Treatment of four-part proximal humerus fractures with depressed humeral head collapse using strut allograft with locking plates / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcomes of allogeneic femoral head as strut allograft combined with proximal humeral internal locking system (PHILOS) in the treatment of proximal humeral Neer grade Ⅳ fracture with humeral head collapse.@*METHODS@#From January 2018 to November 2020, 18 patients with Neer grade Ⅳ fracture with humeral head collapse were treated with strut allograft with PHILOS, including 4 males and 14 females, aged from 55 to 78 years old, with an average of (68.11±7.20) years old. The operation time, intraoperative bleeding, postoperative drainage volume, fracture healing time, neck-shaft angle and the height of the humeral head, failure of internal fixation the shoulder function at the last follow-up was assessed using Neer's scoring system.@*RESULTS@#All 18 patients were followed up, and the duration ranged from 10 to 12 months, with an average of (11.08±0.65) months. The operation time was (66.44±5.06) min, the intraoperative bleeding volume was (206.67±36.14) ml, the postoperative drainage volume was (76.11±9.63) ml, and the fracture healing time was (17.28±3.92) weeks. At the last follow-up, the degree of loss of neck-shaft angle was (5.44±0.86) ° and the loss of the height of humeral head was (1.43±0.27) mm. All 18 patients had healing without complications such as fracture, withdrawal, penetration of internal fixation and necrosis of humeral head. According to Neer's evaluation standard, the total score was (89.61±5.60), 10 cases got an excellent result, 6 good, 2 fair.@*CONCLUSION@#Allogeneic femoral head combined with PHILOS is an appropriate treatment for the four-part proximal humerus fractures with humeral head collapse, exhibiting good clinic outcome.

Study on the long-term effect of three bone graft materials after periodontal regeneration / 国际生物医学工程杂志

Objective:To evaluate the medium and long term clinical effect of three bone graft materials on periodontitis after periodontal regeneration.Methods:Initially, 16 patients with periodontitis after periodontal regeneration in Tianjin Stomatological Hospital from July 2017 to November 2018 were divided into three groups: Bio-Oss ( n=6), Bio-Gene ( n=5) and Bone 3(n=5) according to the differences in bone materials. Clinical and radiological results were evaluated at pre-surgery, post-6 months, and post-4 years. Results:The 6-month and 4-year clinical follow-up showed that, the depth of exploration (PD) and clinical attachment loss (CAL) of patients in the three groups were lower than those before operation (all P<0.05), and the changes of PD (ΔPD) and CAL (ΔCAL) were not statistically significant (all P>0.05). There was no statistically significant difference in gingival recession (GR) between the three groups (all P>0.05), and there was no statistically significant difference in the change of GR (ΔGR) between the groups (all P>0.05). From 6 months to 4 years after operation, there was no significant difference among ΔGR, ΔPD and ΔCAL groups (all P>0.05). At 6 months and 4 years after operation, the residual alveolar bone height (RBH%) of the three groups was significantly higher than that before operation (all P<0.05), and there was no significant difference between the two groups (all P>0.05); From 6 months to 4 years after operation, there was no significant difference in RBH% between the groups (all P>0.05). Conclusions:Three kinds of bone graft materials have significant clinical effects on periodontitis after periodontal regeneration, which can provide a reference for the selection of clinical regeneration materials.

Prótese e implante sobre enxerto alógeno: análise histológica e acompanhamento clínico: radiográfico por 8 anos / Prosthesis and implant on allogenic graft: histological analysis and clinical: radiographic follow-up for 8 years

Este relato de caso clínico tem como objetivo descrever a utilização de osso alógeno na reconstrução de maxila atrófica para posterior reabilitação com prótese fixa metalocerâmica sobre implantes, fazer uma análise histológica do tecido ósseo enxertado e descrever o acompanhamento clínico e radiográfico por 8 anos. Uma paciente de 54 anos, com edentulismo parcial e atrofia moderada-a-severa na maxila, apresentou-se para tratamento demonstrando muito interesse em receber prótese sobre implantes. Após exame clínico e radiográfico, foi realizada montagem dos modelos de estudo em ASA para enceramento diagnóstico e obtenção de um guia multifuncional (tomográfico/ cirúrgico). A tomografia indicou a necessidade de reconstrução óssea maxilar. Procedeuse então à aposição de blocos de osso alógeno para aumento horizontal nas regiões anterior e posterior da maxila. Um dos blocos foi triturado e utilizado para levantamento do assoalho do seio maxilar no lado esquerdo. Dez meses depois, uma nova tomografia foi solicitada, utilizando o mesmo guia inicial, e os implantes instalados, utilizando o guia multifuncional como guia cirúrgico. Neste momento, material ósseo foi coletado na interface osso enxertado/osso nativo com uma broca trefina. Os resultados histológicos demonstraram viabilidade das células ósseas no enxerto, além da presença de vasos sanguíneos. Após o tempo necessário para osseointegração, procedeu-se com tratamento protético. Nenhuma complicação foi relatada até oito anos de controle. A sequência de tratamento proposta forneceu bons resultados estéticos e funcionais. Concluiu-se, então, que o emprego de osso alógeno é uma alternativa viável para a reconstrução de rebordos alveolares severamente reabsorvidos(AU)

This clinical case report aims to describe the use of allogeneic bone in the atrophic maxilla reconstruction for subsequent rehabilitation with a fixed metal-ceramic prosthesis on implants; to perform a histological analysis of the grafted bone tissue; and to describe the clinical and radiographic monitoring for 8 years. A 54-year-old patient, with partial edentulism and moderate-to-severe atrophy in the maxilla showed great interest in receiving implant prostheses. After c linical and radiographic examination, the ASA study models were assembled for diagnostic waxing and a multifunctional guide (tomographic / surgical) was obtained. Tomography indicated the need for maxillary bone reconstruction. Allogeneic bone blocks were then placed for horizontal enlargement in the anterior and posterior regions of the maxilla. One of the blocks was crushed and used to lift the floor of the maxillary sinus on the left side. Ten months later, a new tomography was requested, using the same initial guide, and the implants installed, using the multifunctional guide as a surgical guide. At this time, bone material was collected at the grafted bone / native bone interface with a trephine drill. Histological results demonstrated viability of bone cells in the graft, besides the presence of blood vessels. After the necessary time for osseointegration, a prosthetic treatment was performed. No complications were reported up to eight years of control. The propose treatment sequence provided good aesthetic and functional results. It was concluded, then, that the use of allogeneic bone is a viable alternative for the reconstruction of severely reabsorbed alveolar edges(AU)

Research hotspots and progress of bone repair materials in tissue engineering / 中国组织工程研究

BACKGROUND: With the improvement in medical level, the clinical demand for bone repair materials is gradually Increasing, and the requirements are also getting more and more. OBJECTIVE: To review the related research progress In the field of bone repair materials In recent years, to analyze the advantages and disadvantages of different materials, and to guide future development In this research field. METHODS: A computer-based online search of CNKI, Wanfang, PubMed, Web of Science databases was performed to retrieve papers published during 1950-2019 with the search terms “tissue engineering, bone repair material, bone defect, natural bone material, bone graft replacement material, traditional Chinese medicine” in Chinese and English. A total of over 900 papers were retrieved, and 68 of them were included In the final analysis. RESULTS AND CONCLUSION: In recent year, with the flourish development of bone tissue engineering, the research of bone tissue repair materials is in the ascendant. In addition to optimizing natural bone, a variety of bone graft substitute materials have been developed, for example, natural macromolecule materials, synthetic macromolecule materials, biomedical ceramics materials, biomedical metal materials, etc., but these materials have different properties. Although there are many bone repair materials at present, the Ideal bone repair materials are few. Therefore, bone tissue repair and bone remodeling is still one of the urgent orthopedic problems to be solved In the clinic. In addition, the traditional Chinese medicine for bone repair, such as pyritum combined with modern bone repair materials, can effectively avoid some of the drawbacks of the current bone repair materials, thereby effectively treating bone defect diseases. This deserves In-depth investigation In the field of bone repair.

Extraction of porcine cancellous bone by supercritical carbon dioxide / 中国组织工程研究

BACKGROUND: In recent years, there have been many studies on the use of supercritical fluids for biological material treatment in countries outside China. However, little is reported on application of supercritical fluids to bone tissue extraction, in particular in China. OBJECTIVE: To evaluate the effectiveness of supercritical carbon dioxide extraction technology in the treatment of porcine femur cancellous bone and its effect on bone biological properties. METHODS: Porcine femoral bone blocks that were subjected to supercritical carbon dioxide extraction (study group) or not (control group) were prepared to determine bone mineral density, microstructure, maximum compressive strength, elastic modulus, bone tissue composition, collagen content and perform histological analysis. Bone marrow mesenchymal stem cells (BMSCs) were inoculated into two groups of bone blocks, and cultured for 1 day. The microporous structure of trabecular bone and cell adhesion and growth in bone material-cell composite were observed by scanning electron microscopy. The two groups of bone blocks were implanted subcutaneously in SD rats. The inflammatory reaction of subcutaneous tissue was observed histologically at 1, 2 and 4 weeks after surgery. The experimental protocol had been approved by the Animal Ethics Committee of Chinese PLA General Hospital, China. RESULTS AND CONCLUSION: There were no significant differences in pore size, bone mineral density, maximum compressive strength, elastic modulus and collagen content between the study and control groups (P>0.05). Scanning electron microscopy showed that in the control group, the material pores had poor connectivity and there was soft tissue residue; in the study group, material pores were connected to each other and the structure was intact. Fourier transform infrared spectroscopy and X-ray diffraction analysis showed that the two groups of bone tissue materials had similar absorption and diffraction peaks. Thermogravimetric analysis showed that supercritical carbon dioxide extraction could reduce water content in bone tissue. Hematoxylin-eosin staining showed that there were no soft tissue residues in the bone, and the cell residues in the bone pit were significantly reduced in the study group, while soft tissue and cell residues were observed in the control group. Sirius red staining and modified Masson staining showed that the structure of bone collagen in the study group was intact, the cytoplasmic components reduced, and the cytoplasmic components in the control group remained significantly. Scanning electron microscopy showed that there was no obvious cell adhesion in the control group, but cell adhesion growth was obvious in the study group. Perivascular inflammatory response in the bone tissue implantation region was obviously weaker in the study group than in the study group. These results suggest that supercritical carbon dioxide extraction technology is an effective and environment-friendly bone tissue processing technology. It can effectively remove porcine cancellous bone cells and soft tissue without affecting its collagen structure and content and mechanical properties, retaining intact bone pore structure, increasing cell adhesion and growth, and effectively reducing inflammatory rejection.

Management principle and clinical suggestions of osteotomy gap of opening wedge high tibial osteotomy / 中国修复重建外科杂志

Objective: To summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO). Methods: The related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed. Results: Delayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not. Conclusion: No matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.

Does costal cartilage or bone allografts work for rhinoplasty? / 中华整形外科杂志

A wide range of materials have been used for grafts in rhinoplasty. Both allogeneic and autologous grafts have pros and cons. Recently, allogeneic costal cartilage and bone become more popular in rhinoplasty, although the ongoing controversies thereof still exist. Plastic surgeons and researchers have different opinions on the availability of allografts since they have been introduced, in both scientific researches and clinical observations. In recent 20 years, the authors observed and compared the outcome of various materials, which are used for grafts in nasal augmentation. In this study, the author discussed the ethics, surgical outcomes and complications of different allogeneic materials in rhinoplasty.

Nursing care of a patient with severe aplastic anemia type Ⅱ treated with umbilical cord blood transfusion sequentially combined with second haploid allogeneic bone marrow transplantation / 中国实用护理杂志

Objective To summarize the nursing care for one successful haploidentical allogeneic bone marrow transplantation (haplo-BMT) for one patient with severe aplastic anemia type-Ⅱ (SAA-Ⅱ). The patient accepted an umbilical cord blood transfusion sequentially combined with the second haplo-BMT after an engraftment failure of the first haplo-BMT. The experience of nursing care will be discussed and shared for patients with a second haplo-BMT. Methods The comprehensive nursing cares were utilized during haplo-BMT, it included preventive measures for secondary infections, closely control of side effects, promptly nursing intervention for gastrointestinal mucositis, hemorrhagic cystitis and epilepsy, psychological nursing for appeasing emotional variations, and addition of intravenous indwelling needle if necessary. Results The patient achieved a successful stem cell engraftment and survived a long-term granulopenia (granulocytes＜0.1×109/L) which lasted for 52 days with a recovery of varied complications. Conclusion The comprehensive nursing care can reduce the risk for secondary infections and other complications, it shed a new light on second allogeneic bone marrow transplantation for complicated patients

Comparative analysis of clinical curative effects of allogeneic bone ring and titanium mesh in repairing adolescent spinal tuberculosis kyphosis / 重庆医学

Objective To compare the clinical curative effect of allogeneic bone ring and titanium mesh in repairing adolescent spinal tuberculosis kyphosis.Methods Forty-four cases of kyphosis after adolescent spinal tuberculosis operation in this hospital from January 2012 to January 2015 were selected as the study subjects and divided into the control group and observation group ac-cording to the treatment types,22 cases in each group.The control group was repaired with titanium mesh,while the observation group was given allogeneic bone ring fusion repair.Postoperative follow up lasted for 2 -5 years.The perioperative indexes,repair material and vertebral fusion and neurological score,preoperative and postoperative Cobb angle,ESR,CRP and postoperative com-plications occurrence were compared between the two groups.Results There was no statistically significant difference in periopera-tive indexes between the two groups(P>0.05).The fusion time,occurrence rate of local pain and motion limitation had statistical differences between the two groups(P<0.05).The occurrence rate of material loosening had no statistical difference(P>0.05). No grade A and B spinal injury appeared in both groups.The incidence rate of grade D and E in the observation group was signifi-cantly lower than that in the control group,the difference was statistically significant(P<0.05).The postoperative Cobb angle, ESR and CRP had no statistical difference between the two groups(P>0.05),moreover no significant adverse reactions and post-operative tuberculosis recurrence occurred.Conclusion Allogeneic bone ring and titanium mesh have satisfactory effect for repairing juvenile spinal tuberculosis kyphosis,allogeneic bone ring fusion time is longer,early stability is worse than the titanium mesh,the brace protection is needed in the early time,but the clinical effect of patients is more significant,which is worthy of being promoted and applied in clinical treatment.

Calcium sulfate artificial bone combined with allograft bone versus calcium sulfate artificial bone alone in treatment of benign bone tumor in lower limbs: A comparative study / 第二军医大学学报

Objective To evaluate the efficacy of calcium sulfate artificial bone combined with allogratt bone and calcium sulfate artificial bone alone in the treatment of benign bone tumors in the lower limbs. Methods We retrospectively analyzed the clinical data of 97 patients with benign bone tumor in the lower limbs who received treatment in the Department of Joint and Bone Disease, Changhai Hospital, Second Military Medical University from June 2010 to June 2015 andmet the study criteria. Thirty-two patients received calcium sulfate artificial bone combined with allogratt bone grafting (combined group), and the other 65 patients received calcium sulfate artificial bone grafting alone (artificial bone group). The incidenceof postoperative incisional adverse events and the bone defect rate after the complete absorption of artificial bone of patients were compared between the two groups. Results There was no significant difference in the incidence of postoperative incisional adverse events between the combined and artificial bone groups (15.6% [5/32] vs 26.2% [17/65], P>0.05), while the bone defect rate after the complete absorption of artificial bone was significantly different between the two groups (9.4% [3/32] vs 29.2% [19/65], P=0.028). Conclusion Calcium sulfate artificial bone combined with allogratt bone has a satisfactory effect in the treatment of benign bone tumors in the lower limbs. The combination of the two may reduce the risk of bone defects after complete absorption of artificial bone and do not increase the adverse events of surgical incision.

Induced Pluripotent Stem Cells-derived chimeric Thymus transplantation enhances T cells Reconstitution and prevents GVHD in Murine after allogeneic Bone Marrow Transplantation / 实用医学杂志

Objective To explore the effects of iPS cells-derived chimeric thymus transplantation on T cells reconstitution and graft versus host disease of murine after allo-BMT. Methods iPS cells-derived chimeric thymus was grafted under the renal capsules of mice after allogeneic IBM-BMT. The mice were divided into three groups:IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group. Four weeks after BMT, T lymphocyte subsets in the peripheral blood were analyzed by flow cytometry, the degree and pathological examination of GVHD were observed, respectively. Results Percentage of CD8+T cells in IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group was(5.52 ± 0.83)%,(11.10 ± 1.49)%and(8.49 ± 0.82)%respectively, there was signifi-cant difference between pairwise comparisons(P<0.05), and percentage of CD4 + T cells of the peripheral blood in IBM-BMT+TT group(9.60 ± 0.69)%was significantly higher than IBM-BMT group(6.42 ± 1.40)%and IBM-BMT+DLI group(8.07 ± 0.65)%(P<0.05) . IBM-BMT group and IBM-BMT+TT group showed less clinical and histopathological scoring of GVHD than IBM-BMT + DLI group. Conclusion iPS cells-derived chimeric thymus transplantation could effectively accelerate T cells reconstitution and prevent GVHD after allo-BMT.

Dimensional changes of hard and soft tissues in post-extraction sites: evaluation of two biomaterials / Cambios dimensionales de los tejidos duros y blandos en sitios post-exodoncia: evaluación de dos biomateriales

ABSTRACT Introduction: the techniques for alveolar ridge preservation with different biomaterials show better healing processes and modify the patterns of alveolar bone resorption. The goal of this study was to evaluate the clinical, radiographic, and histological changes of tissues in post-extraction sites after 90 and 180 days by using two biomaterials for alveolar ridge preservation. Materials: descriptive study involving the extraction of twenty-seven uni- and biradicular teeth comparing two biomaterials randomly distributed. Group A received resorbable synthetic hydroxyapatite (OsseoU) and Group B received mineralized freeze-dried allogeneic bone (Tissue Bank®). Quantitative and qualitative measurements were made 180 days post-extraction. The statistical analysis was conducted with the Shapiro-Wilks, Levine, and Student t tests. Results: comparing the two biomaterials on day 180 yielded no statistically significant differences in terms of the "height" variable. The "width" variable yields a p = 0.010 value, suggesting statistically significant differences, since Group A is 0.789 ± 0.276 times better (3.72 ± 0.76) than group B (2.93 ± 0.55). The radiographic evaluation did not yield differences between both groups (p = 0.711). Conclusion: this study shows the dimensional changes of post-extraction sites in both groups, with a clinical difference in ridge width, and no radiographic or histological differences, neither statistically significant changes in terms of alveolar ridge height. Resorbable synthetic hydroxyapatite (OsseoU) is then a biomaterial as effective as mineralized freeze-dried allogeneic bone (Tissue Bank®).

RESUMEN. Introducción: las técnicas de preservación del reborde alveolar con diferentes biomateriales demuestran un mejor proceso de cicatrización que si no se lleva a cabo ningún procedimiento y modifican los patrones de reabsorción del hueso alveolar. El objetivo del presente estudio consistió en evaluar los cambios clínicos, radiográficos e histológicos de los tejidos en sitios post-exodoncia a los 90 y 180 días, utilizando dos biomateriales para la preservación del reborde. Materiales: estudio descriptivo en el que se hacen las exodoncias de veintisiete dientes uni- y birradiculares y se comparan dos biomateriales diferentes repartidos aleatoriamente. El grupo A recibió hidroxiapatita sintética reabsorbible (OsseoU) y el grupo B recibió hueso alogénico mineralizado, secado por congelación (Tissue Bank®). Se hicieron mediciones cuantitativas y cualitativas a los 180 días. El análisis estadístico se realizó con pruebas de Shapiro-Wilks, Levine y t-Student. Resultados: al comparar los dos biomateriales a los 180 días, se observa que en la variable "altura" no existen diferencias estadísticamente significativas. En la variable "amplitud" se establece un valor p = 0,010, lo cual indica que hay diferencias estadísticamente significativas, siendo 0,789 ± 0,276 mejor el grupo A (3,72 ± 0,76) comparado con el grupo B (2,93 ± 0,55). En la evaluación radiográfica no se reportan diferencias entre los dos grupos (p = 0,711). Conclusión: este estudio demuestra cambios dimensionales de los sitios post-exodoncia en ambos grupos, con diferencia clínica en la amplitud de reborde, y sin diferencias radiográficas ni histológicas, ni cambios estadísticamente significativos en cuanto a la altura del reborde. La hidroxiapatita sintética reabsorbible (OsseoU) es entonces un biomaterial igual de efectivo que el hueso alogénico mineralizado, secado por congelación (Tissue Bank®). Palabras claves: técnicas de preservación de reborde, hidroxiapatita sintética, hueso alogénico mineralizado, secado por congelación.

Aloenxerto ósseo cortical desvitalizado com nitrogênio líquido - estudo experimental em ovelhas / Allogeneic bone graft devitalized in liquid nitrogen - sheep experimental study

O objetivo do trabalho foi avaliar a taxa e a forma de incorporação do aloenxerto ósseo cortical, submetido ao congelamento em nitrogênio líquido e inserido em tíbias de ovelhas. Foram utilizadas seis ovelhas clinicamente sadias que, aos pares, foram simultaneamente submetidas à ostectomia da diáfise tibial para a retirada de um segmento de 7cm que, após a desvitalização em nitrogênio líquido, foi implantado imediatamente no outro paciente e fixado com placa de compressão dinâmica (PCD) e parafusos corticais. Realizaram-se avaliações clínicas e radiográficas, imediatamente e a cada 30 dias, até o 180º dia de pós-operatório. Aos 180 dias, foi realizada eutanásia e coletou-se a tíbia direita para avaliação histopatológica. Aos 60 dias de pós-operatório, foi observado o uso funcional do membro operado, sendo a união radiográfica das interfaces proximal e distal verificadas, em média, aos 95 dias. Com isso, pôde-se concluir que o nitrogênio líquido é um método adequado de desvitalização de aloimplantes ósseos corticais de ovelhas, proporcionando altas taxas de incorporação óssea, em média, aos 95 dias de pós-operatório.

This study evaluated the allogeneic cortical bone graft incorporation after submission of the harvested fragment to a bout freezing in liquid nitrogen. Six adult sheep, clinically healthy, were submitted to a 7cm ostectomy of the tibial diaphysis. The fragment was submersed in a liquid nitrogen and implanted in another sheep missing a same-sized segment at the corresponding bone. Stabilization of the allograft in the host bone was accomplished by a dynamic compressive plate (DCP). Clinical and radiographic evaluations were performed in the immediate post-operatory period and in every 30 days for six months after surgery. The proximal and distal host-graft interfaces showed radiographic union at a mean postoperative time of 95 days in all the animals. The cortical bone allograft submitted to liquid nitrogen freezing provided adequate bone healing in the sheep model.

O uso de ossos alógenos para reconstrução dos maxilares pode induzir anticorpos anti-HLA / The use of allogeneic bone for jaw reconstruction can induce anti-HLA antibodies

Uma das maiores controvérsias relacionadas ao uso de osso alógeno relaciona-se à possível sensibilização imunogênica do paciente receptor. Isso, teoricamente, poderia causar rejeição, incorporação óssea lenta, osteólise, erosões ósseas, degeneração articular, infecção e fratura. Existem na literatura alguns trabalhos demonstrando indícios de sensibilização imunológica frente ao uso dos enxertos ósseos alógenos frescos congelados, com sensibilização da molécula HLA doador-específico. No entanto, há carência de trabalhos científicos que avaliem as possibilidades de sensibilização em humanos após transplante ósseo para fins de reconstrução, para posicionamento de implante dentário. Nosso grupo demonstrou em um trabalho recente a sensibilização para HLA em 33,3% dos pacientes receptores de transplante ósseo córtico-medular, porém, não existiu repercussão significativa da sensibilização na incorporação do enxerto, já que em todos os indivíduos da pesquisa os enxertos apresentaram boa incorporação e remodelação. Apesar da ausência de influência da sensibilização por HLA na incorporação dos enxertos ósseos, deve-se ponderar que uma parcela significativa dos pacientes (33,3%) foi sensibilizada, o que poderia acentuar a rejeição a futuros transplantes, como de fígado ou coração, portadores dos mesmos antígenos HLA (second-set rejection). Faz-se necessário o aprofundamento das investigações científicas sobre a possibilidade de sensibilização dos pacientes receptores de transplante ósseo para fins de reabilitação dentária por meio de implantes.

There is much controversy regarding the use of allogeneic bone in relation to the risk of immunogenic sensitization of the host. This could increase the chances of graft rejection, slow bone incorporation, osteolysis, bony erosions, joint degeneration, infection and fracture. Some studies have shown evidence of immunological sensitization, when using fresh frozen allogeneic bone grafts, against the donor-specific HLA molecule. However, there are only a few studies assessing the risk of sensitization in humans after bone grafting for bone reconstruction prior to dental implant placement. Our group has recently demonstrated a 33.3% rate of HLA sensitization in patients receiving a corticancellous bone graft, however, with no significant effect on graft incorporation, since all subjects in the study showed adequate incorporation and bone remodeling. Despite there being no influence of HLA sensitization in bone graft incorporation, it should be highlighted that a significant portion of patients (33.3%) was sensitized, which could jeopardize future transplants, such as liver or heart, from donors with the same HLA type (second-set rejection). Further investigation is necessary on the sensitization risk among patients receiving bone transplant for the purpose of dental rehabilitation using implants.

The clinical effects and immunological rejection of allogenic bone as autologous bone graft substitute materials in the treatment of developmental dislocation of the hip / 中国医师进修杂志

Objective To study the clinical effects and immunological rejection of allogenic bone as autologous bone graft substitute materials in the treatment of developmental dislocation of the hip.Methods Selected 36 chlidren 40 hip joint undergoing Salter innominate osteotomy,shortening and derotational of the femur bone cutting,Allogeneic bone implantation.Results According to the clinical evaluation criteria of Mckay,excellent 32,good 6,satisfaction 87.5％.All 40 cases of hip bone graft healing,complications such as postoperative incisional drainage response,and no obvious immune rejection.Conclusions Allogeneic bone implantion in the treatment of developmental dislocation of the hip is safe.

Human Bone Marrow Subpopulations Sustain Human Islet Function and Viability In vitro.

Aims: Allogeneic bone marrow (BM) has been shown to support human islet survival and function in long-term culture by initiating human islet vascularization and β-cell regeneration. Various BM subpopulations may play different roles in human islet functions and survival. In this paper we investigated the effects of BM and its subpopulations, endothelial progenitor cells (E) and mesenchymal (M) cells on human islet’s β-cell function and regeneration. Study Design: Isolation and identification of subpopulations from human bone marrow and culture with allogeneic human islet to investigate effects of different cell population on human islet function and regeneration. Place and Duration of Study: Department of Medicine, Center for Stem Cell & Diabetes Research, RWMC, Providence, RI, USA, between 2010 - 2014. Methodology: Human islets were distributed from Integrated Islet Distribution Program (IIDP) and human bone marrow (BM) was harvested by Bone marrow transplantation center at Roger Williams Hospital. BM subpopulation was identified cell surface markers through Fluorescenceactivated cell sorting, applied in flow cytometry (FACS), islet function was evaluated by human ELISA kit and β cell regeneration was evaluated by three methods of Cre-Loxp cell tracing, β cell sorting and RT-PCR for gene expression. Results: Four different BM and seven different islet donates contributed human tissues. We observed islet β-cell having self regeneration capability in short term culture (3~5 days) using a Cre-Loxp cell tracing. BM and its subtype E, M have similar benefits on β cell function during coculture with human islet comparison to islet only. However, only whole BM enables to sustain the capability of islet β-cell self regeneration resulting in increasing β cell population while single E and M individual do not significantly affect on that. Mechanism approach to explore β-cell self regeneration by evaluating transcription factor expressions, we found that BM significantly increases the activations of β-cell regeneration relative transcription factors, the LIM homeodomain protein (Isl1), homologue to zebrafish somite MAF1 (MAFa), the NK-homeodomain factor 6.1 (NKX6.1), the paired box family factors 6 (PAX6), insulin promoter factor 1 (IPF1) and kinesin family member 4A (KIF4a). Conclusion: These results suggest that BM and its derived M and E cells enable to support human islet β-cell function. However, only BM can sustain the capability of β-cell self regeneration through initiating β-cell transcriptional factors but not individual E and M cells suggesting pure E and M cells less supportive for islet long-term survival in vitro.

Percutaneous Vertebroplasty Using Fresh Frozen Allogeneic Bone Chips as Filler

BACKGROUND: Vertebroplasty is not free from cement related complications. If an allograft is used as a filler, most of them can be averted. METHODS: Forty consecutive cases of osteoporotic vertebral fracture were divided into two groups by self-selection. The study and the control groups underwent vertebroplasty with fresh frozen allogeneic bone chips and bone cement, respectively. Clinical results were assessed at preoperation, postoperative day 1 and months 3, 6, and 12 by 10-grade visual analog scale (VAS), and radiological results were assessed at the same time by vertebral kyphotic angle (VKA) and local kyphotic angle (LKA). The results were compared within and between the groups. Survival function was analyzed. The criteria of an event were clinical or radiological deterioration versus pre-index surgery state. RESULTS: VAS was improved in the study group from 8.4 +/- 0.8 to 5.2 +/- 1.4, 6.4 +/- 1.2, 5.5 +/- 2.7, and 3.7 +/- 1.4 at postoperative day 1 and months 3, 6, and 12, respectively, and in the control group from 8.4 +/- 1.2 to 3.2 +/- 1.1, 3.2 +/- 1.7, 3.2 +/- 2.7, and 2.5 +/- 1.7, respectively (within group, p < 0.001; between groups, p < 0.001). VKA was improved in the study group from 18.9degrees +/- 8.0degrees to 15.2degrees +/- 6.1degrees (p = 0.046) and in the control group from 14.7degrees +/- 5.2degrees to 10.3degrees +/- 4.7degrees (p < 0.001) at postoperative day 1. LKA was not improved in the study group but was improved in the control group from 16.8degrees +/- 11.7degrees to 14.3degrees +/- 9.6degrees (p = 0.015). Correction angle was 2.7degrees +/- 4.6degrees, -7.9degrees +/- 5.3degrees, -7.2degrees +/- 5.2degrees, and -7.4degrees +/- 6.3degrees at postoperative day 1 and months 3, 6, and 12, respectively, in the study group and 4.3degrees +/- 3.7degrees, 0.7degrees +/- 3.6degrees, 0.7degrees +/- 4.2degrees, and 0.1degrees +/- 4.4degrees, respectively, in the control group. Correction loss was significant in both groups (p < 0.001) and more serious in the study group (p < 0.001). The 6-month survival rate was 16.7% in the study group and 64.3% in the control group (p = 0.003; odds ratio, 5.250). CONCLUSIONS: In treatment of osteoporotic vertebral fracture, fresh frozen allogeneic bone chips are not recommendable as a filler for its worse results than bone cement.

Establishment of an acute graft-versus-host disease animal model in EL4 T-cell leukemia/lymphoma mice / 中华实用儿科临床杂志

Objective To establish an acute graft-versus-host disease (aGVHD) model in EL4 T-cell leukemia/lymphoma mice,for providing experimental model to prevent aGVHD while maintaining graft-versus-leu1 mia (GVL) effect during allogeneic bone marrow transplantation (Allo-BMT).Methods Male BALB/c (H-2Kd)mice were used as donors and female C57BL/6(H-2Kb) mice were used as recipients.C57BL/6 hosts were given 9.5 Gy lethal total body irradiation at 4 hours prior to transplantation.Mice were randomly assigned into 3 groups and each group contained 17 recipients:The recipients in radiation group were injected with 0.2 mL RPMI 1640 as control.The recipients were injected with donor bone marrow cells (5 × 106/mouse) and splenocyte for aGVHD(5 × 106/mouse).The recipients in EL4 T-cell leukemia/lymphoma aGVHD group were injected with donor bone marrow cells (5 × 106/mouse) and plus 500 EL4 cells (5 × 106/mouse).General state,life span and histopathology of the recipient mice and detected chimera were observed.Results The results showed that the mean survival time in radiation group was (10.10 ± 0.43) days,in aGVHD group was(28.12 ± 5.01)days,in EL4 T-cell leukemia/lymphoma aGVHD group was (31.05 ±5.48) days.The mean survival time in aGVHD group and EL4 T-cell leukemia/lymphoma aGVHD group were significantly longer than that in radiation group(all P ＜ 0.01),but there was no significant difference between aGVHD group and EL4 T-cell leukemia/lymphoma aGVHD group (P ＞ 0.05).Histopathological analysis in several target organs (skin,liver and small intestine) confirmed the presence of sever GVHD in aGVHD group and EL4 T-cell leukemia/ lymphoma aGVHD group.Pathological examination showed disorganization of normal tissues and leukemic cell infiltration in EL4 T-cell leukemia/lymphoma aGVHD group.Conclusion The EL4 T-cell leukemia/lymphoma aGVHD mice model is reliable to the experimental research of aGVHD.

An experimental study for prefabrication of skin flap with frozen allogeneic bone / 中华显微外科杂志

Objective To research the feasibility of the prefabrication of skin flap with frozen allogeneic bone.Methods From November 2010 to July 2011,fifteen miniature pigs were randomly divided into three groups(n =5) according to different implanted positions.Rewarming,deep-frozen allogenic bone was implanted in subcutaneous tissue,subfascial compartment and muscle respectively.Emission Computed Tomography (ECT) was used in the 4th week,the 8th week and the 12th week postoperatively.Angiography and pathological examination was used in the 12th week.Results The difference of the result of ECT was statistically significant betweent the 4th week and the 8th week (P ＜ 0.05),and there was not statistically significant difference betweent the 12th week and the 8th week (P ＞ 0.05).Angiography showed that all allogeneic bone was vascularized in each group.Pathological examination showed that the vascularization and the inducing osteogenesis of the allogeneic bone which was implanted in the subfascial compartment or muscle was better than that in the subcutaneous tissue.Conclusion The deep-frozen allogenic bone can be used for the prefabrication of the bone-skin flap.

Allogeneic bone combined with autologous bone marrow stem cell transplantation for the treatment of benign bone tumors and tumor-like lesions / 中国组织工程研究

BACKGROUND:Al ogenic bone is a clinical commonly used bone graft material, but the osteoinductive capacity is the biggest problem. OBJECTIVE:To evaluate the effect of al ogeneic bone combined with autologous bone marrow stem cells on the repair of bone defects after scraping or resection of benign bone tumors and tumor-like lesions. METHODS:Sixty-five cases of benign bone tumors (including patients with tumor-like lesions) were divided into two groups according to bone graft. There were 35 cases in the composite bone marrow stem cells for bone graft group, and 20-40 mL red bone marrow were extracted from anterosuperior iliac spine or iliac spine on both sides according to the expected amount of bone graft, then the bone marrow stem cells were isolated, purified, cultured and amplified for standby, and the bone marrow stromal stem cells and al ogeneic bone particles were ful y blended before bong graft. After tumor scraping or resection, the blended bone marrow stromal stem cells and al ogeneic bone particles were implanted into the bone defect region. In the bone graft group, the bone defect was implanted with al ogeneic bone soaked with saline for half an hour. X-ray examination was performed at 1, 3, 6 and 12 months after treatment to compare the fuzzy boundary and the time for disappear, and the postoperative complications were observed. RESULTS AND CONCLUSION:Al the 62 patients were fol owed-up for more than 12 months. The fuzzy boundary time and disappear time in the composite bone marrow stem cells for bone graft group were shorter than those in the bone graft group (P<0.05). In the composite bone marrow stem cells for bone graft group, one case appeared rejection and healed after treated with immunosuppressive agents for 2 weeks, and no complication observed in two groups. The results indicate that al ogeneic bone composite autologous bone marrow stem cells for bone graft can promote bone fusion and bone defect healing.