Oropharyngeal head and neck squamous cell carcinoma is a common malignant tumor in the oral cavity. High-risk human papillomavirus 16 infection is a major cause of oropharyngeal head and neck squamous cell carcinoma development. Strong antitumor immune responses, especially CD8(+) T cell responses, are thought to be essential to effective cancer treatment and are associated with better prognosis in oropharyngeal head and neck squamous cell carcinoma. In this study, we examined the role of the Tim-3/Gal-9 pathway in oropharyngeal head and neck squamous cell carcinoma patients. We found that Gal-9 expression by CD4(+) T cells was increased in human papillomavirus-positive oropharyngeal head and neck squamous cell carcinoma patients, but not in human papillomavirus-negative oropharyngeal head and neck squamous cell carcinoma patients. Increased Gal-9 secretion by CD4(+) T cells presented multiple immunosuppressive effects. Coculturing monocytes with high Gal-9-expressing CD4(+) T cells resulted in the expansion of Tim-3(+) monocytes, which suppressed interferon gamma production by activated CD8(+) T cells. Subsequently, total monocytes incubated with exogenous Gal-9, or high Gal-9-expressing CD4(+) T cells, suppressed the expression of interferon gamma by CD8(+) T cells. Exogenous Gal-9 and high Gal-9-expressing CD4(+) T cells also suppressed the secretion of both interleukin 10 and interleukin 12 by monocytes. These effects are Tim-3/Gal-9-dependent because blocking Tim-3 and/or Gal-9 could enhance the support of CD8(+) T cell interferon gamma production and the interleukin 10 and interleukin 12 secretion by monocytes. Together, these data suggest that the high Tim-3 expression in monocytes could be utilized by tumor-promoting Gal-9 expression on CD4(+) T cells. Immunotherapy in human papillomavirus-positive oropharyngeal head and neck squamous cell carcinoma patients therefore faces an additional challenge posed by Tim-3 and Gal-9 and likely requires the blockade of these molecules.

Infection by high-risk HPV 16 is usually self-limiting, asymptomatic and subclinical. However, in a minor subset of patients, HPV 16 could induce malignant transformation of infected cells, and is currently accounting for an increasing number of oropharyngeal cancer cases. To examine the host factors that could result in failed HPV clearance and oral cancer development, we examined the CD4+ T cell responses to HPV stimulation in genderand age-matched tongue cancer patients and asymptomatic controls. We observed that in HPV 16-infected asymptomatic controls, the proliferating CD4+ T cells in response to HPV stimulation contained significantly higher frequencies of Th1 and lower Th17 and Treg cells, than in tongue cancer patients. The CD4+ T cell cytokine secretion profile after HPV-stimulation in asymptomatic controls was also more biased toward IFN-g and IL-17 than IL-4 and IL-10, compared to tongue cancer patients. These observations were not due to tumor-mediated immunosuppression because the overall strength of HPV-specific CD4+ T cell activation was higher in HPV-associated tongue cancer patients than in asymptomatic controls. Together, these results indicate that the types of HPV-specific CD4+ T cell responses induced in HPV-infected individuals were associated with different infection outcomes. Furthermore, within the tongue cancer patients, those with low HPV-specific Th1 and high HPV-specific Treg were more likely to die, demonstrating that the types of CD4+ T cell response toward HPV stimulation is associated with tumor prognosis.

目的 研究经翼外肌解剖复位与翼外肌游离复位治疗髁状突骨折的成功率.方法 60例髁状突骨折患者,随机分为观察组与对照组,每组30例.观察组行翼外肌解剖复位术,对照组行翼外肌游离复位术.比较两组手术成功率和并发症发生率.结果 观察组手术成功率为93.33%高于对照组的73.33%,差异有统计学意义(P＜0.05).观察组术后并发症发生率为26.67%低于对照组的43.33%,差异无统计学意义(P＞0.05).结论 经翼外肌解剖复位术较游离复位术治疗髁状突骨折效果更为显著,咀嚼功能和局部结构形态可获得良好恢复,且术后并发症相对较少,经翼外肌游离复位术则可能适用于较高位髁状突骨折患者.

目的探讨髁突颈骨折经颌后入路,直视下解剖复位内固定新方法及疗效。方法对28例36侧髁突颈骨折患者行颌后切口入路,穿过腮腺,解剖面神经,直视下暴露髁颈骨折线,解剖复位并行坚固内固定,术后1、3、6个月复诊。结果经过6个月复诊,所有患者均取得良好的咬合关系及开口度,双侧面部对称,面部瘢痕不明显,3例患者出现面神经不同程度损伤,但6个月后基本恢复,出现腮腺瘘1例。结论经颌后入路直视下解剖复位内固定髁突颈骨折,具有切口隐蔽性、术中视野暴露好、便于坚固内固定操作、术后瘢痕小等优点,是一种良好的恢复解剖形态及功能的疗效方法 。

下颌骨占据面下1／3，极易受意外打击，发生在下颌骨的骨折约占颅面骨折病例的近2／3［1］，目前下颌骨骨折主要采用手术切开复位内固定术和牙弓夹板固定术，手术治疗适合复杂性、多发性、粉碎性骨折，具有效果好、骨折愈合快等优点，但手术创伤大，需二次手术取出内固定物，面部切口易留瘢痕，儿童可能损伤牙胚及费用昂贵等使很多患者望而却步。而外固定法主要为牙弓夹板颌间固定、小环结扎及骨间螺钉颌间固定，普通牙弓夹板均为金属板条制成，具有固位不稳，易造成骨折延期愈合及错位愈合；需按牙弓形态现场弯制夹板，费时、费力尤其是牙冠短小、乳牙，新生恒牙容易滑脱，结扎丝易刺破黏膜等缺点［2-5］，骨间螺钉颌间固定及小环结扎有复位固定力不足，且多用于坚固内固定术后辅助治疗［6-8］，针对以上不足，我们应用模型外科方法制作牙合板，对下颌骨骨折作单颌外固定术，恢复正常咬合关系。

目的通过对不同类型下颌骨骨折后患者上气道间隙变化的螺旋CT研究,为临床病情评估及采取预防措施提供理论依据。方法选取不同类型骨折患者158例,正常对照组30例,均为成年男性,年龄18～45岁。所有患者在同一条件下进行上气道螺旋CT扫描,测量各上气道分区的最小横截面积,进行Dunnett两两比较。结果双侧下颌角骨折患者喉咽气道最小横截面积明显减小(P<0.05)。下颌骨体部及颏/颏旁粉碎性骨折患者的舌咽气道、喉咽气道最小横截面积明显变小(P<0.05)。结论双侧下颌角不利型骨折及下颌体部和颏/颏旁粉碎性骨折后,上气道下部间隙明显减小,影响通气功能。

Objective:The aim of this study was to analyze the variations of upper airway space and hyoid position in cases of different sites of mandible fracture through lateral cephalometric radiography.Methods: 180 mandible fracture patients were consisted in this study and divided into 4 groups according to fracture location site.Group 1(n=40) were cases with fracture of mandibular condyle.Group 2(n=44) were cases with fracture of angle of mandible.Group 3(n=36) were cases with fracture of body of mandible.Group 4(n=60) were cases with fracture of anterior part of mandible.30 medical students with normal occlusal relations were used as control.Lateral cephalometric radiographs were examined.Information of bone and soft tissue profile were used to evaluate airway alterations.Results:Different types of mandibular fractures affected the upper airway space in various degree.In particular,the bilateral mandibular body or parasymphyseal fractures had shown a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces.The ventilatory function of those patients was found severely restricted with serious obstructions.Conclusion:Different types of mandibular fractures are closely related with upper airway structure and hyoid position.The bilateral mandibular body or parasymphyseal fractures have significantly effect on the lower oropharyngeal airway spaces.Clinicians should understand this complication.

患者男性,61岁,因右颊无痛性肿物二十余天就诊于河北医科大学第三医院口腔颌面外科.患者于20dJ前发现面部右侧及右颌下区肿大,可触及硬块,无疼痛不适,肿物增长较快,外院CT检查报告:右颧弓下软组织占位性病变.并行肿块穿刺,病理报告:转移性腺癌.就诊于河北医科大学第三医院口腔颌面外科后查体:面部两侧不对称,右颧部膨隆,触及5cm×5cm×3cm的肿块,质地中等硬、不活动、与深层周围组织粘连,与皮肤无粘连,无压痛;无眼球运动障碍,患侧皮肤感觉及张口度无异常,口内右后上颊黏膜膨隆,牙齿未见松动;肿块与基底部粘连.

Objective It is to observe the influence of fracture micro-osteosynthesis fixation and non-fixation on the growth of the mandible in mandibular condylar neck fracture.Methods 21 healthy New Zealand rabbits were chosen and randomly divided into blank control group,fixation group and non-fixation group.Mandibular condylar neck fracture models were established,and fracture fixation group was treated with micro-titanium board osteosynthesis fixation.Skull X-ray flank film was observed and SNB angle and the mandible were measured.Results Measurement results of fixation group showed no significant difference between right and left mandible,however,in non-fixed group,significant differences were observed,especially in sticks height,the length of the mandible and the condyle,the mandibular angle height.Conclusion Rigid internal fixation has less influence on the mandibular grouth of rabbits at the developmental stage.

目的 分析口腔癌患者T淋巴细胞免疫的特点及手术对口腔癌患者免疫功能的影响.方法 选用20例口腔癌患者和15例健康志愿者为试验组和对照组, 试验组于手术前、后各1周分2次采取新鲜外周静脉血1mL,对照组采取新鲜外周静脉血1mL,均以肝素抗凝.每份样本取血100μL,分别加入CD3、CD4、CD8、CD56单克隆抗体10μL,检测T淋巴细胞各表型占淋巴细胞总量的百分比,并计算CD4/CD8的比值.再分取抗凝静脉血100μL,分别加入10μL 白细胞介素-2(interleukin-2,IL-2)、CD4、干扰素-γ(interferon-γ,INF-γ)单克隆抗体,检测IL-2阳性,INF-γ阳性,IL-2、CD4双阳性及INF-γ、CD4双阳性T细胞占总细胞的百分比.结果 试验组手术前1周与对照组比较CD3、CD4的表达降低,CD8的表达增加,CD4/CD8比值下降(P<0.05).试验组术前淋巴细胞内各细胞因子含量较对照组均明显下降,术后各因子水平有了不同程度的回复.结论 口腔癌患者体内抗肿瘤免疫处于抑制状态,手术对其有一定的改善作用,但仍有必要配合免疫治疗.

Objective To investigate the inhibitory effect of DCs on the tumor-bearing mude mice.Methods Human peripheral blood monocytes (PBMCs) with rhGM-CSF, rhIL-4 and rhTNF-α, DCs were induced and pulsed by Tca8113 cells lysates. Those DCs and T lymphocytes were co-cultured to induce specific cytotoxic Tlymphocytes(CTLs). Immunotherapy was then performed after those DCs and CTLs were implanted into the tumor-bearing nude mice.Results DCs were induced from PBMC with multiple cytokins. Compared with the control group, the growth of tumors was significantly inhibited in the group that had been implanted with DCs and CTLs (P0.05).Conclusion Our experiments improved, the CTLs induced by DCs that were pulsed with oral cancer cells lysates have significantly inhibitory effect on the growth of the tumors. DCs vaccine can be used to anti-tumors of oral cancer cells, so it may become a new method in immunotherapy of oral cancer.

Objective: To compare the phenotype of induced dendritic cell (DC) derived from peripheral blood of the healthy individuals and the patients with oral carcinoma. Methods:15 patients with oral carcinomal at stages II or above were assigned to study group and 15 cases of healthy volunteers were assigned to control group. Leukocyte were isolated by density centrifugation. Adherent fractions were incubated in present of GM-CSF,IL-4 and TNF-α for 7 days in vitro. The morphological change of the cultured cells was observed by light microscopy and electronic microscopy. The phenotype expressions of CD83,CD1a,CD86, CD80, HLA-DR were analysized by flow cytometry. Results:Typical DCs were obtained from two groups after 7 days culture. The expression rate of CD83,CD1a on DC from healthy volunteers was significantly higher than that from patients (P<0.001). The DC from healthy volunteers had the higher expression level of CD80,CD86 and HLA-DR than that from patients, but with no statistically difference (P>0.05). Conclusion:DC derived from oral cancer patient' s peripheral blood monocyte might be more matured and is a good cell model for further immunotherapy and research.