Insuficiencia cardiaca secundaria a amiloidosis AL: diagnóstico y tratamiento / Heart failure secondary to amyloidosis AL: diagnosis and treatment

Resumen La amiloidosis por depósito de cadenas livianas de inmunoglobulinas (AL) es una enfermedad poco frecuen te y subdiagnosticada. El mejor tratamiento disponible al momento es el trasplante autólogo de médula ósea (TMO). El compromiso cardíaco es el principal determi nante pronóstico en esta patología y en ocasiones un impedimento para recibir el TMO. Se presenta el caso de un varón de 44 años que consultó por signos y síntomas de insuficiencia cardiaca (IC) con biomarcadores cardia cos elevados. Se realizó un ecocardiograma transtorácico donde se objetivó aumento de espesores parietales con hipoquinesia global y fracción de eyección deteriorada en grado leve (50%). El paciente se internó en unidad coronaria para balance negativo y para estudio etiológico del cuadro. Ante la sospecha de enfermedad infiltrativa, se solicitaron un centellograma óseo con pirofosfato y cadenas livianas libres en suero. El centellograma óseo resultó no sugestivo para amiloidosis por transtiretina y las cadenas livianas libres mostraron una relación me nor a 0.26 con predominio lambda. Se realizó una biopsia de encía que confirmó el diagnóstico de amiloidosis AL. Posterior al diagnóstico comenzó tratamiento qui mioterápico específico con Ciclofosfamida, Bortezomib y Dexametasona (esquema CYBORD) y Daratumumab. Evolucionó con IC refractaria por lo que ingresó a lista de trasplante cardiaco, recibiendo el mismo al poco tiempo con buena evolución. Esto permitió reiniciar el esquema quimioterápico y en segundo término finalmente recibir el TMO, con buena evolución.

Abstract Light chain amyloidosis (AL) is a rare and underdi agnosed disease. The best treatment available is au tologous bone marrow transplantation (BMT). Cardiac involvement is the main prognostic determinant in this pathology and sometimes an impediment to re ceive BMT. We present a clinical case of a 44-year-old who consulted for signs and symptoms of heart failure (HF) with elevated cardiac biomarkers. A transthoracic echocardiogram showed increased wall thickness with global hypokinesia and mildly impaired ejection fraction (50%). The patient was admitted to the coronary unit for treatment with diuretics and for etiological study of the condition. In view of the suspicion of infiltrative disease, a bone scintigraphy with pyrophosphate and free light chains in serum were requested. The bone scintigraphy was not suggestive of transthyretin amyloidosis and the free light chains showed a ratio of less than 0.26 with lambda predominance. A gum biopsy was per formed and confirmed the diagnosis of AL amyloidosis. After diagnosis, specific chemotherapy treatment with Cyclophosphamide, Bortezomib and Dexamethasone (CYBORD scheme) and Daratumumab was started. He evolved with refractory HF so it was decided to admit him to the cardiac transplantation list, receiving the same soon after, with good evolution. This allowed the patient to restart the chemotherapy regimen and finally receive BMT, with good evolution.

Clinical application of β-tricalcium phosphate artificial bone material for alveolar cleft repair / 口腔疾病防治

Objective@# To investigate the osteogenic effect of β-tricalcium phosphate (β-TCP) and bone morphogenetic protein-2 (BMP-2) in the repair of the alveolar cleft.@*Methods @# Fifty-nine patients with unilateral alveolar cleft who visited Capital Medical University School of Stomatology from January 2016 to May 2021 were included. They were divided into three groups according to the different bone repair materials: autologous bone, β-TCP and BMP-2 +β-TCP. The preoperative and postoperative CBCT data of the patients were imported into Mimics 21.0 software. The preoperative volume of the bone defect and the new volume of bone formation were calculated by the three-dimensional reconstruction method. The osteogenesis rate was calculated to evaluate the osteogenesis effect@*Results@#The wounds in the three groups healed well after the operation, without implant material discharge, infection, dehiscence, rejection or other symptoms. Twelve months after the operation, CBCT scanning and three⁃dimensional reconstruction images of the three groups of patients showed the formation of new bone bridges in the alveolar ridge fissure area. The image density of the new bone tissue was not significantly different from that of normal bone tissue, and the continuity of the maxilla was re⁃ stored to varying degrees. The bone rate of autogenous bone was 65.00% ± 16.66%, β⁃ TCP group and BMP⁃2+ β⁃ The bone composition rate of TCP was 69.82% ± 17.60%, 71.35% ± 17.51%, respectively, and there was no significant dif⁃ ference compared with the autogenous bone group (P = 0.382, P = 0.244). The β⁃TCP and BMP⁃2+ β⁃TCP groups had no significant differences in bone rate (P = 0.789). @*Conclusion@#β⁃TCP could be used to replace autologous bone for alveolar cleft repair. The addition of BMP⁃2 to β⁃TCP did not significantly improve the osteogenesis rate.

Expert consensus on the bone augmentation surgery for alveolar bone defects / 口腔疾病防治

@#Alveolar bone is an important anatomic basis for implant-supported denture restoration, and its different degrees of defects determine the choices of bone augmentation surgeries. Therefore, the reconstruction of alveolar bone defects is an important technology in the clinical practice of implant restoration. However, the final reconstructive effect of bone quality, bone quantity and bone morphology is affected by many factors. Clinicians need to master the standardized diagnosis and treatment principles and methods to improve the treatment effect and achieve the goal of both aesthetic and functional reconstruction of both jaws. Based on the current clinical experience of domestic experts and the relevant academic guidelines of foreign counterparts, this expert consensus systematically and comprehensively summarized the augmentation strategies of alveolar bone defects from two aspects: the classification of alveolar bone defects and the appropriate selection of bone augmentation surgeries. The following consensus are reached: alveolar bone defects can be divided into five types (Ⅰ-0, Ⅰ-Ⅰ, Ⅱ-0, Ⅱ-Ⅰ and Ⅱ-Ⅱ) according to the relationship between alveolar bone defects and the expected position of dental implants. A typeⅠ-0 bone defect is a bone defect on one side of the alveolar bone that does not exceed 50% of the expected implant length, and there is no obvious defect on the other side; guided bone regeneration with simultaneous implant implantation is preferred. Type Ⅰ-Ⅰ bone defects refer to bone defects on both sides of alveolar bone those do not exceed 50% of the expected implant length; the first choice is autologous bone block onlay grafting for bone increments with staged implant placement or transcrestal sinus floor elevation with simultaneous implant implantation. Type Ⅱ-0 bone defects show that the bone defect on one side of alveolar bone exceeds 50% of the expected implant length, and there’s no obvious defect on the other side; autologous bone block onlay grafting (thickness ≤ 4 mm) or alveolar ridge splitting (thickness > 4 mm) is preferred for bone augmentation with staged implant placement. Type Ⅱ-Ⅰ bone defects indicate that the bone plate defect on one side exceeds 50% of the expected implant length and the bone defect on the other side does not exceed 50% of the expected implant length; autologous bone block onlay grafting or tenting techniques is preferred for bone increments with staged implant implantation. Type Ⅱ-Ⅱ bone defects are bone plates on both sides of alveolar bone those exceed 50% of the expected implant length; guided bone regeneration with rigid mesh or maxillary sinus floor elevation or cortical autologous bone tenting is preferred for bone increments with staged implant implantation. This consensus will provide clinical physicians with appropriate augmentation strategies for alveolar bone defects.

Conservación de injerto autólogo de cabeza femoral en colgajo óseo para tratamiento de los defectos acetabulares / Conservation of autologous graft of femoral head in bone flap for treatment of acetabular defects

Resumen: Objetivo: Describir una técnica de conservación ósea de uso común en neurocirugía en un procedimiento ortopédico. Material y métodos: Se describe el caso de una paciente que se somete a artroplastía primaria de cadera con un resultado no satisfactorio inicial, planteándose previo al cierre la necesidad de una revisión con reconstrucción acetabular. Conservando cabeza femoral de paciente en tejidos blandos para realizar reconstrucción en segundo tiempo. Resultados: Tras seguimiento por seis meses se encuentra completa osteointegración de injerto de cabeza femoral, con buena evolución clínica y radiológica de la paciente. Las técnicas de conservación ósea en colgajos óseos han demostrado buenos resultados en la osteointegración de los injertos en otras áreas como neurocirugía. Conclusiones: La conservación de colgajos óseos en tejido celular subcutáneo para posterior uso como injerto es una opción viable de tratamiento también en la cirugía ortopédica.

Abstract: Objective: To describe a bone preservation technique commonly used in neurosurgery in an orthopedic procedure. Material and methods: We describe the case of a patient who undergoes primary hip arthroplasty with an initial unsatisfactory result, the need for a revision with acetabular reconstruction is considered before the wound closure. Keeping the patient's femoral head in soft tissues for second-time reconstruction. Results: After six months of follow-up, complete osseointegration of the femoral head graft was found, with a good clinical and radiological evolution of the patient. Bone conservation techniques in bone flaps have shown good results in the grafts osseointegration in other areas such as neurosurgery. Conclusions: The conservation of bone flaps in subcutaneous tissue for later use as a graft is a viable treatment option also in orthopedic surgery.

Concentrated autologous bone marrow aspirate transplantation versus conservative treatment for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus / Journal of Rural Medicine

Objective: To compare the outcomes of steroid-associated osteonecrosis of the femoral head in patients with systemic lupus erythematosus who underwent conservative treatment and concentrated autologous bone marrow aspirate transplantationMethods: Osteonecrosis of the femoral head was classified according to the Japanese Investigation Committee system. Concentrated autologous bone marrow aspirate transplantation was performed by aspirating the bone marrow from both iliac crests and then transplanting it to the necrotic area after the core decompression. Patients with >2-year follow-up after the concentrated autologous bone marrow aspirate transplantation in our institution (Group I) and those with >2-year follow-up after the first hospital visit in a cooperative institution (Group II) were included in this study. After a randomized matching based on age, sex, type, stage, and etiology, the collapse rate in pre-collapsed stages and total hip arthroplasty conversion rate in all stages were compared between the two groups.Results: After the matching adjustment, 33 pairs of hips were included. Preoperatively, 1, 2, 16, and 14 hips were classified as types A, B, C1, and C2, respectively, and 15, 13, 2, and 3 hips were classified as stages 1, 2, 3A, and 3B, respectively. The collapse rates in the pre-collapsed stages were 68% and 39% in Groups I and II, respectively. Total hip arthroplasty conversion rates were 33% and 45% in Groups I and II, respectively. However, Group I had significantly higher and lower conversion rates in stages 1 and 3, respectively (both P<0.05).Conclusion: Conservative treatment may be preferable in stage 1 hips. In addition, concentrated autologous bone marrow aspirate transplantation may prevent further collapse in stage 3.

Utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar / Bibliographic update on the use of biomaterials and autologous bone grafts in patients with alveolar atrophy

RESUMEN El material de elección para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos (hueso del propio paciente). A partir de la introducción del concepto de osteointegración por Branemark, los implantes dentales son parte de la terapéutica diaria para rehabilitar áreas edéntulas. La atrofia alveolar es quizás una de las condiciones bucales más incapacitantes; la razón reside en que es crónica, progresiva, acumulativa e irreversible, altera las relaciones maxilomandibulares, reduce la cantidad de hueso del área dentosoportada y la profundidad del surco. El material de injerto óseo ideal no debería ser sólo un sustituto óseo, sino un material de regeneración que se reabsorba completamente de modo simultáneo a la formación de hueso nuevo. Evaluar el éxito y fracaso de una terapia permite tomar decisiones para un mejoramiento continuo de la práctica clínica. El objetivo de la investigación fue demostrar la importancia de la utilización de biomateriales e injertos óseos autólogos en pacientes con atrofia alveolar (AU).

SUMMARY The elective material for replacing the bone lost by trauma, congenital or acquired pathological processes and atrophy are the autogenic or autologous bone grafts (the patient´s own bones). From the introduction of the concept of osseointegration by Branemark on, dental implants are part of the daily therapeutic for rehabilitating edentulous areas. Alveolar atrophy is perhaps one of the most disabling oral conditions, because it is chronic, progressive, cumulative and irreversible. It alters maxilla-mandibular relations, reduces the bone quality of the dentosupported area and the depth of the sulcus. The ideal bone graft material should not be only a bone substitute, by a regenerative material that could be completely reabsorbed simultaneously with the new bone formation. To assess the success and failure of a therapy allows taking decisions for the continuous improvement of the clinical practice. The aim of the research was to prove the importance of using biomaterials or autologous bone grafts in patients with alveolar atrophy (AU).

Meta-analysis of bone morphogenetic protein versus autologous bone grafting for limb long bone nonunion / 中国组织工程研究

BACKGROUND: Bone morphogenetic proteins have strong bone induction properties and have been proved to promote bone healing in fracture, bone defect and other diseases. However, few studies are reported on the use of bone morphogenetic proteins in the treatment of bone nonunion, and the results of various studies remain controversial, which makes the role of bone morphogenetic proteins in the treatment of limb long bone nonunion unclear. OBJECTIVE: Meta-analysis was used to systematically evaluate the advantages and disadvantages of bone morphogenetic protein versus autogenous bone grafting in the treatment of limb long bone nonunion. METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and WanFang databases were searched to retrieve the randomized controlled trials and non-randomized controlled trials of bone morphogenetic proteins for limb long bone nonunion published before April 2019. Quality evaluation and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5. 1 software provided by Cochrane system. RESULTS AND CONCLUSION: Eight articles were enrolled, including 4 randomized controlled trials and 4 non-randomized controlled trials, all of which were small sample-size studies involving 30-124 cases. A total of 613 cases of nonunion were included. In the study group, patients received bone morphogenetic proteins or bone morphogenetic proteins in combination with bone grafting. In the control group, patients received autologous bone grafting. Meta-analysis results showed that there were no significant differences in postoperative healing rate, infection rate, secondary operation rate, and postoperative improvement in limb function between study and control groups (P > 0. 05). The mean healing time in the study group was significantly shorter than that in the control group [WMD=-1. 24, 95%C/(-1. 70,-0. 79), P 0. 05). These results suggest that bone morphogenetic protein can provide a viable alternative to autologous bone grafting, and it is also a safe adjuvant for autologous bone grafting, which has the potential advantage of accelerating fracture healing, but the current evidence does not support bone morphogenetic protein in combination with autologous bone grafting.

Possibility of treating large bone defect and reducing the amount of autogenous bone using masquelet technique / 中国组织工程研究

BACKGROUND: Masquelet technique is one of the effective methods to repair large bone defects. This technique requires the use of more autologous bone in the second stage of surgical treatment. However, the source of autologous bone is limited and the complications in the donor area are inevitable. How to reduce the use of autologous bone is an urgent problem to be solved. OBJECTIVE: By combining with the development status of induced membrane technology at home and abroad, this review introduced some effective methods to reduce the amount of autologous bone in induced membrane technology, including filling bone graft replacement materials and some special surgical methods. METHODS: The first author used a computer to retrieve the literature published in PubMed, CNKI and Wanfang databases from January 1996 to September 2019. The search terms were “Masquelet technique; induced membrane; bone transport technique; autologous bone; bone defect; bone graft; 3D printing; tissue engineering”. RESULTS AND CONCLUSION: Since the emergence of the Masquelet technique, the technique has been constantly improved and innovated by scholars. However, there is no international consensus on how to reduce the use of autologous bone in the second stage of Masquelet technique. At present, each of improvement methods has its own advantages and disadvantages, and clinicians need to choose according to objective conditions. The method proposed by Jong-Keon Oh, using gelfoam as the bone grafting center and the peripheral ring for bone grafting, is simple and practical. Tissue engineering technology has potential for development. With the further study of seed cells and scaffold materials, it will gradually replace the existing treatment schemes. According to the existing research, the research direction of Masquelet technique in the future can be roughly summarized into four directions: The improvement of membrane technology, the improvement of surgical methods, the application of combined materials, and the application of 3D printing and tissue engineering technology. These directions need further exploration and development by scholars.

Utilización de injertos óseos autólogos y biomateriales en pacientes con atrofia alveolar. Matanzas / Use of autologous bone grafts and biomaterials in patients with alveolar atrophy.Matanzas

RESUMEN Introducción: los injertos óseos constituyen una de las técnicas más utilizadas en la cirugía reconstructiva implantológicas, son muy utilizadas para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos. Objetivo: caracterizar los pacientes con rebordes atróficos que necesitaron ser rehabilitados en implantología oral como alternativa de tratamiento en la consulta de Cirugía Máxilo Facial del Hospital Universitario "Faustino Pérez" y la Clínica "III Congreso del PCC", municipio Matanzas de septiembre del 2014 a julio de 2016. Material y Método: estudio prospectivo longitudinal. El universo fue de 20 pacientes mayores de 18 años de ambos sexos, que presentaron el diagnóstico de edentulismo parcial y atrofia alveolar. Se determinó por el interrogatorio, el examen clínico y los medios diagnósticos los síntomas y signos que caracterizaron esta entidad. Resultados: los traumatismos alveolares fue la causa que predominó en la pérdida dentaria, en el sexo masculino y en las edades de 18 a 37 años. La zona de mayor afectación fue la región anterior del maxilar superior y predominó la perdida de hueso en altura y en anchura y un gran número de injertos conservaron la cresta alveolar. Conclusiones: el uso de biomateriales en el tratamiento de pacientes con atrofia alveolar junto al injerto óseo fue satisfactorio en pacientes que necesitaron una base de sostén sobre la cual se colocaron los implantes dentales osteointegrados (AU).

SUMMARY Introduction: autogenous and autologous bone grafts are the elective material for replacing bones lost by trauma, congenital or acquired pathologic processes and atrophy. Objective: to characterize patients with atrophic rims needing rehabilitation in oral grafting as an alternative treatment in the Maxilla-Facial Surgery consultation of the University Hospital "Faustino Perez" and the Clinic "III Congreso del PCC", municipality of Matanzas, from September 2014 to July 2016. Materials and Methods: longitudinal prospective study. The universe was 20 patients aged 18 years and older, males and females, who presented the diagnosis of partial lack of teeth and alveolar atrophy. The symptoms and signs characterizing this entity were stated by questioning, physical examination and diagnostic means. Results: alveolar traumas were the predominant cause of dental lost in male patients aged 18-37 years. The most affected zone was the anterior region of the upper maxilla; bone lost in height and width predominated, and a great number of grafts conserved the alveolar crest. Conclusions: the use of biomaterials in the treatment of patients with alveolar atrophy together with bone graft was satisfactory in patients who needed a base support on which to put dental grafts (AU).

Safety of autologous bone marrow mesenchymal stem cells transplantation in proliferative diabetic retinopathy patients / 中华实验眼科杂志

Objective To investigate the safety of autologous bone marrow mesenchymal stem cells (ABMSCs) transplantation into the subretinal space for the treatment of proliferative diabetic retinopathy (PDR). Methods The clinical data of four PDR patients ( four eyes ) who received ABMSCs transplantation into the subretinal space were collected in Army Medical University,Southwest Eye Hospital from March 2014 to December 2015,including 3 males and 1 female;the average age was 55 years old;the average course of diabetes was 10 years, and the blood glucoses were all well controlled before treatment. All the patients underwent conventional ophthalmologic examination,and visual acuity,slit lamp microscope,color fundus photography,fluorescein angiography (FFA) and optical coherence tomography ( OCT) examination were performed at 1 week,1 month,3 months,6 months,9 months and 12 months after surgery. This study protocol was approved by Ethic Committee of Army Medical University,Southwest Eye Hospital (No. 2013-34). Results Four patients diagnosed as PDR were enrolled in this study. All patients were performed ABMSC transplantation,and no one felt discomfort after treatment. FFA and OCT showed that the transplanted cells were present in the subretinal space until 1 month after transplantation. The macular edema of one patient diagnosed as macular edema preoperatively was relived gradually after transplantation,and the effects lasted 3 months after transplantation. The preoperative best corrected visual acuity (BCVA) of the two patients were improved from hand movement and finger counting to 20/20 ( 84 ETDRS) and 20/200 ( 38 ETDRS) after transplantation,respectively,and the visual acuities of the other two eyes were both stable. All patients underwent panretinal photocoagulatio 3 months after transplantation, and the follow-up treatment complied with the routine of post-vitrectomy for DR, no complications occurred during the follow-up period. Conclusions Subretinal transplantation of ABMSCs for PDR is safe. The transplanted cells show local anti-inflammatory effect,and no effect on cell proliferation or circulatory improvement are observed.

Maxillary sinus floor lifting using freeze-dried homologous bone and tibia autologous bone: report on radiographic and histological results / Elevación del piso del seno maxilar usando hueso homólogo liofilizado y hueso autólogo de tibia: reporte de resultados radiográficos e histológicos

ABSTRACT. Introduction: autologous bone grafts for maxillary sinus floor lifting are widely accepted to reconstruct alveolar ridge defects; however, there are donor sites that have not been fully explored and can be valid alternatives for this type of procedures. The objective of this study was to evaluate the behavior of tibia autologous grafts compared with freeze-dried homologous bone in maxillary sinus floor lifting. Methods: prospective, controlled, randomized study in 11 patients requiring maxillary sinus elevation. Panoramic radiographs were taken in three different moments (pre-surgery, immediately after surgery, and 6 months post-surgery) in the two groups (tibia and freeze-dried), measuring the alveolar ridge height in the posterior maxilla. Bone biopsies were taken in the grafted area 6 months after the procedure. Results: A significant reduction in bone height was found in the group grafted with freeze-dried bone. The group grafted with tibia autologous bone showed greater stability between baseline and 6 months after surgery. The histological sections showed equal conditions between the two groups. Conclusion: tibia bone shows greater stability in the evaluated period in terms of the height obtained in maxillary sinus floor lifting procedures, with clinical and histological characteristics suitable for the placement of implants. This study should be complemented with a larger sample to provide more representative results that can be applied to the general population.

RESUMEN. Introducción: los injertos de hueso autólogo para elevación del piso del seno maxilar son ampliamente aceptados para la reconstrucción de defectos en el reborde alveolar; sin embargo, existen sitios donantes que no han sido debidamente explorados y que pueden representar opciones válidas para este tipo de procedimientos. El objetivo de este estudio consistió en evaluar el comportamiento de los injertos autólogos de tibia, comparados con injertos homólogos de hueso liofilizado en la elevación de seno maxilar. Métodos: estudio prospectivo, controlado, aleatorio, que incluyó a 11 pacientes que requerían elevación del seno maxilar. Se tomaron radiografías panorámicas en tres momentos (prequirúrgico, posquirúrgico inmediato y posquirúrgico a 6 meses) en los dos grupos (tibia y liofilizado). En estas se midió la altura del reborde alveolar en el maxilar posterior. Se tomaron biopsias de hueso en la zona injertada 6 meses después del procedimiento. Resultados: Se encontró una disminución significativa de la altura ósea en el grupo injertado con hueso liofilizado. El grupo injertado con hueso autólogo de tibia presentó mayor estabilidad entre el periodo de la cirugía y 6 meses después. En los cortes histológicos se evidenció igualdad de condiciones entre ambos grupos. Conclusión: el hueso de tibia muestra mayor estabilidad en el periodo investigado, en términos de altura obtenida en procedimientos de elevación de piso del seno maxilar, con características clínicas e histológicas adecuadas para la colocación de implantes. Este estudio debe complementarse con una muestra mayor para aportar resultados más representativos aplicables a la población.

Union Patterns of Local Autogenous Bone Grafts Using Metal Cages, Allogenic Bone, and Local Autogenous Bone Around the Cages During Posterior Lumbar Interbody Fusion: A Retrospective CT Analysis

STUDY DESIGN: Retrospective study. OBJECTIVES: To conduct an analysis of the union rate and union patterns of local autogenous bone grafts using metal cages, allogenic bone, and local autogenous bone around the cages in posterior lumbar interbody fusion (PLIF). SUMMARY OF LITERATURE REVIEW: Local autologous bone grafting using metal cages is regarded as an effective method for union during PLIF without iliac bone harvesting. There are few studies about the additional bone grafting except using metal cages. MATERIALS AND METHODS: Thirty-nine patients (68 segments) with postoperative computed tomography (CT) results from 6 to 18 months after PLIF were included. We used 2 metal cages filled with local autogenous bone intraoperatively (region C). We also grafted allogenic bone between 2 cages (region A) and local autogenous bone at the side of the cages (region B). Retrospective analyses of the coronal CT sections were performed using the modified Bridwell criteria for assessing the presence of union. A quantitative evaluation was performed using a scoring system that assessed the proportion of radiopaque parts of the union mass. RESULTS: Among the 68 segments, union was observed in 64 segments, resulting in a union rate of 95.6%. The union rates in regions A, B, and C were 86.8%, 89.7%, and 94.1%, respectively. Trabeculation and the quantitative evaluation of union bone showed a statistically significant trend for improvement from regions A to C (p<0.001). CONCLUSIONS: In this study, the complementary effect of additional bone grafting other than local bone grafting was not proven, but it was effective in increasing the fusion area at around 90%. Keeping the height of disc space with the cages, additional bone grafting using local autogenous and allogenous bone may be used as an effective method for stable union.

Autologous Bone Marrow Derived Stem Cells for the Treatment of Multiple Sclerosis

Stem cell therapy, an evolving, progressive field of therapeutics has shown several successes in areas where classic treatments failed to prevent or stop disability. Starting in 2009, twenty two sequential patients with progressive Multiple Sclerosis (MS) courses were treated with Autologous Bone Marrow Mononuclear stem cells (BM-MNSCs). The cells were given both intravenously and intrathecally. Using the Expanded Disability Status Scale (EDSS) score for evaluation, our data indicates that the majority of the patients benefited on the average one point on the scale. This paper adds to the body of evidence suggesting the safety and efficacy of autologous BM-MNSCs in the treatment of MS and awaits validation through larger, randomized studies.

Efficacy of stem cell in improvement of left ventricular function in acute myocardial infarction - MI3 Trial.

Background & objectives: Acute myocardial infarction (AMI) is characterized by irreparable and irreversible loss of cardiac myocytes. Despite major advances in the management of AMI, a large number of patients are left with reduced left ventricular ejection fraction (LVEF), which is a major determinant of short and long term morbidity and mortality. A review of 33 randomized control trials has shown varying improvement in left ventricular (LV) function in patients receiving stem cells compared to standard medical therapy. Most trials had small sample size and were underpowered. This phase III prospective, open labelled, randomized multicenteric trial was undertaken to evaluate the efficacy in improving the LVEF over a period of six months, after injecting a predefined dose of 5-10 × 108 autologous mononuclear cells (MNC) by intra-coronary route, in patients, one to three weeks post ST elevation AMI, in addition to the standard medical therapy. Methods: In this phase III prospective, multicentric trial 250 patients with AMI were included and randomized into stem cell therapy (SCT) and non SCT groups. All patients were followed up for six months. Patients with AMI having left ventricular ejection fraction (LVEF) of 20-50 per cent were included and were randomized to receive intracoronary stem cell infusion after successfully completing percutaneous coronary intervention (PCI). Results: On intention-to-treat analysis the infusion of MNCs had no positive impact on LVEF improvement of ≥ 5 per cent. The improvement in LVEF after six months was 5.17 ± 8.90 per cent in non SCT group and 4.82 ± 10.32 per cent in SCT group. The adverse effects were comparable in both the groups. On post hoc analysis it was noted that the cell dose had a positive impact when infused in the dose of ≥ 5 X 108 (n=71). This benefit was noted upto three weeks post AMI. There were 38 trial deviates in the SCT group which was a limitation of the study. Interpretation & conclusions: Infusion of stem cells was found to have no benefit in ST elevation AMI. However, the procedure was safe. A possible benefit was seen when the predefined cell dose was administered which was noted upto three weeks post AMI, but this was not significant and needs confirmation by larger trials.

Complicaciones en craneoplastias: hueso autólogo criopreservado vs. polimetilmetacrilato. Análisis retrospectivo de 63 pacientes / Complications in cranioplasties: autologous bone cryopreserved vs. Polymethylmethacrylate. Retrospective analysis of 63 patients

Introducción: se define como craneoplastia a la reparación quirúrgica de los defectos óseos craneanos. En nuestro medio el material utilizado mayormente es el hueso autólogo criopreservado (HACp) y, en caso de no contar con dicho tejido, el Polimetilmetacrilato (PMMA) es de elección. Objetivo: Se plantea un estudio retrospectivo observacional a fin de analizar y comparar complicaciones en pacientes sometidos a craneoplastias con HACp en comparación a un grupo de pacientes a los que se les realizó craneoplastia con PMMA. Materiales y métodos: Se incluyeron pacientes que fueron sometidos a craneopatías durante un periodo de 5 años (2008-2013). El seguimiento delos pacientes fue de al menos 12 meses. Se analizaron variables relacionadas a complicaciones tempranas y tardías. Resultados: 63 pacientes recibieron craneoplastia con HACp (31 pacientes, 52%) o polimetilmetacrilato (31 pacientes, 49%). La tasa de complicación global fue del 36,6%. Doce pacientes (19,04%) requirieron tratamiento quirúrgico. Las complicaciones más frecuentes fueron las colecciones subcutáneas no infectadas (19%), seguidas por las infecciones de heridas (17%). No existen diferencias estadísticamente significativas en cuanto a para complicaciones, tanto globales como en las distintas categorías (p>0,05), para ambas técnicas quirúrgicas. Conclusión: Las craneoplastias tanto con HACp como aquellas con PMMA presentan una alta tasa de complicaciones. En nuestra serie no se hallaron diferencias entre ambos grupos estudiados.

Introduction: cranioplasty is defined as the surgical procedure to cover a skull bone defect. In our institution, we mainly use cryopreserved autologous bone graft (HACp), and if it is not available, polymethylmethacrylate is chosen (PMMA). Objective: We performed an observational retrospective study to assess complications in both groups of patients. Materials and Methods: Patients who underwent cranioplasty between 2008 and 2013 were included. Minimum follow up was 12 months. Variables related with early and late complications were analyzed. Results: 63 patients received cranioplasty consisting of autologous bone graft (32 patients, 52%) or PMMA (31 patients, 48%). The global complications rate was 36.6%. 12 patients (19.04%) required surgical treatment for these complications. The most common complications were sterile persistent subcutaneous fluid collection (19%) and wound infection (17%). No differences in complications rates were found between both groups (p>0.05). Conclusions: Cranioplasty following craniectomy is associated with a high complication rate. In our series, both groups showed no differences in complications rates.

Union Rates of Autologous Bone Marrow, Local Autobone and Biphasic Calcium Phosphate Mixed Graft in Lumbar Posterolateral Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: We examined union rates and clinical outcomes to evaluate the efficacy of using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft with posterolateral fusion in spinal stenosis and spondylolisthesis. SUMMARY OF LITERATURE REVIEW: In lumbar posterolateral fusion, union rates of biphasic calcium phosphate and local autobone mixed graft are low compared to union rates of autogenous iliac bone graft. MATERIALS AND METHODS: Among the patients who had lumbar posterolateral fusion with autologous bone marrow along with local autobone and biphasic calcium phosphate mixed graft between February 2013 and January 2014, we analyzed 40 patients who were available for at least one year of follow-up. There were 22 cases with spinal stenosis and 18 cases with spondylolisthesis. Bone fusion was determined along with the fusion rates based on Lenke's criteria (citation). All patients were evaluated postoperatively at one year, using 3D CT. and the clinical outcomes were assessed using Kim's method (citation). RESULTS: In spinal stenosis, bone union was observed in 19 cases out of 22 (86.4%), and in case of spondylolisthesis, bone union was observed in 16 cases out of 18 (88.9%). In spinal stenosis, the clinical outcomes were: 2 excellent, 16 good, 3 fair, and 1 poor; in other words 18 cases (81.8%) displayed good or excellent outcomes. In spondylolisthesis, 2 excellent, 12 good, 4 fair and 0 poor; in other words, 14 cases (77.8%) showed good or superior outcomes. CONCLUSIONS: Posterolateral fusion using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft showed similar bone fusion rates to using autogenous iliac bone graft. Therefore, this method could serve as an alternative to using autogenous iliac bone graft in posterior lumbar fusion.

Clinical study on optimization scheme of autologous bone marrow stem cell transplantation for decompensated cirrhosis / 中国生化药物杂志

Objective To compare the therapeutic effects of bone marrow stem treatment by different bone marrow mobilization,distinct separation methods or cell suspension density, and to explore the optimal treatment plan of autologous bone marrow stem cell transplantation for decompensated cirrhosis.Methods Twenty three patients with decompensated cirrhosis were studied.100 ~200 mL bone marrow from each patient was harvested in aseptic condition, after isolation and purification by density gradient centrifugation,the stem cells were obtained and transplanted into the liver via hepatic artery.The serum glutamic acid alanine aminotransferase (ALT), albumin (ALB), prothrombin time (PT) and total bilirubin (TBIL) were checked before and l, 2, 3 months after therapy respectively,changes in these indicators of each group were compared by different bone marrow mobilization, distinct separation methods, or cell suspension density.Results After transplantation, levels of albumin increased significantly 1, 2, 3 months after treatment compared with baseline(P<0.05).Patients in bone marrow mobilization group obtained higher stem cell density (P<0.05), which had no significant difference in improving liver function ( ALT, TBIL, ALB, PT) compared with non-bone marrow mobilization group.Patients using the kit significantly improved their albumin (3 months after treatment, P<0.05), which had no significant difference in improving liver function (ALT, TBIL, ALB, PT) compared with using ordinary lymphocyte isolation method group.There was no significant difference in improving liver function ( ALT, TBIL, ALB, PT) between lower magnitude stem cell density group(≤1 ×1010/L) and higher magnitude stem cell density group(1 ×1010/L).Conclusion The treatment for decompensated cirrhosis by transplantation of autologous bone nlarrow stem cells is safe and effective, which can significantly increase the level of albumin in patients with decompensated cirrhosis.Preoperative bone marrow mobilization can increase the rate of stem cells obtained, and the method using the kit improves the leves of protein respectively.They are helpful to improve the efficacy.

Analyses Using Micro-CT Scans and Tissue Staining on New Bone Formation and Bone Fusion According to the Timing of Cranioplasty via Frozen Autologous Bone Flaps in Rabbits : A Preliminary Report

OBJECTIVE: The timing of cranioplasty and method of bone flap storage are known risk factors of non-union and resorption of bone flaps. In this animal experimental study, we evaluated the efficacy of cranioplasty using frozen autologous bone flap, and examined whether the timing of cranioplasty after craniectomy affects bone fusion and new bone formation. METHODS: Total 8 rabbits (male, older than 16 weeks) were divided into two groups of early cranioplasty group (EG, 4 rabbits) and delayed cranioplasty group (DG, 4 rabbits). The rabbits of each group were performed cranioplasty via frozen autologous bone flaps 4 weeks (EG) and 8 weeks (DG) after craniectomy. In order to obtain control data, the cranioplasty immediate after craniectomy were made on the contralateral cranial bone of the rabbits (control group, CG).The bone fusion and new bone formation were evaluated by micro-CT scan and histological examination 8 weeks after cranioplasty on both groups. RESULTS: In the micro-CT scans, the mean values of the volume and the surface of new bone were 50.13+/-7.18 mm3 and 706.23+/-77.26 mm2 in EG, 53.78+/-10.86 mm3 and 726.60+/-170.99 mm2 in DG, and 31.51+/-12.84 mm3 and 436.65+/-132.24 mm2 in CG. In the statistical results, significant differences were shown between EG and CG and between DG and CG (volume : p=0.028 and surface : p=0.008). The histological results confirmed new bone formation in all rabbits. CONCLUSION: We observed new bone formation on all the frozen autologous bone flaps that was stored within 8 weeks. The timing of cranioplasty may showed no difference of degree of new bone formation. Not only the healing period after cranioplasty but the time interval from craniectomy to cranioplasty could affect the new bone formation.

Determining the Best Treatment for Simple Bone Cyst: A Decision Analysis

BACKGROUND: The treatment of simple bone cysts (SBC) in children varies significantly among physicians. This study examined which procedure is better for the treatment of SBC, using a decision analysis based on current published evidence. METHODS: A decision tree focused on five treatment modalities of SBC (observation, steroid injection, autologous bone marrow injection, decompression, and curettage with bone graft) were created. Each treatment modality was further branched, according to the presence and severity of complications. The probabilities of all cases were obtained by literature review. A roll back tool was utilized to determine the most preferred treatment modality. One-way sensitivity analysis was performed to determine the threshold value of the treatment modalities. Two-way sensitivity analysis was utilized to examine the joint impact of changes in probabilities of two parameters. RESULTS: The decision model favored autologous bone marrow injection. The expected value of autologous bone marrow injection was 0.9445, while those of observation, steroid injection, decompression, and curettage and bone graft were 0.9318, 0.9400, 0.9395, and 0.9342, respectively. One-way sensitivity analysis showed that autologous bone marrow injection was better than that of decompression for the expected value when the rate of pathologic fracture, or positive symptoms of SBC after autologous bone marrow injection, was lower than 20.4%. CONCLUSIONS: In our study, autologous bone marrow injection was found to be the best choice of treatment of SBC. However, the results were sensitive to the rate of pathologic fracture after treatment of SBC. Physicians should consider the possibility of pathologic fracture when they determine a treatment method for SBC.

Aplicação de células-tronco mesenquimais no tratamento de lesões raquimedulares naturalmente adquiridas em cães e em gatos domésticos / Application of mesenchymal stem cells in the treatment of naturally acquired spinal cord injuries in dogs and domestic cats

Mecanismos de lesão e suas consequencias decorrentes de injúria da medula espinhal (IME) envolvem morte neuronal tanto por necrose quanto por apoptose. Sabendo-se que a regeneração do sistema nervoso central é limitada após danos tissulares, é crucial o desenvolvimento de novas abordagens que otimizem o retorno funcional após IME. As opções de tratamento tardio em cães e em gatos não estão disponíveis e os aspectos de segurança e terapeutico do transplante autólogo de células-tronco mesenquimais derivadas de medula óssea (BMMC) não foram ainda descritas anteriormente. O objetivo desta pesquisa é isolar e caracterizar as BMMC em cães e em gatos; selecionar cães e gatos com IME crônica; elaborar uma abordagem terapeutica à IME utilizando BMMC...

Lesion mechanisms and its evolution following spinal cord injury (SCI) involves neuronal death by both necrosis and apoptosis. Since regeneration of the central nervous system is limited after injuries, it is crucial to develop novel approaches that optimize functional recovery aft er SCI. Stem cell-based therapy has been investigated in a number of degenerative and traumatic diseases, including SCI. Late spinal cord injury treatment options in dogs and cats are not available. Neither the safety aspects and therapeutic effects of autologous bone marrow mesenchymal stem cell (BMMC)...