自体表皮细胞-纤维蛋白膜创面移植治疗大鼠烧伤

目的：观察自体表皮细胞-纤维蛋白膜移植到大鼠烧伤创面治疗皮肤缺损的效果。方法：健康Wistar大鼠20只,随机分成烧伤皮肤缺损造模组和自体表皮细胞-纤维蛋白膜移植治疗组,治疗后计算表皮细胞在纤维蛋白膜上最佳接种密度,观察移植后的各组创面愈合情况、创面伤口的收缩比例等。结果：在纤维蛋白膜上接种表皮细胞的最佳密度为5×10^4／cm2,烧伤皮肤缺损造模组创面完全愈合时间平均22．3d,自体表皮细胞-纤维蛋白膜移植治疗组为18．1d,造模组创面收缩率为（70±5）％,移植组为（20±5）％（均P〈0．05）。结论：自体表皮细胞-纤维蛋白膜可用于覆盖大面积烧伤造成的皮肤缺损,预防创面伤口瘢痕化的形成,减轻创面收缩率,加速皮肤缺损创面的愈合速度。     

静脉管内膜外翻治疗周围神经缺损

目的探讨自体静脉管内膜外翻移植桥接修复周围神经缺损的效果。方法对20例周围神经损伤患者(缺损长度0.5～3.0 cm)采用自体静脉内膜外翻移植桥接修复。结果 1例失访,19例获得随访,时间3～24个月。根据中华医学会手外科学会上肢周围神经功能评定试用标准进行评分:优5例,良10例,可3例,差1例。结论对较粗大的神经缺损者,自体静脉管内膜外翻桥接接修复周围神经缺损的效果较好。     

湿性脂肪干细胞辅助自体颗粒脂肪移植五年临床回顾总结

目的:回顾总结2008～2013年笔者行湿性脂肪干细胞辅助自体颗粒脂肪注射填充移植术五年的临床经验。方法:549例均采用湿性脂肪干细胞辅助自体颗粒脂肪移植术,单次注射填充移植完成532例(96.91%),17例(3.09%)脂肪存活率较低(30%～40%)需二次注射填充移植完成。结果:本组仅2例(0.36%)出现轻微并发症,成活率和远期效果明显提高,取得预期临床效果。结论:随访1～5,采用规范的湿性肿胀技术和注射器吸脂法抽吸颗粒脂肪及湿性新鲜原代血管基质细胞和脂肪干细胞辅助自体颗粒脂肪移植注射填充移植技术效果明显持久,遵循其正确的临床操作原则和技术指南及标准操作流程,能明显提高移植脂肪成活率和良好远期效果,是一种切实、可行、有效的临床方法。     

自体脂肪联合脂肪干细胞注射隆乳效果观察

目的:评价自体脂肪联合脂肪干细胞(adipose-derived stem cells,ADSCs)隆乳的疗效,探索隆乳更安全的方法。方法:选择2011年1月至2012年1月我院的单纯自体脂肪隆乳20例(A组)及自体脂肪结合ADSCs隆乳患者20例(B组),分别应用排水法对两组的术前、术后1个月、术后3个月、术后6个月、术后12个月、术后18个月乳房体积进行测量,并计算每个患者术后各时间点与术前乳房体积的差值,将差值应用SPASS13.0软件进行处理,以P<0.05差异有统计学意义。对术后效果进行随访,了解患者满意度。结果:A、B两组间各个相对应时间点的差值均具有统计学意义。对于组内,A组术后1个月、3个月、6个月、12个月其差值均有统计学意义,12个月与18个月体积差值无统计学意义。B组术后1个月与3个月差值有统计学意思,术后3个月、6个月、12个月、术后18个月均无统计学意义。结论:自体脂肪结合ADSCs组的隆乳效果优于单纯自体脂肪隆乳组。     

FUT+FUE治疗大面积脱发60例

目的:探索一种治疗大面积脱发的理想方法。方法:分别用FUT(follicle unit transplantation)技术切取梭形头皮条,用FUE(follicle unit extraction)技术于枕部散在提取毛囊,然后分离毛囊周围多余组织,用宝石刀在脱发区打孔后,用移植笔将分离好的毛囊植入脱发区。结果:60例通过本方法治疗的患者均达到了理想的植发效果。结论:FUT+FUE治疗大面积脱发是一种较理想的方法,值得推广。     

Role of vaccine therapy for renal cell carcinoma in the era of targeted therapy

Renal cell carcinoma is the most common malignant tumor originating from the kidney. Compared with other solid tumors, it does not respond to traditional management modalities, such as chemotherapy and radiotherapy. However, it is well known that renal cell carcinoma represents one of the most immune‐responsive cancers and several immunotherapeutic strategies have been investigated in the management of renal cell carcinoma with variable degrees of success. The development of immunotherapy with α‐interferon or high‐dose interleukin‐2 is the best established treatment, and is associated with durable disease control. Although the lack of defined antigens in renal cell carcinoma has hindered more specific vaccine development, research regarding vaccination therapy has been of special interest for the treatment of renal cell carcinoma for more than 30 years. At present, there are three types of cell‐based vaccines in renal cell carcinoma treatment: autologous tumor‐cell vaccines, genetically modified tumor vaccines and dendritic cell‐based vaccines. A further type is peptide‐based vaccination with tumor‐associated antigens as possible targets, such as carbonic anhydrase IX, survivin and telomerase that are overexpressed in renal cell carcinoma. In the present article, we review data from completed clinical trials of vaccine therapy, and discuss future trials to assess the current knowledge and future role of vaccine therapy for renal cell carcinoma in the era of recently developed targeted therapy.     

Alternative bearings in total knee arthroplasty: risk of early revision compared to traditional bearings: An analysis of 62,177 primary cases

Background and purpose There is no substantial clinical evidence for the superiority of alternative bearings in total knee arthroplasty (TKA). We compared the short-term revision risk in alternative surface bearing knees (oxidized zirconium (OZ) femoral implants or highly crosslinked polyethylene (HXLPE) inserts) with that for traditional bearings (cobalt-chromium (CoCR) on conventional polyethelene (CPE)). The risk of revision with commercially available HXLPE inserts was also evaluated.

Methods All 62,177 primary TKA cases registered in a Total Joint Replacement Registry between April 2001 and December 2010 were retrospectively analyzed. The endpoints for the analysis were all-cause revisions, septic revisions, or aseptic revisions. Bearing surfaces were categorized as OZ-CPE, CoCr-HXLPE, or CoCr-CPE. HXLPE inserts were stratified according to brand name. Confounding was addressed using propensity score weights. Marginal Cox-regression models adjusting for surgeon clustering were used.

Results The proportion of females was 62%. Average age was 68 (SD 9.3) years, and median follow-up time was 2.8 (IQR 1.2–4.9) years. After adjustments, the risks of all-cause, aseptic, and septic revision with CoCr-HXLPE and OZ-CPE bearings were not statistically significantly higher than with traditional CoCr-CPE bearings. No specific brand of HXLPE insert was associated with a higher risk of all-cause, aseptic, or septic revision compared to CoCr-CPE.

Interpretation At least in the short term, none of the alternative knee bearings evaluated (CoCr-HXLPE or OZ-CPE) had a greater risk of all-cause, aseptic, and septic revision than traditional CoCr-CPE bearings.     

Iatrogenic collapse of the nasal valve after aesthetic rhinoplasty

We present our experience of reconstruction of the nasal valve after iatrogenic collapse, and evaluate the feasibility and outcome of composite grafts. We selected all collapsed nasal valves that occurred after primary aesthetic rhinoplasties of the total number done at the University Tor Vergata in Rome. We excluded collapses that followed septoplasty for nasal deviation, reconstructions, and rhinoplasties for trauma. We selected 15 patients of 1252 who presented from January 1998 to December 2003. Eleven patients who had collapse of both the external and internal valve were treated with a composite graft (septum plus retroauricular) inserted by an “open tip” technique. Four patients (1 with both internal and external valve collapse, 3 with only internal) were treated with a section and opening of the upper lateral cartilages, transposition and repositioning of mucocartilaginous flaps. Good functional and aesthetic results were achieved in almost all patients without complications. Composite cartilaginous grafts are an easy and safe technique for the treatment of iatrogenic collapse of the nasal valve.     

可吸收修复胶原联合银离子敷料治疗供皮区创面的疗效

 目的 观察可吸收修复胶原联合银离子敷料治疗供皮区创面的临床效果。方法 选取2016-07至2018-12医院收治的100例自体皮移植患者,随机分为治疗组和对照组,每组50例,治疗组采用可吸收修复胶原联合银离子敷料治疗供皮区创面,对照组采用传统凡士林纱布治疗。观察供皮区创面换药时疼痛程度、创面感染率、愈合时间,以及创面愈合后瘢痕指标评定。结果 治疗组供皮区创面换药时疼痛分数在术后3、6、9 d分别为6.24±2.23,4.13±2.37,1.49±1.31,显著低于对照组的7.73±2.14,5.24±1.59,2.43±1.66(P<0.05);治疗组供皮区创面感染率为2%,较对照组14%显著降低(P<0.05);治疗组创面愈合时间明显短于对照组(P<0.05);治疗组创面愈合后3、6、9个月温哥华瘢痕量表评分较对照组显著降低,差异均有统计学意义(P<0.05)。结论 可吸收修复胶原联合银离子敷料治疗供皮区创面相比于传统凡士林纱布治疗是一种更优越的方式,适合临床推广使用。     

Skin substitutes with noncultured autologous skin cell suspension heal porcine full-thickness wounds in a one-stage procedure

Clinical application of skin substitute is typically a two-stage procedure with application of skin substitute matrix to the wound followed by engraftment of a split-thickness skin graft (STSG). This two-stage procedure requires multiple interventions, increasing the time until the wound is epithelialised. In this study, the feasibility of a one-stage procedure by combining bioengineered collagen-chondroitin-6-sulfate (DS1) or decellularised fetal bovine skin substitute (DS2) with autologous skin cell suspension (ASCS) in a porcine full-thickness wound healing model was evaluated. Twelve full-thickness excisional wounds on the backs of pigs received one of six different treatments: empty; ASCS; DS1 with or without ASCS; DS2 with or without ASCS. The ASCS was prepared using a point-of-care device and was seeded onto the bottom side of DS1, DS2, and empty wounds at 80 000 cells/cm². Wound measurements and photographs were taken on days 0, 9, 14, 21, 28, 35, and 42 post-wounding. Histological analysis was performed on samples obtained on days 9, 14, 28, and 42. Wounds in the empty group or with ASCS alone showed increased wound contraction, fibrosis, and myofibroblast density compared with other treatment groups. The addition of ASCS to DS1 or DS2 resulted in a marked increase in re-epithelialisation of wounds at 14 days, from 15 ± 11% to 71 ± 20% (DS1 vs DS1 + ASCS) or 28 ± 14% to 77 ± 26 (DS2 vs DS2 + ASCS) despite different mechanisms of tissue regeneration employed by the DS used. These results suggest that this approach may be a viable one-stage treatment in clinical practice.