Lactate dehydrogenase as a hematopoietic stem cell mobilization biomarker in autologous transplantation

ABSTRACT Introduction: Pre-apheresis peripheral blood CD34+ cell count (PBCD34+) is the most important predictor of good cell mobilization before hematopoietic stem cell transplantation, albeit flow cytometry is not always immediately available. Identification of surrogate markers can be useful. The CD34+ cells proliferate after mobilization, resulting in elevated lactate dehydrogenase (LDH) activity and correlating with the PBCD34+ count. Objective: To determine the LDH cut-off value at which adequate CD34+ cell mobilization is achieved and its diagnostic yield. Materials and methods: A total of 103 patients who received an autologous stem cell transplantation (ASCT) between January 2015 and January 2020 were included. Demographic and laboratory characteristics were obtained, including complete blood count, pre-apheresis PBCD34+ and LDH levels. Receiver operating characteristic (ROC) curves were performed to identify the optimal serum LDH activity cut-off points for ≥ 2 and ≥ 4 × 106 cells/kg post-mobilization CD34+ count and their diagnostic yield. Results: A post-mobilization serum LDH cut-off value of 462 U/L yielded a sensitivity (Se) = 86.8% (positive predictive value [PPV] = 72.7%), a pre- and post-mobilization serum LDH difference cut-off value of 387 U/L, an Se = 45.7% (PPV = 97%) and an LDH ratio of 2.46, with an Se = 47.1% (PPV = 97%) for an optimal mobilization count (CD34+ ≥ 4 × 106). Conclusion: The LDH measurement represents a fast and affordable way to predict PBCD34+ mobilization in cases where flow cytometry is not immediately available. According to the LDH diagnostic yield, it could be used as a surrogate marker in transplant centers, supporting the CD34+ count, which remains the gold standard.

Cirugía de Ross en Chile: Tasa libre de reoperación y supervivencia global en una cohorte de más de 10 años de seguimiento

Antecedentes: El autoinjerto de válvula pulmonar (VP) u operación de Ross (OpR) tiene excelentes resultados a largo plazo. Es superior a otros tipos de reemplazo valvular en jóvenes adultos, aunque no el estándar de primera línea. Un tiempo quirúrgico prolongado o alta morbimortalidad son importantes preocupaciones. Objetivos: Establecer la morbimortalidad asociada a la OpR por un período >10 años, considerando el tiempo quirúrgico, tasa de reoperación y supervivencia global (SG). Métodos: Cohorte prospectiva (1996-2012), en seguimiento hasta agosto-2023. La SG fue estimada desde la OpR hasta la última consulta o deceso. Mediante regresión de Cox (Hazard Ratio, HR) se estimaron factores asociados a la SG. Resultados: La serie consta de 161 pacientes: 118 de etiología congénita (73.3%), 17 infecciosa (10.6%), 26 reumática (16.1%). La lesión fue estenótica en 79 (49.1%), insuficiencia en 40 (24.8%), mixta en 42 (26.1%). La OpR fue urgente en 11 (6.8%). The median time of ECC and the operation was 149 y 232 minutos, respectivamente. Veintisiete pacientes requirieron reoperación (16.8%). Con una mediana de 19.7 años (17.2-22.2), 23 pacientes fallecieron (14.3%): 1/23 asociado a OpR, 17/23 por causa cardiovascular y 5/23 por causas no cardiovasculares. La lesión mixta se asoció a mayor mortalidad (HR 3.07; IC 95% 1.11-8.47; p=.029). Conclusiones: La OpR es un procedimiento con baja morbimortalidad. La lesión mixta es un factor de riesgo independiente de mayor mortalidad. Sin embargo, la mediana de tiempo de CEC y quirúrgico es prolongado frente a otras técnicas de reemplazo valvular.

Background: Pulmonary valve (PV) autograftor reoperation or Ross surgery (RS), presents excellent long-term results. It is superior to other types of PV replacement in young adults, although it is not the first-line gold standard. A longer operative time or high morbidity and mortality rates are important concerns. Aim: To establish the morbidity and mortality associated with RS for >10 years, considering operative time, reoperation rate and overall survival (OS). Methods: Prospective cohort (1996-2012), with a follow-up until August/2023. The OS was estimated from RS to the last consultation/death. Factors associated to OS were estimated using Cox regression (Hazard Ratio, HR) Results: 161 patients were included: the etiology was congenital (118, 73%), infectious (17, 10.6%), and rheumatic (26,16.1%). The lesion was stenotic in 79 (49.1%), heart failure in 40 (24.8%), mixed in 42 (26.1%). RS was urgent in 11 (6.8%). Extracorporeal circulation (ECC) and operative times were 149 and 232 minutes, respectively. Twenty-seven patients required reoperation (16.8%). With a median follow up of 19.7 years (17.2-22.2), 23 patients died (14.3%): 1/23 associated with RS, 17/23 due to cardiovascular causes, and 5/23 due to non-cardiovascular causes. Mixed injury was associated with higher mortality (HR 3.07; 95% CI 1.11-8.47; p=.029). Conclusions: RS is a procedure with low morbidity and mortality. Mixed injury is an independent risk factor for increased mortality. However, the median ECC and operative times were higher compared to other valvular replacement techniques.

Use of enamel matrix- derived proteins combined with bone graft for the treatment of intrabony defects: overview of reviews (FRISBEE review) / Uso de proteínas derivadas de la matriz del esmalte combinado con injerto óseo para el tratamiento de defectos intraóseos: resumen estructurado de revisiones sistemáticas (revisión FRISBEE)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone.

Introducción: El uso de proteínas derivadas de la matriz del esmalte (EMD) ha aumentado en los últimos años debido a sus propiedades inductoras de tejidos que apoyan la regeneración periodontal. Este estudio es una revisión sistemática de revisiones sistemáticas utilizando metodología FRISBEE sobre el uso de EMD solo o combinado con materiales injerto óseo autólogo (BGM) en el tratamiento de defectos intraóseos. Materiales y Métodos: Se realizó una búsqueda sistemática en la base de datos Epistemonikos. Se utilizaron RevMan 5.3 y GRADEpro para el análisis y la presentación de los datos. Resultados: Se identificaron cuatro revisiones sistemáticas y dos ensayos clínicos. Todos los estudios analizaron el cambio en la profundidad de sondaje, el nivel de inserción clínica, el nivel del margen gingival y la profundidad del defecto óseo (todos los cambios a favor de los grupos EMD+BGM: MD: 0,37 mm más, media de diferencia (MD): 0,7 mm más, MD: 0,3 mm menos, MD: 0,75 más, respectivamente). Conclusión: La adición de injerto óseo autólogo a la EMD para tratar defectos intraóseos mostró mejores resultados, pero no una diferencia clínica relevante en comparación con el uso de la EMD sola.

Colgajo adipofascial de flujo reverso del dorso del antebrazo para reconstrucción de la mano y muñeca: nuestra experiencia clínica / Back Forearm Reverse Flow Adipofascial Flap for hand and wrist reconstruction: our clinical experience

Los defectos cutáneos de la mano pueden ser difíciles de resolver. La cobertura cutánea es esencial para proveer una protección adecuada y permitir el funcionamiento correcto de las estructuras subyacentes. El objetivo de este estudio es reportar nuestra experiencia con el uso del colgajo adipofascial de flujo reverso del dorso del antebrazo para cobertura del dorso de la mano, dedos y muñeca en pacientes tratados en la ciudad de San Cristóbal, Estado Táchira, desde mayo de 2015 hasta enero de 2018. Se realizó un estudio longitudinal, descriptivo y prospectivo en pacientes con pérdidas cutáneas extensas de la mano, que fueron cubiertas con el colgajo adipofascial reverso del dorso del antebrazo. Se incluyeron 10 pacientes. 90% de sexo masculino. La edad promedio fue 41±12,32(13-69). La etiología de los defectos fue: 40% traumatismos de alta energía, 30% mano diabética tropical, 10% secuela de quemadura de segundo grado, 10% herida por arma de fuego artesanal, 10% carcinoma primario de piel. 100% de los colgajos sobrevivieron, logrando buena cobertura y cicatrización sin necesidad de otros procedimientos quirúrgicos y con mínimas complicaciones de la zona dadora. La función de la mano y muñeca se recuperó en todos los pacientes. En conclusión, el colgajo adipofascial de flujo reverso del antebrazo es un procedimiento útil, versátil y sencillo para la reconstrucción del dorso de la mano, dedos y cara volar de muñeca en pacientes de distintas edades(AU)

Hand skin defects can be difficult to resolve. Skin coverage is essential to provide adequate protection and allow proper function of the underlying structures. The objective of this study is to report our experience with the use of the Back Forearm Reverse Flow Adipofascial Flap to cover the back of the hand, fingers and wrist in patients treated in the city of San Cristóbal, Táchira State, since may 2015 to january 2018. A longitudinal, descriptive and prospective study was made in patients with extensive skin losses of the hand, which were covered with the Back Forearm Reverse Flow Adipofascial Flap. 10 patients were included. 90,0% male. Mean age 41±12.32(13-69) years. The etiology of the defects was: 40,0% high-energy trauma, 30,0% tropical diabetic hand, 10,0% second degree burn sequel, 10,0% handcrafted firearm wound, 10,0% primary skin carcinoma. 100,0% of the flaps survived, achieving good coverage and healing without the need for other surgical procedures and with minimal complications in the donor area. Hand and wrist function recovered in all patients. In conclusion, the reverse flow adipoascial flap of the forearm is a useful, versatile and simple procedure for the reconstruction of the back of the hand, fingers and volar face of the wrist in patients of different ages(AU)

Aplicações da dentina autógena na regeneração óssea: revisão integrativa de literatura / Applications of dentine in bone regeneration: integrative literature review

A dentina e o osso alveolar apresentam muita semelhança em sua composição. Sendo assim, podemos considerar a utilização da dentina como recurso alternativo nas intervenções que buscam a regeneração tecidual óssea. Objetivo: o presente estudo realizou uma revisão integrativa da literatura sobre o uso da dentina como biomaterial para regeneração óssea. Metodologia: foi realizada uma busca por artigos, nas bases de dados Medline, via PubMed; Scielo, LILACS, BASE, Scopus e Science Direct, queavaliassem ou descrevessem o uso da dentina como biomaterial para regeneração óssea. Foram utilizados os seguintes descritores: "Dentin" AND "Bone Regeneration", sem delimitação de tempo. Os critérios de inclusão foram: estudos clínicos publicados em periódicos, oriundos de dados primários, sobre o uso de dentina como biomaterial. Os critérios de exclusão foram: revisões de literatura, estudos in vitro e em animais, estudos que não fosse possível o acesso na íntegra e estudos que associassem o uso da dentina com outros biomateriais sem que fosse possível relacionar os resultados apenas pelo uso da dentina. Resultados: vinte e três estudos foram selecionados para a presente revisão. As pesquisas demonstraram que há uma heterogenicidade relacionada ao tamanho da partícula de dentina obtida, que pode ser decorrente de diferentes métodos de processamento. Conclusão: a reutilização da dentina como biomaterial pode ser uma alternativa promissora ao enxerto autógeno. Sugere-se, então, que protocolos de processamento da partícula de dentina sejam melhor estabelecidos e estudos longitudinais precisam ser realizados para a garantia de procedimentos seguros, eficazes e práticos.

The dentin and the alveolar bone are very similar in composition, therefore, it's usage as an alternative resource in interventions that seek tissue regeneration can be considered. Objective: the aim of the present study was to carry out an integrative review of the literature on the use of dentin as a biomaterial for bone regeneration. Methodology: a search for articles was carried out in the Medline databases, via PubMed; Scielo, LILACS, BASE, Scopus and Science Direct, which evaluated or described the use of dentin as a biomaterial for bone regeneration. The following descriptors were used: "Dentin" AND "Bone Regeneration", without time limits. The inclusion criteria were: clinical studies published in journals, derived from primary data, on the use of dentin as a biomaterial. Exclusion criteria were: literature reviews, in vitro and in animal studies, studies that were not possible to be accessed in full and studies that associated the usage of dentin with other biomaterials and that it was not possible to relate the results just by using the dentin. Results: twenty-three studies were selected for the present review. Researches have shown that there is heterogeneity related to the size of the obtained dentin particle, which may be due to different processing methods. Conclusion: the reuse of dentin as a biomaterial can be a promising alternative to autogenous graft. It is suggested, then, that dentin particle processing protocols should are better established and longitudinal studies need to be carried out to the in order to ensure safe, effective and practical procedures.

Colgajo submentoniano en la reconstrucción decabeza y cuello / Submental flap in head and neck reconstruction

Introducción. Los colgajos del territorio de la arteria submentoniana pueden ser utilizados como un colgajo cutáneo, musculofacial y osteocutáneo, realizando cierres primarios del defecto del sitio donante, sin generar defectos funcionales ni estéticos mayores. Métodos. Describir la experiencia de nuestro equipo quirúrgico, las complicaciones relacionadas con el uso del colgajo y los resultados oncológicos, así como los desenlaces tardíos durante el seguimiento de los pacientes incluidos en el estudio. Resultados. Se incluyeron veintiún pacientes, con una edad media de 66 años (rango 52 - 86), con patología oncológica de lengua, labio inferior, paladar blando, nariz, órbita y orofaringe. Todos los pacientes fueron sometidos a disección selectiva ipsilateral del cuello, tras la extracción del colgajo y en todos los casos se preservó el nervio mandibular marginal. Se registraron complicaciones como la necrosis parcial. La estancia hospitalaria media fue de 8 días.Conclusiones. El colgajo de la arteria submentoniana ha mostrado resultados favorables debido a su uso versátil, amplio arco de rotación, color y baja morbilidad del sitio donante. Se recomienda realizar estudios más robustos, que incluyan la experiencia de diversos especialistas en países que compartan las mismas limitaciones técnicas y características sociodemográficas.

Introduction. Flaps from the territory of the submental artery can be used as a cutaneous, musculofacial and osteocutaneous flap, performing primary closure of the donor site defect, without generating major functional or aesthetic defects. Methods. To describe the experience of the same surgical team, the complications related to the use of the flap and the oncological results, as well as the late outcomes during the follow-up of the patients included in the study. Results. Twenty-one patients with a mean age of 66 years (range: 52-86), with oncological pathology of the tongue, lower lip, soft palate, nose, orbit, and oropharynx were included. All patients underwent ipsilateral selective neck dissection after flap removal, and in all cases the marginal mandibular nerve was preserved. Complications such as partial necrosis were recorded. The mean hospital stay was 8 days. Conclusions. The submental artery flap has shown favorable results due to its versatile use, wide arc of rotation, color, and low donor site morbidity. More robust studies are recommended, including the experience of various specialists in countries sharing the same technical limitations and sociodemographic characteristics.

Safety and efficacy of upfront autologous transplantation as a consolidation therapy for progressive nasal type extranodal NK/T-cell lymphoma / 中华器官移植杂志

Objective:To evaluate the efficacy and safety of upfront autologous hematopoietic stem cell transplantation(auto-HSCT)as a consolidation therapy of progressive nasal type extranodal NK/T-cell lymphoma, (ENKL).Methods:From January 2012 to June 2021, clinical data were retrospectively reviewed for 28 patients with advanced-stage ENKL on chemotherapy of asparaginase-containing regimen followed by upfront auto-HSCT as a consolidation therapy.The median age at transplantation was 34.5(14-61)years.There were 19 males and 9 females.Clinical types were nasal(n=22)and non-nasal(n=6). Clinical stages were Ann Arbor III(n=15)and IV(n=13). Clinical risks were intermediate(n=8)and high(n=20)according to the Prognostic Index for Natural-Killer cell lymphoma-Epstein-Barr virus(PINK-E).Results:Hematopoietic reconstruction was performed.Median time of neutrophil engraftment was 10(8-17)days and 13(10-22)days for platelet.Median follow-up time was 59.5 months and 5-year OS/PFS 70.0%(95% CI: 50.60%-89.40%)and 59.1%(95% CI: 39.11%-79.10%). And 5-year cumulative recurrence and non-recurrence mortality rates were 35.42%(95% CI: 19.11%-59.39%)and 4.2%(95% CI: 2.16%-29.87%). Conclusions:Asparaginase-based chemotherapy followed by auto-HSCT is both safe and efficacious for progressive ENKTL.

Observation of the effect of autologous retinal pigment epithelium transplantation in the treatment of severe obsolete submacular hemorrhage / 中华眼底病杂志

Objective:To evaluate the functional and anatomical outcomes of autologous single retinal pigment epithelium (RPE) transplantation for severe obsolete submacular hemorrhage (SMH) in late age-related macular degeneration (AMD).Methods:A retrospective clinical study. From January 2012 to December 2015, 11 patients with AMD (11 eyes) with obsolete SMH who were diagnosed and treated by pars plana vitrectomy (PPV) combined with autologous RPE transplantation at the Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included. Among them, there were 9 eyes in 9 males and 2 eyes in 2 females. All the eyes underwent the examinations of best corrected visual acuity (BCVA) and optical coherence tomography; 4 eyes underwent macular fixation function (MAIA) at the same time. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All eyes were treated with PPV combined with autologous single-layer RPE transplantation or autologous RPE-choroidal full-thickness transplantation, and were divided into S group and C group, with 5 and 6 eyes respectively. The differences of age ( t=-0.363), gender composition ratio ( χ2=0.549), course and thickness of SMH ( t=0.118, 0.231), average times of anti-vascular endothelial growth factor drug treatments ( t=0.129), times of PPV ( t=-0.452) between the two groups were not statistically significant ( P>0.05). The follow-up period was 6-40 months after the operation, and the BCVA, MAIA, graft status and complications of the eyes after the operation were observed. The comparison of continuous variables between groups was performed by independent-sample t test; the comparison of categorical variables was performed by χ2 test. Results:At the last follow-up, the average logMAR BCVA of the eyes in group S and C were 1.62±0.34 and 1.03±0.20, respectively; group C was better than group S, however, the difference was not statistically significant ( t=1.532, P=0.160). There were 4 eyes (80%, 4/5) and 6 eyes (100%, 6/6) in S group and C group with BCVA better than preoperative, the difference was no statistical significance ( χ2=0.677, P=0.895). There were 2 (40%, 2/5) and 3 (50%, 3/6) eyes with logMAR BCVA better than 1.0 in S group and C group, and the difference was not statistically significant ( χ2=0.572, P=0.423). After the operation, 6 eyes of grafts were in good condition and 5 eyes were in poor condition; the BCVA of grafts in good condition was significantly higher than that of poor condition, the difference was statistically significant ( t=4.894, P=0.001). Among the 4 eyes that underwent MAIA examination, 2 eyes were unstable and diffusely fixed on the graft; the fixation point was located at the normal retina adjacent to the graft area in 2 eyes. Secondary subretinal hemorrhage occurred in 3 eyes after the operation; the intraocular pressure was high in 1 eye after the operation. During the follow-up period, no intraocular infection, secondary retinal detachment, recurrent choroidal neovascularization or low intraocular pressure occurred in all eyes. Conclusions:Both autologous single-layer RPE transplantation and autologous RPE-choroidal full-thickness transplantation can help stabilize or even improve the visual function of eyes with severe SMH secondary to advanced AMD. The visual acuity after surgery is closely related to the state of the graft.

Efficacy and safety of autologous hematopoietic stem cell transplantation in elderly multiple myeloma patients: a single center retrospective study / 中华血液学杂志

Objective: To evaluate the efficacy and safety of autologous hematopoietic stem cell transplantation (auto-HSCT) in elderly patients (≥65 years old) with multiple myeloma (MM) . Methods: From June 1, 2006 to July 31, 2020, 22 MM patients (≥65 years old) who were diagnosed in the First Affiliated Hospital, Sun Yat-sen University and received novel drug induction followed by auto-HSCT were analyzed retrospectively. These patients were evaluated for important organ functions before transplantation, and the International Myeloma Working Group frail score was used in 2016 to screen out transplant-eligible patients. Results: The median (interquartile range, IQR) age at the time of transplantation of the 22 patients was 66.75 (IQR 4.50) years. A total of 20 patients received stem cell mobilization. The median number of mononuclear cells collected was 4.53×10(8)/kg, that of CD34(+) cells was 3.37×10(6)/kg, and the median number of apheresis procedures performed was 2. After stem cell transfusion, the median time of neutrophil implantation was 11 days, that of platelet implantation was 13 days, and the treatment-related mortality was 0 at 100 days after transplantation. The median follow-up was 48.7 months. The median time to progression time was not reached, and the median overall survival time was 111.8 months. Conclusion: Auto-HSCT is a safe and effective treatment for selected elderly patients of 65 years or older with MM.

Autograft reconstruction of nasal dorsum in cutaneous neoplasia treatment / Reconstrução com autoenxerto de dorso nasal no tratamento de neoplasias cutâneas

ABSTRACT Basal cell carcinoma is the most common type among skin cancers. It occurs in basal cells and is primarily caused by sun exposure. It mainly affects elderly people, mainly man, in exposed areas of the body and is diagnosed through biopsy. The choice of treatment depends on the type, size, location and depth of penetration, the patient's age, health conditions and potential aesthetic outcome. The present study aims to evidence, through a case report, the aesthetic and functional importance of the cutaneous transplant technique in cases of tissue loss in the face region by Basal cell carcinoma. A 56-year-old female patient, leukoderma, attended the Maxillofacial Surgery and Traumatology service of the Federal University of Pernambuco, complaining of asymmetry in the nasal dorsum region, with differentiated staining and raised edges. In anamnesis time she reported having suffered sun exposure for long periods. The patient underwent an incisional biopsy and subsequently, with a diagnosis of basal cell carcinoma, a resection of the lesion followed by skin autografting. Good acceptances of the skin flap as well as excellent aesthetic result were attained. The autogenous grafts use has shown satisfactory aesthetic results for remaining coverage after the lesion excision.

RESUMO O carcinoma basocelular é o tipo mais comum entre os cânceres de pele. Ela ocorre nas células basais e é ocadionado principalmente pela exposição solar. Acomete principalmente idosos, principalmente homens, em áreas expostas do corpo e é diagnosticado por biópsia. A escolha do tratamento depende do tipo, tamanho, localização e profundidade de penetração, idade do paciente, condições de saúde e do potencial resultado estético. O presente estudo visa evidenciar, por meio de um relato de caso, a importância estética e funcional da técnica de transplante cutâneo em casos de perda de tecido da região facial por carcinoma basocelular. Paciente do sexo feminino, 56 anos, leucoderma, compareceu ao Serviço de Cirurgia e Traumatologia Buco Maxilo Facial da Universidade Federal de Pernambuco, com queixa de assimetria na região do dorso nasal, com coloração diferenciada e bordas elevadas. Na anamnese relatou ter sofrido exposição solar por longos períodos. A paciente foi submetida à biópsia incisional e posteriormente, com diagnóstico de carcinoma basocelular, ressecção da lesão seguida de autoenxertia de pele. Foram obtidas boas aceitações do retalho cutâneo e excelente resultado estético. O uso de enxertos autógenos tem mostrado resultados estéticos satisfatórios para a cobertura remanescente após a excisão da lesão.

Mieloma múltiple. Experiencia de 9 años en el Hospital Naval Almirante Nef / Multiple myeloma. Nine years' experience at the Hospital Naval Almirante Nef

Introducción: el mieloma múltiple (MM) continúa siendo una enfermedad incurable sin embargo, el trasplante autólogo de médula ósea (TAH), y las drogas antineoplásicas han permitido mejorar la sobrevida global (SG) de los pacientes. Materiales y métodos: estudio de cohorte retrospectivo de 50 pacientes con diagnóstico de MM en el hospital Naval Almirante Nef, desde 2005 a 2013. Los pacientes se dividieron en dos cohortes, según la eligibilidad a trasplante, y analizados acordes a la primera línea de tratamiento y la sobrevida global (SG) hasta abril de 2019. Resultados: mediana de edad 73 años (47-88 años), SG 49 meses, y 50% en etapa-II del Sistema de Etapificación Internacional. La SG de los 39 no candidatos a TAH fue 46 meses; con un mayor número de respuestas completas y sobrevida, con el esquema melfalán-prednisona-talidomida. La SG de los 11 candidatos a TAH fue 66 meses, siendo el esquema bortezomib-ciclofosfamida-dexame-tasona el que concentró un mayor número de respuestas completas libres de progresión. Se trasplantó el 45% de los candidatos, con una mediana de sobrevida de 79 meses versus a los 51 meses de aquellos no trasplantados. Tres casos de neuropatía asociada a talidomida y uno a bortezomib. La SG a los seis meses y a los cinco años de todos los pacientes fue 86% y 44%, respectivamente. Conclusión: la incorpo-ración de nuevos fármacos permitió obtener mejores resultados de sobrevida lo que se condice con estudios nacionales e internacionales.

Introduction: Multiple myeloma (MM) is still an incurable disease however, autologous stem cell transplantation (ASCT), and antineo-plastic drugs have allowed improving the overall survival (OS) of patients. Materials and methods: A retrospective cohort study of 50 patients diagnosed with MM at the Hospital Naval Almirante Nef, from 2005 to 2013. The patients were divided into two cohorts according to transplantation eligibility and analyzed about first-line treatment and overall survival (OS) up to April 2019. Results: Median age 73 years (47-88 years), OS 49 months, and 50% in stage-II International Staging System. OS of the 39 non-candidates for ASCT was 46 months: with a higher number of complete responses and survival, with the melphalan-prednisone-thalidomide scheme. The OS of the 11 candidates for ASCT was 66 months, with the bortezomib-cyclophosphamide-dexamethasone scheme being the one with the highest number of progression-free complete responses. Forty-five percent of the candidates were transplanted, with a median survival of 79 months versus 51 months for those not transplanted. Three cases of neuropathy were associated with thalidomide and one with bortezomib. OS at six months and five years for all patients was 86% and 44%, respectively. Conclusion: The incorporation of new drugs allowed to obtain better survival results, which is by national and international studies.

Ultra-slow drilling to obtain autologous bone graft in implantological rehabilitation. A forgotten technique with great advantages / Perforación ultralenta para la obtención de injerto óseo autólogo en rehabilitación implantológica. Una técnica olvidada con grandes ventajas

ABSTRACT: Osseointegrated implants are currently the prosthetic treatment by predilection in the oral cavity when dental organs have been lost. Bone deficiency interferes with the placement of these prosthetic attachments; To solve this lack of bone tissue in alveolar ridges, autologous, homologous or heterologous bone grafting techniques are proposed. The ultra-low speed drilling without irrigation, it is possible to collect autologous bone at the time of preparing the surgical site before placing the dental implant, which provides the best properties for bone regeneration without the need for another wound or more morbidity for the patient. We describe our ultra-low speed drilling protocol step by step, obtaining autologous bone from the same surgical site to rehabilitate small bone defects around the implant reducing comorbidities and surgical times.

Transposição da veia cefálica para reconstrução microcirúrgica de cabeça e pescoço: estudo anatômico em cadáveres / Cephalic vein transposition for head and neck microsurgical reconstruction: anatomical study in cadavers

Introdução: A transposição de veia cefálica é uma alternativa interessante como veia doadora na reconstrução oncológica de cabeça e pescoço em pacientes com história de radioterapia cervical. O objetivo do trabalho é avaliar as características anatômicas da veia cefálica em cadáveres. Métodos: Foram dissecadas seis veias cefálicas de três cadáveres. As veias foram seccionadas na parte medial do braço e transpostas até o pescoço por cima das clavículas. Resultados: As veias apresentaram média de comprimento de 18,75±1,84cm e número de tributárias com variação de 7-9. O diâmetro coincidiu em ambas as veias de cada cadáver. O parâmetro anatômico usado para identificálas (sulco deltopeitoral) se mostrou confiável, possibilitando uma dissecação previsível. Conclusão: A veia cefálica tem características constantes e fácil localização, sendo uma opção relevante ao arsenal terapêutico do cirurgião plástico reconstrutor.

Introduction: Cephalic vein transposition is an interesting alternative as a donor vein in head and neck cancer reconstruction in patients with a cervical radiotherapy history. This work aims to evaluate the cephalic vein anatomical characteristics in cadavers. Methods: Six cephalic veins from three cadavers were dissected. The veins were sectioned in the medial part of the arm and transposed to the neck over the clavicles. Results: The veins had an average length of 18.75 ± 1.84 cm and several tributaries with a variation of 7-9. The diameter coincided in both veins of each corpse. The anatomical parameter used to identify them (deltopectoral groove) proved reliable, allowing predictable dissection. Conclusion: The cephalic vein has constant characteristics and is easy to locate, being an option relevant to the reconstructive plastic surgeon's therapeutic arsenal.

Transferência de retalho à distância com secção do pedículo vascular em segundo tempo / Distant flap transfer with the vascular pedicle section in second stage

Introdução: Ocasionalmente não há possibilidade de se cobrir uma ferida com enxertos ou retalhos locais. O objetivo deste trabalho foi avaliar a resolutividade da transferência de retalho à distância com secção do pedículo vascular em segundo tempo para cobertura de região que sofreu perda de substância. Métodos: Cinco pacientes com perda de substância, sem opção de reconstrução com enxertos ou retalhos locais, tiveram suas feridas cobertas por retalhos transferidos à distância, com secção dos pedículos vasculares em segundo tempo. Resultados: Os retalhos transferidos foram eficazes na cobertura das feridas. Conclusão: A transferência de retalho à distância com secção do pedículo vascular em segundo tempo é procedimento simples e eficaz, que deve ser dominado por todo cirurgião plástico.

Introduction: Occasionally, there is no possibility of covering a wound with local grafts or flaps. This study aimed to evaluate the capacity of the distant flap transfer with the vascular pedicle section in second stage to cover the region that suffered a loss of substance. Methods: Five patients with substance loss, with no reconstruction option using grafts or local flaps, had their wounds covered by distant flap transfer with the vascular pedicle section in second stage. Results: The transferred flaps were useful in covering the wounds. Conclusion: distant flap transfer with the vascular pedicle section in second stage is a simple and effective procedure. Every plastic surgeon must master that.

Manejo da orelha constricta: abordagem do serviço de cirurgia plástica do Hospital de Clínicas de Porto Alegre, Brasil / Management of constricted ear: plastic surgery service approach at the Hospital of Clinics in Porto Alegre, Brazil

Introdução: A prevalência de malformações da orelha chega a 5% quando considerada toda a população mundial. Primariamente descrita em 1975 a orelha constricta representa um grupo de deformidades envolvendo o terço superior da cartilagem auricular com características em comum. O impacto estético e o estigma social dessas deformidades podem levar a danos psicológicos ao paciente quando não corrigidos. Métodos: Descrevemos a seguir a técnica utilizada no serviço de cirurgia plástica do Hospital de Clínicas de Porto Alegre. Resultados: O resultado pode ser evidenciado com 30 dias de pós-operatório. Conclusão: O método descrito, de reacomodação da cartilagem, é uma opção para o tratamento dessa deformidade com adequado resultado estético.

Introduction: The prevalence of ear malformations reaches 5% when considering the entire world population. Primarily presented in 1975, the constricted ear represents a group of deformities of the upper third of the auricular cartilage with common features. The aesthetic impact and social stigma of these deformities can cause psychological harm to the patient when not corrected. Methods: We describe below the technique used in the plastic surgery department of the Hospital de Clínicas de Porto Alegre. Results: Result can be evidenced with 30 days postoperatively. Conclusion: The described method, cartilage resettlement, is an option for treatment of this deformity with adequate aesthetic result.

Transplante linfonodal no manejo do linfedema pós-mastectomia: revisão sistemática com metanálise / Lymph node transplantation in the management of post-mastectomy lymphedema: a systematic review with meta-analysis

Este estudo teve o objetivo de analisar, por meio de uma revisão sistemática da literatura com metanálise, os índices de sucesso do uso do transplante autólogo de linfonodos para o manejo do linfedema de membros superiores em pacientes mastectomizadas, quanto à redução do volume excessivo no membro acometido. Foram analisados os mais relevantes estudos publicados originalmente em qualquer idioma até agosto de 2019, indexados às bases de dados US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science e Scientific Electronic Library Online. A amostra foi composta por 10 publicações que se adequaram aos critérios de inclusão e exclusão estabelecidos, incluindo 194 pacientes, as quais apresentaram idade média de 50,0 anos, sendo acompanhadas por, em média, 31,7 meses. A maioria das pacientes apresentou o membro superior direito acometido pelo linfedema (58,1%), iniciando os sintomas há mais de um ano prévio à cirurgia de transplante de linfonodos (86,4%). Apenas quatro pacientes (2,6%) não foram submetidas à linfadenectomia durante o tratamento do câncer de mama. O transplante de linfonodos foi capaz de prover uma redução média de 52,18% no volume excessivo apresentado pelas pacientes no membro em decorrência do linfedema, sendo que, a maior parte das pacientes pesquisadas apresentaram redução de volume maior do que 50%. Conclui-se que o transplante autólogo de linfonodos se apresenta como uma boa opção para o manejo do linfedema relacionado ao câncer de mama, proporcionando considerável redução no volume excessivo do membro acometido.

This study aimed to analyze, through a systematic literature review with meta-analysis, the success rates of the use of autologous lymph node transplantation for the management of upper limb lymphedema in mastectomized patients, regarding the reduction of excessive volume in the affected limb. The most relevant studies originally published and indexed in any language until August 2019 were analyzed, in the US National Library of Medicine, Cochrane Central Register of Controlled Trials, Web of Science, and Scientific Electronic Library Online databases. The sample consisted of 10 publications that met the established inclusion and exclusion criteria, including 194 patients with 50.0 years average age, being followed up for 31.7 months average. Most patients had the right upper limb affected by lymphedema (58.1%), with symptoms that started more than a year before lymph node transplant surgery (86.4%). Only four patients (2.6%) did not undergo lymphadenectomy during the treatment of breast cancer. Lymph node transplantation provided an average reduction of 52.18% in the excessive volume presented by patients in the limb due to lymphedema. Most of the patients surveyed had a volume reduction higher than 50%. It is concluded that autologous lymph node transplantation is a good option for the management of lymphedema related to breast cancer, providing a considerable reduction in the excessive volume of the affected limb.

Effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation for large area cartilage injury of femoral condyle of knee / 中国修复重建外科杂志

Objective: To explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation (OAT) in treatment of large area (4-6 cm 2) cartilage injury of the femoral condyle of knee. Methods: Between March 2016 and June 2017, 22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT. There were 16 males and 6 females with an average age of 22-60 years (mean, 38.6 years). The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases. The disease duration was 1-6 months (mean, 3.4 months). There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries. The area of cartilage defect was 4-6 cm 2 (mean, 4.98 cm 2). According to the International Cartilage Repair Society (ICRS) classification, 9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ. Eighteen cases were combined with meniscus injuries. Preoperative visual analogue scale (VAS) score was 6.36±1.25 and Lysholm score was 36.00±7.77. Results: All incisions healed by first intention. All patients were followed up 2-3 years with an average of 2.3 years. At 2 years after operation, the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21, which were significantly improved when compared with those before operation ( t=16.595, P=0.000; t=21.895, P=0.000). At 2 years after operation, MRI showed that the cartilage defect was repaired well. Conclusion: Arthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee, and the good early effectiveness can be obtained.

Pathogenesis and treatment progress of idiopathic macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

@#Idiopathic macular hole(IMH)refers to a full-thickness tissue defect of the retinal neuroepithelial layer in the macular region without obvious etiology. At present, with the gradual deepening of the understanding of IMH and the continuous innovation and improvement of its treatment methods, its treatment technology has also matured and diversified. Studies have shown that early IMH with small diameter can be observed and followed up. The Ocriplasmin has been approved for use in patients with small to medium sized macular holes and vitreomacular adhesion(VMA); internal limiting membrane(ILM)removal can improve anatomical closure rate. However, for IMH with a diameter of less than 250μm, it is uncertain whether ILM removal is always required. This paper discusses the pathogenesis, stages, classification and current treatment of IMH. Based on the characteristics of IMH and patient differences, an evidence-based medicine method is proposed to select the best and most practical treatment plan for individual patients.

Transplantation of Autologous Peritoneum Using Ileal Seromuscular Flaps for Orthotopic Neobladder Reconstruction / 中国医学科学院学报

To develop an ideal surgical procedure for neobladder reconstruction in experimental porcine models. Six experimental female pigs weighting 28-33 kg underwent transplantation of autologous peritoneum for bladder reconstruction under general anesthesia.The flaps were used to reconstruct the orthotopic neobladder by suturing with the edges of the triangle and neck of the remnant bladder.The ureteral catheters were removed on the 5 postoperative day and the balloon catheter was removed on the 7 postoperative day.Voiding behaviour was monitored.The animals were euthanized at week 12 for routine pathology,immunohistochemistry,and electron microscopy. All the pigs survived after the surgery,and no postoperative complication such as peritonitis,intestinal obstruction,or urinary fistula was observed.All the peritoneum-ileum composite free valves survived after transplantation.Voiding behaviour was normal after catheter removal,and the urine was clear.At autopsy,reconstructed bladders were healthy.Pathological examination showed the neobladder had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual.Scanning electron microscope showed the transitional cells of neobladder were complete and orderly,and the urothelium around suture border was continuous and showed no malposition. Reconstruction of bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach in the experimental pigs as it can prevent regrowth of ileal epithelial cells and avoid the complications of conventional enterocystoplasty.Its clinical application deserves further investigations.

Uso de fáscia peitoral maior em preenchimento de dorso nasal: relato de caso / Use of pectoralis major fascia in dorsal nasal augmentation: case report

O aumento do dorso nasal nas rinoplastias é foco de estudo de diversos trabalhos que buscam as melhores fontes de enxerto e técnicas cirúrgicas. A utilização de cartilagem já é consagrada para este fim, a partir do septo nasal, da concha auricular ou dos arcos costais. Nos últimos anos, têm-se buscado meios para reduzir a palpabilidade e dispersibilidade dos enxertos cartilaginosos. Assim, são descritos materiais sintéticos, como o SURGICEL®; e, autólogos, representados pelas fáscias. A fáscia temporal é mais amplamente utilizada, porém requer uma nova incisão cirúrgica, aumentando o tempo e a morbidade da cirurgia. É também descrito o uso de fáscia lata e fáscia reto abdominal, comparativamente mais espessas e menos flexíveis. Em muitos casos de rinoplastia fazse necessária a retirada da cartilagem costal, o que permite a coleta de fáscia do músculo peitoral maior pela mesma incisão cirúrgica. Dessa forma, descrevemos a utilização da fáscia do músculo peitoral maior envolvendo cartilagem costal picada, em uma rinoplastia estruturada com aumento do dorso.

Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum.