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1.
Zhonghua Xue Ye Xue Za Zhi ; 42(5): 390-395, 2021 May 14.
Artigo em Chinês | MEDLINE | ID: mdl-34218581

RESUMO

Objective: To evaluate the effect of autologous stem cell transplantation (auto-HSCT) on treatment remission and survival of newly diagnosed multiple myeloma (MM) patients. Methods: A total of 243 new diagnosed MM patients (age ≤65 years) who had received auto-HSCT were selected, and 176 MM patients (age ≤65 years) who had not received auto-HSCT were selected as the control group to evaluate the effect of auto-HSCT on the remission and survival. To balance the distribution of prognostic factors between auto-HSCT and non-auto-HSCT patients, the propensity score matching technique was used to reduce the bias between groups in a 1∶1 scale, 64 in each group, and correlation analysis was performed. Results: A total of 128 patients (64 cases in each group) were screened by propensity score matching analysis. 64 patients received auto-HSCT after induction therapy. After auto-HSCT, 24 patients (37.5%) obtained sCR, 16 patients (25.0%) obtained CR, 15 patients (23.4%) obtained VGPR, and 9 patients (14.1%) obtained PR. The efficacy of patients with auto-HSCT was significantly better than that of non-auto-HSCT patients (P=0.032) . Progression-free survival (PFS) and overall survival (OS) were significantly longer in auto-HSCT patients compared with non-auto-HSCT patients[PFS: 42.2 (95% CI 29.9-54.5) months vs 22.4 (95% CI 17.1-27.7) months, P=0.007; OS: 87.6 (95% CI 57.3-117.9) months vs 53.9 (95% CI 36.1-71.7) months, P=0.011]. Multivariate analysis confirmed that auto-HSCT had a favorable effect on OS (HR=0.448, 95%CI 0.260-0.771, P=0.004) and PFS (HR=0.446, 95%CI 0.280-0.778, P=0.003) . Conclusion: These results demonstrated that auto-HSCT was a favorable prognostic factor for newly diagnosed MM patients.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo , Idoso , Intervalo Livre de Doença , Humanos , Estudos Retrospectivos , Transplante Autólogo , Resultado do Tratamento
2.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(6): 947-952, 2021 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-34238750

RESUMO

OBJECTIVE: To investigate the risk factors affecting the survival of parathyroid autograft following total parathyroidectomy combined with autologous sternocleidomastoid muscle transplantation (TPTX + AT) in patients on maintenance hemodialysis (MHD) complicated with secondary hyperparathyroidism (SHPT). OBJECTIVE: This retrospective study was conducted among the patients on maintenance hemodialysis with SHPT, who underwent successful parathyroidectomy and autotransplantation from January, 2010 to February, 2020 in our hospital. The clinical data and serum levels of calcium, phosphorus, intact parathyroid hormone, hemoglobin, and alkaline phosphatase (ALP) of the patients were collected. The enrolled patients were divided into survival group with bilateral forearm parathyroid hormone (iPTH) ratio > 1.5 and death group with a ratio < 1.5 at 2 weeks after surgery for comparison of the clinical data and perioperative indicators. The risk factors of postoperative parathyroid autograft survival were analyzed using logistic regression analysis. OBJECTIVE: A total of 87 patients were included in the study, among whom the graft survival rate after parathyroid transplantation was 78.16%. In both groups, serum levels of calcium, phosphorus, iPTH and ALP decreased and hemoglobin level increased significantly at 1 week and 1, 2, 3, 6 and 12 months after surgery (P < 0.01). Logistic regression analysis showed that serum ALP level was an independent risk factor for graft survival following parathyroid autotransplantation [OR=1.003, 95% CI: 1.001-1.005, P=0.004]. OBJECTIVE: TPTX+AT is a safe and effective treatment for SHPT, and parathyroid autografts are less likely to survive following parathyroid transplantation in patients with high preoperative level of ALP.


Assuntos
Sobrevivência de Enxerto , Paratireoidectomia , Cálcio , Humanos , Hormônio Paratireóideo , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Transplante Autólogo
3.
Rev Med Suisse ; 17(743): 1167-1171, 2021 Jun 16.
Artigo em Francês | MEDLINE | ID: mdl-34133094

RESUMO

Total pancreatectomy is a procedure primarily performed for chronic pancreatitis refractory to conservative therapy. It may nevertheless be indicated in the event of a malignant tumor, either as a treatment for a surgical complication or as a prevention of anastomotic leakage. If possible, islet auto-transplantation should be combined with total pancreatectomy for benign disease, in order to prevent a severe diabetes. Until recently, malignant disease was considered an absolute contraindication to islet auto-transplantation. A recent series from Milan showed promising oncological results in auto-transplantation for malignant disease, opening up new perspectives for total pancreatectomy for cancer.


Assuntos
Diabetes Mellitus , Transplante das Ilhotas Pancreáticas , Pancreatite Crônica , Humanos , Pancreatectomia , Pancreatite Crônica/cirurgia , Transplante Autólogo , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(25): e26330, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160396

RESUMO

PURPOSE: This systematic review aimed to identify the available evidence regarding the comparative effectiveness and safety of various operative treatments in adult patients with osteochondral lesions of the talus (OLT). MATERIALS AND METHODS: The PubMed, Embase, ISI Web of Knowledge, and the Cochrane Controlled Trial Register of Controlled Trials were searched from their inception date to September 2019. Two reviewers selected the randomized controlled trials (RCTs) and non-RCTs assessing the comparative effectiveness and safety of various operative treatments for OLT. The meta-analysis was performed using Revman 5.3. RESULTS: Eight studies (1 RCT and 7 non-RCTs) with 375 patients were included in this review. The difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score between the cartilage repair and replacement was not significant. The cartilage regeneration with or without cartilage repair had significant superiority in improving the AOFAS score compared with the cartilage repair. The difference in the magnetic resonance observation of cartilage repair tissue score between the cartilage repair and replacement and between cartilage repair and cartilage repair plus regeneration was significant. CONCLUSIONS: Cartilage regeneration and cartilage repair plus regeneration had significant superiority in improving the ankle function and radiological evaluation of OLT, although the trials included did not have high-level evidence. Moreover, which treatment between the 2 was safer could not be addressed in this review as most of the trials did not report the safety outcome. Further studies are needed to define the best surgical option for treating OLT.


Assuntos
Articulação do Tornozelo/cirurgia , Cartilagem Articular/cirurgia , Osteocondrite/cirurgia , Tálus/cirurgia , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Artroplastia Subcondral/estatística & dados numéricos , Transplante de Medula Óssea/estatística & dados numéricos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Condrócitos/transplante , Humanos , Imageamento por Ressonância Magnética , Ensaios Clínicos Controlados não Aleatórios como Assunto , Osteocondrite/diagnóstico , Osteocondrite/patologia , Plasma Rico em Plaquetas , Ensaios Clínicos Controlados Aleatórios como Assunto , Tálus/diagnóstico por imagem , Tálus/patologia , Transplante Autólogo/métodos , Transplante Autólogo/estatística & dados numéricos , Resultado do Tratamento
5.
Indian J Ophthalmol ; 69(7): 1697-1701, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34146009

RESUMO

Purpose: Analysis of complication profile after pterygium excision, in primary and recurrent pterygia. Methods: Retrospective analysis of all the patients who had undergone pterygium excision in a tertiary center in South India from 2010 to 2018 was analyzed. A total of 2356 eyes in 2028 patients were included in the study. Patients who had undergone conjunctival autografting for primary pterygium, conjunctival limbal autografting for recurrent pterygium, vertical split conjunctival autografting for double head pterygium were included in the study. In all the surgical procedures fibrin glue was used for fixation of the autograft. The follow-up period ranged from 6 months to 75 months, with an average of 17 months. Patients with less than 6 months of follow-up were excluded from the study. Results: The following postoperative complications were noted, Sub-conjunctival hemorrhage in 912 eyes (38.7%), edema of the graft in 522 cases (22.15%), graft loss in 22 cases (0.93%), graft retraction in 692 cases (29.37%) and sliding of the graft was seen in 9 cases (0.38%). Granuloma was seen in 4 cases (0.16%) at the host site and 5 cases (0.21%) at the donor site. Recurrence was seen in 34 patients (1.44%). Other severe complications like corneal melt were seen in only 1 case (0.04%) who was operated on for recurrent pterygium. In comparison between primary and recurrent pterygia; subconjunctival hemorrhage, edema of the graft, graft loss, and recurrence was significantly (P < 0.05%) higher in recurrent pterygia. Conclusion: Various complications can occur post pterygium surgery as listed above. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications.


Assuntos
Pterígio , Túnica Conjuntiva , Seguimentos , Humanos , Índia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Pterígio/cirurgia , Recidiva , Estudos Retrospectivos , Transplante Autólogo , Resultado do Tratamento
6.
Ann Plast Surg ; 86(6S Suppl 5): S487-S490, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100804

RESUMO

ABSTRACT: Adipose fat grafting (AFG) is a popular technique used to add volume in the face, breasts, and other tissue deficient areas of the body. In terms of scar release, not only has fat provided additional soft tissue coverage but also the relief of pain in scars in those patients suffering from disease processes, such as complex regional pain syndrome with steroid-induced atrophy, burn scars, morphea, and lupus. The purpose of this article is to demonstrate the senior author's technique and outcomes of using AFG in the face and body for treating volume deficiency, atrophic scarring, and deformities.A retrospective chart review of 127 AFG procedures of the face and body from September 2006 to September 2019 was performed. Of these, 14 patients had scar releases performed with fat grafting of areas of scar contracture. Fat was harvested from the abdomen, thighs, and flanks using Toomey syringes or an enclosed power-assisted system with 3.7- or 3.0-mm cannulas. Grafting in small areas, such as the face, was performed with the 0.9-mm blunt cannula.The majority of AFG was completed in the face (45%), followed by breasts (22%), and scar contracture (16%). The mean volume of fat grafted in procedures involving the breasts, buttocks, and face was 102, 182, and 21 mL, respectively. For scar contracture, the mean volume was 38 mL and for deformations, 27 mL. Sixteen percent of the cohort required at least 1 additional AFG procedure to achieve satisfactory results. There were no major complications, such as skin loss, vascular injury, embolization, or blindness. Minor complications, such as erythema, edema, and hematoma at the fat harvest or graft site, did occur and were managed with local measures.Autologous fat grafting has consistently resulted in volume correction. In addition, in patients with autoimmune disorders, burn scars, and retracted scars, not only has there been volume correction but also decreased pain in the area of treatment. In our series of patients, we described our technique of AFG for the face, body, and scar contracture. Our results demonstrate that AFG remains an inexpensive, safe, and effective treatment option to achieve volume.


Assuntos
Cicatriz , Contratura , Tecido Adiposo , Mama/patologia , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/cirurgia , Contratura/etiologia , Contratura/cirurgia , Humanos , Estudos Retrospectivos , Transplante Autólogo
7.
Chin Med J (Engl) ; 134(13): 1584-1592, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34133361

RESUMO

BACKGROUND: There were few studies on real-world data about autologous hematopoietic stem cell transplantation (auto-HSCT) or allogeneic HSCT (allo-HSCT) in peripheral T-cell lymphoma (PTCL). This study aimed to investigate the clinical outcomes of patients who received auto-HSCT or allo-HSCT in China. METHODS: From July 2007 to June 2017, a total of 128 patients who received auto-HSCT (n  = 72) or allo-HSCT (n  = 56) at eight medical centers across China were included in this study. We retrospectively collected their demographic and clinical data and compared the clinical outcomes between groups. RESULTS: Patients receiving allo-HSCT were more likely to be diagnosed with stage III or IV disease (95% vs. 82%, P = 0.027), bone marrow involvement (42% vs. 15%, P = 0.001), chemotherapy-resistant disease (41% vs. 8%, P = 0.001), and progression disease (32% vs. 4%, P < 0.001) at transplantation than those receiving auto-HSCT. With a median follow-up of 30 (2-143) months, 3-year overall survival (OS) and progression-free survival (PFS) in the auto-HSCT group were 70%(48/63) and 59%(42/63), respectively. Three-year OS and PFS for allo-HSCT recipients were 46%(27/54) and 44%(29/54), respectively. There was no difference in relapse rate (34%[17/63] in auto-HSCT vs. 29%[15/54] in allo-HSCT, P = 0.840). Three-year non-relapse mortality rate in auto-HSCT recipients was 6%(4/63) compared with 27%(14/54) for allo-HSCT recipients (P = 0.004). Subanalyses showed that patients with lower prognostic index scores for PTCL (PIT) who received auto-HSCT in an upfront setting had a better outcome than patients with higher PIT scores (3-year OS: 85% vs. 40%, P = 0.003). Patients with complete remission (CR) undergoing auto-HSCT had better survival (3-year OS: 88% vs. 48% in allo-HSCT, P = 0.008). For patients beyond CR, the outcome of patients who received allo-HSCT was similar to that in the atuo-HSCT group (3-year OS: 51% vs. 46%, P = 0.300). CONCLUSIONS: Our study provided real-world data about auto-HSCT and allo-HSCT in China. Auto-HSCT seemed to be associated with better survival for patients in good condition (lower PIT score and/or better disease control). For patients possessing unfavorable characteristics, the survival of patients receiving allo-HSCT group was similar to that in the auto-HSCT group.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Linfoma de Células T Periférico , China , Humanos , Linfoma de Células T Periférico/terapia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Transplante Autólogo , Transplante Homólogo , Resultado do Tratamento
8.
Blood Adv ; 5(12): 2608-2618, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34152404

RESUMO

High-dose chemotherapy and autologous hematopoietic cell transplantation is an effective consolidation therapy in lymphoma; however, its use in elderly patients has been limited because of concerns for greater toxicity in this group. We investigated the toxicities of carmustine, etoposide, cytarabine, and melphalan (BEAM) and autologous hematopoietic cell transplantation (AHCT) in 346 patients in 2 age groups: 279 patients aged 60 to 69 years and 67 patients aged ≥70 years. The majority developed severe toxicities; the most common were febrile neutropenia, gastrointestinal, infections, and cardiovascular. Older patients were at higher risk for grade ≥3 cardiovascular toxicities (hazard ratio [HR], 3.36; 95% confidence interval [CI], 2.25-5.00; P < .001) and skin toxicities (HR, 2.45; 95% CI, 1.08-5.54, P = .032). In the older group, nonrelapse mortality at 100 days and at 2 years was 2.99% (95% CI, 0.55-9.32) and 6.2% (95% CI, 1.97-13.95), respectively, vs 1.79% (95% CI, 0.68-3.92) and 2.91% (95% CI, 1.37-5.42), respectively, in the younger group. When adjusting for the number of grade ≥3 toxicities within the first 100 days, older patients had a 1.71-fold (95% CI, 1.08-2.71) increased risk for progression or death relative to younger patients. Although BEAM followed by AHCT is effective, it is associated with significant organ toxicities, especially in patients aged ≥70 years. Interventions to mitigate toxicities while maintaining efficacy are much needed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Transplante de Células-Tronco Hematopoéticas , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carmustina/efeitos adversos , Humanos , Melfalan/efeitos adversos , Transplante Autólogo
9.
J Orthop Traumatol ; 22(1): 23, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34152483

RESUMO

BACKGROUND: Matrix-induced autologous chondrocyte implantation (mACI) can be performed in a full arthroscopic or mini-open fashion. A systematic review was conducted to investigate whether arthroscopy provides better surgical outcomes compared with the mini-open approach for mACI in the knee at midterm follow-up. METHODS: This systematic review was conducted following the PRISMA guidelines. The literature search was performed in May 2021. All the prospective studies reporting outcomes after mACI chondral defects of the knee were accessed. Only studies that clearly stated the surgical approach (arthroscopic or mini-open) were included. Only studies reporting a follow-up longer than 12 months were eligible. Studies reporting data from combined surgeries were not eligible, nor were those combining mACI with less committed cells (e.g., mesenchymal stem cells). RESULTS: Sixteen studies were included, and 770 patients were retrieved: 421 in the arthroscopy group, 349 in the mini-open. The mean follow-up was 44.3 (12-60) months. No difference between the two groups was found in terms of mean duration of symptoms, age, body mass index (BMI), gender, defect size (P > 0.1). No difference was found in terms of Tegner Score (P = 0.3), Lysholm Score (P = 0.2), and International Knee Documentation Committee (IKDC) Score (P = 0.1). No difference was found in the rate of failures (P = 0.2) and revisions (P = 0.06). CONCLUSION: Arthroscopy and mini-arthrotomy approaches for mACI in knee achieve similar outcomes at midterm follow-up. LEVEL OF EVIDENCE: II, systematic review of prospective studies.


Assuntos
Condrócitos/transplante , Artroscopia , Doenças das Cartilagens/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Transplante Autólogo
10.
BMC Oral Health ; 21(1): 325, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187446

RESUMO

BACKGROUND: The amount of bone remaining at the transplant site for autogenous tooth transplantation can facilitate successful healing. Therefore, this retrospective study evaluated the factors influencing the healing of 50 successful autogenous tooth transplantations with insufficient bone support at the transplanted site without a bone graft. METHODS: The factors were classified as pre- and peri-operative factors, and the healing outcomes were clinical and radiographic observations. The factors were statistically analyzed using the chi-square test to identify correlations between the pre- and peri-operative factors and the clinical and radiographic outcomes. The T-test or one-way analysis of variance was used to compare the percent bone change in each factor. RESULTS: The results indicated that gingival healing was delayed in the intra-arch transplantations, and pulp obliteration was seen earlier when transplanted in the maxilla. Patients under 18-years-old demonstrated a greater percent bone change than the over 18-year-old patients, while the peri-operative variables did not have a relationship with clinical healing and the amount of bone change over 12 months. Furthermore, the percent bone change significantly increased during the first three months. CONCLUSIONS: In conclusion, pre-operative factors, age and transplant site, influenced the healing rate of autogenous transplanted teeth. In contrast, the peri-operative factors were not related with the clinical and radiographic outcomes. Generating the least trauma to the periodontal ligament cells is the most important concern.


Assuntos
Dente , Adolescente , Transplante Ósseo , Humanos , Estudos Retrospectivos , Raiz Dentária , Alvéolo Dental , Transplante Autólogo
11.
Rinsho Ketsueki ; 62(5): 407-417, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34108322

RESUMO

The introduction of autologous stem cell transplantation, proteasome inhibitors, and immunomodulatory drugs (IMiDs) has improved the treatment outcome for multiple myeloma (MM). However, many patients develop resistance to existing therapies, and novel treatment strategies for these patients must be established. Therapeutic antibodies including daratumumab targeting CD38 and elotuzumab targeting SLAMF7 have been introduced in the clinic as immunotherapies for MM. These antibodies exert cytotoxic effects on myeloma cells through the activation of effector cells such as natural killer cells and induction of phagocytosis by macrophages. Suppressed anti-tumor immunity may be related to acquisition of drug resistance by myeloma cells in patients with MM. It has been reported that IMiDs such as lenalidomide and pomalidomide enhance the effect of therapeutic antibodies through the stimulation of anti-tumor immunity. This stimulation of anti-tumor immunity is also observed in the effects of anti-CD38 antibodies, such as daratumumab and isatuximab. Therefore, it is expected that combination therapy with anti-CD38 antibodies and IMiDs may enhance anti-tumor immunity. Furthermore, chimeric antigen receptor (CAR) T cell therapy, antibody drug conjugates (ADC), and bispecific antibodies (BsAbs) are in the process of their introduction to the clinic as novel immunotherapies for MM.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo , Humanos , Fatores Imunológicos , Imunoterapia , Mieloma Múltiplo/terapia , Transplante Autólogo
12.
Chin Med J (Engl) ; 134(12): 1431-1440, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34091525

RESUMO

BACKGROUND: The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes. METHODS: A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs). RESULTS: The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88-40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001). CONCLUSIONS: These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.


Assuntos
Transtornos Cerebrovasculares , Transplante de Células-Tronco Hematopoéticas , Transtornos Cerebrovasculares/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Condicionamento Pré-Transplante , Transplante Autólogo
13.
Int J Mol Sci ; 22(11)2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34070436

RESUMO

The aim was to examine the efficiency of a scaffold made of poly (L-lactic acid)-co-poly(ϵ-caprolactone), collagen (COL), polyaniline (PANI), and enriched with adipose-derived stem cells (ASCs) as a nerve conduit in a rat model. P(LLA-CL)-COL-PANI scaffold was optimized and electrospun into a tubular-shaped structure. Adipose tissue from 10 Lewis rats was harvested for ASCs culture. A total of 28 inbred male Lewis rats underwent sciatic nerve transection and excision of a 10 mm nerve trunk fragment. In Group A, the nerve gap remained untouched; in Group B, an excised trunk was used as an autograft; in Group C, nerve stumps were secured with P(LLA-CL)-COL-PANI conduit; in Group D, P(LLA-CL)-COL-PANI conduit was enriched with ASCs. After 6 months of observation, rats were sacrificed. Gastrocnemius muscles and sciatic nerves were harvested for weight, histology analysis, and nerve fiber count analyses. Group A showed advanced atrophy of the muscle, and each intervention (B, C, D) prevented muscle mass decrease (p < 0.0001); however, ASCs addition decreased efficiency vs. autograft (p < 0.05). Nerve fiber count revealed a superior effect in the nerve fiber density observed in the groups with the use of conduit (D vs. B p < 0.0001, C vs. B p < 0.001). P(LLA-CL)-COL-PANI conduits with ASCs showed promising results in managing nerve gap by decreasing muscle atrophy.


Assuntos
Modelos Animais de Doenças , Células-Tronco Mesenquimais/metabolismo , Nanofibras/química , Regeneração Nervosa , Neurogênese , Traumatismos dos Nervos Periféricos/terapia , Nervo Isquiático/metabolismo , Tecidos Suporte/química , Compostos de Anilina/química , Animais , Caproatos/química , Células Cultivadas , Colágeno/química , Imuno-Histoquímica , Lactonas/química , Masculino , Teste de Materiais , Células-Tronco Mesenquimais/citologia , Microscopia Eletrônica de Varredura , Músculo Esquelético/citologia , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Nanofibras/ultraestrutura , Traumatismos dos Nervos Periféricos/metabolismo , Traumatismos dos Nervos Periféricos/patologia , Poliésteres/química , Ratos , Ratos Endogâmicos Lew , Nervo Isquiático/citologia , Nervo Isquiático/patologia , Transplante Autólogo
14.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(3): 772-780, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34105471

RESUMO

OBJECTIVE: To summarize the clinical and Laboratory characteristics of patients with multiple myeloma (MM) and analyze the prognostic factors. METHODS: Two hundred MM patients were retrospectively analyzed for the following parameters, including peripheral blood, bone marrow morphology, cytogenetics, clinical staging, and response to the chemotherapy in order to summarize related factors affecting overall survival (OS). The prognostic factors were also analyzed. RESULTS: 200 patients with MM were divided into 3 groups according to bone marrow plasma cell percentage (BMPC%) in bone marrow smears: <10% group (74 cases, 37.0%), 10%-50% group (75 cases, 37.5%), >50% group (51 cases, 25.5%). Compared with the other two groups, patients in BMPC%<10% group were characterized by lower clinical staging levels, lower rates of 13q14 deletion and t(11;14) positive, better response to chemotherapy and favorable three-year OS rate. The univariate analysis showed that prognostic factors indicating favorable outcome as evaluated by OS included age≤55 years old, BMPC%<10%, WBC<7.5×109/L, Hb≥68 g/L, PLT≥150×109/L, ß2-MG<5.5 mg/L, LDH≤230 U/L, Durie-Salmon staging A, achievement of VGPR or better outcome after the first chemotherapy, achievement VGPR or better outcome after the fourth chemotherapy, and presence of autologous hematopoietic stem cell transplantation(auto-HSCT)(P<0.05). The multivariate analysis showed that prognostic factors indicating favorable outcome as evaluated by OS included age≤55 years old, BMPC%≤50%, WBC<7.5×109/L, Hb≥68 g/L, achievement of VGPR or better outcome after the fourth chemotherapy (P<0.05). CONCLUSION: The clinical characteristics are different among MM patients with different BMPC% in bone marrow smears at initial diagnosis, and prognostic analysis shows that the BMPC% in bone marrow smears has an effect on OS rate. BMPC% in bone marrow smears at initial diagnosis, age, WBC, Hb, response to the fourth chemotherapy are also the main factors impacting the prognosis of patients.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo , Intervalo Livre de Doença , Humanos , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Prognóstico , Estudos Retrospectivos , Transplante Autólogo , Resultado do Tratamento
15.
Medicine (Baltimore) ; 100(19): e25780, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106611

RESUMO

RATIONALE: Hepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures. PATIENT CONCERNS: We present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities. DIAGNOSES: Preoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium. INTERVENTIONS: Distal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed. OUTCOMES: The operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence. LESSONS: This case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.


Assuntos
Carcinoma Hepatocelular/secundário , Gastrectomia/métodos , Átrios do Coração/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/patologia , Transplante de Fígado/métodos , Trombose/etiologia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/cirurgia , Átrios do Coração/patologia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/cirurgia , Veias Hepáticas/patologia , Veias Hepáticas/cirurgia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Veia Porta/patologia , Veia Porta/cirurgia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/secundário , Neoplasias Gástricas/cirurgia , Trombose/diagnóstico , Trombose/cirurgia , Transplante Autólogo
16.
Am J Sports Med ; 49(7): 1777-1785, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33945339

RESUMO

BACKGROUND: Anterior cruciate ligament reconstructions (ACLRs) fail at an alarmingly high rate in young active individuals. The Multicenter Orthopaedic Outcomes Network (MOON) knee group has developed an autograft risk calculator that uses patient characteristics and lifestyle to predict the probability of graft rupture if the surgeon uses a hamstring tendon (HT) or a bone-patellar tendon-bone (BPTB) graft to reconstruct the ligament. If validated, this risk calculator can be used during the shared decision-making process to make optimal ACLR autograft choices and reduce rupture rates. The STABILITY 1 randomized clinical trial offers a large, rigorously collected data set of similar young active patients who received HT autograft with or without lateral extra-articular tenodesis (LET) for ACLR. PURPOSE/HYPOTHESIS: The purpose was to validate the ACLR graft rupture risk calculator in a large external data set and to investigate the utility of BPTB and LET for ACLR. We hypothesized that the risk calculator would maintain adequate discriminative ability and calibration in the external STABILITY 1 data set when compared with the initial MOON development data set. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: The model predictors for the risk calculator include age, sex, body mass index, sport played at the time of injury, Marx Activity Score, preoperative knee laxity, and graft type. The STABILITY 1 trial data set was used for external validation. Discriminative ability, calibration, and diagnostic test validity of the model were assessed. Finally, predictor strength in the initial and validation samples was compared. RESULTS: The model showed acceptable discriminative ability (area under the curve = 0.73), calibration (Brier score = 0.07), and specificity (85.3%) to detect patients who will experience a graft rupture. Age, high-grade preoperative knee laxity, and graft type were significant predictors of graft rupture in young active patients. BPTB and the addition of LET to HT were protective against graft rupture versus HT autograft alone. CONCLUSION: The MOON risk calculator is a valid predictor of ACLR graft rupture and is appropriate for clinical practice. This study provides evidence supporting the idea that isolated HT autografts should be avoided for young active patients undergoing ACLR. REGISTRATION: NCT00463099 (MOON); NCT02018354 (STABILITY 1) (ClinicalTrials.gov identifiers).


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos/cirurgia , Estudos de Coortes , Humanos , Articulação do Joelho/cirurgia , Transplante Autólogo
17.
Transpl Immunol ; 67: 101412, 2021 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1233623

RESUMO

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a multisystem autoinflammatory disease due to an underlying plasma cell disorder that lacks a standard treatment strategy because of its rarity. We report a case of relapsed POEMS syndrome successfully treated with a second ambulatory autologous hematopoietic-cell transplantation (AHCT) after a daratumumab desensitization protocol performed during the coronavirus disease (COVID-19) pandemic in a patient with coexisting human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis infections. He is a 37-year old Latin-American male who had been treated with radiation, CyBorD regimen, AHCT and bortezomib therapy before being referred to our service. It was decided to administer daratumumab therapy and subsequently perform the transplant. Placement of central venous access, fluid infusion, conditioning regimen with melphalan and previously cryopreserved autograft infusion were carried out in an outpatient basis. Following second AHCT, the patient demonstrated clinical, VEGF, hematological response and remains SARS-CoV-2 infection-free and in POEMS remission with excellent quality-of-life at last follow up (6 months). We evidenced that thanks to an outpatient transplant program, the best therapeutic modalities can be offered to patients with hematologic malignancies in the context of present or future pandemics. Finally, high-complexity patients with HIV infection should have access to the same treatment strategies as non-infected patients. A second AHCT in the outpatient setting is feasible, safe and highly effective to treat patients with relapsed POEMS syndrome.


Assuntos
Infecções por HIV/complicações , Transplante de Células-Tronco Hematopoéticas , Hepatite B Crônica/complicações , Síndrome POEMS/cirurgia , Sífilis/complicações , Adulto , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Bortezomib/uso terapêutico , COVID-19/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Masculino , SARS-CoV-2 , Transplante Autólogo , Resultado do Tratamento
18.
BMC Surg ; 21(1): 226, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933053

RESUMO

BACKGROUND: Forearm autotransplantation after parathyroidectomy has turned into the standard method for secondary hyperparathyroidism (SHPT) treatment in chronic kidney disease patients. Our study aimed to explore the effects of three methods including muscle, subcutaneous and muscle + subcutaneous transplant methods on SHPT. METHODS: Seventy five SHPT patients were enrolled and assigned into the muscle + subcutaneous (M + S) (n = 26), muscle (M) (n = 35), and subcutaneous (S) (n = 14) groups. The operation efficacy evaluation included preoperative and postoperative biological characteristics such as parathyroid hormone (PTH), serum phosphorus, serum calcium and alkaline phosphatase (ALP). The data were recorded from pre-operation time point to 1, 2, 3, 6, 12, 18, 24 month (mo) postoperation periods. After operation, short-form health survey (SF-36) scores was made for life quality identification at 1, 2, 3, 6, 12, 24 time points. Symptoms about SHPT including bone pain, fracture, pruritus, and coronary artery calcification were followed-up based on the scale. RESULTS: Compared with the preoperative record, all the M + S, M, and S groups showed postoperative decreased levels of PTH, serum phosphorus, serum calcium, calcium-phosphorus. In M + S group, the PTH and serum calcium level kept more steady compared with the M and S groups during a 24 mo duration observation. After this, a SF-36 score scale which represents the life quality show M + S group got more scores at 3, 6, 12, 18 and 24 mo points. At last, the incidence of SHPT associated symptoms including Bone pain, Fracture, Pruritus, and Coronary artery calcification in M + S group were decreased compared with M and S groups at 1, 3, 6, 12 and 24 mo post-operation time points. CONCLUSION: M + S seems to be an efficient method for medical treatment of SHPT patients in the control of PTH and serum calcium. This mixed transplant strategy improves the biochemical characterizes compared with M and S groups in SHPT patients. Furthermore, the M + S method make beneficial on clinical outcomes and life quality of patients.


Assuntos
Hiperparatireoidismo Secundário , Paratireoidectomia , Cálcio , Antebraço/cirurgia , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Músculos , Glândulas Paratireoides , Hormônio Paratireóideo , Transplante Autólogo
19.
Stem Cell Res Ther ; 12(1): 259, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933149

RESUMO

OBJECTIVE: To report the clinical outcomes of a novel surgical technique, namely simple limbal epithelial transplantation (SLET), for the treatment of limbal stem cell deficiency (LSCD). METHODS: Thirteen patients (13 eyes) with LSCD who underwent autologous (10 eyes) or allogeneic (3 eyes) modified SLET between 2018 and 2021 were enrolled in this study. Grades of symblepharon, corneal conjunctivalization, vascularization, opacification, and visual acuity (VA) were evaluated preoperatively and postoperatively. In 2 cases, in vivo confocal microscopy (IVCM) and impression cytology (IC) were performed to assess the proliferation and degeneration of limbal tissue. RESULTS: At a postoperative follow-up of 6.5±5.3 (range, 2-20) months, 10 (10/13, 76.92%) eyes maintained a successful outcome. The grades of symblepharon, corneal conjunctivalization, vascularization, and opacification were significantly improved after SLET (P<0.05). Two-line improvement in VA was found in 6 (6/10, 60%) eyes of the successful cases. Recurrence of LSCD occurred in 3 (3/13, 23.08%) eyes, and conjunctival cyst occurred in 1 patient. After SLET, the morphology and structure of corneal epithelial cells and epithelial transition around the limbal tissue fragments were detected by IVCM and IC. CONCLUSIONS: Our findings suggest that the SLET is a safe and effective technique for the treatment of LSCD. The corneal stroma and hAM can provide protection and nutrition for the limbal stem cells (LSCs) without negatively influencing the clinical outcomes. IVCM and IC after SLET can evaluate the effectiveness of surgery and the transition of LSCs and corneal epithelial cells.


Assuntos
Doenças da Córnea , Epitélio Anterior , Limbo da Córnea , China , Doenças da Córnea/cirurgia , Humanos , Estudos Retrospectivos , Transplante de Células-Tronco , Células-Tronco , Transplante Autólogo
20.
J Orthop Traumatol ; 22(1): 20, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34021423

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) tear is the most frequent ligamentous injury of the knee joint. Autografts of hamstring (HS) or quadriceps tendons (QT) are used for primary ACL reconstruction. In this study, we planned to examine whether harvesting an HS graft is related to a deficit in dynamic knee stabilisation and strength revealed by dynamic valgus as compared with QT graft or the uninjured leg. Furthermore, if this deficit exists, is it compensated by higher neuromuscular activity of the quadriceps muscle? MATERIALS AND METHODS: Adult patients who had undergone ACL reconstruction with QT or HS autografts were included in this two-armed cohort study. Clinical outcome was assessed by clinical data analysis, physical examination and the Lysholm Score and Knee Injury and Osteoarthritis Score (KOOS). In addition, gait analysis and non-invasive surface electromyography were performed. RESULTS: A complete data set of 25 patients (QT: N = 8, HS: N = 17) was analysed. There was no significant demographic difference between the groups. Time between surgery and follow-up was significantly longer for the QT group. Significant differences regarding clinical outcome were not found between the treated and untreated leg or between the two groups, with excellent scores at the time of follow-up. Gait analysis revealed no significant differences of varus-valgus angles. Significant differences in surface electromyography were only found in the QT group with increased vastus medialis obliquus activity of the treated legs (p < 0.01). CONCLUSIONS: Our results suggest that harvesting of HS grafts for primary ACL reconstruction will not lead to a medial collapse and consequently impaired medial stabilisation of the knee when compared with QT grafts. LEVEL OF EVIDENCE: IV.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Marcha , Tendões dos Músculos Isquiotibiais/transplante , Músculo Quadríceps/cirurgia , Tendões/transplante , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Criança , Estudos de Coortes , Eletromiografia , Feminino , Análise da Marcha , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Adulto Jovem
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