Autologous Transplantation of Press‐fit Bone Cylinders in the Treatment of Pelvic Nonunion

The present study describes method for autologous bone transplantation to an area of nonunion at the pelvic ring in a way that ensures the best possible bone‐to‐bone interface (“press‐fit”) and provides optimal preconditions for the ingrowth of the bone graft. We modified a technique that has been used to transplant press‐fit bone‐baseplate‐cartilage cylinders for the repair of joint cartilage defects. The technique allows for precise harvesting of bone cylinders with a diamond‐coated and fluid‐cooled instrument. At the site where the graft shall be inserted, a cylindrical hole is created with a corresponding hollow diamond‐coated trephine. This ensures an optimal press‐fit implantation of the graft. The new surgical technique has been applied in four patients with nonunion of the pelvic ring. No intraoperative or postoperative complications occurred. In three patients, the procedure led to a reduction of pain and a higher level of mobility as well as a timely radiographic union (imaging not available for another patient). Our technique offers a valuable new treatment option for pelvic nonunion. The current article serves as a proof of concept. Future comparative studies will have to determine its value in detail.     

自体骨髓单个核细胞移植配合中药治疗下肢慢性缺血

目的:研究自体骨髓单个核细胞移植与中药合用对各种原因所致下肢缺血的治疗作用.方法:用集落细胞刺激因子使患者骨髓处于增生活跃状态,抽取骨髓血分离单个核细胞.移植采用缺血肢体远端动脉腔内及肌肉多点注射.观察患者手术前后肢体疼痛、冷感、间歇性跛行、溃疡创面情况评分以及踝肱比(ABl)变化.结果:治疗后患肢疼痛及冷感明显改善,跛行距离延长,创面愈合加快,ABI在术后短期内无明显升高.结论:自体骨髓单个核细胞移植结合中药治疗可以迅速改善下肢缺血患者的疼痛及冷感,促进伤口愈合,中远期有效改善局部的血液循环.     

The Role of Bone Marrow-Derived Cells During the Bone Healing Process in the GFP Mouse Bone Marrow Transplantation Model

Bone healing is a complex and multistep process in which the origin of the cells participating in bone repair is still unknown. The involvement of bone marrow-derived cells in tissue repair has been the subject of recent studies. In the present study, bone marrow-derived cells in bone healing were traced using the GFP bone marrow transplantation model. Bone marrow cells from C57BL/6-Tg (CAG-EGFP) were transplanted into C57BL/6 J wild mice. After transplantation, bone injury was created using a 1.0-mm drill. Bone healing was histologically assessed at 3, 7, 14, and 28 postoperative days. Immunohistochemistry for GFP; double-fluorescent immunohistochemistry for GFP-F4/80, GFP-CD34, and GFP-osteocalcin; and double-staining for GFP and tartrate-resistant acid phosphatase were performed. Bone marrow transplantation successfully replaced the hematopoietic cells into GFP-positive donor cells. Immunohistochemical analyses revealed that osteoblasts or osteocytes in the repair stage were GFP-negative, whereas osteoclasts in the repair and remodeling stages and hematopoietic cells were GFP-positive. The results indicated that bone marrow-derived cells might not differentiate into osteoblasts. The role of bone marrow-derived cells might be limited to adjustment of the microenvironment by differentiating into inflammatory cells, osteoclasts, or endothelial cells in immature blood vessels.     

A Successful Long-Term Method of Fat Grafting: Recontouring of a Large Subcutaneous Postradiation Thigh Defect with Autologous Fat Transplantation

A method of harvesting fat with intact cells using a veterinary needle and a fine needle aspiration device is described. Viable fat cells are obtained in large amounts. A large subcutaneous postradiation thigh defect was reconstructed with harvested fat placed subcutaneously in various sessions. A good, but not perfect, reconstruction was obtained. This case indicates that viable fat cells can be transplanted and can survive even in the adverse environment of a postradiation defect.     

同种反应性NK细胞在异基因干细胞移植治疗实体性肿瘤中的作用

干细胞移植(stem cell transplantation,SCT)是一种新兴技术,在多个临床领域有着广泛的应用.干细胞移植在肿瘤治疗领域的应用可分为两类:即大剂量化疗/放疗联合自体干细胞移植(autologous stem cell transplantation,Auto-SCT)和异基因干细胞移植(allogeneic stem cell transplantation,Allo-SCT)两大类.     

Treatment of Chronic Osteomyelitis by Free Grafts of Cancellous Autologous Bone Tissue: A Preliminary Report

Chronic osteomyelitis was treated by free grafts of autologous bone tissue in 13 consecutive patients aged 18 to 81 years. In all patients the osteomyelitis was located in the leg, and Staphylococcus aureus was the causative organism. Seven had an infected non-union. The duration of the osteomyelitis varied from less than 1 year to 75 years. Surgical debridement and grafting of cancellous and cortical cancellous bone were performed at the one operation. The osteomyelitis healed after a single operation in all patients but one, who needed three operations before the infection was eradicated. In one patient a second bone grafting operation was necessary before weight-bearing could be allowed. Although the number of patients is small, the results agree well with larger series published recently. Grafting of autologous bone tissue seems to be a very valuable method of treatment for chronic osteomyelitis.     

Role of Bone Graft in Reconstruction of Skull Base Defect: Is a Bone Graft Necessary

Ten patients underwent reconstruction of skull base defects between 1989 and 1992. In this series, the maximum size of the skull base defect was 6 × 5 cm. Three patients underwent bone grafts to reinforce the skull base. The postoperative course of seven patients without bone grafts was uneventful. There was no cerebrospinal fluid leakage, meningitis, extradural abscess, on brain herniation. On the other hand, two of the three patients with bone grafts developed extradural abseesses requiring the bone grafts to be removed. Although the number of patients in this series is not large, this study demonstrates that the use of bone grafts in reconstruction of skull base detects could be one of the factors in increasing the chances of infectious complications. We think that a bone graft is not necessary to reconstruct moderate-sized skull base defects.     

吻合血管的长段腓骨串联组合移植治疗瘤段切除后巨大骨关节缺损

目的：重建骨骼连续性,恢复肢体功能。方法：对四肢长骨大范围的或累及关节的巨细胞瘤以及骨纤维结构不良病灶,采取彻底切除病灶,骨缺损区行吻合膝下外侧血管的带腓骨小头的腓骨近端移植或串联的超长双腓骨组合游离移植等方法进行治疗。结果：随访6个月－3年,移植骨全部骨性连接,肢体长度及负重强度无明显影响,功能恢复接近正常。结论：应用此方法,对因四肢长骨的瘤段切除后所遗留的巨大的或累及关节的骨缺损有很好的疗效,对“保肢疗法”和提高病人的生活质量有较大的现实意义。     

Knowledge and Attitude of Donor Cardholders Toward Organ and Tissue Donation and Transplantation in an Iranian Tissue Bank: A Case-Control Study

Background

Cadaveric organ shortage is the most important obstacle to more widespread provision of transplants. Many factors influence the donation rate: social factors, religion, familial relations, and especially knowledge and attitudes toward organ and tissue donation and transplantation. Increasing public awareness can reform the incorrect beliefs and myths about donation and transplantation. This study investigated knowledge and attitudes of donor cardholders toward organ and tissue donation as well as transplantation.

Methods

This case-control study was performed in 2006 among 178 donor cardholders and the same number of a control group who completed a questionnaire including 23 questions and demographic information.

Findings

Knowledge and attitude among the cardholder was significantly greater than the control group (P < .05). We observed a inverse correlation between age and a positive attitude toward donation and transplantation among cardholders.

Conclusion

This study suggested that the main reasons for refusal to donate organ and tissue were insufficient knowledge and negative attitudes due to misinformation regarding donation and transplantation. We believe that educating and motivating the public via the mass media can increase the rate of consent for organ and tissue donation and transplantation.     

翼状胬肉切除术联合自体角膜缘干细胞移植术治疗翼状胬肉的临床效果

目的 探析翼状胬肉切除术联合自体角膜缘干细胞移植术对于翼状胬肉的治疗效果。方法 选取 2021年1月-2024年1月本院收治的翼状胬肉患者82例,依据手术方式不同分为对照组和观察组,各41例。 对照组行翼状胬肉切除术,观察组在此基础上行自体角膜缘干细胞移植术,比较两组泪膜破裂时间、角 膜荧光染色试验评分、散光度、泪液分泌试验评分、临床疗效、恢复时间、并发症发生率、美容满意 度。结果 观察组干预后泪膜破裂时间、角膜荧光染色试验评分、散光度、泪液分泌试验评分均优于 对照组（P＜0.05）;观察组总有效率为97.56%,高于对照组的82.93%（P ＜0.05）;观察组角膜上皮修复时 间、不适症状持续时间及拆线时间均短于对照组（P ＜0.05）;观察组并发症发生率为4.88%,低于对照组 的19.51%（P ＜0.05）;观察组美容满意度为97.56%,高于对照组的82.93%（P ＜0.05）。结论 翼状胬肉切 除术联合自体角膜缘干细胞移植术治疗翼状胬肉能够有效改善相关临床指标,提高临床疗效,减少并发症 发生率,缩短恢复时间,提高美容满意度。     

High-Dose Melphalan and Autologous Hematopoietic Stem Cell Transplantation in Primary Amyloidosis: Single-Center Results

Background

Systemic immunoglobulin light-chain amyloidosis (AL) is a plasma cell dyscrasia resulting in multisystem organ failure and death. Autologous hematopoietic stem-cell transplantation (ASCT) has been widely used to treat patients with AL. However, treatment-related mortality remains high and reported series are subject to selection bias.

Methods

To define the role of patient selection in stem cell transplantation, we evaluated 24 consecutive AL patients transplanted at our center.

Results

Complete hematologic response was achieved in all 20 patients surviving >100 days posttransplantation. The 1-year overall survival (OS) rate after ASCT was 78.5%. The 5- and 10-year progression-free and OS rates were 57% and 47%, respectively. Treatment-related deaths owing to cardiovascular problems occurred in 16% of cases.

Conclusion

ASCT for AL amyloidosis can be safely performed in experienced transplantation centers, and increased risk is associated mainly with cardiovascular system involvement.     

髓芯减压植骨并自体骨髓间质干细胞移植治疗股骨头坏死手术配合

对5例股骨头缺血性坏死患者采用髓芯减压并自体骨髓问质干细胞移植治疗.结果 5例均于术后3周后下床活动.髋关节疼痛完全消失.3个月后复查示,50%股骨头死骨成活,HHS评分≥95分.提示自体骨髓问质干细胞移植治疗股骨头缺血性坏死创伤小、疗效好,早期股骨头坏死患者可恢复髋关节功能.手术室严格执行消毒隔离制度,巡回护士和器械护士熟悉手术配合步骤,充分准备物品,严格无菌操作,控制术中感染,才能确保手术顺利完成.     

自体外周血干细胞移植治疗糖尿病足

目的：探讨外周血干细胞自体移植治疗糖尿病足的临床疗效.方法：患者共5例,9条肢体.移植前每日皮下注射rhG-CSF 300～600 μg进行外周血干细胞动员,第5 d行血细胞分离机采集干细胞,配成干细胞混悬液进行小腿肌肉局部按3 cm×3 cm距离进行注射移植治疗,观察移植后各项指标综合评估.结果：9条下肢均得以保存,症状好转.2例行数字减影下肢动脉造影显示侧支建立丰富,随访3月无移植相关并发症和不良反应.结论：动员后的外周血干细胞移植治疗糖尿病足是一种简单、安全、有效的方法.     

自体外周血干细胞移植在糖尿病足坏疽中的临床应用研究

目的研究应用自体干细胞移植治疗糖尿病足坏疽的临床疗效。方法 2006年7月至2011年6月,我们应用自体外周血干细胞移植方法治疗糖尿病足坏死患者15例,男6例,女9例,平均年龄67岁,糖尿病史平均年限17年。创面最小6cm×8cm,最大10cm×15cm,术前动脉血管CT成像检查证实下肢主要血管闭塞性病变严重,大部分完全阻塞。术前进行全面查体,确认身体机能符合采集血流条件,术前4天开始应用药物刺激动员骨髓造血干细胞到外周血流中,后连续监测外周血干细胞数量,待干细胞动员量达到最大时应用血细胞分离机分离出干细胞混悬液约50mL。在无菌操作下,由膝关节上至足背,在病变闭塞血管干沿途按照事先做好的标记每隔2cm注射1mL。结果患者注射后早期局部皮温明显升高,创面渗血增多,出现注射部位灼痛,创面肉芽生长明显增快,平均3周左右肉芽健康,可以接受植皮手术。患者在疼痛、间歇性跛行距离、踝肱指数等方面的指标均有明显改善,4～6周复查动脉血管CT成像;下肢闭塞的血管有明显的侧支循环建立。结论自体外周血干细胞提取后于闭塞病变血管沿途注射,术后有明显的侧支循环粗大支建立,局部血运改善,利于溃疡愈合,从而避免了截肢或最大限度降低了截肢平面,该方法较骨髓移植培养干细胞经济实惠、风险小,是一种安全无创、操作简单、效果明显的方法。     

The Role of Cytokines in the Changes in Bone Turnover Following Bone Marrow Transplantation

Osteoporosis is a common disease among patients undergoing transplantation and a loss of bone mass is usually detected after bone marrow transplantation (BMT), particularly during the immediate post-BMT period. Post-BMT bone loss is primarily related to gonadal dysfunction and immunosuppression. Cytokines, especially interleukin 6, play an important role in the pathogenesis of postmenopausal osteoporosis. However, the pathogenetic role of cytokines in post-BMT bone loss is unknown and data on the changes of cytokines in accordance with bone turnover markers are scarce. The aim of this study was to assess the relationship between bone turnover markers and cytokines, which are regularly sampled at peripheral blood and bone marrow before and after allogeneic BMT. This prospective study included two analyses. The first was a study of 46 BMT recipients (M/F 28/18), examining the relationship between bone turnover markers and serum cytokines that were measured before and at 1 week, 2 weeks, 3 weeks, 4 weeks and 3 months after BMT. Serum intact parathyroid hormone was measured before BMT and at 3 weeks after BMT and its relation to other cytokines and bone turnover markers was evaluated. The second analysis was a study of 14 (M/F 9/5) of 46 patients in whom bone marrow plasma cytokines [interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α)] were measured at 3 weeks after BMT. The relationship between bone marrow plasma cytokines and bone turnover markers was studied because bone marrow is the microenvironment where the real changes in bone turnover occur. Serum type I collagen carboxyterminal telopeptide (ICTP), a bone resorption marker, increased progressively until 4 weeks (peak) after BMT and then decreased thereafter. Serum osteocalcin, a bone formation marker, decreased progressively until 3 weeks after BMT and then increased thereafter. Serum IL-6 increased until 2 weeks after BMT and declined thereafter. Serum TNF-a increased until 3 weeks after BMT and declined thereafter. There was a significant positive correlation between serum ICTP and bone marrow IL-6 levels at 3 weeks after BMT, when a marked change in bone metabolism occurs following BMT. However, a correlation between bone turnover markers and bone marrow TNF-aor peripheral blood cytokines was not found. At 3 months after BMT, there was a significant negative correlation between the mean daily steroid dose and the serum osteocalcin level (r=−0.43, p<0.05). The correlation between the mean daily steroid dose and serum ICTP was also significant (r= 0.41, p<0.05). Our data suggest that the progressive increase in bone resorption during the immediate post-BMT period is related to both steroid dose and the increase in bone marrow IL-6, which is a potent stimulator of bone resorption in vivo. Received: 29 November 2000 / Accepted: 1 August 2001     

Tissue Procurement System in Japan: The Role of a Tissue Bank in Medical Center for Translational Research, Osaka University Hospital

Although organ procurement has been regulated by The Organ Transplantation Law (brain-dead donors since 1997, donors after cardiac death since 1979), there has been no law or governmental procurement network (except for cornea) in Japan. Since the late 1980s, some university hospitals have developed original banks. Finally, in 2001 guidelines for tissue procurement were established by The Japanese Society of Tissue Transplantation and Japan Tissue Transplant Network (JTTN) to coordinate tissue harvesting. Five tissue banks were joined to the tissue transplant network (skin in one, heart valves in two, and bone in two). As the number of tissue banks is small, each bank cooperates on procurement, but cannot cover the entire country. With regard to skin transplantation, only one skin bank—The Japan Skin Bank Network (JSBN), which is located in Tokyo—has organized skin procurement. Therefore, it has been difficult to procure skin in areas distant from Tokyo, especially around Osaka. In order to improve such a situation, a tissue bank collaborating with the JSBN was established at The Medical Center for Translational Research (MTR), Osaka University Hospital in April 2008. The bank has played a role in skin procurement center in western Japan and supported procurement and preservation at the time of the skin procurement. Between April 2008 and September 2009, the bank participated in eight tissue procurements in the western area. In the future, the bank is planning to procure and preserve pancreatic islets and bones. Moreover, there is a plan to set up an induced pluripotent stem cells center and stem cell bank in MTR. This tissue bank may play a role to increase tissue procurement in Japan, especially in the western area.     

Stable Vitiligo Treated by a Combination of Low-Dose Oral Pulse Betamethasone and Autologous, Noncultured Melanocyte-Keratinocyte Cell Transplantation

BACKGROUND: Various surgical procedures are in use to treat stable vitiligo. The possibility of Koebner phenomenon always exists with surgical treatment. Partial or complete failure to repigment is observed in spite of clinical stability. AIM: To evaluate the usefulness of a combination treatment of low-dose oral betamethasone and melanocyte-keratinocyte transplantation. METHODS: Oral betamethasone was given to patients who failed to respond either completely or partially to melanocyte-keratinocyte cell transplantation, and the procedure was repeated for previously treated and nontreated area. A simpler and modified method described by Mulekar was performed. RESULTS: Seventeen patients with vitiligo vulgaris and eight patients with segmental vitiligo were retransplanted after giving oral betamethasone for 2 to 10 months after the initial procedure. Two patients of vitiligo vulgaris and one of segmental vitiligo failed to respond completely even after repeat transplantation. Fifteen vulgaris and seven segmental patients showed excellent to good repigmentation after repeat transplantation. CONCLUSION: Combined treatment of oral betamethasone and melanocyte cell transplantation has a potential to produce complete repigmentation in patients with large vitiliginous areas.