Combination of intramuscular transplantation of autologous mononuclear bone marrow cells with sympathectomy (L2, 3) in patients with peripheral arterial disease(PAD)

BackgroundIn most patients with severe, chronic extremity ischemic diseases, intervention or surgical treatment is often not suitable. Combination of intramuscular transplantation of autologous monocular bone marrow cells (AMBMCs) and sympathectomy (L2, 3) has been proved therapeutically beneficial.MethodsWe studied 170 patients (combined group 80, control group 90) with extremity ischemia (TAO, ASO FontaineⅡ,Ⅲ, Ⅳ) between January 2013 and September 2019.ResultsIn contrast to pre-operation, the walking distance of patients increased significantly (from 61.34 ± 52.23 m to 156.0 ± 32.4 m, p < 0.01), and the ankle-brachial index (ABI) remarkably improved (from 0.28 ± 0.13 to 0.59 ± 0.23, p < 0.05).ConclusionCombined therapy is feasible and effective for patients with peripheral arterial disease (PAD).     

Early development of the malleus and incus in humans

It is widely accepted by developmental biologists that the malleus and incus of the mammalian middle ear are first pharyngeal arch derivatives, a contention based originally on classical embryology that has now been backed up by molecular evidence from rodent models. However, it has been claimed in several studies of human ossicular development that the manubrium of the malleus and long process of the incus are actually derived from the second arch. This ‘dual‐arch’ interpretation is commonly presented in otolaryngology textbooks, and it has been used by clinicians to explain the aetiology of certain congenital abnormalities of the human middle ear. In order to re‐examine the origins of the human malleus and incus, we made three‐dimensional reconstructions of the pharyngeal region of human embryos from 7 to 28 mm crown–rump length, based on serial histological sections from the Boyd Collection. We considered the positions of the developing ossicles relative to the pharyngeal pouches and clefts, and the facial and chorda tympani nerves. Confirming observations from previous studies, the primary union between first pharyngeal pouch and first cleft found in our youngest specimens was later lost, the external meatus developing rostroventral to this position. The mesenchyme of the first and second arches in these early embryos seemed to be continuous, but the boundaries of the developing ossicles proved to be very hard to determine at this stage. When first distinguishable, the indications were that both the manubrium of the malleus and the long process of the incus were emerging within the first pharyngeal arch. We therefore conclude that the histological evidence, on balance, favours the ‘classical’ notion that the human malleus and incus are first‐arch structures. The embryological basis of congenital ossicular abnormalities should be reconsidered in this light.     

32例自体血回输在外伤性脾破裂手术中应用的临床研究

目的研究分析在外伤性脾破裂手术中的自体血回输的适应症、流程、安全性等问题。方法选取2010年1月—2013年1月间入院治疗的单纯外伤性脾破裂患者32例,应用自体血液回收技术回输,注意流程的严密性、科学性,加强护理干预操作。结果 32例患者通过自体血回输,有效扩充了血容量,平安度过危险期,均安全出院。32例患者中自体回输血量28160mL,占总引流血量49060mL的57.40%,其中最小回输550mL,最多1400mL,平均回输880mL。其中7例患者应用异体输血共2870mL,占总输血量的10.21%。3例发热患者2例伤口感染经对症处理后恢复正常,无溶血反应,未见持续出血、输血后并发症、过敏反应、细菌污染等疾病。结论外伤性脾破裂中应用自体血回输,操作简便,安全可靠,患者并发症较少,并且减少了血资源的浪费和异体输血排异反应及传染疾病的发生率。     

Recent advances in understanding multiple myeloma

There have been major recent advancements in the understanding and management of multiple myeloma which in turn has led to unprecedented survival outcomes for patients. Diagnostic and response criteria have been recently revised. Our understanding of clonal progression, evolution, and clonal tides will inform therapeutic choices and appropriate treatment for patients. Response rates to initial induction with modern triplet therapies containing proteasome inhibitors and immunomodulators have made this approach the global standard for initial treatment. Although the relevance of autologous transplantation has been questioned in the setting of modern induction therapy, we have new data suggesting its continued relevance. Recent studies performed in the context of novel agent induction suggest that autologous transplantation continues to improve response rates and progression-free survival, thus underscoring its role in transplant-eligible patients. Emerging paradigms in the treatment of multiple myeloma include immune approaches, such as adoptive cellular therapies, vaccines, or antibody-based immune manipulations, all of which seem to synergize with a transplant platform. Allogeneic transplantation is limited in scope by the concern of prohibitive toxicity and is applicable mainly to younger patients with high-risk disease. However, the allogeneic approach offers even more options of immunotherapy at relapse, including donor lymphocyte infusions, immunomodulatory drug maintenance, and withdrawal of immune suppression.     

Epithelial healing in experimental corneal alkali wounds with nondiluted autologous serum eye drops

Purpose: To evaluate the effects of the topical application of nondiluted autologous serum on epithelial healing as an adjuvant therapy in rabbit corneal alkali wounds.

Methods: Central corneal alkali wounds were produced on the right eye of 16 rabbits, by a 60-second application of a 6-mm round filter paper soaked in 1 N sodium hydroxide (NaOH). One group of rabbits (n=8) was treated with non-diluted autologous serum, the other control group (n=8) was treated with physiologic saline, topically 4 times a day. The epithelial healing of the wounds was followed on a slit lamp with and without fluorescein staining daily for 1 week. On day 7, both corneas of each rabbit were excised and assessed histopathologically.

Results: A significant increase in the epithelial healing rate was observed in the autologous serum–treated corneas compared with the controls. Epithelial hyperplasia was noticed in specimens with thickened surface cells with multilayers, revealing disorganization in both groups. The autologous serum–treated epithelium showed a relatively well-organized appearance.

Conclusion: Nondiluted autologous serum eye drops could be used as an adjuvant therapy for promoting the epithelial healing process during the repair stage of corneal alkali wounds.     

Use of bone marrow derived stem cells in a fracture non-union

This is an attempt of using in vitro cultured mesenchymal stem cells (MSCs) from bone marrow in joining of a fracture non-union. Bone marrow cells were obtained and differentially centrifuged for MSCs that were grown in vitro in mesenchymal stem cell basal medium aseptically, for 10 d. The cell mass was injected around the fracture non-union. Healthy conditions of development of tissue regeneration at the trauma site and due bone joining were recorded. It is concluded that in vitro cultured MSCs had a blithesome effect on the fracture non-union.