G-CSF联合普乐沙福动员异基因造血干细胞移植亲缘健康供者外周血造血干细胞的单中心分析

目的:研究粒细胞集落刺激因子(G-CSF)联合普乐沙福对异基因造血干细胞移植(allo-HSCT)的亲缘健康供者外周血造血干细胞动员的效果及安全性。方法:回顾性分析2019年4月至2021年4月在河北燕达陆道培医院采用G-CSF联合普乐沙福动员方案的亲缘健康供者33例(观察组),应用G-CSF细胞动员d 4采集骨髓,d 5采集外周血造血干细胞(PBSC),d 5晚加用普乐沙福,并于d 6再次采集PBSC。随机选取历史同期采用单独G-CSF方案动员的亲缘健康供者46例作为对照组,分析2组供者d 5和d 6 PBSC采集物中CD34⁺细胞计数。以调查问卷的方式观察供者普乐沙福给药后的不良反应。分析接受"G-CSF+普乐沙福"动员方案的allo-HSCT患者和仅接受"G-CSF"动员方案的造血干细胞移植患者在移植后100天总a GVHD、Ⅲ-Ⅳ度a GVHD、CMV血症和EBV血症的发生方面的差异。结果:观察组在d 5和d 6 PBSC采集物中CD34⁺细胞数(M±Q)分别为(1.71±1.02)×10⁶/kg和(4.23±2...     

异体脱细胞真皮加自体刃厚皮复合移植在深度烧伤创面修复中的应用

目的探讨异体脱细胞真皮加自体刃厚皮多种复合方式移植修复深度烧伤创面的临床应用。方法对2003年以来我科用异体脱细胞真皮加自体刃厚皮多种复合方式移植修复63例深度烧伤创面的疗效观察。63例中,深Ⅱ度烧伤瘢痕37例,Ⅲ度烧伤功能部位创面26例,均为一次手术完成;其中49例为异体脱细胞真皮加大张刃厚皮移植,7例为异体脱细胞真皮加自体刃厚皮小皮片移植,7例为异体脱细胞真皮加网状皮片移植。结果63例中术后复合皮全部成活,愈后植皮区及供皮区瘢痕增生不明显,功能恢复较好,色素沉着较轻,外观满意。结论异体脱细胞真皮加自体刃厚皮多种方式复合移植修复深度烧伤创面是一种较好治疗方法。     

异基因造血干细胞移植后乙型肝炎病毒感染2例临床干预并文献复习

目的 加强对造血干细胞移植中HBV感染的重视,注重早期干预,提高移植成功率。方法 回顾性分析97例异基因造血干细胞移植患儿的临床资料,通过对2例HBV感染的诊治体会结合文献复习。结果 2001年5月至2008年5月在上海交通大学附属上海儿童医学中心接受异基因造血干细胞移植的97例患儿中,2例分别在移植后41 d（病例1）、15个月（病例2）发生HBV感染。病例1移植前肝功能正常,乙肝二对半检查阴性,回顾性分析发现该患儿移植时HBV正处于潜伏状态（HBV DNA 1.17×106 copies·mL-1）。该患儿乙肝来势凶猛,移植后41～43 d出现巩膜明显黄染并伴大量腹水,移植后46 d迅速发展至肝、肾功能衰竭,出现少尿,凝血酶原时间38.4 s,部分凝血酶原时间>120 s,凝血酶时间>100 s,Cr 251 μmol·L-1,ALT 3 195 U·L-1,血清总胆红素7 mg·L-1,直接胆红素2.8 mg·L-1,HBV DNA 1.08×108 copies·mL-1,经拉米夫定等积极治疗2周后好转。移植后130 d 随着移植物抗宿主病（GVHD）的复燃和免疫抑制药物的加强应用,HBV再度活跃,HBV DNA从原已控制的3.50×104 copies·mL-1逐升至2.05×106 copies·mL-1,移植后315 d出现HBV YMDD（+）变异株,遂予阿德福韦酯联合治疗至今(移植后3.5年),目前肝、肾功能正常。病例2白血病起病初及干细胞移植前均示HBs Ab(+)、HBc Ab(+)、HBe Ab(+),ALT和HBV DNA正常,移植后12个月发生慢性广泛性GVHD,加强抗排异治疗后于移植后15个月复查发现：ALT 168 U·L-1,HBV DNA升至5×108 copies·mL-1,出现HBs Ag（+）和HBe Ag（+）。予拉米夫定治疗至移植后4.5年,目前ALT 40～80 U·L-1,HBV DNA 1×103～1×104 copies·mL-1。结论 乙肝在移植患儿中并不少见,长期的免疫抑制治疗常使病情反复,加强病毒监测、重视早期干预至关重要;移植前HBV DNA 检测有助于发现潜伏期患儿;HBs Ab(+)、HBe Ab(+)和HBc Ab(+)患儿在强烈免疫抑制下仍有HBV复燃的风险。     

自体成骨细胞的诱导培养及其生物学特性

目的 诱导培养来自自体骨髓间充质干细胞的成骨细胞或成骨细胞的前体细胞，进行自体成骨细胞异体骨复合移植实验研究。方法 抽取动物骨髓、抗凝稀释，以适当条件培养诱导，分化为成骨细胞并分析细胞生物学特性。成骨细胞生长在同种异体骨制成的载体上，形成复合物，植入人工缺损处，观察骨修复情况。结果 可以诱导培养出大量的成骨细胞或成骨细胞的前体细胞。自体成骨细胞异体松质骨复合物修复骨缺损的效果明显优于对照组。结论 本实验为自体成骨细胞异体骨复合移植的临床应用提供一个简单有效的方法。     

Neutropenia and renal dysfunction due to intravesical cidofovir for virus‐associated hemorrhagic cystitis after kidney and allogenic hematopoietic stem cell transplantations

We present a patient with virus‐associated hemorrhagic cystitis who underwent kidney and allogenic hematopoietic stem cell transplantations (allo‐HSCT). Six months post‐allo‐HSCT, adenovirus hemorrhagic cystitis occurred, which has been in remission after a single dose of intravesical cidofovir. This might cause prolonged neutropenia and nephrotoxicity, suggesting cidofovir absorption in the blood.     

Ⅰ型胶原及Ⅲ型胶原在丝素膜移植修复兔眼睑中的表达

目的研究Ⅰ型胶原、Ⅲ型胶原在丝素膜移植修复兔眼睑中的表达,探讨应用丝素膜行眼睑重建的愈合机制。方法将健康新西兰大白兔36只随机分为丝素膜修复组（n=18）和异体巩膜修复组（n=18）,均制作右眼上睑板缺损模型,分别植入丝素膜和异体巩膜予以修复。左眼为正常对照。各组于术后第1、2、4周取手术区域上眼睑,苏木精伊红（HE）染色观察组织形态学变化,免疫组织化学法检测眼睑中Ⅰ型胶原、Ⅲ型胶原的表达。结果所有兔眼睑缺损均Ⅰ期愈合。HE染色结果显示,术后移植区炎性细胞浸润异体巩膜组多于丝素膜组。免疫组化染色结果显示,丝素膜组和异体巩膜组Ⅰ型胶原、Ⅲ型胶原的表达随着术后观察时间的增加而增加。术后各时间点Ⅰ型胶原的表达为异体巩膜组〉丝素膜组〉正常对照组（1周：F=19．586,P〈0．01;2周：F=30．041,P〈0．01;4周：F=32．587,P〈0．01）。术后各时间点Ⅲ型胶原的表达为异体巩膜组〉丝素膜组〉正常对照组（1周：F=19．220,P〈0．01;2周：F=39．414,P〈0．01;4周：F=49．680,P〈0．01）。结论丝素膜移植修复兔眼睑缺损I型胶原、Ⅲ型胶原表达较异体巩膜少,愈合反应较异体巩膜轻,可用于眼睑重建。     

bFGF复合部分脱矿异体骨修复兔下颌骨缺损的电镜观察

目的观察bFGF(basic fibroblast growth factor,碱性成纤维细胞生长因子)复合部分脱矿异体骨在修复下颌骨缺损中的成骨情况,研究bFGF在骨缺损修复中的成骨作用机制及其适宜载体的选择。方法取健康成年家兔新鲜下颌骨,经部分脱矿和冻干辐照处理以降低其免疫原性。在21例兔双侧下颌骨缺损模型中,按照完全随机原则,一侧选用bFGF复合部分脱矿异体骨修复骨缺损,作为实验组;另一侧单纯以部分脱矿冻干辐照异体骨修复,作为对照组。术后3、6、12周分别处死7只实验动物,对标本进行电镜观察。结果实验组和对照组手术创口均为一期愈合,宿主对移植物未发生排斥反应。扫描电镜显示,实验组植骨区有大量新生骨,随时间推移,新骨的量渐多;对照组植骨区多为纤维组织,新骨形成少。结论 bFGF可促进异体骨植骨区骨质形成。部分脱矿异体骨可用于下颌骨缺损的修复并可作为bFGF的载体。     

关节镜下异体韧带重建交叉韧带的围手术期处理

目的探讨关节镜下异体韧带重建膝关节韧带断裂的围手术期处理方法。方法 12例膝关节交叉韧带断裂患者均采用关节镜下异体韧带重建交叉韧带进行围手术期处理,其中单纯前交叉韧带断裂9例,单纯后交叉韧带断裂1例,前后交叉韧带均断裂2例。结果 12例膝关节交叉韧带患者随访时间为6个月至2年,平均随访时间15个月,患者术后膝关节不稳症状均消失,关节前后方向稳定性恢复,术后膝关节Lachman试验及后抽屉试验均为阴性,膝关节Lysholm功能评分术前平均53分,术后8周平均89分,优10例,良2例,无切口感染和免疫排斥反应。结论良好的围手术期处理,可以提高患膝关节的功能,减少术后并发症及患者的伤残率。     

Root and periodontal tissue development after allogenic tooth transplantation between rat littermates

Oral Diseases (2011) 17 , 379–386 Objective: The study was designed to investigate the development of roots and periodontal tissues after allogenic tooth transplantation between rat littermates by micro‐computed tomography (micro‐CT) and histology. Materials and Methods: The upper right second molars in 2‐week‐old rats were extracted and immediately transplanted into the upper right first molar socket of rat littermates under anesthesia. The upper left second molars in 2‐week‐old recipient rats were used as a control. The rats were fixed and tissues analyzed at 0, 4, 8, or 12 weeks after transplantation. Root development of seven rats in each group was analyzed quantitatively using micro‐CT. Periodontal tissue formation was examined qualitatively by histologic methods. Results: Roots developed after allogenic transplantation, but they were significantly shorter than control roots. The number of roots varied from one to four in transplanted teeth, while it was consistently four in control teeth. Periodontal tissue formation in transplanted teeth was equivalent to that of the control teeth. Conclusion: Allogenic transplantation between rat littermates permits root development and periodontal tissue formation.     

Reversal of chlorpyrifos neurobehavioral teratogenicity in mice by allographic transplantation of adult subventricular zone-derived neural stem cells

Neurobehavioral teratogenicity can be reversed with transplantation of neural stem cells. However, the usefulness of this therapy would be greatly enhanced by employing adult stem cells. In pursuit of this this goal, we developed a model that uses subventricular zone (SVZ) cells. HS/Ibg mice were exposed prenatally to chlorpyrifos on gestational days 9-18 (3 mg/kg/day, SC) in order to induce deficits in their performance in the Morris water maze test. Both the control and the exposed offspring were transplanted with SVZ cells (or vehicle) on postnatal day 35; this actually represents an allogenic transplantation, because the HS/Ibg strain is a heterogeneous stock. The transplanted cells were later observed in the host brain by DiI tracing, and their initial differentiation to cholinergic neurons and astrocytes was ascertained. On postnatal day 80, animals that had been exposed prenatally to chlorpyrifos displayed impaired Morris water maze performance, requiring more time to reach the platform. Transplantation of adult SVZ-derived neural stem cells (NSC) reversed the deficits. Applying autologous transplantation provides an important demonstration that the methodological obstacles of immunological rejection and the ethical concerns related to using embryonic stem cells may be successfully bypassed in developing stem cell therapies for neurodevelopmental disorders.