Potential lack of “standardized” processing techniques for production of allogeneic and xenogeneic bone blocks for application in humans

In the present study, the structure of two allogeneic and three xenogeneic bone blocks, which are used in dental and orthopedic surgery, were histologically analyzed. The ultimate goal was to assess whether the components postulated by the manufacturer can be identified after applying conventional histological and histochemical staining techniques. Three samples of each material, i.e. allogeneic material-1 and -2 as well as xenogeneic material-1, -2 and -3, were obtained commercially. After decalcification and standardized embedding processes, conventional histological staining was performed in order to detect inorganic matrix, cellular or organic matrix components. Allogeneic material-1 showed trabecular bone-like structures, which were free of cellular components as well as of organic matrix. The allogeneic material-2 showed trabecular bone structures, in which connective tissue and cellular remnants were embedded. Additionally, some connective tissue, which resembled fat-like tissue, was found within this material. The xenogeneic material-1 showed trabecular bone-like structures and contained organic components comparable to that demonstrated for the allogeneic material-2. The xenogeneic material-2 showed trabecular bone structures with single cells located in lacunae. The xenogeneic material-3 also showed trabecular structures. Neither cellular nor organic matrix components were found within this material. According to the data of the present study, the allogeneic material-1 and the xenogeneic material-3 were the only investigated materials for which the obtained histological data were in accordance with the manufactureŕs advertised information. The remaining three materials showed discrepancies—although the manufacturers of all five bone substitute materials stated that their blocks were free of organic/cellular remnants. These data are of great clinical and material science interest. It seems that even patented processing techniques are not always able to deliver reproducible materials. Although the manufacturers of all five bone blocks stated that their blocks were free of organic/cellular remnants, our histological analysis revealed that three out of five bone blocks did contain such remnants. Such specimens might be able to induce an immune response within the recipient.     

中国脑血管病影像应用指南2019

影像技术在脑血管病诊疗和研究中的重要地位不言而喻。2016年中华医学会神经病学分会及其脑血管病学组发布了中国脑血管病影像应用指南。由于影像技术的迅猛发展以及临床应用的循证医学证据的不断涌现,旧版已经不能满足临床需要。在2019新版指南中,我们对大家已熟悉的应用领域进行了精简,重点介绍了CT和MRI应用的新领域以及一些新技术及其后处理的新方法,如脑出血血肿早期扩大的平扫CT征、高分辨血管壁MRI的应用、定量磁化率成像、血流动力学成像技术等,为临床和科研的应用提供有用的工具。     

两种腰痛家庭训练方案的临床疗效

目的:比较两种家庭训练方案对腰痛患者的临床疗效。方法:门诊招募60例腰痛患者随机分为常规组(n=30)和核心组(n=30)。两组患者均接受腰痛防护知识宣教及评估。常规组接受常规家庭训练方案指导;核心组接受麦吉尔(McGill)"三大训练"(Big3)家庭方案指导。之后两组患者独立完成6周家庭训练。训练前后采用汉化Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛目测类比定级法(visual analogus scale,VAS)作为主要评估指标,腰部活动度和躯干肌群的肌耐力作为次要评估指标对患者治疗效果进行评估。根据患者训练的完成度、自觉帮助度及满意度评估患者治疗依从性及家庭训练方案的可行性。结果:常规组和核心组分别有24例和25例完成了家庭训练。经过6周家庭训练后,两组患者的ODI及VAS均有明显降低(P<0.01)、腰部ROM均有明显增加(P<0.01);常规组部分躯干肌群和核心组全部躯干肌群的肌耐力明显增强(P<0.01);核心组的ODI、VAS和右侧侧方肌的肌耐力与常规组比较差异具有显著性意义(P<0.05);核心组患者的自觉帮助度及满意度得分与常规组比较差异具有显著性意义(P<0.01)。结论:两种腰痛家庭训练方案均可行并有效。与常规家庭训练方案相比,Big3家庭训练方案对于改善腰痛患者疼痛和功能障碍方面具有更好的临床疗效,并且患者的接受度更高。     

侧卧手术体位对老年患者眼压变化的影响及护理观察要点

目的探讨使用有效的测量工具和在适合的测量时间段采集侧卧手术体位老年患者基础数据,找出患者眼压变化随体位变化的规律,旨在制订有效的护理预防措施。方法选取2019年3—6月在首都医科大学附属北京同仁医院中心手术室完成胸科胸腔镜手术的老年患者31例。使用icare回弹式眼压计分别于患者入手术室后、全身麻醉插管后、侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h、翻身拔管、出室前9个时间点测量双眼眼压,同时记录每个时间点患者的血压、心率数据,记录手术过程中液体出入量、特殊用药等。结果患者侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的血压与入室后比较,差异有统计学意义(P<0.05);不同时间点的心率比较,差异无统计学意义(P>0.05)。麻醉插管后患者双眼眼压均低于入室时眼压,差异有统计学意义(P<0.05);侧卧30 min、术中1 h、术中2 h、术中3 h的双眼眼压与入室后眼压比较,差异有统计学意义(P<0.05);侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的受压侧眼压与非受压侧眼压比较,差异有统计学意义(P<0.05)。Pearson相关分析显示,患者平均动脉压与受压侧眼及非受压侧眼的眼压均无相关性(r值分别为-0.1138、0.0179,P>0.05)。进入手术间时患者测试视力与术后6 h回病房后测试视力比较,差异无统计学意义(P>0.05)。结论胸腔镜手术老年患者的眼压随手术体位变化而波动,从侧卧5 min开始眼压出现变化,2 h内受压侧眼眼压达到高峰,体位恢复平卧位后,眼压随即恢复到入室时水平。本研究未发现血压与眼压变化的相关性。     

造血干细胞计数全血质控物的研制与评价

目的评价自制造血干细胞计数全血质控物的均匀性及稳定性。方法依据CNAS-GL03及ISO Guide 35的要求,对两个批号自制质控物的均匀性、稳定性进行评价,同时检测进口质控物作为对照。结果均匀性评价结果显示两批号自制质控物样品间差异均无统计学意义（P〉0.05）;稳定性评价结果显示20111101、2011111批号自制质控物随保存时间的延长均无线性趋势变化（P〉0.05）;各批号自制质控物及进口质控物长期稳定性的不确定度分别为0.023%、0.015%和0.012%。结论自制造血干细胞计数质控物的均匀性及稳定性良好。     

1例HPGD基因新缺失突变致儿童原发性肥大性骨关节病报道

目的通过对1例临床疑似原发性肥大骨关节病的患者进行HPGD基因分析并确诊,提高对该疾病的认识。方法根据患儿症状,体征及骨骼系统放射学检查进行临床诊断,提取患儿及其父亲外周血DNA,PCR扩增HPGD基因编码氨基酸的7个外显子片段,测序检测突变。结果患儿女性,5岁,具有手指及足趾末端指节肥大,手足多汗,前额皮肤增厚等典型临床表现。PCR扩增片段直接测序示患儿HPGD外显子3发生c.308₃09delCT（p.Thr103Thrfs4X）纯合改变。结论原发性肥大骨关节病为一种少见的常染色体隐性遗传疾病,典型的临床及影像学表现有助于诊断,HPGD基因突变分析是确诊的主要方法。     

Effectiveness and Safety of Computer-controlled Periodontal Ligament Injection System in Endodontic Access to the Mandibular Posterior Teeth

Objective To evaluate the effectiveness and safety of a computer-controlled periodontal ligament （PDL） injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis. Methods A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth： the premolar group （PM, z2=38）, first molar group （FM, n=66）, and second molar group （SM, n=58）. All the patients received computer-controlled PDL injection with 4% articaine and 1 ＇ 100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure. Results The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups （92.1%, 53.0%, 93.1%, respectively; 2 X =34.3, P〈0.01）. Both the PM and SM groups showed higher success rates than that of the FM group （v=l, f=16.73, P〈0.01, v=l, Z = 4.5, X2 2 P〈0.01）. No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups. Conclusion The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.     

Primary testicular lymphoma: experience with 13 cases and literature review

To summarize the clinicopathological features, therapeutic regimens, and outcomes for patients with primary testicular lymphoma (PTL), we retrospectively reviewed the medical records of 13 patients diagnosed with PTL between 2001 and 2012 at our hospital. Average age at diagnosis was 62.2 ± 13.9 years, and all patients presented with painless testicular swelling. Diffuse large B-cell lymphoma was the dominant histotype (69.2 %). All 13 patients were treated with inguinal orchiectomy and received chemotherapy and/or radiotherapy. Complete follow-up data were available for 10 patients with an average follow-up duration of 28.4 ± 30.9 months. Seven patients were evaluated as Ann Arbor stage I or II, and three as stage III or IV. Eight patients were found to have hypoechogenic and hypervascular signals in the testis on ultrasound examination. Complete remission was achieved in six patients, and four patients who were still undergoing chemotherapy during the last follow-up showed no signs of relapse. Of the 10 patients with complete follow-up records, three had relapses, which occurred in the CNS, epiglottis, and the nasal cavity. Time to relapse in these cases was 2, 7, and 11 months, respectively (3/10). The mean progression-free survival was 22.57 months (range 1.1–101.9 months).