种植体周角化组织增宽的临床意义和研究进展

种植体周角化组织宽度不足是种植修复过程中常见的问题.已有研究表明,充足的角化组织宽度不仅利于菌斑控制,还可提高种植体的长期稳定性.目前,临床中用于角化组织增宽的术式主要有:根向复位瓣术、自体组织移植和异体组织移植等.本文就种植体周角化组织宽度的意义及各类角化组织增宽术的研究进展作一综述,以期为临床诊疗提供借鉴.     

老年髋部骨折患者围手术期输血和危险因素

目的 评估老年髋部骨折患者围手术期异体红细胞输血(allogeneic red blood cell transfusions,ABT)的需求及不同因素对ABT的影响。方法 对2019年1月至2019年12月期间因髋部骨折入住北京积水潭医院老年创伤骨科病房行手术治疗的1 112例老年(≥65岁)患者进行了研究。收集患者围手术期的资料,用单因素和多因素逐步Logistic回归分析,确定老年髋部骨折患者围手术期ABT的危险因素。结果 1 112例患者中50.6%(563例)的患者围手术期有ABT记录。单因素分析显示:老年髋部骨折患者围手术期ABT组的患者年龄更大、术中出血量(intraoperative blood loss,IBL)更多,体质量指数(body mass index,BMI)、入院血红蛋白(hemoglobin,Hb)及血清白蛋白(albumin,ALB)更低,凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)更长,手术持续时间更短,女性、股骨粗隆间骨折、美国麻醉医师协会(American Association of Anesthesiologists,ASA)分级≥Ⅲ级、全身麻醉和不合并糖尿病的患者所占比例更高。多因素逐步Logistic回归分析提示:入院Hb低、股骨粗隆间骨折、IBL多、高龄、BMI低、ASA分级≥Ⅲ级和全身麻醉是老年髋部骨折患者围手术期ABT的独立危险因素。结论 老年髋部骨折患者围手术期ABT很常见,ABT与入院Hb低、股骨粗隆间骨折、IBL多、高龄、BMI低、ASA分级≥Ⅲ级和全身麻醉相关,可以从这几个方面来考虑降低围手术期ABT,针对不可变的危险因素则需早期充分备血。     

异体骨髓间充质干细胞移植提高皮肤扩张效率

目的探讨异体骨髓间充质干细胞（bone marrow—derived mesenchymal stem cells,BM—MSCs）在皮肤扩张中发挥的作用,为临床更好地使用皮肤扩张术提供新的方法。方法体外分离、培养乳猪BM—MSCs。小型猪随机分为A、B、c、D4组,前3组脊柱两侧各埋置3个扩张器,A组扩张局部注射BM—MSCs、B组耳静脉注射BM—MSCs、C组仅埋置扩张器、D组为对照组。定期注水,测量各组扩张第7、14、28天标记面积,免疫荧光检测BM—MSCs的分化作用。结果流式鉴定BM—MSCs示CD90、CD29阳性表达,CD34、CD45阴性表达。扩张第28天,A组面积较c组增加明显（P〈0．01）,B组与C组之间比较差异具有统计学意义（P〈0．05）。免疫荧光示CD31、PCNA阳性表达率A、B组大于C、D组。结论异体移植的BM—MSCs能有效促进扩张皮肤新生,以局部移植的效果明显。     

成骨细胞及血管内皮细胞复合同种异体颗粒骨治疗大鼠股骨头坏死

目的 探讨骨髓基质干细胞(bone marrow stromal stem cells,BMSCs)来源的大鼠同种异体成骨细胞(osteoblast,OB)及血管内皮细胞(vascular endothelial cells,VEC)与同种异体颗粒骨复合后治疗大鼠创伤性股骨头坏死(osteonecrosis of th...     

重型再生障碍性贫血治疗所面临的机遇和挑战

重型再生障碍性贫血（SAA）是由多种因素介导的骨髓造血功能重度衰竭综合征,具有进展快、死亡率高的特点。目前SAA的治疗方法主要为免疫抑制治疗（IST）、异基因造血干细胞移植（Allo-HSCT）和相应的支持治疗。近年来,随着上述治疗方法的不断完善,SAA的长期生存率得到较大的提高,但同时也面临着更大的挑战。     

异基因外周血造血干细胞移植的护理流程

目的:研究异基因外周血造血干细胞移植的护理特点。方法:对200例异基因外周血造血干细胞移植患者护理措施进行总结和分析。结果:建立了从捐献者的护理、采集过程的护理、预处理的护理、干细胞输注的护理到并发症护理的护理流程。结论:异基因造血干细胞移植护理流程为提高造血干细胞移植疗效,减少患者的并发症,提高患者生活质量提供有力保证。     

Decreased treatment failure in recipients of HLA-identical bone marrow or peripheral blood stem cell transplants with high CD34 cell doses

We studied the association between CD34 cell dose and transplant outcomes in 359 bone marrow (BM) and 511 peripheral blood stem cell (PBSC) transplant recipients from human leucocyte antigen (HLA)-identical siblings, reported to the International Bone Marrow Transplant Registry (IBMTR). Transplants for leukaemia were performed between 1995 and 1998. Patients were divided into those receiving below or above the median CD34+ dose, for BM (3 x 106/kg) and PBSC (6 x 106/kg) grafts respectively. Cox proportional hazards regression was used to adjust for baseline patient-, disease- and transplant-related characteristics. Analysis of the BM recipients showed that high CD34 cell dose was associated with lower transplant-related mortality [relative risk (RR) = 0.60, P = 0.033] and treatment failure (inverse of leukaemia-free survival, RR = 0.69, P = 0.032). Among PBSC recipients, high CD34 dose was associated with faster recovery of neutrophils to > 0.5 x 109/l (RR = 1.38, P < 0.001) and platelets to > 20 x 109/l (RR = 1.34, P = 0.003), lower risk of relapse (RR = 0.62, P = 0.029) and treatment failure (RR = 0.74, P = 0.03). We conclude that higher CD34 cell doses decrease treatment failure in recipients of HLA-identical sibling BM and PBSC transplants.     

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.     

In vivo T‐cell depletion using alemtuzumab in family and unrelated donor transplantation for pediatric non‐malignant disease achieves engraftment with low incidence of graft vs. host disease

In vivo T‐cell depletion, using alemtuzumab therapy prior to SCT, can reduce the incidence of GVHD. This treatment has a potential to delay immune reconstitution resulting in increased morbidity due to viral illnesses. We retrospectively analyzed data on all pediatric patients with non‐malignant disorders who received alemtuzumab‐based conditioning regimens in our center over the last 10 yr (n = 91). Our data show an OS of 91.2%. The incidence of acute (grade 2–4) GVHD was 18.7% and that of chronic GVHD 5.5%. Viremia due to adenovirus, EBV and CMV was seen in 19.8%, 64.8% and 39.6% patients, respectively, with only two deaths attributed to viral infection (adenovirus). Chimerism level at three month was predictive of graft outcome. Nine patients, who had graft failure after first SCT, were salvaged with a second SCT using RIC and same donor (if available). Based on these results, we conclude that the use of in vivo T‐cell depletion is safe, achieves good chimerism and does not lead to increased morbidity and mortality due to viral infections. It is associated with a reduced incidence of chronic GVHD.     

Results of an outpatient-based stem cell allotransplant program using nonmyeloablative conditioning regimens

Using nonmyeloablative, immunosuppressive, fludarabine (FLU)-based conditioning regimens, we have performed allogeneic peripheral blood stem cell transplants in 26 patients (8 with chronic myelogenous leukemia, 6 with acute myelogenous leukemia, 10 with acute lymphoblastic leukemia, 1 with myelodysplasia, and 1 with thalassemia major). Conditioning consisted of FLU/busulphan/cyclophosphamide/cyclosporin-A (CyA)/methotrexate, or FLU/melphalan/CyA/methotrexate. The median granulocyte recovery time to 0.5 x 10(9)/l was 11 days, whereas the median platelet recovery time to 20 x 10(9)/l was 12 days. Twelve patients did not need red blood cell transfusions, and 8 did not need platelet transfusions. In 21 individuals (81%), the procedure could be completed fully on an outpatient basis. Follow-up times range between 30 and 600 days: one patient failed to engraft and recovered endogenous hemopoiesis; six out of 26 patients developed acute graft-versus-host disease (GVHD) whereas 7/22 developed chronic GVHD. Twelve patients (46%) have died, nine of them with a relapsing disease and three with GVHD; median post-transplant survival (SV) was 300 days, whereas the 12-month SV was 42%. The 100-day mortality was 3.8% and the transplant-related mortality was 11.5%. This procedure is substantially less costly than its counterpart, using in-hospital myeloablative conditioning regimens, and it may represent another approach in the management of patients requiring an allogeneic stem cell transplant.