The use of fresh-frozen bone in oral surgery: a clinical study of 14 consecutive cases

Background

Although autologous bone is considered the gold standard among the grafting materials used in implant therapy, it does have a number of drawbacks, in particular morbidity at the site of donation and the limited amount of bone available. To overcome these limitations a number of alternative bone materials have been employed in the last few years. In this study we report the results of the use of homologous fresh-frozen bone from a tissue bank in patients undergoing reconstruction of bone defects in the oral cavity.

Material and methods

Between June 2004 and October 2008, 14 consecutive patients underwent bone reconstruction with fresh-frozen bone from a tissue bank. Four to eight months after surgery, implants were placed in the newly formed bone.

Results

No problems were recorded during the post-operative course. In all cases treatment was successful and osteointegrated implants were placed in the newly formed bone after 4–8 months. All implants showed good osteointegration (100% overall success rate, mean follow-up 20 months), allowing loading with a fixed cemented prosthesis.

Conclusions

Our results support the previous findings that homologous fresh-frozen bone can be considered a valid alternative to autologous bone for the reconstruction of bone defects in the oral cavity in patients undergoing implant therapy.     

Systems,Properties, Surface Modification and Applications of Biodegradable Magnesium-Based Alloys: A Review

In recent years, biodegradable magnesium (Mg) alloys have attracted the attention of many researchers due to their mechanical properties, excellent biocompatibility and unique biodegradability. Many Mg alloy implants have been successfully applied in clinical medicine, and they are considered to be promising biological materials. In this article, we review the latest research progress in biodegradable Mg alloys, including research on high-performance Mg alloys, bioactive coatings and actual or potential clinical applications of Mg alloys. Finally, we review the research and development direction of biodegradable Mg alloys. This article has a guiding significance for future development and application of high-performance biodegradable Mg alloys, promoting the future advancement of the magnesium alloy research field, especially in biomedicine.     

��ת��������־�Ｐ���ٴ�Ӧ��

人的一生不断进行着骨的新陈代谢。这是通过旧骨吸收和新骨形成来完成。在正常人两者紧密偶联,假如两者失偶联会引起骨量、骨结构和骨强度的改变。但体内骨结构和骨强度很难被检测。近代通过测定骨转换生化标志物了解是否存在骨代谢的失衡。文章介绍骨形成和骨吸收的生化标志物及其临床应用,由于无创伤,价较廉,正被推广应用。     

甘露醇治疗脑出血的药理学机制和临床应用

脑出血急性期的重要治疗措施之一是积极治疗脑水肿,降低颅内压.甘露醇为临床应用最广泛的渗透性脱水药,主要有降低颅内压、减轻脑水肿、预防脑疝形成的作用.此外,甘露醇能清除氧自由基、保护脑细胞,对于降低脑出血病死率具有极其重要的意义.     

Use of corticosteroids and bone‐active medications in clinical practice

Aim: To assess the quality of care of patients beginning corticosteroid therapy with respect to bone protection. Methods: Practicing rheumatologists in Australia were approached countrywide to recruit patients beginning corticosteroid therapy under their care. Use of bone‐active medications in the ensuing year was recorded prospectively. Baseline and follow‐up bone mineral density and fracture data were collected. Results: Ninety‐two patients (64% female) were enrolled by 18 rheumatologists. Seven patients reported a medical history of osteoporosis and 14 had already sustained a low‐trauma fracture. The median corticosteroid dose at commencement of therapy was 20 mg of prednisone. Bone‐active medications were commenced in 47% of patients within 3 months of commencing steroid therapy. These included calcium supplements (33%), vitamin D supplements (21%), hormone replacement therapy (11%), selective estrogen receptor antagonists (5%) and bisphosphonates (15%). Calcium and vitamin D supplementation usually accompanied bisphosphonate therapy. Median change in bone mineral density at the lumbar spine was ?0.20 SD units over 12 months (range: ?1.16–0.70, P = 0.007), and at the hip ?0.10 SD units over 12 months (range ?1.66–0.93, P = 0.24). There were 21 new fractures in 13 patients over the study period, with a vertebral fracture incidence of 0.16 per patient year. Of those patients taking bisphosphonate therapy, two had incident low‐trauma fractures but there was no significant change in bone mineral density at the hip or spine. Conclusions: Rheumatologists in Australia appear informed about the need for bone‐active medications in patients who are commencing steroid therapy. However there remains room for improved awareness, as is seen by the low use of bisphosphonates.     

足部骨肿瘤及瘤样病变的发病特点分析

目的分析足部骨肿瘤及瘤样病变的发病特点。方法分析1993～2008年收治的92例足部骨肿瘤及瘤样病变患者的临床资料,分析足部各种骨肿瘤及瘤样病变的发病特点。结果 92例足部骨肿瘤及瘤样病变患者占同期收治骨肿瘤患者（6 247例）的1.5%,其中良性骨肿瘤及瘤样病变79例,占同期收治所有良性骨肿瘤及瘤样病变患者（3 319例）的4.2%;原发恶性骨肿瘤11例,占同期收治原发恶性骨肿瘤患者（2 167例）的0.5%;2例转移癌患者,占同期收治骨转移癌患者（761例）的0.03%。肿瘤发病于跟骨37例、距骨21例、趾骨18例、跖骨11例、楔骨2例、舟骨2例、骰骨1例。结论足部骨肿瘤及瘤样病变发病率低,良性骨肿瘤及瘤样病变的发病率远高于恶性骨肿瘤。部位以跟骨发病率最高,其次为距骨、趾骨。     

微循环阻力指数临床应用的新进展

<正>微循环阻力指数(IMR)易于操作,并可同时测定冠状动脉血流储备分数(FFR),以综合评估心外膜冠状动脉和微循环的功能,与其他有创性和无创性方法相比,其不受血流动力学和冠状动脉病变的影响。本文主要介绍IMR的理论基础、操作技巧及临床应用。     

Abnormal bone remodelling in patients with myelomatosis and normal biochemical indices of bone resorption.

We studied bone biopsies from 26 patients with myelomatosis with apparently normal skeletal metabolism. Quantitative histomorphometric measurements suggested that skeletal disease was progressive despite normocalcaemia and normal urinary excretion rates of calcium and hydroxyproline. When biopsies were divided according to the involvement of marrow by plasma cells, bone resorption--as judged by the eroded surface--increased significantly the greater plasma cell burden. Osteoclasts were frequent with moderate tumour burdens, but there was no further increase in the number of osteoclasts when plasma cell infiltration increased by more than 50% of bone marrow. Contrary to expectation, the numbers of osteoblasts and bone formation rates were increased with bone biopsies with moderate tumour burden, but were markedly lower when plasma cell infiltration occupied more than 50% of bone marrow, due to a decreased functional capacity of osteoblasts. We conclude that skeletal bone disease in myeloma is commonly progressive despite apparently stable bone disease as judged by biochemical measurements. The major mechanism of bone loss in myelomatosis is increased osteoclastic resorption but decreased bone formation contributes to bone loss with heavy plasma cell burdens. Urinary excretion of calcium and hydroxyproline provide insensitive indices of bone resorption in myelomatosis.     

2013-2018年我国七城市新型口服抗凝药临床应用现状及分析

目的 探寻近年来国内新型口服抗凝药使用情况,并根据结果提出建议。 方法 从我国七城市80家医院抽取76 292张含有新型口服抗凝药的门诊处方进行统计分析,并与药品说明书、最新用药指南等循证医学证据进行对比。 结果 开具NOAC处方患者的平均年龄为69岁,男女比例为1:0.91。处方总量成逐年上升趋势。上海、北京和广州的处方量占比最大。诊断为心房颤动、下肢深静脉血栓和肺栓塞的处方占比最大,高达32.23%的处方为适应症不适宜或无适应症用药。1.95%涉及利伐沙班的处方和9.22%涉及达比加群酯的处方用法不适宜,其中24张涉及达比加群酯的处方用法需将胶囊打开服用。高龄、肾功能损伤、肝功能损伤及出血诊断的处方比例较低,但多数未标明损伤程度。1张涉及利伐沙班的处方合并风心病人工瓣膜置换术后诊断。 结论 NOAC逐渐被越来越多的患者所接受。处方在药品适应症方面的不合理情况较多。特殊人群剂量调整和禁忌症方面的处方规范性有待加强。     

Serum osteocalcin levels in diabetes mellitus: analysis of the type of diabetes and microvascular complications

Summary Recent studies indicate that serum levels of osteocalcin, a 49-aminoacid bone matrix protein, are a biochemical marker of bone formation. In order to study bone metabolism in diabetes mellitus, in 28 patients with Type 1 (insulin-dependent) diabetes mellitus, in 38 patients with Type 2 (non-insulin-dependent) diabetes mellitus and two control groups, matched for Type 1 and Type 2 diabetic patients, respectively, serum levels of osteocalcin, parathyroid hormone and 25 hydroxy vitamin D were measured by radioimmunoassay. Whereas in Type 1 diabetic patients and control subjects serum levels of osteocalcin and 25 hydroxy vitamin D were not statistically different, serum osteocalcin and 25 hydroxy vitamin D levels were significantly decreased in Type 2 diabetic patients when compared with corresponding control subjects (p<0.03 and p<0.001, respectively). Independent of the type of diabetes, serum parathyroid hormone levels were comparable in diabetic patients and matched control subjects. Serum osteocalcin levels were significantly lower in Type 1 diabetic patients with retinopathy and/or proteinuria than in Type 1 diabetic patients without microangiopathy (p<0.05). Whereas serum parathyroid hormone levels in Type 2 diabetic patients with retinopathy and/or proteinuria were significantly increased (p<0.02), 25 hydroxy vitamin D levels were decreased (p<0.02) when compared with Type 2 diabetic patients without microangiopathy. Our data give evidence of a vitamin D deficiency and a decreased bone formation in patients with Type 2 diabetes mellitus. In Type 1 diabetes mellitus bone formation as reflected by serum osteocalcin levels is influenced by the presence or absence of microangiopathic complications.     

Molecular cloning and sequence analysis of alboaggregin B

Platelet flow cytometry is restricted by spontaneous platelet activation in unfixed samples or by significant alterations of platelet performance caused by the use of fixatives. Aim of this study was to evaluate the new platelet stabilizer ThromboFix? for clinical diagnostics.

Methods: Whole blood samples with or without addition of a weak (ADP) or strong (TRAP-6) agonist were fixed with either ThromboFix or paraformaldehyde (PFA) and stored for different periods of time for up to 7 days. Samples were then incubated with either CD41 and CD62P or CD42b and CD45 monoclonal antibodies and analyzed by flow cytometry.

Results: The numbers of platelets, microparticles and aggregates remained stable for 7 days after treatment with ThromboFix but not with PFA due to an increasing aggregate formation after 3 days. Platelet activation was restricted to less than 1% of CD62P positive events in resting samples without a significant difference compared to an unfixed reference sample. Fixation, however, significantly reduced CD62P expression after stimulation (P?<?0.05). Stabilized by ThromboFix, the level of platelet activation remained unchanged in resting and ADP stimulated samples for 7 days but decreased moderately with time after a strong stimulation with TRAP-6 (P?<?0.01). After PFA fixation, intact CD62P antigen disappeared from the platelet surface within hours (P?<?0.01). ThromboFix reduced the formation of platelet–leukocyte conjugates significantly (P?<?0.05) and, in contrast to PFA, failed to stabilize the already formed conjugates.

Conclusion: In clinical situations without immediate access to a flow cytometer, ThromboFix is helpful in the flow cytometric analysis of the platelet activation marker CD62P. It should not be used for the investigation of platelet–leukocyte conjugate formation.     

心肌致密化不全16例临床分析及随访报告

目的分析心肌致密化不全(NVM)患者临床特点及预后。方法回顾性分析1999年10月至2002年9月在第四军医大学西京医院就诊的16例NVM患者的临床资料,并进行了临床随访。结果16例患者中,家族集中性发病者7例;有心功能不全表现者6例;存在心律失常者6例;无症状者6例;因胸痛就诊者2例。15例患者接受了随访,平均随访时间(52.06±8.46)个月,随访期间3例死亡,5例因心力衰竭多次入院治疗(包括1例无症状患者及1例因胸痛就诊患者),1例安装永久性起搏器,1例因下壁心肌梗死行冠脉内支架置入术,5例病情稳定,无明显症状。结论NVM总体预后较差,有症状患者预后明显比无症状患者差,早期诊断并进行危险分层至关重要。     

Echocardiographic assessment of the right ventricle in the current era: Application in clinical practice

The right ventricle has unique structural and functional characteristics. It is now well recognized that the so‐called forgotten ventricle is a key player in cardiovascular physiology. Furthermore, there is accumulating evidence that demonstrates right ventricular dysfunction as an important marker of morbidity and mortality in several commonly encountered clinical situations such as heart failure, pulmonary hypertension, pulmonary embolism, right ventricular myocardial infarction, and adult congenital heart disease. In contrast to the left ventricle, echocardiographic assessment of right ventricular function is more challenging as volume estimations are not possible without the use of three‐dimensional (3D) echocardiography. Guidelines on chamber quantification provide a standardized approach to assessment of the right ventricle. The technique and limitations of each of the parameters for RV size and function need to be fully understood. In this era of multimodality imaging, echocardiography continues to remain a useful tool for the initial assessment and follow‐up of patients with right heart pathology. Several novel approaches such as 3D and strain imaging of the right ventricle have expanded the usefulness of this indispensable modality.     

经内镜逆行胰胆管造影术镇静/麻醉的临床研究进展

为了改善行经内镜逆行胰胆管造影术(ERCP)患者的舒适度、满意度与安全性,麻醉在ERCP术中起到至关重要的作用。本文对镇静/麻醉下行ERCP的术前评估、术中监测以及麻醉方法等进行了综述。     

血管性帕金森综合征的临床与影像学分析

目的　探讨血管性帕金森综合征 (VP)的临床和影像学特点。方法　对 5 0例VP及 118例帕金森病 (PD)住院或长期门诊随访患者临床及影像学表现 ,进行归纳分析和统计学处理 ;并与 31例帕金森病合并脑梗死 (PDCI)者对照。结果　VP发病年龄大于PD ;多伴长期高血压 ;以肌强直 少动起病者多见 ;临床上以对称性铅管样肌强直 少动为主 ,静止性震颤少见 ;可伴锥体束损害表现和智能障碍、尿失禁。PD和PDCI多以震颤起病 ;常有静止性震颤 ;非对称齿轮样肌强直多见。VP影像学主要表现为多发基底节 (72 % )、脑室周围腔梗 (5 2 % ) ,且双侧多见 ,分别占相应部位的 6 9%和 73%。结论　VP发病与长期高血压有关 ;基底节、脑室周围多发腔梗是导致VP的主要原因 ;VP临床表现不同于PD或PDCI;出现PD表现后 ,及时MRI或CT检查具有十分重要的鉴别意义。     

关注老年人个体共病状态的临床研究

2010年第六次全国人口普查数据显示,我国老龄化趋势加快,60岁及以上人口占13．26％,比2000年大约上升3％。凸显了老年患者中常见且影响生存和治疗选择的共病状态的重要性。临床医师充分了解共病的发病率及其各种影响十分必要。研究共病有助于了解共病疾病间的相互关系;有助于评估疾病预后的影响因素;有助于评估健康检查项目的成本效益、必要性及风险;有助于更好地评估手术风险;有助于制定更加合适的治疗方案。     

非酒精性脂肪性肝病临床和病理学研究

目的研究非酒精性脂肪性肝病(NAFLD)的临床与病理特征。方法分析41例NAFLD患者的肝组织脂肪变程度、炎症分级和纤维化分期,并研究其与体重指数(BMI)、血清生物化学和B超检查结果的关系。结果41 例NAFLD患者中,肝组织脂肪变分级:Ⅰ级21例(51．2％),Ⅱ级15例(36．6％),Ⅲ级5例(12．2％);肝组织炎症活动度分级:G0级2例(4．9％),G1级25例(61．0％),G2级10例(24．4％),G3级3例(7．3％),G4级1例(2．4％); 肝组织纤维化分期:S0期20例(48．8％),S1期14例(34．2％),S2期4例(9．8％),S3期2例(4．9％),S4期1例(2．4％)。肝脂肪变程度与肝炎症分级(r=-0．131 3,P=0．413)和肝纤维化分期(r=-0．179 2,P=0．262 3)均无显著的相关性。肝细胞脂肪变程度与BMI(r=0．669,P<0．01)和B超检测到的脂肪肝程度(r=0．366,P<0．01) 呈正相关,炎症活动度与丙氨酸氨基转移酶(ALT)(r=0．669,P=0．019)、天冬氨酸氨基转移酶(AST)(r= 0．438,P=0．005)和B超检测到的脂肪肝程度(r=0．562,P<0．001)呈正相关,而与血小板数呈负相关(r= -0．344,P=0．040);肝纤维化分期与ALT(r=0．449,P=0．003)、AST(r=0．477,P=0．002)、γ-谷氨酰转肽酶(r=0．373,P=0．025)和碱性磷酸酶(r=0．346,P=0．039)呈正相关,而与甘油三酯(r=-0．324, P=0．042)和血小板数(r=-0．375,P=0．024)呈负相关。结论肝脂肪变程度与炎症分级和肝纤维化分期均无显著的相关性,BMI、AST、ALT、血小板和B超检测到的脂肪肝程度等与肝组织病理学有关,肝活组织检查有助于明确诊断。     

Preclinical in vivo Performance of Novel Biodegradable,Electrospun Poly(lactic acid) and Poly(lactic-co-glycolic acid) Nanocomposites: A Review

Bone substitute materials have witnessed tremendous development over the past decades and autogenous bone may still be considered the gold standard for many clinicians and clinical approaches in order to rebuild and restore bone defects. However, a plethora of novel xenogenic and synthetic bone substitute materials have been introduced in recent years in the field of bone regeneration. As the development of bone is actually a calcification process within a collagen fiber arrangement, the use of scaffolds in the formation of fibers may offer some advantages, along with additional handling characteristics. This review focuses on material characteristics and degradation behavior of electrospun biodegradable polyester scaffolds. Furthermore, we concentrated on the preclinical in vivo performance with regard to bone regeneration in preclinical studies. The major findings are as follows: Scaffold composition and architecture determine its biological behavior and degradation characteristics; The incorporation of inorganic substances and/or organic substances within composite scaffolds enhances new bone formation; L-poly(lactic acid) and poly(lactic-co-glycolic acid) composite scaffolds, especially when combined with basic substances like hydroxyapatite, tricalcium phosphate or demineralized bone powder, seem not to induce inflammatory tissue reactions in vivo.