细胞移植在白癜风治疗中的应用

目的:介绍细胞移植治疗白癜风的各种方法及效果。资料来源:应用计算机检索Medline 1996-01/2006-12与细胞移植治疗白癜风相关的文章,检索词为“vitili,gotransplantatio,nMelanocyte-keratinocyte cell,epidermal cell”,限定文献语种为“English”;同时检索万方数据库2000-01/2006-12相关文章,检索词为“白癜风,移植,黑素细胞,表皮细胞”,限定文献语种为中文。资料选择:共检索到相关文献180余条,选择细胞移植治疗白癜风临床应用,以及相关的表皮细胞或黑素细胞培养文章,无论是否随机、有无对照组均纳入,排除综述类及重复文献。资料提炼:对筛选的文章进一步查找全文,纳入31篇作为参考文献进行综述。31篇中介绍表皮细胞培养移植的8篇,介绍自体培养的黑素细胞移植的13篇,5篇论述表皮细胞悬液移植情况,报道同种异体黑素细胞移植的5篇。资料综合:文章介绍了4种移植治疗白癜风的不同方法,包括自体表皮细胞培养移植、自体培养的和非培养的黑素细胞移植、以及同种异体黑素细胞移植。治疗方法的选择因人而异,主要根据白斑的部位和大小。自体培养和非培养的黑素细胞移植治疗白癜风比传统的表皮移植效果好,用少量供皮区可以治疗大面积皮损,很有前景,但还有诸如细胞繁殖方法、移植技术、费用以及安全性等问题需要解决。结论:细胞移植是治疗白癜风的一个重要手段,但目前关于细胞移植的临床经验并不多,有的还在研究和探索阶段,所以应该小心谨慎。     

自体表皮移植治疗白癜风加压包扎的技巧及护理

目前自体表皮移植是治疗白癜风较理想的方法 ,其手术方法、术后包扎与一般的外科手术不同 ,除磨削白癜风皮损和移植皮片技术外 ,重要的是掌握加压包扎的技术 ,以能获得自体表皮移植治疗白癜风的效果。 1998年以来我院用自体表皮移植治疗白癜风 2 98例 ,现将加压包扎技巧及护理体会总结如下。1　资料与方法1 1　临床资料　 2 98例中男 15 2例 ,女 14 6例 ,4～ 4 6岁。患者病情稳定 ,白斑在半年内无明显增多 ,术前 3个月内局部未使用任何外用药物 ,皮损位于面部 76例 ,颈部 4 7例 ,四肢 5 8例 ,手部 6 5例 ,躯干 5 2例。1 2　方法　采用神思牌…     

白癜风患者皮损与正常皮肤疱液中抗氧化酶和脂质过氧化物水平比较

目的收集白癜风患者皮损部位及自身正常皮肤部位的疱液进行抗氧化酶和脂质过氧化物水平测定,探讨氧化性损伤和白癜风发生的关系.方法分别对26例白癜风表皮移植的患者抽取皮损部位及正常皮肤部位的疱液进行超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)、谷胱甘肽还原酶(GR)、丙二醛(MDA)测定,并对比分析上述2部位各项指标的变化.结果皮损主要分布于暴光部位的患者,其皮损部位的SOD及CAT活性显著低于正常皮肤部位(P<0.01、0.05),MDA水平显著高于正常皮肤部位(P<0.01),而皮损主要分布于非暴光部位的患者,皮损部位仅SOD活性显著低于正常皮肤部位(P<0.05).结论自由基导致的氧化性损伤与白癜风的发病有关.     

白癜风患者皮损与正常皮肤疱液中抗氧化酶和脂质过氧化物水平比较

目的　收集白癜风患者皮损部位及自身正常皮肤部位的疱液进行抗氧化酶和脂质过氧化物水平测定 ,探讨氧化性损伤和白癜风发生的关系。方法　分别对 2 6例白癜风表皮移植的患者抽取皮损部位及正常皮肤部位的疱液进行超氧化物歧化酶 (SOD)、过氧化氢酶 (CAT)、谷胱甘肽过氧化物酶 (GSH -Px)、谷胱甘肽还原酶 (GR)、丙二醛 (MDA)测定 ,并对比分析上述 2部位各项指标的变化。结果　皮损主要分布于暴光部位的患者 ,其皮损部位的SOD及CAT活性显著低于正常皮肤部位 (P <0 .0 1、0 .0 5 ) ,MDA水平显著高于正常皮肤部位(P <0 .0 1 ) ,而皮损主要分布于非暴光部位的患者 ,皮损部位仅SOD活性显著低于正常皮肤部位 (P <0 .0 5 )。结论　自由基导致的氧化性损伤与白癜风的发病有关     

异基因造血干细胞移植后继发白癜风改变（附1例报告）

慢性移植物抗宿主病（cGVHD）是含大量免疫活性细胞的移植物对宿主组织产生排斥导致宿主组织损伤的临床综合征。多发生在移植后100d以后。临床表现主要累及皮肤、肝脏、肠道,其中皮肤损害最为常见。皮损类型多种多样,有扁平苔藓样皮疹、苔藓样红皮病、干燥综合征、硬皮样皮损及硬化样苔藓等。本例cGVHD继发白癜风皮肤改变国内外未见报道。现结合文献复习报告如下。     

自体黑素细胞体外培养与移植治疗白癜风的研究

[目的]研究和探索黑素细胞培养移植治疗白癜风的方法与疗效.[方法]采用从发疱壁上获取黑素细胞、纯黑素细胞培养与增殖、移植区刮除种植法,进行自体黑素细胞培养移植治疗白癜风.[结果]18例白癜风患者中21块皮损进行了自体黑素细胞培养移植,总有效率为90.48%.[结论]此操作方法较简单、治疗面积大,色素分部均匀,值得临床推广和应用.     

自体表皮移植治疗皮节型白癜风32例疗效观察

本文应用自体吸疱表皮移植治疗３２例皮节型白癜风患者。共移植表皮２５６张，其中２４８张获色素再生，成功率为９６．９％。作者认为：移植表皮的制备、表皮的固定和移植的部位等是影响移植成功的关键。     

自体表皮移植加（bFGF）治疗非平整部位白癜风疗效观察

国内自80年代末至90年代初陆续采用自体表皮移植治疗白癜风取得肯定疗效。但对发生在非平整部位的白癜风，由于皮肤活动度大，使移植表皮不易固定，皮片难以成活，手术成功率较低。本科自2005年1月至2006年10月采用自体表皮移植加碱性成纤维细胞生长因子（bFGF）治疗33例白癜风取得满意疗效，现报道如下。     

窄谱中波紫外线预照射对自体表皮移植治疗稳定期白癜风的疗效影响

目的观察窄谱中波紫外线（NB-UVB）预照射对稳定期白癜风自体表皮移植疗效的影响。 方法将82例稳定期白癜风患者随机分为治疗组与对照组，治疗组患者白斑处首先进行8次以上NB-UVB照射，然后行自体表皮移植治疗；对照组单纯行自体表皮移植治疗。跟踪随访3个月观察疗效。 结果NB-UVB照射可明显提高自体表皮移植患者皮片的存活和复色率，疗效明显优于对照组（P<0.05）；治疗组散在性白癜风的痊愈率明显高于对照组（P<0.05）；疗效与照射次数、移植部位、色素出现时间等有关。 结论NB-UVB预照射可明显提高稳定期白癜风自体表皮移植的疗效。     

移植的嗅鞘细胞在大鼠正常和挫伤脊髓内的迁移

目的明确移植的嗅鞘细胞在脊髓内的迁移特点。方法来源于7日龄绿荧光Sprague Dawley大鼠嗅鞘细胞分别移植于正常大鼠脊髓、脊髓挫伤模型大鼠脊髓损伤部位中心及其临近组织,1周后取材观察移植细胞在脊髓内的迁移能力。结果移植嗅鞘细胞在正常脊髓内主要沿脊髓纵轴方向从注射位点向两侧在白质和灰质内迁移,绝大部分迁移细胞排列无规则;移植于脊髓损伤部位中心的嗅鞘细胞主要围绕注射位点沿脊髓纵轴呈椭圆形分布,占据损伤部位并分布于其周围的脊髓内,小部分在白质内向头侧和尾侧迁移,迁移距离较短;移植于距离损伤部位头侧和尾侧1mm处的嗅鞘细胞的主要在白质和灰质内沿脊髓纵轴向损伤部位迁移,还分别有一小部分沿中央管迁移。移植细胞可表达髓磷脂相关蛋白和神经丝。结论移植的嗅鞘细胞可在脊髓内迁移,其迁移能力取决于其自身特性,移植环境是影响其迁移的重要因素。     

皮肤发疱仪的研制与黑素细胞培养移植治疗白癜风

目的：进一步研制皮肤发疱仪．研究和观察局部皮肤发疱与黑素细胞培养后移植治疗白癜风的方法与效果。方法：采用从发疱壁上获取黑素细胞、纯黑素细胞培养与增殖、移植区刮除种植法、黑素细胞培养移植治疗白癜风。结果：25例白癜风患者中31块皮损进行了自体黑素细胞培养移植．总有效率为90％。结论：皮肤发疱仪临床应用效果好，操作方法较简单，黑素细胞培养后移植治疗白癜风面积大，色素分部均匀，值得临床推广和应用。     

嗅鞘细胞髓内移植修复完全性晚期脊髓损伤手术 多中心比较

目的:比较嗅鞘细胞(OECs)髓内移植修复脊髓损伤(SCI)手术多个临床中心结果,探讨适合临床要求的标准化移植手术。方法:汇总有代表性的临床治疗中心的研究结果,分析其移植细胞浓度、细胞总量、切口选择、移植部位、移植点数目、移植器械的优缺点、术后管理等方面,对比这些不同的参数对临床结果的可能影响。结果:共纳入4项临床研究,均是采用脊髓髓内实质内移植手术方式治疗晚期完全性SCI,包含中国中心2个,澳大利亚中心1个,欧洲中心1个,进行对比。细胞植入脊髓实质对晚期完全性SCI的功能恢复有一定效果。符合临床实际的简洁手术可能比精准的复杂操作手术更有优势。单位体积内过大移植容量,过长手术时间、过多细胞移植穿刺注射点可能是导致手术效果不佳的重要原因,移植术后需要足够的康复训练。结论:细胞植入脊髓实质对晚期完全性SCI患者神经功能恢复有效;简洁的手术可能比精准复杂注射操作更适合临床,但不适当的操作程序会导致无效的结果;移植术后需要足够的康复训练。     

头颈部白斑患者红绿蓝光及紫外光图像在白癜风诊断和治疗中的价值

  目的  探讨头颈部白斑患者红绿蓝(red green blue, RGB)光和紫外线(ultraviolet, UV)光图像在白癜风诊断、治疗及疗效评价中的价值。  方法  应用皮肤分析仪对608例头颈部白斑患者进行RGB光和UV光拍照, 定性分析同一患者头颈部白斑在RGB光和UV光下白癜风病变边界的区别。  结果  白癜风皮损在UV光下表现为界限清楚的亮白色荧光。608例头颈部白斑患者中, 通过RGB和UV图像确诊为白癜风281例(46.2%), 除外286例(47.0%), 不能明确诊断41例(6.7%)。部分黏膜和头皮部位受累的白癜风因颜色浅, 诊断困难, UV图像可明确诊断。肉眼不能明确白癜风皮损界限时, UV图像可明确受累范围, 指导治疗。对于疗效的评价, UV图像可更有效地确定复色范围, 并提示治疗后肉眼不可见皮损。  结论  头颈部白斑患者RGB和UV图像分析可用于诊断或除外白癜风, 特别是肉眼难于鉴别的皮损; 能有效地指导治疗和进行疗效评价, 更有效地确定复色范围。     

Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma

Owing to surveillance programs for detection of hepatocellular carcinoma (HCC) in patients with cirrhosis, more tumors are being detected at an early, asymptomatic stage. Percutaneous ablation is considered the best treatment option for patients with Child-Pugh class A or B cirrhosis and a single, nodular-type HCC smaller than 5 cm or as many as three HCC lesions, each smaller than 3 cm, when surgical resection or liver transplantation is not suitable. Radiofrequency ablation (RFA) has emerged as the most powerful method for percutaneous treatment of early-stage HCC. Recent studies have shown that RFA can achieve more effective local tumor control than ethanol injection and with fewer treatment sessions. In a randomized trial, local recurrence-free survival rates were significantly higher in patients who received RFA than in those treated by ethanol injection, and treatment allocation was confirmed as an independent prognostic factor by multivariate analysis. Due to advances in radiofrequency technology, RFA also has been used to treat patients with more advanced tumors. Preliminary reports have shown that RFA performed after balloon catheter occlusion of the hepatic artery, transarterial embolization, or chemoembolization results in increased volumes of coagulation necrosis, thus enabling successful destruction of large HCC lesions. This report reviews the current status of percutaneous, image-guided RFA in the therapeutic management of HCC.     

Toward epidermal stem cell-mediated ex vivo gene therapy of junctional epidermolysis bullosa

Junctional epidermolysis bullosa (JEB) is a group of severe, inherited skin diseases caused by mutations in the genes encoding laminin 5 or other components of the hemidesmosome. Since human epidermis is a self-renewing tissue, gene therapy of JEB requires the stable integration of the transgene into the genome of the epidermal stem cell. Human epidermal stem cells can indeed be cultivated and stably transduced with replication-defective retroviral vectors, allowing full phenotypic correction of the adhesion properties of JEB keratinocytes. Epidermal stem cells generate cohesive sheets of stratified epithelium suitable for the permanent coverage of massive skin defects, and genetically modified epidermal sheets maintain long-term expression of the transgene after transplantation on immunodeficient animals. Moreover, we have developed a clinical procedure that allows transplantation of cultured epidermal sheets on large body areas under local anesthesia and without cicatricial outcomes. Thus, (1) the possibility of cultivating lining epithelia, (2) the availability of noninvasive surgical procedures that allow the grafting of large skin areas, and (3) the demonstration of sustained transgene expression in vitro and in vivo by epidermal stem cells, prompt us to propose the implementation of a phase I/II clinical trial aimed at the ex vivo gene therapy of selected JEB patients. The aim of the trial is to validate the ex vivo procedure in a clinical setting, to prove its overall safety, and to analyze critical issues such as long-term survival of the genetically modified implant, immune response against the transgene product, and persistence of transgene expression at therapeutic levels.     

Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of Buruli ulcer in humans

Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and three treated for 12 weeks were culture negative. No lesions became enlarged during antibiotic treatment, and most became smaller. Treatment with rifampin and streptomycin for 4 weeks or more inhibited growth of M. ulcerans in human tissue, and it provides a basis for proceeding to a trial of antibiotic therapy as an alternative to surgery for early M. ulcerans disease.     

The 578-nm copper vapor laser in the treatment of cavernous hemangiomas in the oral cavity

A variety of operative and nonoperative treatment methods have been proposed to deal with cavernous hemangiomas. In an otorhinolaryngological unit where experience has been gained from managing superficial vascular lesions in Chinese skin with the 578-nm copper vapor laser, three patients with symptomatic large mucosal hemangiomas in the oral cavity were treated. All lesions have shown significant shrinkage after a single treatment utilizing an energy level of 20 J/cm 2. No further treatment, surgical or laser, has been necessary after follow-up of at least 12 months. The unique biological and tissue interaction of the copper vapor laser light is believed to be responsible for this remarkable response.     

The use of osteochondral allografts in the management of cartilage defects

Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.     

Vitiligo

Vitiligo is characterized by depigmentation in large or small areas of the skin. There is a complete lack of melanin production in the hypopigmented areas, due to the destruction of previously active melanocytes. This is in contrast to albinism, in which melanocytes are present but there is little or no pigmentation because of defective or absent tyrosinase. Although the etiology of vitiligo remains unknown, an autoimmune theory is gaining acceptance.