等级对术后24个月死亡率无明显影响.结论 肌少症会增加髋部骨折患者术后远期(24个月)的死亡风险,对近期(6个月)患者死亡率无明显影响.

Objective To investigate the incidence and type of intraspinal neuro-axis abnormalities in juvenile patients with " presumed idiopathic" scoliosis and to analyze the associated radiographic and clinical characteristics. Methods Four hundred and six cases of children with " esthetic" scoliosis in the spine surgery outpatient clinic of Nanjing Gulou Hospital from January 2012 to October 2016 were retrospectively analyzed. Total spinal MRI, standing full spine positive lateral radiograph and related clinical features were analyzed. There were 128 males and 278 females with an average age of (8.1 ± 1.8) years. The type and incidence of spinal canal malformations were analyzed and counted after MRI scan. Patients were grouped into two cohorts according to the presence of neural axis abnormalities. Radiographic parameters including curve magnitude, direction of main curve, curve pattern, location of apex, degree of thoracic kyphosis, and span of curve were recorded and compared between the two groups. Results Of the 406 children,77 patients (18.7% ) had different types of spinal cord malformations: of which 36 patients had isolated Arnold-Chiari malformation, 14 patients had isolated syringomyelia,11 patients had Arnold-Chiari malformation combined with syringomyelia, 4 patients had tethered cord combined with diastematomyelia, 3 patients had spinal cord fissure, 3 patients had spinal cord occupying lesions, 2 patients had isolated tethered cord disease, 2 patients had syringomyelia and tethered cord combined with diastematomyelia, one patient had tethered cord combined with spinal core occupying lesion, and one patient had syringomyelia combined with spinal cord occupying lesion. Compared with the non-abnormal group, the male 50.6% (39/77), left chest 19.5% (15/77), and right lumbar flexion ratios 7.8% ( 6/77) were higher in the deformed group 27.1(89/329), 7.0% (23/329), 0.6% (2/329) ( χ2 =17.387, 4.811, 15.826, all P values<0.05). Conclusions The incidence of neural axis abnormalities in patients with the presumed JIS is 18.7%. There is a great need for children with JIS to have a full spinal MRI scan in order to detect spinal canal malformations as early as possible, especially in males with left thoracic curve or right lumbar curve.

目的 评价锥形束CT(cone-beam computed tomography,CBCT)和数字化牙片(digital periapical radiographs,DPRs)测量牙齿长度的准确性.方法 需拔牙的正畸患者拍摄CBCT,共46例患者82颗前磨牙纳入研究.利用CBCT自带软件从轴位(axial planes,APs)、矢状位(sagittal planes,SPs)和冠状位(coronal planes,CPs)测量牙齿的长度.牙齿拔出后,利用游标卡尺测量牙齿长度作为金标准.然后将牙齿放入人干头颅的相应牙槽窝内,使用分角线技术拍摄DPRs,并测量牙齿长度.比较CBCT和DPRs测量牙齿长度的准确性.结果 单根前磨牙,CBCT-轴位、矢状位和冠状位的测量值均低于牙齿实际长度,但差异无统计学意义(P>0.05),而数字化牙片测量值显著高于牙齿实际长度(P<0.05).双根前磨牙,CBCT-轴位测量值高于牙齿实际长度,CBCT-矢状位和冠状位测量值低于牙齿实际长度,但差异均无统计学意义(P>0.05).数字化牙片测量值显著低于颊根的实际长度,高于腭根的实际长度(P<0.05).结论 CBCT测量牙齿长度显示较高的可信度.

目的:对比观察多点扫描激光及传统的单点氪激光治疗糖尿病视网膜病变(DR)的效果,评估两种治疗方法:的安全性.设计:病例对照研究.研究对象:2013年1月至2015年6月就诊的117例(220眼)DR患者.方法:将入组的DR患者随机分为两组.实验组行多点扫描激光,共58例(112眼);对照组行传统单点多波长氪激光,共59例(108眼).所有患者光凝前均进行最佳矫正视力(BCVA)、裂隙灯生物显微镜、眼底照相、荧光素眼底血管造影(FFA)、黄斑区OCT及视野检查,术后3个月复查FFA.激光治疗后当天根据数字分级法(NRS)进行疼痛评分,记录激光治疗的能量指标,计算能量密度.术后1、3、6个月分别测量患者的BCVA,OCT检查测量平均黄斑中心凹厚度(CMT),视野检查测量平均视敏度.主要指标:激光术后疼痛评分,激光能量和能量密度,术后1、3、6个月患者BCVA、平均CMT及平均视敏度.结果:实验组激光时间(39.07±5.10 min)少于对照组(52.36±7.47 min)(t=5.63,P=0.00),能量密度实验组(68.23±12.16 mw*ms/μm2)也低于对照组(157.64±31.63 mw*ms/μm2)(t=7.75,P=0.00).激光术后疼痛评分实验组(1.46±0.633分)显著低于对照组(2.43±0.95分)(t=6.61,P=0.00).实验组有30眼(26.78％)视力提高,对照组有32眼(29.62％)视力提高(x2=1.85,P=0.39).术后6个月BCVA提高字符数实验组(2.43±0.95字符)与对照组(2.70±2.62字符)无显著差异(t=0.27,P=0.82),黄斑中心凹厚度下降幅度对照组(34.47±51.77 μm)高于实验组(27.66±46.87 μm)(t=-1.02,P=0.03),平均视敏度下降幅度实验组(1.22±0.50 dB)小于对照组(2.32±1.10dB)(t=9.55,P=0.00).随访期间,实验组有3眼(2.67％)出现玻璃体积血,对照组有2眼(1.85％)(x2=0.17,P=0.68).实验组有28眼(25％)再次行激光治疗,对照组有20眼(18.51％)(x2=1.35,P=0.24).结论:多点扫描激光与单点激光在治疗DR上疗效相同,并对视网膜功能损伤较小.

Compared with periapical X-ray,panoramic radiographs or physical measurement,cone-beam computed tomography(CBCT)has the features of high resolution imaging,no deformation,and has overcome the problem of distortion periapical measurement,and full oral information can be obtained through one scan,which can provide axial,sagittal,coro-nal and 3D images.Compared with the traditional CT,the CBCT scanning time is short and the radiation dose is small.The correct measurement of the teeth length and the positioning of the teeth are essential parts of the oral clinical work.At pre-sent,CBCT has been applied to clinical and scientific research of various disciplines of stomatology.It not only provides a new way for solving difficult cases,but also has wide application prospects.It can also provide reference for teaching and scientific research of stomatology.

Objective To explore the effect of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood on the survival of patients with multiple myeloma (MM). Methods The clinical data of 195 patients with MM who were diagnosed in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2007 to December 2015 were retrospectively analyzed. According to NLR, the patients were divided into the low NLR group (NLR<3) or high NLR group (NLR≥3). The relationship between NLR and the parameters including clinical indicators, treatment response and overall survival of the patients was detected. Results There were 61 cases in the high NLR group and 134 cases in the low NLR group. Compared with the low NLR group, creatinine and serum calcium in the high NLR group were higher (all P < 0.05). Complete remission rate after initial induction therapy in the low NLR group (32.1%, 43/134) was higher than that in the high NLR group (16.4%, 10/61), and there was a statistically significant difference (χ2=5.218, P=0.022). Median survival time in the low NLR group (38 months) was longer than that in the high NLR group (27 months), with a statistically significant difference (P=0.022). Cox univariate and multivariate analysis showed NLR≥3 was a risk factor (P=0.024), but not an independent risk factor (P=0.064). Conclusion NLR is associated with creatinine and serum Ca, which can be used to evaluate the overall survival time and inductive treatment response in patients with MM. Key words: Multiple myeloma; Neutrophil-to-lymphocyte ratio; Overall survival

目的探讨基于计算机图像技术的数字化立体显示系统在口腔颅颌面医学影像诊断学教学中的应用及其效果。方法筛选典型临床病例的三维CBCT数据和二维影像片数据,利用CBCT数据重建三维模型,利用立体显示系统进行展示,引导学生理解三维解剖结构与二维影像片数据之间的逻辑关系,完成病例的解释与分析。通过对学生的影像片阅读考核、网络问卷调查以及由经验丰富的老教师组织的教学监督组抽查,评价教学效果。结果阅读考核的优良率为87.7%,无差评。共82名学生进行了网上打分,98.75%对教学效果满意,对教学模式感兴趣。网络问卷调查结果显示,教师重视度高、讲课明晰、课堂互动好、课程总体满意,综合评分为99.43分,教学帮助度为99.14分。教学督导组的抽查结果为优。结论基于计算机图像技术的立体显示系统的教学方式能充分调动学生的学习积极性,提高学生对临床知识的掌握和灵活应用,提高口腔颌面医学影像诊断学教学的效果。

Certain immunophenotypes in multiple myeloma (MM), including CD56 and CD117, have been reported to be associated with overall survival (OS). However, previous reports have ignored the impact of different treatment regimens and the long-term prognostic value of immunophenotyping in MM when treated with novel agents, including thalidomide and bortezomib, in the absence of transplantation for autologous stem cell transplantation and allo-hematopoietic stem cell transplantation. To further understand the long-term prognostic value of immunophenotyping in MM, when treated with bortezomib combined with thalidomide-based regimens without transplantation, 80 patients who were newly diagnosed between January 2007 and December 2015, were analyzed retrospectively. In contrast to previous studies, no significant survival time difference was observed between CD56+/CD117+ and CD56-/CD117- groups. Multivariate analysis suggested that human leukocyte antigen-antigen D-related (HLA-DR)+ was independently associated with shorter OS and progression-free survival (PFS), while CD117+ was an independent prognostic factor for decreased PFS. In addition, the myeloma prognostic index (MPI), defined by HLA-DR+, age ≥65 years and international staging system stage III, was suitable for risk stratification of patients treated with novel agents for OS and PFS. The results of the current study suggested that HLA-DR+ patients had a shorter OS and PFS and CD117+ patients had shorter PFS. HLA-DR+ or CD117+ was sufficient to affect survival. Evaluating these markers may reveal valuable prognostic factors for MM in patients receiving bortezomib combined with thalidomide-based regimens without autologous stem cell transplantation and allo-hematopoietic stem cell transplantation). MPI may describe an accessible tool to predict the prognosis of patients with MM.

Objective To evaluate the spatiotemporal relationship between the root apex of mandibular molars and the inferior alveolar nerve canal (IANC) in adults. Methods Cone-beam computed tomography (CBCT) images were collected in 236 patients, and the distances from the root apexes of mandibular molars to the IANC were measured in NNT 4.6 software. The relationship between distance and gender was evaluated. Results In two-rooted mandibular first molars, the distances from the mesial root and distal root to the IANC were 7.34 ± 2.07 mm and 6.69 ± 2.08 mm, respectively, in males and 6.47 ± 2.22 mm and 5.94 ± 2.11 mm in females. In three-rooted mandibular first molars, the distances from the mesial root, distobuccal root, and distolingual to the IANC were 7.29 ± 1.30 mm, 7.40 ± 2.33 mm, and 9.97 ± 2.19 mm, respectively, in males and 6.08 ± 2.57 mm, 6.35 ± 2.40 mm, and 9.01 ± 2.90 mm, respectively, in females. In one-rooted mandibular second molars, the distance from the root to the IANC was 4.09 ± 1.64 mm in males and 3.89 ± 1.76 mm in females. In two-rooted mandibular second molars, the distances from the mesial root and distal root to the IANC were 5.14 ± 2.08 mm and 4.39 ± 1.85 mm, respectively, in males and 3.78 ± 1.69 mm and 3.24 ± 1.72 mm, respectively, in females. There were no significant with in-gender differences between the left and right side in the distances from the root apexes to the IANC (P>0.05). The distances from the mandibular first molar were greater in males than in females. The longest average distance was from the distolingual root apexes of three-rooted mandibular first molars to the IANC, and the distances were longer from the distobuccal root apexes of three-rooted mandibular first molars to the IANC than from the distal root apexes of two-rooted mandibular first molars to the IANC (P<0.05). There was no within-gender difference in the distances from the root apexes of single-rooted mandibular second molars to the IANC (P>0.05), but the distances in two-rooted mandibular second molars were larger in males than in females (P<0.05). The distances from the root apexes to the IANC were smaller in mandibular second molars than in mandibular first molars (P<0.05). Conclusion There are significant differences between adult males and females in the distance from the root apex to the IANC for mandibular first molars and two-rooted mandibular second molars. The distances from the root apexes to the IANC were smaller in mandibular second molars than in mandibular first molars.