自体牙移植术的临床效果

目的 评价自体牙移植的临床效果.方法 搜集近10年来的38例(42颗牙)自体牙移植病例,在术后1、3年进行随访观察,从治疗方法、牙根发育情况、牙髓治疗时机、牙根吸收情况及牙齿的稳固性等多方面进行分析总结.结果 1年后成功37颗牙(88.10%),尚可接受5颗牙(11.90%).3年后随访到32例36颗移植牙,成功27颗牙(75.00%),尚可接受7颗牙(19.44%),失败2颗牙(5.56%).结论 自体牙移植术是一种较为成功的治疗方法,能达到快速纠正个别牙错位以及修复一些缺失牙的目的 .     

血管化自体下颌下腺移植治疗重症干眼20年研究

干眼是泪膜异常导致的以角结膜干燥为主的眼表疾病,重症患者因眼干、视力减退甚至失明而严重影响生活质量。1998年以来,北京大学口腔医学院、基础医学院和首都医科大学北京同仁医院组成联合项目组,开展血管化自体下颌下腺移植治疗重症干眼的基础与临床紧密结合的系列研究,将患者自体下颌下腺游离后移植到颞部,相应血管进行吻合,分泌导管转移到眼眶,用下颌下腺分泌的唾液替代泪液,术后采用多种措施,人工调控移植腺体的分泌,取得了良好的治疗效果。     

关节镜下取自体肩胛冈肩盂植骨治疗肩关节复发性前脱位

目的探讨关节镜下取自体肩胛冈肩盂植骨治疗肩关节复发性前脱位的临床疗效。方法回顾性分析2016年7月至2018年8月,采用关节镜下取自体肩胛冈肩盂植骨治疗27例肩关节复发性前脱位患者资料。其中男20例,女7例;年龄30.8岁(范围,19~50岁)。27例患者肩盂均有骨缺损,缺损体积为肩盂体积的10%~15%。初次脱位到手术时间为(24.1±15.8)个月。采用关节镜下取自体肩胛冈肩盂植骨治疗。术后患侧肩关节使用外展支具固定6周,6周后开始被动活动肩关节;术后10~12周开始力量训练;6个月后开始体育活动。末次随访时采用Constant-Murley评分、上肢功能障碍评分(Disability of Arm,Shoulder and Hand,DASH)评价肩关节及上肢功能,采用视觉模拟评分(visual analogue score,VAS)评价疼痛情况。CT三维重建测量患者术后1周及末次随访时移植骨块的长、宽、高并计算骨块的吸收率。记录患者末次随访时的主观满意度。结果27例患者均获得随访,随访时间19.8个月(范围,13~39个月)。术后无一例发生感染、血管神经损伤。末次随访时患者Constant-Murley评分为(85.15±5.62)分(范围,76~94分),DASH评分为(13.39±5.51)分(范围,3.19~21.95分),VAS评分为(1.29±0.45)分(范围,1~2分);以上三个指标分别与术前相比均有明显改善。患者术后活动度为:前屈上举153°±24°,体侧外旋38°±21°,内旋70°±21°,外展139°±18°。末次随访时,骨块吸收率为46.1%±20.6%(范围,24.0%~71.7%);肩关节无一例发生持续疼痛及再脱位,恐惧试验均为阴性。患者满意度评价,19例非常满意,6例满意,2例一般。结论关节镜下取自体肩胛冈肩盂植骨治疗关节盂骨质缺损10%~15%的肩关节复发性前脱位,术后可恢复肩关节稳定性,显著提高肩关节功能,明显降低肩关节脱位复发率。     

复合皮移植在关节部位深度烧伤中的临床应用

目的观察J-1型脱细胞异体真皮＋自体刃厚皮片（复合皮）移植治疗关节功能部位深度烧伤中的应用效果。方法我科近几年采用J-1型脱细胞异体真皮＋自体刃厚皮片复合移植治疗关节功能部位深度烧伤创面病人11例,其中包括颈部、手部、腕部、肘部、膝部、踝部共26处。结果11例病人26处部位通过复合皮移植,全部成活,无排异反应,创面收缩轻,外观平整,色素成着轻,质地较软,关节功能恢复良好,供区无增生疤痕。结论J-1型脱细胞异体真皮＋自体刃厚皮片复合移植修复深度烧伤创面不失为一种较理想的材料。     

自体心包作为主动脉瓣替代材料的可行性研究

目的 探讨自体心包组织作为主动脉瓣膜替代材料的可行性及可靠性,为临床实验提供基础.方法 静脉全麻、腹主动脉阻断下行心包瓣膜材料腹主动脉内移植.进行预试验,筛选实验动物.然后监测实验中动物基本生命、生理指标;采用血管超声和 CTA方法评价其血流动力学指标;通过观察动物存活情况,判断是否有栓塞事件等,以评价其生物相容性.结果 猪是理想的实验动物,手术死亡率6.25%.实验动物无栓塞事件发生,肉眼观察可见心包瓣内有血栓形成.结论 腹主动脉阻断下心包瓣膜移植,手术安全易行,心包瓣膜模型较为可靠.建议术后应常规抗凝.     

非限制性外支架对兔移植静脉血小板源性生长因子表达的影响

目的 探讨非限制性外支架防治移植静脉再狭窄的可能作用机制. 方法新西兰白兔随机分为支架组和对照组,每组18只.均实施颈外静脉-颈总动脉移植术,支架组在移植静脉外套以外支架(直径6 mm的人造涤纶血管),对照组无外支架.术后7、14、28 d每组各6只兔手术取出移植静脉,分别进行血小板源性生长因子B链(PDGF-B)免疫组织化学染色,计算PDGF-B阳性率;以RT-PCR方法检测PDGF-B mRNA的表达量. 结果支架组移植静脉内膜PDGF-B阳性率术后14、28 d均明显低于对照组(15.2%±3.6%vs 21.6%±4.6%,6.5%±2.6%vs 12.5%±4.4%,均P＜0.05);中膜阳性率术后7、14、28 d均明显低于对照组(13.8%±4.6%vs 25.4%±6.2%,21.3%±4.4%vs 35.7%±7.3%,7.2%±3.2%vs 19.2%±5.4%,均P＜0.01);外膜阳性率术后28 d达高峰,而对照组在术后14 d达高峰,28 d时支架组阳性率明显高于对照组.RT-PCR检测显示术后7、14、28 d 2组移植静脉均可见PDGF-B特异条带(457 bp),各时间点支架组PDGF-B mRNA的表达均明显低于对照组(31.2%±6.5%vs 45.4%±8.4%,P＜0.05;42.3%±6.2%vs 65.2%±11.5%,P＜0.01;21.3%±5.6%vs 36.2%±9.4%,P＜0.01). 结论抑制移植静脉PDGF合成、改变PDGF分布规律可能是非限制性外支架防治移植静脉再狭窄的作用机制之一.     

Erythropoietin response to anaemia is not altered by surgery or recombinant human erythropoietin therapy

Summary. Recombinant human erythropoietin (EPO) therapy has been shown to increase red blood cell (RBC) production and facilitate autologous blood donation before elective surgery. However, recent reports have suggested that surgery and/or EPO therapy may suppress endogenous erythropoietin secretion in response to anaemia. We therefore analysed the haemoglobin/erythropoietin relationship preoperatively and postoperatively in 71 autologous blood donors subjected to aggressive phlebotomy and six treatments with either EPO (150U/kg, n=16, 300U/kg, n=18, or 600 U/kg, n=19) or placebo (n=18). Using data from the three prepoerative study visit, the linear relationship between log erythropoietin and haemoglobin was determined for each of the 18 placebo patients. We found no significant differences in the slopes of the relationships in this group during aggressive phlebotomy. Furthermore, there was no evidence of a significant difference in the erythropoietin level recorded postoperatively for each patient to that predicted from the patient's postoperative haemoglobin level, based on the haemoglobin/log erythropoietin relationship preoperatively. Similarly, for each of the EPO-treated groups, there was no evidence of a significant difference when comparing the recorded erythropoietin level to that predicted from each patient's postoperative haemoglobin level, based on the haemoglobin/log erythropoietin relationship preoperatively. We conclude that preoperative recombinant human erythropoietin therapy and/or surgery do not adversely affect the postoperative erythropoietin response to anaemia.     

延迟增强MRI评估基质诱导自体膝关节软骨移植术效果

目的 探讨延迟增强MRI对基质诱导自体膝关节软骨移植术的临床评估效果.方法 随机选取我院2012年1月至2014年2月期间收治的行自体膝关节软骨移植术患者45例作为实验组,另选取同期软骨损伤患者45例作为对照组,对两组患者进行MRI扫描,对扫描结果进行对比分析.结果 实验组患者术后CR值(0.92±0.08)较术前(1.33±0.15)明显降低,且随着患者病情分级的不断升高,其CR也随之增高(P＜0.05);各部位的MRI增强扫描结果明显优于平扫,差异具有统计学意义(P＜0.05).结论 对基质诱导自体膝关节软骨移植术患者进行MRI增强扫描,能够为临床诊断提供高质量的膝关节软骨检查图像,同时通过对手术前后软骨强化率进行分析,有助于对手术效果进行有效评估.     

Therapy-related myelodysplastic syndrome

Introduction: Myelodysplastic syndrome (MDS) is a heterogeneous clonal disorder characterized by deregulation of apoptosis, dysplastic features in hematopoietic precursors, peripheral blood cytopenias and an increased risk for transformation to acute leukemia. Roughly 20% of MDS are therapy related (t-MDS), and this is considered an independent adverse prognostic factor.

Areas covered: This review based on a comprehensive literature search provides an overview on the main features of t-MDS, including its epidemiology, risk factors, molecular pathogenesis, prognostic classifications and therapy.

Expert opinion: Increasing evidence points out that the most important event in t-MDS is genetic alterations in hematopoietic stem precursor cells, however, ineffective hematopoiesis may also result from abnormalities in the bone marrow microenvironment. Thus, novel views onto the processes of t-MDS are needed such as the osteohematology concept. On the other hand, the number of people living with and beyond cancer is increasing worldwide; thus, most emphasis should be placed on preventing secondary malignancies such as t-MDS. From this review, it becomes clear that we are in urgent need not only to deepen our understanding of the leukemogenesis mechanisms induced by exposure to chemotherapy and radiation but also to translate this knowledge into clinical strategies aimed at risk reduction.