Therapeutic effect of osteogenically induced adipose derived stem cells on vascular deprivation-induced osteonecrosis of the femoral head in rabbits

Objective: To explore the therapeutic effect of osteogenically induced adipose-derived stem cells (ADSCs) on vascular deprivation-induced osteonecrosis of the femoral head (ONFH) in rabbit model. Methods: Vascular deprivation-induced ONFH was established by intramuscular injection of methylprednisolone, and vascular occlusion of the capital femoral epiphysis by electrocoagulation in adult New Zealand white rabbits. Eight weeks after the establishment of vascular deprivation-induced ONFH, animals were randomly divided into three equal groups. In Group A (control), no therapy was given. In Group B, core decompression was performed by drilling a hole (1.2 mm in diameter) from the outer cortex 2.5 cm distal to the proximal end of the greater trochanter. In Group C, 1 ×107 osteogenically induced ADSCs were resuspended in 0.5 ml PBS, and then injected directly into the femoral head. Femoral head specimens were obtained at postoperative 8 weeks. The bone formation and three-dimensional microstructure of the femoral head was evaluated by micro-computed tomography scans (μ-CT). Immunohistochemical analysis was performed to detect the expression of osteocalcin. Angiogenesis and repair of the femoral head were observed histologically. Results: In trabecular bone at the proximal femur region, the trabecular volume was higher in Group C (130.70 mm3± 4.33 mm3) than that in Groups A (101.07 mm3±7.76 mm3) and B (107.89 mm3±8.68 mm3, P＜0.01). Bone volume was significantly increased in Group C (40.09 mm3±6.35 mm3) than in Groups A (29.65 mm3±4.61 mm3) and B (31.80 mm3± 4.01 mm3, P＜0.01). The trabecular number was higher in Groups C (1.58±0.25) than other two groups (1.15±0.18, 1.16± 0.21, P＜0.01). Bone mineral density showed statistically significant difference between Groups C and A or B (375.38± 23.06) mg HA/ccm, vs (313.73 ±19.30) mg HA/ccm and (316.09± 16.45) mg HA/ccm, P<0.01). Histological examination indicated that there was more new bone formation in Group C than in other groups. Conclusion: Treatment with autologous osteogenically induced ADSCs transplantation results in an enhanced osteogenesis and microstructure of the vascular deprivation-induced osteonecrosis in rabbits.     

以4种基因诱导产前诊断绒毛细胞建立诱导性多能干细胞

背景：诱导性多能干细胞因具有多能性特征,可以诱导分化为特定的细胞,包括神经细胞、造血细胞等。目的：建立产前诊断绒毛细胞来源的诱导性多能干细胞。方法：运用反转录病毒介导4种基因hOct4、hSox2、hc-Myc、hKlf4诱导产前诊断绒毛细胞,对建立的诱导性多能干细胞进行多能性、体内外分化能力、核型等鉴定。结果与结论：建立的诱导性多能干细胞能维持自我更新状态,在蛋白和mRNA水平上高表达全能性的标志基因,具有体内、外分化潜能;在体外长期培养能维持正常核型。说明4种全能性基因转入绒毛细胞可获得具有多能性的诱导性多能干细胞,这为胎儿的细胞自体移植治疗提供理想来源,为产前诊断疾病机制研究提供很好的细胞模型。     

自体造血干细胞移植治疗恶性血液病疗效分析

目的评价自体造血干细胞移植(AHSCT)治疗恶性血液病的疗效。方法自1996年1月~2007年12月,采用AHSCT治疗恶性血液病患者共30例(男性14例,女性16例),中位年龄40(19~52)岁。其中急性非淋巴细胞白血病(ANLL)25例(CR124例,CR21例),急性淋巴细胞白血病(ALL)4例(CR14例),粒细胞肉瘤1例。预处理方案主要包括:MAC(马法兰Mel160mg/m2+阿糖胞苷Ara-C2.0g/m2+环磷酰胺CY120mg/kg)方案或单次全身放疗(TBI)8~10Gy+环磷酰胺(CY)120mg/kg方案。结果所有AHSCT患者均重建造血,无移植相关死亡。中位随访时间为82(12~144)月,存活21例(70.0%),复发9例(30.0%),与同期单纯接受化疗者比较:5年无病存活率(DFS)[分别为(69±8)%和(34±10)%]前者增高,差异有统计学意义(P<0.05)。结论AHSCT移植患者移植相关死亡率低,无病生存率较高,可作为恶性血液病治疗的重要方法。     

自体脾移植联合食管横断吻合术治疗肝硬化门静脉高压症

目的 本研究比较自体脾移植联合食管横断吻合术与脾切除联合食管横断吻合术治疗门静脉高压症(PHT)的疗效.方法 将30例研究对象平均分为两组.研究组行脾次全切除加自体脾腹膜后移植及食管横断吻合术;对照组行脾切除加食管横断吻合术.于术前1周及术后6个月通过三维动态增强磁共振血管成像(3D DCE MRA)检测其门静脉主干(MPV)管腔横截面积、血流量、血流速度等门静脉系统血流动力学参数及食管胃底曲张静脉的变化,并观察自体移植脾在腹膜后的侧支血管形成与血流方向的改变.并同步检查血清肝纤维化指标及肝功能的重要指标. 结果术后两组MPV的管腔横截面积、MPV的平均流速和MPV的平均流量均比术前明显减小(P＜0.05).且术后研究组MPV的平均流速和平均流量均少于对照组(P＜0.05).两组手术后胃底曲张静脉、食管曲张静脉均消失或明显改善;两组手术前后肝功能的重要指标均差异无统计学意义(P＞0.05).研究组血清透明质酸水平在术后显著下降(P＜0.05),研究组移植脾成活良好,并建立了广泛的侧支循环. 结论自体脾移植联合食管横断吻合术是一种优于脾切除加断流术治疗肝硬化PHT的方法,且未对肝功能造成负面影响.     

血管移植加长血管蒂游离皮瓣移植治疗大面积皮肤缺损

目的探讨加长血管蒂的游离皮瓣移植术治疗创伤性大面积皮肤缺损、肌腱及骨外露伴创面感染病例的手术方法及疗效。方法2000年3月至2004年11月,对6例骨与肌腱外露、皮肤缺损伴创面邻近血管损伤、抽脱及闭塞的慢性感染病例行游离皮瓣移植术,男4例,女2例;年龄17～36岁,平均24岁。皮肤缺损面积最大30cm×15cm,最小20cm×10cm。应用修复的皮瓣种类:背阔肌肌皮瓣3例,阔筋膜张肌肌皮瓣2例,前臂皮瓣1例。静脉移植加长皮瓣动、静脉血管蒂最长15cm,最短5cm,平均8cm。移植皮瓣面积最大32cm×17cm,最小22cm×12cm。在距创面稍远的正常部位,解剖出支配受区的动、静脉,应用静脉移植的方法,做端侧吻合,引出支配受区的动、静脉到创面作供血动脉,切取术前设计的游离皮瓣,将皮瓣动、静脉与引到创面邻近的供血动、静脉做端端吻合,皮瓣血循环恢复后,皮瓣创面彻底止血,缝合覆盖创面。结果随访10个月～5年,平均2年3个月。6例皮瓣全部成活。4例胫、腓骨开放性骨折伴骨缺损、骨外露患者中,3例伤口一期愈合,1例因创缘肌肉发生缺血性坏死致皮瓣着床困难、创面感染,而延迟愈合。结论静脉移植搭桥加长供血动、静脉的手术方法是保证游离皮瓣高质量血管吻合的有效手段,特别适用于创面为慢性感染或其邻近血管发生损伤、抽脱、闭塞等情况。     

紫外线照射充氧自血回输疗法治疗脑梗塞

目的综述紫外线照射充氧自血回输疗法(UBIO)治疗脑梗塞的疗效、机制。方法应用UBIO治疗脑梗塞,治疗前后观察治疗组与对照组临床表现、血液流变学、血浆内皮素等的变化。结果治疗后症状体征明显好转,优于对照组(P<0.05),血液流变学各项指标下降有显著差异(P<0.05),血浆内皮素下降有显著差异(P<0.05)。结论UBIO治疗脑梗塞疗效确切,且无明显毒副作用,具有推广价值。     

医用生物蛋白胶在翼状胬肉切除联合角膜缘干细胞移植术中的应用

目的:探讨医用生物蛋白胶(biomedical fibrin glue,BFG)在翼状胬肉切除联合角膜缘干细胞移植术中应用的临床意义。方法:收集2009-06/2010-12我院门诊翼状胬肉患者59例60眼,分为两组,使用生物蛋白胶组34眼和未使用蛋白胶对照组26眼,均行翼状胬肉切除联合角膜缘干细胞移植术,观察手术时间、术后结膜植片贴附情况,球结膜充血以及患者不适症状。结果:生物蛋白胶组手术时间(13.6±3.5min)明显短于对照组(22.3±5.2min),术后2wk内(拆线前),生物蛋白胶组术眼疼痛、异物感和流泪等局部刺激症状均显著轻于对照组,两组术后均未发生植片移位并发症。生物蛋白胶组术后干细胞移植片贴附紧密,对照组有5眼(19%)植片贴附差,出现结膜后退,巩膜外露。生物蛋白胶组植片愈合良好,局部无明显结膜瘢痕形成;对照组均出现不同程度的缝线刺激性结膜瘢痕。术后6mo随访期内两组均未见翼状胬肉复发。结论:医用生物蛋白胶在翼状胬肉切除联合角膜缘干细胞移植手术中的应用可以缩短结膜伤口愈合的时间,促进角膜缘干细胞结膜植片贴附,使用中未见致敏反应的产生。     

自体骨髓移植治疗急性白血病,恶性,淋巴瘤：附7例报告

本文对6例急性白血病、1例晚期何杰金氏病的自体骨髓移植治疗进行了临床分析,提示其疗效优于常规化疗。介绍一种较简便的ABMT方法,并对有关问题进行讨论。     

犬胰腺移植胰液膀胱引流术后某些生化指标的特征性变化

我所1987年3月在国内成功地建立了犬自体、同种异体胰腺移植胰液经膀胱引流动物模型。本文对试验犬进行了系列血,尿生化测定,并获取移植前、后不同时期各种生化数值及变化,其中术前常值血清葡萄糖4.4～8.1mmol/L,血清淀粉酶576±180U、尿液淀粉酶0.6～64U、尿液蛋白41.6±7.6mg/24h,尿液酸碱度6.3±0.5。术后尿液蛋白及尿液淀粉酶均恒定高于术前值。     

Sequential high dose chemotherapy as initial treatment for aggressive sub-types of non-Hodgkin lymphoma: results of the international randomized phase III trial (MISTRAL).

INTRODUCTION: Sequential high dose (SHiDo) chemotherapy with stem cell support has been shown to prolong the event-free survival in patients with diffuse large B-cell lymphoma. METHODS: To confirm this result in a multicenter trial, we randomized patients with aggressive NHL, to receive either eight cycles of CHOP or SHiDo. The primary endpoint was overall survival. RESULTS: 129 evaluable patients were randomized to receive either CHOP or SHiDo: median age, 48 years; 62% male; stage III+IV: 73%; age adjusted International Prognostic Index 1/2/3: 21%/52%/27%. Toxicity grades 3+4 were more pronounced in the SHiDo-arm with 13% versus 3% of patients with fever; 34% versus 13% with infections; 13% versus 2% with esophagitis/dysphagia/gastric ulcer. The remission rates were similar in SHiDo and CHOP arms with 34%/37% complete remissions and 31%/31% partial remissions, respectively. After a median observation time of 48 months, there was no difference in overall survival at 3 years, with 46% for SHiDo and 53% for CHOP (P = 0.48). CONCLUSION: In this multicenter trial, early intensification with SHiDo did not confer any survival benefit in previously untreated patients with aggressive NHL and was associated with a higher incidence of grades 3/4 toxicity.