生物羊膜移植与自体球结膜移植治疗复发性翼状胬肉的临床观察

目的观察生物羊膜移植与自体球结膜移植治疗翼状胬肉的术后临床观察，比较两种手术方法的疗效。方法随机将复发性翼状胬肉患者64例（70只眼）分为A、B两组-A组30例（34眼）采用翼状胬肉切除联合生物羊膜移植．B组34例（36眼）采用翼状胬肉切除及自体球结膜移植．观察术后角膜愈合情况、角膜缘新生血管及角结膜是否有翼状胬肉样组织．结果术后随访10-18个月，A组复发2眼（6%）；B组复发3眼（8%）．两组比较没有统计学意义（P〉0.05．）结论生物羊膜移植与自体球结膜移植治疗翼状胬肉，效果良好，复发率低，随诊观察二者无显著统计学差异。     

手术切除并新鲜羊膜移植治疗复发性翼状胬肉

目的探讨手术切除联合新鲜羊膜移植术治疗复发性翼状胬肉的临床效果。方法施行翼状胬肉手术切除联合新鲜羊膜移植治疗复发性翼状胬肉病例32例（32只眼）,随访12～24个月。结果本组全部病例新鲜羊膜移植成功,无排斥反应,30眼术后角膜光滑透明或残留角膜云翳,无胬肉增生,无睑球粘连,治愈率93.8%,2例复发,复发率6.2%。结论手术切除联合新鲜羊膜移植术是治疗复发性翼状胬肉的理想方法 ,值得临床推广和应用,有利于基层医院开展。     

新鲜羊膜与生物羊膜移植治疗翼状胬肉的疗效对比

目的探讨新鲜羊膜和成品生物羊膜移植治疗翼状胬肉的治疗效果。方法收集初发的翼状胬肉患者60例（78眼），随机分成新鲜羊膜组和生物羊膜组2组，术后观察角膜上皮愈合情况，羊膜移植片成活和动态变化，翼状胬肉的复发率等指标，随访6～12个月。结果手术均一次成功，无免疫排斥反应。3～4d角膜上皮修复，2周左右可见羊膜开始融解、吸收。随访期内新鲜羊膜组有3眼胬肉复发，复发率为7．89％，生物羊膜组4眼发病，复发率为10％，两组间的复发率比较没有统计学差别（P〉0．05）。结论新鲜羊膜和成品生物羊膜移植均可降低翼状胬肉术后的复发率，而成品羊膜因取用方便，安全性高而值得推广使用。     

手术切除并新鲜羊膜移植治疗复发性翼状胬肉

目的 探讨手术切除联合新鲜羊膜移植术治疗复发性翼状胬肉的临床效果.方法 施行翼状胬肉手术切除联合新鲜羊膜移植治疗复发性翼状胬肉病例32例(32只眼),随访12～24个月.结果 本组全部病例新鲜羊膜移植成功,无排斥反应,30眼术后角膜光滑透明或残留角膜云翳,无胬肉增生,无睑球粘连,治愈率93.8%,2例复发,复发率6.2%.结论 手术切除联合斯鲜羊膜移植术是治疗复发性翼状胬肉的理想方法,值得临床推广和应用,有利于基层医院开展.     

新鲜羊膜移植治疗复发性翼状胬肉的临床疗效

目的探讨新鲜羊膜移植治疗复发性翼状胬肉的临床疗效。方法对30例(36只眼)复发性胬肉患者行胬肉切除及部分睑球粘连分离联合新鲜羊膜移植。结果术后平均随访12个月,所有患者除4只眼有复发外,其余全部治愈。移植术后复发率为11.1%。结论新鲜羊膜移植是治疗复发性胬肉的有效方法。     

新鲜人羊膜移植在翼状胬肉治疗中的应用

背景:翼状胬肉在北方的发病率较高,使用传统手术方法切除后角膜易出现散光,复发率也较高,患者往往需要行二次甚至多次手术处理,痛苦较大。目的:观察新鲜羊膜移植治疗翼状胬肉中的临床效果。方法:选择原发性翼状胬肉患者48例58眼,根据患者自愿选择分为新鲜人羊膜移植组29眼与单纯性切除组29眼,在显微镜下分别行翼状胬肉切除联合新鲜羊膜移植、单纯性翼状胬肉切除,术后随访6～12个月,观察两组胬肉复发及眼表修复情况。结果与结论:末次随访时,新鲜人羊膜移植组29眼中2眼复发,27眼治愈,复发率为6%。单纯性切除组29眼中4眼复发,25眼治愈,复发率为13%。两组复发率比较差异有显著性意义(P0.05)。说明新鲜人羊膜移植可明显降低翼状胬肉术后复发率,是一种有效方法,其远期疗效有待进一步验证。     

新鲜羊膜移植在翼状胬肉手术中的应用

目的新鲜羊膜移植在翼状胬肉手术中临床应用观察。方法采用新鲜羊膜治疗翼状胬肉。结果140例（172眼）随访观察1-3年,仅一眼复发,角膜混浊明显改善,视力有所提高。结论应用新鲜羊膜移植治疗翼状胬肉,方法简便,效果满意。     

丝裂霉素联合自体角膜移植术治疗翼状胬肉50例分析

目的探讨丝裂霉素C联合自体角膜缘干细胞移植治疗翼状胬肉的效果。方法对50例（75）眼翼状胬肉患者行翼状胬肉切除和丝裂霉素C联合自体角膜缘干细胞移植术。结果50例（75眼）翼状胬肉患者随访12-24个月，2例复发。结论翼状胬肉切除和丝裂霉素C联合自体角膜缘干细胞移植术疗效好．可较大地降低胬肉术后的复发率。     

带自体角膜缘的结膜瓣移植治疗翼状胬肉

目的探讨带自体角膜缘的结膜瓣移植在翼状胬肉治疗中的效果。方法采用手术显微镜下翼状胬肉切除联合带自体角膜缘移植治疗原发性和复发性翼状胬肉50例60眼,术后随访12～24个月。结果50眼治愈,4眼翼状胬肉复发。结论带自体角膜缘的结膜瓣移植治疗原发性和复发性翼状胬肉安全有效。     

翼状胬肉三种手术方式疗效对比

目的：探讨翼状胬肉逆向切除联合自体角膜缘干细胞移植术治疗及预防翼状胬肉复发的临床疗效.方法：将翼状胬肉患者129例（129眼）随机分成3组,每组43例（43眼）,分别采用单纯翼状胬肉逆向切除术（A组）、翼状胬肉逆向切除联合羊膜移植术（B组）、翼状胬肉逆向切除联合自体角膜缘干细胞移植术（C组）治疗.术后随访6个月,比较3组的复发率.结果：本组129例术后均治愈.A、B、C三组在术后6个月时的复发率分别为37.21%、13.95%和6.98%,其中翼状胬肉逆向切除联合自体角膜干细胞移植术后复发率最低.经统计学处理,A组复发率高于B组（P＜0.05）和C组（P＜0.01）,而B、C两组间比较差异无统计学意义（P＞0.05）.结论：翼状胬肉逆向切除联合自体角膜缘干细胞移植术是治疗翼状胬肉、预防其复发的有效方法.     

角膜缘干细胞移植联合丝裂霉素C治疗复发性翼状胬肉

目的 观察自体角膜缘干细胞移植联合丝裂霉素C治疗复发件翼状胬肉的疗效.方法 将58例(62眼)复发性翼状胬肉患者随机分为2组,治疗组(32例,35跟)采用角膜缘于细胞移植联合应用丝裂霉素C;对照组(26例,27眼)单纯采用角膜缘干细胞移植术治疗.术后随访6～30个月并比较疗效.结果 治疗组1眼冉复发,再复发率2.86%;对照组5眼再复发,再复发率18.52%,两组差异具有统计学意义(P<0.05).治疗组角膜创面上皮平均愈合时间为(8.34 ±2.38)d,对照组为(7.21±2.55)d,差异无统计学意义(P>0.05).两组均未发现严重并发症.结论 角膜缘干细胞移植联合应用丝裂霉素C治疗复发性翼状胬肉再复发率低,并发症少,为复发性翼状胬肉安全和有效的治疗方法 .     

新鲜羊膜移植治疗重症角膜溃疡

背景：羊膜具有抗原性低、促进眼表上皮化修复、减轻炎性反应、抑制纤维组织增生和新生血管形成等作用。在修复角膜缺损区的创面,可提供一个理想的基底膜,使其迅速上皮化和创口愈合。 目的：新鲜羊膜移植治疗重症角膜溃疡的安全性及其临床疗效。 方法：纳入非感染性继发角膜溃疡6例(6只眼)和感染性原发角膜溃疡8例(8只眼),共14例临床连续住院患者。非感染性角膜溃疡行单纯新鲜羊膜移植(6只眼),感染性角膜溃疡羊膜移植联合碘酊烧灼(8只眼)。移植后裂隙灯显微镜下观察角膜溃疡的愈合过程,角膜透明性的变化,移植羊膜存活的时间。 结果与结论：新鲜羊膜植片未发生排斥反应。14例重症角膜溃疡移植治疗后病情缓解,未发生角巩膜穿孔、坏死等严重并发症。其中非感染性角膜溃疡组1 只眼溃疡未愈合。角结膜未发生进行性溶解、穿孔,视力无提高。随访期间溃疡未出现复发及严重的并发症。提示,新鲜羊膜移植治疗重症角膜溃疡是一种有效、安全的方法。     

HLA匹配角膜缘干细胞联合羊膜移植修复翼状胬肉

背景：HLA匹配的角膜缘干细胞联合羊膜移植治疗翼状胬肉是眼科医生治疗的新理念,该方法治疗后并发症少、康复快、复发率低,尤其是能减少移植排斥反应等已被广泛接受。 目的：探讨HLA匹配的角膜缘干细胞联合羊膜移植治疗翼状胬肉疗效。 方法：选取2013年3月1日至2014年4月30日行HLA匹配的角膜缘干细胞联合羊膜移植治疗的翼状胬肉患者47例(47眼)作为试验组;回顾性分析2010年3月1日至2012年12月1日采用单纯翼状胬肉切除方法治疗的翼状胬肉患者40例(47眼)作为对照组,对两组患者治愈和复发情况进行比较。 结果与结论：试验组47例,全部顺利完成治疗,无并发症,其中1例切口感染,特殊对症治疗后均已好转出院,全部患者均无移植排斥反应。试验组治愈45眼,复发2眼,复发率为4.3%。对照组47眼中治愈32眼,复发15眼,复发率31.9%。结果表明HLA匹配的角膜缘干细胞联合羊膜移植治疗翼状胬肉并发症少、复发率低,是治疗翼状胬肉一种行之有效的方法。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

Safety and efficiency of transplantation of allogenic multipotent stromal cells in surgical treatment of dilatated cardiomyopathy

Clinical study of intracoronary transplantation of allogenic multipotent bone marrow stromal cells was carried out in patients with severe chronic cardiac failure against the background of dilatated cardiomyopathy. The results indicate that intracoronary injection of allogenic multipotent stromal precursors is a safe procedure. No complications and side effects directly or indirectly related to cell transplantation were recorded during the immediate and delayed postoperative periods. The positive effect of cell transplantation developed from week 1 after transplantation and persisted for 6 months. It manifested in reduction of the level of brain natriuretic peptide and improvement of patient’s functional status and quality of life. No appreciable changes in the main echocardiographic values were noted. Transplantation of allogenic multipotent stromal cells is effective as a component of combined therapy for chronic cardiac failure at the stage of preparation to surgery as a “bridge to surgical treatment”.     

肾移植后并发肺结核感染的诊断与治疗

背景：肾移植后患者肺结核感染率较高,临床表现缺乏典型性,给诊断和治疗带来不便。 目的：总结同种异体肾移植后肺结核感染的诊断和治疗方法。 方法：回顾性分析2010年1月至2013年10月期间在南方医科大学珠江医院器官移植科诊断为肾移植后肺结核感染的13例患者相关临床诊断和治疗方法。 结果与结论：肾移植后并发肺结核感染的患者发病时间为肾移植后4-120个月,62%(8/13)患者于移植后18个月内发病。患者多以长时间发热为主要的临床表现,常以低热为首发表现。4例根据病史、影像学资料结合病原学阳性确诊,5例根据病史、影像学资料结合肺穿刺活检组织病理学阳性确诊,其余4例根据病史、影像学资料结合实验性抗结核治疗有效而做出临床诊断。患者肺部体征早期不明显,胸部CT有助于早期诊断和鉴别诊断。所有患者遵循早期、规律、全程、适量、联合原则进行抗结核治疗,疗程一般6-10个月,经给予联合抗结核感染药物、调整免疫抑制剂及五酯胶囊保肝等综合治疗,13例患者均存活,未出现死亡病例。2例由于感染早期未及时正规治疗,发生急性排斥反应,导致移植肾功能丧失而恢复血液透析,其余患者均痊愈出院,随访6个月肾功能正常(查血肌酐变化)。 说明肾移植后并发肺结核病的患者应早发现、早诊断、早治疗。CT引导下穿刺活检可作为肾移植后菌阴肺结核诊断和鉴别的有效且可行的手段。在调整免疫方案和抗结核治疗同时给予五酯胶囊可显著减少钙调神经蛋白抑制剂类药物剂量,减轻钙调神经蛋白抑制剂类药不良反应。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

膜诱导联合皮瓣移植修复长段骨缺损并软组织缺损

文题释义：骨诱导膜技术：包含体内形成诱导和诱导膜内植骨2个阶段,其中体内形成诱导膜首先行骨缺损部位彻底清创,依据骨折具体状况选取合适固定方式对骨折行稳定固定,采用聚甲基丙烯酸甲酯骨水泥填充骨缺损部位,感染性骨缺损则依据细菌培养药敏结果或经验采用含敏感抗生素骨水泥。该术后6-8周纵行切开诱导膜结构,小心去除骨水泥,采用钻头或骨锉去除两侧骨端和髓腔硬化骨,促进植骨融合,于骨膜内填充自体松质骨,缝合诱导膜,预防移植骨重吸收。 Iliazarov外固定牵张成骨：经过应力牵拉刺激加速骨折断端间充质干/祖细胞分化增殖,加速生成新骨与肢体重建,在修复骨缺损时还可恢复肢体长度完成骨折断端加压愈合。但Iliazarov外固定牵张成骨需要长时间固定,技术操作复杂,治疗周期长,费时费力。 背景：采用膜诱导技术治疗长段骨缺损具有并发症少、治疗效果显著且操作简便等优势,既往研究多采用该技术治疗软组织条件较好的骨缺损患者,对于骨缺损且软组织缺损面积较大或者伴随感染等患者的研究较少。 目的：分析膜诱导技术联合皮瓣移植修复长段骨缺损并软组织缺损的疗效。 方法：选择2016年10月至2018年8月南华大学附属南华医院收治的长段骨缺损合并软组织缺损患者15例,平均年龄(47.15±8.16)岁,创面软组织缺损面积5.1 cm×3.4 cm至21.8 cm×9.4 cm,骨缺损长度5.8-19.5 cm,平均(11.4±2.3) cm。对于创面轻度污染者行清创、骨折外固定、骨缺损区域骨水泥填塞,局部带蒂皮瓣或游离皮瓣覆盖皮肤创面;对于创面感染患者,先予封闭式负压引流治疗,待感染控制后再填充骨水泥及皮瓣手术。一期术后8-12周行二期植骨手术,术后随访12个月。试验获得南华大学附属医院伦理委员会批准。 结果与结论：①创面轻度污染的9例患者,清创后固定外固定架、填充骨水泥和皮瓣移植修复软组织缺损,均未发生感染;②6例感染患者清创封闭式负压引流一二周完全控制感染后进行填充骨水泥和皮瓣手术,创面愈合;③15例患者在骨缺损二期植骨以后均骨性愈合,愈合时间在8-12个月间,平均(9.18±2.10)个月;④结果表明,膜诱导技术联合皮瓣移植可有效治疗长段骨缺损并软组织缺损。 ORCID: 0000-0002-6182-9993(陈彦名) 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Reconstruction of damaged corneas by transplantation of autologous limbal epithelial cells

BACKGROUND: Stevens-Johnson syndrome, ocular pemphigoid, and thermal or chemical burns can cause scarring and opacification of the cornea and loss of vision. Transplantation of epithelial cells from the limbus of the contralateral cornea can restore useful vision. However, this procedure requires a large limbal graft from the healthy eye and is not possible in patients who have bilateral lesions. METHODS: We took specimens of limbal epithelial cells from the healthy contralateral eyes of six patients with severe unilateral corneal disease. The epithelial cells were cultured and expanded on amniotic membrane. The amniotic membrane, together with the sheet of limbal epithelial cells, was transplanted to the denuded corneal surface of the damaged eye after superficial keratectomy to remove fibrovascular ingrowth. The mean (+/-SD) follow-up period was 15+/-2 months. RESULTS: Complete reepithelialization of the corneal surface occurred within two to four days of transplantation in all six eyes receiving transplants. By one month, the ocular surface was covered with corneal epithelium, and the clarity of the cornea was improved. In five of the six eyes receiving transplants (83 percent), the mean visual acuity improved from 20/112 to 20/45. In one patient with a chemical burn who had total opacification of the cornea, the acuity improved from the ability to count fingers at 40 cm to 20/200. No patient had recurrent neovascularization or inflammation in the transplanted area during the follow-up period. CONCLUSIONS: Transplantation of autologous limbal epithelial cells cultured on amniotic membrane is a simple and effective method of reconstructing the corneal surface and restoring useful vision in patients with unilateral deficiency of limbal epithelial cells.     

Model for End-Stage Liver Disease,Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients

OBJECTIVES:

Liver transplantation has not increased with the number of patients requiring this treatment, increasing deaths among those on the waiting list. Models predicting post-transplantation survival, including the Model for Liver Transplantation Survival and the Donor Risk Index, have been created. Our aim was to compare the performance of the Model for End-Stage Liver Disease, the Model for Liver Transplantation Survival and the Donor Risk Index as prognostic models for survival after liver transplantation.

METHOD:

We retrospectively analyzed the data from 1,270 patients who received a liver transplant from a deceased donor in the state of São Paulo, Brazil, between July 2006 and July 2009. All data obtained from the Health Department of the State of São Paulo at the 15 registered transplant centers were analyzed. Patients younger than 13 years of age or with acute liver failure were excluded.

RESULTS:

The majority of the recipients had Child-Pugh class B or C cirrhosis (63.5%). Among the 1,006 patients included, 274 (27%) died. Univariate survival analysis using a Cox proportional hazards model showed hazard ratios of 1.02 and 1.43 for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival, respectively (p<0.001). The areas under the ROC curve for the Donor Risk Index were always less than 0.5, whereas those for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival were significantly greater than 0.5 (p<0.001). The cutoff values for the Model for End-Stage Liver Disease (≥29.5; sensitivity: 39.1%; specificity: 75.4%) and the Model for Liver Transplantation Survival (≥1.9; sensitivity 63.9%, specificity 54.5%), which were calculated using data available before liver transplantation, were good predictors of survival after liver transplantation (p<0.001).

CONCLUSIONS:

The Model for Liver Transplantation Survival displayed similar death prediction performance to that of the Model for End-Stage Liver Disease. A simpler model involving fewer variables, such as the Model for End-Stage Liver Disease, is preferred over a complex model involving more variables, such as the Model for Liver Transplantation Survival. The Donor Risk Index had no significance in post-transplantation survival in our patients.     

Outcomes of Allogeneic Hematopoietic Cell Transplantation in Patients with Dyskeratosis Congenita

We describe outcomes after allogeneic transplantation in 34 patients with dyskeratosis congenita who underwent transplantation between 1981 and 2009. The median age at transplantation was 13 years (range, 2 to 35). Approximately 50% of transplantations were from related donors. Bone marrow was the predominant source of stem cells (24 of 34). The day-28 probability of neutrophil recovery was 73% and the day-100 platelet recovery was 72%. The day-100 probability of grade II to IV acute GVHD and the 3-year probability of chronic graft-versus-host disease were 24% and 37%, respectively. The 10-year probability of survival was 30%; 14 patients were alive at last follow-up. Ten deaths occurred within 4 months from transplantation because of graft failure (n = 6) or other transplantation-related complications; 9 of these patients had undergone transplantation from mismatched related or from unrelated donors. Another 10 deaths occurred after 4 months; 6 of them occurred more than 5 years after transplantation, and 4 of these were attributed to pulmonary failure. Transplantation regimen intensity and transplantations from mismatched related or unrelated donors were associated with early mortality. Transplantation of grafts from HLA-matched siblings with cyclophosphamide-containing nonradiation regimens was associated with early low toxicity. Late mortality was attributed mainly to pulmonary complications and likely related to the underlying disease.