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Effect of radiation therapy on autologous and allogeneic bone grafts
International Nuclear Information System (INIS)
Purpose: Currently no significant literature exists regarding the effects of therapeutic radiation on bone graft integrity in humans. As the combination of these procedures is frequently necessary in the treatment of neoplasms, we have retrospectively analyzed graft outcomes in irradiated sites. Materials and Methods: 40 autologous or allogeneic bone grafts in 35 patients treated at the Massachusetts General Hospital (MGH) between 1977 and 1995 were evaluated. Preoperative radiation was given in 28 cases, postoperative in 21 cases. Radiation was delivered as external beam photons, 160 MeV protons or brachytherapy implant. Doses ranged from 3 to 83 Gy. Grafts were located in the spine (17), pelvis (13), femur (5), humerus (2) and tibia (3). Functional graft survival and healing quality were determined radiographically. Failure free survival rates were calculated using the Kaplan-Meier method and linear regressions were performed using the Wilcoxan method. Results: Overall rates of graft survival were 86% at 1 yr and 73% at 5 yrs. For auto grafts and allografts the 1 yr rates were 100% and 80% (p=.96). No significant differences in outcome based on treatment chronology were found with survival rates of 81% for preoperative treatment and 86% for postoperative treatment. With linear regression analysis there was no relation between outcome and time between surgery and radiation (p=.89). Further, no relation between bone dose (preoperative + postoperative dose), graft dose (postoperative dose) or mean dose/day and outcome was found (p=.50, p=.49 and p=.43). Failures were evenly distributed amongst high and low dose groups. The use of chemotherapy did not significantly effect outcome with a survival rate of 85% compared to 87%. Tobacco use was a significant predictor of failure with 63% graft survival compared to 94% in non-smokers (p=.038). Quality of bone healing rated poor overall, but was highly variable and did not correlate with dose or chronology of therapy
Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones
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Rubenbauer Bianka
Full Text Available Abstract Background Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the market, this comparative study aims to evaluate healing characteristics of ununited bones treated with ORIF combined with either iliac-crest-autologous-bone-grafting (ICABG or demineralized-bone-matrix (DBM. Methods and results From 2000 to 2006 out of sixty-two consecutive patients with non-unions presenting at our Level I Trauma Center, twenty patients had ununited diaphyseal fractures of long bones and were treated by ORIF combined either by ICABG- (n = 10 or DBM-augmentation (n = 10. At the time of index-operation, patients of the DBM-group had a higher level of comorbidity (ASA-value: p = 0.014. Mean duration of follow-up was 56.6 months (ICABG-group and 41.2 months (DBM-group. All patients were clinically and radiographically assessed and adverse effects related to bone grafting were documented. The results showed that two non-unions augmented with ICABG failed osseous healing (20% whereas all non-unions grafted by DBM showed successful consolidation during the first year after the index operation (p = 0.146. No early complications were documented in both groups but two patients of the ICABG-group suffered long-term problems at the donor site (20% (p = 0.146. Pain intensity were comparable in both groups (p = 0.326. However, patients treated with DBM were more satisfied with the surgical procedure (p = 0.031. Conclusion With the use of DBM, the costs for augmentation of the non-union-site are more expensive compared to ICABG (calculated difference: 160 Ō
The composite of bone marrow concentrate and PRP as an alternative to autologous bone grafting.
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Mohssen Hakimi
Full Text Available One possible alternative to the application of autologous bone grafts represents the use of autologous bone marrow concentrate (BMC. The purpose of our study was to evaluate the potency of autologous platelet-rich plasma (PRP in combination with BMC. In 32 mini-pigs a metaphyseal critical-size defect was surgically created at the proximal tibia. The animals were allocated to four treatment groups of eight animals each (1. BMC+CPG group, 2. BMC+CPG+PRP group, 3. autograft group, 4. CPG group. In the BMC+CPG group the defect was filled with autologous BMC in combination with calcium phosphate granules (CPG, whereas in the BMC+CPG+PRP group the defect was filled with the composite of autologous BMC, CPG and autologous PRP. In the autograft group the defect was filled with autologous cancellous graft, whereas in the CPG group the defect was filled with CPG solely. After 6 weeks radiological and histomorphometrical analysis showed significantly more new bone formation in the BMC+CPG+PRP group compared to the BMC+CPG group and the CPG group. There were no significant differences between the BMC+CPG+PRP group and the autograft group. In the PRP platelets were enriched significantly about 4.7-fold compared to native blood. In BMC the count of mononuclear cells increased significantly (3.5-fold compared to the bone marrow aspirate. This study demonstrates that the composite of BMC+CPG+PRP leads to a significantly higher bone regeneration of critical-size defects at the proximal tibia in mini-pigs than the use of BMC+CPG without PRP. Furthermore, within the limits of the present study the composite BMC+CPG+PRP represents a comparable alternative to autologous bone grafting.
Treatment of oroantral fistula with autologous bone graft and application of a non-reabsorbable membrane
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Adele Scattarella, Andrea Ballini, Felice Roberto Grassi, Andrea Carbonara, Francesco Ciccolella, Angela Dituri, Gianna Maria Nardi, Stefania Cantore, Francesco Pettini
Full Text Available Aim: The aim of the current report is to illustrate an alternative technique for the treatment of oroantral fistula (OAF, using an autologous bone graft integrated by xenologous particulate bone graft.Background: Acute and chronic oroantral communications (OAC, OAF can occur as a result of inadequate treatment. In fact surgical procedures into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing can occur in defects smaller than 3 mm while larger communications should be treated without delay, in order to avoid sinusitis. The most used techniques for the treatment of OAF involve buccal flap, palatal rotation - advancement flap, Bichat fat pad. All these surgical procedures are connected with a significant risk of morbidity of the donor site, infections, avascular flap necrosis, impossibility to repeat the surgical technique after clinical failure, and patient discomfort.Case presentation: We report a 65-years-old female patient who came to our attention for the presence of an OAF and was treated using an autologous bone graft integrated by xenologous particulate bone graft. An expanded polytetrafluoroethylene titanium-reinforced membrane (Gore-Tex ® was used in order to obtain an optimal reconstruction of soft tissues and to assure the preservation of the bone graft from epithelial connection.Conclusions: This surgical procedure showed a good stability of the bone grafts, with a complete resolution of the OAF, optimal management of complications, including patient discomfort, and good regeneration of soft tissues.Clinical significance: The principal advantage of the use of autologous bone graft with an expanded polytetrafluoroethylene titanium-reinforced membrane (Gore-Tex ® to guide the bone regeneration is that it assures a predictable healing and allows a possible following implant-prosthetic rehabilitation.
Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.
LENUS (Irish Health Repository)
Heneghan, Helen M
BACKGROUND: Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. METHODS: All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. RESULTS: Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest CONCLUSION: ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical
Successful treatment of a humeral capitulum osteonecrosis with bone morphogenetic protein-7 combined with autologous bone grafting
Marsell, Richard; Hailer, Nils P
We present the case of a 27-year-old female with subcortical osteonecrosis of the humeral capitulum. Percutaneous retrograde drilling of the lesion and application of recombinant human bone morphogenetic protein (BMP)-7 were combined with autologous bone grafting. At follow-up the patient was almost pain-free, had normalized her range of motion, and radiography showed consolidation of the lesion without any heterotopic bone formation. By timing surgery prior to subchondral collapse, biomechan...
Reengineering autologous bone grafts with the stem cell activator WNT3A.
Jing, Wei; Smith, Andrew A; Liu, Bo; Li, Jingtao; Hunter, Daniel J; Dhamdhere, Girija; Salmon, Benjamin; Jiang, Jie; Cheng, Du; Johnson, Chelsey A; Chen, Serafine; Lee, Katherine; Singh, Gurpreet; Helms, Jill A
Autologous bone grafting represents the standard of care for treating bone defects but this biomaterial is unreliable in older patients. The efficacy of an autograft can be traced back to multipotent stem cells residing within the bone graft. Aging attenuates the viability and function of these stem cells, leading to inconsistent rates of bony union. We show that age-related changes in autograft efficacy are caused by a loss in endogenous Wnt signaling. Blocking this endogenous Wnt signal using Dkk1 abrogates autograft efficacy whereas providing a Wnt signal in the form of liposome-reconstituted WNT3A protein (L-WNT3A) restores bone forming potential to autografts from aged animals. The bioengineered autograft exhibits significantly better survival in the hosting site. Mesenchymal and skeletal stem cell populations in the autograft are activated by L-WNT3A and mitotic activity and osteogenic differentiation are significantly enhanced. In a spinal fusion model, aged autografts treated with L-WNT3A demonstrate superior bone forming capacity compared to the standard of care. Thus, a brief incubation in L-WNT3A reliably improves autologous bone grafting efficacy, which has the potential to significantly improve patient care in the elderly. PMID:25682158
Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating
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Albertoni Walter
Full Text Available Abstract Background The treatment of forearm fracture-nonunions continues to represent a therapeutic challenge, and reported outcomes are moderate at best. Limiting aspects of this particular anatomic location include the relation between restoration of shaft length with the anatomy and long-term functional outcome of adjacent joints, as well as the risk of elbow and wrist stiffness related to prolonged immobilization. The present study was designed to assess the outcome of autologous bone grafting with compression plating and early functional rehabilitation in patients with forearm fracture non-unions. Methods Prospective follow-up study in 31 consecutive patients presenting with non-unions of the forearm diaphysis (radius, n = 11; ulna, n = 9; both bones, n = 11. Surgical revision was performed by restoring anatomic forearm length by autologous bone grafting of the resected non-union from the iliac crest and compression plating using a 3.5 mm dynamic compression plate (DCP or limited-contact DCP (LC-DCP. The main outcome parameters consisted of radiographic bony union and functional outcome, as determined by the criteria defined by Harald Tscherne in 1978. Patients were routinely followed on a short term between 6 weeks to 6 months, with an average long-term follow-up of 3.6 years (range 2 to 6 years. Results Radiographically, a bony union was achieved in 30/31 patients within a mean time of 3.5 months of revision surgery (range 2 to 5 months. Clinically, 29/31 patients showed a good functional outcome, according to the Tscherne criteria, and 26/31 patients were able to resume their previous work. Two postoperative infections occurred, and one patient developed a persistent infected nonunion. No case of postoperative failure of fixation was seen in the entire cohort. Conclusion Revision osteosynthesis of forearm nonunions by autologous iliac crest bone grafting and compression plating represents a safe and efficacious modality for the
Platelet-rich plasma-induced bone marrow mesenchymal stem cells versus autologous nerve grafting for sciatic nerve repair
Institute of Scientific and Technical Information of China (English)
Changsuo Xia; Yajuan Li; Wen Cao; Zhaohua Yu
Autologous nerve grafting is the gold standard of peripheral nerve repair.We previously showed that autologous platelet-rich plasma(PRP)contains high concentrations of growth factors and can induce in vitro cultured bone marrow mesenchymal stem cells(BMSCs)to differentiate into Schwann cells.Here we used PRP-induced BMSCs combined with chemically extracted acellular nerves to repair sciatic nerve defects and compared the effect with autologous nerve grafting.The BMSCs and chemically extracted acellular nerve promoted target muscle wet weight restoration,motor nerve conduction velocity,and axonal and myelin sheath regeneration,with similar effectiveness to autologous nerve grafting.This finding suggests that PRP induced BMSCs can be used to repair peripheral nerve defects.
Scaffold-free Three-dimensional Graft From Autologous Adipose-derived Stem Cells for Large Bone Defect Reconstruction
Dufrane, Denis; Docquier, Pierre-Louis; Delloye, Christian; Poirel, H├®l├©ne A.; Andr├®, Wivine; Aouassar, Najima
Abstract Long bone nonunion in the context of congenital pseudarthrosis or carcinologic resection (with intercalary bone allograft implantation) is one of the most challenging pathologies in pediatric orthopedics. Autologous cancellous bone remains the gold standard in this context of long bone nonunion reconstruction, but with several clinical limitations. We then assessed the feasibility and safety of human autologous scaffold-free osteogenic 3-dimensional (3D) graft (derived from autologous adipose-derived stem cells [ASCs]) to cure a bone nonunion in extreme clinical and pathophysiological conditions. Human ASCs (obtained from subcutaneous adipose tissue of 6 patients and expanded up to passage 4) were incubated in osteogenic media and supplemented with demineralized bone matrix to obtain the scaffold-free 3D osteogenic structure as confirmed in vitro by histomorphometry for osteogenesis and mineralization. The 3D ŌĆ£bone-likeŌĆØ structure was finally transplanted for 3 patients with bone tumor and 3 patients with bone pseudarthrosis (2 congenital, 1 acquired) to assess the clinical feasibility, safety, and efficacy. Although minor clones with structural aberrations (aneuploidies, such as tri or tetraploidies or clonal trisomy 7 in 6%ŌĆō20% of cells) were detected in the undifferentiated ASCs at passage 4, the osteogenic differentiation significantly reduced these clonal anomalies. The final osteogenic product was stable, did not rupture with forceps manipulation, did not induce donor site morbidity, and was easily implanted directly into the bone defect. No acute (development, were associated with the graft up to 4 years after transplantation. We report for the first time that autologous ASC can be fully differentiated into a 3D osteogenic-like implant without any scaffold. We demonstrated that this engineered tissue can safely promote osteogenesis in extreme conditions of bone nonunions with minor donor site morbidity and no oncological side effects. PMID
Locking plate fixation combined with iliac crest bone autologous graft for proximal humerus comminuted fracture
Institute of Scientific and Technical Information of China (English)
Zhu Lian; Liu Yueju; Yang Zongyou; Li Han; Wang Juan; Zhao Changping; Chen Xiao
Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft (experimental group),and 22 were treated with only the locking plate and no bone graft (control group).Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale (VAS),and the SF-36 (Short Form (36) Health Survey),as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group ((4.66┬▒1.63) months) compared with the control group ((5.98┬▒1.57) months) (P '╝£0.05).For the experimental versus controls groups,the mean shoulder active flexion (148.00┬▒18.59 vs.121.73┬▒17.20) degrees,extension (49.00┬▒2.22 vs.42.06┬▒2.06) degrees,internal rotation (45.00┬▒5.61 vs.35.00┬▒3.55)degrees,external rotation (64.00┬▒9.17 vs.52.14┬▒5.73)degrees,and abduction (138.00┬▒28.78 vs.105.95┬▒15.66) degrees were all significantly higher (all P
Predictive value of ridge dimensions on autologous bone graft resorption in staged maxillary sinus augmentation surgery using Cone-Beam CT.
Klijn, R.J.; Beucken, J.J.J.P van den; Bronkhorst, E.M.; Berge, S.J.; Meijer, G.J.; Jansen, J.B.M.J.
INTRODUCTION: No studies are available that provide predictive parameters regarding the expected amount of resorption after maxillary sinus augmentation surgery using autologous bone grafts. Therefore, the aim of this study was to determine parameters influencing the outcome of the bone graft resorp
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D. O. Joshi
Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of
Sinus lift tissue engineering using autologous pulp micro-grafts: A case report of bone density evaluation
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Giorgio Brunelli
Full Text Available Background: Although autografts are the standard procedure for bone grafting, the use of bone regeneration by means of dental pulp stem cell is an alternative that opens a new era in this field. Rigenera Protocol is a new technique able to provide the surgeon autologous pulp micro-grafts. Materials and Methods: At the Department of Oral Surgery, Don Orione Hospital, Bergamo, Italy, one patient underwent sinus lift elevation with pulp stem micro-grafts gentle poured onto collagen sponge. A CT scan control was performed after 4 months and DICOM data were processed with medical imaging software which gives the possibility to use a virtual probe to extract the bone density. PearsonŌĆ▓s Chi-square test was used to investigate difference in bone density (BD between native and newly formed bone. Results: BD in newly formed bone is about the double of native bone. Conclusion: This report demonstrated that micro-grafts derived from dental pulp poured onto collagen sponge are a useful method for bone regeneration in atrophic maxilla.
Effect of zoledronate acid treatment on osseointegration and fixation of implants in autologous iliac bone grafts in ovariectomized rabbits.
Qi, Mengchun; Hu, Jing; Li, Jianping; Li, Jinyuan; Dong, Wei; Feng, Xiaojie; Yu, Jing
One main problem associated with alveolar bone augmentation in implant dentistry is resorption of grafted bone, which may be further compromised by systemic skeletal disorders such as osteoporosis. Zoledronate acid (ZOL) is the most potent bisphosphonate to treat osteoporosis and therefore it is hypothesized to be able to invert the negative effect of osteoporosis on osseointegration and fixation of dental implants in autologous bone grafts. In this study, 56 rabbits received bilateral ovariectomy (OVX) (40 rabbits) or sham operation (16 rabbits). Three months later, 8 animals from each group were sacrificed for bone mineral density (BMD) examination. Then the remaining animals underwent bilateral autologous iliac bone grafting with simultaneous implantation of titanium implants in tibiae and were divided into 5 groups (n=8): Sham, OVX, Loc-ZOL (local treatment), Sys-ZOL (systemic treatment) and Loc+Sys-ZOL (local plus systemic) group. At 3 months after implantation, all animals were sacrificed and specimens were harvested for examinations. Both BMD and histological examinations of femurs showed osteoporotic changes after ovariectomy, while systemic treatment with ZOL restored mineralized bone. Micro-CT examination demonstrated that OVX group showed significant decrease of mineralized bone and implant-bone contact when compared with sham control, whereas both systemic and local treatments of ZOL significantly increased mineralized bone and implant-bone contact in ovariectomized animals. However, the best effects were observed in Loc+Sys-ZOL group (combined use of ZOL) and most of bone indices were similar to (IBCR, p>0.05) or higher than (BV/TV, Conn.D and Tb.N) (peffects were also confirmed by histomorphometric analysis of bone indices on implant-bone contact and mineralized bone. In addition, biomechanical testing further supported the beneficial effect of ZOL treatment and maximal removal torque of titanium implants was observed in Loc+Sys-ZOL group. In
Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.
Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M
The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use.
Sinus floor augmentation surgery using autologous bone grafts from various donor sites: a meta-analysis of the total bone volume.
Klijn, R.J.; Meijer, G.J.; Bronkhorst, E.M.; Jansen, J.A.
BACKGROUND: To date, no studies have been published that evaluated histomorphometric data from a large number of patients while comparing different sites and methods of autologous bone grafting in sinus floor augmentation procedures. A meta-analysis of the English literature from January 1995 till A
... repair and rebuild diseased bones in your hips, knees, spine, and sometimes other bones and joints. Grafts can also repair bone loss caused by some types of fractures or cancers. Once your body accepts the bone ...
Autologous Bone Marrow Stem Cells combined with Allograft Cancellous Bone in Treatment of Nonunion
Le Thua Trung Hau; Duc Phu Bui; Nguyen Duy Thang; Pham Dang Nhat; Le Quy Bao; Nguyen Phan Huy; Tran Ngoc Vu; Le Phuoc Quang; Boeckx willy Denis; Mey Albert De
Autologous cancellous bone graft is currently used as a gold standard method for treatment of bone nonunion. However, there is a limit to the amount of autologous cancellous bone that can be harvested and the donor site morbidity presents a major disadvantage to autologous bone grafting. Embedding viable cells within biological scaffolds appears to be extremely promising. The purpose of this study was to assess the outcome of autologous bone marrow stem cells combined with a cancellous bone a...
Three-Dimensional Upper Lip and Nostril Sill Changes After Cleft Alveolus Reconstruction Using Autologous Bone Grafting Versus Recombinant Human Bone Morphogenetic Protein-2.
Raposo-Amaral, Cassio Eduardo; Denadai, Rafael; Alonso, Nivaldo
Cleft alveolus in patients with unilateral complete cleft lip and palate has been alternatively reconstructed with recombinant human bone morphogenetic protein (rhBMP)-2. However, its effects on upper lip and nostril sill anatomy are not known. Thus, the objective of this investigation was to assess and compare upper lip and nostril sill changes after cleft alveolus reconstruction with autologous bone from the iliac crest region and rhBMP-2. Patients were randomly allocated into 2 groups. In group 1, autologous bone from the iliac crest region was used to fill the cleft alveolus (nŌĆŖ=ŌĆŖ4), and in group 2, rhBMP-2 was used to fill the cleft alveolus (nŌĆŖ=ŌĆŖ8). Preoperatively and at one after the surgery, computerized tomography (CT) was performed. Reformatted CT imaging was used to perform cephalometric linear measurements of the upper lip and nostril sill regions. Inter- and intragroup data of the pre and postoperative reformatted CT measurements of the upper lip and nostril sill regions did not show differences (PŌĆŖ>0.05) in cutaneous upper lip height and projection, nostril sill elevation, and subnasale projection. There were no significant upper lip and nostril sill anatomical changes after cleft alveolus reconstruction using autologous bone grafting and rhBMP-2. PMID:27244210
Grafting after sinus lift with anorganic bovine bone alone compared with 50:50 anorganic bovine bone and autologous bone: results of a pilot randomised trial at one year.
Meloni, S M; Jovanovic, S A; Lolli, F M; Cassisa, C; De Riu, G; Pisano, M; Lumbau, A; Lugli├©, P F; Tullio, A
Our aim was to compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone grafts compared with those augmented with mixed 50:50 bovine and autologous bone grafts. Twenty sinuses with 1-4mm of residual crestal height below the maxillary sinuses were randomised into two groups according to a parallel group design (n=10 in each). Sinuses were grafted using a lateral approach. In one group the grafts were 50:50 anorganic bovine bone and autologous bone and in the other anorganic bovine bone alone. After 7 months, 32 implants had been inserted. Outcome measures were survival of implants, complications, marginal changes in the height of the bone, and soft tissue variables (pocket probing depth and bleeding on probing). Probabilities of less than 0.05 were accepted as significant. No patient failed to complete the trial and no implant had failed at 1 year. There were some minor complications. After 12 months, the mean (SD) marginal bone loss (mm) was 1.06 (0.61) in the 50:50 group and 1.19 (0.53) in the anorganic bovine group. The mean (SD) values for pocket probing depth (mm) and bleeding on probing (score) were 2.49 (0.38) and 1.59 (0.82) in the 50:50 group and 2.31 (0.64) and 1.36 (0.87) in the anorganic bovine group (neither difference was significant). The present data are consistent with the hypothesis that the outcome of implants inserted in sinuses grafted with either material is comparable. PMID:25796408
Autologous grafts of double-strut fibular cortical bone plate to treat the fractures and defects of distal femur: a case report and review of literature
Institute of Scientific and Technical Information of China (English)
CHEN Xu; LI Jian-jun; KONG Zhan; YANG Dong-xiang; YUAN Xiang-nan
We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction and internal fixation with cloverleaf plate. And one hundred days after the surgery, the proximal screws were pulled-out, but the bone union was not achieved. Treat ment consisted of exchanging the cloverleaf plate with a locking compression plate and using an auto-iliac bone graft to fill the nonunion gap. In July 2009, the patient had a sharp pain in the right lower limb. The X-ray revealed that the plate implanted last year was broken, causing a nonunion at the fracture site. Immediately the plate and screws were removed and an intramedullary nail was inserted reversely from the distal femur as well as a 7 cm long bone from the right fibula was extracted and longitudinally split into two pieces to construct cortical bone plates. Then we placed them laterally and medially to fracture site, drilled two holes respectively, and fastened them with suture. We carried on auto-iliac bone grafting with the nonunion bone grafts. The follow-up at 15 months after operation showed that the treatment was successful, X-ray confirmed that there was no rotation and no angular or short deformity. We briefly reviewed the literature regarding such an unusual presentation and discussed in details the possible etiology and the advantages of autologous double-strut fibular grafts to cope with such an intractable situation.
Correlation of lung abnormalities on high-resolution CT with clinical graft-versus-host disease after allogeneic versus autologous bone marrow transplantation in children
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Merlini, Laura; Borzani, Irene Maria Olivia; Anooshiravani, Mehrak; Hanquinet, Sylviane [University of Geneva Children' s Hospital, Paediatric Radiology Unit, Geneva (Switzerland); Rochat, Isabelle [University of Geneva Children' s Hospital, Paediatric Pneumology Unit, Geneva (Switzerland); Ozsahin, Ayse Hulya [University of Geneva Children' s Hospital, Paediatric Oncology Unit, Geneva (Switzerland)
Late-onset noninfectious pulmonary complications (LONIPCs) are life-threatening complications of bone marrow transplantation (BMT). Several pathological patterns are described in the literature with different prognoses, and with different relationships to graft-versus-host disease (GVHD). The role of high-resolution CT (HRCT) is not yet well established. To illustrate different patterns of LONIPCs on HRCT in allogeneic versus autologous BMT in order to investigate the correlation with chronic GVHD (cGVHD). A total of 67 HRCT scans were performed in 24 patients with noninfectious pulmonary disease at least 3 months after BMT (16 allogeneic, 8 autologous). Abnormality patterns and extension on HRCT images were correlated with the clinical outcome and with the severity of cGVHD. Of 24 patients, 9 showed LONIPCs (1 autologous, 8 allogeneic). There was a significant association between abnormalities on HRCT and severe cGVHD (P = 0.038), with no specific pattern. Prognosis seemed to be related to the severity of cGVHD and not to the extent of abnormalities on HRCT. The significant association between abnormalities on HRCT and severe GVHD suggests that LONIPCs can be a pulmonary manifestation of the disease. HRCT is a useful tool when combined with clinical data. (orig.)
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Prasanna Kumar
Full Text Available Bone grafts are used as a filler and scaffold to facilitate bone formation and promote wound healing. These grafts are bioresorbable and have no antigen-antibody reaction. These bone grafts act as a mineral reservoir which induces new bone formation.
Bone graft revascularization strategies
W.F. Willems
Reconstruction of avascular necrotic bone by pedicled bone grafting is a well-known treatment with little basic research supporting its application. A new canine model was used to simulate carpal bone avascular necrosis. Pedicled bone grafting proved to increase bone remodeling and bone blood flow,
Autologous Bone Marrow Stem Cells combined with Allograft Cancellous Bone in Treatment of Nonunion
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Le Thua Trung Hau
Full Text Available Autologous cancellous bone graft is currently used as a gold standard method for treatment of bone nonunion. However, there is a limit to the amount of autologous cancellous bone that can be harvested and the donor site morbidity presents a major disadvantage to autologous bone grafting. Embedding viable cells within biological scaffolds appears to be extremely promising. The purpose of this study was to assess the outcome of autologous bone marrow stem cells combined with a cancellous bone allograft as compared to an autologous bone graft in the treatment of bone nonunion. Bone marrow aspiration concentrate (BMAC was previously produced from bone marrow aspirate via a density gradient centrifugation. Autologous cancellous bone was harvested in 9 patients and applied to the nonunion site. In 18 patients of the clinical trial group after the debridement, the bone gaps were filled with a composite of BMAC and allograft cancellous bone chips (BMAC-ACB. Bone consolidation was obtained in 88.9 %, and the mean interval between the cell transplantation and union was 4.6 +/- 1.5 months in the autograft group. Bone union rate was 94.4 % in group of composite BMAC-ACB implantation. The time to union in BMAC-ACB grafting group was 3.3 +/- 0.90 months, and led to faster healing when compared to the autograft. A mean concentration of autologous progenitor cells was found to be 2.43 +/- 1.03 (x106 CD34+ cells/ml, and a mean viability of CD34+ cells was 97.97 +/- 1.47 (%. This study shows that the implantation of BMAC has presented the efficacy for treatment of nonunion and may contribute an available alternative to autologous cancellous bone graft. But large clinical application of BM-MSCs requires a more appropriate and profound scientific investigations. [Biomed Res Ther 2015; 2(12.000: 409-417
Autologous Fat Grafting for Whole Breast Reconstruction
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Benjamin H. L. Howes, MBBS
Full Text Available Summary: This is the first reported case of a patient who had a single-stage large-volume breast reconstruction with autologous fat grafting, following rotation flap approach (RoFA mastectomy. The purpose of this case study was to evaluate the viability of reconstruction of the breast by autologous fat grafting alone, in the context of RoFA mastectomy. The hypothesis was that there would be minimal interval loss of autologous fat on the whole breast reconstruction side. Right RoFA mastectomy was used for resection of an invasive primary breast cancer and resulted in the right breast skin envelope. Eleven months later, the patient underwent grafting of 400ŌĆēml of autologous fat into the skin envelope and underlying pectoralis major muscle. Outcome was assessed by using a validated 3D laser scan technique for quantitative breast volume measurement. Other outcome measures included the BREAST-Q questionnaire and 2D clinical photography. At 12-month follow-up, the patient was observed to have maintenance of volume of the reconstructed breast. Her BREAST-Q scores were markedly improved compared with before fat grafting, and there was observable improvement in shape, contour, and symmetry on 2D clinical photography. The 2 new techniques, RoFA mastectomy and large-volume single-stage autologous fat grafting, were used in combination to achieve a satisfactory postmastectomy breast reconstruction. Novel tools for measurement of outcome were the 3D whole-body laser scanner and BREAST-Q questionnaire. This case demonstrates the potential for the use of fat grafting for reconstruction. Outcomes in a larger patient populations are needed to confirm these findings.
Radiographic evaluation of the symphysis menti as a donor site for an autologous bone graft in pre-implant surgery
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Bari, Roberto Di; Cicconetti, Andrea [Dept. of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome (Italy); Coronelli, Roberto [Dr. Coronelli Dental Clinic, Rome (Italy)
This study was performed to obtain a quantitative evaluation of the cortical and cancellous bone graft harvestable from the mental and canine regions, and to evaluate the cortical vestibular thickness. This study collected cone-beam computed tomographic (CBCT) images of 100 Italian patients. The limits of the mental region were established: 5 mm in front of the medial margin of each mental foramen, 5 mm under the apex of each tooth present, and above the inferior mandibular cortex. Cortical and cancellous bone volumes were evaluated using SimPlant software (SimPlant 3-D Pro, Materialize, Leuven, Belgium) tools. In addition, the cortical vestibular thickness (minimal and maximal values) was evaluated in 3 cross-sections corresponding to the right canine tooth (3R), the median section (M), and the left canine tooth (3L). The cortical volume was 0.71┬▒0.23 mL (0.27-1.96 mL) and the cancellous volume was 2.16┬▒0.76 mL (0.86-6.28 mL). The minimal cortical vestibular thickness was 1.54┬▒0.41 mm (0.61-3.25 mm), and the maximal cortical vestibular thickness was 3.14┬▒0.75mm(1.01-5.83 mm). The use of the imaging software allowed a patient-specific assessment of mental and canine region bone availability. The proposed evaluation method might help the surgeon in the selection of the donor site by the comparison between bone availability in the donor site and the reconstructive exigency of the recipient site.
Importance of mesenchymal stem cells in autologous fat grafting
DEFF Research Database (Denmark)
Trojahn K├Ėlle, Stig-Frederik; Oliveri, Roberto S; Glovinski, Peter Viktor;
Autologous fat grafting (lipofilling) enables repair and augmentation of soft tissues and is increasingly used both in aesthetic and reconstructive surgery. Autologous fat has several advantages, including biocompatibility, versatility, natural appearance, and low donor site morbidity. The main...
Subclinical pulmonary function defects following autologous and allogeneic bone marrow transplantation: relationship to total body irradiation and graft-versus-host disease
International Nuclear Information System (INIS)
Pulmonary function results pre- and post-transplant, to a maximum of 4 years, were analyzed in 98 patients with haematological disorders undergoing allogeneic (N = 53) or autologous bone marrow transplantation (N = 45) between 1982 and 1988. All received similar total body irradiation based regimens ranging from 9.5 Gy as a single fraction to 14.4 Gy fractionated. FEV1/FVC as a measure of airway obstruction showed little deterioration except in patients experiencing graft-versus-host disease in whom statistically significant obstructive ventilatory defects were evident by 6 months post-transplant (p less than 0.01). These defects appeared to be permanent. Restrictive ventilatory defects, as measured by reduction in TLC, and defects in diffusing capacity (DLCO and KCO) were also maximal at 6 months post-transplant (p less than 0.01). Both were related, at least in part, to the presence of GVHD (p less than 0.01) or use of single fraction TBI with absorbed lung dose of 8.0 Gy (p less than 0.05). Fractionated TBI resulted in less marked restricted ventilation and impaired gas exchange, which reverted to normal by 2 years, even when the lung dose was increased from 11.0 Gy to between 12.0 and 13.5 Gy. After exclusion of patients with GVHD (30% allografts) there was no significant difference in pulmonary function abnormalities between autograft and allograft recipients
A Role For Photodynamic Therapy In Autologous Bone Marrow Transplantation
Sieber, Fritz
Simultaneous exposure to the amphipathic fluorescent dye merocyanine 540 (MC 540) and light of a suitable wavelength rapidly kills leukemia, lymphoma, and neuroblastoma cells but spares normal pluripotent hematopoietic stem cells. Tests in several preclinical models and early results of a phase I clinical trial suggest that MC 540-mediated photosensitization may be useful for the extracorporeal purging of autologous remission bone marrow grafts.
... cadavers. The types of allograft bone used for spine surgery include fresh frozen and lyophilized (freeze dried). The ... the most common uses of bone grafts in spine surgery is during spinal fusion. The use of autogenous ...
Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study
Putzier, Michael; Strube, Patrick; Funk, Julia F.; GROSS, Christian; M├Čnig, Hans-Joachim; Perka, Carsten; Pruss, Axel
The current gold standard in lumbar fusion consists of transpedicular fixation in combination with an interbody interponate of autologous bone from iliac crest. Because of the limited availability of autologous bone as well as the still relevant donor site morbidity after iliac crest grafting the need exists for alternative grafts with a comparable outcome. Forty patients with degenerative spinal disease were treated with a monosegmental spondylodesis (ventrally, 1 PEEK-cage; dorsally, a scre...
... Complications Potential problems after a PTBG include infection, fracture of the proximal tibia and pain related to the procedure. Frequently Asked Questions If proximal tibial bone graft is taken from my knee, will this prevent me from being able to ...
õ║║ÕĘźķ¬©µł¢Ķć¬õĮōķ¬©ń¦╗µżŹĶüöÕÉłµżÄÕ╝ōµĀ╣ķÆēÕåģÕø║Õ«Üõ┐«ÕżŹĶäŖµ¤▒ń╗ōµĀĖ%Artificial bone or autologous bone grafting combined with pedicle screw fixation for repair of spinal tuberculosis
Institute of Scientific and Technical Information of China (English)
Õ¦£µŻÜĶÅ▓; ń┐¤µ¢ćµ¢ī
BACKGROUND:With the development of fixation materials and technology, scholars began to use artificial bone materials combined with pedicle screw fixation in the repair of spinal tuberculosis. OBJECTIVE: To summarize the characteristics of artificial bone materials combined with pedicle screw fixation in the repair of spinal tuberculosis. METHODS:The literatures about artificial bone graft materials in repair of spinal tuberculosis were retrieved from CNKI and PubMed database during 1985 to 2014 by computer. The keywords were ŌĆ£spinal tuberculosis, bone transplantation, internal fixationŌĆØ in Chinese and English, respectively. RESULTS AND CONCLUSION:In the repair of spinal tuberculosis using artificial bone materials combined with pedicle screw fixation, autologous bone is the gold standard for bone grafting, presenting with no immune rejection. To avoid the occurrence of limited bone mass, pain and other complications, however, artificial bone materials have been extensively studied. Currently used artificial materials mainly include titanium and its aloys, hydroxyapatite composites and medical calcium sulfate, which al have good biocompatibility. But there are stil certain limitations and shortcomings.%ĶāīµÖ»'╝ÜķÜÅńØĆÕåģÕø║իܵØɵ¢ÖÕÆīÕåģÕø║իܵŖƵ£»ńÜäÕÅæÕ▒Ģ'╝īĶČŖµØźĶČŖÕżÜńÜäÕøĮÕåģÕż¢ÕŁ"ĶĆģÕ╝ĆÕ¦ŗÕ║öńö©õ║║ÕĘźķ¬©µØɵ¢ÖĶüöÕÉłµżÄÕ╝ōµĀ╣ķÆēÕåģÕø║Õ«Üõ┐«ÕżŹĶäŖµ¤▒ń╗ōµĀĖŃĆéńø«ńÜä'╝Üń╗╝Ķ┐░õ║║ÕĘźķ¬©õ┐«ÕżŹµØɵ¢ÖĶüöÕÉłµżÄÕ╝ōµĀ╣ÕåģÕø║Õ«Üõ┐«ÕżŹĶäŖµ¤▒ń╗ōµĀĖńÜäńē╣ńé╣ŃĆéµ¢╣µ│Ģ'╝ÜÕ║öńö©Ķ«Īń«Śµ£║µŻĆń┤óCNKIÕÆīPubMedµĢ░µŹ«Õ║ō1985Ķć│2014Õ╣┤µ£ēÕģ│õ║║ÕĘźķ¬©ń¦╗µżŹµØɵ¢Öõ┐«ÕżŹĶäŖµżÄń╗ōµĀĖµ¢╣ķØóńÜäµ¢ćńī«'╝īõĖŁµ¢ćÕģ│ķö«Ķ»ŹõĖ║ŌĆ£ĶäŖµżÄń╗ōµĀĖŃĆüķ¬©ń¦╗µżŹŃĆüÕåģÕø║Õ«ÜŌĆØ'╝īĶŗ▒µ¢ćÕģ│ķö«Ķ»ŹõĖ║ŌĆ£Spinal tuberculosis'╝īBone graft,FixationŌĆØŃĆéń╗ōµ×£õĖÄń╗ōĶ«║'╝ÜÕ£©ķ¬©õ┐«ÕżŹµØɵ¢ÖĶüöÕÉłµżÄÕ╝ōµĀ╣ÕåģÕø║Õ«Üõ┐«ÕżŹĶäŖµ¤▒ń╗ōµĀĖõĖŁ'╝īĶć¬õĮōķ¬©µś»ķ¬©ń¦╗µżŹńÜäķćæµĀćÕćå'╝īµŚĀÕģŹń¢½µÄƵ¢źÕÅŹÕ║ö'╝īõĮåõĖ║õ║åķü┐ÕģŹĶć¬õĮōķ¬©ÕÅ¢ķ¬©ķćŵ£ēķÖÉŃĆüÕÅ¢ķ¬©ÕÉÄń¢╝ńŚøńŁēÕ╣ČÕÅæńŚćńÜäÕÅæńö¤'╝īõ║║ÕĘźķ¬©µØɵ¢ÖÕŠŚÕł░õ║åÕ╣┐µ│øń
Autologous fat grafting: use of closed syringe microcannula system for enhanced autologous structural grafting
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Alexander RW
Full Text Available Robert W Alexander,1 David Harrell2 1Department of Surgery, School of Medicine and Dentistry, University of Washington, Seattle, WA, USA; 2Harvest-Terumo Inc, Plymouth, MA, USA Objectives: Provide background for use of acquiring autologous adipose tissue as a tissue graft and source of adult progenitor cells for use in cosmetic plastic surgery. Discuss the background and mechanisms of action of closed syringe vacuum lipoaspiration, with emphasis on accessing adipose-derived mesenchymal/stromal cells and the stromal vascular fraction (SVF for use in aesthetic, structural reconstruction and regenerative applications. Explain a proven protocol for acquiring high-quality autologous fat grafts (AFG with use of disposable, microcannula systems. Design: Explain the components and advantage of use of the patented super luer-lock and microcannulas system for use with the closed-syringe system. A sequential explanation of equipment selection for minimally traumatic lipoaspiration in small volumes is presented, including use of blunt injection cannulas to reduce risk of embolism. Results: Thousands of AFG have proven safe and efficacious for lipoaspiration techniques for large and small structural fat grafting procedures. The importance and advantages of gentle harvesting of the adipose tissue complex has become very clear in the past 5 years. The closed-syringe system offers a minimally invasive, gentle system with which to mobilize subdermal fat tissues in a suspension form. Resulting total nuclear counting of undifferentiated cells of the adipose-derived -SVF suggests that the yield achieved is better than use of always-on, constant mechanical pump applied vacuum systems. Conclusion: Use of a closed-syringe lipoaspiration system featuring disposable microcannulas offers a safe and effective means of harvesting small volumes of nonmanipulated adipose tissues and its accompanying progenitor cells within the SVF. Closed syringes and microcannulas are
Meta-analysis of complications following autologous iliac crest bone graft from donor site%Ķć¬õĮōķ½éķ¬©µżŹķ¬©õŠøķ¬©Õī║Õ╣ČÕÅæńŚćńÜäMetaÕłåµ×É**Ōśģ
Institute of Scientific and Technical Information of China (English)
ķé╣µ▓Öµ▓Ö; ķÖłÕ®ĘÕ®Ę; ńö░µ▒ØĶŠē; ÕĖĖńćĢńćĢ; ńÄŗõ║ܵźĀ; µØÄķō«; ĶāĪµ┤¬õ║«
ŃĆĆŃĆĆĶāīµÖ»'╝Üńø«ÕēŹ'╝īĶć¬õĮōķ½éķ¬©ń¦╗µżŹĶó½Õ╣┐µ│øĶ«żõĖ║µś»µ▓╗ń¢Śķ¬©ń╝║µŹ¤ńÜäŌĆ£ķćæµĀćÕćåŌĆØ'╝øńäČĶĆī'╝īķ½éÕĄ┤õŠøķ¬©Õī║ÕĖĖÕć║ńÄ░Õ╣ČÕÅæńŚć'╝īķÖÉÕłČõ║åÕģČÕ£©õĖ┤Õ║ŖõĖŖńÜäµÄ©Õ╣┐õĮ┐ńö©ŃĆéńø«ńÜä'╝Üķććńö©ÕŠ¬Ķ»üÕī╗ÕŁ"ńĀöń®Čµ¢╣µ│Ģ'╝īÕ»╣ÕĘ▓ÕÅæĶĪ©ńøĖÕģ│µ¢ćńī«Ķ┐øĶĪīµ▒ćµĆ╗Õłåµ×É'╝īµĆ╗ń╗ōĶć¬õĮōķ½éķ¬©µżŹķ¬©ÕÉÄõŠøķ¬©Õī║Õ╣ČÕÅæńŚćńÜäń¦Źń▒╗ÕÅŖÕÅæńö¤ńÄćŃĆéµ¢╣µ│Ģ'╝ܵŻĆń┤ó PubMed MedlineŃĆüOvid MedlineŃĆüCochrane DatabaseŃĆüEmbase Database ńŁēµĢ░µŹ«Õ║ō'╝īµŻĆń┤óµŚČķŚ┤ĶīāÕø┤'╝Ü2002Õ╣┤1µ£łĶć│2011Õ╣┤12µ£ł'╝īõ╗źŌĆ£Iliac crest bone graftŌĆصł¢ŌĆ£autologous bone graftŌĆصł¢ŌĆ£bone graft donor siteŌĆصł¢ŌĆ£complicationŌĆصł¢ŌĆ£MorbidityŌĆØõĖ║µŻĆń┤óĶ»Ź'╝īÕģ▒µŻĆń┤óÕł░174ń»ćµ¢ćńī«ŃĆéµĀ╣µŹ«µŻĆń┤óµØĪõ╗ČÕÅŖĶ»äõ╗ʵĀćÕćå'╝īµ£Ćń╗łńŁøķĆēÕć║30ń»ćõĖ┤Õ║ŖńĀöń®ČµŖźķüōĶ┐øĶĪī Meta Õłåµ×É'╝īÕģ▒Ķ«Ī2476õŠŗµéŻĶĆģŃĆéķććńö© SPSS 13.0ÕÆī R ĶĮ»õ╗ČÕÅŖÕģČ Meta ń©ŗÕ║ÅÕīģÕ»╣µŻĆń┤óń╗ōµ×£Ķ┐øĶĪīń╗¤Ķ«ĪÕłåµ×ÉŃĆéń╗ōµ×£õĖÄń╗ōĶ«║'╝ÜĶć¬õĮōķ½éķ¬©µżŹķ¬©ÕÉÄõŠøķ¬©Õī║õĖ╗Ķ"üÕ╣ČÕÅæńŚćÕīģµŗ¼õŠøķ¬©Õī║Ōēź6õĖ¬µ£łķĢ┐µ£¤ń¢╝ńŚø(ÕÅæńö¤ńÄć=7.88%'╝ī95%ÕÅ»õ┐ĪÕī║ķŚ┤4.76%-12.79%)ŃĆüõŠøķ¬©Õī║µä¤µ¤ō(ÕÅæńö¤ńÄć=4.26%'╝ī95%ÕÅ»õ┐ĪÕī║ķŚ┤2.95%-6.12%)ŃĆüĶĪĆĶé┐ÕÅŖĶĪƵĖģĶé┐(ÕÅæńö¤ńÄć=6.55%'╝ī95%ÕÅ»õ┐ĪÕī║ķŚ┤4.90%-8.70%)ŃĆüńź×ń╗ŵŹ¤õ╝ż(ÕÅæńö¤ńÄć=5.85%'╝ī95%ÕÅ»õ┐ĪÕī║ķŚ┤3.46%-9.71%)ŃĆüµä¤Ķ¦ēķÜ£ńóŹ(ÕÅæńö¤ńÄć=10.1%'╝ī95%ÕÅ»õ┐ĪÕī║ķŚ┤6.07%-16.23%)ŃĆéÕÅ»Ķ¦üķ½éķ¬©ÕÅ¢ķ¬©ÕÉÄÕ╣ČÕÅæńŚćÕÅæńö¤ńÄćĶŠāķ½ś'╝īõĖ┤Õ║ŖÕī╗ÕĖłÕ║öõ║łõ╗źķćŹĶ¦åŃĆé%BACKGROUND: Recently, autologous iliac crest bone graft is considered to be the ŌĆ£gold standardŌĆØ therapeutic method for bone defects. However, there are some complications in iliae crest bone donor site, and the clinical application is limited. OBJECTIVE: To compiled analyze the published articles and evaluate the types of complications and morbidity fol owing autologous iliac crest bone graft by employing evidence-based medicine method. METHODS: A computer-based online search in PubMed Medline database, Ovid Medline database, Cochrane database and Embase database was performed using key words of ŌĆ£Iliac crest bone graftŌĆØ,ŌĆ£autologous bone
Experimental autologous substitute vascular graft for transplantation surgery
Kobori, L; Dallos, G; Gouw, ASH; Nemeth, T; Nemes, B; Fehervari, I; Tegzess, Adam; Slooff, MJH; Perner, F; De Jong, KP
Vascular complications in fiver transplantation are a major cause of graft failure and mortality. The aim of the study was to create autologous vascular graft without risk of rejection. Posterior rectus fascia sheath lined with peritoneum was used for iliac artery replacement in seven mongrel dogs.
Secondary alveolar bone grafting in combination with autologous iliac crest cortical plate and concellous bone for 19 adult cleft patients%Ķć¬õĮōķ½éķ¬©ńÜ«Ķ┤©ķ¬©ÕØŚõĖĵ؊Ķ┤©ķ¬©ĶüöÕÉłń¦╗µżŹõ┐«ÕżŹµłÉõ║║ńēÖµ¦Įń¬üĶŻé19õŠŗÕłåµ×É
Institute of Scientific and Technical Information of China (English)
µØÄÕó×Õüź; ÕŹóÕł®; ķćæÕ▒▒; õ╗╗Õ¬øÕ¬ø; ÕłśÕ╝║; Õ╝Āµ¢ī; Õ╝ĀĶĢŠ; ÕÉ┤µźĀ; µØ©ķĖŻĶē»; ńÄŗń╗¬Õć»
Objective To retrospectively study secondary alveolar bone grafting in combination with autologous iliac crest cortical bone and concellous bone for adult cleft patients. Methods Analveolar bone grafting procedure in combination with autologous illiac crest cortical bone and concellous bone has been applied in 19 adult cleft patients since 2008. A water-tight mucocusperiosteum pocket was formed around the alveolar cleft. The iliac concellous bone was put into the alveolar cleft with tender pressing. The carved iliac crest cortical bone was then covered on to the labial surface of alveolar cleft and pyriform aperture with titanium screws. Results Based on Bergland's criterion, the overall survival rate of bone grafting was 84.2% , clinical success rate was 73.7% , clinical failure rate was 26. 3%. Oral-nasal fistular recurred in 2 patients. Conclusion Secondary alveolar bone grafting in combination with autologous iliac crest cortical bone and concellous bone can effectively improve the grafting survival rate and keep a sufficient volume in regions of cleft and the pyriform aperture of adult cleft patients.%ńø«ńÜä Ķ¦éÕ»¤Ķć¬õĮōķ½éķ¬©ÕØŚÕÆīµØŠĶ┤©ķ¬©ĶüöÕÉłń¦╗µżŹõ┐«ÕżŹµłÉõ║║ńēÖµ¦Įń¬üĶŻéńÜäµĢłµ×£.µ¢╣µ│Ģ Õ»╣2008Õ╣┤õ╗źµØźÕ£©µłæķÖóÕ░▒Ķ»ŖńÜ䵳Éõ║║ńēÖµ¦Įń¬üĶŻéµéŻĶĆģ19õŠŗķććńö©Ķć¬õĮōķ½éķ¬©ÕØŚÕÆīµØŠĶ┤©ķ¬©ĶüöÕÉłń¦╗µżŹõ┐«ÕżŹ.Õ░åķ½éµØŠĶ┤©ķ¬©ÕĪ½ÕģģńēÖµ¦Įń¬üĶŻéķŚ┤ķÜÖÕåģ,ńö©ķ¬©ÕØŚµüóÕżŹµó©ńŖČÕŁöĶŠ╣ń╝śÕĮóµĆüÕÆīķ╝╗ń┐╝Õ¤║Õ║Ģķā©ķ½śÕ║"ÕÉÄ,ķććńö©ÕŠ«Õ×ŗķÆøµØ┐ÕÆīÕŹĢńÜ«Ķ┤©ķÆøķÆēÕø║Õ«Ü.µ£»ÕÉÄ1Õ╣┤ÕżŹµ¤źĶ┐øĶĪīBergland Õłåń║¦Ķ»äõ╗Ę.ń╗ōµ×£ µżŹÕģźķ¬©µłÉµ┤╗ńÄć(ŌģĀ'Į×Ōģóń║¦)õĖ║84.2%,õĖ┤Õ║ŖµłÉÕŖ¤ńÄć(ŌģĀŃĆüŌģĪń║¦)õĖ║73.7%,õĖ┤Õ║ŖÕż▒Ķ┤źńÄć(ŌģóŃĆüŌģŻń║¦)õĖ║26.3%.2õŠŗµéŻĶĆģÕåŹµ¼ĪÕć║ńÄ░ÕÅŻķ╝╗ńśśÕŁö.ń╗ōĶ«║ Ķć¬õĮōķ½éķ¬©ÕØŚÕÆīµØŠĶ┤©ķ¬©ĶüöÕÉłń¦╗µżŹõ┐«ÕżŹµłÉõ║║ńēÖµ¦Įń¬üĶŻéÕÅ»õ╗źµ£ēµĢłµüóÕżŹńēÖµ¦Įń¬üķ½śÕ║",Õó×ÕŖĀµéŻõŠ¦µó©ńŖČÕŁöÕæ©Õø┤ķ¬©ķćÅ.
Enrichment of autologous fat grafts with ex-vivo expanded adipose tissue-derived stem cells for graft survival
DEFF Research Database (Denmark)
K├Ėlle, Stig-Frederik Trojahn; Fischer-Nielsen, Anne; Mathiasen, Anders Bruun;
Autologous fat grafting is increasingly used in reconstructive surgery. However, resorption rates ranging from 25% to 80% have been reported. Therefore, methods to increase graft viability are needed. Here, we report the results of a triple-blind, placebo-controlled trial to compare the survival ...... of fat grafts enriched with autologous adipose-derived stem cells (ASCs) versus non-enriched fat grafts....
Safety Concern between Autologous Fat Graft, Mesenchymal Stem Cell and Osteosarcoma Recurrence
Perrot, Pierre; Rousseau, Julie; Bouffaut, Anne-Laure; R├®dini, Fran├¦oise; Cassagnau, Elisabeth; Deschaseaux, Fr├®d├®ric; Heymann, Marie-Fran├¦oise; Heymann, Dominique; Duteille, Franck; Trichet, Val├®rie; Gouin, Fran├¦ois
Background Osteosarcoma is the most common malignant primary bone tumour in young adult treated by neo adjuvant chemotherapy, surgical tumor removal and adjuvant multidrug chemotherapy. For correction of soft tissue defect consecutive to surgery and/or tumor treatment, autologous fat graft has been proposed in plastic and reconstructive surgery. Principal Findings We report here a case of a late local recurrence of osteosarcoma which occurred 13 years after the initial pathology and 18 months after a lipofilling procedure. Because such recurrence was highly unexpected, we investigated the possible relationship of tumor growth with fat injections and with mesenchymal stem/stromal cell like cells which are largely found in fatty tissue. Results obtained in osteosarcoma pre-clinical models show that fat grafts or progenitor cells promoted tumor growth. Significance These observations and results raise the question of whether autologous fat grafting is a safe reconstructive procedure in a known post neoplasic context. PMID:20544017
Autologous Bone Marrow Mesenchymal Stem Cells Associated with Tantalum Rod Implantation and Vascularized Iliac Grafting for the Treatment of End-Stage Osteonecrosis of the Femoral Head
Directory of Open Access Journals (Sweden)
Dewei Zhao
Full Text Available Tantalum rod implantation with vascularized iliac grafting has been reported to be an effective method for the treatment of young patients with osteonecrosis of the femoral head (ONFH to avert the need for total hip arthroplasty (THA. However, there have been unsatisfactory success rates for end-stage ONFH. The authors describe a modified technique using bone marrow mesenchymal stem cells (BMMSCs associated with porous tantalum rod implantation combined with vascularized iliac grafting for the treatment of end-stage ONFH. A total of 24 patients (31 hips with end-stage ONFH were treated with surgery; ARCO IIIc stage was observed in 19 hips and ARCO IV stage was observed in 12 hips. All patients were followed for a mean time of 64.35ŌĆē┬▒ŌĆē13.03 months (range 26ŌĆō78. Operations on only five hips were converted to THA. The joint-preserving success rate of the entire group was 89.47% for ARCO stage IIIc and 75% for ARCO stage IV. The mean Harris hip score of the 31 hips improved significantly from 38.74ŌĆē┬▒ŌĆē5.88 points (range 22ŌĆō50 to 77.23ŌĆē┬▒ŌĆē14.75 points (range 33ŌĆō95. This intervention was safe and effective in delaying or avoiding total hip replacement for end-stage ONFH.
Bone Grafting the Cleft Maxilla
... systemic disease such as diabetes, or has poor oral hygiene, the risk that the graft may fail increases even more. Once the bone graft has been placed, there are three options that ... replacement (dental bridge); or 3) dental metallic bone implants. The ...
Subcostal Skin Graft Donor Site for Autologous Ear Construction.
Hassanein, Aladdin H; Greene, Arin K
Autologous ear construction for microtia creates an auricle using a costal cartilage framework. To separate the construct from the mastoid, a skin graft is required to form a retroauricular sulcus. Skin graft donor sites that have been described include the inguinal area (split or full-thickness) or scalp (split-thickness). The purpose of this study is to report a novel skin graft donor site for ear construction. We harvest a full-thickness graft from the subcostal area based on the previous scar from the cartilage harvest. Unlike the inguinal donor site, this method does not place an additional scar on the child. In contrast to the scalp donor site, the technique is simpler and a full-thickness graft minimizes contraction of the retroauricular sulcus. PMID:26080199
Bone graft substitutes in anterior cervical discectomy and fusion
Chau, Anthony M.T.; Mobbs, Ralph J.
Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in hum...
Nonallograft osteoconductive bone graft substitutes.
Bucholz, Robert W
An estimated 500,000 to 600,000 bone grafting procedures are done annually in the United States. Approximately (1/2) of these surgeries involve spinal arthrodesis whereas 35% to 40% are used for general orthopaedic applications. Synthetic bone graft substitutes currently represent only 10% of the bone graft market, but their share is increasing as experience and confidence in their use are accrued. Despite 15 to 20 years of clinical experience with various synthetic substitutes, there have been few welldesigned, controlled clinical trials of these implants. Synthetic bone graft substitutes consist of hydroxyapatite, tricalcium phosphate, calcium sulfate, or a combination of these minerals. Their fabrication technique, crystallinity, pore dimensions, mechanical properties, and resorption rate vary. All synthetic porous substitutes share numerous advantages over autografts and allografts including their unlimited supply, easy sterilization, and storage. However, the degree to which the substitute provides an osteoconductive structural framework or matrix for new bone ingrowth differs among implants. Disadvantages of ceramic implants include brittle handling properties, variable rates of resorption, poor performance in diaphyseal defects, and potentially adverse effects on normal bone remodeling. These inherent weaknesses have refocused their primary use to bone graft extenders and carriers for pharmaceuticals. The composition, histologic features, indications, and clinical experience of several of the synthetic bone graft substitutes approved for orthopaedic use in the United States are reviewed. PMID:11937865
Ultrastructural study of grafted autologous cultured human epithelium.
Aihara, M
An electron microscopical study of grafted autologous cultured human epithelium is presented. Biopsy samples were collected from four patients with full thickness burns at 9 days, 6 weeks and 5-21 months after grafting of the cultured epithelium. By the sixth week after transplantation, grafted cultured epithelial sheets had developed to consist of 10 to 20 layers of cells and the epithelium showed distinct basal, spinous, granular and horny layers, and a patchy basement membrane had formed. Langerhans cells and melanocytes were identifiable. From 5 months onwards flat basal cells became oval, and oval keratohyalin granules in the keratinocytes also assumed a normal irregular shape. Membrane-coating granules in the keratinocytes increased in number. The fine structures of desmosomes also showed a normal mature appearance. Furthermore, complete extension of the basement membrane could be observed. The maturation of cultured human epithelium is complete by 5 months after grafting.
Autologous miniature punch skin grafting in stable vitiligo
Savant S
Autologous split thickness miniature punch skin grafting is one of the surgical modes of treatment of stable vitiligo. Out of 87 different sites, of stable vitiligo, occurring in 62 cases, (32 focal, 22 segmental and 8 generalised) 75 sites showed total repigmentation with excellent cosmetic colour match. Out of the 62 cases, 46 cases who were treated postsurgically with PUVA therapy repigmented within 2 ┬Į to 3 months, 10 cases, who received no treatment postsurgically repigmented by 3...
Autologous Rib Grafts in the Management of the Crooked Nose.
Porter, Paul; Kriet, J David; Humphrey, Clinton D
Rhinoplasty is arguably one of the most challenging procedures a facial plastic surgeon performs. Numerous techniques have been developed since the inception of rhinoplasty to aid in correction of aesthetic and functional issues. Congenital, iatrogenic, and traumatic etiologies can all lead to a crooked nose. Autologous rib or costal cartilage grafting is a powerful tool that can aid the surgeon in successful correction of the crooked nose. PMID:26126219
Autologous bone marrow transplantation by photodynamic therapy
Gulliya, Kirpal S.
Simultaneous exposure of Merocyanine 540 dye containing cultured tumor cells to 514-nm laser light (93.6 J/cm2) results in virtually complete cell destruction. Under identical conditions, 40% of the normal progenitor (CFU-GM) cells survive the treatment. Laser- photoradiation treated, cultured breast cancer cells also were killed, and living tumor cells could not be detected by clonogenic assays or by anti-cytokeratin monoclonal antibody method. Thus, laser photoradiation therapy could be useful for purging of contaminating tumor cells from autologous bone marrow.
Evaluation of hydroxyapatite and beta-tricalcium phosphate mixed with bone marrow aspirate as a bone graft substitute for posterolateral spinal fusion
Bansal Sanjay; Chauhan Vijendra; Sharma Sansar; Maheshwari Rajesh; Juyal Anil; Raghuvanshi Shailendra
Background: Autologous cancellous bone is the most effective biological graft material. However, harvest of autologous bone is associated with significant morbidity. Since porous hydroxyapatite and beta-tricalcium phosphate are biodegradable materials and can be replaced by bone tissue, but it lacks osteogenic property. We conducted a study to assess their use as a scaffold and combine them with bone marrow aspirate for bone regeneration using its osteogenic property for posterolateral spina...
Bone regeneration with cultured human bone grafts
Energy Technology Data Exchange (ETDEWEB)
Yoshikawa, T.; Nakajima, H. [Nara Medical Univ., Kashihara City (Japan). Dept. of Pathology; Nara Medical Univ., Kashihara City (Japan). Dept. of Orthopedic Surgery; Ohgushi, H.; Ueda, Y.; Takakura, Y. [Nara Medical Univ., Kashihara City (Japan). Dept. of Orthopedic Surgery; Uemura, T.; Tateishi, T. [National Inst. for Advanced Interdisciplinary Research (NAIR), Ibaraki (Japan). Tsukuba Research Center; Enomoto, Y.; Ichijima, K. [Nara Medical Univ., Kashihara City (Japan). Dept. of Pathology
From 73 year old female patient, 3 ml of bone marrow was collected from the ilium. The marrow was cultured to concentrate and expand the marrow mesenchymal cells on a culture dish. The cultured cells were then subculturedeither on another culture dish or in porous areas of hydroxyapatite ceramics in the presence of dexamethasone and beta-glycerophosphate (osteo genic medium). The subculturedtissues on the dishes were analyzed by scanning electron microscopy (SEM), and subculturedtissues in the ceramics were implanted intraperitoneally into athymic nude mice. Vigorous growth of spindle-shaped cells and a marked formation of bone matrix beneath the cell layers was observed on the subculture dishes by SEM. The intraperitoneally implanted ceramics with cultured tissues revealed thick layer of lamellar bone together with active osteoblasts lining in many pore areas of the ceramics after 8 weeks. The in vitro bone formations on the culture dishes and in vivo bone formation in porous ceramics were detected. These results indicate that we can assemble an in vitro bone/ceramic construct, and due to the porous framework of the ceramic, the construct has osteogenic potential similar to that of autologous cancellous bone. A significant benefit of this method is that the construct can be made with only a small amount of aspirated marrow cells from aged patients with little host morbidity. (orig.)
Autologous miniature punch skin grafting in stable vitiligo
Directory of Open Access Journals (Sweden)
Savant S
Full Text Available Autologous split thickness miniature punch skin grafting is one of the surgical modes of treatment of stable vitiligo. Out of 87 different sites, of stable vitiligo, occurring in 62 cases, (32 focal, 22 segmental and 8 generalised 75 sites showed total repigmentation with excellent cosmetic colour match. Out of the 62 cases, 46 cases who were treated postsurgically with PUVA therapy repigmented within 2 ┬Į to 3 months, 10 cases, who received no treatment postsurgically repigmented by 3 ┬Į to 6 months. In addition 6 cases in whom no treatment was given postsurgically had to be given PUVA therapy 3 months after surgery as there was poor repigmentation. The complications seen were graft rejection due to improper immobilization in 6 cases, graft rejection due to secondary infection in 1, contact allergic dermatitis to framycetin in 3, and reactivation of vitiligo in 2. Side effects seen were cobblestoning in 32, sinking pits in 12, variegated appearance in 4, and superficial scarring at donor site in all 62 cases.
Bilateral maxillary sinus floor augmentation with tissue-engineered autologous osteoblasts and demineralized freeze-dried bone
Directory of Open Access Journals (Sweden)
Aashish Deshmukh
Full Text Available The pneumatization of the maxillary sinus often results in a lack of sufficient alveolar bone for implant placement. In the last decades, maxillary sinus lift has become a very popular procedure with predictable results. Sinus floor augmentation procedures are generally carried out using autologous bone grafts, bone substitutes, or composites of bone and bone substitutes. However, the inherent limitations associated with each of these, have directed the attention of investigators to new technologies like bone tissue engineering. Bone marrow stromal cells have been regarded as multi-potent cells residing in bone marrow. These cells can be harvested from a person, multiplied outside his body using bioengineering principles and technologies and later introduced into a tissue defect. We present a case where tissue-engineered autologous osteoblasts were used along with demineralized freeze-dried bone for sinus floor augmentation.
Long-term use and follow-up of autologous and homologous cartilage graft in rhinoplasty
Directory of Open Access Journals (Sweden)
Ghasemali Khorasani
Full Text Available Background: Cartilage grafting is used in rhinoplasty and reconstructive surgeries. Autologous rib and nasal septum cartilage (auto graft is the preferred source of graft material in rhinoplasty, however, homologous cartilage (allograft has been extensively used to correct the nasal framework in nasal deformities. Autologous cartilage graft usage is restricted with complication of operation and limiting availability of tissue for extensive deformities. Alternatively, preserved costal cartilage allograft represents a readily available and easily contoured material. The current study was a formal systematic review of complications associated with autologous versus homologous cartilage grafting in rhinoplasty patients. Methods: In this cohort retrospective study, a total of 124 patients undergone primary or revision rhinoplasty using homologous or autologus grafts with postoperative follow-up ranging from 6 to 60 months were studied. The types of grafts and complications related to the grafts were evaluated. This included evaluation for warping, infection, resorption, mobility and fracture. Results: The total complications related to the cartilage grafts were 7 cases, which included 1 warped in auto graft group, three cases of graft displacement (two in allograft group and one in auto graft group and three fractures in allograft group. No infection and resorption was recorded. Complication rate (confidence interval 0.95 in autologous and homologous group were 1.25(0.4-3.88 and 2.08(0.78-5.55 in 1000 months follow up. There was no statistically significant difference between autologous and homologous group complications. Onset of complication in autologous and homologous group were 51.23(49.27-53.19 and 58.7(54.51-62.91 month respectively (P=0.81. Conclusion: The allograft cartilage has the advantage of avoiding donor-site scar. Moreover, it provides the same benefits as autologous costal cartilage with comparable complication rate. Therefore, it
Fresh-frozen bone: case series of a new grafting material for sinus lift and immediate implants.
LENUS (Irish Health Repository)
Viscioni, A
Although autologous bone is considered to be the gold standard grafting material, it needs to be harvested from patients, a process that can be off-putting and can lead to donor site morbidity. For this reason, homologous fresh-frozen bone (FFB) was used in the current study as an alternative graft material.
Evaluation of hydroxyapatite and beta-tricalcium phosphate mixed with bone marrow aspirate as a bone graft substitute for posterolateral spinal fusion
Directory of Open Access Journals (Sweden)
Bansal Sanjay
Full Text Available Background: Autologous cancellous bone is the most effective biological graft material. However, harvest of autologous bone is associated with significant morbidity. Since porous hydroxyapatite and beta-tricalcium phosphate are biodegradable materials and can be replaced by bone tissue, but it lacks osteogenic property. We conducted a study to assess their use as a scaffold and combine them with bone marrow aspirate for bone regeneration using its osteogenic property for posterolateral spinal fusion on one side and autologous bone graft on the other side and compare them radiologically in terms of graft incorporation and fusion. Materials and Methods: Thirty patients with unstable dorsal and lumbar spinal injuries who needed posterior stabilization and fusion were evaluated in this prospective study from October 2005 to March 2008. The posterior stabilization was done using pedicle screw and rod assembly, and fusion was done using hydroxyapatite and beta-tricalcium phosphate mixed with bone marrow aspirate as a bone graft substitute over one side of spine and autologous bone graft obtained from iliac crest over other side of spine. The patients were followed up to a minimum of 12 months. Serial radiographs were done at an interval of 3, 6, and 12 months and CT scan was done at one year follow-up. Graft incorporation and fusion were assessed at each follow-up. The study was subjected to statistical analysis using chi-square and kappa test to assess graft incorporation and fusion. Results: At the end of the study, radiological graft incorporation and fusion was evident in all the patients on the bone graft substitute side and in 29 patients on the autologous bone graft side of the spine ( P > 0.05. One patient showed lucency and breakage of distal pedicle screw in autologous bone graft side. The interobserver agreement (kappa had an average of 0.72 for graft incorporation, 0.75 for fusion on radiographs, and 0.88 for the CT scan findings
Experimental posterolateral spinal fusion with beta tricalcium phosphate ceramic and bone marrow aspirate composite graft
Gupta Ankit; Chauhan Vijendra; Chauhan Neena; Sharma Sansar; Maheshwari Rajesh; Agarwal Atul
Background: Beta tricalcium phosphate is commonly used in metaphyseal defects but its use in posterolateral spinal fusion remains controversial. There are very few published animal studies in which use of beta tricalcium phosphate has been evaluated in the posterolateral lumbar arthrodesis model. Hence we conducted a study to evaluate the potential of composite graft of beta tricalcium phosphate and bone marrow aspirate in comparison to autologous bone graft, when used for posterolateral spin...
Combined bone grafting: an alternative method for bone healing stimulation
International Nuclear Information System (INIS)
The most provocative problem in bone grafting is the effectiveness of healing of the graft. When you use the heterogenous bone graft, it may take one or more than two years for consolidation and union depends on the graft quality and the situation of surrounding blood supply. In our preliminary report seven cases of freeze-dried heterogenous bone graft from the Bangkok Biomaterial Center were mixed with autogenous iliac bone graft from the patient in the ratio of 3:1. After that the healing was checked by clinical examination and X-ray in the periodic follow up. The causes of bone lost are post evacuation of benign bone tumor and post infection of bone after trauma. The result of bony union could be tested by clinical examination and showed in the X-ray films as early as 3 months post grafting
Instrumented fusion of thoracolumbar fracture with type I mineralized collagen matrix combined with autogenous bone marrow as a bone graft substitute: a four-case report
Faundez, Antonio; Taylor, Sofia; Kaelin, Andr├®
In order to avoid the morbidity from autogenous bone harvesting, bone graft substitutes are being used more frequently in spinal surgery. There is indirect radiological evidence that bone graft substitutes are efficacious in humans. The purpose of this four-case study was to visually, manually, and histologically assess the quality of a fusion mass produced by a collagen hydroxyapatite scaffold impregnated with autologous bone marrow aspirate for posterolateral fusion. Four patients sustained...
Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regeneration in┬Āvitro and in┬Āvivo.
Wei, Xiaowei; Zhao, Dewei; Wang, Benjie; Wang, Wei; Kang, Kai; Xie, Hui; Liu, Baoyi; Zhang, Xiuzhi; Zhang, Jinsong; Yang, Zhenming
Porous tantalum metal with low elastic modulus is similar to cancellous bone. Reticulated vitreous carbon (RVC) can provide three-dimensional pore structure and serves as the ideal scaffold of tantalum coating. In this study, the biocompatibility of domestic porous tantalum was first successfully tested with bone marrow stromal stem cells (BMSCs) in┬Āvitro and for bone tissue repair in┬Āvivo. We evaluated cytotoxicity of RVC scaffold and tantalum coating using BMSCs. The morphology, adhesion, and proliferation of BMSCs were observed via laser scanning confocal microscope and scanning electron microscopy. In addition, porous tantalum rods with or without autologous BMSCs were implanted on hind legs in dogs, respectively. The osteogenic potential was observed by hard tissue slice examination. At three weeks and six weeks following implantation, new osteoblasts and new bone were observed at the tantalum-host bone interface and pores. At 12 weeks postporous tantalum with autologous BMSCs implantation, regenerated trabecular equivalent to mature bone was found in the pore of tantalum rods. Our results suggested that domestic porous tantalum had excellent biocompatibility and could promote new bone formation in┬Āvivo. Meanwhile, the osteogenesis of porous tantalum associated with autologous BMSCs was more excellent than only tantalum implantation. Future clinical studies are warranted to verify the clinical efficacy of combined implantation of this domestic porous tantalum associated with autologous BMSCs implantation and compare their efficacy with conventional autologous bone grafting carrying blood vessel in patients needing bone repairing. PMID:26843518
Comparison of autologous ilium spongy bone combined with human decalcified dentinal matrix in alveolar process cleft bone grafting%Ķä▒ķÆÖõ║║ńēÖÕ¤║Ķ┤©µØɵ¢ÖĶüöÕÉłķ½éķ¬©õĖÄÕŹĢń║»ķ½éķ¬©ń¦╗µżŹõ┐«ÕżŹńēÖµ¦Įń¬üĶŻéńÜäÕ»╣µ»öµĆ¦ńĀöń®Č
Institute of Scientific and Technical Information of China (English)
ķ£Źµ░ĖÕŖø; Õ╝ĀķøĘ; ńÄŗÕ╗║ÕŹÄ; µØÄÕŹÄ; ķéóÕ╗║Õ│░; ÕŁÖÕ┐ŚÕ╣▓; ķÖåń½ŗµ£¼; ÕłśĶŗ▒ÕŹÄ
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Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.
LENUS (Irish Health Repository)
Ong, J C Y
The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.
Ķ┤¤ÕÄŗÕ╝ĢµĄüµŖƵ£»ĶŠģÕŖ®õ║║ÕĘźń£¤ńÜ«õĖÄĶć¬õĮōńÜ«ń¦╗µżŹõ┐«ÕżŹÕģ│ĶŖéÕ╝ƵöŠÕÆī/µł¢ķ¬©µŖśÕżäķ¬©Õż¢ķ£▓ÕłøķØóńÜäõĖ┤Õ║ŖńĀöń®Č%Clinical study on repair of open joint wounds and/or wounds with exposed bone fracture using negative pressure wound therapy combined with artificial dermis grafting and autologous skin grafting
Institute of Scientific and Technical Information of China (English)
ķÖłµ¼Ż; ńÄŗµĄ®; µł┤ÕģüõĖ£; Õ╝ĀńÉ«; ńÄŗµłÉ
Objective To explore the clinical effects of negative pressure wound therapy (NPWT)combined with artificial dermis grafting and autologous skin grafting on repair of open joint wounds and/or wounds with exposed bone fracture.Methods Eleven patients with open joint wounds and/or wounds with exposed bone fracture,hospitalized from November 2008 to November 2014,were enrolled in the study.According to the differences of the first stage treatment,all patients were divided into experimental group (n =6,including 4 patients of open joint wounds,1 patient of wound with exposed bone fracture,and ŌģĀ patient of open joint wound with exposed bone fracture),and control group (n =5,including 2 patients of open joint wounds,2 patients of wounds with exposed bone fracture,and 1 patient of open joint wound with exposed bone fracture).After debridement,the wounds in both groups were grafted with punctured artificial dermis,while NPWT was only used over the artificial dermis of experiment group for 1 week.In the operation at second stage,autologous split-thickness skin was grafted on the vascularized artificial dermis in both groups.Results In 5 patients of open joint wounds in experimental group,the artificial dermis was vascularized well,autologous skin grafts survived,and wounds were healed.In 3 patients of open joint wounds in control group,the artificial dermis grafting all failed due to local infection,and then these wounds were repaired with local tissue flap grafting.Artificial dermis in 3 patients of wounds with exposed bone fracture in both groups was vascularized well after grafting,and the wounds were healed after autologous skin grafting,whether or not NPWT was used.Conclusions NPWT combined with artificial dermis grafting and autologous skin grafting can be used for repairing open joint wounds and/or wounds with exposed bone fracture.%ńø«ńÜä µÄóĶ«©Õ║öńö©Ķ┤¤ÕÄŗÕ╝ĢµĄüµŖƵ£»ĶŠģÕŖ®õ║║ÕĘźń£¤ńÜ«ÕÆīĶć¬õĮōńÜ«ń¦╗µżŹõ┐«ÕżŹÕģ│ĶŖéÕ╝ƵöŠÕÆī/µł¢ķ¬©µŖśÕżäķ¬
Autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC).
Huh, Sung Woo; Shetty, Asode Ananthram; Ahmed, Saif; Lee, Dong Hwan; Kim, Seok Jung
Degenerative and traumatic articular cartilage defects are common, difficult to treat, and progressive lesions that cause significant morbidity in the general population. There have been multiple approaches to treat such lesions, including arthroscopic debridement, microfracture, multiple drilling, osteochondral transplantation and autologous chondrocyte implantation (ACI) that are currently being used in clinical practice. Autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC) is a single-staged arthroscopic procedure. This method combines a modified microfracture technique with the application of a bone marrow aspirate concentrate (BMAC), hyaluronic acid and fibrin gel to treat articular cartilage defects. We reviewed the current literatures and surgical techniques for mesenchymal cell induced chondrogenesis. PMID:27489409
Treatment of severe post-traumatic bone defects with autologous stem cells loaded on allogeneic scaffolds.
Vulcano, Ettore; Murena, Luigi; Cherubino, Paolo; Falvo, Daniele A; Rossi, Antonio; Baj, Andreina; Toniolo, Antonio
Mesenchymal stem cells may differentiate into angiogenic and osteoprogenitor cells. The effectiveness of autologous pluripotent mesenchymal cells for treating bone defects has not been investigated in humans. We present a case series to evaluate the rationale of using nucleated cells from autologous bone marrow aspirates in the treatment of severe bone defects that failed to respond to traditional treatments. Ten adult patients (mean age, 49.6-years-old) with severe bone defects were included in this study. Lower limb bone defects were >or=5 cm3 in size, and upper limb defects .or=2 cm3. Before surgery, patients were tested for antibodies to common pathogens. Treatment consisted of bone allogeneic scaffold enriched with bone marrow nucleated cells harvested from the iliac crest and concentrated using an FDA-approved device. Postsurgery clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months. To assess viability, morphology, and immunophenotype, bone marrow nucleated cells were cultured in vitro, tested for sterility, and assayed for the possible replication of adventitious (contaminating) viruses. In 9 of 10 patients, both clinical and radiographic healing of the bone defect along with bone graft integration were observed (mean time, 5.6 months); one patient failed to respond. No post-operative complications were observed. Bone marrow nucleated cells were enriched 4.49-fold by a single concentration step, and these enriched cells were free of microbial contamination. The immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. We detected the replication of Epstein-Barr virus in 2/10 bone marrow cell cultures tested. Hepatitis B virus, cytomegalovirus, parvovirus B19, and endogenous retrovirus HERV-K replication were not detected. Overall, 470 to 1,150 million nucleated cells were grafted into each patient. This case series, with a mean follow-up of almost 2 years, demonstrates that an allogeneic bone scaffold
Impact of bone graft harvesting techniques on bone formation and graft resorption
DEFF Research Database (Denmark)
Saulacic, Nikola; Bosshardt, Dieter D; Jensen, Simon S;
formation and graft resorption in vivo. MATERIAL AND METHODS: Four harvesting techniques were used: (i) corticocancellous blocks particulated by a bone mill; (ii) bone scraper; (iii) piezosurgery; and (iv) bone slurry collected from a filter device upon drilling. The grafts were placed into bone defects...
Fenestration of bone flap during interval autologous cranioplasty
Ha Son Nguyen; Ninh Doan; Christopher Wolfla; Glen Pollock
Background: Symptomatic extra-axial fluid may complicate cranioplasty and require urgent evacuation. Fenestration (F) of the bone flap may encourage extra-axial fluid absorption; however, literature has not explored this technique. Methods: Thirty-two consecutive patients who underwent interval autologous cranioplasty were divided into two groups: Fenestration, n = 24, and no fenestration (NF), n = 8. Fenestration involves placement of twist-drill holes 1-2 cm apart throughout the bone fl...
Transplantation of deproteined bovine cancellous bone combined with autogenous red marrow for repairing bony cavity defect due to benign bone tumor: Compared with autologous bone graft%Ķä▒ĶøŗńÖĮńēøµØŠĶ┤©ķ¬©ń╗ōÕÉłĶć¬õĮōń║óķ¬©ķ½ōń¦╗µżŹõ┐«ÕżŹķ¬©Ķé┐ńśżµĆ¦ķ¬©ń╝║µŹ¤:õĖÄĶć¬õĮōķ¬©ń¦╗µżŹµØɵ¢ÖõĖ║Õ»╣ńģ¦µĀćÕćåńÜäµĢłµ×£µ»öĶŠā
Institute of Scientific and Technical Information of China (English)
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BACKGROUND: Autologous bone graft was always applied to repair bony cavity defect produced by benign bone tumor.OBJECTIVE: Taking autogenous bone graft for repairing bony cavity defect caused by bone tumor or tumor-like pathological change as control standard, to observe transplantation of deproteined bovine cancellous bone combined with autogenous red marrow in occluding the residual cavity and the density of newly formed bone.DESIGN: A randomized grouping design, controlled observation SETTING: Department of Orthopaedics, the 175 Hospital of Chinese PLA PARTICIPANTS:We recruited 175 cases of bony cavity defect who received treatment in the Department of Orthopaedics, the 175 Hospital of Chinese PLA from July 1993 to July 1998. They were randomly assigned into two groups: experimental group and control group. There were 63 cases treated in the experimental group. The average disease-suffering time was (6.2┬▒2.1) months and bone defect was (136┬▒30) mm3. There were 62 cases treated in the control group. The average disease-suffering time was (6.1┬▒2.3)months, and bone defect was (133┬▒37) mm3.METHODS: Deproteined bovine cancellous bone combined with autogenous red marrow was transplanted in the experimental group and autologous bone graft was applied in the control group. We curetted tumor completely, cauterized the wound with alcohol of 0.95 volume fraction, then curetted the area of cauterization to make it bled. Bone graft was applied.The quantity of implanted bone should be abundant, and disposed compactly. The X-ray films of the first week after operation were used as a standard for density of new bone growth. X-ray films were taken at the 3rd,6th and 8th months postoperatively, and the X-ray films of the eighth months after operation were used as a standard.MAIN OUTCOME MEASURES: To compare the bone union in two groups with a standard of residual cavity occluding and density of bone growth.RESULTS: All patients were followed up for an average of 20 months
Vascularized tail bone grafts in rats.
Sempuku, T; Tamai, S; Mizumoto, S; Yajima, H
A new experimental model for vascularized corticocancellous bone grafts was established by investigation of vascular anatomy of the tail in 15 adult Fischer 344 rats and determination of the viability of vascularized tail bone grafts into the abdominal wall in 22 7-week-old rats. The tail bones of 40 rats were then raised on the pedicle of the caudal artery and its venae comitantes, transferred to a resected portion in the femur, and observed for 16 weeks. The vascularized graft showed marked reactive periosteal bone formation during the first and second weeks following transfer, and thereafter, the graft continued to show active bone formation. In transverse section, the sharp processes became rounded. In the cancellous bone, both bone resorption and bone formation were noticeably activated early after transfer, although resorption predominated and the amount of the cancellous bone consequently diminished. The nonvascularized grafts showed "creeping substitution." The results suggest that morphologic adaptation occurs if living (i.e., vascularized) tail bones are transferred to long-bone femurs.
Delayed Cranioplasty: Outcomes Using Frozen Autologous Bone Flaps.
Hng, Daniel; Bhaskar, Ivan; Khan, Mumtaz; Budgeon, Charley; Damodaran, Omprakash; Knuckey, Neville; Lee, Gabriel
Reconstruction of skull defects following decompressive craniectomy is associated with a high rate of complications. Implantation of autologous cryopreserved bone has been associated with infection rates of up to 33%, resulting in considerable patient morbidity. Predisposing factors for infection and other complications are poorly understood. Patients undergoing cranioplasty between 1999 and 2009 were identified from a prospectively maintained database. Records and imaging were reviewed retrospectively. Demographics, the initial craniectomy and subsequent cranioplasty surgeries, complications, and outcomes were recorded. A total of 187 patients underwent delayed cranioplasty using autologous bone flaps cryopreserved at -30┬░C following decompressive craniectomy. Indications for craniectomy were trauma (77.0%), stroke (16.0%), subarachnoid hemorrhage (2.67%), tumor (2.14%), and infection (2.14%). There were 64 complications overall (34.2%), the most common being infection (11.2%) and bone resorption (5.35%). After multivariate analysis, intraoperative cerebrospinal fluid (CSF) leak was significantly associated with infection, whereas longer duration of surgery and unilateral site were associated with resorption. Cranioplasty using frozen autologous bone is associated with a high rate of infective complications. Intraoperative CSF leak is a potentially modifiable risk factor. Meticulous dissection during cranioplasty surgery to minimize the chance of breaching the dural or pseudodural plane may reduce the chance of bone flap. PMID:26269726
Autologous Fat Grafting as a Novel Approach to Parastomal Soft-tissue Volume Deficiencies
Robert C. Wu, MD; Ian Maxwell, MD; Ilun Yang, MD, FRCSC; Mario B. Jarmuske, MD, FRCSC; Robin P. Boushey, MD, PhD, FRCSC
Summary: The aim of this study is to describe a novel approach to revise maladaptive soft-tissue contour around an ileostomy. A patient with permanent ileostomy suffered from significant defects in soft-tissue contour due to scarring and wound contraction. He underwent autologous fat grafting to achieve sealing of his stoma appliance and improve cosmesis. Due to numerous surgeries, the stoma appliance would not seal and required daily appliance changes. The patient received autologous fat gra...
PENGGUNAAN BONE GRAFT PADA PERAWATAN KERUSAKAN TULANG PERIODONTAL (Used Bone Graft for Periodontal Defect Treatment)
Elly Munadziroh; Mohamad Rubianto; Asti Meizarini
Generally the signs and symptoms of advances periodontal disease are periodontal pockets formation to alveolar bone defect. Bone defect treated with placement a preparation material to promote new bone formation. Tissue transplantation were developed, to recontsruct bone defect with the placement of bone graft material. This paper will discuss the used of demineralied freeze dried bone allograft (DFDBA) and anorganic bone mineral combined with synthetic 15 amino acid sequence within type I co...
Autologous mini punch grafting: An experience of using motorized power punch in 10 patients
B S Chandrashekar; C Madura; D V Varsha
Background: Autologous mini punch grafting (MPG) is a safe, effective and easy technique that can be performed on any site with minimal side effects and good cosmetic results. Large areas of stable generalised vitiligo require more grafts and are time consuming. Hence multiple sessions of surgery need to be scheduled. We share our experience of using motorised power punches to increase the speed of surgery in large areas of stable vitiligo in 10 patients. Materials and Methods: Ten patients i...
Allogeneic and Autologous Bone-Marrow Transplantation
Deeg, H. Joachim
The author of this paper presents an overview of the current status of bone marrow transplantation, including indications, pre-transplant considerations, the transplant procedure, acute and delayed transplant-related problems, results currently attainable, and a short discussion of possible future developments.
Membranous nephropathy in autologous hematopoietic stem cell transplant: autologous graft-versus-host disease or autoimmunity induction?
Abudayyeh, Ala; Truong, Luan D.; Beck, Laurence H.; Weber, Donna M.; Rezvani, Katy; Abdelrahim, Maen
With the increasing utility of hematopoietic stem cell transplantation (SCT) as a treatment for cancer and noncancerous disorders, more challenges and complications associated with SCT have emerged. Renal injury immediately after transplant is common and well understood, but long-term renal injury is becoming more evident. Chronic graft-versus-host disease (GVHD) is a known long-term complication of SCT, and membranous nephropathy (MN) is emerging as the most common cause of SCT-associated glomerular pathology. In this case report, we present a patient who developed features of anti-PLA2R antibody-negative MN following autologous SCT. The renal injury responded well to steroids and further response to rituximab therapy was noted, suggesting antibody-mediated autoimmune glomerular disease. We also present a review of the literature on autologous GVHD and the role of T and B cells in induction of autoimmunity by SCT. PMID:26251713
The Efficacy of Autologous Femoropopliteal Vein Reconstruction for Primary Aortic and Aortic Graft Infection
Dirven, M.; Jagt, M.F.P. van der; Barendregt, W.B.; Vliet, D. van der
BACKGROUND: The objective of our study was to analyze the efficacy of autologous superficial femoropopliteal vein reconstruction for primary aortic or aortic graft infection. METHODS: We performed a retrospective analysis of 14 patients treated for an infected aortic prosthesis or primary infected a
Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage
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Roenning Paal
Full Text Available Abstract Background Anterior cervical discectomy with fusion (ACDF is challenging with respect to both patient selection and choice of surgical procedure. The aim of this study was to evaluate the clinical outcome of ACDF, with respect to both patient selection and choice of surgical procedure: fusion with an autologous iliac crest graft (AICG versus fusion with an artificial cage made of polyetheretherketone (PEEK. Methods This was a non-randomized prospective single-center outcome study of 258 patients who underwent ACDF for cervical disc degeneration (CDD. Fusion was attained with either tricortical AICG or PEEK cages without additional anterior plating, with treatment selected at surgeon's discretion. Radicular pain, neck-pain, headache and patient satisfaction with the treatment were scored using the visual analogue scale (VAS. Results The median age was 47.5 (28.3-82.8 years, and 44% of patients were female. 59% had single-level ACDF, 40% had two level ACDF and 1% had three-level ACDF. Of the patients, 181 were fused with AICG and 77 with a PEEK-cage. After surgery, the patients showed a significant reduction in radicular pain (ΔVAS = 3.05, neck pain (ΔVAS = 2.30 and headache (ΔVAS = 0.55. Six months after surgery, 48% of patients had returned to work: however 24% were still receiving workers' compensation. Using univariate and multivariate analyses we found that high preoperative pain intensity was significantly associated with a decrease in pain intensity after surgery, for all three pain categories. There were no significant correlations between pain relief and the following patient characteristics: fusion method (AICG or PEEK-cage, sex, age, number of levels fused, disc level fused, previous neck surgery (except for neck pain, previous neck trauma, or preoperative symptom duration. Two hundred out of the 256 (78% patients evaluated the surgical result as successful. Only 27/256 (11% classified the surgical result as a failure
A new cost-effective and fast method of autologous fat grafting.
Sorin, T; Rausky, J; Rem, K; Ozil, C; Nguyen Van Nuoi, V; Revol, M; Mazouz Dorval, S
Due to the increasing number of fat grafting procedures, several laboratories have developed their own fat processing system (Puregraft(®), LipiVage(®), Viafill(®), etc.), such as closed harvesting systems, centrifugation or washing and filtration devices, or even simple decantation techniques. However, all these tissue-engineering systems are expensive. Our team has developed a simple and fast autologous fat grafting system, useable even for a large volume of lipofilling, and based on low-pressure suction and a sterile closed-system for processing the harvested fat tissue. It is a cost-effective system, as it only costs 9.28Eur (10.52USD) for a 500milliliters autologous fat graft procedure.
Engineering anatomically shaped vascularized bone grafts with hASCs and 3D-printed PCL scaffolds.
Temple, Joshua P; Hutton, Daphne L; Hung, Ben P; Huri, Pinar Yilgor; Cook, Colin A; Kondragunta, Renu; Jia, Xiaofeng; Grayson, Warren L
The treatment of large craniomaxillofacial bone defects is clinically challenging due to the limited availability of transplantable autologous bone grafts and the complex geometry of the bones. The ability to regenerate new bone tissues that faithfully replicate the anatomy would revolutionize treatment options. Advances in the field of bone tissue engineering over the past few decades offer promising new treatment alternatives using biocompatible scaffold materials and autologous cells. This approach combined with recent advances in three-dimensional (3D) printing technologies may soon allow the generation of large, bioartificial bone grafts with custom, patient-specific architecture. In this study, we use a custom-built 3D printer to develop anatomically shaped polycaprolactone (PCL) scaffolds with varying internal porosities. These scaffolds are assessed for their ability to support induction of human adipose-derived stem cells (hASCs) to form vasculature and bone, two essential components of functional bone tissue. The development of functional tissues is assessed in vitro and in vivo. Finally, we demonstrate the ability to print large mandibular and maxillary bone scaffolds that replicate fine details extracted from patient's computed tomography scans. The findings of this study illustrate the capabilities and potential of 3D printed scaffolds to be used for engineering autologous, anatomically shaped, vascularized bone grafts.
PENGGUNAAN BONE GRAFT PADA PERAWATAN KERUSAKAN TULANG PERIODONTAL (Used Bone Graft for Periodontal Defect Treatment
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Elly Munadziroh
Full Text Available Generally the signs and symptoms of advances periodontal disease are periodontal pockets formation to alveolar bone defect. Bone defect treated with placement a preparation material to promote new bone formation. Tissue transplantation were developed, to recontsruct bone defect with the placement of bone graft material. This paper will discuss the used of demineralied freeze dried bone allograft (DFDBA and anorganic bone mineral combined with synthetic 15 amino acid sequence within type I collagen (PepGen P-15 the potential healing of bone defect to enhance the optimum treatment of periodontal disease.
Injection of Autologous Bone Marrow versus Hanging Cast in Treatment of Humeral Fracture
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to the high risk of non-union and mal-union in humerus shaft fracture, and because applying this simple and inexpensive technique significantly decreased these complications, injecting autologous bone marrow grafts is recommended for accelerating union in cases of humerus fracture.
Anterior plate internal fixation and autologous iliac bone graft fusion in the repair of thoracic spinal tuberculosis:bone healing%ÕēŹĶĘ»ķÆóµØ┐ńĮ«ÕģźÕåģÕø║Õ«ÜõĖÄĶć¬õĮōķ½éķ¬©µżŹķ¬©Ķ׏ÕÉłõ┐«ÕżŹĶāĖµżÄń╗ōµĀĖńÜäķ¬©µäłÕÉł
Institute of Scientific and Technical Information of China (English)
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focus and achieve a good internal fixation, but this treatment needs to cut the rid. The surgeon discovered in years of clinical practice that distraction of intercostal space without cutting off the ribs could completely remove the focus and achieve fixation and fusion. OBJECTIVE:To explore the feasibility, advantages and disadvantages of anterior plate fixation and autologous bone graft fusion in the repair of thoracic spinal tuberculosis. METHODA total of 30 cases of thoracic spinal tuberculosis were enrol ed. On the base of traditional thoracic spinal anterior surgical approach, the rib was reserved. Anterior distraction device was used to open the ribs for clearance and to move the focus of thoracic spinal tuberculosis. Autologous ilium was obtained and subjected to fusion and anterior plate fixation. Visual Analog Scale, Oswestry Disability Index, Frankel grade and Bridwel┬Ābone healing rating were used before and after treatment. RESULTS AND CONCLUSION:A total of 30 patients were fol owed up for 3-60 months. The bone healing (class A) was seen, but no fistula formation was visible. Nerve compression symptoms were improved, without aggravating cases. Postoperatively, the average Cobb angle correction was 10.32┬░. After 6 months, imaging revealed bone fusion of affected vertebral body. After 18 months, the vertebral height was not lost obviously, no recurrence of vertebral tuberculosis. These results indicated that anterior intercostal space without cutting ribs exposed clearly, showing a large space, where can meet the requirement of first-stage debridement fixation and fusion in the repair of thoracic tuberculosis. The pathological changes were visibly clear;the focus was thoroughly removed, and the ribs were reserved. The outcomes are identical to rib resection. Simultaneously, autogenous iliac trilateral cortex has good supporting effects. Loose cancellous bone mesh has good osteogenesis and is helpful to bone healing.
Effects of Hydroxyapatite on Bone Graft Resorption in an Experimental Model of Maxillary Alveolar Arch Defects
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Ozgur Pilanci
Full Text Available Most commonly used treatments use autologous bone grafts to address bony defects in patients with cleft palate. Major disadvantages of autogenous bone grafts include donor site morbidity and resorption. Suggestions to overcome such problems include biomaterials that can be used alone or in combination with bone. We examined the effect of hydroxyapatite cement on bone graft resorption in a rabbit maxillary alveolar defect model. We divided 16 young adult albino New Zealand rabbits into two groups. A defect 1 cm wide was created in each rabbit's maxillary arch. In Group 1, the removed bone was disrupted, and the pieces were replaced in the defect. In the other group, the pieces were replaced after mixing (1:1 with hydroxyapatite cement. Quantitative computed tomographic evaluation of these grafts was performed in axial and coronal planes for each rabbit at 2 and 12 weeks. In axial images at 12 weeks, the group without cement showed mean bone resorption of 15%. In the cement group, a mean volumetric increase of 68% was seen. No resorption occurred when bone grafts were mixed with hydroxyapatite cement. [Arch Clin Exp Surg 2013; 2(3.000: 170-175
Autologously generated tissue-engineered bone flaps for reconstruction of large mandibular defects in an ovine model.
Tatara, Alexander M; Kretlow, James D; Spicer, Patrick P; Lu, Steven; Lam, Johnny; Liu, Wei; Cao, Yilin; Liu, Guangpeng; Jackson, John D; Yoo, James J; Atala, Anthony; van den Beucken, Jeroen J J P; Jansen, John A; Kasper, F Kurtis; Ho, Tang; Demian, Nagi; Miller, Michael John; Wong, Mark E; Mikos, Antonios G
The reconstruction of large craniofacial defects remains a significant clinical challenge. The complex geometry of facial bone and the lack of suitable donor tissue often hinders successful repair. One strategy to address both of these difficulties is the development of an in vivo bioreactor, where a tissue flap of suitable geometry can be orthotopically grown within the same patient requiring reconstruction. Our group has previously designed such an approach using tissue chambers filled with morcellized bone autograft as a scaffold to autologously generate tissue with a predefined geometry. However, this approach still required donor tissue for filling the tissue chamber. With the recent advances in biodegradable synthetic bone graft materials, it may be possible to minimize this donor tissue by replacing it with synthetic ceramic particles. In addition, these flaps have not previously been transferred to a mandibular defect. In this study, we demonstrate the feasibility of transferring an autologously generated tissue-engineered vascularized bone flap to a mandibular defect in an ovine model, using either morcellized autograft or synthetic bone graft as scaffold material. PMID:25603924
Autologously generated tissue-engineered bone flaps for reconstruction of large mandibular defects in an ovine model.
Tatara, Alexander M; Kretlow, James D; Spicer, Patrick P; Lu, Steven; Lam, Johnny; Liu, Wei; Cao, Yilin; Liu, Guangpeng; Jackson, John D; Yoo, James J; Atala, Anthony; van den Beucken, Jeroen J J P; Jansen, John A; Kasper, F Kurtis; Ho, Tang; Demian, Nagi; Miller, Michael John; Wong, Mark E; Mikos, Antonios G
The reconstruction of large craniofacial defects remains a significant clinical challenge. The complex geometry of facial bone and the lack of suitable donor tissue often hinders successful repair. One strategy to address both of these difficulties is the development of an in vivo bioreactor, where a tissue flap of suitable geometry can be orthotopically grown within the same patient requiring reconstruction. Our group has previously designed such an approach using tissue chambers filled with morcellized bone autograft as a scaffold to autologously generate tissue with a predefined geometry. However, this approach still required donor tissue for filling the tissue chamber. With the recent advances in biodegradable synthetic bone graft materials, it may be possible to minimize this donor tissue by replacing it with synthetic ceramic particles. In addition, these flaps have not previously been transferred to a mandibular defect. In this study, we demonstrate the feasibility of transferring an autologously generated tissue-engineered vascularized bone flap to a mandibular defect in an ovine model, using either morcellized autograft or synthetic bone graft as scaffold material.
Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach
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Sang Yang Lee
Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.
Autologous Fat Grafting in the Treatment of Painful Postsurgical Scar of the Oral Mucosa
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Andrea Lisa
Full Text Available Background. Persistent pain as a consequence of surgical treatment has been reported for several common surgical procedures and represents a clinical problem of great magnitude. Material and Methods. We describe the case of a 47-year-old female who presented a retractile scar that adhered to deep planes at the upper right of the vestibule due to surgical removal of maxillary exostosis, which determined important pain symptoms extending till the right shoulder during both chewing and rest. We subsequently treated her with autologous fat grafting according to ColemanŌĆÖs technique. Results. Clinical assessments were performed at 5 and 14 days, 1, 3, and 6 months, and 1 year after surgical procedure. We observed a progressive release of scar retraction together with an important improvement of pain symptoms. Conclusion. The case described widens the possible application of autologous fat grafting on a new anatomical site as buccal vestibule and in one specific clinical setting confirming its promising biological effects.
Autologous mini punch grafting: An experience of using motorized power punch in 10 patients
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B S Chandrashekar
Full Text Available Background: Autologous mini punch grafting (MPG is a safe, effective and easy technique that can be performed on any site with minimal side effects and good cosmetic results. Large areas of stable generalised vitiligo require more grafts and are time consuming. Hence multiple sessions of surgery need to be scheduled. We share our experience of using motorised power punches to increase the speed of surgery in large areas of stable vitiligo in 10 patients. Materials and Methods: Ten patients in the age group of 12-55 years were treated with miniature punch grafting using power punches in single session on various sites. The power punches of 1-1.5 mm diameter were used to score donor and recipient sites, either of same or less than 0.2-0.3 mm size punches. The harvested grafts from donor site were then secured in the recipient beds and dressed. Results: The average number of grafts harvested per session was 125-185, the duration of surgery ranged from 45 to 90 minutes. Perigraft pigment spread was seen at 3 weeks. Complete repigmentation was observed in 3-4 months in eight patients. Cobble stoning was observed in one patient, and all donor sites healed well with superficial scarring. Conclusion: We conclude that autologous MPG with motorised power punches for stable vitiligo, especially on large areas including difficult sites can be performed with ease in comparatively lesser time in a single session, greatly benefiting the patients.
Onlay Rib Bone Graft in Elevation of Reconstructed Auricle: 17 Years of Experience
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Taehoon Kim
Full Text Available BackgroundŌĆé A cartilage wedge block and covering flap are standard procedures for firmelevation of the ear in microtia correction. However, using costal cartilage for elevation ofthe reconstructed auricle can be insufficient, and the fixed cartilage wedge block may beabsorbed or may slip out. Furthermore, elevating covering flaps is time-consuming and usesup fascia, a potential source of reconstruction material. Therefore, we propose an innovativemethod using autologous onlay rib bone graftfor auricular elevation ofmicrotia.MethodsŌĆé From February 1995 to August 2012, 77 patients received a first stage operationwith a rib cartilage framework graft. In the second stage operation, a small full thickness ofrib bone was harvested through the previous donor scar. The bihalved rib bone was insertedinto the subperiosteal pocket beneath the cartilage framework.ResultsŌĆé The follow-up time ranged from 1 month to 17 years, with a mean of 3 years. Allof the patients sustained the elevation of their ears very well during the follow-up period.Donorsite problems, exceptfor hypertrophic scars,were not observed. Surgery-related complications,specifically skin necrosis, infection, or hematoma, occurred in 4 cases.ConclusionsŌĆé Onlay rib bone graft used to elevate the reconstructed auricle is a more anatomically appropriate materialthan cartilage, due to the bone-to-bone contact between thebone graft and the temporal bone. Postoperative minor correction of the elevation degree isstraightforward and the skin graft survives better. Therefore, reconstructed auricle elevationusing onlay rib bone graftis a useful and valuablemethod.
Mini-invasive treatment for delayed or non-union: the use of percutaneous autologous bone marrow injection
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Trung Hau LE THUA
Full Text Available Delayed union or nonunion of bone fracture is becoming less frequent, but still remains a challenging clinical problem. Autologous cancellous bone grafting that is the gold standard method, often involves donor site morbidities and complications. Once these fractures have been mechanically stabilized, other local factors should be investigated to promote delayed healing. The purpose of this study was to evaluate the initial outcome of the percutaneous injection of autologous bone marrow after concentration for the treatment of delayed or nonunion. Our subjects included 10 patients of delayed or nonunion fracture (3 female, 7 male with an average age of 28 years. All fractures were mechanically stabilized after accident. Delayed or nonunion affected the femur in 2 patients, the tibia in 5 patients, the humerus in 2 patients, and the ulna in 1 patient. Bone marrow aspirates were obtained from both the posterior superior iliac crest. Bone marrow aspiration concentrate was produced via density gradient centrifugation. Trocars were inserted in the delayed or nonunion gap under fluoroscopic guidance. The bone marrow aspiration concentrate was injected slowly. As results, all of 10 delayed or nonunion healed after treatment with percutaneous injection of autologous bone marrow. The mean time for new bone formation was 3.3 months, for clinical union was 5.2 months, and for radiological union was 11.8 months. The current study is encouraging in the initial outcome and percutaneous bone marrow implantation could be an effective and safe treatment for delayed or nonunion. [Biomed Res Ther 2015; 2(11.000: 389-395
Bone formation in cranial, mandibular, tibial and iliac bone grafts in rats
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Solheim, E; Pinholt, E M; Talsnes, O;
Several studies have suggested that grafts from membranous derived bone (e.g., calvarial grafts) retain their volume better than those from endochondral derived bone (e.g., iliac bone grafts). Increased osteogenesis in grafts of the former type has been offered as the explanation. However, simple...
Technical factors affecting cup stability in bone impaction grafting.
Bolder, S.B.T.; Verdonschot, N.J.J.; Schreurs, B.W.
Favourable long-term clinical results can be achieved by the bone impaction technique in bone stock deficient acetabuli. Originally, firm impaction of manually prepared bone grafts using a rongeur was performed. An alternative technique for producing bone grafts is reaming from the pelvic wall or fe
Autologous Bone Marrow Mononuclear Cells Intrathecal Transplantation in Chronic Stroke
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Alok Sharma
Full Text Available Cell therapy is being widely explored in the management of stroke and has demonstrated great potential. It has been shown to assist in the remodeling of the central nervous system by inducing neurorestorative effect through the process of angiogenesis, neurogenesis, and reduction of glial scar formation. In this study, the effect of intrathecal administration of autologous bone marrow mononuclear cells (BMMNCs is analyzed on the recovery process of patients with chronic stroke. 24 patients diagnosed with chronic stroke were administered cell therapy, followed by multidisciplinary neurorehabilitation. They were assessed on functional independence measure (FIM objectively, along with assessment of standing and walking balance, ambulation, and hand functions. Out of 24 patients, 12 improved in ambulation, 10 in hand functions, 6 in standing balance, and 9 in walking balance. Further factor analysis was done. Patients of the younger groups showed higher percentage of improvement in all the areas. Patients who underwent cell therapy within 2 years after the stroke showed better changes. Ischemic type of stroke had better recovery than the hemorrhagic stroke. This study demonstrates the potential of autologous BMMNCs intrathecal transplantation in improving the prognosis of functional recovery in chronic stage of stroke. Further clinical trials are recommended. This trial is registered with NCT02065778.
Bone graft substitutes for spine fusion: A brief review
Gupta, Ashim; Kukkar, Nitin; Sharif, Kevin; Main, Benjamin J; Albers, Christine E; El-Amin III, Saadiq F
Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been develo...
Autologous serum improves bone formation in a primary stable silica-embedded nanohydroxyapatite bone substitute in combination with mesenchymal stem cells and rhBMP-2 in the sheep model
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Boos AM
in the group with autologous serum and after 12 weeks in every experimental group. This study clearly demonstrates the positive effects of autologous serum in combination with mesenchymal stem cells and rhBMP-2 on bone formation in a primary stable silica-embedded nano-HA bone grafting material in the sheep model. In further experiments, the results will be transferred to the sheep arteriovenous loop model in order to engineer an axially vascularized primary stable bone replacement in clinically relevant size for free transplantation. Keywords: nanostructured bone substitute, bone tissue engineering, autologous serum, mesenchymal stem cells, recombinant human bone morphogenetic protein 2, sheep model
Feasibility of arthroscopic placement of autologous matrix-induced chondrogenesis grafts in the cadaver hip joint
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Fritz Thorey
Full Text Available An assortment of clinical trials have been done presenting the effectiveness of autologous matrix-induced chondrogenesis (AMIC for the regeneration of chondral leasions. The purpose of the study was to underline the accessability of the acetabulum and the femoral head through the known portals and prove i the feasibility of placing the AMIC in the different zones of the hip joint and ii check for dislocation after joint movement. Six human cadavers underwent hip arthroscopy on both hips. Two chondral lesions were set on each femoral head and two in the acetabulum to evaluate a total of 48 defects. After microfracturing an autologous matrix-induced chondrogenesis graft was placed on these lesions arthroscopically. After repeated joint movement the dislocation of the graft was checked. It was possible to place the AMIC graft in all 48 chondral lesions. The time needed for placing the graft was 8┬▒2.9 minutes. A trend of time reduction could be detected throughout this study as the surgeon gained more experience. For the femoral head, after twenty cycles of joint movement 18/24 spots showed no displacement, 4/24 showed minor displacement (<3 mm and 2/24 showed major displacement (>3 mm. None showed total displacement. For the acetabulum 22/24 spots showed no displacement and 2/24 showed minor displacement. A combined microfracturing and placing of an AMIC graft of focal chondral lesions of the hip joint can be done arthroscopically. Prospective randomized in vivo studies should compare the results of arthroscopilally placed AMIC grafts with microfracturing and microfracturing alone.
[Autologous fat grafting in the surgical management of painful scar: preliminary results].
Baptista, C; Iniesta, A; Nguyen, P; Legr├®, R; Gay, A-M
The purpose of this study was to report our experience about the effectiveness of autologous fat injections in the management of painful scars. Between 2010 and 2012, all patients with persistent incisional pain despite a well-conduced 6 months medical treatment received an autologous fat graft according to the technique originally described by Coleman. Results interpretation was based on pain improvement thanks to a Visual Analogic Scale (VAS), postoperative patient satisfaction, reduction on analgesics intake and quality of life improvement. Eleven patients were included, the mean quantity of fat injected was 11cm(3). Nine patients (1.5%) benefited from a complete or significant pain decrease, 74.5% reported being very satisfied or satisfied with the result. The mean reduction of VAS was 3.5 points. We did not observe any complication. Autologous fat grafting is an innovative therapeutic approach and appears to be an attractive concept in the management of scar neuromas resistant to drug treatment, by providing an easy effective and safe surgical treatment.
Bone marrow mesenchymal stem cell transplantation combined with core decompression and bone grafting in the repair of osteonecrosis of femoral head
Institute of Scientific and Technical Information of China (English)
Zhang Yang; Wang Nan; Yang Li-feng; Ma Ji; Li Zhi
BACKGROUND: Core decompression alone for osteonecrosis of femoral head easily causes fovea of femoral head and colapse of inner microstructure. Therefore, autologous bone is needed for filing and supporting. Moreover, bone marrow stem cel transplantation can decrease the incidence of femoral head colapse. OBJECTIVE:To discuss the clinical effects of core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels for osteonecrosis of femoral head. METHODS: A total of 33 patients were treated by core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels in the Fourth Department of Bone Surgery, Central Hospital Affiliated to Shenyang Medical Colege in China from December 2012 to May 2013. RESULTS AND CONCLUSION:After the treatment by core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels, Harris hip function score increased and pain disappeared in patients with osteonecrosis of femoral head. They could do various labors. Radiographs or CT examination displayed normal femoral head in 30 hips, accounting for 79%. Pain significantly reduced. Normal or slight limp walking was found in 15 hips, accounting for 40%. There were 35 hips in patients, whose walking distance was extended, accounting for 92%. 24 hips dysfunction was improved markedly, accounting for 63%. Al results suggested that core decompression and bone grafting combined with autotransplantation of bone marrow mesenchymal stem cels improved the local blood supply of femoral head, and played a positive role in promoting the necrotic bone absorption and bone repairing.
Optimizing autologous cell grafts to improve stem cell gene therapy.
Psatha, Nikoletta; Karponi, Garyfalia; Yannaki, Evangelia
Over the past decade, stem cell gene therapy has achieved unprecedented curative outcomes for several genetic disorders. Despite the unequivocal success, clinical gene therapy still faces challenges. Genetically engineered hematopoietic stem cells are particularly vulnerable to attenuation of their repopulating capacity once exposed to culture conditions, ultimately leading to low engraftment levels posttransplant. This becomes of particular importance when transduction rates are low or/and competitive transplant conditions are generated by reduced-intensity conditioning in the absence of a selective advantage of the transduced over the unmodified cells. These limitations could partially be overcome by introducing megadoses of genetically modified CD34(+) cells into conditioned patients or by transplanting hematopoietic stem cells hematopoietic stem cells with high engrafting and repopulating potential. On the basis of the lessons gained from cord blood transplantation, we summarize the most promising approaches to date of increasing either the numbers of hematopoietic stem cells for transplantation or/and their engraftability, as a platform toward the optimization of engineered stem cell grafts. PMID:27106799
Deepak P; Eknath D; Vijayanand; Satish
BOHLER'S ANGLE: correlation with outcome in displaced intra-articular calcaneal fractures Treated with locking compression Plate Fixation with and without bone grafting. AIMS: The aim is an accurate reduction of the fracture with reconstruction of BohlerŌĆÖs angle, length and axis and sub talar joint surface. To determine whether autologous bone graft supplementation is beneficial in achieving and maintaining restoration of Calcaneal height and anatomic reduction. SETTINGS AND ...
Bone reconstruction of large defects using bone marrow derived autologous stem cells.
Lucarelli, Enrico; Donati, Davide; Cenacchi, Annarita; Fornasari, Pier Maria
Bone is a tissue that has the ability to heal itself when fractured. Occasionally, a critical defect can be formed when part of the bone is lost or excised, in this case the bone fails to heal and requires bone reconstruction to prevent a non-union defect. Autogenous cancellous bone is the current gold standard treatment in bone loss. Because the amount of autogenous cancellous bone that can be harvested is limited, the expanding need for bone reconstruction is paired by the growth of interest in the discipline of tissue engineering. Labs worldwide are working to provide the right carrier and the right set of cells that, once retransplanted, will ensure bone repair. Several investigators have focused their attention on a subset of autologous non-hematopoietic stem/progenitor cells contained in the adult bone marrow stroma, referred to as stromal stem cells (SSC), as the appropriate cells to be transplanted. The use of autologous cells is facilitated by less stringent ethical and regulatory issues and does not require the patient to be immunologically suppressed. In pre-clinical and clinical protocols of critical defects in which SSC are employed, two approaches are mainly used: in the first, SSC are derived from bone marrow and directly introduced at the lesion site, in the second, SSC are derived from several sites and are expanded ex vivo before being implanted. Both approaches, equally correct in principle, will have to demonstrate, with definitive evidence of their efficacy, their capability of solving a critical clinical problem such as non-union. In this report we outline the difficulties of working with SSC. PMID:15062758
Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: What is the evidence?
E.M.M. van Lieshout (Esther); V. Alt (Volker)
textabstractDespite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substi
A Simple, Reliable, and Inexpensive Intraoperative External Expansion System for Enhanced Autologous Structural Fat Grafting
Oranges, Carlo M.; Tremp, Mathias; Ling, Barbara; Wettstein, Reto; Largo, Ren├® D.
External volume expansion of the recipient site by suction has been proposed as a way of improving fat graft survival. The objective of this study was to present an innovative and simple intraoperative external expansion system to enhance small-volume autologous fat grafting (40ŌĆō80 mL) and to discuss its background and its mechanism of action. In this system, expansion is performed using a complete vacuum delivery system known as the Kiwi VAC-6000M with a PalmPump (Clinical Innovations). The recipient site is rapidly expanded intraoperatively 10 times for 30 seconds each with a negative pressure of up to 550 mm Hg before autologous fat injection. During this repetitive stimulation, the tissues become grossly expanded, developing macroscopic swelling that regresses slowly over the course of hours following the cessation of the stimulus. The system sets various mechanisms in motion, including scar release, mechanical stimulation, edema, ischemia, and inflammation, which provide an environment conducive for cell proliferation and angiogenesis. In order to maintain the graft construct in its expansive state, all patients are encouraged postoperatively to use the Kiwi three times daily for one minute per session over the course of three days. The handling of this system is simple for both the patients and the surgeon. Satisfactory clinical outcomes have been achieved without significant complications. PMID:27689056
A Simple, Reliable, and Inexpensive Intraoperative External Expansion System for Enhanced Autologous Structural Fat Grafting.
Oranges, Carlo M; Tremp, Mathias; Ling, Barbara; Wettstein, Reto; Largo, Ren├® D; Schaefer, Dirk J
External volume expansion of the recipient site by suction has been proposed as a way of improving fat graft survival. The objective of this study was to present an innovative and simple intraoperative external expansion system to enhance small-volume autologous fat grafting (40-80 mL) and to discuss its background and its mechanism of action. In this system, expansion is performed using a complete vacuum delivery system known as the Kiwi VAC-6000M with a PalmPump (Clinical Innovations). The recipient site is rapidly expanded intraoperatively 10 times for 30 seconds each with a negative pressure of up to 550 mm Hg before autologous fat injection. During this repetitive stimulation, the tissues become grossly expanded, developing macroscopic swelling that regresses slowly over the course of hours following the cessation of the stimulus. The system sets various mechanisms in motion, including scar release, mechanical stimulation, edema, ischemia, and inflammation, which provide an environment conducive for cell proliferation and angiogenesis. In order to maintain the graft construct in its expansive state, all patients are encouraged postoperatively to use the Kiwi three times daily for one minute per session over the course of three days. The handling of this system is simple for both the patients and the surgeon. Satisfactory clinical outcomes have been achieved without significant complications. PMID:27689056
Vancomycin graft composite for infected bone defects
International Nuclear Information System (INIS)
Reconstructive surgery under septic conditions represents a major challenge in orthopaedics. Local application of antibiotics can provide high drug levels at the site of infection without systemic effects. However, removal of non-resorbable implants and filling of defects usually requires additional operative procedures. An ideal antibiotic carrier should provide for : 1) Effective bactericidal activity, especially against staphylococci including MRSA; 2) High and long lasting levels at the site of infection without local or systemic toxicity; 3) Repair of defects without a second stage procedure. Allogeneic cancellous bone is proven to be effective in restoration of bone stock. Vancomycin is effective against all gram-positive populations and the agent of choice for infections with MRSA. The aim of our study is to investigate the efficacy of a combination of both components in bone infection. Cancellous bone of human origin was processed during several steps and incubated in 10% vancomycin solution. The antimicrobial activity of the vancomycin graft composite (VGC) was evaluated using an agar diffusion bioassay against staphylococcus aureus and high performance liquid chromatography (HPLC). The testing period was up to 9 weeks. Elution of vancomycin from the graft was evaluated in 2.5% human albumin solution, which was exchanged every 24 hours. Concentration of vancomycin in allograft-bone was between 6.653[tg/g and 23.194gg/g with an average of 15.250 [tg/g, which is equivalent to 10.000 times the minimum inhibitory concentration (MIC) for s. aureus. The initial activity decreased to approx. 50% during the first week and approx. 30% at the end of the 9th week. The lowest values measured exceeded the MIC by 2000 times. Concentration in surrounding fluid decreased from 24.395,80 to 18,43pg/ml after 11 complete exchanges. Human cancellous bone, processed in an adequate way, offers capability to store high quantities of vancomycin. Vancomycin graft composites are
Bone Forming Potential of An-Organic Bovine Bone Graft: A Cone Beam CT study
Uzbek, Usman Haider; Rahman, Shaifulizan Ab; Alam, Mohammad Khursheed; gillani, syed wasif
Purpose: An-organic bovine bone graft is a xenograft with the potential of bone formation. The aim of this study was to evaluate the bone density using cone beam computed tomography scans around functional endosseous implant in the region of both augmented maxillary sinus with the an-organic bovine bone graft and the alveolar bone over which the graft was placed to provide space for the implants.
Experimental Comparison of Cranial Particulate Bone Graft, rhBMP-2, and Split Cranial Bone Graft for Inlay Cranioplasty.
Hassanein, Aladdin H; Couto, Rafael A; Kurek, Kyle C; Rogers, Gary F; Mulliken, John B; Greene, Arin K
Background :ŌĆā Particulate bone graft and recombinant human bone morphogenetic protein-2 (rhBMP-2) are options for inlay cranioplasty in children who have not developed a diploic space. The purpose of this study was to determine whether particulate bone graft or rhBMP-2 has superior efficacy for inlay cranioplasty and to compare these substances to split cranial bone. Methods :ŌĆā A 17 mm ├Ś 17 mm critical-sized defect was made in the parietal bones of 22 rabbits and managed in four ways: Group I (no implant; n=5), Group II (particulate bone graft; n=5), Group III (rhBMP-2; n=7), and Group IV (split cranial bone graft; n=5). Animals underwent microcomputed tomography and histologic analysis 16 weeks after cranioplasty. Results :ŌĆā Defects without an implant (Group I) demonstrated inferior ossification (41.4%; interquartile range [IQR], 28.9% to 42.5%) compared to those treated with particulate bone graft (Group II: 99.5%; IQR, 97.8% to 100%), rhBMP-2 (Group III: 99.6%; IQR, 99.5% to 100%), or split cranial bone (Group IV: 100%) (P inlay calvarial defect areas equally, although the thickness of bone healed with rhBMP-2 is inferior. Clinically, particulate bone graft or split cranial bone graft may be superior to rhBMP-2 for inlay cranioplasty.
Two-Year Follow-Up of Autologous Fat Grafting With Laser-Assisted Facelifts.
Boneti, Cristiano; Anakwenze, Chidinma P; de la Torre, Jorge; Weaver, Tony L; Collawn, Sherry S
Skin tightening and improved facial contouring can be achieved through a variety of modalities including traditional facelifts, autologous fat injections, laser resurfacing, laser liposuction fibers, and includes the popular use of botox and synthetic fillers. Facial fat grafting has been helpful in treating the volume deficient aging face and can easily be injected following subcutaneous laser therapy. We will demonstrate in this clinical study that lasers and fat grafting can be used safely in combination with facelifts to improve skin contouring and tightness compared with single therapy. From 2012 to 2014, 31 patients received facial laser fiber contouring, facial fat injections and 25 of these patients underwent a concomitant facelift. Facial contouring was achieved using a subcutaneous laser fiber with the wavelengths 1064 nm and 1320 nm. After the laser treatment, fat injections were performed with 1-mL syringes and small injection cannulas. Standard surgical facelifts with were then performed. Results showed excellent improvement in perioral, periorbital, and cheek rejuvenation with excellent fat retention in the temples at 2 years.In conclusion, laser fiber contouring with autologous facial fat injections represents an excellent therapy for facial contouring and can be used safely and effectively in combination with facelifts. PMID:27070682
Autologous Bone-Marrow-Derived-Mononuclear-Cells-Enriched Fat Transplantation in Breast Augmentation: Evaluation of Clinical Outcomes and Aesthetic Results in a 30-Year-Old Female
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Dmitry Bulgin
Full Text Available Autologous fat transfer (lipofilling is becoming an invaluable tool for breast augmentation as well as for breast reconstruction. Autologous lipofilling has several advantages, including biocompatibility, versatility, natural appearance, and low donor site morbidity. The main limitation is unpredictable fat graft resorption, which ranges from 25% to 80%, probably as a result of ischaemia and lack of neoangiogenesis. To obviate these disadvantages, several studies have searched for new ways of increasing the viability of the transplanted fat tissue. One promising approach is to enrich the fat graft with autologous bone-marrow-derived mononuclear cells (BMMNCs before transplantation. BMMNCs produce many angiogenic and antiapoptotic growth factors, and their secretion is significantly enhanced by hypoxia. All of these mechanisms of actions could be beneficial for the stimulation of angiogenesis in ischemic tissues by BMMNCs administration. In our aesthetic surgery practice, we use fat transplantation enriched with BMMNCs, which caused a significant improvement in survival of fat grafts, compared with that of traditional lipofilling. Our experience with freshly isolated autologous fat enriched with BMMNCs for breast augmentation procedures is presented. The concept of this surgical and tissue handling technique is based on ability of BMMNCs to stimulate blood vessel growth.
Revascularisation of fresh compared with demineralised bone grafts in rats
DEFF Research Database (Denmark)
Solheim, E; Pinholt, E M; Talsnes, O;
Revascularisation of bone grafts is influenced by both the anatomical origin and the pre-implantation processing of the graft. We investigated the revascularisation by entrapment of 141Ce (cerium)-labelled microspheres in large, fresh and demineralised syngeneic grafts of predominantly cancellous...
Unicameral bone cysts managed with CHRONOS bone graft substitute: A case series.
Benjamin, Biju; Ketan PANDE
A unicameral bone cyst (UBC) may require surgery if its location increases the risk for pathologic fracture, or if it is painful or increasing in size. This case series demonstrates that curettage and grafting with a bone graft substitute alone can result in healing of the UBC. Three children with UBC and pathological fractures were treated with curettage and grafting using bone graft substitute beta-tricalcium phosphate granules (CHRONOS). All three went on to full union of the fracture and ...
Quantitative magnetic resonance imaging in autologous bone marrow transplantation for Hodgkin's disease.
Smith, S. R.; Williams, C E; Edwards, R H; Davies, J M
Fifteen consecutive patients with refractory or relapsed Hodgkin's disease (HD) referred for autologous bone marrow transplantation (ABMT) underwent quantitative magnetic resonance (MR) studies of the lumbar vertebral bone marrow. Markedly elevated lumbar vertebral marrow T1 values suggestive of bone marrow involvement with HD were seen in four patients, two of whom had no evidence of HD on bilateral iliac crest bone marrow biopsy. Serial studies showed normalisation of T1 values in the post-...
21 CFR 872.3930 - Bone grafting material.
...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices ┬¦ 872.3930 Bone grafting material. (a) Identification... ŌĆ£Class II Special Controls Guidance Document: Dental Bone Grafting Material Devices.ŌĆØ (See ┬¦ 872.1(e) for...) Date premarket approval application (PMA) or notice of product development protocol (PDP) is...
Simultaneous Osteoperiosteal Autologous Iliac Crest Graft and Lateral Meniscus Allograft Transplantation for Osteochondral Lesion with Bony Defect and Lateral Discoid Meniscus Tear
Lee, Dhong Won; Ha, Jeong Ku; Kim, Woo Jong
The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus. PMID:27274475
Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience
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Fabio Caviggioli
Full Text Available Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of ŌĆ£Postmastectomy Pain SyndromeŌĆØ (PMPS and had undergone mastectomy with axillary dissection (113 patients or quadrantectomy (96 patients. Both procedures were followed by radiotherapy. We performed fat grafting following ColemanŌĆÖs procedure. Mean amount of adipose tissue injected was 52ŌĆēcc (┬▒8.9ŌĆēcc per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7ŌĆō13.5 months. In 120 treated patients we detected pain decrease (mean ┬▒ SD point reduction, 3.19 ┬▒ 2.86. Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean ┬▒ SD decrease of pain of 1.14 ┬▒ 2.72. Results showed that pain decreased significantly in patients treated (p<0.005, Wilcoxon rank-sum test. Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain.
Autologous nerve graft repair of different degrees of sciatic nerve defect: stress and displacement at the anastomosis in a three-dimensional fnite element simulation model
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Cheng-dong Piao
Full Text Available In the repair of peripheral nerve injury using autologous or synthetic nerve grafting, the magnitude of tensile forces at the anastomosis affects its response to physiological stress and the ultimate success of the treatment. One-dimensional stretching is commonly used to measure changes in tensile stress and strain however, the accuracy of this simple method is limited. Therefore, in the present study, we established three-dimensional finite element models of sciatic nerve defects repaired by autologous nerve grafts. Using PRO E 5.0 finite element simulation software, we calculated the maximum stress and displacement of an anastomosis under a 5 N load in 10-, 20-, 30-, 40-mm long autologous nerve grafts. We found that maximum displacement increased with graft length, consistent with specimen force. These findings indicate that three-dimensional finite element simulation is a feasible method for analyzing stress and displacement at the anastomosis after autologous nerve grafting.
Breast reconstruction de novo by water-jet assisted autologous fat grafting ŌĆō a retrospective study
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Hoppe, Delia Letizia
Full Text Available [english] Background: Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone.Methods: A retrospective European multicenter trial included 135 procedures on 28 (35 breasts postmastectomy patients (mean 52.4 years. All women were treated with the water-jet assisted fat grafting method (BEAULIŌäó combined with additional procedures (NAC reconstruction, contralateral mastoplasty and evaluated with at least 6 months follow-up (mean 2.6 years. Sonography or mammography, clinical examination, patient questionnaire (10-point Likert scale and digital photographs were carried out.Results: On average the patients received 4 to 6 procedures each with a single volume of 159 ml (┬▒61 ml over 21 months (range 9 months to 2.5 years. In total 1,020 ml (┬▒515 ml fat were grafted till a complete breast reconstruction was achieved. Irradiated patients needed a significantly higher volume than non-irradiated (p<0.041. Main treatment complications were liponecrosis (2.59%, infection (0.74% and granuloma (0.74%. Patient satisfaction was overall high to very high (96% and confirmed the good aesthetic results (68% and the natural softness, contour and shape of the reconstructed breast.Conclusions: A complete breast reconstruction with large volume fat grafting is alternatively possible to standard techniques in selected cases. It takes at least 4 to 6 lipotransfers in the course of 2 years. Patients with prior radiotherapy may require even up to 8 sessions over nearly 3 years of treatment.
Breast reconstruction de novo by water-jet assisted autologous fat grafting ŌĆō a retrospective study
Hoppe, Delia Letizia; Ueberreiter, Klaus; Surlemont, Yves; Peltoniemi, Hilkka; Stabile, Marco; Kauhanen, Susanna
Background: Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone. Methods: A retrospective European multicenter trial included 135 procedures on 28 (35 breasts) postmastectomy patients (mean 52.4 years). All women were treated with the water-jet assisted fat grafting method (BEAULIŌäó) combined with additional procedures (NAC reconstruction, contralateral mastoplasty) and evaluated with at least 6 months follow-up (mean 2.6 years). Sonography or mammography, clinical examination, patient questionnaire (10-point Likert scale) and digital photographs were carried out. Results: On average the patients received 4 to 6 procedures each with a single volume of 159 ml (┬▒61 ml) over 21 months (range 9 months to 2.5 years). In total 1,020 ml (┬▒515 ml) fat were grafted till a complete breast reconstruction was achieved. Irradiated patients needed a significantly higher volume than non-irradiated (p<0.041). Main treatment complications were liponecrosis (2.59%), infection (0.74%) and granuloma (0.74%). Patient satisfaction was overall high to very high (96%) and confirmed the good aesthetic results (68%) and the natural softness, contour and shape of the reconstructed breast. Conclusions: A complete breast reconstruction with large volume fat grafting is alternatively possible to standard techniques in selected cases. It takes at least 4 to 6 lipotransfers in the course of 2 years. Patients with prior radiotherapy may require even up to 8 sessions over nearly 3 years of treatment. PMID:24403878
Autologous Bone Marrow Stem Cell Infusion (AMBI therapy for Chronic Liver Diseases
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Rajkumar JS
Full Text Available Liver Cirrhosis is the end stage of chronic liver disease which may happen due to alcoholism, viral infections due to Hepatitis B, Hepatitis C viruses and is difficult to treat. Liver transplantation is the only available definitive treatment which is marred by lack of donors, post operative complications such as rejection and high cost. Autologous bone marrow stem cells have shown a lot of promise in earlier reported animal studies and clinical trials. We have in this study administered in 22 patients with chronic liver disease, autologous bone marrow stem cell whose results are presented herewith.
Transplantation of autologous bone marrow-derived mesenchymal stem cells for traumatic brain injury
Institute of Scientific and Technical Information of China (English)
Jindou Jiang; Xingyao Bu; Meng Liu; Peixun Cheng
Results from the present study demonstrated that transplantation of autologous bone marrow-derived mesenchymal stem cells into the lesion site in rat brain significantly ameliorated brain tissue pathological changes and brain edema, attenuated glial cell proliferation, and increased brain-derived neurotrophic factor expression. In addition, the number of cells double-labeled for 5-bromodeoxyuridine/glial fibrillary acidic protein and cells expressing nestin increased. Finally, blood vessels were newly generated, and the rats exhibited improved motor and cognitive functions. These results suggested that transplantation of autologous bone marrow-derived mesenchymal stem cells promoted brain remodeling and improved neurological functions following traumatic brain injury.
Effects of extravascular trestle model coated phosphorus radioisotope on intimal hyperplasia in autologous vein grafts
Institute of Scientific and Technical Information of China (English)
ķÆ▒µĄÄÕģł; µØĵĪéõ║æ; ķÆ▒ÕģåÕźć; ńÄŗÕåø; ÕÉĢĶŹŻ
Objective: To design an extravascular trestle model coated phosphorus-32, an isotope radiating beta rays, and investigate its effects on intimal hyperplasia of autologous vein grafts. Methods: ETA cDNA was used as a gene probe specific to vascular SMCs on the basis of in situ hybridization. The femoral veins were transplanted reversely into colateral femoral arteries in rabbits, and the animals were divided into control, chemical agents and phosphorus-32 groups. The morphometry was applied to calculate the ETA cDNA expression and intimal thickness. Spearman correlation method was utilized to investigate their relationship. Results: Intimal thickness in grafts of phosphorus-32 group was markedly reduced. Additionally, intimal ETA gene expression was also decreased in beta rays group. The values increased at a slower rate significantly different from that of control and aspirin groups (P<0.01). The correlation of ETA cDNA expression and intimal thickness exhibited a strongly positive relation. Conclusion: Beta rays in extravascular model could remarkably inhibit intimal thickening and SMC proliferation. The correlation is an indirect evidence indicating that intimal hyperplasia composed of SMCs proliferation. It suggests that ETA cDNA expression could be a quantitative estimation of vascular SMC because of its specifics.
Bone marrow concentrate for autologous transplantation in minipigs. Characterization and osteogenic potential of mesenchymal stem cells.
Herten, M; Grassmann, J P; Sager, M; Benga, L; Fischer, J C; J├żger, M; Betsch, M; Wild, M; Hakimi, M; Jungbluth, P
Autologous bone marrow plays an increasing role in the treatment of bone, cartilage and tendon healing disorders. Cell-based therapies display promising results in the support of local regeneration, especially therapies using intra-operative one-step treatments with autologous progenitor cells. In the present study, bone marrow-derived cells were concentrated in a point-of-care device and investigated for their mesenchymal stem cell (MSC) characteristics and their osteogenic potential. Bone marrow was harvested from the iliac crest of 16 minipigs. The mononucleated cells (MNC) were concentrated by gradient density centrifugation, cultivated, characterized by flow cytometry and stimulated into osteoblasts, adipocytes, and chondrocytes. Cell differentiation was investigated by histological and immunohistological staining of relevant lineage markers. The proliferation capacity was determined via colony forming units of fibroblast and of osteogenic alkaline-phosphatase-positive-cells. The MNC could be enriched 3.5-fold in nucleated cell concentrate in comparison to bone marrow. Flow cytometry analysis revealed a positive signal for the MSC markers. Cells could be differentiated into the three lines confirming the MSC character. The cellular osteogenic potential correlated significantly with the percentage of newly formed bone in vivo in a porcine metaphyseal long-bone defect model. This study demonstrates that bone marrow concentrate from minipigs display cells with MSC character and their osteogenic differentiation potential can be used for osseous defect repair in autologous transplantations.
Periosteal augmentation of allograft bone and its effect on implant fixation - an experimental study on 12 dogs()
DEFF Research Database (Denmark)
Barckman, Jeppe; Baas, Jorgen; S├Ėrensen, Mette;
Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants.......Periosteum provides essential cellular and biological components necessary for fracture healing and bone repair. We hypothesized that augmenting allograft bone by adding fragmented autologous periosteum would improve fixation of grafted implants....
Bone graft materials in fixation of orthopaedic implants in sheep
DEFF Research Database (Denmark)
Babiker, Hassan
Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many...... orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include...... skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human...
In Vivo Study of Ligament-Bone Healing after Anterior Cruciate Ligament Reconstruction Using Autologous Tendons with Mesenchymal Stem Cells Affinity Peptide Conjugated Electrospun Nanofibrous Scaffold
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Jingxian Zhu
Full Text Available Electrospinning nanofibrous scaffold was commonly used in tissue regeneration recently. Nanofibers with specific topological characteristics were reported to be able to induce osteogenic differentiation of MSCs. In this in vivo study, autologous tendon grafts with lattice-like nanofibrous scaffold wrapping at two ends of autologous tendon were used to promote early stage of ligament-bone healing after rabbit ACL reconstruction. To utilize native MSCs from bone marrow, an MSCs specific affinity peptide E7 was conjugated to nanofibrous meshes. After 3 months, H-E assessment and specific staining of collagen type I, II, and III showed direct ligament-bone insertion with typical four zones (bone, calcified fibrocartilage, fibrocartilage, and ligament in bioactive scaffold reconstruction group. Diameters of bone tunnel were smaller in nanofibrous scaffold conjugated E7 peptide group than those in control group. The failure load of substitution complex also indicated a stronger ligament-bone insertion healing using bioactive scaffold. In conclusion, lattice-like nanofibrous scaffold with specific MSCs affinity peptide has great potential in promoting early stage of ligament-bone healing after ACL reconstruction.
Secondary Alveolar Bone Grafting (CLEFTSiS) 2007-2010.
Paterson, Michael; Rae, Jennifer; Paterson, Paul; Gilgrass, Toby; Devlin, Mark; McIntyre, Grant
Objective To determine whether alveolar bone graft outcomes for unilateral and bilateral cleft lip and palate patients have continued to improve since the reorganization of cleft services in Scotland in 2000. Design Retrospective analysis of postoperative anterior occlusal radiographs. Patients and Participants Eighty-one of 106 patients who were eligible for alveolar bone grafting between 2007 and 2010 had suitable postoperative radiographs available. Interventions Twenty-seven percent of the patients (n = 22) had presurgical orthodontic intervention. All patients underwent alveolar bone grafting with bone harvested from the iliac crest. Main Outcome Measures The Kindelan bone-fill index was used to evaluate success. Weighted kappa statistics were used to assess intra- and interobserver reproducibility. A comparison was made with results from 2000 to 2004 to assess any improvement. Chi-square tests (or Fisher exact test) were used to determine whether outcomes differed depending on the laterality of the cleft, use of presurgical expansion, or age at bone grafting. Results Interobserver scoring agreement was good (weighted kappa = .383). Intraobserver reproducibility was greater (weighted kappas of .835 and .620). Success was achieved in 99% of bone grafts, compared with 76% in the period from 2000 to 2004 (P < .001). There was no statistically significant relationship between the laterality of the cleft (P = 1.000), use of presurgical expansion (P = 1.000), or age at time of bone grafting and outcome (P = .259). Conclusion Scottish secondary alveolar bone graft outcomes improved during 2007 to 2010 in comparison to the 2000 to 2004 results. PMID:26914161
Early Postoperative Magnetic Resonance Imaging Findings After Autologous Osteochondral Plug Grafts For Osteochondritis Dissecans of the Humeral Capitellum
Maruyama, Masahiro; Takahara, Masatoshi; Harada, Mikio; Satake, Hiroshi; Uno, Tomohiro; Takagi, Michiaki
Objectives: Although good clinical outcomes of autologous osteochondral plug grafts for capitellar osteochondritis dissecans (OCD) have been reported, the timing of return to sports was various and still controversial. The period of graft incorporation and the lesion healing at repair site is important to establish the rehabilitation protocol, however there is little information. The aim of this study was to investigate early postoperative magnetic resonance imaging (MRI) findings and clinical outcomes after autologous osteochondral plug grafts for capitellar OCD. Methods: Fifteen young baseball players with advanced lesions of capitellar OCD underwent a procedure using autologous osteochondral plug grafts and underwent MRI (1.5 T) scan at 3 and 6 months, postoperatively. Their mean age at the time of surgery was 13.5 years (range, 13-15 years). Four lesions were classified as International Cartilage Repair Society (ICRS) OCD III and 11 lesions as OCD IV. The mean size of the lesions (sagittal ├Ś coronal) was 16 ├Ś 14 mm and the mean surface area was 181 mm2. One to two osteochondral plug grafts, with a mean diameter of 7 mm (range, 6-8 mm), were harvested from the lateral femoral condyle and transplanted to the defects. The mean reconstruction rate was 41% (range, 12%-65%), which was calculated as (total surface area of the grafts ├Ś 100%)/ (surface area of the lesion). Patients were allowed to begin throwing after 3 months and to return to sports after 6 months. The mean follow-up was 21 months (range, 12-36 months). The MRI findings were assessed graft incorporation, which was indicated by no T1-low-signal-intensity at the graft and no fluid surrounding the graft on T2-weighted fat-suppression (Figure 1), and the lesion healing according to the scoring system of Henderson (4, complete healing; 16, no healing). MRI were blinded and randomized, and two observers reviewed independently and conferred when they differed. Clinical outcomes were evaluated as elbow pain
Intrathecal application of autologous bone marrow cell preparations in parkinsonian syndromes
DEFF Research Database (Denmark)
Storch, Alexander; Csoti, Ilona; Eggert, Karla;
A growing number of patients is treated with intrathecal application of autologous bone marrow cells (aBMCs), but clinical data are completely lacking in movement disorders. We provide first clinical data on efficacy and safety of this highly experimental treatment approach in parkinsonian...
Peri-Implant Tissue Findings in Bone Grafted Oral Cancer Patients Compared to non Bone Grafted Patients without Oral Cancer
Jan Wolff; Hideki Agata; George K. S├Īndor; Suvi Haimi
ABSTRACT Objectives The aim of this study was to compare microbiological, histological, and mechanical findings from tissues around osseointergrated dental implants in patients who had undergone tumour resection and subsequent bone grafting with non bone grafted patients without a history of oral cancer and to develop an effective tool for the monitoring of the peri-implant tissues. A third aim was to assess and compare the masticatory function of the two patient groups after reconstruction w...
Relleno de cavidades ├│seas en cirug├Ła maxilofacial con materiales aut├│logos Bone cavity augmentation in maxillofacial surgery using autologous material
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P. Infante-Coss├Ło
Full Text Available Aunque se han descrito numerosos materiales para rellenar una cavidad ├│sea, el mejor material sigue siendo el hueso aut├│logo corticoesponjoso o particulado, que puede formar hueso nuevo por mecanismos de osteog├®nesis, osteinducci├│n y osteoconducci├│n. El cirujano oral y maxilofacial debe conocer las propiedades biol├│gicas y las caracter├Łsticas fundamentales de los materiales aut├│logos, las diferentes t├®cnicas de obtenci├│n y sus aplicaciones cl├Łnicas. Como zonas donantes se emplean preferentemente las intraorales, el filtro de hueso y los raspadores para peque├▒os defectos, y el hueso il├Łaco, tibia o calota cuando se requiere m├Īs cantidad. No existen estudios concluyentes respecto a la asociaci├│n de injertos ├│seos con membranas. La combinaci├│n de injertos aut├│logos con otros materiales de relleno, ha desembocado en m├║ltiples estudios, sin que se puedan establecer conclusiones definitivas por el momento. El hueso aut├│logo es de elecci├│n para el relleno de cavidades ├│seas, ya que es ├║til para dar soluci├│n a variadas situaciones cl├Łnicas de forma simple, r├Īpida y segura.Although a large number of materials have been described for augmenting bone cavities, the best material is still autologous cortical-cancellous bone or bone chip, which can form new bone through osteogenesis, osteoinduction and osteoconduct ion mechanisms. The oral and maxillofacial surgeon needs to be familiar with the biological properties and the fundamental characteristics of autologous material, the different techniques for obtaining it and its clinical application. Donor sites should preferably be intraoral. Bone filters and scrapers should be used for small defects, and the iliac, tibial or calvaria bones [should be used] when more quantity is required. There are no conclusive studies with regard to combining bone grafts with membranes. The combination of autologous grafts with other augmentation material has led to multiple studies, although
The Palatal Bone Block Graft for Onlay Grafting Combined with Maxillary Implant Placement: A Case Series.
Gluckman, Howard; Du Toit, Jonathan; Salama, Maurice
The aim of this study was to introduce an intraoral bone block harvesting technique--the palatal bone block graft (PBBG)--as an alternative harvest site for autogenous bone blocks. The PBBG technique was used to onlay graft esthetic zone defects simultaneous to implant placement in five patients. Measurable objectives were used to evaluate outcomes, and treatment was reassessed at up to 6 years. Defects of the maxilla were successfully grafted with PBBG in all five cases, and tissues remained stable at 1- and 6-year follow-ups. Harvesting an autogenous bone block from the palate is an advantageous, predictable, and reproducible method for augmenting buccofacial defects at implant placement, and may be considered as an alternative to conventional intraoral bone block donor sites when treating the maxilla.
Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report
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Farzad Izadi
Full Text Available Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents. ┬Ā Case Report:This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen. ┬Ā Conclusion:┬Ā It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations.
Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report
Izadi, Farzad; Vaghardoost, Reza; Derakhshandeh, Vita; Sobouti, Behnam; Ghavami, Yaser
Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents. Case Report: This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen. Conclusion: It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations. PMID:27280104
Bone graft complications: what can we do to prevent them?
Tandon, Rahul; Herford, Alan S.
Introduction: Bone grafts are commonly used in oral and maxillofacial surgery, helping to restore missing bone structure and provide osseous support. In spite of their reported success, complications can and do arise. Examples include loosening and resorption of the graft, infection, and complete loss of the graft. These complications can potentially lead to larger defects, necessitating additional procedures to correct the problem. This not only causes great discomfort to the patient, but also drains considerable time and resources away from the clinician. Thus, improvements on identifying ways to identify and prevent these complications are constantly being sought. We have performed a literature review and identified several areas in the field of optics that could potentially help solve our problem. Optical Techniques: Raman spectroscopy has been shown to provide a transcutaneous measurement of bone mineral and matrix Raman bands. This could potentially provide surgeons with the ability to more accurately assess bone graft osseointegration. In-vivo near-infrared optical imaging could potentially provide accurate diagnosis of pathologic lesions such as osteosarcoma. Contrast-enhanced ultrasound could be used to detect vascular disturbances and other information related to the transplantation of osseous components. Conclusion: Bone graft complications can be one of the most devastating consequences of osseous surgery. As surgeons, we are constantly searching for ways to identify them earlier and prevent them. We hope that by presenting areas that could be used, we can gain a better insight to ways in which both fields can benefit.
Fenestration of bone flap during interval autologous cranioplasty
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Ha Son Nguyen
Conclusion: Presumably, fenestrations augment surface area for extra-axial fluid absorption through the bone flap. Our results, regarding MLS and postoperative volume, provide support for this concept. Accordingly, bone flap fenestration has the potential to reduce extra-axial fluid accumulation.
Preparation and characterization of a novel bone graft composite containing bone ash and egg shell powder
Indian Academy of Sciences (India)
Gunasekaran Krithiga; Thotapalli P Sastry
Egg shells which were hitherto discarded as wastes were collected, purified and powdered into a particle size in the range of 5ŌĆō50 m. A composite bone graft material in cylindrical form was prepared using egg shell powder (ESP), bone ash (BA) and gelatin. These bone grafts were characterized for their FTŌĆōIR, TGA, XRD, SEM and mechanical properties. The mechanical studies indicate that the composite having a stoichiometric ratio of BA (3 g) and ESP (7 g) has shown better mechanical properties. X-ray diffraction (XRD) data indicated the crystallographic nature of BA is akin to hydroxyapatite (HA) and both BA and ESP did not lose their crystalline nature when bone grafts were prepared. This revealed that ESP may be used as a component in bone graft utilizing the solid waste from the poultry industry.
Application of modern computer-aided technologies in the production of individual bone graft: A case report
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Mirkovi─ć Sini┼Īa
Full Text Available Introduction. An autologous bone (bone derived from the patient himself is considered to be a ŌĆ£golden standardŌĆØ in the treatment of bone defects and partial atrophic alveolar ridge. However, large defects and bone losses are difficult to restore in this manner, because extraction of large amounts of autologous tissue can cause donor-site problems. Alternatively, data from computed tomographic (CT scan can be used to shape a precise 3D homologous bone block using a computer-aided design-computer-aided manufacturing (CAD-CAM system. Case report. A 63-year old male patient referred to the Clinic of Dentistry of Vojvodina in Novi Sad, because of teeth loss in the right lateral region of the lower jaw. Clinical examination revealed a pronounced resorption of the residual ridge of the lower jaw in the aforementioned region, both horizontal and vertical. After clinical examination, the patient was referred for 3D cone beam (CBCT scan that enables visualization of bony structures and accurate measurement of dimensions of the residual alveolar ridge. Considering the large extent of bone resorption, the required ridge augmentation was more than 3 mm in height and 2 mm in width along the length of some 2 cm, thus the use of granular material was excluded. After consulting prosthodontists and engineers from the Faculty of Technical Sciences in Novi Sad we decided to fabricate an individual (custom bovine-derived bone graft designed according to the obtained 3D CBCT scan. Conclusion. Application of 3D CBCT images, computer-aided systems and software in manufacturing custom bone grafts represents the most recent method of guided bone regeneration. This method substantially reduces time of recovery and carries minimum risk of postoperative complications, yet the results fully satisfy the requirements of both the patient and the therapist.
Reconstruction of saddle nose deformity with calvarial bone graft
International Nuclear Information System (INIS)
Objective: To evaluate the efficacy of calvarial bone in the reconstruction of saddle nose deformity. Methods: The cross-sectional study was conducted at the Plastic Surgery Unit of Imam Reza Hospital, Tabriz University of Medical Sciences, Iran, from July 2004 to October 2009. It comprised 19 patients who underwent saddle nose deformity reconstruction with calvarial bone graft. All patients were operated upon under general anaesthesia. They were followed up periodically. Results: The patients followed up for 25 to 61 months for an average period of 39.2+-4.3 months. In 14 (74%) patients the result of the surgical intervention was excellent, while in 5 (26%) it was acceptable. All patients were satisfied and there was not displacement, absorption, distortion or infection of the graft. Conclusion: Calvarial bone graft is a viable option for the reconstruction of saddle nose deformity, especially in severe cases. (author)
Intra-arterial Autologous Bone Marrow Cell Transplantation in a Patient with Upper-extremity Critical Limb Ischemia
International Nuclear Information System (INIS)
Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.
Intra-arterial Autologous Bone Marrow Cell Transplantation in a Patient with Upper-extremity Critical Limb Ischemia
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Madaric, Juraj, E-mail: firstname.lastname@example.com [National Institute of Cardiovascular Diseases (NUSCH) and Slovak Medical University, Department of Cardiology and Angiology (Slovakia); Klepanec, Andrej [National Institute of Cardiovascular Diseases, Department of Diagnostic and Interventional Radiology (Slovakia); Mistrik, Martin [Clinic of Hematology and Transfusiology, Faculty Hospital (Slovakia); Altaner, Cestmir [Slovak Academy of Science, Institute of Experimental Oncology (Slovakia); Vulev, Ivan [National Institute of Cardiovascular Diseases, Department of Diagnostic and Interventional Radiology (Slovakia)
Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.
No negative effects of bone impaction grafting with bone and ceramic mixtures.
Arts, J.J.C.; Gardeniers, J.W.M.; Welten, M.L.M.; Verdonschot, N.J.J.; Schreurs, B.W.; Buma, P.
Reconstructing large loaded bone defects with ceramic bone graft extenders is tempting considering the expected future donor bone shortage. However, whether there are negative effects is unknown. Standardized large defects in the acetabulum of goats were created and subsequently reconstructed with m
Nasal bone grafts from the removed hump used as overlay grafts to camouflage concave lateral crura.
Kubilay, Utku; Erdogdu, Suleyman; Sezen, Ozan Seymen
Alar cartilage consists of a medial crus, middle crus and lateral crus. The lateral crus is an important aesthetic and functional structure of the nose. A 32-year-old male patient with concave lateral crura was operated by the authors. An open rhinoplasty with a dorsal approach to the septum is preferred. The nasal bones harvested from the hump, which is an autogenous graft trimmed and sutured on both concave lateral crura as an overlay camouflage grafts. Satisfactory result was achieved.
Autologous Graft versus Host Disease: An Emerging Complication in Patients with Multiple Myeloma
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Anu Batra
Full Text Available Autologous graft versus host disease (autoGVHD is a rare transplant complication with significant morbidity and mortality. It has been hypothesized that patients with multiple myeloma might be predisposed to autoGVHD through dysregulation of the immune response resulting from either their disease, the immunomodulatory agents (IMiDs used to treat it, or transplant conditioning regimen. Hematopoietic progenitor cell (HPC products were available from 8 multiple myeloma patients with biopsy-proven autoGVHD, 16 matched multiple myeloma patients who did not develop autoGVHD, and 7 healthy research donors. The data on number of transplants prior to developing autoGVHD, mobilization regimens, exposure to proteasome inhibitors, use of IMiDs, and class I human leukocyte antigen types (HLA A and B were collected. The HPC products were analyzed by flow cytometry for expression of CD3, CD4, CD8, CD25, CD56, and FoxP3. CD3+ cell number was significantly lower in autoGVHD patients compared to unaffected controls (P=0.047. On subset analysis of CD3+ cells, CD8+ cells (but not CD4+ cells were found to be significantly lower in patients with autoGVHD (P=0.038. HLA-B55 expression was significantly associated with development of autoGVHD (P=0.032. Lower percentages of CD3+ and CD8+ T-cells and HLA-B55 expression may be predisposing factors for developing autoGVHD in myeloma.
Autologous bone marrow-derived stem cells in amyotrophic lateral sclerosis: A pilot study
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Sudesh Prabhakar
Full Text Available Background: Amyotrophic lateral sclerosis (ALS is a neurodegenerative disorder with no effective treatment. Stem cell therapy may be one of the promising treatment options for such patients. Aim: To assess the feasibility, efficacy and safety of autologous bone marrow-derived stem cells in patients of ALS. Settings and Design: We conducted an open-label pilot study of autologous bone marrow-derived stem cells in patients with ALS attending the Neurology Clinic of a tertiary care referral centre. Materials and Methods: Ten patients with ALS with mean revised ALS Functional Rating Scale (ALSFRS-R score of 30.2 (┬▒ 10.58 at baseline received intrathecal autologous bone marrow-derived stem cells. Primary end point was improvement in the ALSFRS-R score at 90, 180, 270 and 365 days post therapy. Secondary endpoints included ALSFRS-R subscores, time to 4-point deterioration, median survival and reported adverse events. Paired t-test was used to compare changes in ALSFRS-R from baseline and Kaplan-Meier analysis was used for survival calculations. Results: There was no significant deterioration in ALSFRS-R composite score from baseline at one-year follow-up (P=0.090. The median survival post procedure was 18.0 months and median time to 4-point deterioration was 16.7 months. No significant adverse events were reported. Conclusion: Autologous bone marrow-derived stem cell therapy is safe and feasible in patients of ALS. Short-term follow-up of ALSFRS-R scores suggests a trend towards stabilization of disease. However, the benefit needs to be confirmed in the long-term follow-up period.
Obtention of injectable platelets rich-fibrin (i-PRF) and its polymerization with bone graft: technical note.
Mour├Żo, Carlos Fernando de Almeida Barros; Valiense, Helder; Melo, Elias Rodrigues; Mour├Żo, Nat├Īlia Belmock Mascarenhas Freitas; Maia, M├┤nica Diuana-Calasans
The use of autologous platelet concentrates, represent a promising and innovator tools in the medicine and dentistry today. The goal is to accelerate hard and soft tissue healing. Among them, the platelet-rich plasma (PRP) is the main alternative for use in liquid form (injectable). These injectable form of platelet concentrates are often used in regenerative procedures and demonstrate good results. The aim of this study is to present an alternative to these platelet concentrates using the platelet-rich fibrin in liquid form (injectable) and its use with particulated bone graft materials in the polymerized form.
Obtention of injectable platelets rich-fibrin (i-PRF and its polymerization with bone graft: technical note
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Carlos Fernando de Almeida Barros Mour├Żo
Full Text Available The use of autologous platelet concentrates, represent a promising and innovator tools in the medicine and dentistry today. The goal is to accelerate hard and soft tissue healing. Among them, the platelet-rich plasma (PRP is the main alternative for use in liquid form (injectable. These injectable form ofplatelet concentrates are often used in regenerative procedures and demonstrate good results. The aim of this study is to present an alternative to these platelet concentrates using the platelet-rich fibrin in liquid form (injectable and its use with particulated bone graft materials in the polymerized form.
Composite ceramic bone graft substitute in the treatment of locally aggressive benign bone tumours.
Schindler, O. S.; Cannon, S.R.; Briggs, T. W.; Blunn, G. W.
PURPOSE: To report the use of a composite ceramic bone graft substitute containing calcium sulphate and hydroxyapatite (HA) in the treatment of large expansive osteolytic benign bone tumours. METHODS: 4 women and 9 men aged 8 to 49 (mean, 22) years with aneurysmal bone cysts (n=6) or giant cell tumours (n=7) in the epi- or meta-physeal areas of the lower limbs underwent curettage, phenolisation, and filling with bone graft substitute containing calcium sulphate and HA. The mean tumour size wa...
Nostril Base Augmentation Effect of Alveolar Bone Graft
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Woojin Lee
Full Text Available Background The aims of alveolar bone grafting are closure of the fistula, stabilization ofthe maxillary arch, support for the roots of the teeth adjacent to the cleft on each side.We observed nostril base augmentation in patients with alveolar clefts after alveolar bonegrafting. The purpose of this study was to evaluate the nostril base augmentation effect ofsecondary alveolar bone grafting in patients with unilateral alveolar cleft.Methods Records of 15 children with alveolar clefts who underwent secondary alveolar bonegrafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 werereviewed. Preoperative and postoperative wormŌĆÖs-eye view photographs and reconstructedthree-dimensional computed tomography (CT scans were used for photogrammetry. Thedepression of the nostril base and thickness of the philtrum on the cleft side were measuredin comparison to the normal side. The depression of the cleft side pyriform aperture wasmeasured in comparison to the normal side on reconstructed three-dimensional CT.Results Significant changes were seen in the nostril base (P=0.005, the philtrum length(P=0.013, and the angle (P=0.006. The CT measurements showed significant changes in thepyriform aperture (P<0.001 and the angle (P<0.001.Conclusions An alveolar bone graft not only fills the gap in the alveolar process but alsoaugments the nostril base after surgery. In this study, only an alveolar bone graft was performedto prevent bias from other procedures. Nostril base augmentation can be achieved byperforming alveolar bone grafts in children, in whom invasive methods are not advised.
The Subfascial Approach to Primary and Secondary Breast Augmentation with Autologous Fat Grafting and Form-Stable Implants.
Sampaio Goes, Jo├Żo Carlos; Munhoz, Alexandre Mendon├¦a; Gemperli, Rolf
This article presents an overview of the subfascial approach to primary and secondary breast augmentation with form-stable implants associated with autologous fat grafting. Although breast augmentation is a well-studied procedure, there are few previous reports concerning the subfascial technique and, especially, this technique associated with lipofilling. Consequently, the authors present their experience with a form-stable, anatomically shaped silicone gel breast implant, which has recently been approved in the United States following FDA clinical trials. Primary and secondary breast augmentations using form-stable implants resulted in satisfactory outcomes.
Treatment of Infected Tibial Nonunion with Bone Defect Using Central Bone Grafting Technique
Gulan, Gordan; Jotanovi─ć, Zdravko; Jurdana, Hari; ┼Āestan, Branko; Rapan, Sa┼Īa; Rubini─ć, Du┼Īan; Ravli─ć-Gulan, Jagoda
Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaedic surgeon. Various methods of treatment have been described for nonunions with infection, bone loss or both. One of them is the central bone grafting technique, which is a safe and effective treatment for nonunions of the tibia. The technique involves placement of autogenous cancellous bone from the iliac crest on the anterior surface of the interosseous membrane with the aim of creating...
Tissue Engineering Bone Using Autologous Progenitor Cells in the Peritoneum
Jinhui Shen; Ashwin Nair; Ramesh Saxena; Cheng Cheng Zhang; Joseph Borrelli; Liping Tang
Despite intensive research efforts, there remains a need for novel methods to improve the ossification of scaffolds for bone tissue engineering. Based on a common phenomenon and known pathological conditions of peritoneal membrane ossification following peritoneal dialysis, we have explored the possibility of regenerating ossified tissue in the peritoneum. Interestingly, in addition to inflammatory cells, we discovered a large number of multipotent mesenchymal stem cells (MSCs) in the periton...
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Deepak P
Full Text Available BOHLER'S ANGLE: correlation with outcome in displaced intra-articular calcaneal fractures Treated with locking compression Plate Fixation with and without bone grafting. AIMS: The aim is an accurate reduction of the fracture with reconstruction of BohlerŌĆÖs angle, length and axis and sub talar joint surface. To determine whether autologous bone graft supplementation is beneficial in achieving and maintaining restoration of Calcaneal height and anatomic reduction. SETTINGS AND DESIGN: Level 1 trauma center, Prospective, randomized. METHODS AND MATERIAL: Consecutive 46 patients who had fracture calcaneum were treated by open reduction and internal fixation by locking plate with and without bone graft during the period from November 2009 to April 2012. STATISTICAL ANALYSIS USED: AOFAS-Ankle-Hind foot Scale, t Test. RESULTS: Fewer complications and statistically significant better results related to treatment with locking plates with bone grafting confirmed in comparison to without bone grafting ones were noted for intra-articular calcaneal fractures. In Group A the mean time for union was 10.39wks. The results were good and excellent in 86.95%, 8.69 % had fair result and 4.34% had poor results. In Group B the mean time for union was 11.95 wks. The overall results were good and excellent in 73.91%, 13.04 % had fair result and 13.04 % had poor results. CONCLUSIONS: The operative treatment of intra-articular calcaneal fractures could restore B├Čhler's angle better and the patient could return to full weight bearing earlier. We confirmed that autologous bone graft supplementation is beneficial in achieving and maintaining restoration of calcaneal height and anatomic reduction.
A Biological Pacemaker Restored by Autologous Transplantation of Bone Marrow Mesenchymal Stem Cells
Institute of Scientific and Technical Information of China (English)
REN Xiao-qing; PU Jie-lin; ZHANG Shu; MENG Liang; WANG Fang-zheng
Objective:To restore cardiac autonomic pace function by autologous transplantation and committed differentiation of bone marrow mesenchymal stem cells, and explore the technique for the treatment of sick sinus syndrome. Methods:Mesenchymal stem cells isolated from canine bone marrow were culture-expanded and differentiated in vitro by 5-azacytidine. The models of sick sinus syndrome in canines were established by ablating sinus node with radio-frequency technique. Differentiated mesenchymal stem cells labeled by BrdU were autologously transplanted into sinus node area through direct injection. The effects of autologous transplantation of mesenchymal stem cells on cardiac autonomic pace function in sick sinus syndrome models were evaluated by electrocardiography, pathologic and immunohistochemical staining technique.Results:There was distinct improvement on pace function of sick sinus syndrome animal models while differentiated mesenchymal stem cells were auto-transplanted into sinus node area. Mesenchymal stem cells transplanted in sinus node area were differentiated into similar sinus node cells and endothelial cells in vivo, and established gap junction with native cardiomyocytes. Conclusion:The committed-induced mesenchymal stem cells transplanted into sinus node area can differentiate into analogous sinus node cells and improve pace function in canine sick sinus syndrome models.
The Use Of Laser Irradiation To Stimulate Adipose Derived Stem Cell Proliferation And Differentiation For Use In Autologous Grafts
Abrahamse, Heidi
fluences on ADSC viability and proliferation. This paper reviews the development of MSCs as potential therapeutic interventions such as autologous grafts as well as the contribution of low intensity laser irradiation on the maintenance of these cells.
Successful repigmentation of vitiligo after allogeneic bone marrow transplantation for HodgkinŌĆ▓s lymphoma by autologous noncultured melanocyte-keratinocyte transplantation
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Huijuan Tang
Full Text Available The treatment of vitiligo is derisory since the pathogenesis of vitiligo is not clear at present. Most conservative treatments are difficult to approach satisfactory therapy. So transplantation is the only way left when the disease becomes insensitive to those conservative treatments. Here we describe an 18-year-old patient who developed vitiligo, which was triggered by graft-versus-host disease after a allogeneic bone marrow transplantation for the treatment of HodgkinŌĆ▓s lymphoma from his sister. In the following treatment to vitiligo, the patient successfully performed the transplantation of autologous uncultured melanocyte on the premise of poor reaction to other conservative methods. We infer that transplantation can be a treatment of the vitiligo after allogeneic bone marrow transplantation.
Press-fit Femoral Fixation in ACL Reconstruction using Bone-Patellar Tendon-Bone Graft
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Kaseb Mohammad Hasan
Full Text Available Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86 preoperatively and 91.88(73-100 at the latest follow up (P < 0.005. No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.
Bioreactor activated graft material for early implant fixation in bone
DEFF Research Database (Denmark)
Snoek Henriksen, Susan; Ding, Ming; Overgaard, S├Ėren
Introduction The combined incubation of a composite scaffold with bone marrow stromal cells in a perfusion bioreactor could make up a novel hybrid graft material with optimal properties for early fixation of implant to bone. The aim of this study was to create a bioreactor activated graft (BAG......) material, which could induce early implant fixation similar to that of allograft. Two porous scaffold materials incubated with cells in a perfusion bioreactor were tested in this study. Methods and Materials Two groups of 8 skeletally mature female sheep were anaesthetized before aspiration of bone marrow...... from the iliac crest. For both groups, mononuclear cells were isolated, and injected into a perfusion bioreactor (Millenium Biologix AG, Switzerland). Scaffold granules (├ś~900-1500 ┬Ąm, ~88% porosity) in group 1, consisted of hydroxyapatite (HA, 70%) with ╬▓-tricalcium-phosphate (╬▓-TCP, 30%) (Danish...
Autologous bone marrow stem cells--properties and advantages.
Rice, Claire M; Scolding, Neil J
The properties of self-renewal and multi-lineage differentiation make stem cells attractive candidates for use in cellular reparative therapy, particularly in neurological diseases where there is a paucity of treatment options. However, clinical trials using foetal material in Parkinson's disease have been disappointing and highlighted problems associated with the use of embryonic stem cells, including ethical issues and practical concerns regarding teratoma formation. Understandably, this has led investigators to explore alternative sources of stem cells for transplantation. The expression of neuroectodermal markers by cells of bone marrow origin focused attention on these adult stem cells. Although early enthusiasm has been tempered by dispute regarding the validity of reports of in vitro (trans)differentiation, the demonstration of functional benefit in animal models of neurological disease is encouraging. Here we will review some of the required properties of stem cells for use in transplantation therapy with specific reference to the development of bone marrow-derived cells as a source of cells for repair in demyelination. PMID:17669432
Bone marrow transplantation in miniature swine: I. Autologous and SLA matched allografts
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We developed a successful bone marrow transplant protocol in MHC-inbred miniature swine (MS). Three groups of MS were studied: irradiation controls, autologous bone marrow transplants and SLA matched bone marrow allografts. One day prior to irradiation, all animals underwent Hickman catheter placement via the external jugular vein. Bone marrow was harvested by direct mechanical removal of marrow from four long bones in Groups 2 and 3 one day prior to irradiation. All animals received 900 rads of midline body radiation from a Cobalt-60 source, were treated 1 g of cephalothin IV bid from day 1 to 14, 20 mg of genetamicin IV bid, from day 4 through 14 and 250 to 350 ml of fresh, irradiated whole blood from blood group identical donors on days 7, 11 and 14. Bone marrow was filtered, washed, stored overnight at 4 C and reinfused one to six hr after irradiation. Engraftment was defined by return of the peripheral WBC to 1000/mm3. All six animals in Group 1 died of aplasia between days 7 and 12. Marrow engrafted in eight of 12 animals in Group 2 and 7 of 10 animals in Group 3. This model provides a means to study the biological characteristics of bone marrow transplantation in immunologically well characterized large animals and should prove useful as a model for bone marrow transplants in man
Peri-Implant Tissue Findings in Bone Grafted Oral Cancer Patients Compared to non Bone Grafted Patients without Oral Cancer
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Jan Wolff
Full Text Available Objectives: The aim of this study was to compare microbiological, histological, and mechanical findings from tissues around osseointergrated dental implants in patients who had undergone tumour resection and subsequent bone grafting with non bone grafted patients without a history of oral cancer and to develop an effective tool for the monitoring of the peri-implant tissues. A third aim was to assess and compare the masticatory function of the two patient groups after reconstruction with dental implants.Material and Methods: A total of 20 patients were divided into 2 groups. The first group was edentulous and treated with dental implants without the need for bone grafting. The second edentulous group, with a history of oral cancer involving the mandible, received onlay bone grafts with concurrent placement of dental implants. Microbiological, histological, mechanical and biochemical assessment methods, crevicular fluid flow rate, hygiene-index, implant mobility, and the masticatory function were analysed and compared in both patient groups.Results: The microbiological examinations showed no evidence of the three most common pathogenic bacteria: Porphyromonas gingivalis, Prevotella intermedius, Actinobacillus actinomycetencomitans. A causal relationship between specific microbes and peri-implant inflammation could not be found. All biopsies in both patient groups revealed early signs of soft tissue peri-implant inflammation.Conclusions: The crevicular fluid volume and grade of gingival inflammation around the dental implants were related. Peri-implant tissue findings were similar in the two patient groups despite the history of oral cancer and the need for bone grafting at the time of dental implant placement.
Bone graft materials in fixation of orthopaedic implants in sheep.
Babiker, Hassan
Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include the risk of bacterial contamination and disease transmission as well as non-union and poor bone quality. Other bone graft and substitutes have been considered as alternative in order to improve implant fixation. Hydroxyapatite and collagen type I composite (HA/Collagen) have the potential in mimicking skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human bone and includes bone collagen, morphogenetic proteins and growth factors. The combination of DBM with CB and with allograft might improve the healing potential of these grafts around non-cemented orthopaedic implants and thereby the implant fixation. Study I investigates the effect of HA/Collagen composite alone and in combination with BMA on the early fixation of porous coated titanium implants. In addition, the study compares also the effect of autograft with the gold standard allograft. By using a sheep model, the implants were inserted in the trabecular bone of femoral condyles. The test biomaterials were placed in a well defined peri-implant gap. After the observation period, the bone-implant specimens were harvested and evaluated mechanically by a destructive push
Use of genetically modified muscle and fat grafts to repair defects in bone and cartilage
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CH Evans
Full Text Available We report a novel technology for the rapid healing of large osseous and chondral defects, based upon the genetic modification of autologous skeletal muscle and fat grafts. These tissues were selected because they not only possess mesenchymal progenitor cells and scaffolding properties, but also can be biopsied, genetically modified and returned to the patient in a single operative session. First generation adenovirus vector carrying cDNA encoding human bone morphogenetic protein-2 (Ad.BMP-2 was used for gene transfer to biopsies of muscle and fat. To assess bone healing, the genetically modified (ŌĆ£gene activatedŌĆØ tissues were implanted into 5mm-long critical size, mid-diaphyseal, stabilized defects in the femora of Fischer rats. Unlike control defects, those receiving gene-activated muscle underwent rapid healing, with evidence of radiologic bridging as early as 10 days after implantation and restoration of full mechanical strength by 8 weeks. Histologic analysis suggests that the grafts rapidly differentiated into cartilage, followed by efficient endochondral ossification. Fluorescence in situ hybridization detection of Y-chromosomes following the transfer of male donor muscle into female rats demonstrated that at least some of the osteoblasts of the healed bone were derived from donor muscle. Gene activated fat also healed critical sized defects, but less quickly than muscle and with more variability. Anti-adenovirus antibodies were not detected. Pilot studies in a rabbit osteochondral defect model demonstrated the promise of this technology for healing cartilage defects. Further development of these methods should provide ways to heal bone and cartilage more expeditiously, and at lower cost, than is presently possible.
Efficacy of PRP in the Reconstruction of Mandibular Segmental Defects Using Iliac Bone Grafts
Magesh, D. P. Uma; Kumaravelu, C.; Maheshwari, G. Uma
This retrospective study was conducted to evaluate the role of platelet-rich plasma (PRP) in the reconstruction of segmental mandibular defects using iliac bone grafts. Thirteen patients underwent reconstruction of post-resection segmental defects of the mandible using titanium reconstruction plates, cortico cancellous iliac bone graft. The patients were randomly separated into two groups. One group of the patients received a PRP graft in addition to the iliac bone graft. Post-operative dimen...
Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas
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Petersen, Michael M├Ėrk; Hovgaard, Dorrit; Elberg, Jens J├Ėrgen;
We evaluated the results of limb-sparing surgery and reconstruction of bone defects with vascularized fibula grafts in 8 consecutive patients (mean age at operation 13.6 years (range 4.1-24.2 years), female/male = 6/2) with bone sarcomas (BS) (osteosarcoma/Ewing's sarcoma/chondrosarcoma= 4...... (n = 2), and hip dislocation (n = 1). Limb-sparing surgery with reconstruction of bone defects using vascularized fibular grafts in BS cases is feasible with acceptable clinical results, but fractures should be expected in many patients....
The autologous bone marrow mononuclear cell transplantation by intracoronary route treat patients with severe heart failure after myocardial infarction
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Objective To investigate the chronic effects of intracoronary autologous bone marrow mononuclear cell (BM-MNCs) transplantation in patients with refractory heart failure (RIHF) after myocardial infarction. Methods Thirty patients with RIHF (LVEF<40%) were enrolled in this nonrandomized study, autologous BM-MNCs (5.0┬▒0.7)├Ś107 were transplanted with via infarct-related coronary artery in 16 patients and 14 patients received
Autologous bone marrow cell therapy for peripheral arterial disease
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Botti C
Full Text Available C Botti, C Maione, A Coppola, V Sica, G CobellisDepartment of General Pathology, Second University of Naples, Naples, ItalyAbstract: Inadequate blood supply to tissues caused by obstruction of arterioles and/or capillaries results in ischemic injuries ŌĆō these injuries can range from mild (eg, leg ischemia to severe conditions (eg, myocardial infarction, stroke. Surgical and/or endovascular procedures provide cutting-edge treatment for patients with vascular disorders; however, a high percentage of patients are currently not treatable, owing to high operative risk or unfavorable vascular involvement. Therapeutic angiogenesis has recently emerged as a promising new therapy, promoting the formation of new blood vessels by the introduction of bone marrowŌĆōderived stem and progenitor cells. These cells participate in the development of new blood vessels, the enlargement of existing blood vessels, and sprouting new capillaries from existing blood vessels, providing evidence of the therapeutic utility of these cells in ischemic tissues. In this review, the authors describe peripheral arterial disease, an ischemic condition affecting the lower extremities, summarizing different aspects of vascular regeneration and discussing which and how stem cells restore the blood flow. The authors also present an overview of encouraging results from early-phase clinical trials using stem cells to treat peripheral arterial disease. The authors believe that additional research initiatives should be undertaken to better identify the nature of stem cells and that an intensive cooperation between laboratory and clinical investigators is needed to optimize the design of cell therapy trials and to maximize their scientific rigor. Only this will allow the results of these investigations to develop best clinical practices. Additionally, although a number of stem cell therapies exist, many treatments are performed outside international and national regulations and many
Autologous bone marrow stem cell intralesional transplantation repairing bisphosphonate related osteonecrosis of the jaw
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Cella Luigi
Full Text Available Abstract Purpose Bisphosphonate - related osteonecrosis of the JAW (BRONJ is a well known side effect of bisphosphonate therapies in oncologic and non oncologic patients. Since to date no definitive consensus has been reached on the treatment of BRONJ, novel strategies for the prevention, risk reduction and treatment need to be developed. We report a 75 year old woman with stage 3 BRONJ secondary to alendronate and pamidronate treatment of osteoporosis. The patient was unresponsive to recommended treatment of the disease, and her BRONJ was worsening. Since bone marrow stem cells are know as being multipotent and exhibit the potential for differentiation into different cells/tissue lineages, including cartilage, bone and other tissue, we performed autologous bone marrow stem cell transplantation into the BRONJ lesion of the patient. Methods Under local anesthesia a volume of 75 ml of bone marrow were harvested from the posterior superior iliac crest by aspiration into heparinized siringes. The cell suspension was concentrated, using Ficoll - Hypaque® centrifugation procedures, in a final volume of 6 ml. Before the injection of stem cells into the osteonecrosis, the patient underwent surgical toilet, local anesthesia was done and spongostan was applied as a carrier of stem cells suspension in the bone cavity, then 4 ml of stem cells suspension and 1 ml of patient's activated platelet-rich plasma were injected in the lesion of BRONJ. Results A week later the residual spongostan was removed and two weeks later resolution of symptoms was obtained. Then the lesion improved with progressive superficialization of the mucosal layer and CT scan, performed 15 months later, shows improvement also of bone via concentric ossification: so complete healing of BRONJ (stage 0 was obtained in our patient, and 30 months later the patient is well and without signs of BRONJ. Conclusion To our knowledge this is the first case of BRONJ successfully treated with
Conditioning with total body irradiation for autologous bone marrow transplantation in patients with advanced neuroblastoma
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We administered a combination of chemotherapy, autologous bone marrow purged with magnet immunobeads and total body irradiation (TBI) for advanced neuroblastoma (NB). The effect of TBI was retrospectively studied with regard to hematological recovery and complications after autologous bone marrow transplantation (A-BMT). The bone marrow was engrafted in all patients, both recipients and non-recipients of TBI. In patients receiving TBI, the average number or days after A-BMT required for the white blood cell count to exceed 1,000/╬╝l, the neutrophile count to exceed 500/╬╝l and the platelet count to exceed 5.0 x 104/╬╝l was 15.0┬▒6.5, 16.0┬▒6.4 and 59.7┬▒24.4, respectively. In patients not receiving TBI, the corresponding figures were 12.2┬▒6.2, 12.9┬▒6.9 and 43.2┬▒17.8 days, respectively. During hematological recovery after A-BMT, there was no statistical difference between patients having received TBI and those who did not receive TBI. Hemolytic uremic syndrome (HUS) was observed in four patients while receiving TBI, but no HUS developed after shielding the kidney from TBI. In terms or engraftment and complications, A-BMT can be performed on patients receiving TBI as safely as on those patients not receiving TBI. (author)
Autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia
Institute of Scientific and Technical Information of China (English)
Lu Debin; Jiang Youzhao; Liang Ziwen; Li Xiaoyan; Zhang Zhonghui; Chen Bing
Objective: To study the efficacy and safety of autologous transplantation of bone marrow mesenchymal stem cells on diabetic patients with lower limb ischemia. Methods: Fifty Type 2 diabetic patients with lower limb ischemia were enrolled and randomized to either transplanted group or control group. Patients in both group received the same conventional treatment. Meanwhile, 20 ml bone marrow from each transplanted patient were collected, and the mesenchymal stem cells were separated by density gradient centrifugation and cultured in the medium with autologous serum. After three-weeks adherent culture in vitro, 7.32├Ś108-5.61├Ś109 mesenchymal stern cells were harvested and transplanted by multiple intramuscular and hypodermic injections into the impaired lower limbs. Results: At the end of 12-week follow-up, 5 patients were excluded from this study because of clinical worsening or failure of cell culture. Main ischemic symptoms, including rest pain and intermittent claudication, were improved significantly in transplanted patients. The ulcer healing rate of the transplanted group (15 of 18, 83.33%) was significantly higher than that of the control group (9 of 20, 45.00%, P=0.012).The mean of resting ankle-brachial index (ABI) in transplanted group significantly was increased from 0.61┬▒0.09 to 0.74┬▒0.11 (P<0.001). Magnetic resonance angiography (MRA) demonstrated that there were more patients whose score of new vessels exceeded or equaled to 2 in the transplant patients (11 of 15) than in control patients (2 of 14, P=0.001). Lower limb amputation rate was significantly lower in transplanted group than in the control group (P=0.040). No adverse effects was observed in transplanted group. Conclusion: These results indicate that the autologous transplantation of bone marrow mesenehymal stem cells relieves critical lower limb ischemia and promotes ulcers healing in Type 2 diabetic patients.
Our experience of application of Autologous Bone Marrow Stem Cells in critical limb ischemia in six diabetic patients ŌĆō A five-year follow-up
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Subrammaniyan R
Full Text Available Background: Numerous Clinical studies have reported the safety and efficacy of injection of one Marrow and Peripheral Blood Mononuclear cells in patients with lower limb ischemia. Earlier we have reported the six months follow-up of successful application of autologous bone marrow mononuclear cells in patients with Fontaine Stage IV critical limb ischemia due to diabetes. As a continuation of the previous study, herein we report the long term results of the six patients after a follow-up for five years.Materials and Methods: Six Diabetic patients with Fontaine Stage IV critical limb ischemia with ulcers were given intra-lesional injections of their autologous bone marrow mononuclear cells (BMMNC, isolated following the cGMP protocols. The patients have been followed up at regular intervals for five years after the treatment with all relevant clinical investigations. Results: Six months follow-up results revealed that all the patients showed improvements with appearance of healthy granulation tissue and uniform revascularization. Complete healing was reported at a mean duration of nine months in five patients and one patient died due to a complication of renal failure, peritoneal dialysis and cardiac failure, which were unrelated to the BMMNC injection. Five year continuous follow-up revealed that the healed tissue with or without skin grafting remained healthy in all the five patients and two of the patients are able to walk without support with a pain free walking distance of greater than 100m.There were no adverse effects in any of the patients. Conclusion: Autologous bone marrow stem cell therapy has been found to be salvaging the affected limb in patients with Fontaine Stage IV Critical Limb ischemia patients where revascularization was not feasible. Hence with our experience of six patients we recommend that the same should be considered in patients of similar clinical parameters before considering an amputation.
Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia
Institute of Scientific and Technical Information of China (English)
GU Yong-quan; LI Xue-feng; YU Heng-xi; CUI Shi-jun; WANG Zhong-gao; ZHANG Jian; GUO Lian-rui; QI Li-xing; ZHANG Shu-wen; XU Juan; LI Jian-xin; LUO Tao; JI Bing-xin
Background Many treatment options for lower limb ischemia are difficult to apply for the patients with poor arterial outflow or with poor general conditions.The effect of medical treatment alone is far from ideal.especially in patients with diabetic foot.A high level amputation is inevitable in these patients.This study aimed to explore the effect of transplantation of autologous bone marrow mononuclear cells on the treatment of lower limb ischemia and to compare the effect of intra-artedal transplantation with that of intra-muscular transplantation.Methods In this clinical trial,32 patients with lower limb ischemia were divided into two groups.Group 1 (16 patients with 18 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs;and group 2(16 patients with 17 affected limbs)received transplantation of autologous bone marrow mononucJear cells by intra-arterial injection into the affected limbs.Rest pain,coldness,ankle/brachial index (ABI),claudication,transcutaneous oxygen pressure(tcPO2)and angiography(15 limbs of 14 patients)were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment.Results Two patients died from heart failure.The improvement of rest pain was seen in 76.5%(13/17)of group 1 and 93.3%(14/15)of group 2.The improvement of coldness was 100%in both groups.The increase of ABI was 44.4%(8/18)in group 1 and 41.2%(7,17)in group 2.The value of tcPO2 increased to 20 mmHg or more in 20 limbs.Nine of 15 limbs which underwent angiography showed rich collaterals.Limb salvage rate was 83.3%(15,18)in group 1 and 94.1%(16/17)in group 2.There was no statistically significant difference in the effectiveness of the treatment between the two groups.Conclusions Transplantation of autologous bone marrow mononucJear cells is a simple,safe and effective method for the treatment of lower limb ischemia,and the two approaches for the implantation
Our Experience with Autologous Bone Marrow Stem Cell Application in Dilated Cardiomyopathy
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Mukund K
Full Text Available Background - Use of autologous bone marrow stem cell is a newly evolving treatment modality for end stage cardiac failure as reported in the literature. We report our experience with two patients with dilated cardiomyopathy who underwent this treatment after failure of maximal conventional therapy. Methods - A 29 year old Male patient with history of orthopnea and PND, with a diagnosis of dilated cardiomyopathy and echocardiographic evidence of severe LV dysfunction was referred for further treatment. His echo on admission showed EF of 17% and no other abnormal findings except elevated bilirubin levels. He was in NYHA functional class IV. He received intracoronary injection of autologous bone marrow stem cells in January 2009. 254X106 cells were injected with a CD34+ of 0.20%. His clinical condition stabilized and he was discharged home. He received a second injection of 22X106 in vitro expanded stem cells with a CD34+ of 0.72% in Aug 2009. He is now in NYHA class II-III with EF 24%. A 31year old Male patient with history of increasing shortness of breath, severe over the past 3-4 days was admitted for evaluation and treatment. His echo on admission showed EF of 20% and was in NYHA functional class IV. Coronary angiogram was normal and he was stabilized on maximal anti failure measures. He received intracoronary autologous bone marrow stem cell injection of 56X106 with a CD34+ of 0.53% in August 2009. His clinical condition stabilized over the next 10 days and he was discharged home. Conclusions - In our experience of two cases of dilated cardiomyopathy, safety of intracoronary injection of autologous bone marrow stem cells both isolated and in vitro expanded has been proven in both the cases with efficacy proven in one of the cases. Long term follow-up of these two cases and inclusion of more number of similar cases where all available conventional therapies have not resulted in significant improvement for such studies are planned.
A Novel Method of Orbital Floor Reconstruction Using Virtual Planning, 3-Dimensional Printing, and Autologous Bone.
Vehmeijer, Maarten; van Eijnatten, Maureen; Liberton, Niels; Wolff, Jan
Fractures of the orbital floor are often a result of traffic accidents or interpersonal violence. To date, numerous materials and methods have been used to reconstruct the orbital floor. However, simple and cost-effective 3-dimensional (3D) printing technologies for the treatment of orbital floor fractures are still sought. This study describes a simple, precise, cost-effective method of treating orbital fractures using 3D printing technologies in combination with autologous bone. Enophthalmos and diplopia developed in a 64-year-old female patient with an orbital floor fracture. A virtual 3D model of the fracture site was generated from computed tomography images of the patient. The fracture was virtually closed using spline interpolation. Furthermore, a virtual individualized mold of the defect site was created, which was manufactured using an inkjet printer. The tangible mold was subsequently used during surgery to sculpture an individualized autologous orbital floor implant. Virtual reconstruction of the orbital floor and the resulting mold enhanced the overall accuracy and efficiency of the surgical procedure. The sculptured autologous orbital floor implant showed an excellent fit in┬Āvivo. The combination of virtual planning and 3D printing offers an accurate and cost-effective treatment method for orbital floor fractures. PMID:27137437
A Novel Method of Orbital Floor Reconstruction Using Virtual Planning, 3-Dimensional Printing, and Autologous Bone.
Vehmeijer, Maarten; van Eijnatten, Maureen; Liberton, Niels; Wolff, Jan
Fractures of the orbital floor are often a result of traffic accidents or interpersonal violence. To date, numerous materials and methods have been used to reconstruct the orbital floor. However, simple and cost-effective 3-dimensional (3D) printing technologies for the treatment of orbital floor fractures are still sought. This study describes a simple, precise, cost-effective method of treating orbital fractures using 3D printing technologies in combination with autologous bone. Enophthalmos and diplopia developed in a 64-year-old female patient with an orbital floor fracture. A virtual 3D model of the fracture site was generated from computed tomography images of the patient. The fracture was virtually closed using spline interpolation. Furthermore, a virtual individualized mold of the defect site was created, which was manufactured using an inkjet printer. The tangible mold was subsequently used during surgery to sculpture an individualized autologous orbital floor implant. Virtual reconstruction of the orbital floor and the resulting mold enhanced the overall accuracy and efficiency of the surgical procedure. The sculptured autologous orbital floor implant showed an excellent fit in┬Āvivo. The combination of virtual planning and 3D printing offers an accurate and cost-effective treatment method for orbital floor fractures.
Effects of pre- and postoperative irradiation on the healing of bone grafts in the rabbit
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Healing of cellular bone grafts irradiated at various times in the postsurgical course was compared to the healing characteristics of bone grafts placed into already irradiated tissue and to controls of irradiated host mandible in a rabbit model. Physical graft consolidation was assessed by load stress characteristics and serial histologic examination. Results indicated that grafts placed into already irradiated tissues failed to form bone in both phases of expected regeneration resulting in structurally weakened and histologically deficient ossicles. Bone grafts irradiated after placement were tolerant of irradiation. Bone grafts irradiated after four weeks were found to be less affected by irradiation than those irradiated within the first four weeks, forming an ossicle structurally and histologically superior to that of bone ossicles developed from grafts placed into irradiated tissues
Segment distraction to reduce a wide alveolar cleft before alveolar bone grafting.
Binger, T.; Katsaros, C.; Rucker, M.; Spitzer, W.J.
OBJECTIVE: To demonstrate a method for reduction of wide alveolar clefts prior to bone grafting. This method aims to facilitate bone grafting and achieve adequate soft tissue coverage of the graft with attached gingiva. CASE REPORT: Treatment of a patient with bilateral cleft lip and palate with a s
Differences in heat sensitivity between normal and acute myeloid leukemic stem cells : Feasibility of hyperthermic purging of leukemic cells from autologous stem cell grafts
Wierenga, PK; Setroikromo, R; Kamps, G; Kampinga, HH; Vellenga, E
Objectives. In autologous stem cell transplantation contamination of the graft with malignant cells is frequently noticed and necessitates the use of in vivo or in vitro purging modalities. The hematopoietic recovery after transplantation depends on the number of stem and progenitor cells in the tra
A new double bone-double bundle patellar tendon-bone graft model: A calf model study
Ûztürk, Hayati; Ûztemur, Zekeriya; Bulut, Okay; Tezeren, Seyfi Gündüz
AbstractThe aim of this study is to improve a new graft model for anatomic double bundle Anterior Crucial Ligament reconstruction (ACL). The aim of ACL reconstruction is to reproduce the functions of the native ACL. An anatomic double bundle ACL reconstruction utilizes two separate grafts to replace the Anterior Medial (AM) and Posterior Lateral (PL) bundles of the ACL. Bone-Patellar Tendon-Bone (BPTB) Graft was harvested from calf knee. Patellar tendon and distal bone were split as longitudi...
Dose escalation of consolidation radiation therapy (involved field) following autologous bone marrow transplant for recurrent Hodgkin's disease and lymphoma
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post-AT IFRT is 70% vs 35% respectively and for the subgroup with large disease burden it is 65% vs 15%. The 2 year EFS for HD patients treated with or without post-AT IFRT is 60% vs 45%, respectively and for the subgroup with large disease burden it is 25% vs 10%. Approximately 50% of patients with an identifiable abnormality on CT scan, presumably representing residual disease demonstrated a response to 30 Gy RT and were boosted. Only a single irradiated patient experienced significant RT-related toxicity, pneumonitis complicated by pneumcystis, and none experienced graft failure. No irradiated patients experienced graft failure or severe RT-related toxicity. The 2 year EFS rate for NHL patients with 2 cm disease at AT is 50% vs 35% and for HD it is 65% vs 20%. Conclusions: NHL patients with large disease burden treated with post-AT IFRT may experience an improved EFS compared with those not irradiated. A benefit for other patients is clearly demonstrated at this time but patient follow-up is continuing. The observation that some patients with clinical or radiographic evidence of disease show a response to IFRT suggests that at least some of these patients would have progressed if not given RT. For both NHL and HD, disease burden at the time of transplant is an important predictor of EFS. These results support the benefit of consolidative involved field radiation therapy following autologous bone marrow transplant for relapsed/recurrent NHL/HD, and are the basis for a clinical trial currently being conducted at this center
The graft of autologous adipose-derived stem cells in the corneal stromal after mechanic damage.
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Xiao-Yun Ma
Full Text Available This study was designed to explore the feasibility of using autologous rabbit adipose derived stem cells (rASCs as seed cells and polylactic-co-glycolic acid (PLGA as a scaffold for repairing corneal stromal defects. rASCs isolated from rabbit nape adipose tissue were expanded and seeded on a PLGA scaffold to fabricate cell-scaffold constructs. After 1 week of cultivation in vitro, the cell-scaffold complexes were transplanted into corneal stromal defects in rabbits. In vivo, the autologous rASCs-PLGA constructed corneal stroma gradually became transparent without corneal neovascularization after 12 weeks. Hematoxylin and eosin staining and transmission electron microscopy examination revealed that their histological structure and collagen fibril distribution at 24 weeks after implantation were similar to native counterparts. As to the defect treated with PLGA alone, the stromal defects remained. And scar tissue was observed in the untreated-group. The implanted autologous ASCs survived up to 24 weeks post-transplantation and differentiated into functional keratocytes, as assessed by the expression of aldehyde-3-dehydrogenase1A1 (ALDH1A1 and cornea-specific proteoglycan keratocan. Our results revealed that autologous rASCs could be one of the cell sources for corneal stromal restoration in diseased corneas or for tissue engineering of a corneal equivalent.
Flap revascularization in patients following immediate reconstruction using an autologous free dermal fat graft for breast cancer: a report of two cases.
Shima, Hiroaki; Kutomi, Goro; Kyuno, Takuro; Satomi, Fukino; Uno, Satoko; Maeda, Hideki; Kameshima, Hidekazu; Omura, Tosei; Kimura, Yasutoshi; Mizuguchi, Toru; Hirata, Koichi; Takemasa, Ichiro
It has been reported that use of the free dermal fat graft (FDFG) technique produces a good cosmetic outcome for breast cancer. An FDFG is harvested from the lower abdomen as a columnar-shaped specimen and implanted into the defect of the breast after a partial mastectomy as a volume replacement technique. In this report, two patients who underwent breast-conserving surgery with immediate reconstruction using an autologous FDFG are described in order to show the difference in status between one case with and one without blood flow in the graft. To assess the benefit of this technique using FDFGs, their cosmetic satisfaction was evaluated using a questionnaire, graft shrinkage was measured by CT, and blood flow was assessed using contrast-enhanced ultrasound (CEUS). Both patients scored 10 of 12 points on the questionnaire. After 2┬Āyears, shrinkage of the grafts was 21.6 and 25.2┬Ā%, respectively. Although one patient had no blood flow in the center of the graft, the other had blood flow from the pectoralis major muscle to the center of the graft. While satisfaction and graft shrinkage were similar in the two patients, one case showed blood flow and had a somewhat softer graft than the other. The graft status was maintained with a good cosmetic outcome for 3┬Āyears after breast-conserving surgery with immediate reconstruction using an autologous FDFG, despite mild shrinkage and hardness of the graft. It is notable that blood flow was observed into the graft on CEUS, and more distinct perfusion was seen in the softer graft case after more than 3┬Āyears. PMID:27256332
Circulation, bone scans, and tetracycline labeling in microvascularized and vascular bundle implanted rib grafts
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The circulation in microvascularized rib grafts has been compared with that in conventional rib grafts and in those augmented by a direct vascular bundle implantation into the bone grafts. A new experimental model has been designed to correlate vascular perfusion, bone scan patterns, tetracycline labeling, and histological findings in these bone grafts. Posterior microvascularized rib grafts were found to have a circulatory pattern identical to that of the normal rib. Failed microvascularized rib grafts were revascularized more slowly than conventional rib grafts. Vascular bundles implanted into rib grafts remained patent and increased the rate of revascularization. The stripping or preservation of periosteum had no observable effects on the rate or pattern of conventional rib graft revascularization. The circulation in rib grafts was accurately reflected in technetium 99 bone scans, as was the patency of the anastomoses of microvascularized rib grafts and of implanted vascular bundles. In contrast, tetracycline labeling was repeatedly observed in avascular areas of bone grafts and, therefore, is not a reliable indicator of bone graft circulation
Local treatment of a bone graft by soaking in zoledronic acid inhibits bone resorption and bone formation. A bone chamber study in rats
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Belfrage Ola
Full Text Available Abstract Background Bone grafts are frequently used in orthopaedic surgery. Graft remodelling is advantageous but can occur too quickly, and premature bone resorption might lead to decreased mechanical integrity of the graft. Bisphosphonates delay osteoclastic bone resorption but may also impair formation of new bone. We hypothesize that these effects are dose dependent. In the present study we evaluate different ways of applying bisphosphonates locally to the graft in a bone chamber model, and compare that with systemic treatment. Methods Cancellous bone grafts were placed in titanium chambers and implanted in the tibia of 50 male rats, randomly divided into five groups. The first group served as negative control and the grafts were rinsed in saline before implantation. In the second and third groups, the grafts were soaked in a zoledronic acid solution (0.5 mg/ml for 5 seconds and 10 minutes respectively before being rinsed in saline. In the fourth group, 8 ╬╝L of zoledronic acid solution (0.5 mg/ml was pipetted onto the freeze-dried grafts without rinsing. The fifth group served as positive control and the rats were given zoledronic acid (0.1 mg/kg systemically as a single injection two weeks after surgery. The grafts were harvested at 6 weeks and analysed with histomorphometry, evaluating the ingrowth distance of new bone into the graft as an equivalent to the anabolic osteoblast effect and the amount (bone volume/total volume; BV/TV of remaining bone in the remodelled graft as equivalent to the catabolic osteoclast effect. Results In all chambers, almost the entire graft had been revascularized but only partly remodelled at harvest. The ingrowth distance of new bone into the graft was lower in grafts soaked in zoledronic acid for 10 minutes compared to control (p = 0.007. In all groups receiving zoledronic acid, the BV/TV was higher compared to control. Conclusions This study found a strong inhibitory effect on bone resorption by
Remo├¦├Żo da cartilagem articular associada ou n├Żo a implante hom├│geno ou enxerto aut├│geno de osso esponjoso em c├Żes submetidos ├Ā artrodese atlantoaxial Joint cartilage removal associated or not to homologous implant or autologous cancellous bone graft in dogs submitted to atlantoaxial arthrodesis
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Rafael Festugatto
same amount. Group III (GIII: this was the same procedure as GI, however, was used autogenous cancellous bone graft at the given location. Radiographic examinations were performed on all animals at 30, 60 and 90 days postoperatively. At 90 days of PO was carried out euthanasia of animals for testing of manual palpation and CT evaluation and histological. Samples were kept in solution in 10% buffered formaldehyde for fixation for a minimum of 72 hours and after, decalcified in formic acid and sodium citrate for subsequent processing and included in paraffin. Sections were stained with hematoxylin-eosin for light microscopy evaluation. Statistical analysis of the association between the degree of joint fusion assessed by manual palpation, the digitized radiographic images and CT scans and treatment groups, we applied the Chi-square test of independence. The test results were evaluated by the exact significance and considered statistically significant at 5% significance (P<0.05. By manual palpation test and by the CT images can be seen that there was no statistically significant difference between groups at 90 days postoperatively. Radiographic analysis of the atlantoaxial joint showed that the degree of fusion was similar among treatments, no statistical difference at 30, 60 and 90 days postoperatively. Regarding the histopathological study of atlantoaxial joint of dogs after 90 days postoperatively was found that bone formation in group I had 25% of each intensity (absent, mild, moderate, severe in group II, 75% lighter and 25% sharp and in group III, 25% moderate and 75% severe. It can be concluded that the use of graft homogenous preserved in 98% glycerin in dogs undergoing atlantoaxial fusion method is a viable alternative for treatment of atlantoaxial instability. There is no difference in the degree of joint fusion and bone formation when the technique of atlantoaxial arthrodesis in dogs is associated with autogenous cancellous bone graft or implant homogenous. The
In vitro fabrication of autologous living tissue-engineered vascular grafts based on prenatally harvested ovine amniotic fluid-derived stem cells.
Weber, Benedikt; Kehl, Debora; Bleul, Ulrich; Behr, Luc; Sammut, S├®bastien; Frese, Laura; Ksiazek, Agnieszka; Achermann, Josef; Stranzinger, Gerald; Robert, J├®r├┤me; Sanders, Bart; Sidler, Michele; Brokopp, Chad E; Proulx, Steven T; Frauenfelder, Thomas; Schoenauer, Roman; Emmert, Maximilian Y; Falk, Volkmar; Hoerstrup, Simon P
Amniotic fluid cells (AFCs) have been proposed as a valuable source for tissue engineering and regenerative medicine. However, before clinical implementation, rigorous evaluation of this cell source in clinically relevant animal models accepted by regulatory authorities is indispensable. Today, the ovine model represents one of the most accepted preclinical animal models, in particular for cardiovascular applications. Here, we investigate the isolation and use of autologous ovine AFCs as cell source for cardiovascular tissue engineering applications. Fetal fluids were aspirated in vivo from pregnant ewes (nŌĆē=ŌĆē9) and from explanted uteri post mortem at different gestational ages (nŌĆē=ŌĆē91). Amniotic non-allantoic fluid nature was evaluated biochemically and in vivo samples were compared with post mortem reference samples. Isolated cells revealed an immunohistochemical phenotype similar to ovine bone marrow-derived mesenchymal stem cells (MSCs) and showed expression of stem cell factors described for embryonic stem cells, such as NANOG and STAT-3. Isolated ovine amniotic fluid-derived MSCs were screened for numeric chromosomal aberrations and successfully differentiated into several mesodermal phenotypes. Myofibroblastic ovine AFC lineages were then successfully used for the in vitro fabrication of small- and large-diameter tissue-engineered vascular grafts (nŌĆē=ŌĆē10) and cardiovascular patches (nŌĆē=ŌĆē34), laying the foundation for the use of this relevant pre-clinical in vivo assessment model for future amniotic fluid cell-based therapeutic applications.
Anterior Lumbar Intervertebrai Fusion with Artificial Bone in Place of Autologous Bone
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ÕŠÉÕŹ½ÕøĮ; ķÖłÕ«ēµ░æ; Õ廵ŚŁ; ÕŹ░ÕŹ½ķöŗ
The feasibility of anterior lumbar intervertebral fusion with artificial bone in place of au-togenous bone was investigated. Porous hydroxyapatite(HA)/ZrO2 ceramics loading bone morpho-genetic protein (BMP) were implanted after removal of lumbar vertebral disc in rabbits. The adja-cent intervertebral discs were also removed by the same way and autogenous illic bone was implan-ted. SEM observation and biomechanical test were carried out. Compound bone had a bit lower os-teoinductive activity than autogenous bone by SEM(Osteoindutive activity of artificial bone in 12weeks was the same as that of autogenous bone in 9 weeks). Biomechanical test revealed that com-pound bone had lower anti-pull strength than autogenous bone (P'╝£0. 001), but there was no sig-nificant difference in anti-pull strength between compound bone at 12th week and autogenous boneat 9th week (P'╝×0.05). It was concluded that compound bone could be applied for anterior spinalfusion, especially for those patients who can't use autogenous bone.
Treatment of a Refractory Skin Ulcer Using Punch Graft and Autologous Platelet-Rich Plasma
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Mauro Carducci
Full Text Available Background. Chronic ulceration of the lower legs is a relatively common condition amongst adults: one that causes pain and social distress and results in considerable healthcare and personal costs. The technique of punch grafting offers an alternative approach to the treatment of ulcers of the lower limbs. Objective. Combining platelet-rich plasma and skin graft enhances the efficacy of treating chronic diabetic wounds by enhancing healing rate and decreasing recurrence rate. Platelet-rich plasma could, by stimulating dermal regeneration, increase the take rate after skin grafting or speed up reepithelialization. Methods and Materials. The ulcer was prepared by removing fibrin with a curette and the edges of the ulcer were freshened. The platelet-rich plasma has been infiltrated on the bottom and edges of the ulcer. The punch grafts were placed in 5ŌĆēmm holes arranged. The ulcer was medicated with hydrogel and a pressure dressing was removed after 8 days. Results. After a few days the patient did not report more pain. Granulation tissue appeared quickly between implants. Most of the grafts were viable in 2-3 weeks. The grafts gradually came together to close the ulcer and were completed in four months.
Single-blinded prospective randomized study comparing open versus needle technique for obtaining autologous cancellous bone from the iliac crest.
Bartels, R.H.M.A.
One of the most frequent complications of cervical anterior discectomy with fusion is pain at the donor site, usually the iliac crest. Despite the advent of new materials, autologous bone is still the "gold standard" for fusion procedures. A prospective, single blinded, randomized study was performe
Bone formation by autogenous grafting of cultured bone/porous ceramic constructs in a dog
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Iida, J.; Ueda, Y.; Ohgushi, H.; Takakura, Y. [Nara Medical Univ., Kashihara (Japan). Dept. of Orthopedic Surgery; Yoshikawa, T. [Nara Medical Univ., Kashihara (Japan). Dept. of Orthopedic Surgery; Nara Medical Univ., Kashihara (Japan). Dept. of Phathology; Uemura, T.; Tateishi, T. [National Inst. for Advanced Interdisciplinary Research (NAIR), Ibaraki (Japan). Tsukuba Research Center; Enomoto, Y.; Ichijima, K. [Nara Medical Univ., Kashihara (Japan). Dept. of Phathology
Five ml of bone marrow was collected from the humerus of a 6 month old female dog by needle aspiration. The marrow was cultured in T-75 flask and expand the marrow mesenchymal cells. After 1 week in primary culture, cells were released by trypsin treatment, concentrated and loaded onto porous hydroxyapatite (HA) blocks. The marrow/HA constructs were subcultured in the presence of dexamethasone and beta-glycerophosphate (osteogenic medium). After 2 weeks of subculture, the autogenous cultured bone/HA constructs were subcutaneously implanted into the back of the dog. Histological findings of the constructs at 3 weeks after implantation revealed thick layer of lamellar bone together with active osteoblasts lining in many pore areas of the HA. High alkaline phosphatase activity could be detected in the construct. These results indicate that autogenous cultured bone/HA constructs can produce extensive bone formation after implantation in a large animal(dog). Therefore, based upon the fact that human marrow-derived culture bone/HA construct possesses osteogenic potential when it is grafted into nude mice, it can be expected that autogenous human cultured bone/ceramic grafts may be useful to reconstruct bone in the clinical setting. (orig.)
Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients
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Christian Hendrich
tumor formation, as well as no morbidity due to the bone marrow aspiration from the iliac crest were seen. There were no specific complications within the short follow-up period and a simple intra-operative use of the system for different forms of bone loss could be demonstrated. In the authorsŌĆÖ opinion, the on-site preparation of the bone marrow cells within the operating theater eliminates the specific risk of ex vivo cell proliferation and has a safety advantage in the use of autologous cell therapy for bone regeneration. Additional studies should be completed to determine efficacy.
No effect of Osteoset, a bone graft substitute, on bone healing in humans: a prospective randomized double-blind study
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Petruskevicius, Juozas; Nielsen, Mette Strange; Kaalund, S├Ėren;
We studied the effects of a newly marketed bone substitute, Osteoset, on bone healing in a tibial defect in humans. 20 patients undergoing an ACL (anterior cruciate ligament) reconstruction with bone-patella tendon-bone graft were block-randomized into 2 groups of 10 each. In the treatment group...
Human mandible bone defect repair by the grafting of dental pulp stem/progenitor cells and collagen sponge biocomplexes
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R dŌĆÖAquino
Full Text Available In this study we used a biocomplex constructed from dental pulp stem/progenitor cells (DPCs and a collagen sponge scaffold for oro-maxillo-facial (OMF bone tissue repair in patients requiring extraction of their third molars. The experiments were carried out according to our Internal Ethical Committee Guidelines and written informed consent was obtained from the patients. The patients presented with bilateral bone reabsorption of the alveolar ridge distal to the second molar secondary to impaction of the third molar on the cortical alveolar lamina, producing a defect without walls, of at least 1.5 cm in height. This clinical condition does not permit spontaneous bone repair after extraction of the third molar, and eventually leads to loss also of the adjacent second molar. Maxillary third molars were extracted first for DPC isolation and expansion. The cells were then seeded onto a collagen sponge scaffold and the obtained biocomplex was used to fill in the injury site left by extraction of the mandibular third molars. Three months after autologous DPC grafting, alveolar bone of patients had optimal vertical repair and complete restoration of periodontal tissue back to the second molars, as assessed by clinical probing and X-rays. Histological observations clearly demonstrated the complete regeneration of bone at the injury site. Optimal bone regeneration was evident one year after grafting. This clinical study demonstrates that a DPC/collagen sponge biocomplex can completely restore human mandible bone defects and indicates that this cell population could be used for the repair and/or regeneration of tissues and organs.
Autologous Bone Marrow-Derived Mesenchymal Stem Cells Modulate Molecular Markers of Inflammation in Dogs with Cruciate Ligament Rupture.
Muir, Peter; Hans, Eric C; Racette, Molly; Volstad, Nicola; Sample, Susannah J; Heaton, Caitlin; Holzman, Gerianne; Schaefer, Susan L; Bloom, Debra D; Bleedorn, Jason A; Hao, Zhengling; Amene, Ermias; Suresh, M; Hematti, Peiman
Mid-substance rupture of the canine cranial cruciate ligament rupture (CR) and associated stifle osteoarthritis (OA) is an important veterinary health problem. CR causes stifle joint instability and contralateral CR often develops. The dog is an important model for human anterior cruciate ligament (ACL) rupture, where rupture of graft repair or the contralateral ACL is also common. This suggests that both genetic and environmental factors may increase ligament rupture risk. We investigated use of bone marrow-derived mesenchymal stem cells (BM-MSCs) to reduce systemic and stifle joint inflammatory responses in dogs with CR. Twelve dogs with unilateral CR and contralateral stable partial CR were enrolled prospectively. BM-MSCs were collected during surgical treatment of the unstable CR stifle and culture-expanded. BM-MSCs were subsequently injected at a dose of 2x106 BM-MSCs/kg intravenously and 5x106 BM-MSCs by intra-articular injection of the partial CR stifle. Blood (entry, 4 and 8 weeks) and stifle synovial fluid (entry and 8 weeks) were obtained after BM-MSC injection. No adverse events after BM-MSC treatment were detected. Circulating CD8+ T lymphocytes were lower after BM-MSC injection. Serum C-reactive protein (CRP) was decreased at 4 weeks and serum CXCL8 was increased at 8 weeks. Synovial CRP in the complete CR stifle was decreased at 8 weeks. Synovial IFN╬│ was also lower in both stifles after BM-MSC injection. Synovial/serum CRP ratio at diagnosis in the partial CR stifle was significantly correlated with development of a second CR. Systemic and intra-articular injection of autologous BM-MSCs in dogs with partial CR suppresses systemic and stifle joint inflammation, including CRP concentrations. Intra-articular injection of autologous BM-MSCs had profound effects on the correlation and conditional dependencies of cytokines using causal networks. Such treatment effects could ameliorate risk of a second CR by modifying the stifle joint inflammatory response
Autologous Bone Marrow-Derived Mesenchymal Stem Cells Modulate Molecular Markers of Inflammation in Dogs with Cruciate Ligament Rupture
Muir, Peter; Hans, Eric C.; Racette, Molly; Volstad, Nicola; Sample, Susannah J.; Heaton, Caitlin; Holzman, Gerianne; Schaefer, Susan L.; Bloom, Debra D.; Bleedorn, Jason A.; Hao, Zhengling; Amene, Ermias; Suresh, M.; Hematti, Peiman
Mid-substance rupture of the canine cranial cruciate ligament rupture (CR) and associated stifle osteoarthritis (OA) is an important veterinary health problem. CR causes stifle joint instability and contralateral CR often develops. The dog is an important model for human anterior cruciate ligament (ACL) rupture, where rupture of graft repair or the contralateral ACL is also common. This suggests that both genetic and environmental factors may increase ligament rupture risk. We investigated use of bone marrow-derived mesenchymal stem cells (BM-MSCs) to reduce systemic and stifle joint inflammatory responses in dogs with CR. Twelve dogs with unilateral CR and contralateral stable partial CR were enrolled prospectively. BM-MSCs were collected during surgical treatment of the unstable CR stifle and culture-expanded. BM-MSCs were subsequently injected at a dose of 2x106 BM-MSCs/kg intravenously and 5x106 BM-MSCs by intra-articular injection of the partial CR stifle. Blood (entry, 4 and 8 weeks) and stifle synovial fluid (entry and 8 weeks) were obtained after BM-MSC injection. No adverse events after BM-MSC treatment were detected. Circulating CD8+ T lymphocytes were lower after BM-MSC injection. Serum C-reactive protein (CRP) was decreased at 4 weeks and serum CXCL8 was increased at 8 weeks. Synovial CRP in the complete CR stifle was decreased at 8 weeks. Synovial IFN╬│ was also lower in both stifles after BM-MSC injection. Synovial/serum CRP ratio at diagnosis in the partial CR stifle was significantly correlated with development of a second CR. Systemic and intra-articular injection of autologous BM-MSCs in dogs with partial CR suppresses systemic and stifle joint inflammation, including CRP concentrations. Intra-articular injection of autologous BM-MSCs had profound effects on the correlation and conditional dependencies of cytokines using causal networks. Such treatment effects could ameliorate risk of a second CR by modifying the stifle joint inflammatory response
Bone grafting with granular biomaterial in segmental maxillary osteotomy: A case report
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Orion Luiz Haas Junior
Conclusion: This is the first report of bone grafting with a granular biomaterial in segmental maxillary osteotomy. Successful formation of new bone with density greater than that of the surrounding tissue was achieved, preventing pseudarthrosis and postoperative instability.
Clinical Application of Autologous Fat Graft%Ķć¬õĮōĶäéĶé¬ń¦╗µżŹńÜäõĖ┤Õ║ŖÕ║öńö©
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µØÄÕÅæµłÉ; ń©ŗńÉ│
ĶäéĶé¬ń¦╗µżŹµēŗµ£»õŠ┐õ║ĵōŹõĮ£ŃĆüÕłøõ╝żÕ░ÅŃĆüµüóÕżŹÕ┐½ŃĆüµĢłµ×£ÕźĮ'╝īÕżćÕÅŚµĢ┤ÕĮóÕż¢ń¦æÕī╗ÕĖłķØÆńØÉŃĆéķÜÅńØƵŖƵ£»ńÜäĶ┐øµŁź'╝īĶć¬õĮōĶäéĶé¬ń¦╗µżŹÕ║öńö©ĶīāÕø┤õĖŹµ¢Łµē®Õ▒Ģ'╝īÕģČÕ║öńö©õ║ĵĢ┤ÕĮóńŠÄÕ«╣Õż¢ń¦æńÜäÕÉäõĖ¬µ¢╣ķØó'╝īńö©õ║Äõ┐«ÕżŹÕÉäń¦ŹÕĤÕøĀķĆĀµłÉńÜäĶĮ»ń╗äń╗ćń╝║µŹ¤ŃĆéĶäéĶé¬ń¦╗µżŹµēŗµ£»Ķ┐ćń©ŗÕīģµŗ¼ĶäéĶé¬ńÜäĶÄĘÕÅ¢ŃĆüĶäéĶé¬ńÜäÕżäńÉåõ╗źÕÅŖĶäéĶé¬ń¦╗µżŹ'╝īÕĘ▓ń╗ŵś»õĖĆķĪ╣µłÉńå¤ńÜäµŖƵ£»ŃĆéõĮåµś»'╝īĶäéĶé¬ń¦╗µżŹµēŗµ£»õ╗Źµ£ēÕŠłÕżÜńÜäµ£¬ń¤źÕī║Õ¤¤'╝īµ»öÕ"éĶäéĶ鬵łÉµ┤╗µ£║ÕłČ'╝īÕĮ▒ÕōŹĶäéĶ鬵łÉµ┤╗ńÄćńÜäÕøĀń┤ĀńŁē'╝īńÄ░Õ»╣ĶäéĶé¬ń¦╗µżŹńÜäÕ║öńö©õĮ£õĖĆń╗╝Ķ┐░ŃĆé%A renewed clinical interest in fat grafting for both reconstructive and aesthetic purposes has prompted plastic surgeons to perform such procedures . Autologous fat grafting is safe and easy , and can achieve splendid results , moreover ,there is no downtime to the patients ,so it has gained popularity among patients .It appears that the procedure is being performed more frequently and for broader indications such as in breast augmentation ,facial rejuvenation and other subcutaneous lipoatrophy resulted from acne , trauma , lipodystrophy , hemifacial atrophy etc .. However , there are relatively lack of information for surgeons to guide them in choosing optimal techniques and offering reliable advice on fat survival rate to their patients .Now we offer a review to help optimize the clinical use of fat grafts .
Fat fulŌĆ▓fillŌĆ▓ment: A review of autologous fat grafting
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Manjot Marwah
Full Text Available For more than a century, clinicians have attempted to utilise fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft-tissue augmentation has become increasingly popular in recent years. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the authors have described their approach to fat transplantation.
Autologous Platelet Gel in Coronary Artery Bypass Grafting: Effects on Surgical Wound Healing
Vang, See N.; Brady, Chad P.; Christensen, Kevin A.; Allen, Keith R.; Anderson, John E.; Isler, Jack R.; Holt, David W.; Smith, Lynette M.
Stimulating the bodyŌĆÖs natural healing at the cellular level can be achieved through the application of growth factors located within platelets. Once combined with a mixture of calcium and thrombin, this substance, now referred to as autologous platelet gel (APG), can be applied to surgical wound sites for patients undergoing cardiac surgery. The purpose of this study was to examine the effects of APG on surgical site infection, post-operative pain, blood loss, and bruising. After 30 mL plate...
Treatment of chondroblastoma of the calcaneus with a secondary aneurysmal bone cyst using endoscopic curettage without bone grafting.
Otsuka, Takanobu; Kobayashi, Masaaki; Yonezawa, Masato; Kamiyama, Fumiaki; Matsushita, Yasusi; Matsui, Nobuo
Chondroblastoma is a relatively rare benign bone tumor. Approximately 7% of chondroblastomas occur in the calcaneus, and 17% of chondroblastoma associated with cystic lesions. We report a case of a chondroblastoma in the calcaneus with a secondary aneurysmal bone cyst treated successfully by endoscopic curettage without bone grafting. New bone formation is facilitated by minimal damage to the bone and soft tissue. The cosmetic results of this procedure are good. Two years later, the patient is asymptomatic with no radiographic evidence of recurrence. Endoscopic curettage without bone grafting is a promising new treatment for chondroblastoma.
Application of autologous bone marrow stem cells in giant axonal neuropathy
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Alok Sharma
Full Text Available Giant axonal neuropathy is a rare disorder of autosomal recessive inheritance, morphologically characterized by accumulation of neurofilaments in enlargements of preterminal regions of central and peripheral axons. We present a 7-year-old girl with thick and tightly curled lackluster hair suffering from giant axonal neuropathy. The diagnosis was confirmed on the brain MRI which showed white matter abnormalities in the anterior and posterior periventricular regions as well as the cerebellar white matter. In view of the same, the patient was given intrathecal autologous bone marrow-derived stem cell therapy as part of the neuroregenerative rehabilitation therapy protocol. The patient showed functional improvements in her disability after receiving the therapy. A detailed case report is presented here with.
Our Experience in treating Ischemic Ulcer of a Lower Limb in 4 diabetic patients with Autologous Bone Marrow Stem Cells
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Subrammaniyan SR
Full Text Available Chronic limb ischemia is an outcome of peripheral arterial occlusive disease. When conventional medical and surgical treatments are not feasible, amputation is the only option left. Recent studies report that the injection of bone marrow mononuclear cells and Peripheral blood mononuclear cells rich in CD34+ cells have resulted in symptomatic recovery, improved functional activity of the ischemic limb as well as healing of the ulcers. Here we report our experience with 4 patients of such case where autologous bone marrow mononuclear cells were injected and the patient followed up for 6 months. Materials and Methods: Four patients with critical limb ischemia with ulcers were referred for amputation of their limb. A 68-year-old female with critical limb ischemia with an ulcer in the left leg measuring 30X12 cm over the posterior portion of the leg and extending to the medial aspect of the foot measuring 14X10 cm, a 65-year-old male with necrotic wound in his lower foot, a 69-year-old male with a deep wound in his lower foot and a 61-year-old male with ulcer in his toe amputated with all the toe fingers. The first two patients were given injections for more than one sitting at appropriate intervals specified by the clinician. Under short general anesthesia, 110 ml of Bone marrow was aspirated each time, transported in Acid Citrate Dextrose and was processed for mononuclear cells (MNC by Ficoll density gradient centrifugation, following the cGMP protocols. The MNC concentrate was injected at various sites in the Gastrocnemius muscle and the surrounding area after necessary debridement. Skin grafting was performed in the first two patients and followed up for a period of at regular intervals of 6 to 9 months. The patients have been followed up at regular intervals for six months after the treatment with investigations such as Ankle-Brachial Index, Doppler and Angiogram.Results: All the patients showed improvements with healthy granulation gradually
A new harvest site for bone graft in anterior cruciate ligament revision surgery.
Franceschi, Francesco; Papalia, Rocco; Di Martino, Alberto; Rizzello, Giacomo; Allaire, Robert; Denaro, Vincenzo
During revision anterior cruciate ligament (ACL) surgery, femoral interference screws frequently require removal. This may lead to significant tunnel widening and possible graft fixation failure as a result. Solutions include drilling the revision tunnel in a different location, using stacked interference screws, or using bone graft to fill the defect. Autogenous iliac crest graft and allograft are both used, but there are significant comorbidities associated with each. We developed a new technique for harvesting autogenous bone graft that avoids many of the complications associated with other graft sources. By use of the existing surgical incision from the initial harvest of the bone-patellar tendon-bone autograft, bone from the medial tibial metaphyseal safe zone is harvested via an OATS tube harvester (Arthrex, Naples, FL). A bone plug 1 mm larger in size than the femoral defect is harvested and arthroscopically inserted via a press-fit technique. At 3 months after bone grafting, patients undergo revision ACL reconstruction. The proximal tibial metaphysis is a safe bone graft harvest site in revision ACL surgery and offers an effective method for filling large bony defects, allowing anatomic reconstruction of the ACL after bone healing has occurred. Furthermore, it eliminates the problems associated with allograft or use of a remote graft donor site. PMID:17478290
The outcome of intraoral onlay block bone grafts on alveolar ridge augmentations: A systematic review
Aloy Pr├│sper, Amparo; Pe├▒arrocha Oltra, David; Pe├▒arrocha Diago, Mar├Ła; Pe├▒arrocha Diago, Miguel
Aim: The purpose of this study was to systematically review clinical studies examining the survival and success rates of implants placed with intraoral onlay autogenous bone grafts to answer the following question: do ridge augmentations procedures with intraoral onlay block bone grafts in conjunction with or prior to implant placement influence implant outcome when compared with a control group (guided bone regeneration, alveolar distraction, native bone or short dental implants.)? Material ...
Obesity phenotypes and resorption percentage after breast autologous fat grafting: Rule of low-grade inflammation
Gentile, Pietro; Sarlo, Francesca; De Angelis, Barbara; De Lorenzo, Antonio; Cervelli, Valerio
Background: One of the main reasons why the breast fat grafting was questioned is that there may be lipofilling resorption. In the literature, the resorption rate reported over the 1st year is highly variable (20ŌĆō90%). Objective: The aim of this work was to identify the biochemical and clinical parameters, which increase fat graft maintenance in breast reconstruction. Materials and Methods: A sample of 19 patients was treated with fat grafting mixed with platelet-rich plasma. A complete screening of anthropometry, body composition, and blood biochemical parameters was assessed using the standardized equipment. Pre- and post-operative evaluation was performed, which included a complete clinical examination, photographic assessment, nuclear magnetic resonance imaging of the soft tissue, and ultrasound. The follow-up period was 2 years. Results: The authors divided the results into two types of patients: ŌĆ£responderŌĆØ and ŌĆ£not a responder.ŌĆØ In the ŌĆ£responderŌĆØ group patients with normal weight, gynoid fat distribution, obese, with normal blood biochemical parameters, and atherogenic indices but with high preoperative values of platelet-to-lymphocyte ratio (PLR) (174.49) and neutrophil-lymphocyte ratio (NLR) (2.65) showed a greater increase of fat graft maintenance at 6 and 12 months after the last lipofilling session. In the ŌĆ£not responder groupŌĆØ patients with overweight, android fat distribution, obese, high values of atherogenic indices, but with normal preoperative NLR and PLR ratios showed a lower fat graft maintenance at 6 and 12 months. Conclusion: We assume, the problem of fat resorption may be resolved by analysis of body composition and by examine the predictive role of preoperative markers of low-grade inflammation. PMID:27656603
The relationship between revascularisation and osteogenesis in fresh or demineralised bone grafts
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Solheim, E; Pinholt, E M; Talsnes, O;
.50, p = 0.001), no correlation could be demonstrated in demineralised grafts (r = 0.09, p = 0.6). The results may indicate differences in the mechanisms of vascularisation and osteogenesis in the grafts used fresh or after demineralization but are, at present, difficult to fully explain.......Bone formation generally depends on adequate blood flow. Failure of bone grafts has been attributed to delayed revascularisation of the graft. We compared the relationship between revascularisation and osteogenesis, evaluated as entrapment of (141)Ce-labelled microspheres and uptake of (85)Sr......, respectively, in fresh or demineralised syngeneic bone grafts 3 weeks after heterotopic implantation in rats. Whereas a moderately high linear correlation between (85)Sr and (141)Ce radioactivity was found both in the (intact) host iliac bone (r = 0.75, p = 0.0001) and implanted fresh syngeneic grafts (r = 0...
Treatment of severe bone deficiency in acetabular revision surgery using a reinforcement device and bone grafting
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ZHAI Ji-liang; LIN Jin; JIN Jin; QIAN Wen-wei; WENG Xi-sheng
Background Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.Methods This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky ŌģĪC, 6 were ŌģóA, and 4 were ŌģóB. The mean age at the time of surgery was 63.0 years (range, 46-78 years). During revision surgery, a reinforcement ring was implanted in 6patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9-71 months).Results The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit.The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes,debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification,aseptic loosening, or infection.Conclusion Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.
Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate
J. Guo; C. Li; Q. Zhang; G. Wu; S.A. Deacon; J. Chen; H. Hu; S. Zou; Q. Ye
BACKGROUND: Secondary alveolar bone grafting has been widely used to reconstruct alveolar cleft. However, there is still some controversy. OBJECTIVES: To compare the effectiveness and safety of different secondary bone grafting methods. SEARCH STRATEGY: The final electronic and handsearches were car
Treatment of Early-Stage Pressure Ulcers by Using Autologous Adipose Tissue Grafts
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Giovanni Francesco Marangi
Full Text Available Assessing pressure ulcers (PUs in early stages allows patients to receive safer treatment. Up to now, in addition to clinical evaluation, ultrasonography seems to be the most suitable technique to achieve this goal. Several treatments are applied to prevent ulcer progression but none of them is totally effective. Furthermore, the in-depth knowledge of fat regenerative properties has led to a wide use of it. With this study the authors aim at introducing a new approach to cure and prevent the worsening of early-stage PUs by using fat grafts. The authors selected 42 patients who showed clinical and ultrasonographic evidence of early-stage PUs. Values of skin thickness, fascial integrity, and subcutaneous vascularity were recorded both on the PU area and the healthy trochanteric one, used as control region. Fat grafting was performed on all patients. At three months, abnormal ultrasonographic findings, such as reduction of cutaneous and subcutaneous thickness, discontinuous fascia, and decrease in subcutaneous vascularity, all were modified with respect to almost all the corresponding parameters of the control region. Results highlight that the use of fat grafts proved to be an effective treatment for early-stage PUs, especially in the care of neurological and chronic bedridden patients.
The improved biological response of shark tooth bioapatites in a comparative in vitro study with synthetic and bovine bone grafts.
L├│pez-├ülvarez, M; P├®rez-Davila, S; Rodr├Łguez-Valencia, C; Gonz├Īlez, P; Serra, J
Autologous bone is considered to be the gold standard for bone tissue regeneration, providing more highly efficient functional responses compared to synthetic materials, and avoiding the rejection risks of allogenic grafts. However, it presents limitations for certain types of surgery due to its high resorption levels and donor site morbidity. Different biphasic synthetic composites, based onnon-apatitic calcium phosphates enriched with apatitic phases-such as hydroxyapatite, and bioderived bone grafts of bovine and porcine origin-are proposed as lower resorption materials due to their higher crystalline structure. The present work proposes two new sources of bioapatites for bone filler applications obtained from the dentine and enameloid of shark teeth, respectively. These bioapatites each present a characteristic apatite-based composition and additional enrichments of specific trace elements, such as magnesium and fluorine, with proven roles in bone metabolism. Their processing and physicochemical characterization (SEM, FT-Raman and XRD) is presented, together with an in vitro evaluation of osteogenic activity compared to a commercial bovine mineralized matrix and synthetic HA/╬▓ŌĆēTCP grafts. The results proved the globular morphology (0.5-1.5 ╬╝m) and porosity (~50 ╬╝m and ~0.5-1 ╬╝m) of shark dentine bioapatites with biphasic composition: apatitic (hydroxyapatite and apatite-(CaF)), non-apatitic (whitlockite), and an apatitic phase (fluorapatite), organized in oriented crystals in enameloid bioapatites. An evaluation of the pre-osteoblast MC3T3-E1 morphology revealed the colonization of pores in dentine bioapatites and an aligned cell growth in the oriented enameloid crystals. A higher proliferation (pŌĆēŌĆē<ŌĆēŌĆē0.01) was detected at up to 21 d in both the shark bioapatites and synthetic biphasic graft with respect to the bovine mineralized matrix. Finally, the great potential of porous biphasic dentine bioapatites enriched with Mg and the aligned
[Use of the calvarium for bone grafting in cranio-maxillo-facial surgery].
Raulo, Y; Baruch, J
Bone grafts's traditional donor sites in cranio-maxillo-facial surgery have been for many years and are still in some occasions the ribs, iliac crest and tibia. Bone grafts taken from the calvaria have been used by some surgeons in the past but its wide acceptance was only achieved after Paul Tessier had reported his own experience. The calvaria is composed of inner and outer tables that encloses a layer of cancellous bone called the diploe. A high degree of variability exist with respect to skull thickness. Nevertheless parietal bones is the preferable site for the harvesting of the graft. The embryonic origin of the cranium should be responsible for greater survival of the graft. Membranous bone would maintain its volume to a greater extent than endochondral bone when autografted in the cranio-facial region. However this remains controversial. Two techniques can be used for the harvesting of a calvarial bone grafts. A split thickness calvarial graft involves removal of the outer table while leaving the inner layer in place. Its main disadvantage is the relatively thinness of the bone transferred. A full thickness segment of skull involves the cranium cavity be entered. A half of the graft can be split along the diploe space and returned to fill the donor site. The other half is used for reconstruction. It is a more complicated procedure. Cranial grafts have been used in the following cases. Correction of contour defect of the forehead and zygomatic bones, orbital floor reconstruction, restoration of the nasal bridge, bone grafting of the maxilla and mandibule. The advantages are the following: the donor and recipient sites are in adjacent surgical fields, the donor site scar is hidden in the scalp, morbidity associated with removing the graft is almost inexistent. (ABSTRACT TRUNCATED AT 250 WORDS)
A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications
Institute of Scientific and Technical Information of China (English)
Nan-Ze Yu; Jiu-Zuo Huang; Hao Zhang; Yang Wang; Xiao-Jun Wang; Ru Zhao; Ming Bai
Objective:Clinical application ofautologous fat grafting (AFG) is quickly expanding.Despite the widely acceptance,long-term survival rate (SR) of AFG remains a question not yet solved.Meanwhile,although rare,severe complications related to AFG including vision loss,stroke even death could be seen in the literature.Data Sources:A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology.Articles were screened using predetermined inclusion and exclusion criteria.Study Selection:Data collected included patient characteristics,surgical technique,donor site,recipient site,graft amount,and quantified measurement methods.Patient cohorts were pooled,and SR was calculated.All the severe complications were also summarized according to the different clinical characteristics.Results:Of 550 articles,16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods.Totally,596 patients were included.SR varied from 34'╝ģ to 82'╝ģ in breast and 30-83'╝ģ in the facial area.Nude mice were applied to investigate human fat grafting SR (38.3-52.5'╝ģ after 15 weeks).Rabbits were commonly used to study animal AFG SR (14.00-14.56'╝ģ after 1-year).Totally,21 severe complications were reported,including death (2),stroke (10),vision loss (11,8 of which accompanied with stroke),sepsis (3),multiple abscess (1) and giant fat necrotic cyst (2).Ten of these complications happened within 10 years.Conclusions:There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite.Body mass index change between pre-and postoperation may be the bias factor in evaluating fat SR.Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.
Effects of liquid nitrogen cryotherapy and bone grafting on artificial bone defects in minipigs: a preliminary study.
Pogrel, M A; Regezi, J A; Fong, B; Hakim-Faal, Z; Rohrer, M; Tran, C; Schiff, T
Liquid nitrogen cryotherapy has been advocated as an adjunct in the enucleation and curettage of locally aggressive lesions of the jaws. Simultaneous autogenous bone grafting has also been advocated to accelerate bone formation and reduce morbidity. There is, however, relatively little scientific basis for either of these hypotheses. In this study, nine Yucatan minipigs had artificial defects created in the mandible, which were treated with liquid nitrogen spray. Half of the defects were grafted with autogenous bone from the chin and half were closed primarily. Two animals were sacrificed 3 days postoperatively to measure the width of necrosis and the rest were sacrificed at 3 months to assess healing and new bone formation. It was found that drilling the artificial defects alone caused bone necrosis for a mean depth of 0.09 mm. Liquid nitrogen cryospray caused a mean depth of bone necrosis of 0.82 mm (range 0.51-1.52 mm). The defects that were bone grafted healed well clinically. Defects not bone grafted showed a 50% rate of wound breakdown and sequestrum formation with delayed healing. Vital staining showed a non-significantly greater rate of bone formation in the grafted defects. Digitally superimposed radiography showed a non-significantly greater bone density in the non-grafted defects at 3 months postoperatively. It appears that liquid nitrogen cryospray does devitalize an area of bone around defects in the mandible. The width of necrosis is usually less than 1 mm and subsequent healing is enhanced by autogenous bone grafting. This has clinical implications. PMID:12190137
Reconstruction of large limb bone defects with a double-barrel free vascularized fibular graft
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BI Zheng-gang; HAN Xing-guang; FU Chun-jiang; CAO Yang; YANG Cheng-lin
Background The use of a free,vascularized fibular graft is an important technique for the reconstruction of large defects in long bones.The technique has many advantages in strong,tubular bones; a more reliable vascular anatomy with a large vascular diameter and long pedicle is used,minimizing donor-site morbidity.Due to limitations in both fibular anatomy and mechanics,they cannot effectively be used to treat large limb bone defects due to their volume and strength.Methods From 1990 to 2001,16 clinical cases of large bone defects were treated using vascularized double-barrel fibular grafts.Patients were evaluated for an average of 10 months after surgery.Results All the patients achieved bony union; the average bone union took 10 months post surgery,and no stress fractures occurred.Compared with single fibular grafts,the vascularized double-barrel fibular grafts greatly facilitate bony union and are associated with fewer complications,suggesting that the vascularized double-barrel fibular graft is a valuable procedure for the correction of large bone defects in large,long bones in addition to enhancing bone intensity.Conclusions The vascularized double-barrel fibular graft is superior to the single fibular graft in stimulating osteogenous activity and biological mechanics for the correction of very large bone defects in large,long bones.Free vascularized folded double-barrel fibular grafts can not only fill up large bone defects,but also improve the intensity margin.Therefore,this study also widens its application and enlarges the treatment targets.However,in the case of bone deformability,special attention should be paid to bone fixation and protection of donor and recipient sites.
Phase 1 Trial of Autologous Bone Marrow Stem Cell Transplantation in Patients with Spinal Cord Injury
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Zurab Kakabadze
Full Text Available Introduction. A total of 18 patients, with complete motor deficits and paraplegia caused by thoracic and lumbar spine trauma without muscle atrophy or psychiatric problems, were included into this study. Materials and Methods. The bone marrow was aspirated from the anterior iliac crest under local anesthesia and the mononuclear fraction was isolated by density gradient method. At least 750 million mononuclear-enriched cells, suspended in 2ŌĆēmL of saline, were infused intrathecally. Results and Discussion. The study reports demonstrated improvement of motor and sensory functions of various degrees observed in 9 of the 18 (50% cases after bone marrow stem cell transplantation. Measured by the American Spinal Injury Association (ASIA scale, 7 (78% out of the 9 patients observed an improvement by one grade, while two cases (22% saw an improvement by two grades. However, there were no cases in which the condition was improved by three grades. Conclusions. Analysis of subsequent treatment results indicated that the transplantation of mononuclear-enriched autologous BMSCs is a feasible and safe technique. However, successful application of the BMSCs in the clinical practice is associated with the necessity of executing more detailed examinations to evaluate the effect of BMSCs on the patients with spinal cord injury.
Phase 1 Trial of Autologous Bone Marrow Stem Cell Transplantation in Patients with Spinal Cord Injury.
Kakabadze, Zurab; Kipshidze, Nickolas; Mardaleishvili, Konstantine; Chutkerashvili, Gocha; Chelishvili, Irakli; Harders, Albrecht; Loladze, George; Shatirishvili, Gocha; Kipshidze, Nodar; Chakhunashvili, David; Chutkerashvili, Konstantine
Introduction. A total of 18 patients, with complete motor deficits and paraplegia caused by thoracic and lumbar spine trauma without muscle atrophy or psychiatric problems, were included into this study. Materials and Methods. The bone marrow was aspirated from the anterior iliac crest under local anesthesia and the mononuclear fraction was isolated by density gradient method. At least 750 million mononuclear-enriched cells, suspended in 2ŌĆēmL of saline, were infused intrathecally. Results and Discussion. The study reports demonstrated improvement of motor and sensory functions of various degrees observed in 9 of the 18 (50%) cases after bone marrow stem cell transplantation. Measured by the American Spinal Injury Association (ASIA) scale, 7 (78%) out of the 9 patients observed an improvement by one grade, while two cases (22%) saw an improvement by two grades. However, there were no cases in which the condition was improved by three grades. Conclusions. Analysis of subsequent treatment results indicated that the transplantation of mononuclear-enriched autologous BMSCs is a feasible and safe technique. However, successful application of the BMSCs in the clinical practice is associated with the necessity of executing more detailed examinations to evaluate the effect of BMSCs on the patients with spinal cord injury. PMID:27433165
Feasibility of Bone Marrow Stromal Cells Autologous Transplantation for Dilated Cardiomyopathy
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ZHOU Cheng; YANG Chenyuan; XIAO Shiliang; FEI Hongwen
The feasibility of bone marrow stromal cells autologous transplantation for rabbit model of dilated cardiomyopathy induced by adriamycin was studied. Twenty rabbits received 2 mg/kg of adriamycin intravenously once a week for 8 weeks (total dose, 16 mg/kg) to induce the cardiomyopathy model with the monitoring of cardiac function by transthoracic echocardiography. Marrow stromal cells were isolated from cell-transplanted group rabbits and were culture-expanded on the 8th week. On the 10th week, cells were labeled with 4,6-diamidino-2-phenylindole (DAPI), and then injected into the myocardium of the same rabbits. The results showed that viable cells labeled with DAPI could be identified in myocardium at 2nd week after transplantation. Histological findings showed the injury of the myocardium around the injection site was relieved with less apoptosis and more expression of bcl-2. The echocardiography found the improvement of local tissue movement from (2.12┬▒0.51) cm/s to (3.81┬▒0.47) cm/s (P'╝£0.05) around the inject site, but no improvement of heart function as whole. It was concluded bone marrow stromal cells transplantation for dilated cardiomyopathy was feasibe. The management of cells in vitro, the quantity and the pattern of the cells transplantation and the action mechanism still need further research.
Histological evaluation of the influence of magnetic field application in autogenous bone grafts in rats
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Ponzoni Deise
Full Text Available Abstract Background Bone grafts are widely used in oral and maxillofacial reconstruction. The influence of electromagnetic fields and magnets on the endogenous stimulation of target tissues has been investigated. This work aimed to assess the quality of bone healing in surgical cavities filled with autogenous bone grafts, under the influence of a permanent magnetic field produced by in vivo buried devices. Methods Metal devices consisting of commercially pure martensitic stainless steel washers and titanium screws were employed. Thirty male Wistar rats were divided into 3 experimental and 3 control groups. A surgical bone cavity was produced on the right femur, and a bone graft was collected and placed in each hole. Two metallic washers, magnetized in the experimental group but not in the control group, were attached on the borders of the cavity. Results The animals were sacrificed on postoperative days 15, 45 and 60. The histological analysis of control and experimental samples showed adequate integration of the bone grafts, with intense bone neoformation. On days 45 and 60, a continued influence of the magnetic field on the surgical cavity and on the bone graft was observed in samples from the experimental group. Conclusion The results showed intense bone neoformation in the experimental group as compared to control animals. The intense extra-cortical bone neoformation observed suggests that the osteoconductor condition of the graft may be more susceptible to stimulation, when submitted to a magnetic field.
Beneficial effects of autologous bone marrow-derived mesenchymal stem cells in naturally occurring tendinopathy.
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Roger Kenneth Whealands Smith
Full Text Available Tendon injuries are a common age-related degenerative condition where current treatment strategies fail to restore functionality and normal quality of life. This disease also occurs naturally in horses, with many similarities to human tendinopathy making it an ideal large animal model for human disease. Regenerative approaches are increasingly used to improve outcome involving mesenchymal stem cells (MSCs, supported by clinical data where injection of autologous bone marrow derived MSCs (BM-MSCs suspended in marrow supernatant into injured tendons has halved the re-injury rate in racehorses. We hypothesized that stem cell therapy induces a matrix more closely resembling normal tendon than the fibrous scar tissue formed by natural repair. Twelve horses with career-ending naturally-occurring superficial digital flexor tendon injury were allocated randomly to treatment and control groups. 1X10(7 autologous BM-MSCs suspended in 2 ml of marrow supernatant were implanted into the damaged tendon of the treated group. The control group received the same volume of saline. Following a 6 month exercise programme horses were euthanized and tendons assessed for structural stiffness by non-destructive mechanical testing and for morphological and molecular composition. BM-MSC treated tendons exhibited statistically significant improvements in key parameters compared to saline-injected control tendons towards that of normal tendons and those in the contralateral limbs. Specifically, treated tendons had lower structural stiffness (p<0.05 although no significant difference in calculated modulus of elasticity, lower (improved histological scoring of organisation (p<0.003 and crimp pattern (p<0.05, lower cellularity (p<0.007, DNA content (p<0.05, vascularity (p<0.03, water content (p<0.05, GAG content (p<0.05, and MMP-13 activity (p<0.02. Treatment with autologous MSCs in marrow supernatant therefore provides significant benefits compared to untreated tendon repair
Autologous transplantation of bone marrow mononuclear cells improved heart function after myocardial infarction
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Guo-sheng LIN; Jing-jun L(U); Xue-jun JIANG; Xiao-yan LI; Geng-shan LI
AIM: To investigate whether autologous transplantation of adult stem cells could improve post-infarcted heart function. METHODS: Bone marrow mononuclear cells (MNCs) were isolated from adult rabbits' tibias after coronary ligation. These cells were exposed to 5-azacytidine 10 ╬╝mol/L for 24 h on the third day of culture. After being labeled with bromodeoxyuridine (BrdU), the cells were auto-transplanted into bordering zone of the infarcted area at 2 weeks after injury. The animals were killed at 3 days, 2 weeks, 1 month, and 2 months after transplantation,respectively. The left ventricular functions, capillary density, and cardiac nerve density were measured and the differentiation of the engrafted cells was determined by immunostaining. RESULTS: BrdU-labeled MNCs were well aligned with the host cardiomyocytes. Parts of them were incorporated into capillary and arteriolar vessel walls. In addition to inducing angiogenic ligands (basic fibroblast growth factor, vascular endothelial growth factor) and imflammation cytokines (interleukin 1-╬▓) during the early period of MNCs implantation, MNCs induced 2.0-fold increase in capillary density as well. Moreover, GAP43-positive and TH-positive nerve density were markedly higher in the MNCs-treated groups than that in the non-treated hearts. Left ventricular ejection fraction,LV+dp/dt and LV-dp/dtmax were 47 %, 67 %, and 55 % in MNCs-treated heart respectively, which was higher than that of the control heart, whereas left ventricular end-diastolic volume, left ventricular end-diastolic diameter,and left ventricular end-diastolic pressure were 45 %, 22 %, and 50 % respectively in MNCs-treated heart, which was lower than that of the control heart at 2 months after cell transplantation. CONCLUSION: Autologous transplantation of MNCs induced angiogenesis and nerve sprouting and improved left ventricular diastolic function.
Autologous Bone Marrow Mononuclear Cell Transplantation Delays Progression of Carotid Atherosclerosis in Rabbits.
Cui, Kefei; Ma, Xiao; Yu, Lie; Jiang, Chao; Fu, Chao; Fu, Xiaojie; Yu, Xiaofang; Huang, Yuanjing; Hou, Suyun; Si, Caifeng; Chen, Zhengguang; Yu, Jing; Wan, Jieru; Wang, Jian
Bone marrow mononuclear cells (BMMNCs) can counteract oxidative stress and inhibit the inflammatory response in focal ischemic stroke models. However, the effect of BMMNC transplantation on carotid atherosclerosis needs to be determined. The carotid atherosclerotic plaque model was established in New Zealand White rabbits by balloon injury and 8┬Āweeks of high-fat diet. Rabbits were randomized to receive an intravenous injection of autologous bromodeoxyuridine (BrdU)-labeled BMMNCs or an equal volume of phosphate-buffered saline. Plaques were evaluated for expression of proinflammatory and anti-inflammatory cytokines, anti-oxidant proteins, and markers of cell death. BMMNCs migrated into atherosclerotic plaque on the first day after cell transplantation. BMMNC-treated rabbits had smaller plaques and more collagen deposition than did the vehicle-treated controls on day 28 (pŌĆē<ŌĆē0.05). BMMNC treatment significantly increased endothelial nitric oxide synthase and the anti-oxidant enzymes glutathione peroxidase and superoxide dismutase in plaques compared to vehicle treatment on day 7. BMMNC-treated rabbits also had lower levels of cleaved caspase-3 expression; lower levels of proinflammatory cytokines interleukin-1╬▓, tumor necrosis factor alpha, and matrix metalloproteinase 9; and higher levels of insulin-like growth factor-1 and its receptor (pŌĆē<ŌĆē0.05). Autologous BMMNC transplantation can suppress the process of atherosclerotic plaque formation and is associated with enhanced anti-oxidative effect, reduced levels of inflammatory cytokines and cleaved caspase-3, and increased expression of insulin-like growth factor-1 and its receptor. BMMNC transplantation represents a novel approach for the treatment of carotid atherosclerosis. PMID:26232064
Bioengineering of cultured epidermis from adult epidermal stem cells using Mebio gel sutable as autologous graft material
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Lakshmana K Yerneni
Full Text Available Closure of burn wound is the primary requirement in order to reduce morbidity and mortality that are otherwise very high due to non-availability of permanent wound covering materials. Sheets of cultured epidermis grown from autologous epidermal keratinocyte stem cells are accepted world over as one of the best wound covering materials. In a largely populated country like ours where burn casualties occur more frequently due to inadequate safety practices, there is a need for indigenous research inputs to develop such methodologies. The technique to culturing epidermal sheets in vitro involves the basic Reheinwald-Green method with our own beneficial inputs. The technique employs attenuated 3T3 cells as feeders for propagating keratinocyte stem cells that are isolated from the epidermis of an initial skin biopsy of about 5 cm2 from the patient. The cultures are then maintained in Dulbecco's modified Eagle's medium strengthened with Ham's F12 formula, bovine fetal serum and various specific growth-promoting agents and factors in culture flasks under standard culture conditions. The primary cultures thus established would be serially passaged to achieve the required expansion. Our major inputs are into the establishment of (1 an efficient differential trypsinization protocol to isolate large number epidermal keratinocytes from the skin biopsy, (2 a highly specific, unique and foolproof attenuation protocol for 3T3 cells and (3 a specialized and significant decontamination protocol. The fully formed epidermal sheet as verified by immuno-histochemical and light & electron microscopic studies, is lifted on to paraffin gauze by incubating in a neutral protease. The graft is then ready to be transported to the operating theatre for autologous application. We have a capability of growing cultured epidermal sheets sufficient enough to cover 40 per cent burn wound in 28 days. The preliminary small area clinical applications undertaken so far revealed
Alendronate reduced peri-tunnel bone loss and enhanced tendon graft to bone tunnel healing in anterior cruciate ligament reconstruction
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PPY Lui
Full Text Available Peri-tunnel bone loss after anterior cruciate ligament (ACL reconstruction is commonly observed, both clinically and experimentally. We aimed to study the effect and mechanisms of different doses of alendronate in the reduction of peri-tunnel bone loss and promotion of graft-bone tunnel healing in ACL reconstruction. Eighty-four ACL-reconstructed rats were divided into 4 groups. Alendronate at different dosages, or saline, were injected subcutaneously weekly, for 2 or 6 weeks post-reconstruction, for vivaCT (computed tomography imaging, biomechanical tests, histology and immunohistochemistry. Alendronate significantly increased bone mass and density of tissue inside bone tunnels except at the epiphyseal region of tibial tunnel. The femoral tunnel diameter decreased significantly in the mid-dose and high-dose alendronate groups compared to that in the saline group at week 6. Alendronate significantly increased the peri-tunnel bone mass and density along all tunnel regions at week 6. Better graft-bone tunnel integration and intra-tunnel graft integrity were observed in the alendronate groups. The ultimate load was significantly higher in the mid-dose and high-dose alendronate groups at week 2, but not at week 6. There was a reduction in matrix metalloprotein (MMP1, MMP13 and CD68-positive cells at the peri-tunnel region and graft-bone interface in the alendronate-treated group compared to the saline group. Alendronate reduced peri-tunnel bone resorption, increased mineralised tissue inside bone tunnel as well as histologically and biomechanically promoted graft-bone tunnel healing, probably by reducing the expression of MMP1, MMP13 and CD68-positive cells. Alendronate might be used for reducing peri-tunnel bone loss and promoting graft-bone tunnel healing at early stage post-ACL reconstruction.
ÕÉīń¦ŹÕ╝éõĮōķ¬©ÕżŹÕÉłĶć¬õĮōķ¬©ķ½ōÕ╣▓ń╗åĶā×ń¦╗µżŹµ▓╗ń¢ŚĶē»µĆ¦ķ¬©Ķé┐ńśżÕÆīńśżµĀĘńŚģÕÅś%Allogeneic bone combined with autologous bone marrow stem cell transplantation for the treatment of benign bone tumors and tumor-like lesions
Institute of Scientific and Technical Information of China (English)
ÕłśĶŗ▒ķŻ×; ńÄŗµČø; Õ╝ĀÕ╣│ÕŠĘ
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Treatment of chronic hepatic cirrhosis with autologous bone marrow stem cells transplantation in rabbits
International Nuclear Information System (INIS)
Objective: To evaluate the feasibility of treatment for rabbit model with hepatic cirrhosis by transplantation of autologous bone marrow-derived stem cells via the hepatic artery and evaluate the effect of hepatocyte growth-promoting factors (pHGF) in the treatment of stem cells transplantation to liver cirrhosis. To provide empirical study foundation for future clinical application. Methods: Chronic hepatic cirrhosis models of rabbits were developed by subcutaneous injection with 50% CCl4 0.2 ml/kg. Twenty-five model rabbits were randomly divided into three experimental groups, stem cells transplant group (10), stem cells transplant + pHGF group (10) and control group (5). Autologous bone marrow was harvested from fibia of each rabbit, and stem cells were disassociated using density gradient centrifugation and transplanted into liver via the hepatic artery under fluoroscopic guidance. In the stem cells transplant + pHGF group, the hepatocyte growth-promoting factor was given via intravenous injection with 2 mg/kg every other day for 20 days. Liver function tests were monitored at 4, 8,12 weeks intervals and histopathologic examinations were performed at 12 weeks following transplantation. The data were analyzed using analysis of variance Results: Following transplantation of stern cells, the liver function of rabbits improved gradually. Twelve weeks after transplantation, the activity of ALT and AST decreased from (73.0┬▒10.6) U/L and (152.4┬▒ 22.8) U/L to (48.0┬▒1.0) U/L and (86.7┬▒2.1) U/L respectively; and the level of ALB and PTA increased from (27.5┬▒1.8) g/L and 28.3% to (33.2┬▒0.5) g/L and 44.1% respectively. The changes did not have statistically significant difference when compared to the control group (P>0.05). However, in the stem cellstransplant + pHGF group, the activity of ALT and AST decreased to (43.3┬▒0.6) U/L and (78.7┬▒4.0) U/L respectively and the level of ALB and PTA increased to (35.7┬▒0.4) g/L and 50.5% respectively. The difference was
Bone graft substitutes for the treatment of traumatic fractures of the extremities [Knochenersatzmaterialien zur Behandlung von traumatischen Frakturen der Extremit├żten
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Hagen, Anja
patient subgroup with high-grade open fractures (Gustilo-Anderson grade IIIB. Cost-effectiveness for BMP-2 versus standard care with autologous bone grafts as well as for other bone graft substitutes in fracture treatment has not been determined yet. Although there were some significant differences in favour of BMP-2, due to the overall poor quality of the studies the evidence can only be interpreted as suggestive for efficacy. In the case of CaP cements and bone marrow-based bone substitute materials, the evidence is only weakly suggestive for efficacy. From an overall economic perspective, the transferability of the results of the health economic evaluations to the current situation in Germany is limited.The current evidence is insufficient to evaluate entirely the use of different bone graft substitutes for fracture treatment. From a medical point of view, BMP-2 is a viable alternative for treatment of open fractures of the tibia, especially in cases where bone grafting is not possible. Autologous bone grafting is preferable comparing to the use of OP-1. Possible advantages of CaP cements and composites containing bone marrow over autogenous bone grafting should be taken into account in clinical decision making. The use of the hydroxyapatite material and allograft bone chips compared to autologous bone grafts cannot be recommended. From a health economic perspective, the use of BMP-2 in addition to standard care without bone grafting is recommended as cost-saving in patients with high-grade open fractures (Gustilo-Anderson grade IIIB. Based on the current evidence no further recommendations can be made regarding the use of bone graft substitutes for the treatment of fractures. To avoid legal implications, use of bone graft substitutes outside their approved indications should be avoided.[german] Bei der Behandlung von traumatischen Frakturen werden zus├żtzlich zur Standardtherapie und ggf. alternativ zu Knochentransplantaten zunehmend verschiedene
Optimal graft source for allogeneic hematopoietic stem cell transplant: bone marrow or peripheral blood?
Adhikari, Janak; Sharma, Priyadarshani; Bhatt, Vijaya Raj
Peripheral blood (PB), compared with bone marrow graft, has higher stem cell content, leads to faster engraftment and is more convenient for collection. Consequently, the use of PB graft has significantly increased in recent years. Although the use of PB graft is acceptable or even preferred to bone marrow graft in matched related donor allogeneic transplant due to a possibility of improved survival, PB graft increases the risk of chronic graft-versus-host disease and associated long-term toxicities in the setting of matched unrelated donor allogeneic transplant. In haploidentical transplant, mitigation of graft-versus-host disease with the use of post-transplant cyclophosphamide is a hypothesis-generating possibility; however, available studies have significant limitations to draw any definite conclusion. PMID:27168462
Use of Autologous Mesenchymal Stem Cells Derived from Bone Marrow for the Treatment of Naturally Injured Spinal Cord in Dogs
Euler Moraes Penha; C├Īssio Santana Meira; Elisalva Teixeira Guimar├Żes; Marcus Vin├Łcius Pinheiro Mendon├¦a; Faye Alice Gravely; Cl├Īudia Maria Bahia Pinheiro; Taiana Maria Bahia Pinheiro; Stella Maria Barrouin-Melo; Ricardo Ribeiro-dos-Santos; Milena Botelho Pereira Soares
The use of stem cells in injury repair has been extensively investigated. Here, we examined the therapeutic effects of autologous bone marrow mesenchymal stem cells (MSC) transplantation in four dogs with natural traumatic spinal cord injuries. MSC were cultured in vitro, and proliferation rate and cell viability were evaluated. Cell suspensions were prepared and surgically administered into the spinal cord. The animals were clinically evaluated and examined by nuclear magnetic resonance. Ten...
Intracoronary autologous mononucleated bone marrow cell infusion for acute myocardial infarction: results of the randomized multicenter BONAMI trial.
Roncalli, J├®r├┤me; Mouquet, Fr├®d├®ric; Piot, Christophe; Trochu, Jean-Noel; Le Corvoisier, Philippe; Neuder, Yannick; Le Tourneau, Thierry; Agostini, Denis; Gaxotte, Virginia; Sportouch, Catherine; Galinier, Michel; Crochet, Dominique,; Teiger, Emmanuel; Richard, Marie-Jeanne; Polge, Anne-Sophie
International audience AIMS: Intracoronary administration of autologous bone marrow cells (BMCs) leads to a modest improvement in cardiac function, but the effect on myocardial viability is unknown. The aim of this randomized multicentre study was to evaluate the effect of BMC therapy on myocardial viability in patients with decreased left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) and to identify predictive factors for improvement of myocardial viability....
Autologous bone marrow stem cell transplantation for the treatment of type 2 diabetes mellitus
Institute of Scientific and Technical Information of China (English)
WANG Li; ZHAO Shi; MAO Hong; ZHOU Ling; WANG Zhong-jing; WANG Hong-xiang
Background Autologous peripheral stem cell transplantation was first reported in 2007 to treat type 1 diabetes mellitus (DM) and achieved encouraging effect,but whether similar outcome can be achieved in type 2 DM is not well demonstrated.The objective of this study was to determine the effect of combination of autologous bone marrow stem cell transplantation (BMT) and hyperbaric oxygen treatment on type 2 DM.Methods The study involved 31 patients with type 2 DM (aged 33 to 62 years) from January 2009 to January 2011 in the Central Hospital of Wuhan,China.Clinical variables (body mass index,duration of DM,insulin requirement,oral hypoglycemic drugs,time free from insulin,time free from oral drugs) and laboratory variables (hemoglobin A1c (HbA1c)),mononuclear cells infused,and C-peptide in four time points) were assessed.Purified bone marrow stem cells were infused into major pancreatic arteries.Follow-up was performed at the 30,90,180,360,540 and 720 days (mean 321 days) after BMT.Results Mean HbA1c values showed a significant reduction during follow-up in all patients after BMT.It decreased by more than 1.5'╝ģ (from 8.7'╝ģ to 7.1'╝ģ) as quickly as at 30 days after BMT.Afterwards mean HbA1c fluctuated between plus or minus 0.5'╝ģ until 24 months rather than declined continuously.At 90 days after the combined therapy C-peptide increased significantly compared with baseline (P '╝£0.0001).But in other time points C-peptide was similar with baseline data (P'╝×0.3).All patients had insulin and/or oral hypoglycemic drugs reduced to different levels.The dose of insulin of 7 patients (7/26,27'╝ģ) reduced for a period of time after BMT.Conclusions Combined therapy of intrapancreatic BMT and hyperbaric oxygen treatment can improve glucose control and reduce the dose of insulin and/or oral hypoglycemic drugs in type 2 DM patients,but it only improve pancreatic ╬▓-cell function transiently.Further randomized controlled clinical trials involved more patients will be required to
Xenograft Enriched with Autologous Bone Marrow in Inlay Reconstructions: A Tomographic and Histomorphometric Study in Rabbit Calvaria
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Marcelo de Oliveira e Silva
Full Text Available Objective. The aim of this study was to evaluate the bone healing after the usage of a scaffold enriched with bone marrow. Study Design. Ten rabbits were divided into 2 groups of 5 animals. Bilateral 12ŌĆēmm diameter defects were created in the parietal bones. In control group Bio-Oss were inserted in both defects and, in experimental group, Bio-Oss enriched with autologous bone marrow were inserted in both defects. In these two groups, one of the calvarial defects was covered with Bio-Gide. The rabbits were sacrified 8 weeks after surgery and both CT and histomorphometric analysis were done. Results. The CT showed a lower remaining defect area in the experimental group covered with Bio-Gide when compared with control group, with and without Bio-Gide. The histomorphometrics showed no difference between groups regarding the non-vital mineralized tissue area. For vital mineralized tissue area, the experimental group covered with Bio-Gide obtained a higher percentage area when compared with control group, with and without Bio-Gide. For non-mineralized tissue area, the experimental group covered with Bio-Gide obtained a lower percentage area when compared with control group, with and without Bio-Gide. Conclusion. Both autologous bone marrow and membrane can contribute to the enhancement of bone healing.
Application of tridimensional intravertebral bone graft combined with AxiaLIF technique in lumbar interbody fusion
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Xiangdong Duan
Full Text Available "nLumbar interbody fusion techniques are becoming more and more minimally invasive. AxiaLIF technique can be used in low back pain caused by degenerative disc disease or minor spondylolisthesis, but there are risks for fusion failure. Intravertebral bone graft is performed in painful osteoporotic or posttraumatic vertebral compression fractures (VCFs. Until now, no attempt has been made to apply intravertebral bone graft with AxiaLIF technique."nSo first, we hypothesize a novel method for tridimensional intravertebral bone graft with a special designed bone grafting instrument and describe it vividly. The special instrument would mainly consist of a hollow tube and a rod, the distal parts of them would be shape into 45o slope, so the direction of grafting would be decided by the slope. By rotating the tube we can deliver cancellous bone granules in one plane, but by retreating the tube we can perform tridimensional intravertebral bone graft. Second, intravertebral bone graft is supposed to be performed combined with AxiaLIF technique in order to create biologic vertebral reconstruction and raise fusion rate. We believe this is the first description of such a method, future clinical studies are needed to validate these hypotheses.
Autologous bone marrow-derived progenitor cell transplantation for myocardial regeneration after acute infarction
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Obradovi─ć Slobodan
Full Text Available Background. Experimental and first clinical studies suggest that the transplantation of bone marrow derived, or circulating blood progenitor cells, may beneficially affect postinfarction remodelling processes after acute myocardial infarction. Aim. This pilot trial reports investigation of safety and feasibility of autologous bone marrow-derived progenitor cell therapy for faster regeneration of the myocardium after infarction. Methods and results. Four male patients (age range 47-68 years with the first extensive anterior, ST elevation, acute myocardial infarction (AMI, were treated by primary angioplasty. Bone marrow mononuclear cells were administered by intracoronary infusion 3-5 days after the infarction. Bone marrow was harvested by multiple aspirations from posterior cristae iliacae under general anesthesia, and under aseptic conditions. After that, cells were filtered through stainless steel mesh, centrifuged and resuspended in serum-free culture medium, and 3 hours later infused through the catheter into the infarct-related artery in 8 equal boluses of 20 ml. Myocardial viability in the infarcted area was confirmed by dobutamin stress echocardiography testing and single-photon emission computed tomography (SPECT 10-14 days after infarction. One patient had early stent thrombosis immediately before cell transplantation, and was treated successfully with second angioplasty. Single average ECG revealed one positive finding at discharge, and 24-hour Holter ECG showed only isolated ventricular ectopic beats during the follow-up period. Early findings in two patients showed significant improvement of left ventricular systolic function 3 months after the infarction. There were no major cardiac events after the transplantation during further follow-up period (30-120 days after infarction. Control SPECT for the detection of ischemia showed significant improvement in myocardial perfusion in two patients 4 months after the infarction
Vascularized Fibula Grafts for Reconstruction of Bone Defects after Resection of Bone Sarcomas
Petersen, Michael M├Ėrk; Hovgaard, Dorrit; Elberg, Jens J├Ėrgen; Rechnitzer, Catherine; Daugaard, S├Ėren; Muhic, Aida
We evaluated the results of limb-sparing surgery and reconstruction of bone defects with vascularized fibula grafts in 8 consecutive patients (mean age at operation 13.6 years (range 4.1ŌĆō24.2 years), female/male = 6/2) with bone sarcomas (BS) (osteosarcoma/Ewing's sarcoma/chondrosarcoma= 4/3/1) operated on form 2000 to 2006. The bone defects reconstructed were proximal femoral diaphysis and epiphysis (n = 2), humeral diaphysis (n = 2), humeral proximal diaphysis and epiphysis (n = 1), femoral diaphysis (n = 1), ulnar diaphysis (n = 1), and tibial diaphysis (n = 1). One patient with Ewing's sarcoma had an early hip disarticulation, developed multiple metastases, and died 9 months after the operation. The remaining patients (n = 7) are all alive 50 months (range 26ŌĆō75 months) after surgery. During the follow-up the following major complications were seen: 1-2 fractures (n = 4), pseudarthrosis (n = 2), and hip dislocation (n = 1). Limb-sparing surgery with reconstruction of bone defects using vascularized fibular grafts in BS cases is feasible with acceptable clinical results, but fractures should be expected in many patients. PMID:20490263
Bone grafts and dental implants in the reconstruction of the severely atrophied, edentulous maxilla
Johansson, Bj├Črn
In two prospective, clinical studies the stability of implants and prosthetic constructions were evaluated after three years of loading. In the first study, the implant and the bridge stability of 39 patients with 1-stage bone grafts, were compared to a reference-group of 37 patients who did not need bone grafts. In the second study, 40 patients were randomised to have either 1-stage sinus inlay bloc grafts or 2-stage sinus inlay particulated grafts. Implant success in Paper 1, was 75.3% in...
Revascularization of calvarial, mandibular, tibial, and iliac bone grafts in rats
DEFF Research Database (Denmark)
Pinholt, E M; Solheim, E; Talsnes, O;
area of harvest of bone graft is important regarding early revascularization, but the results do not support the theory that different embryological mode of development is the cause since mandibula (high 141Ce index) and calvaria (low 141Ce index) are of membranous origin and iliac bone (high 141Ce...... index) and tibia (low 141Ce index) are of endochondral origin. The difference in revascularization between the different grafts may be explained by differences in quantity of cancellous bone since cancellous bone is revascularized faster than cortical bone....
Evaluation of bone response to synthetic bone grafting material treated with argon-based atmospheric pressure plasma
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Beutel, Bryan G., E-mail: firstname.lastname@example.com; Danna, Natalie R.; Gangolli, Riddhi; Granato, Rodrigo; Manne, Lakshmiprada; Tovar, Nick; Coelho, Paulo G.
Bone graft materials are utilized to stimulate healing of bone defects or enhance osseointegration of implants. In order to augment these capabilities, various surface modification techniques, including atmospheric pressure plasma (APP) surface treatment, have been developed. This in vivo study sought to assess the effect of APP surface treatment on degradation and osseointegration of SynthograftŌäó, a beta-tricalcium phosphate (╬▓-TCP) synthetic bone graft. The experimental (APP-treated) grafts were subjected to APP treatment with argon for a period of 60 s. Physicochemical characterization was performed by environmental scanning electron microscopy, surface energy (SE), and x-ray photoelectron spectroscopy analyses both before and after APP treatment. Two APP-treated and two untreated grafts were surgically implanted into four critical-size calvarial defects in each of ten New Zealand white rabbits. The defect samples were explanted after four weeks, underwent histological analysis, and the percentages of bone, soft tissue, and remaining graft material were quantified by image thresholding. Material characterization showed no differences in particle surface morphology and that the APP-treated group presented significantly higher SE along with higher amounts of the base material chemical elements on it surface. Review of defect composition showed that APP treatment did not increase bone formation or reduce the amount of soft tissue filling the defect when compared to untreated material. Histologic cross-sections demonstrated osteoblastic cell lines, osteoid deposition, and neovascularization in both groups. Ultimately, argon-based APP treatment did not enhance the osseointegration or degradation of the ╬▓-TCP graft. Future investigations should evaluate the utility of gases other than argon to enhance osseointegration through APP treatment. - Highlights: ŌĆó Degradation/osseointegration of bone graft treated with argon-based APP is studied. ŌĆó APP treatment did
Sellar repair with autologous muscle and composite septal cartilage grafts for treatment of cerebrospinal fluid leakage following trans-sphenoidal pituitary surgery
El Shazly, Ayman A.; El Wardany, Mohammed A.; Abo El Ezz, Tamer A.
Context: Many reconstructive techniques have been proposed to prevent postoperative cerebrospinal fluid (CSF) leakage after trans-sphenoidal pituitary surgery. However, no total agreement has been reached to the best technique. Aim: Assessment of the efficacy of sellar repair with autologous muscle and composite septal cartilage grafts for treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain. Study Design: This is a retrospective case series study, level IV evidence. Materials and Methods : Twenty three patients were involved in this study. Seventeen patients had intraoperative CSF leakage and were treated immediately by our technique. Six patients had postoperative CSF rhinorrhea and had delayed treatment with our technique after failure of conservative measures and external lumbar CSF drainage for more than three days. The technique involved intradural placement of autologous muscle graft supplemented with extradural composite septal cartilage graft, composed of a piece of the posterior cartilaginous septum with its covering mucoperichondrium on one side only to fit into the sellar defect as a double layer button. Results: CSF leak was of grade 1 in 6 patients (26.1%), grade 2 in 10 patients (43.5%) and grade 3 in 7 patients (30.4%). None of the patients in our study had postoperative CSF leak after the use of our technique during the follow up period (mean 24 ┬▒ 10.47 standard deviation months). None of the patients developed treatment-related complications. All the patients had well developed mucosal covering of the sellar defect after two months. Conclusion: Our technique of sellar repair by using autologous muscle and composite septal cartilage grafts is effective in treatment of intraoperative and delayed postoperative CSF leakage following trans-sphenoidal pituitary surgery without the use of postoperative external lumbar CSF drain even in
Results of autogenous trephine biopsy needle bone grafting in fractures of radius and ulna.
Lakhey, S; Shrestha, B P; Pradhan, R L; Pandey, B; Rijal, K P
Cortico-Cancellous bone graft harvested from the anterior iliac crest by the conventional open method is associated with more morbidity and is more time consuming as compared to the percutaneous method using trephine biopsy needle. The aim of the study was to determine whether cancellous bone graft harvested from anterior iliac crest using trephine biopsy needle consistently achieved bone union in comminuted fractures and fractures of more than 3 weeks duration of radius and ulna and also to determine the morbidity at the donor site. Autogenous cancellous bone graft was harvested percutaneously from 28 iliac crests in 16 patients and applied at fracture sites of 30 forearm bones using a 4mm trephine biopsy needle after the fractures had been fixed with plate and screws. The patients were followed up regularly upto 6 to 9 months post - operatively in the OPD to determine the union status of the fractured bones and the morbidity at the donor site. 29 of the 30 fractures of the forearm bones united without any problems. The shaft of a trephine got bent during the harvesting procedure at the beginning of the study due to improper technique. Cancellous bone graft harvested from the anterior iliac crest results in predictable good union results in comminuted fractures of forearm bones and also fractures presenting after 3 weeks of injury. It is also an easier and quicker way of harvesting bone graft and is associated with lesser morbidity and earlier recovery as compared to conventional open method. PMID:16554860
Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research
SHEN, Jia-zuo; YAO, Jian-fei; LIN, Da-sheng; Lian, Ke-jian; Ding, Zhen-qi; Lin, Bin; GUO, Zhi-min; Zhang, Ming-Hua; Li, Qiang; LI, Lin; Qi, Peng
Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise. Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model. Design: Testing of specifically designed fixation devices in a pig animal model....
Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research
Jia-zuo SHEN, Jian-fei YAO, Da-sheng LIN, Ke-jian LIAN, Zhen-qi DING, Bin LIN, Zhi-min GUO, Ming-hua ZHANG, Qiang LI, Lin LI, Peng QI
Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise.Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model.Design: Testing of specifically designed fixation devices in a pig animal model.In...
Prospective Analysis of Secondary Alveolar Bone Grafting in Cleft Lip and Palate Patients
Reddy, M Gokul Chandra; Babu, V Ramesh; Rao, V Eswar; Chaitanya, J Jaya; Allareddy, S; Reddy, C Charan Kumar
Background: To assess the success of the uptake of bone graft in cleft alveolus of the cleft lip and palate patients, quantitatively through computed tomography (CT) scan 6 months postoperative. To assess the successful eruption of permanent lateral incisor or canine in the bone grafted area. Materials and Methods: The children age group of 9-21 years with unilateral cleft lip and palate came to the hospital, needing secondary alveolar bone grafting. A detailed history and clinical examination of the patient was taken. A 3D CT scan was taken and the volume of the cleft was measured pre-operatively. After ambulatory period, 3D CT scan of the alveolar cleft region was taken and volume of the bone grafted was measured and patient was discharged from the hospital. After 6 months, patient was recalled and again 3D CT scan was taken and the volume of remaining bone was measured. Results: The mean volume of the defect pre-operatively is 0.80 cm3 with a standard deviation of 0.36 cm3 with minimum volume of the defect 0.44 cm3 and maximum volume of the defect 1.60 cm3. The mean volume of the bone post-operative immediately after grafting is 1.01 cm3 with a standard deviation of 0.52 cm3 with minimum of bone volume is 0.48 cm3 and maximum of 2.06 cm3. The mean volume of the bone after 6 months after bone grafting is 0.54 cm3 with a standard deviation of 0.33 cm3, minimum bone volume of 0.22 cm3 and maximum bone volume of 1.42 cm3. Conclusion: The CT scan is a valuable radiographic imaging modality to assess and follow the clinical outcome of secondary alveolar bone grafting. PMID:25954076
Autologous cell therapy as a new approach to treatment of radiation-induced bone marrow aplasia: preliminary study in a baboon model
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Herodin, F.; Drouet, M. [Radiohematology Unit, Centre de Recherches du Service de Sante des Armees, La Tronche CEDEX (France)
The sparing of viable hematopoietic stem and progenitor cells located in underexposed bone marrow territories associated with the relative radioresistance of certain stem cell populations is the rationale for autologous cell therapy consisting of ex vivo expansion of residual cells after collection postirradiation. The feasibility of this treatment mainly depends on time constraints and hematopoietic cell threshold. We showed in this study that in the absence of early-acting mobilizing agent administration, subliminar amounts of CD34{sup +} cells can be collected (1 x 10{sup 6} CD34{sup +} cells/100 mL bone marrow or for 1 L apheresis) from 6-Gy {gamma} globally irradiated baboons. Residual CD34{sup +} cells were successfully expanded in serum-free medium in the presence of antiapoptotic cytokine combination (stem cell factor + FLT-3 ligand + thrombopoietin + interleukin 3, 50 ng/mL each, i.e., 4F): K{sub CD34{sup +}} = x2.8 and x13.7 (n=2). Moreover, we demonstrated the short-term neutrophil engraftment potential of a low-size mixed expanded graft (1.5 x 10{sup 6} final CD34{sup +}cells/kg) issued from the coculture of unirradiated (20%) and 2.5-Gy in vitro irradiated (80%) CD34{sup +} cells on an allogeneic stromal cell layer in the presence of 4F. Further preclinical research needs to be performed to clearly establish this therapeutic approach that could be optimized by the early administration of antiapoptotic cytokines. (author)
Institute of Scientific and Technical Information of China (English)
Objective. To evaluate the treatment results of bilateral alveolar bone grafting (BABG) in patients with bilateral complete clefts of lip and palate.Methods. A retrospective study was performed in 66 bilateral complete cleft lip and palate patients who received the procedure of BABG, among them 15 were primary BABG and 51 were secondary BABG. The patients were further divided into three groups according to age and eruption stage of the canine at the time of surgery. The result of BABG was evaluated on the radiographs. Results. (1)The overall success rate of BABG was 75.0%, with 83.3% and 72.5% for primary and secondary BABG respectively; (2)The marginal bone level was found to be significantly higher in the youngest age group than in the other groups both for primary and secondary BABG; (3)For both primary and secondary BABG, Group C (patients' age more than 16 years) had the least optimal success rate, with 66.7% and 65.4% respectively. Conclusion. Simultaneous primary palate repair and BABG is safe and feasible procedure for treating unoperated bilateral complete cleft lip and cleft palate patients. For both primary and secondary BABG, significantly better results can be achieved if the operation is performed before eruption of the canine.
Alveolar bone grafting in association with polyostotic fibrous dysplasia and bisphosphonate-induced abnormal bone turnover in a bilateral cleft lip and palate patient: a case report.
Kodama, Yasumitsu; Ogose, Akira; Oguri, Yoshimitsu; Ubaidus, Sobhan; Iizuka, Tateyuki; Takagi, Ritsuo
A case is presented of extensive alveolar bone grafting in a patient with bilateral cleft lip and palate and polyostotic fibrous dysplasia. The patient previously underwent bisphosphonate therapy. Because of an abnormal and often decreased bone turnover caused by the fibrous dysplasia and the bisphosphonate therapy, bone grafting in such a patient poses several potential difficulties. In addition, the histomorphometric analysis of the bone grafts showed markedly decreased bone turnover. However, alveolar bone grafting using the iliac crest was performed successfully. Sufficient occlusion was achieved by postoperative low-loading orthodontic treatment.
Autologous Bone Marrow Mononuclear Cell Therapy for Autism: An Open Label Proof of Concept Study
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Alok Sharma
Full Text Available Cellular therapy is an emerging therapeutic modality with a great potential for the treatment of autism. Recent findings show that the major underlying pathogenetic mechanisms of autism are hypoperfusion and immune alterations in the brain. So conceptually, cellular therapy which facilitates counteractive processes of improving perfusion by angiogenesis and balancing inflammation by immune regulation would exhibit beneficial clinical effects in patients with autism. This is an open label proof of concept study of autologous bone marrow mononuclear cells (BMMNCs intrathecal transplantation in 32 patients with autism followed by multidisciplinary therapies. All patients were followed up for 26 months (mean 12.7. Outcome measures used were ISAA, CGI, and FIM/Wee-FIM scales. Positron Emission Tomography-Computed Tomography (PET-CT scan recorded objective changes. Out of 32 patients, a total of 29 (91% patients improved on total ISAA scores and 20 patients (62% showed decreased severity on CGI-I. The difference between pre- and postscores was statistically significant (P<0.001 on Wilcoxon matched-pairs signed rank test. On CGI-II 96% of patients showed global improvement. The efficacy was measured on CGI-III efficacy index. Few adverse events including seizures in three patients were controlled with medications. The encouraging results of this leading clinical study provide future directions for application of cellular therapy in autism.
Establishment of an animal model of a pasteurized bone graft, with a preliminary analysis of muscle coverage or FGF-2 administration to the graft
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Nakayama Koichi
Full Text Available Abstract Background Pasteurized bone grafting is used following the excision of a bone tumor for the purpose of eliminating neoplastic cells while preserving bone-inducing ability. In the hopes of guaranteeing the most favourable results, the establishment of an animal model has been urgently awaited. In the course of establishing such a model, we made a preliminary examination of the effect of muscle coverage or fibroblast growth factor 2 (FGF-2 administration radiographically. Methods Forty pasteurized intercalary bone grafts of the Wistar rat femur treated at 60┬░C for 30 min were reimplanted and stabilized with an intramedullary nail (1.1 mm in diameter. Some grafts were not covered by muscle after the implantation, so that they could act as a clinical model for wide resection, and/or these were soaked with FGF-2 solution prior to implantation. The grafts were then divided into 3 groups, comprising 12 grafts with muscle-covering but without FGF-2 (MC+; FGF2-, 12 grafts without muscle-covering and without FGF-2 (MC-; FGF2- and 16 grafts without muscle covering but with FGF-2 (MC-; FGF2+. Results At 2 weeks after grafting, the pasteurized bone model seemed to be successful in terms of eliminating living cells, including osteocytes. At 4 weeks after grafting, partial bone incorporation was observed in half the (MC+; FGF2- cases and in half the (MC-; FGF2+ cases, but not in any of the (MC-; FGF2- cases. At 12 weeks after grafting, bone incorporation was seen in 3 out of 4 in the (MC+; FGF2- group (3/4: 75% and in 3 out of 8 in the (MC-; FGF2+ group (3/8: 38%. However, most of the grafted bones without FGF-2 were absorbed in all the cases, massively, regardless of whether there had been muscle-covering (MC+; FGF2-; 4/4: 100% or no muscle-covering (MC-; FGF2-; 4/4: 100%, while bone absorption was noted at a lower frequency (2/8: 25% and to a lower degree in the (MC-; FGF2+ group. Conclusion In conclusion, we have established an animal pasteurized
Stability of dental implants in grafted bone in the anterior maxilla: longitudinal study.
LENUS (Irish Health Repository)
Al-Khaldi, Nasser
We aimed to assess the stability over time of dental implants placed in grafted bone in the maxilla using resonance frequency analysis, and to compare the stability of implants placed in grafted and non-grafted bone. Data were collected from 23 patients (15 test and 8 controls) in whom 64 implants (Br├źnemark system, Nobel Biocare, G├Čteborg, Sweden) were placed in accordance with the two-stage surgical protocol. In the test group 36 fixtures were placed in grafted bone, and in the control group 28 fixtures were placed in non-grafted bone. Resonance frequency analysis was used to assess the test sites at implant placement and abutment connection. The mean (SD) implant stability quotient (ISQ) for test sites at the time of implant placement was 61.91 (6.68), indicating excellent primary stability, and was 63.53 (5.76) at abutment connection. ISQ values at abutment connection were similar for test and control sites. Implants placed in grafted bone compared favourably with those in non-grafted bone, and showed excellent stability.
MR tomography of bone marrow changes after high-dose chemotherapy and autologous peripheral stem cell transplantation
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Purpose: Evaluation of MR standard imaging and short time inversion recovery (STIR) imaging to assess changes in red bone marrow cellularity after high-dose chemotherapy (HDC) and peripheral blood stem cells transplantation (PBSCT). Results: STIR sequences demonstrated marked changes in signal intensity not only until the aplasia occurred but also during bone marrow repopulation. An increased signal intensity was observed after HDC in 13/15 patients (87%), followed by a decrease in signal intensity immediately after aplasia in 14/15 patients (93%). Signal intensity further changed parallel to marrow engraftment in 11/15 patients (73%). T2-TSE only showed clear changes during repopulation in 8/15 patients (53%). The individual course of the signal in T1-TSE was markedly inhomogeneous. Conclusions: STIR sequences show bone marrow edema during aplasia and marrow cellularity during reconstitution and are suitable for characterisation of red bone marrow after HDC and autologous PBSCT. (orig.)
Effects observation of autologous fat grafting on augmentation mammoplasty%Ķć¬õĮōĶäéĶé¬ķóŚń▓ÆķÜåõ╣│40õŠŗµĢłµ×£Ķ¦éÕ»¤
Institute of Scientific and Technical Information of China (English)
ĶóüÕ╝║; Պɵ░ĖµłÉ; Õłśķ╣ż; ńÄŗµÖōÕåø
Objective To investigate the clinical effect of autologous fat grafting on augmentation mammoplasty. Methods Autologous fat was selected from waist and abdomen or thigh fat particles, transplant to the pectoralis to breast clearance and subcutaneous for breast augmentation.The second transplantation was operated within six months.After 12 months of follow- up,compared with preoperative and postoperative bust,to evaluate the effect of the operation. Results All cases had no operative complications.After the two operation,bust increased by an average of 4.2cm.Autologous fat grafting breast augmentation surgery had good results. Conclusion Autologous fat breast augmentation surgery is safe and effective.%ńø«ńÜä'╝ܵÄóĶ«©Ķć¬õĮōĶäéĶé¬ķóŚń▓ÆķÜåõ╣│ńÜäõĖ┤Õ║ŖµĢłµ×£ŃĆéµ¢╣µ│Ģ'╝ÜÕÅ¢Ķģ░Ķģ╣ķā©µł¢Õż¦Ķģ┐ĶäéĶé¬ķóŚń▓Æ,ÕżäńÉåÕÉÄÕ░åĶäéĶé¬ķóŚń▓Æń¦╗µżŹõ║ÄĶāĖÕż¦ĶéīŃĆüõ╣│Ķģ║ÕÉÄÕÅŖńÜ«õĖŗĶ┐øĶĪīķÜåõ╣│'╝ī6õĖ¬µ£łÕåģĶ┐øĶĪīń¼¼õ║īµ¼Īń¦╗µżŹŃĆéµ£»ÕÉÄķÜÅĶ«┐12õĖ¬µ£ł'╝īķĆÜĶ┐ćÕ»╣µ»öµ£»ÕēŹÕÅŖµ£»ÕÉÄĶāĖÕø┤'╝īĶ┐øĶĪīµēŗµ£»µĢłµ×£Ķ»äõ╝░ŃĆéń╗ōµ×£'╝Üń╗ÅĶ┐ćõĖżµ¼ĪĶäéĶé¬ķóŚń▓Æń¦╗µżŹ'╝īµēƵ£ēµéŻĶĆģµŚĀµśÄµśŠµēŗµ£»Õ╣ČÕÅæńŚć'╝īĶāĖÕø┤Õ╣│ÕØćÕó×ÕŖĀ4.2cm'╝īķÜåõ╣│µĢłµ×£ńĪ«Õ«×µ£ēµĢłŃĆéń╗ōĶ«║'╝ÜĶć¬õĮōķóŚń▓ÆĶäéĶé¬ķÜåõ╣│µ£»Õ«ēÕģ©µ£ēµĢłÕĆ╝ÕŠŚµÄ©Õ╣┐ŃĆé
Histologic Evaluation of Critical Size Defect Healing With Natural and Synthetic Bone Grafts in the Pigeon ( Columba livia ) Ulna.
Tunio, Ahmed; Jalila, Abu; Goh, Yong Meng; Shameha-Intan; Shanthi, Ganabadi
Fracture and bone segment loss are major clinical problems in birds. Achieving bone formation and clinical union in a fracture case is important for the survival of the bird. To evaluate the efficacy of bone grafts for defect healing in birds, 2 different bone grafts were investigated in the healing of a bone defect in 24 healthy pigeons ( Columba livia ). In each bird, a 1-cm critical size defect (CSD) was created in the left ulna, and the fracture was stabilized with external skeletal fixation (ESF). A graft of hydroxyapatite (HA) alone (n = 12 birds) or demineralized bone matrix (DBM) combined with HA (n = 12 birds) was implanted in the CSD. The CSD healing was evaluated at 3 endpoints: 3, 6, and 12 weeks after surgery. Four birds were euthanatized at each endpoint from each treatment group, and bone graft healing in the ulna CSD was evaluated by histologic examination. The CSD and graft implants were evaluated for quality of union, cortex development, and bone graft incorporation. Results showed no graft rejection in any bird, and all birds had connective tissue formation in the defect because of the bone graft application. These results suggest that bone defect healing can be achieved by a combination of osteoinductive and osteoconductive bone graft materials for clinical union and new bone regeneration in birds. The combination of DBM and HA resulted in a better quality bone graft (P < .05) than did HA alone, but there was no significant differences in cortex development or bone graft incorporation at 3, 6, or 12 weeks. From the results of this study, we conclude that HA bone grafts, alone or in combination with DBM, with external skeletal fixation is suitable and safe for bone defect and fracture treatment in pigeons.
Use of Nasal Septal Bone for Septal Extension Graft after Jaw Surgery
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Gui Rak Kim, MD
Conclusions: Use of septal bone for septal extension graft may serve as a valuable option in septal cartilageŌĆōdepleted patients. It gives a strong construct for tip surgery with patient satisfaction.
Cemented total hip arthroplasty with impacted morcellized bone-grafts to restore acetabular bone defects in congenital hip dysplasia.
Bolder, S.B.T.; Melenhorst, J.; Gardeniers, J.W.M.; Slooff, T.J.J.H.; Veth, R.P.H.; Schreurs, B.W.
We evaluated the results of 27 acetabular reconstructions in 21 patients with secondary osteoarthritis resulting from congenital dysplasia of the hip in which the acetabular bone defects were restored with impacted morcellized bone-grafts in combination with a cemented cup. At an average follow-up o
Reconstruction of mandibular defects with autogenous bone grafts: a review of 30 cases
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Multitudes of options are available for reconstruction of functional and cosmetic defects of the mandible, caused by various ailments. At the present time, autogenous bone grafting is the gold standard by which all other techniques of reconstruction of the mandible can be judged. The purpose of this study was to evaluate the outcome of different osseous reconstruction options using autogenous bone grafts for mandibular reconstruction. Methods: This Interventional study was conducted at Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital Lahore, from January 2008 to July 2009 including one year follow-up. The study was carried out on thirty patients having bony mandibular defects. They were reconstructed with the autogenous bone grafts from different graft donor sites. On post-operative visits they were evaluated for outcome variables. Results: Success rate of autogenous bone grafts in this study was 90%. Only 10% of the cases showed poor results regarding infection, resorption and graft failure. Conclusion: Autogenous bone grafts, non-vascularized or vascularized, are a reliable treatment modality for the reconstruction of the bony mandibular defects with predictable functional and aesthetic outcome. (author)
Osseous and dental outcomes of primary gingivoperiosteoplasty with iliac bone graft: A radiological evaluation.
Touzet-Roumazeille, Sandrine; Vi-Fane, Brigitte; Kadlub, Natacha; Genin, Michaël; Dissaux, Caroline; Raoul, Gwenaël; Ferri, Joël; Vazquez, Marie-Paule; Picard, Arnaud
Primary alveolar cleft repair has two main purposes: to restore normal morphology and normal function. Gingivoperiosteoplasty with bone grafting in mixed dentition has been a well-established procedure. We hypothesized that 1) performance of this surgery in deciduous dentition would provide favorable bone graft osseointegration, and 2) would improve the support of incisor teeth eruption, thereby avoiding maxillary growth disturbances. We conducted a retrospective study of clinical and tridimensional radiological data for 73 patients with alveolar clefts (with or without lip and palate clefts) who underwent gingivoperiosteoplasty with iliac bone graft in deciduous dentition. Pre- and post-operative Cone Beam Computed Tomography (CBCT) comparison allowed evaluation of the ratio between bone graft volume and initial cleft volume (BGV/ICV ratio), and measurement of central incisor teeth movements. This series of 73 patients included 44 males and 29 females, with a mean age of 5.5 years. Few complications were observed. Post-operative CBCT was performed at 7.4 months. The mean BGV/ICV ratio was 0.62. Axial rotation was significantly improved post-operatively (p = 0.004). Gingivoperiosteoplasty with iliac bone graft is safe when performed in deciduous dentition and results in a sufficient bone graft volume to support lateral incisor eruption and upper central incisor tooth position improvement.
Bone grafting, corticotomy, and orthodontics: treatment of cleft alveolus in a chinese cohort.
Mao, Li-Xia; Shen, Guo-Fang; Fang, Bing; Xia, Yun-Hui; Ma, Xu-Hui; Wang, Bo
Objective : A multimodal therapy was applied to solve a set of related problems including collapse of the posterior segment, high level gingival margin of canine, and resorption of grafted bone in a cohort of Chinese youngsters with cleft lip and palate. This study aimed to evaluate the benefits of this treatment procedure. Methods : Thirty patients with unilateral cleft lip and palate were included in this prospective study. All patients had previously undergone only cleft lip and palate repair and presented with alveolar cleft and an obvious step in the gingival margin between the canine tooth and the teeth beside it. A multimodal therapy that included bone grafting, corticotomy, and orthodontics was applied to solve these problems. Grafted bone volume, parallelism of the roots, root resorption, gingival margin, and mobility of the canine on the cleft side were established before surgery, 1 week after surgery, and after straightening of the canine. Results : Less than 25% of the grafted bone was reabsorbed in 25 of the 30 patients, while less than 50% was resorbed in the remaining five. The roots of the canines on the cleft side were mostly parallel to the adjacent teeth. Root resorption and mobility of the canines were slight. The difference in the gingival margin between the canines on the cleft side and the other side was small. Conclusions : Canines moved into the grafted bone safely and effectively, thus achieving a normal gingival margin and retaining grafted bone volume in one operation. PMID:22849663
Handling of the bone long pseudoarthrosis with autologo structural bone graft in failure osteosynthesis
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We find in the literature that the usual way to treat pseudoarthrosis always includes the removal of the material used to stabilize the fractures, with bring along high hospital and social costs for the patient and the family. The treatment we purpose is the appliance of an autologo structural iliac bone graft, trapezoid form, throughout a minimal incision into the lesion. We treated 12 patients that included 14 long bones in a two year period, age range of 23,2 y 12 (86%) patients with femur pseudoarthrosis, 1 (7%) with tibia y 1 (7%) humerus. we obtained 100% consolidation at 5 months after surgery. no complications reported from the patients, and an important reduce in hospital and social costs
Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence?
Van Lieshout, Esther M M; Alt, Volker
Despite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substitutes are often used for stabilizing the implant and for providing a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials are available. Products generally contain hydroxyapatite, tricalcium phosphate, dicalcium phosphate, calcium phosphate cement, calcium sulfate (plaster of Paris), or combinations of the above. Products have been used for the treatment of osteoporotic fractures of the proximal humerus, distal radius, vertebra, hip, and tibia plateau. Although there is generally consensus that screw augmentation increased the biomechanical properties and implant stability, the results of using these products for void filling are not unequivocal. In osteoporotic patients, Bone Morphogenetic Proteins (BMPs) have the potential impact to improve fracture healing by augmenting the impaired molecular and cellular mechanisms. However, the clinical evidence on the use of BMPs in patients with osteoporotic fractures is poor as there are no published clinical trials, case series or case studies. Even pre-clinical literature on in vitro and in vivo data is weak as most articles focus on the beneficial role for BMPs for restoration of the underlying pathophysiological factors of osteoporosis but do not look at the specific effects on osteoporotic fracture healing. Limited data on animal experiments suggest stimulation of fracture healing in ovariectomized rats by the use of BMPs. In conclusion, there is only limited data on the clinical relevance and optimal indications for the use of bone graft substitute materials and BMPs on the treatment of osteoporotic fractures despite the clinical benefits of these materials in other clinical indications. Given the
Pulmonary fat embolism induced intravenous injection of autologous bone marrow in rabbit: CT and pathologic correlation
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To evaluate the correlation between CT and pathologic findings of pulmonary fat embolism in rabbits. In 16 rabbits, pulmonary fat embolism was induced by intravenous injection of autologous bone marrow(mean 3.3 mL). Chest CT scans were obtained immediately(within 1 hour), and 1, 3, and 7 days after embolization. The rabbits were divided into four groups. Group 1 underwent CT scanning immediately after embolization, group 2 immediately and 1 day after embolization, group 3 immediately, 1 day and 3 days after embolization, group 4 immediately, 1 day, 3 days and 7 days after embolization. Pathologic specimens were obtained immediately after the last CT scan. The earliest CT findings of pulmonary fat embolism in rabbits were peripheral lung lucency(16/16, 100%), perivascular ground-glass(12/16, 75.0%) and enlargement of the central pulmonary artery(11/16, 68.8%). Pathologically, perivascular ground-glass opacity correlated with extensive perivascular alveolar congestion and enlargement of the central pulmonary artery correlated with perivascular connective tissue edema and reactive pulmonary arterial engorgement. Peripheral lung lucency was probably caused by embolic occlusion of the pulmonary artery and decreased perfusion and air trapping induced by arterial and bronchial spasm associated with hypoxia. CT scans obtained 1 and 3 days after embolization showed nodules and patchy ground-glass opacity and consolidation. Aggregation of nodules resulted in patch opacities. Pathologically, pulmonary nodules correlated with focal inflammation surrounding an artery and parenchymal opacity correlated with parenchymal consolidation and hemorrhagic edema. CT scans and pathologic specimens obtained 7 days after embolization showed improvement of parenchymal lung abnormalities. Pulmonary fat embolism in rabbits show CT and pathologic findings which vary with dynamic change. Typical earliest findings of pulmonary fat embolism were peripheral lung lucency, perivascular ground
"Percutaneous bone marrow grafting of fracture (An experimental study in rabbits "
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Motamedi M
Full Text Available Since bone marrow has been shown to contain osteoprogenitor cells, an experiment was devised to test its effects when injected percutaneously into osteotomies sites in rabbit radii. In this experimental study, the osteogenicity and its effect on early bone repair of bone marrow grafts were investigated. The purpose of this study was to determine whether bone marrow grafted percutaneously led to increased bone production or had any effect on the early healing of fractures. The parameters tested included, cross-sectional area of callus (XS, breaking load (BL, tensile strength (TS and callus volume (CV at the fracture site. At two weeks post grafting four parameters, specially callus volume, were significantly higher 0.001
Treatment of the benign bone tumors including femoral neck lesion using compression hip screw and synthetic bone graft
Nakamura Tomoki; Matsumine Akihiko; Asanuma Kunihiro; Matsubara Takao; Sudo Akihiro
Purpose: The proximal femur is one of the most common locations for benign bone tumors and tumor like conditions. We describe the clinical outcomes of the surgical treatment of benign lesions of the proximal femur including femoral neck using compression hip screw and synthetic bone graft. Methods: Thirteen patients with benign bone tumors or tumor like conditions of the proximal femur including femoral neck were surgically treated. Their average age at the time of presentatio...
Incompatible SLA bone marrow graft in the pig after fractionated irradiation and administration of cyclosporin A
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A series of fractionated partial irradiations which consisted of either 3 gray x 6 times or 3 gray x 4 times, combined with pharmacological immunosuppression (Cyclosporin A: Cs-A) ensure a SLA semidifferent bone marrow graft in the pig. Bone marrow and peripheral blood lymphocytes chimerism was readily detectable. No graft versus host disease (GVHD) symptoms were noticed as long as Cs-A was given at a sufficient dose. However when Cs-A treatment was stopped GVHD or rejection of the graft developed rapidly
Preoperative color duplex echographical venous mapping before autologous fat graft for calf augmentation: a case report of superficial vein thrombosis and prevalence of intersaphenic anastomosis.
Fraccalvieri, Marco; Contessa, Luigi; Salomone, Marco; Zingarelli, Enrico Maria; Bruschi, Stefano
Autologous fat grafting for calf augmentation is considered an easy and safe technique. Only few cases of potential complications have been described in literature; among them, vein thrombosis was never reported. We report a case of superficial vein thrombosis of the intersaphenic anastomosis after fat graft for calf symmetrization in club-foot syndrome. A color duplex echographical study showed that such intersaphenic anastomoses are present in all patients, but they have an ectatic diameter in 70% of patients with great saphenous vein insufficiency and in 50% of patients without insufficiency. The plastic surgeon should be aware of the presence and topography of such anatomical variations before performing the procedure. Moreover, a preoperative color duplex echographical venous mapping may help the surgeon in avoiding the trauma on vein variants and subsequent complications. PMID:23528632
Experience of using vascularized bone grafts in reconstructive surgery of the upper limbs
Atamanov, E. A.; Keosyan, V. T.; Bryukhanov, A. V.; Tsaregorodtseva, E. M.; Danilov, A. V.
The article describes the results of treatment patients with defects and diseases of bone tissue using bone grafting with vascularized bone grafts from different areas of the body. The results of treatment of 27 patients with bone tissue defects of the upper extremities are demonstrated. 16 of patients had scaphoid nonunion. 2 cases of nonunion were reported: one scaphoid nonunion due to unstable osteosynthesis and one lunate fragmentation nonunion in patient with late stage Kienbock`s disease. Vascularized bone graft from distal radius was used in both cases. We had two cases of delayed union at 18 months in surgical treatment of scaphoid. 2 patients had metacarpal bone defect, 1 patient with radius bone defect, 2 patients with SLAC (scapholunate advanced collapse), 2 patients with bone defect of the humerus, 1 patient with bone defect of the ulna. In all cases we used vascularized bone crafts from various anatomical areas. We achieved union in all other cases. The study shows high efficiency of upper extremity bone defect replacement methods.
Tooth Movement out of the Bony Wall Using Augmented Corticotomy with Nonautogenous Graft Materials for Bone Regeneration
Kye-Bok Lee; Dong-Yeol Lee; Hyo-Won Ahn; Seong-Hun Kim; Eun-Cheol Kim; Igor Roitman
This prospective randomized split-mouth study was performed to compare the effects of augmented corticotomy with those of different nonautogenous bone graft materials combined with orthodontic tooth movement in dogs. Decortication was performed on the buccal bone surface of 6 male beagle dogs that were randomly assigned to receive grafts of deproteinized bovine bone mineral, irradiated cortical bone, or synthetic bone. Immediate orthodontic force was applied to the second and third premolars ...
Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis
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T. A. G. van Vugt
Full Text Available Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.
Alternative method to treat oroantral communication and fistula with autogenous bone graft and platelet rich firbin
Niedzielska, Iwona; Borgiel-Marek, Halina; R├│┼╝anowski, Bartosz
Background Removing a tooth from the jaw results in the occurrence of oroantral communication in beneficial anatomic conditions or in the case of a iatrogenic effect. Popularized treatments of the oroantral communication have numerous faults. Large bone defect eliminates the chance to introduce an implant. Purpose of this work was assessment of the usefulness of autogenous bone graft and PRF in normal bone regeneration in the site of oroantral communication. Material and Methods Bone regeneration in the site of oroantral communication was assessed in 20 patients. Bone defects were supplemented autogenous bone graft from mental protuberance in 14 cases and from oblique line in 6 cases. The graft was covered with a PRF membrane. Results In the study group in all cases closure of the oroantral communication was observed. The average width of the alveolar was 13 mm and the average height was 12.5 mm. In 3 patients an average increase of alveolar height of 1.5 mm was observed. Conclusions This method may be the best option to prepare alveolar for new implant and prosthetic solutions. Key words:Oroantral communication, oroantral fistula, autogenous bone graft, bone regeneration, platelet rich fibrin. PMID:27475687
ń║żń╗┤ĶøŗńÖĮĶāČÕżŹÕÉłĶć¬õĮōķ¬©ķ½ōõĖÄõ║║ÕĘźķ¬©õ┐āĶ┐øĶäŖµ¤▒Ķ׏ÕÉłńÜäńÄ░ńŖČõĖÄÕ▒Ģµ£ø%Fibrin sealant combined with autologous bone marrow and artificial bone to promote spine fusion
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ĶöĪÕ┐ŚÕłÜ; ĶŖ«ķÆó
and repairing bone defects, the application of autologous bone marrow graft combined with artificial bone transplantation in repairing bone defects, the application of bone graft methods of spinal fusion.RESULTS AND CONCLUSION: Autologous bone marrow graft combined with artificial bone repairing bone defects achieved good clinical efficacy. Therefore, it should be a feasible solution which using autologous bone marrow combined with artificial bone to increase spinal fusion rate in spinal fusion. However, the process of autologous bone marrow combined with artificial bone was relatively simple in the past. Because of a large fluidity of autologous bone marrow, it lost easily after injection, and reduced its bone formation fu nction. Therefore, it is envisaged in clinical surgery that the adhesion properties of fibrin glue were used to adhere autologous bone marrow and artificial bone together, implant it in spinal zygapophysial joints and transverse process and make full use of its largest bone formation fu nction. This will be a simple, fast and effective clinical way for increasing spinal fusion rate. It needs to be further researched.
Minimally invasive harvest of a quadriceps tendon graft with or without a bone block.
Fink, Christian; Herbort, Mirco; Abermann, Elisabeth; Hoser, Christian
The quadriceps tendon (QT) as a graft source for anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction has recently achieved increased attention. Although many knee surgeons have been using the QT as a graft for ACL revision surgery, it has never gained universal acceptance for primary ACL reconstruction. The QT is a very versatile graft that can be harvested in different widths, thicknesses, and lengths. Conventionally, the QT graft is harvested by an open technique, requiring a 6 to 8 cm longitudinal incision, which often leads to unpleasant scars. We describe a new, minimally invasive, standardized approach in which the QT graft can be harvested through a 2- to 3-cm skin incision and a new option of using the graft without a bone block. PMID:25264512
One stage rescue procedure after capsular contracture of breast implants with autologous fat grafts collected by water assisted liposuction (ŌĆ£BEAULI MethodŌĆØ
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Ueberreiter, Klaus
Full Text Available With increasing number of patients with silicone implants for breast augmentation or reconstruction we are confronted with more and more cases of capsular contracture. Not every case is resolved by resection of the capsule and exchange of implants. Many patients rather bear the consequences of severe fibrosis than to have their implants removed. The one stage procedure of implant removal and lipofilling proved to be highly efficient with good to excellent results and high patient satisfaction. Between January 2008 and October 2012 a total of 64 patients (124 breasts with capsular fibrosis Baker III to IV were treated with autologous fat grafts collected with the body-jet by water-assisted liposuction (ŌĆ£BEAULI MethodŌĆØ. Magnetic resonance imaging (MRI of the breasts was performed in 5 patients preoperatively and 6 month postoperatively, a clinical examination and photo documentation of all patients was done on day 1 and after 4 weeks, 12 weeks and 6 months postoperatively. The procedure included implant removal and lipofilling of the subcutaneous and intramuscular space in a single procedure by means of the BEAULI Method. The average gross amount of grafted fat was 260 ml. The average drainage time was one day. The shape of the breast changed to a more natural and ptotic form. Negative side effects like oily cysts or infections were not observed. The time of the overall procedure including liposuction was 70┬▒15 min. Reoccurring capsular contracture is one of the hazards in plastic surgery. Until now the treatment of choice after more than two failed implant changes combined with resection of the capsule is usually the final removal of implants with or without possible additional autologous tissue transfer (microvascular flaps. We could add a relatively simple and efficient procedure to resolve and improve those cases by autologous fat transfer using water-assisted liposuction and the BEAULI Method.
Comparative Analysis of Remyelinating Potential of Focal and Intravenous Administration of Autologous Bone Marrow Cells Into the Rat Demyelinated Spinal Cord
Inoue, Michio; HONMOU, OSAMU; Oka, Shinichi; Houkin, Kiyohiro; Hashi,Kazuo; Kocsis, Jeffery D.
The remyelinating potential of autologous bone marrow cells was studied after direct injection and following intravenous injection into rats with a demyelinated lesion in the spinal cord. Both focal and intravenous injections of acutely isolated mononuclear bone marrow cell fractions resulted in varying degrees of remyelination. Suspensions of bone marrow cells collected from the same rat were delivered at varied concentrations (102 to 105 for direct injection and 104 to 107 for i.v. injectio...
Late sarcoma development after curettage and bone grafting of benign bone tumors
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Picci, Piero, E-mail: email@example.com [Bone Tumor Center, Istituto Ortopedico Rizzoli, Bologna (Italy); Sieberova, Gabriela [Dept. of Pathology, National Cancer Institute, Bratislava (Slovakia); Alberghini, Marco; Balladelli, Alba; Vanel, Daniel [Bone Tumor Center, Istituto Ortopedico Rizzoli, Bologna (Italy); Hogendoorn, Pancras C.W. [Dept. of Pathology, Leiden University Medical Center, Leiden (Netherlands); Mercuri, Mario [Bone Tumor Center, Istituto Ortopedico Rizzoli, Bologna (Italy)
Background and aim: Rarely sarcomas develop in previous benign lesions, after a long term disease free interval. We report the experience on these rare cases observed at a single Institution. Patients and methods: 12 cases curetted and grafted, without radiotherapy developed sarcomas, between 1970 and 2005, 6.5-28 years from curettage (median 18, average 19). Age ranged from 13 to 55 years (median 30, average 32) at first diagnosis; tumors were located in the extremities (9 GCT, benign fibrous histiocytoma, ABC, and solitary bone cyst). Radiographic and clinic documentation, for the benign and malignant lesions, were available. Histology was available for 7 benign and all malignant lesions. Results: To fill cavities, autogenous bone was used in 4 cases, allograft in 2, allograft and tricalcium-phosphate/hydroxyapatite in 1, autogenous/allograft in 1, heterogenous in 1. For 3 cases the origin was not reported. Secondary sarcomas, all high grade, were 8 osteosarcoma, 3 malignant fibrous histiocytoma, and 1 fibrosarcoma. Conclusions: Recurrences with progression from benign tumors are possible, but the very long intervals here reported suggest a different cancerogenesis for these sarcomas. This condition is extremely rare accounting for only 0.26% of all malignant bone sarcomas treated in the years 1970-2005 and represents only 8.76% of all secondary bone sarcomas treated in the same years. This incidence is the same as that of sarcomas arising on fibrous dysplasia, and is lower than those arising on bone infarcts or on Paget's disease. This possible event must be considered during follow-up of benign lesions.
Bone tissue engineering for spine fusion : An experimental study on ectopic and orthotopic implants in rats
van Gaalen, SM; Dhert, WJA; van den Muysenberg, A; Oner, FC; van Blitterswijk, C; Verbout, AJ; de Bruijn, J.D.
Alternatives to the use of autologous bone as a bone graft in spine surgery are needed. The purpose of this study was to examine tissue-engineered bone constructs in comparison with control scaffolds without cells in a posterior spinal implantation model in rats. Syngeneic bone marrow cells were cul
Ordinary and Activated Bone Grafts: Applied Classification and the Main Features
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R. V. Deev
Full Text Available Bone grafts are medical devices that are in high demand in clinical practice for substitution of bone defects and recovery of atrophic bone regions. Based on the analysis of the modern groups of bone grafts, the particularities of their composition, the mechanisms of their biological effects, and their therapeutic indications, applicable classification was proposed that separates the bone substitutes into ŌĆ£ordinaryŌĆØ and ŌĆ£activated.ŌĆØ The main differential criterion is the presence of biologically active components in the material that are standardized by qualitative and quantitative parameters: growth factors, cells, or gene constructions encoding growth factors. The pronounced osteoinductive and (or osteogenic properties of activated osteoplastic materials allow drawing upon their efficacy in the substitution of large bone defects.
Secondary Alveolar Bone Grafting and Iliac Cancellous Bone Harvesting for Patients With Alveolar Cleft.
Pan, Weiyi; Wu, Chenzhou; Yang, Zheng; Duan, Zexi; Su, Zhifei; Wang, Peiqi; Zheng, Qian; Li, Chunjie
To assess the efficacy of present interventions optimizing the result of secondary alveolar bone grafting (SABG) and the interventions alleviating the donor site morbidity after iliac cancellous bone harvesting. Researches were identified by searching the electronic database of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Chinese BioMedical Literature Database, and the China National Knowledge Infrastructure. In addition, relevant journals and references of the included studies were searched manually. The Oxford 2011 Levels of Evidence were applied to assess the methodological quality of selected studies, and the best evidence synthesis system was applied afterward to measure the strength of evidence. As a result, 42 studies were considered eligible and included, among which 4 were of high quality while 38 were of low quality. Thirty lines of evidences were acquired after the synthesis, among which 13 were rated as moderate while 17 were rated as insufficient. As for the interventions optimizing the result of SABG, moderate evidence confirmed the efficacy of preoperative orthodontic treatment, the superiority of performing SABG before the eruption of canine, and the accuracy of cone beam computed tomography in preoperative estimation of the cleft volume. As for the interventions alleviating the morbidity of iliac cancellous bone harvesting, moderate evidence confirmed the treatment benefit of the interventions below: minimally invasive technique, including trephine and Shepard osteotomy; preemptive analgesia, including continuous bupivacaine infusion or transversus abdominis plane block. As for the rest interventions, only insufficient evidence was found. PMID:27244214
Histomorphometric Evaluation of Anorganic Bovine Bone Coverage to Reduce Autogenous Grafts Resorption: Preliminary Results
C Maiorana; Beretta, M.; G B Grossi; Santoro, F.; A. Scott Herford; Nagursky, H; CICCIÙ, M.
Physiologic resorption due to remodeling processes affects autogenous corticocancellous grafts in the treatment of atrophic jawbone alveolar ridges. Such a situation in the past made overgrafting of the recipient site mandatory to get enough bone support to dental implants in order to perform a prosthetic rehabilitation. Anorganic bovine bone, conventionally used to treat alveolar bone deficiencies in implant surgery, showed a high osteoconductive property thanks to its micro and macrostructu...
Autogenous iliac crest bone graft versus banked allograft bone in scoliosis surgery in patients with Duchenne muscular dystrophy
Nakazawa, Toshiyuki; Takaso, Masashi; Imura, Takayuki; Adachi, Kou; Fukushima, Kensuke; Saito, Wataru; Miyajima, Gennyo; Minatani, Atsushi; Shinntani, Ryousuke; Itoman, Moritoshi; Takahashi, Kazuhisa; Yamazaki, Masashi; Ohtori, Seiji; Sasaki, Atsushi
A total of 36 consecutive nonambulatory DMD patients underwent scoliosis surgery. Patients were divided into two groups: the autogenous iliac crest bone graft group (the ICBG group; 20 patients) and the allogenous bone graft group (the ALBG group; 16 patients). The mean preoperative curves measured 87┬░ and 31┬░ at the last follow-up in the ICBG group and 83┬░ and 28┬░ in the ALBG group. In the ICBG group, three (15%) patients had intraoperative sacroiliac joint penetration, five (25%) had iliac ...
Autologous bone marrow stem cell transplantation in patients with liver failure: a meta-analytic review.
Wang, Kewei; Chen, Xiaopan; Ren, Jinma
Autologous bone marrow stem cell (ABMSC) transplantation has been utilized in clinical practice to treat patients with liver failure, but the therapeutic effect remains to be defined. A meta-analysis is essential to assess clinical advantages of ABMSC transplantation in patients with liver failure. A systematic search of published works [eg, PubMed, Medline, Embase, Chin J Clinicians (Electronic edition), and Science Citation Index] was conducted to compare clinical outcomes of ABMSC transplantation in patients with liver failure. Meta-analytic results were tested by fixed-effects model or random-effects model, dependent on the characteristics of variables. A total of 534 patients from seven studies were included in final meta-analysis. Subsequent to ABMSC transplantation, there was no significant improvement in general symptom and signs such as loss of appetite, fatigue, and ascites. Activities of serum ALT were not significantly decreased with weighted mean difference (WMD) of -19.36 and 95% confidence interval (CI) -57.53 to 18.80 (P=0.32). Postoperative level of albumin (ALB) was expectedly enhanced by stem cell transplantation (WMD 2.97, 95% CI 0.52 to 5.43, P<0.05, I(2)=84%). Coagulation function was improved as demonstrated by a short prothrombin time (PT) (WMD -1.18, 95% CI -2.32 to -0.03, P<0.05, I(2)=6%), but was not reflected by prothrombin activity (PTA) (P=0.39). Total bilirubin (TBIL) was drastically diminished after ABMSC therapy (WMD -14.85, 95% CI -20.39 to -9.32, P<0.01, I(2)=73%). Model for end-stage liver disease (MELD) scores were dramatically reduced (WMD -2.27, 95% CI -3.53 to -1.02, P<0.01, I(2)=0%). The advantage of ABMSC transplantation could be maintained more than 24 weeks as displayed by time-courses of ALB, TBIL, and MELD score. ABMSC transplantation does provide beneficial effects for patients with liver failure. Therapeutic effects can last for 6 months. However, long-term effects need to be determined. PMID:25356526
Bone grafting versus distraction osteogenesis in pre-implant surgery. Literature review
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Fotios TZERMPOS
Full Text Available Nowadays there is an increasing demand for implant-supported prosthetic rehabilitation of the edentulous ridges. However problems occur regarding adequate bone support for implants. Loss of alveolar bone may be gradual due to age resorption or due to previous local pathology. Alveolar bone augmentation may be achieved by using a variety of different techniques.The aim of the present paper is to compare two methods for bone augmentation: distraction osteogenesis and bone grafting. Advantages and disadvantages of each one are presented and discussed together with their ability to reconstruct the deficient edentulous ridges with ultimate purpose the placement of implants upported prostheses.
Autologous bone marrow mononuclear cell transplantation in patients with decompensated alcoholic liver disease: a randomized controlled trial.
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Laurent Spahr
Full Text Available OBJECTIVE: Impaired liver regeneration is associated with a poor outcome in patients with decompensated alcoholic liver disease (ALD. We assessed whether autologous bone marrow mononuclear cell transplantation (BMMCT improved liver function in decompensated ALD. DESIGN: 58 patients (mean age 54 yrs; mean MELD score 19, all with cirrhosis, 81% with alcoholic steatohepatitis at baseline liver biopsy were randomized early after hospital admission to standard medical therapy (SMT alone (nŌĆŖ=ŌĆŖ30, including steroids in patients with a Maddrey's score Ōēź32, or combined with G-CSF injections and autologous BMMCT into the hepatic artery (nŌĆŖ=ŌĆŖ28. Bone marrow cells were harvested, isolated and reinfused the same day. The primary endpoint was a Ōēź3 points decrease in the MELD score at 3 months, corresponding to a clinically relevant improvement in liver function. Liver biopsy was repeated at week 4 to assess changes in Ki67+/CK7+ hepatic progenitor cells (HPC compartment. RESULTS: Both study groups were comparable at baseline. After 3 months, 2 and 4 patients died in the BMMCT and SMT groups, respectively. Adverse events were equally distributed between groups. Moderate alcohol relapse occurred in 31% of patients. The MELD score improved in parallel in both groups during follow-up with 18 patients (64% from the BMMCT group and 18 patients (53% from the SMT group reaching the primary endpoint (pŌĆŖ=ŌĆŖ0.43 (OR 1.6, CI 0.49-5.4 in an intention to treat analysis. Comparing liver biopsy at 4 weeks to baseline, steatosis improved (p<0.001, and proliferating HPC tended to decrease in both groups (-35 and -33%, respectively. CONCLUSION: Autologous BMMCT, compared to SMT is a safe procedure but did not result in an expanded HPC compartment or improved liver function. These data suggest either insufficient regenerative stimulation after BMMCT or resistance to liver regenerative drive in patients with decompensated alcoholic cirrhosis. TRIAL REGISTRATION
Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.
Chahla, Jorge; Dean, Chase S; Cram, Tyler R; Civitarese, David; O'Brien, Luke; Moulton, Samuel G; LaPrade, Robert F
Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.
Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.
Chahla, Jorge; Dean, Chase S; Cram, Tyler R; Civitarese, David; O'Brien, Luke; Moulton, Samuel G; LaPrade, Robert F
Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction. PMID:27274452
Haematological toxicity of radiotherapy following high-dose chemotherapy and autologous bone marrow transplantation in patients with recurrent Hodgkin's disease
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17 patients with recurrent Hodgkin's disease received 21 courses of radiotherapy (RT) 1-23 months after high-dose chemotherapy and autologous bone marrow transplantation. WHO grade III-IV haematological toxicity, of median duration 38 days (range 4-236), was observed following 10 courses of radiotherapy in 9 patients. This haematological morbidity could be predicted with an 80.0% sensitivity when the pre-RT white cell count was 9/1 or the platelet count 9/1. It occurred to 9/11 patients with initial stage III-IV disease, including all 6 given extended radiotherapy fields, but in no patients with initial stage II disease (Žć2 = 9.35, P < 0.005). Age, histology, the presence of B symptoms, performance status, previous radiotherapy or chemotherapy, the interval between autologous bone marrow transplantations and radiotherapy, the high-dose regimen used, and the radiotherapy dose or field size, did not appear to affect haematological toxicity. The median survival was 18 months from the date of starting radiotherapy. (author)
Immobilization of a bone and cartilage stimulating peptide to a synthetic bone graft.
Wang, Vivian; Misra, Gauri; Amsden, Brian
A synthetic peptide fragment of human collagen type I (BCSP-1) was linked to the surface of a commercially available ceramic in an effort to improve the properties of the bone graft substitute to accelerate local healing. BCSP-1 was covalently immobilized on the surface of the ceramic via the linkers 3-aminopropyl-triethoxysilane (APTES) and suberic acid bis-N-hydroxysuccinimide ester (DSS). The chosen chemistry was non-cytotoxic. A rat calvaria cell assay using alkaline phosphatase (ALP) as an osteoblast differentiation marker, showed that modifying the surface of the ceramic was enough to enhance ALP activity, although the total cell population on the surface decreased. A significant increase in ALP activity/cell was noted with serum albumin bound to the surface, however, the BCSP-1 bound surface exhibited an even greater ALP activity that showed a surface concentration dependent trend. An optimal BCSP-1 surface density in the range of 0.87-2.24 nmol/cm2 elicited the maximum ALP activity/cell at day 6 of culture. The peptide bound ceramic generated an ALP activity/cell that was roughly 3-fold higher than the non-modified ceramic and 2-fold higher than the APTES-grafted ceramic. PMID:18030432
Clinical evaluation of bone- patellar tendon- bone grafts for anterior cruciate ligament injury
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One thousand and thirty-eight cases of Anterior Cruciate Ligament (ACL) rupture were treated between January 2002 and November 2010. Eight hundred sixty-six cases (83.9%) were observed for at least six months. All cases were reconstructed with a bone to tendon to bone (BTB) graft from the patella. Much effort was made to return the patient to a competitive sports activity level within one year. The age at suffering from the initial injury ranged from 9 to 74 years old with a mean of 24.7 years old. There were 493 female (50.7%) and 427 male (49.3%) cases. The injured side was right in 408 cases and left in 458 cases. The mean postoperative observation period was 449.2 days. The number of patients who felt 80% or more certain that they could return to competitive sports activities was 538 (61.9%). From the MRI findings, continuity of the reconstructed graft was observed in 793 cases (98.5%). Arthroscopy after reconstruction was performed in 775 cases (89.5%). The reconstructed ACL was observed to be covered with an adequate synovium in 629 cases (81.2%). The medial meniscus and lateral meniscus showed no changes in 657 cases (84.8%) and 666 cases (85.9%) respectively. Reconstructions performed less than two weeks after injury showed no significant differences in terms of Range Of Motion (ROM), arthroscopic findings, or the number of patients who could return to competitive sports activities. Statistically significantly more patients who underwent their reconstruction at an age over forty experienced a loss motion of five degree in extension or ten degree in flexion and resumed a lower level of sports activities. Patients who underwent the reconstruction could return to exercises for muscle strengthening and ROMs within 2 weeks. Patients over forty years old who underwent their reconstruction could prevent their menisci from fraying, tearing, or undergoing osteoarthritic changes. (author)
Two sittings of Autologous Bone Marrow Stem Cells within two years in a case of Ischemic Cardiomyopathy
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Rao YY
Full Text Available A 66yrs old Diabetic and Hypertensive female, who had Anterior Wall MI 5yrs ago and had undergone PTCA with Stent to LAD, was admitted for refractory CHF with Severe LVD 2yrs ago and the LVEF then was 25%. Coronary Angiogram was done which showed Total Occlusion of LAD and 50% Stenosis of RCA. Method: 100ml of her bone marrow was harvested from posterior iliac crest and the BMMNCs were isolated as per cGMP protocols at NCRM, Chennai and 325X106 cells with a CD34+ count of 0.84% were injected the next day by transfemoral catheter into the coronary arteries. Post treatment she had clinical improvement. EF increased by 5%. She was in Class-II for 1 year. After 1 yr, she was admitted with severe CHF and EF had deteriorated to 20%. This time BMMNCs isolated from the bone marrow were subjected to in vitro expansion by which the initial 0.15% CD34+ cells increased by nearly 30 fold to 4.62%. Totally 315X106 cells were injected into the coronaries. Post treatment there is clinical as well as Echo evidence of improvement and BNP level has come down by 30%. Conclusion:ŃĆĆ Isolated and expanded CD34+ cells from bone marrow mononuclear cells of autologous origin, administered into the coronaries in an Ischemic Cardiomyopathy patient has been proven to be safe. The clinical and Echo cardiographic improvement that has sustained for long-term, proves the feasibility and efficacy of two consecutive autologous bone marrow stem cell applications, one isolated and the second ex vivo expanded. More case studies may be undertaken to further evaluate the results.
Distribution of 99Tcm-sulphur colloid during granulocyte colony-stimulating factor administration in autologous bone marrow transplantation
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The distribution of 99Tcm-sulphur colloid (99Tcm-SC) in 15 patients receiving human recombinant granulocyte colony-stimulating factor (G-CSF) following high-dose combination chemotherapy and autologous bone marrow transplantation (ABMT) for treatment of solid tumours was prospectively determined. 99Tcm-SC imaging was performed before treatment and at the time of leukocyte recovery during G-CSF administration. On the baseline 99Tcm-SC study, lung and bone marrow radiocolloid activity were not detected. The study performed during G-CSF infusion demonstrated lung colloid activity in 12 of 15 patients and bone marrow colloid activity in 11 of 15 patients. The average background corrected region of interest counts significantly increased for lung, bone marrow and cardiac blood pool, and significantly decreased for liver during G-CSF compared to the baseline study. No relationship between the distribution of 99Tcm-SC and response to therapy or patient outcome could be established. In conclusion, these data demonstrate a shift of 99Tcm-SC to lung, bone marrow and cardiac blood pool, and away from liver following high-dose combination chemotherapy and ABMT and during G-CSF administration in patients undergoing treatment for solid tumours. (author)
Bone tissue engineering using polyetherketoneketone scaffolds combined with autologous mesenchymal stem cells in a sheep calvarial defect model.
Adamzyk, Carina; Kachel, Paul; Hoss, Mareike; Gremse, Felix; Modabber, Ali; H├Člzle, Frank; Tolba, Rene; Neuss, Sabine; Lethaus, Bernd
Polyetherketoneketone (PEKK) a high performance thermoplastic polymer that is FDA-approved for cranio- and maxillo-facial as well as spineal surgery. We studied the viability, growth and osteogenic differentiation of bone marrow-derived human and sheep mesenchymal stem cells (MSC) in combination with a 3D scaffold made of PEKK using different cell-based assays. To investigate if autologous MSC, either undifferentiated or osteogenically pre-differentiated, augmented bone formation after implantation, we implanted cell-seeded 3D PEKK scaffolds into calvarial defects in sheep for 12 weeks. The volume and quality of newly formed bone were investigated using micro-computer tomography (micro-CT) and histological stainings. Our results show that the 3D PEKK scaffolds were cyto- and bio-compatible. They allowed for adherence, growth and osteogenic differentiation of human and ovine MSC. However, bone healing seemed unaffected by whether the scaffolds were seeded with MSC. Considerable amounts of newly formed bone were found in all PEKK treated groups, but a fibrous capsule was formed around the implants regardless of cell seeding with MSC. PMID:27328894
Biologic and clinical aspects of integration of different bone substitutes in oral surgery: a literature review.
Zizzari, Vincenzo Luca; Zara, Susi; Tet├©, Giulia; Vinci, Raffaele; Gherlone, Enrico; Cataldi, Amelia
Many bone substitutes have been proposed for bone regeneration, and researchers have focused on the interactions occurring between grafts and host tissue, as the biologic response of host tissue is related to the origin of the biomaterial. Bone substitutes used in oral and maxillofacial surgery could be categorized according to their biologic origin and source as autologous bone graft when obtained from the same individual receiving the graft; homologous bone graft, or allograft, when harvested from an individual other than the one receiving the graft; animal-derived heterologous bone graft, or xenograft, when derived from a species other than human; and alloplastic graft, made of bone substitute of synthetic origin. The aim of this review is to describe the most commonly used bone substitutes, according to their origin, and to focus on the biologic events that ultimately lead to the integration of a biomaterial with the host tissue.
Ķć¬õĮōĶäéĶé¬ń¦╗µżŹÕ£©ķó×ķā©Õć╣ķÖĘÕĪ½ÕģģõĖŁńÜäÕ║öńö©%Autologous Fat Grafting in the Augmentation of Temporal Depression
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Autologous Fat Grafting in the Augmentation of Temporal Depression%Ķć¬õĮōĶäéĶé¬ń¦╗µżŹÕ£©ķó×ķā©Õć╣ķÖĘÕĪ½ÕģģõĖŁńÜäÕ║öńö©
Institute of Scientific and Technical Information of China (English)
ÕÉ┤õĖ║µ░æ; µĖ®ń½ŗķ£×; ÕÉ┤ńŻŖ
ńø«ńÜä'╝ܵÄóĶ«©Ķć¬õĮōĶäéĶé¬ń¦╗µżŹÕ£©ķó×ķā©Õć╣ķÖĘÕĪ½ÕģģõĖŁńÜäÕ║öńö©ŃĆéµ¢╣µ│Ģķććńö©õĮÄÕÄŗµŖĮÕÉĖŃĆüõĮÄķƤń"╗Õ┐āŃĆüÕżÜńé╣ŃĆüÕżÜķܦķüōŃĆüÕżÜÕ▒éµ¼ĪŃĆüÕ░æķćŵ│©Õ░ä'╝łLow-pressure liposuction, Low-speed centrifuge, Multi-points, Multi-tunnels, Multi-layers and Low-amounts in-jection'╝ī3L3M'╝ēńÜäĶć¬õĮōĶäéĶé¬ń¦╗µżŹµŖƵ£»'╝īÕ»╣36õŠŗķó×ķā©Õć╣ķÖʵéŻĶĆģĶĪīÕżÜÕī║Õ¤¤ĶäéĶé¬ń¦╗µżŹŃĆéŌæĀķó×Õī║Õ£©ńÜ«õĖŗÕ▒éŃĆüķó×µĄģńŁŗĶå£Õ▒éŃĆüĶéīĶéēÕ▒éĶĪīÕĪ½Õģģ'╝øŌæĪķóØÕī║Õ£©ķóØĶéīńÜ«õĖŗÕ▒éÕÆīķóØĶéīõĖŗĶĪīÕĪ½Õģģ'╝øŌæóń£ČÕż¢õŠ¦Õī║õ║ÄńÜ«õĖŗÕ▒éĶĪīµ×üÕ░æķćÅńÜäĶäéĶé¬ÕĪ½ÕģģŃĆéń╗ōµ×£36õŠŗķó×ķā©Õć╣ķÖʵéŻĶĆģń╗ÅĶäéĶé¬ÕĪ½ÕģģÕÉÄÕż¢ÕĮóÕØćµ£ēµśÄµśŠµö╣Õ¢äŃĆéķÜÅĶ«┐3'Į×24õĖ¬µ£ł'╝īÕÉäÕĪ½ÕģģÕī║Õż¢ÕĮóõ┐صīüĶŠāÕźĮ'╝īń¦╗µżŹĶäéĶé¬ÕÉĖµöČńÄćĶŠāõĮÄ'╝īõĖēµ¢╣Ķ»äõ╗ʵ╗ĪµäÅńÄćÕłåÕł½õĖ║83.3%ŃĆü88.9%ÕÅŖ86.1%ŃĆéń╗ōĶ«║ķććńö©3L3MńÜäĶć¬õĮōĶäéĶé¬ń¦╗µżŹµŖƵ£»ÕĪ½Õģģķó×ķā©Õć╣ķÖĘ'╝īÕÅ»õ╗źÕŠŚÕł░µ╗ĪµäÅńÜäµĢłµ×£ŃĆé%Objection To explore the application of autologous fat grafting in the augmentation of temporal depression. Methods Autologous fat grafting technique of 3L3M was performed to 36 patients with temporal depression adopting low-pressure liposuction, low-speed centrifuge, multi-points, multi-tunnels, multi-layers and low-amounts injection (3L3M).ŌæĀThe temple area was injected through subcutaneous layer, superficial fascia layer and muscle layer. ŌæĪThe frontal area was injected through subcutaneous layer and subfrontalis layer.ŌæóOrbital outer area was injected through subcutaneous layer with little fat. Results The apperence of all 36 patients was improved clearly after autologous fat grafting. All the patients were followed up for three months to two years, the appearance of each area of temple augmented were satisfied and the absorbtion of the grafted fat was low. The satisfaction rates of patient, plastic surgeon and the third person were 83.3%, 88.9%and 86.1%respectively. Conclusion The 3L3M autologous fat grafting technique is effective in the augmentation of temporal depression.
Recombinant human bone morphogenetic protein-2 in debridement and impacted bone graft for the treatment of femoral head osteonecrosis.
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Wei Sun
Full Text Available The purpose of this study was to compare the clinical outcomes of impacted bone graft with or without recombinant human bone morphogenetic protein-2 (rhBMP-2 for osteonecrosis of the femoral head (ONFH. We examined the effect of bone-grafting through a window at the femoral head-neck junction, known as the "light bulb" approach, for the treatment of ONFH with a combination of artificial bone (Novobone mixed with or without rhBMP-2. A total of 42 patients (72 hips were followed-up from 5 to 7.67 years (average of 6.1 years. The patients with and without BMP were the first group (IBG+rhBMP-2 and the second group (IBG, respectively. The clinical effectiveness was evaluated by Harris hip score (HHS. The radiographic follow-up was evaluated by pre-and postoperative X-ray and CT scan. Excellent, good, and fair functions were obtained in 36, 12, and 7 hips, respectively. The survival rate was 81.8% and 71.8% in the first and second group, respectively. However, the survival rate was 90.3% in ARCO stage IIb, c, and only 34.6% in ARCO stage IIIa (P<0.05. It was concluded that good and excellent mid-term follow-up could be achieved in selected patients with ONFH treated with impacted bone graft operation. The rhBMP-2 might improve the clinical efficacy and quality of bone repair.
Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series
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Centeno CJ
Full Text Available Christopher J Centeno,1,2 John Pitts,1 Hasan Al-Sayegh,2 Michael D Freeman,3 1Centeno-Schultz Clinic, 2Regenerative Sciences, LLC., Broomfield, CO, 3Public Health Department, Oregon Health and Science University, Portland, OR, USA Introduction: This was a prospective case series designed to investigate treatment for anterior cruciate ligament (ACL tears using an injection of autologous bone marrow concentrate. Methods: Consecutive adult patients presenting to a private outpatient interventional musculoskeletal and pain practice with knee pain, ACL laxity on exam, and magnetic resonance imaging (MRI evidence of a grade 1, 2, or 3 ACL tears with less than 1 cm retraction were eligible for this study. Eligible patients were treated with an intraligamentous injection of autologous bone marrow concentrate, using fluoroscopic guidance. Pre- and postprocedural sagittal MRI images of the ACLs were analyzed using ImageJ software to objectively quantify changes between pre- and posttreatment scans. Five different types of measurement of ACL pixel intensity were examined as a proxy for ligament integrity. In addition pain visual analog scale (VAS and Lower Extremity Functional Scale (LEFS values were recorded at baseline and at 1 month, 3 months, 6 months, and annually postinjection. Objective outcomes measured were pre- to post-MRI measurement changes, as analyzed by the ImageJ software. Subjective outcomes measured were changes in the VAS and LEFS, and a self-rated percentage improvement. Results: Seven of ten patients showed improvement in at least four of five objective measures of ACL integrity in their postprocedure MRIs. In the entire study group, the mean gray value, median, raw integrated density, and modal gray value all decreased toward low-signal ACLs (P=0.01, P=0.02, P=0.002, and P=0.08, indications of improved ligament integrity. Seven of ten patients responded to the self-rated metrics follow up. The mean VAS change was a decrease of 1.7 (P
Osteogenesis effect of guided bone regeneration combined with alveolar cleft grafting: assessment by cone beam computed tomography.
Xiao, W-L; Zhang, D-Z; Chen, X-J; Yuan, C; Xue, L-F
Cone beam computed tomography (CBCT) allows for a significantly lower radiation dose than conventional computed tomography (CT) scans and provides accurate images of the alveolar cleft area. The osteogenic effect of guided bone regeneration (GBR) vs. conventional alveolar bone grafting alone for alveolar cleft defects was evaluated in this study. Sixty alveolar cleft patients were divided randomly into two groups. One group underwent GBR using acellular dermal matrix film combined with alveolar bone grafting using iliac crest bone grafts (GBR group), while the other group underwent alveolar bone grafting only (non-GBR group). CBCT images were obtained at 1 week and at 3 months following the procedure. Using Simplant 11.04 software, the bone resorption rate was calculated and compared between the two groups. The bone resorption rate from 1 week to 3 months following bone grafting without the GBR technique was 36.50┬▒5.04%, whereas the bone resorption rate using the GBR technique was 31.69┬▒5.50% (P=0.017). The application of autogenous iliac bone combined with the GBR technique for alveolar bone grafting of alveolar cleft patients can reduce bone resorption and result in better osteogenesis.
Osteogenesis effect of guided bone regeneration combined with alveolar cleft grafting: assessment by cone beam computed tomography.
Xiao, W-L; Zhang, D-Z; Chen, X-J; Yuan, C; Xue, L-F
Cone beam computed tomography (CBCT) allows for a significantly lower radiation dose than conventional computed tomography (CT) scans and provides accurate images of the alveolar cleft area. The osteogenic effect of guided bone regeneration (GBR) vs. conventional alveolar bone grafting alone for alveolar cleft defects was evaluated in this study. Sixty alveolar cleft patients were divided randomly into two groups. One group underwent GBR using acellular dermal matrix film combined with alveolar bone grafting using iliac crest bone grafts (GBR group), while the other group underwent alveolar bone grafting only (non-GBR group). CBCT images were obtained at 1 week and at 3 months following the procedure. Using Simplant 11.04 software, the bone resorption rate was calculated and compared between the two groups. The bone resorption rate from 1 week to 3 months following bone grafting without the GBR technique was 36.50┬▒5.04%, whereas the bone resorption rate using the GBR technique was 31.69┬▒5.50% (P=0.017). The application of autogenous iliac bone combined with the GBR technique for alveolar bone grafting of alveolar cleft patients can reduce bone resorption and result in better osteogenesis. PMID:26876144
A comparative study of calcium sulfate artificial bone graft versus allograft in the reconstruction of bone defect after tumor curettage
Institute of Scientific and Technical Information of China (English)
Yang Yongkun; Niu Xiaohui; Zhang Qing; Hao Lin; Ding Yi; Xu Hairong
Background Cavity reconstruction after benign bone tumor removal is varied and controversial.AIIograft is widely used but is associated with complications.New bone substitutes,such as calcium sulfate artificial bone,have been introduced for bone tumor operation.However,the bone healing response of artificial bone has not been compared with allograft bone.We therefore compared calcium sulfate grafts (study group) with bone allografts (control group) for the treatment of benign bone tumors.Methods We retrospectively reviewed 50 patients who underwent calcium sulfate reconstruction and 50 patients who underwent allograft cancellous bone reconstruction.The two groups were well matched.The mean follow-up time of the study group was 19.9 (12-55) months.We investigated bone healing response,complications,and factors affecting bone healing.Results At the last follow-up,84'╝ģ (42/50) of cases in the study group and 62'╝ģ (31/50) of cases in the control group had achieved clinical healing (P=0.013).The initial healing rate showed no significant difference between the two groups (100'╝ģ vs.96'╝ģ,P=0.153).The mean healing times for calcium sulfate and allograft bone were 9.6 (3-42) months and 13.8 (3-36) months,respectively (P '╝£0.01).Complications in the study group were minor and resolved.Implant volume was a significant factor affecting bone healing.Conclusion The calcium sulfate bone substitute showed a satisfactory healing outcome and safety profile in reconstruction of bone defects after benign bone tumor curettage,especially in smaller cavities.
Different bone regeneration patterns in periimplant circumferential gap defects grafted with two types of osteoconductive biomaterial.
Lee, Jung-Seok; Sohn, Joo-Yeon; Lim, Hyun-Chang; Jung, Ui-Won; Choi, Seong-Ho
This study aimed to determine healing patterns in periimplant gap defect grafted with demineralized bovine bone mineral (DBBM) and porous titanium granules (PTG), which are known to induce a minimal tissue reaction and to undergo minimal biodegradation in healing process. Experiments were performed using a standardized periimplant gap-defect model in dogs with two observational periods: 4 and 8 weeks. Circumferential defects were surgically induced around dental implants on unilateral mandibles in five dogs, and collagen barrier membranes were placed over the DBBM and PTG grafts at two experimental sites and over a nongrafted site. Four weeks later, the same procedures were performed on the contralateral mandible, and the animals allowed to heal for a further 4 weeks, after which they were sacrificed and their mandibles with graft/control sites harvested for histologic evaluation. Both types of grafted biomaterials significantly enhanced the defect fill with newly formed bone, but the bone-to-implant contact (BIC) was significantly increased only at sites that had been grafted with DBBM. The two experimental sites exhibited different healing patterns, with new bone formation being observed on the surface of the DBBM particles throughout the defect, while there was no de novo bone formation on the PTG surface, but rather appositional bone growth from the base and lateral walls of the defect. It has been suggested that gap-defect filling with DBBM around dental implants may enhance both BIC and defect fill; however, the present findings show that defect grafting with PTG enhances only defect fill and not BIC. ┬® 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1202-1209, 2016. PMID:26087247
Reconstruction of mandibular defects using nonvascularized autogenous bone graft in Nigerians
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Kizito Chioma Ndukwe
Full Text Available Objectives: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria. Patients and Methods: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patientsŌĆ▓ records. This information include patientsŌĆ▓ demographics (age and sex as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications. Result: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ┬▒ standard deviation (SD 12.9 and for females 35.0 ┬▒ SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%. Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients and postoperative wound infection (eight patients were the most common complications recorded. Conclusion: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care
Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients
DEFF Research Database (Denmark)
Meyer, Steffen; Pedersen, Kirsten M├Ėlsted
The objective was to assess the long-term outcome of secondary alveolar bone grafting (SABG) in cleft lip and palate patients and to examine relationships between preoperative and postoperative factors and overall long-term bone graft success. The records of 97 patients with cleft lip and palate......, who had secondary alveolar bone grafting of 123 alveolar clefts, were examined. Interalveolar bone height was assessed radiographically a minimum of 10 years after grafting using a 4-point scale (I-IV), where types I and II were considered a success. After an average follow-up of 16 years after SABG...... (range = 10.2-22.7 years), 101 of the 123 grafts (82%) were categorised as successes. Mean age in the success group was 12.1 years and 13.6 years in the failure group (p = 0.03). It was found that the success rate was significantly lower (p = 0.02) if SABG was performed after eruption of the tooth distal...
No effect of bone morphogenetic protein-7 (OP-1) on the incorporation of impacted bone grafts in a realistic acetabular model.
Buma, P.; Arts, J.J.C.; Gardeniers, J.W.M.; Verdonschot, N.J.J.; Schreurs, B.W.
Bone morphogenetic proteins (BMPs) accelerate bone repair in experimental and clinical conditions. Impacted Morsellized Cancellous Bone grafts (MCB) are successfully used to reconstruct bone defects after failed hip implants. The main question in this study was if BMP-7 (OP-1) mixed with MCB could a
Evaluation of laser photobiomodulation on healing of bone defects grafted with bovine bone in diabetic rats
Paraguass├║, Gard├¬nia Matos; da Costa Lino, Ma├Łra Doria Martinez; de Carvalho, Fab├Łola Bastos; Cangussu, Maria Cristina; Pinheiro, Ant├┤nio Luiz Barbosa; Ramalho, Luciana Maria Pedreira
Previous studies have shown positive effects of Low Level Laser Therapy (LLLT) on the repair of bone defects, but there is a few that associates bone healing in the presence of a metabolic disorder such as Diabetes Mellitus, a systemic disorder associated to impair of the repair of different tissues. The aim of this study was to assess, histologically, the repair of surgical defects created in the femur of diabetic and non-diabetic rats treated or not with LLLT (λ780nm, 70mW, CW, o/˜0.4mm, 16J/cm2 per session) associated or not to the use of a biomaterial. Surgical tibial bone defects were created in 60 animals that were divided into 4 groups: Group B (non-diabetic + biomaterial); Group BL (non-diabetic + biomaterial + LLLT); Group BD (diabetic + biomaterial); Group BDL (diabetic + biomaterial + LLLT). The irradiated group received 16 J/cm2 per session divided into 4 points around the defect, being the first irradiation carried out immediately after surgery and repeated every 48h for 14 days. The animals were killed 15, 21 and 30 days after surgery. The specimens underwent a semi-quantitative analysis. The results showed inflammation more intense in the BD and BDL groups than in the B and BL groups in the period of 15 days (p = 0.02), however the cortical repair in the BDL group was below 25% in more than half of the specimens, while in the BD group, the repair was more than to 25% in all specimens. At 30 days, both osteoblastic activity and collagen deposition were significantly higher in the B group when compared to the BD group (p=0.04). Bone deposition was significantly higher in the BL group (p=0.023) than in BDL group. It is concluded that LLLT has a positive biomodulative effect in the early stages of the healing process of bone defects grafted with biomaterial in diabetic and non-diabetic rats.
Roos, Milton Valdomiro; Roos, Bruno Dutra; Giora, Ta├Łs Stedile Busin; Taglietti, Thiago Martins
To perform a clinical and radiographic assessment of patients undergoing surgical treatment using a cortical structural homologous bone graft for femoral reconstruction following mechanical failure of total hip arthroplasty and periprosthetic fractures. Methods: A retrospective study was conducted on 27 patients who underwent surgical treatment for femoral reconstruction following mechanical failure of total hip arthroplasty (12 cases) and periprosthetic fractures (15 cases), using a cortical structural homologous bone graft and cemented implants, between June 1999 and February 2008. Of these, 21 fulfilled all the criteria required for this study. The patients underwent pre and postoperative clinical assessments using the Harris Hip Score. Preoperative, immediate postoperative and late postoperative radiographs were also evaluated, with comparisons of fracture consolidation, radiographic signs of graft consolidation, changes to the bone stock and femoral bone quality, and femoral alignment. Results: Nine patients (42.9%) underwent femoral reconstruction following mechanical failure of total hip arthroplasty and 12 cases (57.1%) underwent femoral reconstruction following periprosthetic fracture. Regarding the postoperative clinical classification, the results were considered satisfactory in 85.7% of the cases and unsatisfactory in 14.3%. Radiographic signs of graft consolidation were seen in all cases. There was an increase in bone stock in 90.5% of the hip reconstructions, as measured by the cortical index. Furthermore, the changes to femoral bone quality were considered good in 66.7% of the cases. Conclusion: The use of cortical structural homologous bone grafts for both femoral reconstructive surgery on total hip arthroplasty and periprosthetic fractures is a good treatment option for selected cases, enabling satisfactory clinical and radiographic results. PMID:27026955
Therapeutic efficacy of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting for tuberculosis of lumbar vertebra
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Jia-ming LIU
Full Text Available ObjectiveŃĆĆTo evaluate the efficacy and safety of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting in the treatment of tuberculosis of mono-segmental lumbar vertebra. MethodsŃĆĆFrom January 2010 to April 2013, 21 patients (9 males and 12 females with an average age of 49.1 years with mono-segmental tuberculosis of lumbar vertebra underwent surgery in our hospital were included. Eight patients had neurological deficit. The focus of tuberculosis was located on one side of the vertebral body, and all the patients had obvious signs of bone destruction on CT and MRI. All the patients were given anti-tuberculosis chemotherapy for 2-3 weeks before surgery. The local bone chips and autologous iliac cancellous bone were used as the intervertebral bone graft. Postoperative plain radiographs and CT were obtained to evaluate the fusion rate and degree of lumbar lordosis. The visual analogue scale score (VAS, erythrocyte sedimentation rate (ESR, and C-reactive protein (CRP before and after operation, and at final follow-up date were recorded. ResultsŃĆĆAll the patients were followed up for 25.3┬▒4.2 months. The mean operation time was 157┬▒39 minutes, and the average blood loss was 470┬▒143ml. The fusion rate of the interbody bone graft was 95.2%, with an average fusion period of 6.1┬▒2.5 months. The neurological function was improved by 100%, and no severe complication or neurological injury occured. The preoperative and postoperative lordosis angles of the lumbar spine were 21.4┬░┬▒5.7┬░ and 33.6┬░┬▒3.1┬░, respectively, and it was 31.3┬░┬▒2.7┬░ at the final follow up. The preoperative and postoperative VAS scores were 7.8┬▒2.6 and 2.4┬▒1.7 respectively, and it was 0.9┬▒0.7 at the final follow up. The ESR and CRP were significantly decreased 3 months after surgery, and they became normal at 6 months. ConclusionŃĆĆPedicle screw-rod internal fixation after one-stage posterior
Acellular Dermal Matrix Combined with Autologous Skin Grafts for Closure of Chronic Wounds after Reconstruction of Skull Defects with Titanium Mesh.
Luo, Xu; Lin, Cai; Wang, Xinling; Lin, Xiangwei; He, Sunyue; Liu, Yunfeng; Zhang, Yong; Yang, Ruijin; Zhu, Xinguo
ObjectiveŌĆāThe closure of chronic wounds after skull defect reconstruction with titanium mesh is one of the most challenging problems for plastic and reconstructive surgeons. Current approaches are disappointing. MethodsŌĆāIn 10 patients, we explored the role of acellular dermal matrix (ADM) in combination with autologous skin grafts (ASGs) for closure of chronic wounds after skull reconstruction with titanium. ResultsŌĆāADM and ASG survived in all patients. Grade A healing (healing well without defect) was achieved. The average operating time was 30 to 45 minutes, and the average blood loss 30 to 50 mL. After 3 months, the wound was still closed in all patients. ConclusionŌĆāThe combination of ADM plus ASG obtained a high wound closure rate. ADM plus ASG allows avoiding other procedures such as rotational flaps and free flaps that require more operating time, special equipment, and adequate training. PMID:27088591
Increased serum IgE concentrations during infection and graft versus host disease after bone marrow transplantation.
Walker, S. A.; Rogers, T. R.; Perry, D; Hobbs, J R; Riches, P G
Serum IgE concentrations estimated in 25 bone marrow transplant recipients during episodes of infection or graft versus host disease, or both, were raised not only in some patients with acute graft versus host disease but also in many patients with infection. Raised values were not seen in chronic graft versus host disease. The routine estimation of serum IgE in bone marrow transplant recipients had minimal value because of the lack of specificity of the IgE response.
State of the art. Autologous fat graft and adipose tissue-derived stromal vascular fraction injection for hand therapy in systemic sclerosis patients.
Guillaume-Jugnot, P; Daumas, A; Magalon, J; Sautereau, N; Veran, J; Magalon, G; Sabatier, F; Granel, B
Systemic sclerosis is an autoimmune disease characterized by sclerosis (hardening) of the skin and deep viscera associated with microvascular functional and structural alteration, which leads to chronic ischemia. In the hands of patients, ischemic and fibrotic damages lead to both pain and functional impairment. Hand disability creates a large burden in professional and daily activities, with social and psychological consequences. Currently, the proposed therapeutic options for hands rely mainly on hygienic measures, vasodilatator drugs and physiotherapy, but have many constraints and limited effects. Developing an innovative therapeutic approach is crucial to reduce symptoms and improve the quality of life. The discovery of adult stem cells from adipose tissue has increased the interest to use adipose tissue in plastic and regenerative surgery. Prepared as freshly isolated cells for immediate autologous transplantation, adipose tissue-derived stem cell therapy has emerged as a therapeutic alternative for the regeneration and repair of damaged tissues. We aim to update literature in the interest of autologous fat graft or adipose derived from stromal vascular fraction cell-based therapy for the hands of patients who suffer from systemic sclerosis. PMID:27140597
Evaluations of guided bone regeneration in canine radius segmental defects using autologous periosteum combined with fascia lata under stable external fixation
Yu, Zhe; Geng, Jie; Gao, Haoran; Zhao, Xinwen; Chen, Jingyuan
Background Although bone defect is one of the most common orthopaedic diseases, treatment remains a challenge and an issue of debate. Guided bone regeneration (GBR) is primarily accompanied by barrier membranes; however, optional membranes show some inherent flaws in clinical application. The purpose of this study was to observe the healing velocity and quality of repairing canine radius segmental defect using transferred autologous periosteum combined with fascia lata, which can provide bett...
Examining the effects of platelet-rich plasma and platelet-rich fibrin on autologous full thickness skin graft survival in rats
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Noorahmad Latifi
Full Text Available Background: Graft survival has been considered the major problem in reconstructive surgery. Clinical studies have helped us to understand the role of PRP in increasing skin survival. Our goal in this study was to examine the treatment effects of platelet-rich plasma (PRP and platelet-rich fibrin (PRF on autologous full thickness skin graft survival in male rats. Methods: This experimental study was performed on 36 rats of Sprague-Dawley race with weighing approximately 250 to 300 gr on May 2015 in animal laboratory of Hazrat Fatima Hospital. After anesthesia, rats were divided into 3 groups. We injected platelet-rich plasma (PRP in the first group, platelet-rich fibrin (PRF in the second and saline in the third group after removing the skin. Microscopic analysis was performed with camera (Canon powershot SX200, Tokyo, Japan on days 7, 14, 21 and 28 after surgery. We used image analysis system (ImageJ, ver. 1.45 to examine necrosis and survival rate. Samples were studied with H&E staining on day 28 microscopically for histological analysis of vascular density and angiogenesis. Results: Our findings showed the area of necrosis in animals injected with PRP on days 7 and 14, was meaningfully less than control group (P= 0.0001. There was no meaningful difference between control and PRP groups (P> 0.05. The area of necrosis in animals injected with PRF did not have any significant difference with control group from beginning to 21st day (P< 0.0001. there was no meaningful difference in vascular density between control and PRP group, whereas in animals injected with PRF the vascular density was significantly less than control group (P= 0.002. Conclusion: According to our results in this study, we can conclude that using autologous PRP can enhance the process of healing soft tissue injury and be affective at increasing graft survival. This method is suggested to be conducted for patients highly at risk of graft loss and also for those who are in need of
The effect of bone allografts combined with bone marrow stromal cells on the healing of segmental bone defects in a sheep model
Fernandes, Marco Bernardo C; Guimar├Żes, Jo├Żo Ant├┤nio Matheus; Casado, Priscila Ladeira; Cavalcanti, Amanda dos Santos; Gon├¦alves, Natalia N; Carlos E. Ambr├│sio; Rodrigues, Fernando; Pinto, Ana Carolina F; Miglino, Maria Ang├®lica; Duarte, Maria Eug├¬nia L.
Background The repair of large bone defects is a major orthopedic challenge because autologous bone grafts are not available in large amounts and because harvesting is often associated with donor-site morbidity. Considering that bone marrow stromal cells (BMSC) are responsible for the maintenance of bone turnover throughout life, we investigated bone repair at a site of a critically sized segmental defect in sheep tibia treated with BMSCs loaded onto allografts. The defect was created in the ...
ŌĆ£Over-inlayŌĆØ block graft and differential morphometry: a novel block graft model to study bone regeneration and host-to-graft interfaces in rats
Purpose The aim of this study was to present new a model that allows the study of the bone healing process, with an emphasis on the biological behavior of different graft-to-host interfaces. A standardized ŌĆ£over-inlayŌĆØ surgical technique combined with a differential histomorphometric analysis is presented in order to optimize the use of critical-size calvarial defects in pre-clinical testing. Methods Critical-size defects were created into the parietal bone of 8 male Wistar rats. Deproteinized bovine bone (DBBM) blocks were inserted into the defects, so that part of the block was included within the calvarial thickness and part exceeded the calvarial height (an ŌĆ£over-inlayŌĆØ graft). All animals were sacrificed at 1 or 3 months. Histomorphometric and immunohistochemical evaluation was carried out within distinct regions of interest (ROIs): the areas adjacent to the native bone (BA), the periosteal area (PA) and the central area (CA). Results The animals healed without complications. Differential morphometry allowed the examination of the tissue composition within distinct regions: the BA presented consistent amounts of new bone formation (NB), which increased over time (24.53%┬▒1.26% at 1 month; 37.73%┬▒0.39% at 3 months), thus suggesting that this area makes a substantial contribution toward NB. The PA was mainly composed of fibrous tissue (71.16%┬▒8.06% and 78.30%┬▒2.67%, respectively), while the CA showed high amounts of DBBM at both time points (78.30%┬▒2.67% and 74.68%┬▒1.07%, respectively), demonstrating a slow remodeling process. Blood vessels revealed a progressive migration from the interface with native bone toward the central area of the graft. Osterix-positive cells observed at 1 month within the PA suggested that the periosteum was a source of osteoprogenitor elements. Alkaline phosphatase data on matrix deposition confirmed this observation. Conclusions The present model allowed for a standardized investigation of distinct graft
Cytokine profile of autologous platelet-derived eye drops in patients with ocular chronic graft-versus-host disease.
Valentini, C G; Nuzzolo, E R; Orlando, N; Metafuni, E; Bianchi, M; Chiusolo, P; Zini, G; Teofili, L
Ocular chronic GVHD is efficaciously treated with autologous platelet-derived eye drops. We investigated the cytokine content of eye drops produced using a non-gelified lysate obtained from autologous platelet-rich plasma in six patients with ocular GVHD. In both the responding (n = 4) and the resistant (n = 2) patients, the eye drops were significantly enriched with various growth factors, in amounts proportional with the platelet counts. In contrast, chemokine ligand and interleukin levels were similar to those of plasma. The non-responding patients showed the highest levels of chemokine (C-X-C motif) ligand (CXCL)10. These findings provide possible explanations for beneficial or detrimental effects of eye drops. PMID:26383050
High-dose therapy followed by autologous bone marrow transplantation (ABMT) in previously untreated non-Hodgkin's lymphoma
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13 previously untreated patients with poor prognosis non-Hodgkin's lymphoma (NHL) underwent high-dose therapy followed by autologous bone marrow transplantation (ABMT). All patients experienced a great cytoreductive effect and 9 of them reached a complete remission (mean duration 32 months). The best results were observed in patients with more limited disease and in those without symptoms. 7 patients still remain in complete unmaintained remission 15-46 months from the transplant. The probability of survival is 74% at 46 months. No therapy-related deaths were recorded. In differentiating our preliminary approach, we propose high dose therapy followed by ABMT as induction phase in patients with stage II and as consolidation after first line therapy in patients with stages III-IV. Further studies are warranted to determine which type of lymphoma may benefit more and which conditioning regimens may improve the remission rate. (author)
Einhorn, T. A.
The development of new strategies to enhance the healing of fractures continues to evolve with the introduction of both locally and systemically delivered compounds. The recent refinement in the use of autologous bone marrow as a bone graft material has brought the field of stem cell biology into orthopaedic practice. New recombinant peptides such as platelet- derived growth factor and teriparatide show promise as local and systemic enhancers respectively. Finally, recent evidence that mutati...
Bone impaction grafting and a cemented cup after acetabular fracture at 3-18 years.
Schreurs, B.W.; Zengerink, M.; Welten, M.L.M.; Kampen, A. van; Slooff, T.J.J.H.
The outcome of total hip arthroplasty after acetabular fracture is compromised. We studied if the bone impaction grafting technique could provide long-term prosthesis survival in deformed and irregular acetabula. We studied 20 hips in 20 patients (mean age, 53.3 years; range, 35-75 years) that were
Interleukin-15-activated natural killer cells kill autologous osteoclasts via LFA-1, DNAM-1 and TRAIL, and inhibit osteoclast-mediated bone erosion in┬Āvitro
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Feng, Shan; Madsen, Suzi H; Viller, Natasja N;
Osteoclasts reside on bone and are the main bone resorbing cells playing an important role in bone homeostasis, while natural killer (NK) cells are bone-marrow-derived cells known to play a crucial role in immune defence against viral infections. Although mature NK cells traffic through bone marrow...... as well as to inflammatory sites associated with enhanced bone erosion, including the joints of patients with rheumatoid arthritis, little is known about the impact NK cells may have on mature osteoclasts and bone erosion. We studied the interaction between human NK cells and autologous monocyte......-derived osteoclasts from healthy donors in vitro. We show that osteoclasts express numerous ligands for receptors present on activated NK cells. Co-culture experiments revealed that interleukin-15-activated, but not resting, NK cells trigger osteoclast apoptosis in a dose-dependent manner, resulting in drastically...
Xavier, M├Īrio S├®rgio Viana; Leite, Vilnei Mattioli
Objective: To evaluate the effect of butyl-2-cyanoacrylate tissue adhesive in osteotomies and bone grafts, with regard to macroscopic and radiographic characteristics. Methods: Forty-eight rabbits were used, randomly divided into four groups of 12 animals, with observation periods of two, four, eight and 16 weeks. Both thoracic limbs were operated in each animal and two osteotomies were performed in each of the radii, withdrawing a bone fragment (bone graft) of 1 cm in length. On one side, th...
Design and optimization of a tissue-engineered bone graft substitute
Shimko, Daniel Andrew
In 2000, 3.1 million surgical procedures on the musculoskeletal system were reported in the United States. For many of these cases, bone grafting was essential for successful fracture stabilization. Current techniques use intact bone obtained either from the patient (autograft) or a cadaver (allograft) to repair large defects, however, neither source is optimal. Allografts suffer integration problems, and for autografts, the tissue supply is limited. Because of these shortcomings, and the high demand for graft tissues, alternatives are being explored. To successfully engineer a bone graft replacement, one must employ a three pronged research approach, addressing (1) the cells that will inhabit the new tissue, (2) the culture environment that these cells will be exposed to, and (3) the scaffold in which these cells will reside. The work herein examines each of these three aspects in great detail. Both adult and embryonic stem cells (ESCs) were considered for the tissue-engineered bone graft. Both exhibited desirable qualities, however, neither were optimal in all categories examined. In the end, the possibility of teratoma formation and ethical issues surrounding ESCs, made the use of adult marrow-derived stem cells in the remaining experiments obligatory. In subsequent experiments, the adult stem cells' ability to form bone was optimized. Basic fibroblast growth factor, fetal bovine serum, and extracellular calcium supplementation studies were all performed. Ultimately, adult stem cells cultured in alpha-MEM supplemented with 10% fetal bovine serum, 10mM beta-glycerophosphate, 10nM dexamethasone, 50mug/ml ascorbic acid, 1%(v/v) antibiotic/antimycotic, and 10.4mM CaCl2 performed the best, producing nearly four times more mineral than any other medium formulation. Several scaffolds were then investigated including those fabricated from poly(alpha-hydroxy esters), tantalum, and poly-methylmethacrylate. In the final study, the most appealing cell type, medium
Bone Repair on Fractures Treated with Osteosynthesis, ir Laser, Bone Graft and Guided Bone Regeneration: Histomorfometric Study
dos Santos Aciole, Jouber Mateus; dos Santos Aciole, Gilberth Tadeu; Soares, Luiz Guilherme Pinheiro; Barbosa, Artur Felipe Santos; Santos, Jean Nunes; Pinheiro, Antonio Luiz Barbosa
The aim of this study was to evaluate, through the analysis of histomorfometric, the repair of complete tibial fracture in rabbits fixed with osteosynthesis, treated or not with infrared laser light (╬╗780 nm, 50 mW, CW) associated or not to the use of hydroxyapatite and guided bone regeneration (GBR). Surgical fractures were created, under general anesthesia (Ketamina 0,4 ml/Kg IP and Xilazina 0,2 ml/Kg IP), on the dorsum of 15 Oryctolagus rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with wire osteosynthesis. Animals of groups III and V were grafted with hydroxyapatite and GBR technique used. Animals of groups IV and V were irradiated at every other day during two weeks (16 J/cm2, 4├Ś4 J/cm2). Observation time was that of 30 days. After animal death (overdose of general anesthetics) the specimes were routinely processed to wax and underwent histological analysis by light microscopy. The histomorfometric analysis showed an increased bone neoformation, increased collagen deposition, less reabsorption and inflammation when laser was associated to the HATCP. It is concluded that IR laser light was able to accelerate fracture healing and the association with HATCP and GBR resulted on increased deposition of CHA.
Ortho- and heterotopic bone grafts in bifocal transport osteogenesis for craniofacial reconstruction--an experimental study in sheep.
Kramer, F-J; Mueller, M; Rahmstorf, M; Swennen, G R J; Dempf, R; Schierle, H
Bifocal transport osteogenesis (BTO) is a promising technique for the reconstruction of extended osseous craniofacial defects. Aim of this study was to determine the potential of this technique related to various donor sites of the transport segment. In 10 adult sheep critical size defects of the calvaria were treated by gradual movement of a transport segment consisting either of autogenous regional free calvarial bone grafts (n=5) or autogenous illiac free bone grafts (n=5). Latency period was 5 days; the rate of distraction was 1mm per day and extended approximately 40 days. The consolidation period was 28 days. After harvesting, specimens were investigated by conventional radiography, CT-scans, histologically and by fluorescence. In both groups transport osteogenesis resulted in a complete closure of the critical size defect. Membranous bone formation and remodeling occurred during the entire period of distraction and consolidation. The volumes and thickness of newly formed bone at the defect site were increased significantly when calvarial bone grafts were used (P<0.05). Iliac bone grafts became progrediently smaller during distraction, while the volume of calvarial grafts remained relatively constant (P<0.05). In conclusion, transport segments consisting of calvarial and iliac bone resulted in a reliable closure of craniofacial critical size defects in adult organisms; the application of calvarial bone grafts resulted in an increased extend of bone formation.
Preoperative implant planning considering alveolar bone grafting needs and complication prediction using panoramic versus CBCT images
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This study was performed to determine the efficacy of observers' prediction for the need of bone grafting and presence of perioperative complications on the basis of cone-beam computed tomography (CBCT) and panoramic radiographic (PAN) planning as compared to the surgical outcome. One hundred and eight partially edentulous patients with a need for implant rehabilitation were referred for preoperative imaging. Imaging consisted of PAN and CBCT images. Four observers carried out implant planning using PAN image datasets, and at least one month later, using CBCT image datasets. Based on their own planning, the observers assessed the need for bone graft augmentation as well as complication prediction. The implant length and diameter, the need for bone graft augmentation, and the occurrence of anatomical complications during planning and implant placement were statistically compared. In the 108 patients, 365 implants were installed. Receiver operating characteristic analyses of both PAN and CBCT preoperative planning showed that CBCT performed better than PAN-based planning with respect to the need for bone graft augmentation and perioperative complications. The sensitivity and the specificity of CBCT for implant complications were 96.5% and 90.5%, respectively, and for bone graft augmentation, they were 95.2% and 96.3%, respectively. Significant differences were found between PAN-based planning and the surgery of posterior implant lengths. Our findings indicated that CBCT-based preoperative implant planning enabled treatment planning with a higher degree of prediction and agreement as compared to the surgical standard. In PAN-based surgery, the prediction of implant length was poor.
Preoperative implant planning considering alveolar bone grafting needs and complication prediction using panoramic versus CBCT images
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Guerrero, Maria Eugenia; Jacobs, Reinhilde [OIC, OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven (Belgium); Noriega, Jorge [Master of Periodontology, Universidad San Martin de Porres, Lima (Peru)
This study was performed to determine the efficacy of observers' prediction for the need of bone grafting and presence of perioperative complications on the basis of cone-beam computed tomography (CBCT) and panoramic radiographic (PAN) planning as compared to the surgical outcome. One hundred and eight partially edentulous patients with a need for implant rehabilitation were referred for preoperative imaging. Imaging consisted of PAN and CBCT images. Four observers carried out implant planning using PAN image datasets, and at least one month later, using CBCT image datasets. Based on their own planning, the observers assessed the need for bone graft augmentation as well as complication prediction. The implant length and diameter, the need for bone graft augmentation, and the occurrence of anatomical complications during planning and implant placement were statistically compared. In the 108 patients, 365 implants were installed. Receiver operating characteristic analyses of both PAN and CBCT preoperative planning showed that CBCT performed better than PAN-based planning with respect to the need for bone graft augmentation and perioperative complications. The sensitivity and the specificity of CBCT for implant complications were 96.5% and 90.5%, respectively, and for bone graft augmentation, they were 95.2% and 96.3%, respectively. Significant differences were found between PAN-based planning and the surgery of posterior implant lengths. Our findings indicated that CBCT-based preoperative implant planning enabled treatment planning with a higher degree of prediction and agreement as compared to the surgical standard. In PAN-based surgery, the prediction of implant length was poor.
Efficacy of guided bone regeneration using composite bone graft and resorbable collagen membrane in Seibert's Class I ridge defects: radiological evaluation.
Saravanan, Pushparajan; Ramakrishnan, T; Ambalavanan, N; Emmadi, Pamela; John, Thomas Libby
The purpose of the study was to evaluate radiologically the efficacy of guided bone regeneration using composite bone graft (autogenous bone graft and anorganic bovine bone graft [Bio-Oss]) along with resorbable collagen membrane (BioMend Extend) in the augmentation of Seibert's class I ridge defects in maxilla. Bone width was evaluated using computerized tomography at day 0 and at day 180 at 2 mm, 4 mm, and 6 mm from the crest. There was a statistically significant increase in bone width between day 0 and day 180 at 2 mm, 4 mm, and 6 mm from the crest. The results of the study demonstrated an increase in bone width of Seibert's class I ridge defects in the maxilla of the study patients. PMID:23964779
Internal fixation and muscle pedicle bone grafting in femoral neck fractures
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Gupta A
Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by MeyersŌĆ▓ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed GardenŌĆ▓s screws ( n = 7, parallel Asnis screws ( n = 5 and MooreŌĆ▓s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with
Autologous bone marrow stem cell transplantation for the treatment of postoperative hand infection with a skin defect in diabetes mellitus: A case report.
Liu, Yihong; Liu, Yuchen; Wang, Pujie; Tian, Haoming; Ai, Jianzhong; Liu, Yangbo; Zhou, Yi; Liu, Zhongwen; Guo, Wenjun; Yang, Shenke
Among stem cells, autologous mesenchymal stem cells (MSCs) are ideal for transplantation by virtue of limited rejection reactions and marked proliferative ability. This study presents a novel method by which MSCs were harvested from the bone marrow of a patient who presented with severe post-traumatic infection and a non-healing skin defect in the hand, secondary to uncontrolled diabetes mellitus (DM). An autologous MSC suspension was injected into the persistent skin defect after stabilizing the blood glucose level and appropriate infection control. During the course of a regular 18-month postoperative follow-up, the patient exhibited immediate recovery with no transplant-associated complications, as well as no evidence of tumorigenicity. Thus, transplantation of autologous MSCs may play a role in the clinical application of stem cells, particularly for treatment of skin defects following surgery in cases of DM and for those caused by various other traumas.
A new Fe-Mn-Si alloplastic biomaterial as bone grafting material: In vivo study
F├ónt├ónariu, Mircea; Trinc─ā, Lucia Carmen; Solcan, Carmen; Trofin, Alina; Strungaru, ┼×tefan; ┼×indilar, Eusebiu Viorel; Pl─āvan, Gabriel; Stanciu, Sergiu
Designing substrates having suitable mechanical properties and targeted degradation behavior is the key's development of bio-materials for medical application. In orthopedics, graft material may be used to fill bony defects or to promote bone formation in osseous defects created by trauma or surgical intervention. Incorporation of Si may increase the bioactivity of implant locally, both by enhancing interactions at the graft-host interface and by having a potential endocrine like effect on osteoblasts. A Fe-Mn-Si alloy was obtained as alloplastic graft materials for bone implants that need long recovery time period. The surface morphology of the resulted specimens was investigated using scanning electrons microscopy (VegaTescan LMH II, SE detector, 30 kV), X-ray diffractions (X'Pert equipment) or X-ray dispersive energy analyze (Bruker EDS equipment). This study objective was to evaluate in vivo the mechanisms of degradation and the effects of its implantation over the main metabolic organs. Biochemical, histological, plain X radiography and computed tomography investigations showed good compatibility of the subcutaneous implants in the rat organism. The implantation of the Fe-Mn-Si alloy, in critical size bone (tibiae) defect rat model, did not induced adverse biological reactions and provided temporary mechanical support to the affected bone area. The biodegradation products were hydroxides layers which adhered to the substrate surface. Fe-Mn-Si alloy assured the mechanical integrity in rat tibiae defects during bone regeneration.
ABSTRACT Objective: To evaluate the outcome of olecranon bone graft and compression screw for the treatment of nonunion of the Lichtman type I scaphoid. Method: We evaluated 15 patients of 32 who underwent surgical treatment for nonunion of the Lichtman type I scaphoid with olecranon bone graft and screw compression. Results: We obtained 100% consolidation in our sample. The mean flexion of the wrist on the affected side was 68┬░ and 75┬░ on the non-affected side. The average extension was 63┬░ and 72┬░, respectively. The average grip strength was 35 kgf. This corresponds to 98% of the handgrip strength of the non-affected side, which was 37 kgf. The DASH score averaged 5 points. Conclusion: We believe that the use of bone graft obtained from the olecranon and secured with cannulated screw is a resolute technique for cases of linear nonunion of the Lichtmann type I scaphoid. It has the advantages of a new anesthesia for removal of the graft and the access is easy, providing a good exposure for removal and good aesthetic results. Level of evidence IV. Case series. PMID:27217819
From natural bone grafts to tissue engineering therapeutics: Brainstorming on pharmaceutical formulative requirements and challenges.
Baroli, Biancamaria
Tissue engineering is an emerging multidisciplinary field of investigation focused on the regeneration of diseased or injured tissues through the delivery of appropriate molecular and mechanical signals. Therefore, bone tissue engineering covers all the attempts to reestablish a normal physiology or to speed up healing of bone in all musculoskeletal disorders and injuries that are lashing modern societies. This article attempts to give a pharmaceutical perspective on the production of engineered man-made bone grafts that are described as implantable tissue engineering therapeutics, and to highlight the importance of understanding bone composition and structure, as well as osteogenesis and bone healing processes, to improve the design and development of such implants. In addition, special emphasis is given to pharmaceutical aspects that are frequently minimized, but that, instead, may be useful for formulation developments and in vitro/in vivo correlations.
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A. M. Cherniavsky
Full Text Available Aim. Evaluation of long-term results of drug therapy and intramyocardial administration of a mononuclear fraction of bone marrow cells in CHD patients with chronic cardiac insufficiency. Materials and methods. 109 patients were randomized into two groups by using an envelope method. Intramyocardial administration of a mononuclear fraction of autologous bone marrow cells and cardiac insufficiency therapy were performed for the 1st group (n = 55, while the 2nd group (n = 54 received drug therapy only. All patients underwent clinical examination at admission and at 6 and 12 months after the onset of the study. Results. In the 1st group the angina functional class was reliably lowered (from 3.3 ┬▒ 0.2 at the onset of the study down to 2.5 ┬▒ 0.1 after 12 months. The distance covered during a 6-minute walk test increased from the initial 185 ┬▒ 39 meters up to 359 ┬▒ 69 me- ters by the end of the 12th month. The angina class decreased from 3.1 ┬▒ 0.4 at the onset of the study down to 1.6 ┬▒ 0.4 by the end of the 12th month. Minnesota Life Quality Index reduced from 65.3 ┬▒ 21 points down to 22.4 ┬▒ 6 points in the first group, while in the control one it decreased down to 59.9 ┬▒ 16 points. On the contrary, cardiac insufficiency in patients of the second group tended to continually progress: from NYHA FC 3.5 ┬▒ 0.1 at the beginning of the study up to 3.9 ┬▒ 0.1 in the course of 12-month observation. The angina class remained the same (3.5 ┬▒ 0.5 at the beginning and 3.5 ┬▒ 0.4 after 12 months respectively. Conclusion. Intramyocardial implantation of a mononuclear fraction of autologous bone marrow cells is a safe method that contributes to the improvement of the left ventricular function, clinical data and prognosis.┬Ā
A bioreactor system for clinically relevant bone tissue engineering
Janssen, Franciscus Wilhelmus
Tissue engineering of bone by combining mesenchymal stem cells (MSCs) with a suitable ceramic carrier provides a potential alternative for autologous bone grafts. However, for large scale-production, the current two dimensional (2D) multiplication process in tissue culture flasks has some serious dr
Secondary alveolar bone grafting in cleft of the lip and palate patients
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Abhilashaa Walia
Full Text Available Aim: The aim was to restore the function and form of both arches with a proper occlusal relationship and eruption of tooth in the cleft area. Materials and Methods: Eleven patients were selected irrespective of sex and socio-economic status and whose age was within the mixed dentition period. Iliac crest is grafted in cleft area and subsequently evaluated for graft success using study models, and periapical and occlusal radiographs. Results: At the time of evaluation teeth were erupted in the area and good alveolar bone levels were present. Premaxilla becomes immobile with a good arch form and arch continuity. There are no major complications in terms of pain, infection, paraesthesia, hematoma formation at donor site without difficulty in walking. There is no complication in terms of pain, infection, exposure of graft, rejection of graft, and wound dehiscence at the recipient site. Discussion: It is evident that secondary alveolar grafting during the mixed dentition period is more beneficial for patients at the donor site as well as the recipient site. Conclusion: Long-term follow-up is required to achieve maximum advantage of secondary alveolar grafting; the age of the patient should be within the mixed dentition period, irrespective of sex, socio-economic status. It may be unilateral or bilateral.
Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research
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Jia-zuo SHEN, Jian-fei YAO, Da-sheng LIN, Ke-jian LIAN, Zhen-qi DING, Bin LIN, Zhi-min GUO, Ming-hua ZHANG, Qiang LI, Lin LI, Peng QI
Full Text Available Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise.Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS and standard dynamic hip screws (DHS in an animal model.Design: Testing of specifically designed fixation devices in a pig animal model.Interventions/Methods: We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each. Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively.Results: There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P < 0.05. There were also significant differences between the Hb-DHS and DHS groups in postmortem visually assessed indicators of bone healing at both 8 and 16 weeks postoperatively.Conclusions: The Hb-DHS device promotes femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.
Human dental pulp stem cell is a promising autologous seed cell for bone tissue engineering
Institute of Scientific and Technical Information of China (English)
LI Jing-hui; LIU Da-yong; ZHANG Fang-ming; WANG Fan; ZHANG Wen-kui; ZHANG Zhen-ting
Background The seed cell is a core problem in bone tissue engineering research.Recent research indicates that human dental pulp stem cells (hDPSCs) can differentiate into osteoblasts in vitro,which suggests that they may become a new kind of seed cells for bone tissue engineering.The aim of this study was to evaluate the osteogenic differentiation of hDPSCs in vitro and bone-like tissue formation when transplanted with three-dimensional gelatin scaffolds in vivo,and hDPSCs may become appropriate seed cells for bone tissue engineering.Methods We have utilized enzymatic digestion to obtain hDPSCs from dental pulp tissue extracted during orthodontic treatment.After culturing and expansion to three passages,the cells were seeded in 6-well plates or on three-dimensional gelatin scaffolds and cultured in osteogenic medium.After 14 days in culture,the three-dimensional gelatin scaffolds were implanted subcutaneously in nude mice for 4 weeks.In 6-well plate culture,osteogenesis was assessed by alkaline phosphatase staining,Von Kossa staining,and reverse transcription-polymerase chain reaction (RT-PCR) analysis of the osteogenesis-specific genes type I collagen (COL l),bone sialoprotein (BSP),osteocalcin (OCN),RUNX2,and osterix (OSX).In three-dimensional gelatin scaffold culture,X-rays,hematoxylin/eosin staining,and immunohistochemical staining were used to examine bone formation.Results In vitro studies revealed that hDPSCs do possess osteogenic differentiation potential.In vivo studies revealed that hDPSCs seeded on gelatin scaffolds can form bone structures in heterotopic sites of nude mice.Conclusions These findings suggested that hDPSCs may be valuable as seed cells for bone tissue engineering.As a special stem cell source,hDPSCs may blaze a new path for bone tissue engineering.
Histological and morphometric aspects of ridge preservation with a moldable, in situ hardening bone graft substitute
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Juri┼Īi─ć M.
Full Text Available Biphasic calcium phosphates (BCP are widely used in alveolar ridge regeneration as a porous scaffold for new bone formation. The aim of this case series was to evaluate the regenerative effect of the combination of BCP and polylactide-co-glycolide (PLGA which can serve as a barrier membrane during bone regeneration. The study included five patients. Four months into the healing period, bone samples were collected for histological and morphometric analyses. The results of morphometric analysis showed that newly formed bone represented 32.2 ┬▒ 6.8% of the tissue, 31.9 ┬▒ 8.9% was occupied by residual graft and 35.9 ┬▒ 13.5% by soft tissue. Active osteogenesis was seen around the particles of the graft. The particles were occupied mostly by immature woven bone and connective tissue. The quality and quantity of newly formed bone, after the use of BCP/PLGA for ridge preservation, can be adequate for successful implant therapy after tooth extraction. [Projekat Ministarstva nauke Republike Srbije, br. OI 175021 i br. OI 173009
Structural mechanical properties of radiation-sterilized human Bone-Tendon-Bone grafts preserved by different methods.
Gut, Grzegorz; Marowska, Joanna; Jastrzebska, Anna; Olender, Ewa; Kamiński, Artur
To avoid the risk of infectious disease transmission from donor to recipient, allografts should be terminally sterilized. In the previous paper (Kaminski et al. in Cell Tissue Bank 10:215-219, 2009) we presented the effect of various methods of preservation (deep fresh freezing, glycerolization, lyophilization), followed by irradiation with different doses of electron beam (EB), on material (intrinsic) mechanical properties of human patellar tendons cut out as for anterior cruciate ligament reconstruction, obtained in failure tensile test. As structural mechanical properties are equally important to predict the behaviour of the graft as a whole functional unit, the purpose of the present paper was to show the results for failure load and elongation, obtained in the same experiment. Paired Bone-Tendon-Bone grafts (BTB) were prepared from cadaveric human patella tendons with both patellar and tibial attachments. They were preserved by deep freezing, glycerolization or lyophilization and subsequently EB-irradiated with the doses of 25, 35, 50 or 100┬ĀkGy (fresh-frozen grafts) or a single dose of 35┬ĀkGy (glycerolized and lyophilized grafts). Each experimental (irradiated) group was provided with control (non-irradiated), donor-matched group. The specimens from all groups were subjected to mechanical failure tensile test with the use of Instron system in order to measure their structural properties (failure load and elongation). All lyophilized grafts were rehydrated before mechanical testing. In our study we did not observe significant deterioration of structural mechanical properties of BTB grafts processed by fresh-freezing and then terminal sterilized with growing doses of EB up to 100┬ĀkGy. In contrast, BTB grafts processed by glycerolization or lyophilization and irradiated with 35┬ĀkGy showed significant decrease of failure load. Obtained results suggest that deep-frozen irradiated grafts retain their initial mechanical properties to an extent which does not
Structural mechanical properties of radiation-sterilized human Bone-Tendon-Bone grafts preserved by different methods.
Gut, Grzegorz; Marowska, Joanna; Jastrzebska, Anna; Olender, Ewa; Kamiński, Artur
To avoid the risk of infectious disease transmission from donor to recipient, allografts should be terminally sterilized. In the previous paper (Kaminski et al. in Cell Tissue Bank 10:215-219, 2009) we presented the effect of various methods of preservation (deep fresh freezing, glycerolization, lyophilization), followed by irradiation with different doses of electron beam (EB), on material (intrinsic) mechanical properties of human patellar tendons cut out as for anterior cruciate ligament reconstruction, obtained in failure tensile test. As structural mechanical properties are equally important to predict the behaviour of the graft as a whole functional unit, the purpose of the present paper was to show the results for failure load and elongation, obtained in the same experiment. Paired Bone-Tendon-Bone grafts (BTB) were prepared from cadaveric human patella tendons with both patellar and tibial attachments. They were preserved by deep freezing, glycerolization or lyophilization and subsequently EB-irradiated with the doses of 25, 35, 50 or 100┬ĀkGy (fresh-frozen grafts) or a single dose of 35┬ĀkGy (glycerolized and lyophilized grafts). Each experimental (irradiated) group was provided with control (non-irradiated), donor-matched group. The specimens from all groups were subjected to mechanical failure tensile test with the use of Instron system in order to measure their structural properties (failure load and elongation). All lyophilized grafts were rehydrated before mechanical testing. In our study we did not observe significant deterioration of structural mechanical properties of BTB grafts processed by fresh-freezing and then terminal sterilized with growing doses of EB up to 100┬ĀkGy. In contrast, BTB grafts processed by glycerolization or lyophilization and irradiated with 35┬ĀkGy showed significant decrease of failure load. Obtained results suggest that deep-frozen irradiated grafts retain their initial mechanical properties to an extent which does not
Bone grafting and one-stage revision of THR - biological reconstruction and effective antimicrobial treatment using antibiotic impregnated allograft bone.
Winkler, Heinz
Infection of a total hip replacement (THR) is considered one of the most serious complications in orthopaedic surgery. Problems derive from the presence of biofilms with inherent resistance to usual antibiotic treatment and bone defects resulting from infection induced osteolysis. Discussions on the choice of treatment mainly focus on the chance of eradicating the infection in either one or more stages. The advantages of only one operation with regard to patients' satisfaction, functional results and economical burden are evident. However, the fear of re-infection usually leads surgeons to multiple stage procedures, mostly using antibiotic loaded spacers in the interval. Spacers have no effect on biofilms and are associated with a high rate of complications such as breakage or dislocation. Cemented revisions show several disadvantages like reduction of biomechanical properties through added antibiotics, inferior long term results, difficulties of removal in case of recurrence etc. Uncemented implants appear more advantageous but are at risk of becoming colonised by remaining biofilm fragments. To overcome this risk higher local concentrations of antibiotics are needed. Allograft bone may be impregnated with high loads of antibiotics using special incubation techniques, resulting in an antibiotic bone compound (ABC). ABC provides local concentrations exceeding those of cement by more than a 100-fold and efficient release is prolonged for several weeks. At the same time it is likely to restore bone stock, which is usually compromised after removal of an infected endoprosthesis. Based on these considerations new protocols for one-stage exchange of infected THR have been established. Bone voids may be filled with ABC, uncemented implants may be fixed in original healthy bone. Recent studies indicate an overall success rate of more than 90% with one operation, without any adverse side effects. Incorporation of allografts appears as after grafting with unimpregnated bone
Potential therapeutic role of cisplatinum in autologous bone marrow transplantation: in vitro eradication of neuroblastoma cells from bone marrow.
Bettan-Renaud, L.; De Vathaire, F.; B├ā┬®nard, J.; Morardet, N.; Pauzie, N.; Bayet, S.; Hartmann, O; Parmentier, C.
Cisplatinum may prove to be a valuable agent for the elimination of diseased cells in the bone marrow of patients with neuroblastoma. In this study, we measured the efficacy of cisplatinum on human neuroblastoma cell lines and on normal human bone marrow progenitors, GM-CFC and CFU-F. Data indicate that the therapeutic index of cisplatinum is high. We set up an experimental model consisting of a mixture of human bone marrow and human neuroblastoma cells in order to confirm these preliminary r...
Ceacam1 separates graft-versus-host-disease from graft-versus-tumor activity after experimental allogeneic bone marrow transplantation.
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Sydney X Lu
Full Text Available Allogeneic bone marrow transplantation (allo-BMT is a potentially curative therapy for a variety of hematologic diseases, but benefits, including graft-versus-tumor (GVT activity are limited by graft-versus-host-disease (GVHD. Carcinoembryonic antigen related cell adhesion molecule 1 (Ceacam1 is a transmembrane glycoprotein found on epithelium, T cells, and many tumors. It regulates a variety of physiologic and pathological processes such as tumor biology, leukocyte activation, and energy homeostasis. Previous studies suggest that Ceacam1 negatively regulates inflammation in inflammatory bowel disease models.We studied Ceacam1 as a regulator of GVHD and GVT after allogeneic bone marrow transplantation (allo-BMT in mouse models. In vivo, Ceacam1(-/- T cells caused increased GVHD mortality and GVHD of the colon, and greater numbers of donor T cells were positive for activation markers (CD25(hi, CD62L(lo. Additionally, Ceacam1(-/- CD8 T cells had greater expression of the gut-trafficking integrin ╬▒(4╬▓(7, though both CD4 and CD8 T cells were found increased numbers in the gut post-transplant. Ceacam1(-/- recipients also experienced increased GVHD mortality and GVHD of the colon, and alloreactive T cells displayed increased activation. Additionally, Ceacam1(-/- mice had increased mortality and decreased numbers of regenerating small intestinal crypts upon radiation exposure. Conversely, Ceacam1-overexpressing T cells caused attenuated target-organ and systemic GVHD, which correlated with decreased donor T cell numbers in target tissues, and mortality. Finally, graft-versus-tumor survival in a Ceacam1(+ lymphoma model was improved in animals receiving Ceacam1(-/- vs. control T cells.We conclude that Ceacam1 regulates T cell activation, GVHD target organ damage, and numbers of donor T cells in lymphoid organs and GVHD target tissues. In recipients of allo-BMT, Ceacam1 may also regulate tissue radiosensitivity. Because of its expression on both the
Beneficial effects of concurrent autologous bone marrow cell therapy and metabolic intervention in ischemia-induced angiogenesis in the mouse hindlimb
Napoli, Claudio; Williams-Ignarro, Sharon; Nigris, Filomena; De Rosa, Gaetano; Lerman, Lilach O.; Farzati, Bartolomeo; Matarazzo, Angelo; Sica, Giacomo; Botti, Chiara; Fiore, Andrea; Byrns, Russell E.; Sumi, Daigo; Sica, Vincenzo; Ignarro, Louis J.
Lower-limb ischemia is a major health problem. Because of the absence of effective treatment in the advanced stages of the disease, amputation is undertaken to alleviate unbearable symptoms. Novel therapeutic approaches include the intramuscular use of autologous bone marrow cells (BMCs). Because tissue ischemia is associated with an overwhelming generation of oxygen radicals and negative effects due to perturbed shear-stress, metabolic intervention with antioxidants and l-arginine could pote...
Histologic and histomorphometric study of bone repair around short dental implants inserted in rabbit tibia, associated with tricalcium phosphate graft bone
Marlice Azoia Lukiantchuki Barbosa; Liogi Iwaki Filho; Lilian Cristina Vessoni Iwaki; Maria Raquel Mar├¦al Natali; Wilton Mitsunari Takeshita; S├®rgio S├Ībio
The use of short dental implants represents one way to overcome this limitation, in association with bone grafting procedures. Tricalcium phosphate-based grafts are among those widely used. The purpose of this study was to assess the biocompatibility of this biomaterial in the coverage of bone defects around short dental implants. Ten New Zealandrabbits were used in this study, each animal received 4 implants, two were placed in the right tibia region (control group) and two in the left tibia...
Intravenous Autologous Bone Marrow Mononuclear Cell Transplantation for Stroke: Phase1/2a Clinical Trial in a Homogeneous Group of Stroke Patients.
Taguchi, Akihiko; Sakai, Chiaki; Soma, Toshihiro; Kasahara, Yukiko; Stern, David M; Kajimoto, Katsufumi; Ihara, Masafumi; Daimon, Takashi; Yamahara, Kenichi; Doi, Kaori; Kohara, Nobuo; Nishimura, Hiroyuki; Matsuyama, Tomohiro; Naritomi, Hiroaki; Sakai, Nobuyuki; Nagatsuka, Kazuyuki
The goal of this clinical trial was to assess the feasibility and safety of transplanting autologous bone marrow mononuclear cells into patients suffering severe embolic stroke. Major inclusion criteria included patients with cerebral embolism, age 20-75 years, National Institute of Health Stroke Scale (NIHSS) score displaying improvement of Ōēż 5 points during the first 7 days after stroke, and NIHSS score of Ōēź 10 on day 7 after stroke. Bone marrow aspiration (25 or 50 mL; N = 6 patients in each case) was performed 7-10 days poststroke, and bone marrow mononuclear cells were administrated intravenously. Mean total transplanted cell numbers were 2.5 ├Ś 10(8) and 3.4 ├Ś 10(8) cells in the lower and higher dose groups, respectively. No apparent adverse effects of administering bone marrow cells were observed. Compared with the lower dose, patients receiving the higher dose of bone marrow cells displayed a trend toward improved neurologic outcomes. Compared with 1 month after treatment, patients receiving cell therapy displayed a trend toward improved cerebral blood flow and metabolic rate of oxygen consumption 6 months after treatment. In comparison with historical controls, patients receiving cell therapy had significantly better neurologic outcomes. Our results indicated that intravenous transplantation of autologous bone marrow mononuclear cells is safe and feasible. Positive results and trends favoring neurologic recovery and improvement in cerebral blood flow and metabolism by cell therapy underscore the relevance of larger scale randomized controlled trials using this approach.
Interleukin-15-activated natural killer cells kill autologous osteoclasts via LFA-1, DNAM-1 and TRAIL, and inhibit osteoclast-mediated bone erosion in┬Āvitro.
Feng, Shan; Madsen, Suzi H; Viller, Natasja N; Neutzsky-Wulff, Anita V; Geisler, Carsten; Karlsson, Lars; S├Čderstr├Čm, Kalle
Osteoclasts reside on bone and are the main bone resorbing cells playing an important role in bone homeostasis, while natural killer (NK) cells are bone-marrow-derived cells known to play a crucial role in immune defence against viral infections. Although mature NK cells traffic through bone marrow as well as to inflammatory sites associated with enhanced bone erosion, including the joints of patients with rheumatoid arthritis, little is known about the impact NK cells may have on mature osteoclasts and bone erosion. We studied the interaction between human NK cells and autologous monocyte-derived osteoclasts from healthy donors in┬Āvitro. We show that osteoclasts express numerous ligands for receptors present on activated NK cells. Co-culture experiments revealed that interleukin-15-activated, but not resting, NK cells trigger osteoclast apoptosis in a dose-dependent manner, resulting in drastically decreased bone erosion. Suppression of bone erosion requires contact between NK cells and osteoclasts, but soluble factors also play a minor role. Antibodies masking leucocyte function-associated antigen-1, DNAX accessory molecule-1 or tumour necrosis factor-related apoptosis-inducing ligand enhance osteoclast survival when co-cultured with activated NK cells and restore the capacity of osteoclasts to erode bone. These results suggest that interleukin-15-activated NK cells may directly affect bone erosion under physiological and pathological conditions.
Long-term clinical results of autologous bone marrow CD 133+ cell transplantation in patients with ST-elevation myocardial infarction
Kirgizova, M. A.; Suslova, T. E.; Markov, V. A.; Karpov, R. S.; Ryabov, V. V.
The aim of the study was investigate the long-term results of autologous bone marrow CD 133+ cell transplantation in patients with primary ST-Elevation Myocardial Infarction (STEMI). Methods and results: From 2006 to 2007, 26 patients with primary STEMI were included in an open randomized study. Patients were randomized to two groups: 1st - included patients underwent PCI and transplantation of autologous bone marrow CD 133+ cell (n = 10); 2nd - patients with only PCI (n = 16). Follow-up study was performed 7.70┬▒0.42 years after STEMI and consisted in physical examination, 6-min walking test, Echo exam. Total and cardiovascular mortality in group 1 was lower (20% (n = 2) vs. 44% (n = 7), p = 0.1 and 22% (n = 2) vs. 25% (n = 4), (p=0.53), respectively). Analysis of cardiac volumetric parameters shows significant differences between groups: EDV of 100.7 ┬▒ 50.2 mL vs. 144.40┬▒42.7 mL, ESV of 56.3 ┬▒ 37.8 mL vs. 89.7 ┬▒ 38.7 mL in 1st and 2nd groups, respectively. Data of the study showed positive effects of autologous bone marrow CD 133+ cell transplantation on the long-term survival of patients and structural status of the heart.
Biomechanical Comparison Between Bashti Bone Plug Technique and Biodegradable Screw for Fixation of Grafts in Ligament surgery
Kaveh Bashti; Mohammad Naghi Tahmasebi; Hasan Kaseb; Farzam Farahmand; Mohammad Akbar; Amir Mobini
┬Ā Background: Ligament reconstruction is a common procedure in orthopedic surgery. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction and to compare its biomechanical features with conventional absorbable interference screw technique in a bovine ...
Exploring CBCT-Based DICOM Files. A Systematic Review on the Properties of Images Used to Evaluate Maxillofacial Bone Grafts
Rubens SPIN-NETO; Marcantonio, Elcio; Gotfredsen, Erik; Wenzel, Ann
Previous studies suggests that cone beam computerized tomography (CBCT) images could provide reliable information regarding the fate of bone grafts in the maxillofacial region, but no systematic information regarding the standardization of CBCT settings and properties is available, i.e., there is a lack of information on how the images were generated, exported, and analyzed when bone grafts were evaluated. The aim of this study was to (1) do a systematic review on which type of CBCT-based DIC...
An Injectable Hydrogel as Bone Graft Material with Added Antimicrobial Properties
Tommasi, Giacomo; Perni, Stefano
Currently, the technique which provides the best chances for a successful bone graft, is the use of bone tissue from the same patient receiving it (autograft); the main limitations are the limited availability and the risks involved in removing living bone tissue, for example, explant site pain and morbidity. Allografts and xenografts may overcome these limitations; however, they increase the risk of rejection. For all these reasons the development of an artificial bone graft material is particularly important and hydrogels are a promising alternative for bone regeneration. Gels were prepared using 1,4-butanediol diacrylate as crosslinker and alpha tricalciumphosphate; ZnCl2 and SrCl2 were added to the aqueous phase. MTT results demonstrated that the addition of strontium had a beneficial effect on the osteoblast cells density on hydrogels, and zinc instead did not increase osteoblast proliferation. The amount of calcium produced by the osteoblast cells quantified through the Alizarin Red protocol revealed that both strontium and zinc positively influenced the formation of calcium; furthermore, their effect was synergistic. Rheology properties were used to mechanically characterize the hydrogels and especially the influence of crosslinker's concentration on them, showing the hydrogels presented had extremely good mechanical properties. Furthermore, the antimicrobial activity of strontium and zinc in the hydrogels against methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis was determined. PMID:27174392
Internal fixation and bone grafting for intraarticular nonunion of tibial plateau: a report of four cases
Institute of Scientific and Technical Information of China (English)
Ramesh K Sen; Ashwani Soni; Uttam Chand Saini; Daljit Singh
Intraarticular nonunion of tibial plateau is rare.In the literature,only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results.Internal fixation along with bone grafting was done as a standard treatment in all cases.We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods.We treated these cases with plaster of paris cast,internal fixation along with bone graft,arthrodesis with K-nail and total knee replacement.Case 1 was treated with plaster of paris (POP)cast as the patient refused surgery.The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment.Case 2 was managed with open reduction internal fixation along with bone grafting.The patient had a good union and got full range of motion at the knee joint.Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result.Case 4 was an infected nonunion.Arthrodesis was done and the patient could walk with full weight bearing independently.We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau.Causes of nonunion,present condition and range of motion of the knee joint,as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.
Improving the Clinical Evidence of Bone Graft Substitute Technology in Lumbar Spine Surgery
Hsu, Wellington K.; Nickoli, M. S.; Wang, J.C.; Lieberman, J. R.; An, H S; Yoon, S. T.; Youssef, J. A.; Brodke, D.S.; McCullough, C. M.
Bone graft substitutes have been used routinely for spine fusion for decades, yet clinical evidence establishing comparative data remains sparse. With recent scrutiny paid to the outcomes, complications, and costs associated with osteobiologics, a need to improve available data guiding efficacious use exists. We review the currently available clinical literature, studying the outcomes of various biologics in posterolateral lumbar spine fusion, and establish the need for a multicenter, indepen...
Roos, Milton Valdomiro; Roos, Bruno Dutra; Giora, Ta├Łs Stedile Busin; Taglietti, Thiago Martins
To perform a clinical and radiographic assessment of patients undergoing surgical treatment using a cortical structural homologous bone graft for femoral reconstruction following mechanical failure of total hip arthroplasty and periprosthetic fractures. Methods: A retrospective study was conducted on 27 patients who underwent surgical treatment for femoral reconstruction following mechanical failure of total hip arthroplasty (12 cases) and periprosthetic fractures (15 cases), using a cortical...
Analysis of donor sites for mandibular bone grafts by computerized cone beam tomography to evaluate bone remodeling
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Thomaz Wassall
Full Text Available Objective: To analyze the graft donor site (posterior region of the mandible by means of cone-beam volumetric tomographies to assess boneremodeling, verifying the degree of morbidity with regard to this parameter. Methods: The sample was composed of twenty individuals, irrespective of age, gender and ASA I and ASA II surgical risk classification. Three volume computed tomographies were performed: one before surgery, another seven days after surgery and the last 180 days after surgery. Image acquisition by volumetric cone-beam tomography and the computer program Dental Slice were used to make the measurements. Results: Statistics showed that there was significant bone remodeling. Although there are several concerns about the graft donor sites, no data were obtained in the literature, about the assessment of bone remodeling of the donor site. Conclusion: Mean remodeling in the posterior region of the mandible, assessed 180 days after graft removal is 81.3%, on an average, andmorbidity in the posterior donor site of the mandible has been small, when compared with the other donor sites, both intra-oral and extra-oral, according to the data in the specific literature.
Tissue engineering of bone: the reconstructive surgeon's point of view
Kneser, U; Schaefer, D. J.; Polykandriotis, E; Horch, R E
Bone defects represent a medical and socioeconomic challenge. Different types of biomaterials are applied for reconstructive indications and receive rising interest. However, autologous bone grafts are still considered as the gold standard for reconstruction of extended bone defects. The generation of bioartificial bone tissues may help to overcome the problems related to donor site morbidity and size limitations. Tissue engineering is, according to its historic definition, an ŌĆ£interdisciplin...
Current trends and future perspectives of bone substitute materials - from space holders to innovative biomaterials.
Kolk, Andreas; Handschel, J├Črg; Drescher, Wolf; Rothamel, Daniel; Kloss, Frank; Blessmann, Marco; Heiland, Max; Wolff, Klaus-Dietrich; Smeets, Ralf
An autologous bone graft is still the ideal material for the repair of craniofacial defects, but its availability is limited and harvesting can be associated with complications. Bone replacement materials as an alternative have a long history of success. With increasing technological advances the spectrum of grafting materials has broadened to allografts, xenografts, and synthetic materials, providing material specific advantages. A large number of bone-graft substitutes are available including allograft bone preparations such as demineralized bone matrix and calcium-based materials. More and more replacement materials consist of one or more components: an osteoconductive matrix, which supports the ingrowth of new bone; and osteoinductive proteins, which sustain mitogenesis of undifferentiated cells; and osteogenic cells (osteoblasts or osteoblast precursors), which are capable of forming bone in the proper environment. All substitutes can either replace autologous bone or expand an existing amount of autologous bone graft. Because an understanding of the properties of each material enables individual treatment concepts this review presents an overview of the principles of bone replacement, the types of graft materials available, and considers future perspectives. Bone substitutes are undergoing a change from a simple replacement material to an individually created composite biomaterial with osteoinductive properties to enable enhanced defect bridging.
Effects of low-level laser therapy on autogenous bone graft stabilized with a new heterologous fibrin sealant.
de Oliveira Gon├¦alves, J├®ssica Barbosa; Buchaim, Daniela Vieira; de Souza Bueno, Cleuber Rodrigo; Pomini, Karina Torres; Barraviera, Benedito; J├║nior, Rui Seabra Ferreira; Andreo, Jesus Carlos; de Castro Rodrigues, Antonio; Cestari, Tania Mary; Buchaim, Rog├®rio Leone
Autogenous bone grafts are used to repair bone defects, and the stabilization is needed for bone regeneration. Laser photobiomodulation is a modality of treatment in clinical practice for tissue regeneration, and it has therapeutic effects as an anti-inflammatory, analgesic and modulating cellular activity. The aim of the present study was to evaluate the effects of low-level laser therapy (LLLT) on an autogenous bone graft integration process stabilized with a new heterologous fibrin sealant. Forty rats were divided into two groups: Autogenous Fibrin Graft (AFG, n=20), in which a 5mm dome osteotomy was conducted in the right parietal bone and the graft was adhered to the left side using fibrin sealant; and Autogenous Fibrin Graft Laser (AFGL, n=20), which was subjected to the same procedures as AFG with the addition of LLLT. The treatment was performed immediately following surgery and then three times a week until euthanasia, using an 830nm laser (30mW, 6J/cm(2), 0.116cm(2), 258.6mW/cm(2), 2.9J). Five animals from each group were euthanized at 10, 20, 30 and 40days postoperative, and the samples were submitted to histomorphological and histomorphometric analysis. Partial bone regeneration occurred, with new bone tissue integrating the graft to the recipient bed and small areas of connective tissue. Comparative analysis of the groups at the same intervals revealed minor interfaces in group AFGL, with statistically significant differences (p<0.05) at all of the analyzed intervals (10days p=0.0087, 20days p=0.0012, 30days p<0.0001, 40days p=0.0142). In conclusion, low-level laser therapy stimulated bone regeneration and accelerated the process of integration of autogenous bone grafts. PMID:27497370
Evaluation of alveolar bone grafting in unilateral cleft lip and palate patients using a computer-aided diagnosis system
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Sutthiprapaporn, Pipop; Kongsomboon, Supaporn; Limmonthol, Saowaluck; Pisek, Poonsak; Keinprasit, Chutimaporn [Khon Kaen University, Khon Kaen (Thailand); Tanimoto, Keiji; Nakamoto, Takashi [Dept. of Oral and Maxillofacial Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan)
This study aimed to evaluate the trabecular bone changes after alveolar bone grafting in unilateral cleft lip and palate (UCLP) patients using a computer-aided diagnosis (CAD) system. The occlusal radiographs taken from 50 UCLP patients were surveyed retrospectively. The images were categorized as: 50 images in group 0 (before bone grafting), 33 images in group 1 (one month after bone grafting), 24 images in group 2 (2-4 months after bone grafting), 15 images in group 3 (5-7 months after bone grafting), and 21 images in group 4 (8 or more months after bone grafting). Each image was grouped as either 'non-cleft side' or 'cleft side'. The CAD system was used five times for each side to calculate the pixel area based on the mathematical morphology. Significant differences were found using a Wilcoxon signed ranks test or paired samples t test. The pixel area showed a significant difference between the 'non-cleft side' and 'cleft side' in group 0 (404.27{+-}103.72/117.73{+-}92.25; p=0.00), group 1 (434.29{+-}86.70/388.31{+-}109.51; p=0.01), and group 4 (430.98{+-}98.11/366.71{+-}154.59; p=0.02). No significant differences were found in group 2 (423.57{+-}98.12/383.47{+-}135.88; p=0.06) or group 3 (433.02{+-}116.07/384.16{+-}146.55; p=0.19). Based on the design of this study, alveolar bone grafting was similar to normal bone within 2-7 months postoperatively.
Autologous transplantation of CD34(+) bone marrow derived mononuclear cells in management of non-reconstructable critical lower limb ischemia.
Ismail, Ahmed M; Abdou, Said M; Aty, Hassan Abdel; Kamhawy, Adel H; Elhinedy, Mohammed; Elwageh, Mohammed; Taha, Atef; Ezzat, Amal; Salem, Hoda A; Youssif, Said; Salem, Mohamed L
Patients with a decrease in limb perfusion with a potential threat to limb viability manifested by ischemic rest pain, ischemic ulcers, and/or gangrene are considered to have critical limb ischemia (CLI). Because of this generally poor outcome, there is a strong need for attempting any procedure to save the affected limb. The aim of this work is to evaluate the possibility to use stem cell therapy as a treatment option for patients with chronic critical lower limb ischemia with no distal run off. This study includes 20 patients with chronic critical lower limb ischemia with no distal run off who are unsuitable for vascular or endovascular option. These patients underwent stem cell therapy (SCT) by autologous transplantation of bone marrow derived mononuclear cells. 55┬Ā% of patients treated with SCT showed improvement of the rest pain after the first month, 60┬Ā% continued improvement of the rest pain after 6┬Āmonths, 75┬Ā% after 1┬Āyear and 80┬Ā% after 2┬Āyears and continued without any deterioration till the third year. Limb salvage rate after STC was 80┬Ā% after the first year till the end of the second and third years. SCT can result in angiogenesis in patients with no-option CLI, providing a foundation for the application of this therapy to leg ischemia. PMID:25511801
Early Results of Clinical Application of Autologous Whole Bone Marrow Stem Cell Transplantation for Critical Limb Ischemia with Buerger's Disease.
Heo, Seon-Hee; Park, Yoong-Seok; Kang, Eun-Suk; Park, Kwang-Bo; Do, Young-Soo; Kang, Kyung-Sun; Kim, Dong-Ik
Our goal was to evaluate early results of the clinical application of autologous whole bone marrow stem cell transplantation (AWBMSCT) for critical limb ischemia (CLI) in patients with Buerger's disease. We retrospectively analyzed the data of 58 limbs of 37 patients (mean age, 43.0 years; range, 28-63 years; male, 91.9%) with Buerger's disease with CLI who were treated with AWBMSCT from March 2013 to December 2014. We analyzed Rutherford category, pain score, pain-free walking time (PFWT), total walking time (TWT), ankle brachial pressure index (ABPI), and toe brachial pressure index (TBPI), and investigated wound healing and occurrence of unplanned amputations. The mean follow-up duration was 11.9 ┬▒ 7.2 months (range, 0.9-23.9 months) and 100%, 72.4%, and 74.1% of patients were available to follow-up 1, 3 and 6 months after AWBMST, respectively. At 6 months, patients demonstrated significant improvements in Rutherford category (P ABPI was increased compared to baseline, but the difference was not significant. A total of 76.5% ischemic wounds achieved complete or improved healing. AWBMSCT is a safe and effective alternative or adjunctive treatment modality to achieve clinical improvement in patients with CLI. PMID:26791280
Autologous bone marrow stromal cells are promising candidates for cell therapy approaches to treat bone degeneration in sickle cell disease
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Ang├®lique Lebouvier
SCD-ON patients have a higher frequency of BMSCs that retain their bone regeneration potential. Our findings suggest that BMSCs isolated from SCD-ON patients can be used clinically in cell therapy approaches. This work provides important preclinical data that is necessary for the clinical application of expanded BMSCs in advanced therapies and medical products.
The Chondrogenic Induction Potential for Bone Marrow-Derived Stem Cells between Autologous Platelet-Rich Plasma and Common Chondrogenic Induction Agents: A Preliminary Comparative Study
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Shan-zheng Wang
Full Text Available The interests in platelet-rich plasma (PRP and their application in stem cell therapy have contributed to a better understanding of the basic biology of the prochondrogenesis effect on bone marrow-derived stem cells (BMSCs. We aimed at comparing the effect of autologous PRP with common chondrogenic induction agents (CCIAs on the chondrogenic differentiation of BMSCs. Rabbit BMSCs were isolated and characterized by flow cytometry and differentiated towards adipocytes and osteoblasts. The chondrogenic response of BMSCs to autologous PRP and CCIAs which included transforming growth factor-╬▓1 (TGF-╬▓1, dexamethasone (DEX, and vitamin C (Vc was examined by cell pellet culture. The isolated BMSCs after two passages highly expressed CD29 and CD44 but minimally expressed CD45. The osteogenic and adipogenic differentiation potentials of the isolated BMSCs were also confirmed. Compared with common CCIAs, autologous PRP significantly upregulated the chondrogenic related gene expression, including Col-2, AGC, and Sox-9. Osteogenic related gene expression, including Col-1 and OCN, was not of statistical significance between these two groups. Thus, our data shows that, compared with common chondrogenic induction agents, autologous PRP can be more effective in promoting the chondrogenesis of BMSCs.
Feasibility and safety of autologous bone marrow mononuclear cell transplantation in patients with advanced chronic liver disease
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Andre Castro Lyra; Bernd Genser; Ricardo Ribeiro dos Santos; Luiz Guilherme Costa Lyra; Milena Botelho Pereira Soares; Luiz Flavio Maia da Silva; Marcos Fraga Fortes; Andr├® Goyanna Pinheiro Silva; Augusto C├®sar de Andrade Mota; Sheilla A Oliveira; Eduardo Lorens Braga; Wilson Andrade de Carvalho
AIM:To evaluate the safety and feasibility of bone marrow cell(BMC)transplantation in patients with chronic liver disease on the waiting list for liver transplantation.METHODS:Ten patients(eight males)with chronic liver disease were enrolled to receive infusion of autologous bone marrow-derived cells.Seven patients were classified as Child-Pugh B and three as Child-Pugh C.Baseline assessment included complete clinical and laboratory evaluation and abdominal MRI.Approximately 50 mL of bone marrow aspirate was prepared by centrifugation in a ficoll-hypaque gradient.At least of 100 millions of mononuclear-enriched BMCs were infused into the hepatic artery using the routine technique for arterial chemoembolization for liver tumors.Patients were followed up for adverse events up to 4 mo.RESULTS:The median age of the patients was 52 years(range 24-70 years).All patients were discharged 48 h after BMC infusion.Two patients complained of mild pain at the bone marrow needle puncture site.No other complications or specific side effects related to the procedure were observed.Bilirubin levels were lower at 1(2.19 ┬▒ 0.9)and 4 mo(2.10 ┬▒ 1.0)after cell transplantation that baseline levels(2.78 ┬▒ 1.2).Albumin levels 4 mo after BMC infusion(3.73 ┬▒ 0.5)were higher than baseline levels(3.47 ┬▒ 0.5).International normalized ratio(INR)decreased from 1.48(SD = 0.23)to 1.43(SD = 0.23)one month after cell transplantation.CONCLUSION:BMC infusion into hepatic artery of patients with advanced chronic liver disease is safe and feasible.In addition,a decrease in mean serum bilirubin and INR levels and an increase in albumin levels are observed.Our data warrant further studies in order to evaluate the effect of BMC transplantation in patients with advanced chronic liver disease.
Autologous grafting of extraocular muscles: experimental study in rabbits Transplante aut├│logo de musculatura ocular extr├Łnseca: estudo experimental em coelhos
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Jorge Meireles-Teixeira
Full Text Available PURPOSE: To evaluate the feasibility of autologous extraocular muscle grafting as a type of muscle expansion surgery. METHODS: The left superior rectus muscle of twenty-nine rabbits was resected and this fragment was attached to the endpoint of the respective right superior rectus (test group. Thereafter, the superior rectus of the left eye was reattached to the sclera (control group. Both groups were examined during different postoperative periods in order to assess their outcomes. RESULTS: The presence of hyperemia was slightly more frequent in the grafted group. Secretion and muscle atrophy were negligible in both groups. Fibrosis was greater in grafted animals. These muscles were weaker than the control muscles, although the force required to split muscular parts was always greater than the physiological one. CONCLUSIONS: This surgical technique was reliable and useful if one intends to achieve muscle expansion without the intrinsic risks of dealing with heterologous/artificial materials.OBJETIVO: Avaliar a viabilidade do uso de segmentos de m├║sculos oculares extr├Łnsecos como expansores de tend├Ąes musculares. M├ēTODOS: Vinte e nove coelhos tiveram seu m├║sculo reto superior esquerdo ressecado e o fragmento de cada um foi transplantado para o reto superior contralateral (grupo-teste. Ent├Żo, o reto superior esquerdo foi reinserido na esclera (grupo-controle. Os animais foram ent├Żo examinados em diversos per├Łodos p├│s-operat├│rios, at├® os seus sacrif├Łcios, para que se avaliasse o desenrolar dessa t├®cnica cir├║rgica. RESULTADOS: A hiperemia foi maior entre os testes. A secre├¦├Żo e a atrofia muscular foram m├Łnimas nos dois grupos. Houve maior presen├¦a de fibrose no grupo-teste, mas n├Żo t├Żo expressiva a ponto de inviabilizar os efeitos da cirurgia. Esses m├║sculos tamb├®m se romperam mais facilmente do que os do grupo-controle, por├®m, a for├¦a de rompimento foi sempre bem maior do que aquela presente numa contra├¦├Żo muscular normal
Tooth movement out of the bony wall using augmented corticotomy with nonautogenous graft materials for bone regeneration.
Lee, Kye-Bok; Lee, Dong-Yeol; Ahn, Hyo-Won; Kim, Seong-Hun; Kim, Eun-Cheol; Roitman, Igor
This prospective randomized split-mouth study was performed to compare the effects of augmented corticotomy with those of different nonautogenous bone graft materials combined with orthodontic tooth movement in dogs. Decortication was performed on the buccal bone surface of 6 male beagle dogs that were randomly assigned to receive grafts of deproteinized bovine bone mineral, irradiated cortical bone, or synthetic bone. Immediate orthodontic force was applied to the second and third premolars for buccal tipping for 6 weeks. The pocket depth and width of keratinized tissue (WKT) were measured. Histologic and histomorphometric analyses were performed. The probing depth, WKT, and ratio of the area of new bone to that of total bone on the buccal side were not significantly different between groups. All groups had considerable new bone formation on the pressure side. New bone formation on the buccal side and buccal plate formation in the coronal direction along the root surfaces were induced by the bone-derived and PDL-derived mesenchymal matrix, respectively. The angular change between groups was significantly different (P corticotomy using nonautogenous graft materials facilitated tooth movement without fenestrations and accelerated new bone formation on the pressure side. PMID:25247172
Tooth Movement out of the Bony Wall Using Augmented Corticotomy with Nonautogenous Graft Materials for Bone Regeneration
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Kye-Bok Lee
Full Text Available This prospective randomized split-mouth study was performed to compare the effects of augmented corticotomy with those of different nonautogenous bone graft materials combined with orthodontic tooth movement in dogs. Decortication was performed on the buccal bone surface of 6 male beagle dogs that were randomly assigned to receive grafts of deproteinized bovine bone mineral, irradiated cortical bone, or synthetic bone. Immediate orthodontic force was applied to the second and third premolars for buccal tipping for 6 weeks. The pocket depth and width of keratinized tissue (WKT were measured. Histologic and histomorphometric analyses were performed. The probing depth, WKT, and ratio of the area of new bone to that of total bone on the buccal side were not significantly different between groups. All groups had considerable new bone formation on the pressure side. New bone formation on the buccal side and buccal plate formation in the coronal direction along the root surfaces were induced by the bone-derived and PDL-derived mesenchymal matrix, respectively. The angular change between groups was significantly different (P < 0.001. Augmented corticotomy using nonautogenous graft materials facilitated tooth movement without fenestrations and accelerated new bone formation on the pressure side.
Phase 1 Trial of Autologous Bone Marrow Stem Cell Transplantation in Patients with Spinal Cord Injury
Kakabadze, Zurab; Kipshidze, Nickolas; MARDALEISHVILI, KONSTANTINE; Chutkerashvili, Gocha; Chelishvili, Irakli; Harders, Albrecht; Loladze, George; Shatirishvili, Gocha; Kipshidze, Nodar; Chakhunashvili, David; Chutkerashvili, Konstantine
Introduction. A total of 18 patients, with complete motor deficits and paraplegia caused by thoracic and lumbar spine trauma without muscle atrophy or psychiatric problems, were included into this study. Materials and Methods. The bone marrow was aspirated from the anterior iliac crest under local anesthesia and the mononuclear fraction was isolated by density gradient method. At least 750 million mononuclear-enriched cells, suspended in 2ŌĆēmL of saline, were infused intrathecally. Results and...
Preliminary Study of Autologous Bone Marrow Nucleated Cells Transplantation in Children With Spinal Cord Injury
Jarocha, Danuta; Milczarek, Olga; Kawecki, Zdzislaw; Wendrychowicz, Anna; Kwiatkowski, Stanislaw; Majka, Marcin
The objective of the study was to assess the safety and efficacy of transplanting bone marrow nucleated cells (BMNCs) to treat children with complete interruption of spinal cord (SC) continuity. The results demonstrate the safety and feasibility of BMNC transplantation in children with complete SC injury and indicate that a certain degree of neurological and quality-of-life improvement can be attained by children with chronic complete SC injury who receive multiple BMNC implantations.
Intralesional Application of Autologous Bone Marrow Stem Cells with Scaffold in Canine for Spinal Cord Injury
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Justin William B
Full Text Available A three year old male non-descriptive companion dog was presented to the Small Animal Orthopedic Unit of Madras Veterinary College Teaching Hospital (MVC with paraplegia of fourth degree neurological deficit of hind limbs due to automobile trauma. Radiographic views were suggestive of dislocation at T8-T9 vertebral segment with fracture of L2 vertebra. Myelography confirmed the signs of abrupt stoppage of the contrast column cranial to dislocated area and was interpretive of transected spinal cord at L2 level. Construct was prepared with bone marrow mononuclear cells (BMMNC isolated from bone marrow aspirate of femur and the cells were seeded in Thermoreversible Gelatin Polymer (TGP at the cell processing facility of Nichi-In Centre for Regenerative Medicine (NCRM as per GMP protocols and was engrafted after hemilaminectomy and durotomy procedures in the MVC. Postoperatively the animal was clinically stable; however the animal died on the 7th day. Autopsy revealed co-morbid conditions like cystitis, nephritis and transmissible venereal tumor. Histopathology of the engrafted area revealed sustainability of aggregated stem cells that were transplanted revealing an ideal biocompatibility of the construct prepared with bone marrow mononuclear cells and polymer hydrogel for spinal cord regeneration in dogs. Further studies in similar cases will have to be undertaken to prove the long term efficacy.
Titanium-Enriched HydroxyapatiteŌĆōGelatin Scaffolds with Osteogenically Differentiated Progenitor Cell Aggregates for Calvaria Bone Regeneration
Ferreira, Jo├Żo R.; Padilla, Ricardo; Urkasemsin, Ganokon; Yoon, Kun; Goeckner, Kelly; Hu, Wei-Shou; Ko, Ching-Chang
Adequate bony support is the key to re-establish both function and esthetics in the craniofacial region. Autologous bone grafting has been the gold standard for regeneration of problematic large bone defects. However, poor graft availability and donor-site complications have led to alternative bone tissue-engineering approaches combining osteoinductive biomaterials and three-dimensional cell aggregates in scaffolds or constructs. The goal of the present study was to generate novel cell aggreg...
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A. M. Chernyavsky
Full Text Available Aim. Clinical and instrumental assessment of long-term results of autologous bone marrow cells (BMC implantation in laser channels in surgery of ischemic heart disease with diffuse and distal coronary disease.Materials and Methods. In the period of 2007ŌĆō2008 35 CHD patients with diffuse and distal coronary disease underwent BMC implantation in laser channels during coronary artery bypass grafting (CABG. The control group consisted of 29 patients. All patients in this group underwent only direct myocardial revascularization (DMR. In the long-term period we examined only 30 patients of the first group. Clinical and instrumental assessment of the method efficacy was carried out in 2 weeks, 6 months and 6 years after surgery.Results. FC (NYHA mean value in indirect revascularization group significantly decreased from 2.57 ┬▒ 0.61 preoperatively to 1.77 ┬▒0.66 in6 months after surgery (p = 0.043. After 6 years FC (NYHA was not significantly changed ŌĆō 1.84 ┬▒ 0.42 (p = 0.053. Perfusion scintigraphy revealed a slight decrease of stable perfusion defect (SPD in the immediate postoperative period, a more pronounced reduction of SPD in 6 months after surgery. The average value of SPD before surgery was 20.46 ┬▒ 10.75%, in 2 weeks after the operation ŌĆō 19.07 ┬▒ 9.69%, in 6 months after surgery ŌĆō 15.22 ┬▒ 9.49%. In the long-term period (6 years SPD was 14.8 ┬▒ 8.43% (p = 0.047. A similar pattern was observed in the analysis of transient perfusion defect: baseline ŌĆō 30 ┬▒ 2.2%, in 6 months ŌĆō 15 ┬▒ 1.3%, in the long term period ŌĆō 20 ┬▒ 6.1% (p = 0.047. The average value of left ventricular ejection fraction (LVEF before surgery was 55 ┬▒ 10.4%, in 2 weeks after the operation ŌĆō 55.7 ┬▒ 9.3%, in 6 months ŌĆō 56.7 ┬▒ 10%, after 6 years ŌĆō 54 ┬▒ 12%. The dynamics is unauthentic (p = 0.068.Conclusion. BMC implantation in laser channels in addition to CABG is a safe and effective method of surgical treatment in case of CABG inability. The effect of
Self-deploying shape memory polymer scaffolds for grafting and stabilizing complex bone defects: A mouse femoral segmental defect study.
Baker, Richard M; Tseng, Ling-Fang; Iannolo, Maria T; Oest, Megan E; Henderson, James H
Treatment of complex bone defects places a significant burden on the US health care system. Current strategies for treatment include grafting and stabilization using internal metal plates/screws, intramedullary rods, or external fixators. Here, we introduce the use of shape memory polymer (SMP) materials for grafting and adjunct stabilization of segmental defects. Self-deploying SMP grafts and SMP sleeves capable of expanding and contracting, respectively, under intraoperative conditions were developed and evaluated in a mouse segmental defect model in┬Āvivo. Integration between grafts/sleeves and native bone was assessed using x-ray radiography, microcomputed tomography, and torsional mechanical testing. We found that SMP grafts were able to integrate with the native bone after 12 weeks, maintain defect stability, and provide torsional mechanical properties comparable to an allograft alone treatment; however no gross de novo bone formation was observed. SMP sleeves did not inhibit bony bridging at the margins, and limbs treated with a sleeve/allograft combination had torsional mechanical properties comparable to limbs treated with an allograft alone. In┬Āvitro torsional and bending tests suggest sleeves may provide additional torsional stability to defects. Incorporation of shape memory into synthetic bone graft substitutes and adjunct stabilization devices is anticipated to enhance functionality of synthetic materials employed in both applications.
Bone-marrow MR imaging before and after autologous marrow transplantation in lymphoma patients without known bone-marrow involvement
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Purpose: To study lumbar bone marrow by means of MR imaging before and after bone-marrow transplantation in lymphoma patients. Particular emphasis was paid to heterogeneity and to focal manifestations, i.e. appearances that could simulate tumor. Material and Methods: Twenty-two patients who were disease-free for a minimum of 30 months after transplantation were studied in 107 MR examinations. Two radiologists visually evaluated coronal T1-weighted and short inversion time inversion-recovery (STIR) images. Results: T1-weighted images demonstrated a more heterogeneous marrow after transplantation than before it. Sharply defined focal low signal intensity areas appeared on this sequence in 5 (23%) of the 22 patients at between 21 and 60 weeks after transplantation. The mean age of these 5 patients was 48.4 years (range 42-54 years). The difference in age between these 5 patients and the remaining 17 patients, who had a mean age of 33.4 years (range 14-51 years), was statistically significant (p<0.01, Student's t-test, 2-sided test). Conclusion: Sharply defined focal low signal intensity areas may be seen on T1-weighted images of bone marrow in patients who are in complete remission after transplantation, particularly in those aged over 40-45 years. (orig.)
Octacalcium phosphate ceramics combined with gingiva-derived stromal cells for engineered functional bone grafts
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Biocompatible ceramic fillers are capable of sustaining bone formation in the proper environment. The major drawback of these scaffolding materials is the absence of osteoinductivity. To overcome this limitation, bioengineered scaffolds combine osteoconductive components (biomaterials) with osteogenic features such as cells and growth factors. The bone marrow mesenchymal stromal cells (BMMSCs) and the β-tricalcium phosphate (β-TCP) are well-known and characterized in this regard. The present study was conducted to compare the properties of novel octacalcium phosphate ceramic (OCP) granules with β-TCP (Cerasorb®), gingiva-derived mesenchymal stromal cells (GMSCs) properties with the BMMSCs and osteogenic and angiogenic properties of a bioengineered composite based on OCP granules and the GMSCs. This study demonstrates that GMSCs and BMMSCs have a similar osteogenic capacity. The usage of OCP ceramic granules in combination with BMMSCs/GMSCs significantly affects the osteo- and angiogenesis in bone grafts of ectopic models. (paper)
Mechanisms of improvement of left ventricle remodeling by transplanting two kinds of autologous bone marrow stem cells in pigs
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LI Shu-ren; WU Di; DONG Jie; XUN Li-ying; GAO Li-hui; JIN Fu-chang; QI Xiao-yong; HU Fu-li; ZHANG Jian-qing; WANG Tian-hong; DANG Yi; MENG Cun-liang; LIU Hui-liang; LI Ying-xiao
Background The necrosis of a large number of myocardial cells after acute myocardial infarction (AMI) results in a decrease of cardiac function and ventricle remodeling.Stem cell transplantation could improve cardiac function after AMI,but the involving mechanisms have not been completely understood.The present study aimed to investigate the effects of transplantation of autologous bone marrow mononuclear cells (BM-MNC) and rnesenchymal stem cells (MSCs) via the coronary artery on the ventricle remodeling after AMI as well as the mechanisms of the effects of transplantation of different stem cells on ventricle remodeling.Methods A total of 36 male pigs were enrolled in this study,which were divided into 4 groups: control group,simple infarct model group,BM-MNC transplantation group,and MSCs transplantation group.At 90 minutes when a miniature porcine model with AMI was established,transplantation of autologous BM-MNC ((4.7┬▒1.7)├Ś107) and MSCs ((6.2┬▒1.6)├Ś105) was performed in the coronary artery via a catheter.Ultrasound,electron microscope,immunohistochemical examination and real time reverse transcdptase-polymerase chain reaction were used respectively to observe cardiac fun~ons,counts of blood vessels of cardiac muscle,cardiac muscle nuclear factor (NF)-KB,myocardial cell apoptosis,and the expression of the mRNA of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in cardiac muscles.Multivariate Logistic regression was used to analyze the correlation factors of left ventricular end-diastolic diameter (EDD).Results The number of blood vessels in the infarct zone and around its border in the BM-MNC transplantation group was more than those in the infarct model group and MSCs group (P=0.0001) and there was less myocardial cell apoptosis in the stem cell transplantation group than that in the infarct model group (all P <0.01).The positive rate of NF-KB in the stem cell transplantation group was lower than that in the infarct model
Management of scaphoid nonunion with avascular necrosis using 1,2 intercompartmental supraretinacular arterial bone graft
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Mohamad Dehghani
Full Text Available Background: 1,2 ICSRA, introduced by Aidembery et al., is a well-established technique, with up to 100% union rate among different studies . The purpose of our study was to evaluate the outcome of scaphoid nonunion undergoing 1,2 ICSRA bone graft in Iran. Materials and Methods: All participants who presented sequentially over a period of 24 months between 2010 and 2013 with nonunion scaphoid fracture with AVN in proximal pole were included in the study. Anteroposterior and lateral view plain radiographs of carpal bones were obtained for diagnosis of nonunion, and a diagnosis of avascular necrosis was made by MRI of the scaphoid. Subjects underwent 1,2 ICSRA bone graft surgery. Patients were assessed based on radiographs and the Mayo Wrist Score (MWS questionnaire on before and after surgery. Data were analyzed using SPSS ver. 18 by paired t test. Results: Overall, 16 patients (100% male were included in the study. Mean age of subjects was 27.50 ┬▒ 5.86 (18 to 38. Mean Mayo score was 36.63 ┬▒ 8.92 and 83.75 ┬▒ 9.22 before and 6 month after surgery, respectively, and the difference was statistically significant (P < 0.001. after 8 weeks, 10 (62.5% had union, and after 12 weeks, all subjects had union. Nine (56.25% of our patients had excellent functional outcome, 5 (31.25% had good and 2 (12.5% had satisfactory functional outcome. Conclusion: 1,2 ICSRA is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.
Guided tissue regeneration and bone grafts in the treatment of furcation defects.
Caffesse, R G; Nasjleti, C E; Plotzke, A E; Anderson, G B; Morrison, E C
The present study evaluated the effects of guided tissue regeneration (GTR), with and without demineralized freeze-dried cortical bone grafts, in the treatment of furcation defects in 4 female beagle dogs with naturally occurring periodontal disease. The root surfaces were thoroughly debrided. Four weeks later, full thickness facial and lingual mucoperiosteal flaps were reflected using inverse bevel incisions on both sides of the mandible involving the 2nd, 3rd, and 4th premolar, and the 1st molar teeth. Following debridement, notches were placed on the roots at the level of supporting bone. Test quadrants were randomly selected and furcations were filled with reconstituted, demineralized, freeze-dried human cortical bone grafts. Following bone grafting, all defects were covered with an expanded polytetrafluoroethylene (ePTFE) membrane, which was sutured with 4-0 sutures. Afterward, interproximal sutures were placed through the flaps, assuring the flaps covered the membranes completely. The contralateral side, serving as control, was treated by debridement only and application of ePTFE membrane. All membranes were removed 6 weeks after surgery. Dogs were sacrificed at 4 months after surgery. Both mesio-distal and bucco-lingual histologic sections were evaluated by descriptive histology. Linear measurements and surface area determination of the furcal tissues were carried out using the microscope attached to a digitizer. Twelve to 20 nonserial sections were made of the mid-buccal aspects of each root of each treated tooth. Half of these sections were stained with Harris' hematoxylin and eosin (H&E) and the other half stained with Mallory's trichrome stain.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8295103
Biomechanical Comparison Between Bashti Bone Plug Technique and Biodegradable Screw for Fixation of Grafts in Ligament surgery
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Kaveh Bashti
Full Text Available ┬Ā Background: Ligament reconstruction is a common procedure in orthopedic surgery. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL reconstruction and to compare its biomechanical features with conventional absorbable interference screw technique in a bovine model. Methods: Twenty pairs of bovine knees were harvested after death. Soft tissue was removed and the Achilles tendon was harvested to be used as an ACL graft. It was secured into the bone tunnel on the tibial side via two different methods: Bashti Bone Plug technique and conventional screw method. Biomechanical strength was measured using 200 N and 300 N cyclic loading on the graft. Pull out strength was also tested until the graft fails. Results: No graft failure was observed after 200 N and 300 N cyclic loading in either fixation methods. When testing for pull out failure, 21 tendons (53% were torn and 19 tendons (48% slipped out. No fixation failure occurred, which did not reveal a significant difference between the bone plug or interference screw group (P=0.11. The mean pull out force until failure of the graft was 496┬▒66 N in the screw group and 503┬▒67 N in the bone plug group (P=0.76. Conclusions: Our suggested fixation technique of Bashti bone plug is a native, cheap, and feasible method that provides comparable biomechanical strength with interference screw when soft tissue fixation was attempted in bovine model.
Beneficial effects of autologous bone marrow mononuclear cell transplantation against ischemic bile duct in rats
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LI Li-xin; CHEN DA-zhi; HE Qiang
Background Bone marrow cell transplantation has been shown to induce angiogenesis and thus improve ischemic disease.This study evaluated the effect of bone marrow mononuclear cell (BM-MNCs) implantation on neovascularization in rats with ischemic bile duct.Methods We established an animal model for ischemic biliary stenosis by clamping manipulation.There were 10 rats in each group:BM-MNCs implantation group,control group and normal group.Rat femur BM-MNCs were isolated using density gradient centrifugation.BM-MNCs or phosphate buffered saline were injected into three points around bile duct tissue in the three groups (25 ╬╝l/point).Control rats received injections of saline under similar conditions.At the 21 days after operation,cholangiography was performed.Differentiation of the engrafted cells and capillary density in the bile duct were analyzed by immunohistochemical staining.Results Engrafted cells could differentiate into endothelial cells.The stricture rate in the implantation group was 40%,significantly lower than that in the control group (100%).The capillary density in the implantation group was significantly higher than in the control group or the normal group.Conclusions The implantation of BM-MNCs induced neovascularization in the ischemic bile duct.It improved the blood supply of the ischemic bile duct to prevent or decrease biliary ischemic stricture.
Bone Morphogenetic Proteins in Craniofacial Surgery: Current Techniques, Clinical Experiences, and the Future of Personalized Stem Cell Therapy
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Kristofer E. Chenard
Full Text Available Critical-size osseous defects cannot heal without surgical intervention and can pose a significant challenge to craniofacial reconstruction. Autologous bone grafting is the gold standard for repair but is limited by a donor site morbidity and a potentially inadequate supply of autologous bone. Alternatives to autologous bone grafting include the use of alloplastic and allogenic materials, mesenchymal stem cells, and bone morphogenetic proteins. Bone morphogenetic proteins (BMPs are essential mediators of bone formation involved in the regulation of differentiation of osteoprogenitor cells into osteoblasts. Here we focus on the use of BMPs in experimental models of craniofacial surgery and clinical applications of BMPs in the reconstruction of the cranial vault, palate, and mandible and suggest a model for the use of BMPs in personalized stem cell therapies.
Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures
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Wang Xianhui; Mei Jiong; Li Shanzhu; Ni Ming; Shang Hongjing
Objective: To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods: Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases (16 sides) with intra-articular calcaneal fractures including 13 males (14 feet) and 2 females (2 feet) ,with average age of 36. 6 years (24-61 years). All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type ŌģĪ (3 type ŌģĪ a, 3 type ŌģĪ b and 8 type ŌģĪ c)and 2 feet of type lilac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results: All patients were followed up for an average of 18.4 months (ranged, 12 to 34 months). No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group (86.5+4.4) was better than in joint depression type group (81.2┬▒1.7, P<0.05). Radiography showed basic restoration of Bohler's angle, Gissane's angle and calcaneal shape. Conclusion: The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders 11 and III type
Reconstruction of the medial patellofemoral ligament using autologous graft from quadriceps tendon to treat recurrent patellar dislocationŌśå
Calapodopulos, Constantino Jorge; Nogueira, Marcelo Corvino; Eust├Īquio, Jos├® Martins Juliano; Calapodopulos J├║nior, Constantino Jorge; Rodrigues, Oreston Alves
Objective The objective of this study was to evaluate the efficacy of the surgical technique using the quadriceps tendon as a graft in static reconstruction of the medial patellofemoral ligament. Methods This was a prospective case series study in which the participants were 22 patients with a diagnosis of recurrent patellar dislocation without any other anatomical alterations that required surgical treatment. The functional results from the technique were evaluated using clinical data and the Lysholm questionnaire, one year after the operation. Results It was observed that the patients were predominantly female (86%) and under 21 years of age (73%), just like in the literature. At the first annual return after the surgery, there was no significant pain on medium efforts, no loss of range of motion and a positive apprehension test. According to the questionnaire used, the results were graded as good. The patients who reported having severe pain on greater effort were involved in employment-related legal disputes. Conclusion This technique showed low morbidity and good functional results over the short term. PMID:27069888
Reconstruction of the medial patellofemoral ligament using autologous graft from quadriceps tendon to treat recurrent patellar dislocation
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Constantino Jorge Calapodopulos
Full Text Available OBJECTIVE: The objective of this study was to evaluate the efficacy of the surgical technique using the quadriceps tendon as a graft in static reconstruction of the medial patellofemoral ligament. METHODS: This was a prospective case series study in which the participants were 22 patients with a diagnosis of recurrent patellar dislocation without any other anatomical alterations that required surgical treatment. The functional results from the technique were evaluated using clinical data and the Lysholm questionnaire, one year after the operation. RESULTS: It was observed that the patients were predominantly female (86% and under 21 years of age (73%, just like in the literature. At the first annual return after the surgery, there was no significant pain on medium efforts, no loss of range of motion and a positive apprehension test. According to the questionnaire used, the results were graded as good. The patients who reported having severe pain on greater effort were involved in employment-related legal disputes. CONCLUSION: This technique showed low morbidity and good functional results over the short term.
Development of a Three-Dimensional (3D Printed Biodegradable Cage to Convert Morselized Corticocancellous Bone Chips into a Structured Cortical Bone Graft
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Ying-Chao Chou
Full Text Available This study aimed to develop a new biodegradable polymeric cage to convert corticocancellous bone chips into a structured strut graft for treating segmental bone defects. A total of 24 adult New Zealand white rabbits underwent a left femoral segmental bone defect creation. Twelve rabbits in group A underwent three-dimensional (3D printed cage insertion, corticocancellous chips implantation, and Kirschner-wire (K-wire fixation, while the other 12 rabbits in group B received bone chips implantation and K-wire fixation only. All rabbits received a one-week activity assessment and the initial image study at postoperative 1 week. The final image study was repeated at postoperative 12 or 24 weeks before the rabbit scarification procedure on schedule. After the animals were sacrificed, both femurs of all the rabbits were prepared for leg length ratios and 3-point bending tests. The rabbits in group A showed an increase of activities during the first week postoperatively and decreased anterior cortical disruptions in the postoperative image assessments. Additionally, higher leg length ratios and 3-point bending strengths demonstrated improved final bony ingrowths within the bone defects for rabbits in group A. In conclusion, through this bone graft converting technique, orthopedic surgeons can treat segmental bone defects by using bone chips but with imitate characters of structured cortical bone graft.
Development of a Three-Dimensional (3D) Printed Biodegradable Cage to Convert Morselized Corticocancellous Bone Chips into a Structured Cortical Bone Graft.
Chou, Ying-Chao; Lee, Demei; Chang, Tzu-Min; Hsu, Yung-Heng; Yu, Yi-Hsun; Liu, Shih-Jung; Ueng, Steve Wen-Neng
This study aimed to develop a new biodegradable polymeric cage to convert corticocancellous bone chips into a structured strut graft for treating segmental bone defects. A total of 24 adult New Zealand white rabbits underwent a left femoral segmental bone defect creation. Twelve rabbits in group A underwent three-dimensional (3D) printed cage insertion, corticocancellous chips implantation, and Kirschner-wire (K-wire) fixation, while the other 12 rabbits in group B received bone chips implantation and K-wire fixation only. All rabbits received a one-week activity assessment and the initial image study at postoperative 1 week. The final image study was repeated at postoperative 12 or 24 weeks before the rabbit scarification procedure on schedule. After the animals were sacrificed, both femurs of all the rabbits were prepared for leg length ratios and 3-point bending tests. The rabbits in group A showed an increase of activities during the first week postoperatively and decreased anterior cortical disruptions in the postoperative image assessments. Additionally, higher leg length ratios and 3-point bending strengths demonstrated improved final bony ingrowths within the bone defects for rabbits in group A. In conclusion, through this bone graft converting technique, orthopedic surgeons can treat segmental bone defects by using bone chips but with imitate characters of structured cortical bone graft.
Six Years Follow-up of Spinal Tuberculosis Treated by Anterior Debridement, Instrumentation and Bone Grafting
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Hao Dingjun; Dou Yusheng; Wen Shiming; He Baorong
@@ Tuberculosis of the spine comprises approximately 50% of all skeletal cases. 50 years ago,costotranseversectomy was the preferred surgical treatment. The primary limitation of costotranseversectomy has the difficulty exposing the entire phlegmon. Frequently multiple debridement were required to adequately remove all evidence of infection. In the 1970s, posterior debridement was used. Posterior debridement also had many disadvantages, including long-term bed rest, increased risk of pulmonary and urinary infection, poor fusion rate, and high recurrence rate of infection,and residual kyphosis [1]. Because of the limitations with posterior and posterior lateral approaches, anterior approaches for debridement, instrumentation,and bone grafting are more commonly used today.Anterior treatment will prevent progression of kyphosis, prevent recurrence, and protect the position of the graft material.
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Chong-jian Li; Ji-lin Chen; Jian-jun Li; Run-lin Gao; Yue-jin Yang; Feng-huan Hu; Wei-xian Yang; Shi-jie You; Lai-feng Song; Ying-mao Ruan; Shu-bin Qiao
Objective To investigate the therapeutic effectiveness of intracoronary implantation of autologous bone marrow mononuelear cells (BM-MNC) in miniswine model of reperfused myocardial infarction.Methods Sixteen miniswine myocardial isehemic reperfusion injury models made by ligation of the distal one third segment of left anterior descending artery for 90 minutes were randomized into 2 groups.In BM-MNC group (n=9),(3.54┬▒0.90)├Ś108 BM-MNC were intracoronary injected,and in the control group (n=7),phosphate buffered saline was injected by the same way.Echoeardiographic and hemodynamic results,vessel density,and myocardial infarction size were evaluated and compared before and 4 weeks after cell transplantation.Results In BM-MNC group,there were no differences between before and 4 weeks after transplantation in aspects of left ventricular ejection fraction (LVEF),interventricular septai thickness,left ventricular lateral and anterior septal wall thickness,cardiac output,or +dp/dtmax.In control group,LVEF,interventrieular septal thickness,left ventricular lateral and anterior septal wall thickness,cardiac output,and +dp/dtmax decreased significantly 4 weeks after transplantation (P'╝£0.05).Left ventricular end-diastolic pressure and -dp/dtmax did not change significantly before and after cell transplantation in both groups.Capillary density in BM-MNC group was greater than that in control group [(13.39┬▒6.96)/high power field vs.(3.50 ┬▒ 1.90)/high power field,P'╝£0.05].Infarction area assessed by tetrazolium red staining and the infarction percentage decreased in BM-MNC group compared with those in control group (P'╝£0.05).Conclusions Transplantation of BM-MNC into myocardium with isehemie reperfusion injury increases capillary density and decreases infarction area.It has significantly beneficial effect on cardiac systolic function rather than on diastolic function.
Long-term effects of autologous bone marrow stem cell treatment in acute myocardial infarction: factors that may influence outcomes.
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David M Clifford
Full Text Available AIMS: To investigate whether there are important sources of heterogeneity between the findings of different clinical trials which administer autologous stem cell treatment for acute myocardial infarction (AMI and to evaluate what factors may influence the long-term effects of this treatment. METHODS AND RESULTS: MEDLINE (1950-January 2011, EMBASE (1974-January 2011, CENTRAL (The Cochrane Library 2011, Issue 1, CINAHL (1982-January 2011, and ongoing trials registers were searched for randomised trials of bone marrow stem cells as treatment for AMI. Hand-searching was used to screen recent, relevant conference proceedings (2005-2010/11. Meta-analyses were conducted using random-effects models and heterogeneity between subgroups was assessed using chi-squared tests. Planned analyses included length of follow-up, timing of cell infusion and dose, patient selection, small trial size effect, methodological quality, loss of follow-up and date of publication. Thirty-three trials with a total of 1,765 participants were included. There was no evidence of bias due to publication or time-lag, methodological quality of included studies, participant drop-out, duration of follow-up or date of the first disclosure of results. However, in long-term follow-ups the treatment seemed more effective when administered at doses greater than 10(8 cells and to patients with more severe heart dysfunction. CONCLUSIONS: Evaluation of heterogeneity between trials has not identified significant sources of bias in this study. However, clinical differences between trials are likely to exist which should be considered when undertaking future trials.
Repair of segmental bone defect using Totally Vitalized tissue engineered bone graft by a combined perfusion seeding and culture system.
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Lin Wang
Full Text Available BACKGROUND: The basic strategy to construct tissue engineered bone graft (TEBG is to combine osteoblastic cells with three dimensional (3D scaffold. Based on this strategy, we proposed the "Totally Vitalized TEBG" (TV-TEBG which was characterized by abundant and homogenously distributed cells with enhanced cell proliferation and differentiation and further investigated its biological performance in repairing segmental bone defect. METHODS: In this study, we constructed the TV-TEBG with the combination of customized flow perfusion seeding/culture system and ╬▓-tricalcium phosphate (╬▓-TCP scaffold fabricated by Rapid Prototyping (RP technique. We systemically compared three kinds of TEBG constructed by perfusion seeding and perfusion culture (PSPC method, static seeding and perfusion culture (SSPC method, and static seeding and static culture (SSSC method for their in vitro performance and bone defect healing efficacy with a rabbit model. RESULTS: Our study has demonstrated that TEBG constructed by PSPC method exhibited better biological properties with higher daily D-glucose consumption, increased cell proliferation and differentiation, and better cell distribution, indicating the successful construction of TV-TEBG. After implanted into rabbit radius defects for 12 weeks, PSPC group exerted higher X-ray score close to autograft, much greater mechanical property evidenced by the biomechanical testing and significantly higher new bone formation as shown by histological analysis compared with the other two groups, and eventually obtained favorable healing efficacy of the segmental bone defect that was the closest to autograft transplantation. CONCLUSION: This study demonstrated the feasibility of TV-TEBG construction with combination of perfusion seeding, perfusion culture and RP technique which exerted excellent biological properties. The application of TV-TEBG may become a preferred candidate for segmental bone defect repair in orthopedic and
Safety of intramedullary autologous peripheral nerve grafts for post-rehabilitated complete motor spinal cord injuries: a phase I study.
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Nazi Derakhshanrad
Full Text Available Many experimental studies have reported behavioral improvement after transplantation of peripheral nerve tissue into the contused spinal cord, even in large animals. The safety of this treatment in human remains unknown. In this translational phase 1 study, safety of peripheral nerve grafting for chronic spinal cord injuries and possible outcomes are being reported. Twelve complete motor spinal cord injury patients, who had finished their rehabilitation program, were enrolled. There were 4 thoracic and 8 cervical cases. Patients underwent sural nerve preconditioning in the calf, followed 1 week later, by intramedullary transplantation of the harvested nerve fascicles. The patients were followed up for potential complications periodically, and final assessment by American Spinal Injury association (ASIA and Spinal Cord Independence Measure (SCIM III were reported after 2 years of follow-up. The median duration of the spinal cord injury was 31 months. At two years of follow up, out of 7 cases with ASIA Impairment Scale (AIS A, 4(57.1% cases improved to AIS B and 1 (14.3% case became AIS C. There were 1 patient with transient increased spasm, one case of transient cystitis, 3 patients with transient increased neuropathic pain and 1 case with transient episode of autonomic dysreflexia, all being managed medically. There was no case of donor site infection. The above complications were transient as they responded to temporary medical treatment. It may be deduced that after two years follow-up of patients that the procedure may be safe, however further controlled studies are needed to prove its efficacy.
Design of ceramic-based cements and putties for bone graft substitution
M Bohner
In the last 15 years, a large number of commercial ceramic-based cements and putties have been introduced as bone graft substitutes. As a result, large efforts have been made to improve our understanding of the specific properties of these materials, such as injectability, cohesion, setting time (for cements), and in vivo properties.┬ĀThe aim of this manuscript is to summarize our present knowledge in the field.┬ĀInstead of just looking at scientific aspects, industrial needs are also considere...
Design of ceramic-based cements and putties for bone graft substitution
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M Bohner
Full Text Available In the last 15 years, a large number of commercial ceramic-based cements and putties have been introduced as bone graft substitutes. As a result, large efforts have been made to improve our understanding of the specific properties of these materials, such as injectability, cohesion, setting time (for cements, and in vivo properties.┬ĀThe aim of this manuscript is to summarize our present knowledge in the field.┬ĀInstead of just looking at scientific aspects, industrial needs are also considered, including mixing and delivery, sterilization, and shelf-life.
Design of ceramic-based cements and putties for bone graft substitution.
Bohner, M
In the last 15 years, a large number of commercial ceramic-based cements and putties have been introduced as bone graft substitutes. As a result, large efforts have been made to improve our understanding of the specific properties of these materials, such as injectability, cohesion, setting time (for cements), and in vivo properties. The aim of this manuscript is to summarize our present knowledge in the field. Instead of just looking at scientific aspects, industrial needs are also considered, including mixing and delivery, sterilization, and shelf-life. PMID:20574942
Open Defective Trapezium Fracture Treated with Local Bone Graft: A Case Report
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Omer Ersen
Full Text Available Generally fractures of trapezium are uncommon and account for 3-5% of all carpal fractures. About 20% of these are vertical sagittal split fractures and rarely occur isolated. The number of reported cases of open trapezium fractures is few. Open trapezium injuries of thumb are demanding injuries that need accurate restoration of damaged stuructures to gain normal thumb function. Otherwise it results in impairment of funtion due to limitation of motion, pain and weakness of the thumb. In this case report treatment of trapezium fracture with corticocancellous bone grafting from distal radius presented.
Comparison of autogenous bone graft donor site haemostatic agents used in spinal surgery
Copuroglu, Cem; Ercan, Selcuk; Ozcan, Mert; Ciftdemir, Mert; Turan, F. Nesrin; Yalniz, Erol
Objective: The aim of our study was to investigate the effects of haemostatic agents used at the autograft donor sites in spinal fusion. Methods: The study included 66 patients (26 men, 40 women; mean age: 42.9 years) who underwent spinal fusion surgery between March 1999 and October 2002. Patients were randomly assigned to 4 different groups according to the haemostatic agents used during surgery. In Group 1, bone wax was used on the graft donor site. In Group 2, spongostan was used. In ...
Biological dressings combined with autologous skin grafting treatment of pediatric efficacy of deep burn%ńö¤ńē®µĢʵ¢ÖĶ"åńø¢ĶüöÕÉłĶć¬õĮōńÜ«ń¦╗µżŹµ▓╗ń¢ŚÕ░ÅÕä┐µĘ▒Õ║"ńā¦õ╝ż
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Õ╝Āõ┐ØÕŠĘ; ĶĄĄķüĄµ▒¤; Ķ¢øÕ┐Āõ┐Ī; ń½ĀĶŹŻµČø; ÕłśÕŗć; µóüÕģČÕøĮ
ńø«ńÜä'╝ܵÄóĶ«©Õ░ÅÕä┐µĘ▒Õ║"ńā¦õ╝żÕłøķØóńÜäµ▓╗ń¢Śµ¢╣µ│Ģ'╝īĶ┐øõĖƵŁźµÅÉķ½śµēŗµ£»µĢłµ×£ŃĆéµ¢╣µ│Ģ'╝ÜÕ░ÅÕä┐µĘ▒Õ║"ńā¦õ╝żÕłøķØ󵌮µ£¤ÕłćÕēŖńŚéõĮ┐ńö©ńö¤ńē®µĢʵ¢ÖĶ"åńø¢ÕłøķØó'╝īµ£»ÕÉÄ3'Į×5dĶĪīĶć¬õĮōńÜ«ń¦╗µżŹŃĆéń╗ōµ×£'╝ÜÕģ©ń╗ä67õŠŗµżŹńÜ«Õ«īÕģ©µłÉÕŖ¤'╝īÕØćµ£¬ĶĪźÕģģµżŹńÜ«'╝īńÜ«ńēćµäłÕÉłÕÉÄńśóńŚĢĶĮ╗ŃĆéń╗ōĶ«║'╝ÜÕ░ÅÕä┐µĘ▒Õ║"ńā¦õ╝żÕłøķØóÕłćÕēŖńŚéÕÉÄõĮ┐ńö©ńö¤ńē®µĢʵ¢ÖĶ"åńø¢ĶüöÕÉłĶć¬õĮōńÜ«ń¦╗µżŹ'╝īńÜ«ńē浳ɵ┤╗ńÄćķ½ś'╝īÕŖ¤ĶāĮµüóÕżŹÕźĮ'╝īµś»õ┐«ÕżŹµĘ▒Õ║"ńā¦õ╝żÕłøķØóĶŠāõĖ║ńÉåµā│µ¢╣µ│ĢŃĆé%Objective:Investigate the treatment of deep burn wounds in children to further improve surgical re-sults. Methods:Pediatric tangential excision deep burn wounds use biological dressing early to cover the wound, after 3~5 d autologous skin grafting.Results:The group of 67 cases of graft prove 100%success rate, no supplement skin graft, skin graft scar after healing light.Conclusion:Tangential excision deep burn wounds in children after the use of biological dressings combined with autologous skin is high in skin graft survival rate, good functional recovery,which is a more desirable method to repair deep burn.
Clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation: a meta-analysis of seven case-control studies
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Heng-feng Yuan
Full Text Available The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p<0.001, a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p<0.01 and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01. The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings.
Clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation: a meta-analysis of seven case-control studies.
Yuan, Heng-Feng; Zhang, Jing; Guo, Chang-An; Yan, Zuo-Qin
The purpose of this study was to evaluate the clinical outcomes of osteonecrosis of the femoral head after autologous bone marrow stem cell implantation. We searched the PubMed, Embase and Web of Science databases and included all case-control trials that reported on the clinical outcomes of osteonecrosis progression, incidence of total hip arthroplasty and improvement in Harris hip scores. Overall, seven case-control trials were included. Compared with the controls, patients treated with the bone marrow stem cells implantation treatment showed improved clinical outcomes with delayed osteonecrosis progression (odds ratio = 0.17, 95% CI: 0.09 - 0.32; p <0.001), a lower total hip arthroplasty incidence (odds ratio = 0.30, 95% CI: 0.12 - 0.72; p <0.01) and increased Harris hip scores (mean difference = 4.76, 95% CI: 1.24 - 8.28; p<0.01). The heterogeneity, publication bias, and sensitivity analyses showed no statistical difference significant differences between studies. Thus, our study suggests that autologous bone marrow stem cells implantation has a good therapeutic effect on osteonecrosis of the femoral, resulting in beneficial clinical outcomes. However, trials with larger sample sizes are needed to confirm these findings. PMID:26934241
Effects of Guiyuanfang and autologous transplantation of bone marrow stem cells on rats with liver fibrosis
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Li-Mao Wu; Lian-Da Li; Hong Liu; Ke-Yong Ning; Yi-Kui Li
AIM: To investigate the therapeutic effects of Guiyuanfang and bone marrow stem cells (BMSCs) on rats with liver fibrosis.METHODS: Liver fibrosis model was induced by carbon tetrachloride, ethanol, high lipid and assessed biochemically and histologically. Liver function and hydroxyproline contents of liver tissue were determined.Serum hyaluronic acid (HA) level and procollagen Ōģó level were performed by radioimmunoassay. The VG staining was used to evaluate the collagen deposit in the liver.Immunohistochemical SABC methods were used to detect transplanted BMSCs and expression of urokinase plasminogen activator (uPA).RESULTS: Serum transaminase level and liver fibrosis in rats were markedly reduced by Guiyuanfang and BMSCs. HA level and procollagen Ōģó level were also reduced obviously,compared to model rats (HA: 47.18┬▒10.97 ng/mL,48.96┬▒14.79 ng/mL; PCŌģó: 22.48┬▒5.46 ng/mL, 26.90┬▒3.35ng/mL; P'╝£0.05).Hydroxyproline contents of liver tissue in both BMSCs group and Guiyuanfang group were far lower than that of model group (1 227.2┬▒43.1 ╬╝g/g liver tissue, 1390.8┬▒156.3 ╬╝g/g liver tissue; P'╝£0.01). After treatment fibrosis scores were also reduced. Both Guiyuanfang and BMSCs could increase the expression of uPA. The transplanted BMSCs could engraft, survive, and proliferate in the liver.CONCLUSION: Guiyuanfang protects against liver fibrosis.Transplanted BMSCs may engraft, survive, and proliferate in the fibrosis livers indefinitely. Guiyuanfang may synergize with BMSCs to improve recovery from liver fibrosis.
Successful use of autogenous bone graft for the treatment of a radius-ulna nonunion in an amputee dog
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B.W. Minto
Full Text Available Fracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of S├Żo Paulo State University, with a right radius-ulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks.
Correlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting
Jabbari, Fatima; Reiser, Erika; Thor, Andreas; Hakelius, Malin; Nowinski, Daniel
Objective To determine in individuals with unilateral cleft lip and palate the correlation between initial cleft size and dental anomalies, and the outcome of alveolar bone grafting. Methods A total of 67 consecutive patients with non-syndromic unilateral complete cleft lip and palate (UCLP) were included from the cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. All patients were operated by the same surgeon and treated according to the Uppsala protocol entailing: lip plasty at 3 months, soft palate closure at 6 months, closure of the residual cleft in the hard palate at 2 years of age, and secondary alveolar bone grafting (SABG) prior to the eruption of the permanent canine. Cleft size was measured on dental casts obtained at the time of primary lip plasty. Dental anomalies were registered on radiographs and dental casts obtained before bone grafting. Alveolar bone height was evaluated with the Modified Bergland Index (mBI) at 1 and 10-year follow-up. Results Anterior cleft width correlated positively with enamel hypoplasia and rotation of the central incisor adjacent to the cleft. There was, however, no correlation between initial cleft width and alveolar bone height at either 1 or 10 years follow-up. Conclusions Wider clefts did not seem to have an impact on the success of secondary alveolar bone grafting but appeared to be associated with a higher degree of some dental anomalies. This finding may have implications for patient counseling and treatment planning. PMID:26923345
Osteointegration of soft tissue grafts within the bone tunnels in anterior cruciate ligament reconstruction can be enhanced
Kuang, GM; Yau, WP; Lu, WW; Chiu, KY
Anterior cruciate ligament reconstruction with a soft tissue autograft (hamstring autograft) has grown in popularity in the last 10 years. However, the issues of a relatively long healing time and an inferior histological healing result in terms of Sharpey-like fibers connection in soft tissue grafts are still unsolved. To obtain a promising outcome in the long run, prompt osteointegration of the tendon graft within the bone tunnel is essential. In recent decades, numerous methods have been r...
Mandible vertical height correction using lingual bone-split pedicle onlay graft technique
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Coen Pramono D
Full Text Available As edentulous mandible become atrophic, a denture bearing area will also be reduced. Difficulty in the removable prosthesis rehabilitation will be present as well. The purpose of this paper reports an innovative surgical technique to cope a problem of unstable complete lower denture due to bone atrophy and resulted of vertical height reduction of the anterior region of the mandible necessary for denture retention. Vertical advancement of the lower jaw using lingual bone split pedicle onlay graft technique in the anterior region of the mandible and followed by secondary epithelization vestibuloplasty in achieving the vertical height dimension. The surgery was achieved satisfactorily as the vertical dimension of the mandible anterior region had increased and the denture seated more stable comparing with the previous denture worn by the patient. It concluded that the surgery was achieved with a great result as the vertical height of the anterior region of the mandible had increased positively therefore lead the denture seated more stable.
Restaura├¦├Żo do diafragma de felino com enxerto aut├│logo de peric├Īrdio Reconstruction of feline diaphragm with autologous pericardium graft
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Saulo Tadeu Lemos Pinto Filho
Full Text Available OBJETIVO: Avaliar o uso de enxerto aut├│logo de peric├Īrdio para corre├¦├Żo de defeitos diafragm├Īticos em felinos. M├ēTODOS: Foram utilizados doze gatos dom├®sticos, adultos, sem ra├¦a definida, pesando entre dois e quatro quilogramas. O procedimento cir├║rgico consistiu de toracotomia no 7┬║ espa├¦o intercostal esquerdo, remo├¦├Żo de um retalho do peric├Īrdio de, aproximadamente, 2,0 x 4,0 cm e sutura desse em um defeito de tamanho aproximado criado no diafragma. Cinco animais foram observados por um per├Łodo de 30 dias de p├│s-operat├│rio e o restante em 60 dias, quando foram submetidos ├Ā eutan├Īsia para observa├¦├Żo macrosc├│pica e coleta de amostras para avalia├¦├Żo histol├│gica. RESULTADOS: Foi observada nos animais do grupo de 30 dias, substitui├¦├Żo parcial e no grupo de 60 dias, substitui├¦├Żo total do enxerto de peric├Īrdio por tecido fibrovascular, permitindo o restabelecimento completo do diafragma. Macroscopicamente, foi verificada presen├¦a de ader├¬ncia na cavidade tor├Īcica, com o pulm├Żo e pleura parietal e, na cavidade abdominal, com o f├Łgado e omento, por├®m, sem comprometimento cl├Łnico das estruturas envolvidas. CONCLUS├āO: O enxerto aut├│logo felino pode ser utilizado para repara├¦├Żo de defeitos diafragm├Īticos, pois suporta a diferen├¦a de press├Żo presente, sendo substitu├Łdo por tecido cicatricial, sem apresentar sinais cl├Łnicos e histol├│gicos de rejei├¦├Żo.PURPOSE: Evaluate the use of feline autologous pericardium to correct diaphragmatic defects. METHODS: Twelve male and female, adult, mixed breed, domestic cats were used weighing between 2 and 4 kilogram. The surgical procedure consisted of thoracotomy of the 7th left intercostal space, removal of a pericardium graft of approximately 2,0 x 4,0 cm and the graft was sutured in a defect of the same size in the diaphragm. Six animals were observed for a period of 30 days postoperatively and six for 60 days. After this period they were submitted to euthanasia for
Assessment of bone repair following the use of anorganic bone graft and membrane associated or not to 830-nm laser light
de Assis Limeira, Francisco, Jr.; Barbosa Pinheiro, Ant├┤nio L.; Marquez de Martinez Gerbi, Marleny E.; Pedreira Ramalho, Luciana Maria; Marzola, Clovis; Carneiro Ponzi, Elizabeth A.; Soares, Andre O.; Bandeira de Carvalho, L├Łvia C.; Vieira Lima, Helena Cristina; Oliveira Gon├¦alves, Thais; Silva Meireles, Gyselle C.; Possa, Thaise R.
The aim of this study was to assess the effect of LLLT (╬╗830nm, Thera lase, DMC Equipmentos, Sao Carlos, SP, Brazil, 40mW, CW, spot size 0.60mm, 16J/cm2 per session) on the repair of bone defects on the femur of Wistar albinus rats which were grafted with anorganic bovine bone associated or not to bovine bone membrane. Five randomized groups were studied: I (Control); II (anorganic bovine bone); III (anorganic bovine bone + LLLT); IV (anorganic bovine bone + bovine bone membrane) and V (anorganic bovine bone + bovine bone membrane + LLLT). The animals were irradiated at every 48h during 15 days, the first irradiation was performed immediately after the procedure. The animals were irradiated transcutaneuosly in four points around the defect. At each point a dose of 4J/cm2 was given (f~0,60mm, 40mW) totaling 16J/cm2 per session. The animals were sacrificed 15, 21 and 30 days after surgery. The specimens were routinely processed to wax and stained with H&E and Picros├Łrius stains and analyzed under light microscopy. The results showed evidence of a more advanced repair on the irradiated groups when compared to non-irradiated ones. The repair of irradiated groups was characterized by both increased bone formation and amount of collagen fibers around the graft within the cavity early, considering the osteoconductive capacity of the anorganic bovine bone and the increment of the cortical repair in specimens with membrane. It is concluded that LLLT had a positive effect on the repair of bone defect submitted the implantation of graft associated or not to the use of biological membrane.
MR appearance of autologous chondrocyte implantation in the knee: correlation with the knee features and clinical outcome
Energy Technology Data Exchange (ETDEWEB)
Takahashi, Tomoki [Department of Radiology and Institute of Orthopaedics, Oswestry, Shropshire (United Kingdom); Kumamoto University, Department of Orthopaedic and Neuro-Musculoskeletal Surgery, Kumamoto (Japan); Tins, Bernhard; McCall, Iain W.; Ashton, Karen [Department of Radiology and Institute of Orthopaedics, Oswestry, Shropshire (United Kingdom); Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Department of Diagnostic Imaging, Oswestry, Shropshire (United Kingdom); Richardson, James B. [Department of Radiology and Institute of Orthopaedics, Oswestry, Shropshire (United Kingdom); RJAH Orthopaedic Hospital, Institute of Orthopaedics, Oswestry, Shropshire (United Kingdom); Takagi, Katsumasa [Department of Radiology and Institute of Orthopaedics, Oswestry, Shropshire (United Kingdom); Kumamoto Aging Research Institute, Kumamoto (Japan)
To relate the magnetic resonance imaging (MRI) appearance of autologous chondrocyte implantation (ACI) in the knee in the 1st postoperative year with other knee features on MRI and with clinical outcome. Forty-nine examinations were performed in 49 patients at 1 year after ACI in the knee. Forty-one preoperative magnetic resonance (MR) examinations were also available. The grafts were assessed for smoothness, thickness in comparison with that of adjacent cartilage, signal intensity, integration to underlying bone and adjacent cartilage, and congruity of subchondral bone. Presence of overgrowth and bone marrow appearance beneath the graft were also assessed. Presence of osteophyte formation, further cartilage defects, appearance of the cruciate ligaments and the menisci were also recorded. An overall graft score was constructed, using the graft appearances. This was correlated with the knee features and the Lysholm score, a clinical self-assessment score. The data were analysed by a Kruskal-Wallis H test followed by a Mann-Whitney U test with Bonferroni correction as post-hoc test. Of 49 grafts, 32 (65%) demonstrated complete defect filling 1 year postoperatively. General overgrowth was seen in eight grafts (16%), and partial overgrowth in 13 grafts (26%). Bone marrow change underneath the graft was seen; oedema was seen in 23 grafts (47%), cysts in six grafts (12%) and sclerosis in two grafts (4%). Mean graft score was 8.7 (of maximal 12) (95% CI 8.0-9.5). Knees without osteophyte formation or additional other cartilage defects (other than the graft site) had a significantly higher graft score than knees with multiple osteophytes (P=0.0057) or multiple further cartilage defects (P=0.014). At 1 year follow-up improvement in the clinical scores was not significantly different for any subgroup. (orig.)
The effects of bone marrow aspirate, bone graft, and collagen composites on fixation of titanium implants
DEFF Research Database (Denmark)
Babiker, Hassan; Ding, Ming; Sandri, Monica;
contamination, and non union as well as the potential risk of disease transmission. Hydroxyapatite and collagen composites (HA/Collagen) have the potential in mimicking and replacing skeletal bones. This study attempted to determine the effects of newly developed HA/Collagen-composites with and without bone....../Collagen-BMA; autograft or allograft. Allograft was served as the control group. The observation period was 5 weeks. The sheep were euthanized and both femurs were harvested. A push-out mechanical test and histological analysis were performed. Results: No significant differences were seen in the mechanical properties...
External fixation and bone grafting for collapsed and comminuted distal radius fracture
Institute of Scientific and Technical Information of China (English)
ZHANG Shuang-xi; GU Fang-rui; PENG Yong-li; ZHU Guang-ming; FU Jiang; LU Jun-yue; WANG Jiang-tao; LIU Zhang-min
Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June 2003. All fractures were treated by the methods of open reduction, sustained bone grafting and passing joint external fixator to restore the anatomic shape of distal radius. Results: All 26 cases were followed up, and the results showed that the fractures have been united radiographically. The joint surfaces were intact and there was no length discrepancy occurred in patient's radius. The average volar tilt was 6┬░ to 15┬░ and the average ulnar tilt was 18┬░ to 25┬░. According to the Dieust criterion, 19 cases were rated as excellent and 7 as good. Conclusions: The method that applying passing joint external fixator and bone grafting for the treatment of collapsed and comminuted distal radius fracture could maintain the stability of fracture and restore the length of radius and the intact of joint surface.
Imaging of vascularized fibular grafts in large bone reconstruction in skeletally immature patients
International Nuclear Information System (INIS)
Objective. To describe the imaging findings of vascularized fibular grafts (VFG) in large bone reconstruction in children and teenagers. Design and patients. Fifteen patients aged from 4 to 19 years underwent VFG for bone reconstruction for primary tumors involving bone in 13 cases and for chronic osteomyelitis in 2 cases. Lesions were located in the femur (6 cases), the tibia (6 cases), the humerus, the distal fibula and the ilium. Radiographic follow-up was performed in all patients, radionuclide studies in 12 patients and MRI in 8. Results. Plain films showed a lamellated periosteal reaction on the VFG within 3 weeks following the procedure in all cases. Fusion of VFG and host bone occurred during the first 3 months. Radionuclide uptake of the VFG was seen in all cases but one. MRI showed cortical thickening and conservation of the high signal intensity of fatty marrow on T1-weighted sequences, and periosteal enhancement on dynamic post-contrast studies in all but one of the patients. Conclusion. Radionuclide studies and MRI show the periosteal enhancement and assess the viability of the VFG satisfactorily. However, we feel that plain films may be sufficient to ascertain this viability. (orig.). With 4 figs., 1 tab
Imaging of vascularized fibular grafts in large bone reconstruction in skeletally immature patients
Energy Technology Data Exchange (ETDEWEB)
Panuel, M. [Department of Pediatric Radiology, Hopital d`Enfants CHU Timone, 13 - Marseille (France)]|[Department of Radiology, CHU Nord, 13 - Marseille (France)]|[Anthropology Department, Universite de la Mediterranee, Marseille (France); Petit, P. [Department of Pediatric Radiology, Hopital d`Enfants CHU Timone, 13 - Marseille (France); Jouve, J.L. [Department of Pediatric Orthopedics, Hopital d`Enfants CHU Timone, 13 - Marseille (France); Portier, F. [Department of Radiology, CHU Nord, 13 - Marseille (France); Legre, R. [Department of Plastic Surgery, Hopital d`Enfants CHU Timone, 13 - Marseille (France); Bourliere, B. [Department of Pediatric Radiology, Hopital d`Enfants CHU Timone, 13 - Marseille (France); Devred, P. [Department of Pediatric Radiology, Hopital d`Enfants CHU Timone, 13 - Marseille (France)
Objective. To describe the imaging findings of vascularized fibular grafts (VFG) in large bone reconstruction in children and teenagers. Design and patients. Fifteen patients aged from 4 to 19 years underwent VFG for bone reconstruction for primary tumors involving bone in 13 cases and for chronic osteomyelitis in 2 cases. Lesions were located in the femur (6 cases), the tibia (6 cases), the humerus, the distal fibula and the ilium. Radiographic follow-up was performed in all patients, radionuclide studies in 12 patients and MRI in 8. Results. Plain films showed a lamellated periosteal reaction on the VFG within 3 weeks following the procedure in all cases. Fusion of VFG and host bone occurred during the first 3 months. Radionuclide uptake of the VFG was seen in all cases but one. MRI showed cortical thickening and conservation of the high signal intensity of fatty marrow on T1-weighted sequences, and periosteal enhancement on dynamic post-contrast studies in all but one of the patients. Conclusion. Radionuclide studies and MRI show the periosteal enhancement and assess the viability of the VFG satisfactorily. However, we feel that plain films may be sufficient to ascertain this viability. (orig.). With 4 figs., 1 tab.
Expressions of CDK2 and CDK4 in intimal cell proliferation in autologous vein grafts%CDK2ŃĆüCDK4Õ¤║ÕøĀõĖÄĶć¬õĮōń¦╗µżŹķØÖĶäēÕåģĶå£Õó×µ«¢ńÜäÕģ│ń│╗
Institute of Scientific and Technical Information of China (English)
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[ Objecttive ] To observe CDK2, CDK4 expressions of proliferative intima in autologous grafted vein of rat. [Methods] Rat autologous vein graft model was established. Fifty rats were divided into five groups randomly, and the graft veins were respectively collectived at the 1st, 2nd, 3rd, 7th, and 14th day after the operation. Then the protein expressions of CDK2 and CDK4 were detected by immunohistochemistry and the expressions of their mRNA were detected by RT - PCR in intima of the graft vein. Normal veins were used for control. [ Results] At 7d after operation, the intima proliferation of autologous grafted vein reached nearly to the high point, and it was more obvious than those of control group and groups at 1 d, 2 d and 3 d after operation (P < 0.05) . The numbers of CDK2 and CDK4 positive cells in graft vein increased from 2 d after operation and reached to the peak at 7 d after operation. The expressions of CDK2, CDK4 mRNA reached to the peak during 7 d to 14 d after operation. [ Conclusions ] The expressions of CDK2 and CDK4 increased from early phrase after vein graft, and reached the peak during 7 d to 14 d after operation. The CDK2 and CDK4 played a role in intima proliferation of autologous graft vein.%[ńø«ńÜä]õ║åĶ¦ŻCDK2ŃĆüCDK4Õ£©Õż¦ķ╝Āń¦╗µżŹĶĪĆń«ĪńÜäĶĪ©ĶŠŠÕÅŖÕ»╣Õ╣│µ╗æĶéīń╗åĶā×Õó×µ«¢ńÜäÕĮ▒ÕōŹ.[µ¢╣µ│Ģ]WistarÕż¦ķ╝Ā50ÕŬ,ķÜŵ£║ÕłåõĖ║5ń╗ä,Õ╗║ń½ŗĶć¬õĮōķØÖĶäēń¦╗µżŹµ©ĪÕ×ŗ,ÕłåÕł½õ║ĵ£»ÕÉÄ1ŃĆü2ŃĆü3ŃĆü7ÕÅŖ14 dÕÅ¢ń╗äń╗ćÕĮóµĆüÕŁ"Ķ¦éÕ»¤,Õ╣Čńö©ÕģŹń¢½ń╗äń╗ćÕī¢ÕŁ"ÕÆīRT-PCRµ¢╣µ│ĢµŻĆµĄŗĶĪĆń«Īń¦╗µżŹÕÉÄõĖŹÕÉīµŚČµ£¤CDK2ŃĆüCDK4ńÜäĶĪ©ĶŠŠµāģÕåĄ,ÕÅ¢µŁŻÕĖĖķØÖĶäēõĖ║Õ»╣ńģ¦ń╗ä.[ń╗ōµ×£]ń¦╗µżŹÕÉÄ7d,ÕåģĶå£ÕÄÜÕ║"õĖÄń«ĪÕŻüÕÄÜÕ║"µÄźĶ┐æķ½śÕ│░,õĖÄÕ»╣ńģ¦ń╗äÕÅŖń¦╗µżŹÕÉÄ1ŃĆü2ŃĆü3dµ»öĶŠā,ÕĘ«Õ╝éµ£ēµśŠĶæŚµĆ¦µäÅõ╣ē(P'╝£0.05).ÕģŹń¢½ń╗äń╗ćÕī¢ÕŁ"µśŠńż║,ń¦╗µżŹķØÖĶäēCDK2ŃĆüCDK4ķś│µĆ¦ń╗åĶā×Õ£©ń¦╗µżŹÕÉÄ2dµśÄµśŠÕó×ÕŖĀ,7dĶŠŠÕł░ķ½śÕ│░,õĖÄń¦╗µżŹÕÉÄ1dµ»öĶŠā,ÕĘ«Õ╝éµ£ēµśŠĶæŚµĆ¦µäÅõ╣ē(P'╝£0.05).RT-PCRµŻĆµĄŗń╗ōµ×£µśŠńż║,CDK2ŃĆüCDK4Õ¤║ÕøĀmRNAĶĪ©ĶŠŠõ║¦ķćÅ7'Į×14 dĶŠŠÕł░ķ½śÕ│░,õĖÄń¦╗µżŹÕÉÄ1ŃĆü2ŃĆü3dµ»öĶ
Chakf├®, N; Dieval, F; Thaveau, F; Rinckenbach, S; Hassani, O; Camelot, G; Durand, B; Kretz, J-G
Performed since the 1950s, vascular grafting has opened modern era of vascular surgery. Autologous venous grafts are of first choice for revascularisation of small arteries. Synthetic grafts are mainly modelled using microporous polytetrafluoroethylene or terephtalate polyethylene. These prosthesis are mainly used for revascularization of medium and large size arteries. PMID:15220107
Osteogenic protein 1 device increases bone formation and bone graft resorption around cementless implants
DEFF Research Database (Denmark)
Jensen, Thomas B; Overgaard, S├Ėren; Lind, Martin;
In each femoral condyle of 8 Labrador dogs, a non weight-bearing hydroxyapatite-coated implant was inserted surrounded by a 3 mm gap. Each gap was filled with bone allograft or ProOsteon with or without OP-1 delivered in a bovine collagen type I carrier (OP-1 device). 300 microg OP-1 was used in ...
Effect of Simvastatin collagen graft on wound healing of defective bone
Energy Technology Data Exchange (ETDEWEB)
Kang, Jun Ho; Kim, Gyu Tae [Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul (Korea, Republic of); Choi, Yong Suk; Lee, Hyeon Woo; Hwang, Eui Hwan [Institute of Oral Biology, School of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)
To observe and evaluate the effects of Simvastatin-induced osteogenesis on the wound healing of defective bone. 64 defective bones were created in the parietal bone of 32 New Zealand White rabbits. The defects were grafted with collagen matrix carriers mixed with Simvastatin solution in the experimental group of 16 rabbits and with collagen matrix carriers mixed with water in the controlled group. The rabbits were terminated at an interval of 3, 5, 7, and 9 days, 2, 4, 6, and 8 weeks after the formation of defective bone. The wound healing was evaluated by soft X-ray radiography. The tissues within defective bones were evaluated through the analysis of flow cytometry for the manifestation of Runx2 and Osteocalcin, and observed histopathologically by using H-E stain and Masson's trichrome stain. Results : 1. In the experimental group, flow cytometry revealed more manifestation of Runx2 at 5, 7, and 9 days and Osteocalcin at 2 weeks than in the controlled groups, but there was few difference in comparison with the controlled group. 2. In the experimental group, flow cytometry revealed considerably more cells and erythrocytes at 5, 7, and 9 days in comparison with the controlled group. 3. In the experimental group, soft x-ray radiography revealed the extended formation of trabeculation at 2, 4, 6, and 8 weeks. 4. Histopathological features of the experimental group showed more fibroblasts and newly formed vessels at 5 and 7 days, and the formation of osteoid tissues at 9 days, and the newly formed trabeculations at 4 and 6 weeks. As the induced osteogenesis by Simvastatin, there was few contrast of the manifestation between Runx2 and Osteocalcin based on the differentiation of osteoblasts. But it was considered that the more formation of cells and erythrocytes depending on newly formed vessels in the experimental group obviously had an effect on the bone regeneration.
Autologous bone marrow mesenchymal stem cells combined with hydroxyapatite/tricalcium phosphate complex in the spinal fusion%Ķć¬õĮōķ¬©ķ½ōÕ»īķøåķŚ┤Ķ┤©Õ╣▓ń╗åĶā×õĖÄńŠ¤Õ¤║ńŻĘńü░ń¤│ńŻĘķģĖõĖēķÆÖµØɵ¢ÖÕżŹÕÉłÕ£©ĶäŖµ¤▒Ķ׏ÕÉłõĖŁńÜäÕ║öńö©
Institute of Scientific and Technical Information of China (English)
ķŚ½õ╝¤; µØ©ĶÄē; Õćīµóģ; ńöśÕśēõ║«
ĶāīµÖ»'╝ÜĶäŖµ¤▒Ķ׏ÕÉłĶ┐ćń©ŗõĖŁõĮ┐ńö©õĖĆÕ«ÜńÜäķ¬©ń¦╗µżŹµØɵ¢ÖÕÅ»õ╗źĶŠŠÕł░õ┐āĶ┐øķ¬©Ķ׏ÕÉłŃĆüÕó×Õ╝║ĶäŖµ¤▒ń©│Õ«ÜµĆ¦ńÜäµĢłµ×£ŃĆéńø«ńÜä'╝ܵÄóĶ«©Ķć¬õĮōķ¬©ķ½ōÕ»īķøåńÜäķŚ┤Ķ┤©Õ╣▓ń╗åĶā×ÕżŹÕÉłńŠ¤Õ¤║ńŻĘńü░ń¤│ńŻĘķģĖõĖēķÆÖÕ£©ĶäŖµ¤▒Ķ׏ÕÉłõĖŁńÜäÕ║öńö©µĢłµ×£ŃĆéµ¢╣µ│Ģ'╝ÜÕø×ķĪŠµĆ¦Õłåµ×É64õŠŗĶĪīĶäŖµ¤▒Ķ׏ÕÉłµéŻĶĆģńÜäõĖ┤Õ║ŖĶĄäµ¢Ö'╝īµīēńģ¦µżŹķ¬©Ķ׏ÕÉłµØɵ¢ÖńÜäõĖŹÕÉīÕłåõĖ║Õ»╣ńģ¦ń╗ä(32õŠŗ)ÕÆīĶ¦éÕ»¤ń╗ä(32õŠŗ)'╝īÕłåÕł½õ║łõ╗źĶć¬õĮōķ½éķ¬©ń¦╗µżŹÕÆīĶć¬õĮōķ¬©ķ½ōÕ»īķøåńÜäķŚ┤Ķ┤©Õ╣▓ń╗åĶā×ÕżŹÕÉłńŠ¤Õ¤║ńŻĘńü░ń¤│ńŻĘķģĖõĖēķÆÖń¦╗µżŹŃĆéµ▓╗ń¢ŚÕÉÄķÜÅĶ«┐12õĖ¬µ£ł'╝īÕ»╣õĖżń╗äµéŻĶĆģĶģ░Ķāīń¢╝ńŚøŃĆüĶäŖµ¤▒Ķ׏ÕÉłŃĆüõ╝żµżÄÕżŹõĮŹµāģÕåĄńŁēĶ┐øĶĪīĶ»äõ╝░ŃĆéń╗ōµ×£õĖÄń╗ōĶ«║'╝ܵ▓╗ń¢ŚÕÉÄõĖżń╗äµéŻĶĆģ LBOS Ķ»äÕłåŃĆüLBOS Ķ»äÕłåõ╝śĶē»ńÄćŃĆüĶäŖµ¤▒Ķ׏ÕÉł Lenke Õłåń║¦ŃĆüCobb Ķ¦Æń╗ŵ»öĶŠāÕĘ«Õ╝鵌ĀµśŠĶæŚµĆ¦µäÅõ╣ē(P >0.05)ŃĆéõĖżń╗äµéŻĶĆģÕØćµ£¬Õć║ńÄ░µä¤µ¤ōÕÆīńéÄńŚćĶĪ©ńÄ░'╝īÕåģÕø║Õ«Üńē®Õ»╣ńÜ«ĶéżµŚĀÕł║µ┐ĆńÄ░Ķ▒ĪŃĆéõĖżń╗äµéŻĶĆģÕćØĶĪĆÕŖ¤ĶāĮŃĆüĶéŠÕŖ¤ĶāĮŃĆüńéĵƦÕøĀÕŁÉńøĖÕģ│µīćµĀćÕØćÕżäõ║ĵŁŻÕĖĖµ░┤Õ╣│'╝īÕĘ«Õ╝鵌ĀµśŠĶæŚµĆ¦µäÅõ╣ē(P >0.05)ŃĆéĶ»Ģķ¬īń╗ōµ×£ĶĪ©µśÄ'╝īĶć¬õĮōķ¬©ķ½ōÕ»īķøåńÜäķŚ┤Ķ┤©Õ╣▓ń╗åĶā×ÕżŹÕÉłńŠ¤Õ¤║ńŻĘńü░ń¤│ńŻĘķģĖõĖēķÆÖÕ║öńö©õ║ÄĶäŖµ¤▒Ķ׏ÕÉłÕÅ»õ╗źĶÄĘÕŠŚõĖÄĶć¬õĮōķ½éķ¬©ń¦╗µżŹÕ¤║µ£¼ńøĖÕĮōńÜäõĖ┤Õ║ŖµĢłµ×£ŃĆé%BACKGROUND: The use of bone graft materials can promote bone fusion and enhance the stability of the spine during the spinal fusion. OBJECTIVE: To investigate the effect of autologous bone marrow mesenchymal stem cel s with hydroxyapatite/ tricalcium phosphate in the spinal fusion. METHODS: A retrospective analysis of clinical data of 64 patients with spinal fusion was carried out, and these patients were divided into two groups (n=32 per group): control group undergoing autogenous iliac bone grafting and observation group undergoing autologous bone marrow mesenchymal stem cel s combined with hydroxyapatite/tricalcium phosphate. Al patients were fol owed up for 12 months, and their recovery conditions about low back pain, spinal fusion and vertebral reset were assessed. RESULTS AND CONCLUSION: The low-back outcome scale scores and excel
Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical ...
Ķć¬õĮōĶäéĶé¬ń¦╗µżŹõ┐«ÕżŹķØóķā©Õć╣ķÖʵƦÕÅŖĶÉÄń╝®µĆ¦ńśóńŚĢ%Autologous fat grafting for facial depressed and atrophic scars
Institute of Scientific and Technical Information of China (English)
ÕÉĵ֩Ķōē; ÕłśńźźÕÄ"; Õ╝Āµ£ēĶē»; µøŠńæ×µø"; ĶŗÅńł▒õ║æ; ÕöÉÕ║å
Objective To evaluate the methodology and clinical efficacy of autologous fat grafting for the reconstruction of facial depressed and atrophic scars. Methods 10 patients with facial depressed and atrophic scars were treated with autologous fat grafting.Fat harvest, refinement and injection were done by 3M3L's fat grafting technique. Every patient was treated 1- 3 times with an interval of 3- 6 months.The improvement of facial contour deformity and skin texture were assessed after surgery. Results All patients were followed up postoperatively within 3- 12 months.No complications such as infection,cysts,calcification, vascular or nerve injury occurred,nor new deformity and scars were observed.The contour deformity was corrected significantly compared before. The local skin texture of scars was also improved greatly.Patients were all satisfied with the cosmetic results. Conclusion Although further studies are required to provide surgeons with definitive guidelines for the implementation of fat grafting,we propose autologous fat grafting is a feasible minimally invasive and safe technique for facial depressed and atrophic scars.%ńø«ńÜä'╝ܵÄóĶ«©Ķć¬õĮōĶäéĶé¬ń¦╗µżŹõ┐«ÕżŹķØóķā©Õć╣ķÖʵƦÕÅŖĶÉÄń╝®µĆ¦ńśóńŚĢńÜäµ¢╣µ│ĢÕÆīõĖ┤Õ║Ŗń¢ŚµĢłŃĆéµ¢╣µ│Ģ'╝ÜÕ»╣10õŠŗķØóķā©Õć╣ķÖʵƦÕÅŖĶÉÄń╝®µĆ¦ńśóńŚĢµéŻĶĆģķććńö©Ķć¬õĮōĶäéĶé¬ń¦╗µżŹĶ┐øĶĪīµ▓╗ń¢ŚŃĆéĶäéĶé¬ĶÄĘÕÅ¢ŃĆüµÅÉń║»ÕÅŖµ│©Õ░äķććńö©3M3Lń¦╗µżŹµŖƵ£»ŃĆéµ»ÅõŠŗĶć¬õĮōĶäéĶé¬ń¦╗µżŹ1'Į×3µ¼Ī'╝īµ»Åµ¼ĪķŚ┤ķÜö3'Į×6õĖ¬µ£ł'╝īń╗╝ÕÉłĶ»äõ╗ʵéŻĶĆģµ£»ÕÉÄķØóķā©ĶĮ«Õ╗ōńĢĖÕĮóŃĆüńśóńŚĢńÜ«ĶéżĶ┤©Õ£░µö╣Õ¢äµāģÕåĄŃĆéń╗ōµ×£'╝ܵéŻĶĆģÕØćĶÄĘķÜÅĶ«┐3õĖ¬µ£ł'Į×1Õ╣┤'╝īµŚĀµä¤µ¤ōŃĆüÕøŖĶé┐ŃĆüķÆÖÕī¢ŃĆüĶĪĆń«ĪÕÆīńź×ń╗ŵŹ¤õ╝żńŁēÕ╣ČÕÅæńŚćÕÅæńö¤'╝īõ╣¤µ£¬õ║¦ńö¤µ¢░ńĢĖÕĮóÕÅŖµ¢░ńśóńŚĢŃĆéĶĮ«Õ╗ōÕć╣ķÖĘńĢĖÕĮóÕŠŚÕł░ń¤½µŁŻ'╝īńśóńŚĢńÜ«ĶéżĶ┤©Õ£░ÕÅŖĶē▓µ│Įµ£ēµēƵö╣Õ¢ä'╝īµéŻĶĆģÕØćÕ»╣µ▓╗ń¢ŚµĢłµ×£µ╗ĪµäÅŃĆéń╗ōĶ«║'╝ÜĶć¬õĮōĶäéĶé¬ń¦╗µżŹµś»õĖĆń¦Źµ▓╗ń¢ŚķØóķā©Õć╣ķÖʵƦÕÅŖĶÉÄń╝®µĆ¦ńśóńŚĢÕÅ»ĶĪīńÜäÕŠ«Õłøµ¢╣µ│ĢŃĆé
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Full Text Available INTRODUCTION An ideal rehabilitation program post anterior cruciate ligament reconstruction enables an individual to return to pre injury levels at a faster rate with minimal to no risk of reinjury to the graft. Rehabilitation protocols have changed considerably over time in the past. It has become ŌĆ£aggressiveŌĆØ, meaning an intensive rehabilitation which includes greater variety of exercises and sports related training. AIM OF THE STUDY The aim of our study is to assess the outcome of accelerated rehabilitation post anterior cruciate ligament (ACL reconstruction. METHODOLOGY 106 patients were operated by a single surgeon underwent arthroscopic anterior cruciate ligament reconstruction using bone patella tendon bone graft and partial meniscectomy for associated meniscal tear. Patients were put on an accelerated rehabilitation protocol designed in our institute on first post-operative day, under the guidance of a physical therapist in consultation with the operated surgeon. Patients were followed up at 3 weeks, 6 months and 9 months, post onset of rehabilitation, patients were assessed using KT1000 Arthrometer and Lysholm knee scoring system. RESULTS Out of 106 patients, who were selected, 96(91% were males and 10(9% were females. The mean pre-operative Lysholm score was 55.09. Post operatively, while on accelerated rehabilitation program the Lysholm scores were 69.73 at 3 weeks, 89.13 at 6 months and 89.19 at 9 months. In our pre-operative evaluation mean KT 1000 arthrometer score was 10.53 and post-operative at six months was 3.49. At nine months 105 patients had excellent results whereas 1 patient had good result. CONCLUSION Accelerated rehabilitation protocol enables the patient to functionally recover faster to pre injury levels. A rehabilitation protocol for 6 months is sufficient in enabling a patient to get back to pre-injury levels. Functional outcome is the same with or without associated meniscal injuries.
Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion
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Khayat Andre
Full Text Available Abstract We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.
A New Method for Xenogeneic Bone Graft Deproteinization: Comparative Study of Radius Defects in a Rabbit Model.
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Pengfei Lei
Full Text Available Deproteinization is an indispensable process for the elimination of antigenicity in xenograft bones. However, the hydrogen peroxide (H2O2 deproteinized xenograft, which is commonly used to repair bone defect, exhibits limited osteoinduction activity. The present study was designed to develop a new method for deproteinization and compare the osteogenic capacities of new pepsin deproteinized xenograft bones with those of conventional H2O2 deproteinized ones.Bones were deproteinized in H2O2 or pepsin for 8 hours. The morphologies were compared by HE staining. The content of protein and collagen I were measured by the Kjeldahl method and HPLC-MS, respectively. The physical properties were evaluated by SEM and mechanical tests. For in vivo study, X-ray, micro-CT and HE staining were employed to monitor the healing processes of radius defects in rabbit models transplanted with different graft materials.Compared with H2O2 deproteinized bones, no distinct morphological and physical changes were observed. However, pepsin deproteinized bones showed a lower protein content, and a higher collagen content were preserved. In vivo studies showed that pepsin deproteinized bones exhibited better osteogenic performance than H2O2 deproteinized bones, moreover, the quantity and quality of the newly formed bones were improved as indicated by micro-CT analysis. From the results of histological examination, the newly formed bones in the pepsin group were mature bones.Pepsin deproteinized xenograft bones show advantages over conventional H2O2 deproteinized bones with respect to osteogenic capacity; this new method may hold potential clinical value in the development of new biomaterials for bone grafting.
Research progress of autologous fat graft and fat cells apoptosis%Ķć¬õĮōĶäéĶé¬ń¦╗µżŹõĖÄĶäéĶé¬ń╗åĶā×Õćŗõ║ĪńÜäńĀöń®ČĶ┐øÕ▒Ģ
Institute of Scientific and Technical Information of China (English)
Ķć¬õĮōĶäéĶé¬ń¦╗µżŹńö▒õ║ÄÕĪ½ÕģģµĢłµ×£õĮ│ŃĆüÕÅ»ÕĪæµĆ¦Õ╝║ŃĆüµŚĀµÄƵ¢źÕģŹń¢½ÕÅŹÕ║öŃĆüÕÅ¢µØɵ¢╣õŠ┐ŃĆüÕłøõ╝żÕ░ÅńŁēõ╝śńé╣,ĶĆīµłÉõĖ║ńŠÄÕ«╣Õī╗ÕŁ"ÕÆīµĢ┤ÕĮóÕż¢ń¦æÕĖĖńö©ńÜäµēŗµ£»µ¢╣µ│Ģ.õĮåńö▒õ║ĵ£»ÕÉÄĶäéĶé¬ń╗åĶā×µłÉµ┤╗ńÄćĶŠāõĮÄ,õ╗ÄĶĆīķÖÉÕłČõ║åÕģČÕ£©õĖ┤Õ║ŖńÜäÕ╣┐ĶīāÕ║öńö©.ń╗åĶā×Õćŗõ║Īµś»ń¦╗µżŹÕÉÄĶäéĶé¬ń╗åĶā×µŁ╗õ║ĪńÜäķćŹĶ"üµ£║ÕłČ,ķĆÜĶ┐ćµŖæÕłČĶäéĶé¬ń╗åĶā×ńÜäÕćŗõ║ĪÕÅ»µśÄµśŠµÅÉķ½śĶć¬õĮōĶäéĶé¬ń¦╗µżŹńÜäÕŁśµ┤╗ńÄć,ńÄ░Õ░åÕćŗõ║ĪńøĖÕģ│ńĀöń®ČĶ┐øÕ▒Ģõ║ÄĶć¬õĮōĶäéĶé¬ń¦╗µżŹõĖŁńÜäÕ║öńö©Ķ┐øĶĪīń╗╝Ķ┐░.%Autologous fat graft has become the most commonly operation method in aestheticmedicine and plastic surgery,due to its better filling effect,strong plasticity, no immune response,easydrawing materials and little trauma.However,the low survival rate of fat cells,which limits its wideapplication in clinic. Apoptosis is an important mechanism of fat cell death which after transplantation.The survival rate of autologous fat transplantation can be significantly improved by inhibiting theapoptosis of fat cells,related factors affecting the survival rate of grafted fat was reviewed in this paper.
Survival of dental implants in native and grafted bone in irradiated head and neck cancer patients: A retrospective analysis
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Aravind Buddula
Full Text Available Aim: To study the long-term survival of dental implants placed in native or grafted bone in irradiated bone in subjects who had received radiation for head and neck cancer. Materials and Methods: A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 and July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. Results: A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987-July 2008. There was no statistically significant difference between implant failure in native and grafted bone (P=0.76. Survival of implants in grafted bone was 82.3% and 98.1% in maxilla and mandible, respectively, after 3 years. Survival of implants in native bone in maxilla and mandible was 79.8% and 100%, respectively, after 3 years. For implants placed in the native bone, there was a higher likelihood of failure in the maxilla compared to the mandible and there was also a tendency for implants placed in the posterior region to fail compared to those placed in the anterior region. Conclusion: There was no significant difference in survival when implants were placed in native or grafted bone in irradiated head and neck cancer patients. For implants placed in native bone, survival was significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior.
Treatment of Thoracolumbar Vertebrate Fracture by Transpedicular Morselized Bone Grafting in Vertebrae for Spinal Fusion and Pedicle Screw Fixation
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Jinguo WANG; Hua WU; Xiaolin DING; Yutian LIU
To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A (n=20) were reinforced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B (n=50) did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B (group A: 6.4 degree; group B: 5.4 degree)/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B (P=0.0001). Postoperatively, greater anterior height was achieved in group A than in group B (P<0.01). During follow-up study, anterior vertebral height was maintained only in Group A (P<0.001). Both group A and group B showed good Denis pain scores (P1 and P2) but group A outdid group B in terms of control of severe and constant pain (P4 and P5). By Frankel criteria, the changes in neurological functions in group A was better than those of group B (P<0.001). It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with
Fabrication of nano-hydroxyapatite/collagen/osteonectin composites for bone graft applications
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Liao, Susan; Ngiam, Michelle; Chan, Casey K; Ramakrishna, S [Division of Bioengineering, Nanoscience and Nanotechnology Initiative, Faculty of Engineering, National University of Singapore, 117576 (Singapore)
Mineralized type I collagen (collagen I) nanofibers and their nanofibril bundles make up the microstructure of natural bone tissue, which range from nanometers to micrometers. However, attempts to achieve this hierarchically assembled structure in vitro have been unsuccessful. In this study, we added osteonectin into the collagen I solution, either at a high or low weight ratio (osteonectin: collagen I = 1:30 or 1:90) before co-precipitation. Results indicated that spindle-like nano-hydroxyapatite (nano-HA) was deposited on collagen/osteonectin and pure osteonectin (control) groups. Furthermore, transmission electron microscope (TEM) and scanning electron microscope (SEM) results showed that the assembled mineralized fiber bundles were formed randomly at different levels from 50 nm, 250 nm to 1100 nm. However, when we replaced collagen I with collagen II, osteonectin addition did not induce the formation of mineralized fiber bundles. The participation of osteonectin in the assembly of the mineralized fibers could provide new insights into the novel mineralization function of osteonectin for bone development in vivo and advancing new biomimetic methods for bone graft applications.
Fatal CMV-Infection after Autologous Stem Cell Transplantation in Refractory Systemic Lupus Erythematosus
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L├Īszl├│ V├Īr├│czy
Full Text Available High-dose chemotherapy followed by autologous stem cell transplantation can be a rescue for patients with severe refractory systemic lupus erythematosus (SLE. However, the procedure might have fatal complications including infections and bleeding. We report on a young female patient with SLE whose disease started in her early childhood. After many years, severe renal, neurological, and bone marrow involvement developed that did not respond to conventional therapy. She was selected for autologous stem cell transplantation. A successful peripheral stem cell apheresis was performed in March 2006. The nonselected graft was reinfused in August 2006 after a conditioning chemotherapy containing high-dose cyclophosphamide and antithymocyte globulin. Engraftment was detected within 11 days. On the 38th posttransplant day, severe cytomegalovirus (CMV infection developed that included pneumonitis, hepatitis, and pancytopenia. The patient died in a week due to multiorgan failure. With her case, we want to call the attention to this rare, but lethal complication of the autologous transplantation.
Preliminary study showing safety/efficacy of nanoss bioactive versus vitoss as bone graft expanders for lumbar noninstrumented fusions
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Nancy E Epstein
Conclusion: In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders. Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising.
Clinical study of reconstructing the medial malleolus with free grafting of fibular head composite tendon bone flap
Institute of Scientific and Technical Information of China (English)
WU Shui-pei
Objective: To explore new surgical procedure for repairing and reconstructing medial malleolus and soft tissue defect.Methods: According to the size of medial malleolus and composite soft tissue defect, vascular fibular head composite tendon bone flap free grafting using anterior tibial recurrent vessel as the perforating branch was designed to reconstruct the medial malleolar saddle and triangular ligament, and composite back broadest muscle flap free grafting was designed to repair the medical malleolar wound surface. From January 2000 to December 2006, the technique was used in 5 male patients who were injured by machine or in traffic accidents, causing bone and soft tissue defect. The size of wound surface ranged from 19 cm├Ś12 cm to 24 cm├Ś12 cm.Results: The wound surface was healed at the first stage in 4 cases, and the other case had infection and was cured in 6 months with anti infection therapy. Postoperative follow-ups from 6 months to 6 years showed that grafted bones and free cutaneous flaps were healed well, malleolar joints were stable, joint movement was normal, and the appearance was satisfactory. The overall outcome was good.Conclusion: Fibular head composite tendon bone flap free grafting is effective for repairing medical malleolar defect.
An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures
D.M.J. Milstein; Y.W. Cheung; L. Ziukaite; C. Ince; H.P. van den Akker; J.A.H. Lindeboom
Objective The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. Study Design This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bon
Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft in animals
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Jensen, T; Schou, S; Stavropoulos, Andreas;
The objective of the present systematic review was to test the hypothesis of no differences between the use of Bio-Oss or Bio-Oss mixed with autogenous bone as graft for maxillary sinus floor augmentation (MSFA) applying the lateral window technique, as evaluated in animals. A MEDLINE (Pub...
The tent pole splint: a bone-supported stereolithographic surgical splint for the soft tissue matrix expansion graft procedure.
Cillo, Joseph E; Theodotou, Nicholas; Samuels, Marc; Krajekian, Joseph
This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible. PMID:20231048
Metacarpal resection with a contoured iliac bone graft and silicone rubber implant for metacarpal giant cell tumor: a case report.
Carlow, S B; Khuri, S M
A definitive surgical procedure for a giant cell tumor that combines metacarpal resection with an iliac bone graft and arthroplasty with a silicone rubber implant is proposed for the elderly patient. The results were encouraging in one patient who had a cosmetically and functionally acceptable hand and no evidence of recurrence.
Br├źnemark and ITI dental implants in the human bone-grafted maxilla: a comparative evaluation
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Pinholt, Else M
The development of new characteristics concerning implant surface makes it interesting to clinically compare different implant systems in the bone-grafted maxilla. The aim of this evaluation was to compare clinical data of a two-staged procedure on the augmented extremely atrophic maxilla using e...
Thoracolumbar spinal fractures : radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients
Leferink, VJM; Zimmerman, KW; Veldhuis, EFM; ten Vergert, EM; ten Duis, HJ
In internal posterior fixation of thoracolumbar fractures combined with transpedicular cancellous bone graft and posterior fusion of the intervertebral facet joints at the level of the destroyed end plate it is still uncertain as to whether significant vertebral body collapse and loss of correction
Within Patient Radiological Comparative Analysis of the Performance of Two Bone Graft Extenders Utilized in Posterolateral Lumbar Fusion: A Retrospective Case Series
Stewart, Geoffrey; Gage, Gary B.; Neidert, Gary; Adkisson, Huston Davis
Two bone graft extenders differing in chemical composition were implanted contralaterally in 27 consecutive patients undergoing instrumented posterolateral lumbar fusion as standard-of-care. Bone marrow aspirate and autogenous bone graft were equally combined either with ╬▓-tricalcium phosphate (╬▓-TCP) or a hybrid biomaterial [containing hyaluronic acid (HyA) but lacking a calcium salt] and implanted between the transverse processes. Fusion status on each side of the vertebrae was retrospectiv...
Cytocompatibility Evaluation of Grafted IKVAV PLEOF Hydrogels with Bone Marrow Mesenchymal Stem Cells
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LI Binbin; ZHANG Ping; YIN Yixia; QIU Tong; TAO Yuan; WANG Xinyu; LI Shipu
The novel hydrogels-grafted IKVAV poly (lactide-co-ethylene oxide-co-fumarate) (PLEOF) hydrogels (GIPHs) were developed. The rat bone marrow mesenchymal stem cells (BMMSCs) were employed, and the cell vitality and apoptosis assays were carried out to evaluate the cytocomptibility of GIPHs. Our data demonstrated that the influence of GIPHs on the proliferation of BMMSCs was in a concentration and time dependent manner. The proliferative ability of BMMSCs in GIPHs-treated group (100╬╝g/mL) after 72 h presented a maximum response which was 30.1%more than that of control group. The numbers of apoptotic cells in GIPHs-treated group (100╬╝g/mL) were just as much as that of control group after 24 h treatment. The GIPHs are able to provide an appropriate environment for BMMSCs survival and proliferation.
Improved outcome for high-risk acute myeloid leukemia patients using autologous bone marrow transplantation and monoclonal antibody-purged bone marrow.
Selvaggi, K J; Wilson, J W; Mills, L E; Cornwell, G G; Hurd, D; Dodge, W; Gingrich, R; Martin, S E; McMillan, R; Miller, W
We have conducted a 9-year multicenter trial of autologous bone marrow transplantation (ABMT) for acute myeloid leukemia (AML). Remission BM was purged in vitro using monoclonal antibodies (MoAbs; PM-81, AML-2-23) and complement targeting myeloid differentiation antigens (CD15, CD14). In 1988, the preparative regimen changed from 60 mg/kg/d cyclophosphamide x 2 and fractionated total body irradiation (TBI) total dose, 1,200 cGy (Cy/fTBI), to 4 mg/kg/d busulfan x 4 and 60 mg/kg/d Cy x 2 (Bu/Cy2). Recent analysis (October 1, 1993) shows that the Bu/Cy2 regimen along with the same MoAb purging method yields an improved outcome. Seven first complete-remission (CR) (CR1), 45 second- or third-CR (CR2/3), and 11 first-relapse (R1) patients were treated with chemotherapy and TBI or chemotherapy alone followed by ABMT with MoAb-purged BM. Median age at ABMT for those patients in CR 2/3 and R1 patients was 36 years. Twenty-nine CR 2/3 and R1 patients were conditioned with Cy/fTBI, and 27 CR2/3 and R1 patients were conditioned with Bu/CY. Using the Kaplan-Meier method, the CY/fTBI, CR2/3, and R1 patients have a 3-year disease-free survival (DFS) of 21%. On the other hand, the Bu/Cy2, CR2/3, and R1 patients have a 3-year DFS of 48%. Nineteen CR2/3 and R1 patients relapsed post-ABMT. On analysis by conditioning regimen, those treated with Cy/fTBI have a 3-year relapse rate (RR) of 58%, whereas the patients conditioned with Bu/Cy2 have a 39% 3-year RR. Long-term DFS can be achieved in about 50% of patients with advanced remissions and relapsed AML using Bu/Cy2 with MoAb-purged BM. PMID:8123862
Improved outcome for high-risk acute myeloid leukemia patients using autologous bone marrow transplantation and monoclonal antibody-purged bone marrow.
Selvaggi, K J; Wilson, J W; Mills, L E; Cornwell, G G; Hurd, D; Dodge, W; Gingrich, R; Martin, S E; McMillan, R; Miller, W
We have conducted a 9-year multicenter trial of autologous bone marrow transplantation (ABMT) for acute myeloid leukemia (AML). Remission BM was purged in vitro using monoclonal antibodies (MoAbs; PM-81, AML-2-23) and complement targeting myeloid differentiation antigens (CD15, CD14). In 1988, the preparative regimen changed from 60 mg/kg/d cyclophosphamide x 2 and fractionated total body irradiation (TBI) total dose, 1,200 cGy (Cy/fTBI), to 4 mg/kg/d busulfan x 4 and 60 mg/kg/d Cy x 2 (Bu/Cy2). Recent analysis (October 1, 1993) shows that the Bu/Cy2 regimen along with the same MoAb purging method yields an improved outcome. Seven first complete-remission (CR) (CR1), 45 second- or third-CR (CR2/3), and 11 first-relapse (R1) patients were treated with chemotherapy and TBI or chemotherapy alone followed by ABMT with MoAb-purged BM. Median age at ABMT for those patients in CR 2/3 and R1 patients was 36 years. Twenty-nine CR 2/3 and R1 patients were conditioned with Cy/fTBI, and 27 CR2/3 and R1 patients were conditioned with Bu/CY. Using the Kaplan-Meier method, the CY/fTBI, CR2/3, and R1 patients have a 3-year disease-free survival (DFS) of 21%. On the other hand, the Bu/Cy2, CR2/3, and R1 patients have a 3-year DFS of 48%. Nineteen CR2/3 and R1 patients relapsed post-ABMT. On analysis by conditioning regimen, those treated with Cy/fTBI have a 3-year relapse rate (RR) of 58%, whereas the patients conditioned with Bu/Cy2 have a 39% 3-year RR. Long-term DFS can be achieved in about 50% of patients with advanced remissions and relapsed AML using Bu/Cy2 with MoAb-purged BM.
Engineering interaction between bone marrow derived endothelial cells and electrospun surfaces for artificial vascular graft applications.
Ahmed, Furqan; Dutta, Naba K; Zannettino, Andrew; Vandyke, Kate; Choudhury, Namita Roy
The aim of this investigation was to understand and engineer the interactions between endothelial cells and the electrospun (ES) polyvinylidene fluoride-co-hexafluoropropylene (PVDF-HFP) nanofiber surfaces and evaluate their potential for endothelialization. Elastomeric PVDF-HFP samples were electrospun to evaluate their potential use as small diameter artificial vascular graft scaffold (SDAVG) and compared with solvent cast (SC) PVDF-HFP films. We examined the consequences of fibrinogen adsorption onto the ES and SC samples for endothelialisation. Bone marrow derived endothelial cells (BMEC) of human origin were incubated with the test and control samples and their attachment, proliferation, and viability were examined. The nature of interaction of fibrinogen with SC and ES samples was investigated in detail using ELISA, XPS, and FTIR techniques. The pristine SC and ES PVDF-HFP samples displayed hydrophobic and ultrahydrophobic behavior and accordingly, exhibited minimal BMEC growth. Fibrinogen adsorbed SC samples did not significantly enhance endothelial cell binding or proliferation. In contrast, the fibrinogen adsorbed electrospun surfaces showed a clear ability to modulate endothelial cell behavior. This system also represents an ideal model system that enables us to understand the natural interaction between cells and their extracellular environment. The research reported shows potential of ES surfaces for artificial vascular graft applications. PMID:24564790
Reconstitution of the myeloid and lymphoid compartments after the transplantation of autologous and genetically modified CD34(+) bone marrow cells, following gamma irradiation in cynomolgus macaques
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Derdouch, S.; Gay, W.; Prost, S.; Le Dantec, M.; Delache, B.; Auregan, G.; Andrieu, T.; Le Grand, R. [CEA, DSV, Serv Immunovirol, Inst Maladies Emergentes et Therapies Innovantes, Fontenay Aux Roses (France); Derdouch, S.; Gay, W.; Prost, S.; Le Dantec, M.; Delache, B.; Auregan, G.; Andrieu, T.; Le Grand, R. [Univ Paris 11, UMR E01, Orsay (France); Negre, D.; Cosset, F. [Univ Lyon, UCB Lyon 1, IFR 128, F-69007 Lyon (France); Negre, D.; Cosset, F. [INSERM, U758, F-69007 Lyon (France); Negre, D.; Cosset, F.L. [Ecole NormaleSuper Lyon, F-69007 Lyon (France); Leplat, J.J. [CEA, DSV, IRCM, SREIT, Lab Radiobiol, F-78352 Jouy En Josas (France); Leplat, J.J. [CEA, DSV, IRCM, SREIT, Etude Genome, F-78352 Jouy En Josas (France); Leplat, J.J. [INRA, DGA, Radiobiol Lab, F-78352 Jouy En Josas (France); Leplat, J.J. [INRA, DGA, Etude Genome, F-78352 Jouy En Josas (France)
Prolonged, altered hematopoietic reconstitution is commonly observed in patients undergoing myelo-ablative conditioning and bone marrow and/or mobilized peripheral blood-derived stem cell transplantation. We studied the reconstitution of myeloid and lymphoid compartments after the transplantation of autologous CD34{sup +} bone marrow cells following gamma irradiation in cynomolgus macaques. The bone marrow cells were first transduced ex vivo with a lentiviral vector encoding eGFP, with a mean efficiency of 72% {+-} 4%. The vector used was derived from the simian immunodeficiency lentivirus SIVmac251, VSV-g pseudo-typed and encoded eGFP under the control of the phosphoglycerate kinase promoter. After myeloid differentiation, GFP was detected in colony-forming cells (37% {+-} 10%). A previous study showed that transduction rates did not differ significantly between colony-forming cells and immature cells capable of initiating long-term cultures, indicating that progenitor cells and highly immature hematopoietic cells were transduced with similar efficiency. Blood cells producing eGFP were detected as early as three days after transplantation,and eGFP-producing granulocyte and mononuclear cells persisted for more than one year in the periphery. Conclusion: The transplantation of CD34{sup +} bone marrow cells had beneficial effects for the ex vivo proliferation and differentiation of hematopoietic progenitors, favoring reconstitution of the T-and B-lymphocyte, thrombocyte and red blood cell compartments. (authors)
Reconstitution of the myeloid and lymphoid compartments after the transplantation of autologous and genetically modified CD34(+) bone marrow cells, following gamma irradiation in cynomolgus macaques
International Nuclear Information System (INIS)
Prolonged, altered hematopoietic reconstitution is commonly observed in patients undergoing myelo-ablative conditioning and bone marrow and/or mobilized peripheral blood-derived stem cell transplantation. We studied the reconstitution of myeloid and lymphoid compartments after the transplantation of autologous CD34+ bone marrow cells following gamma irradiation in cynomolgus macaques. The bone marrow cells were first transduced ex vivo with a lentiviral vector encoding eGFP, with a mean efficiency of 72% ┬▒ 4%. The vector used was derived from the simian immunodeficiency lentivirus SIVmac251, VSV-g pseudo-typed and encoded eGFP under the control of the phosphoglycerate kinase promoter. After myeloid differentiation, GFP was detected in colony-forming cells (37% ┬▒ 10%). A previous study showed that transduction rates did not differ significantly between colony-forming cells and immature cells capable of initiating long-term cultures, indicating that progenitor cells and highly immature hematopoietic cells were transduced with similar efficiency. Blood cells producing eGFP were detected as early as three days after transplantation,and eGFP-producing granulocyte and mononuclear cells persisted for more than one year in the periphery. Conclusion: The transplantation of CD34+ bone marrow cells had beneficial effects for the ex vivo proliferation and differentiation of hematopoietic progenitors, favoring reconstitution of the T-and B-lymphocyte, thrombocyte and red blood cell compartments. (authors)
Effects of Tongxinluo-facilitated cellular cardiomyoplasty with autologous bone marrow-mesenchymal stem cells on postinfarct swine hearts
Institute of Scientific and Technical Information of China (English)
QIAN Hai-yan; LU Min-jie; ZHAO Shi-hua; YANG Yue-jin; HUANG Ji; GAO Run-lin; DOU Ke-fei; YANG Guo-sheng; LI Jian-jun; SHEN Rui; HE Zuo-xiang
Background Treatment of ischemic heart disease remains an important challenge, though there have been enormous progresses in cardiovascular therapeutics. This study was conducted to evaluate whether Tongxinluo (TXL) treatment around the transplantation of mesenchymal stem cells (MSCs) can improve survival and subsequent activities of implanted cells in swine hearts with acute myocardial infarction (AMI) and reperfusion.Methods Twenty-eight Chinese mini-pigs were divided into four groups including a control group (n=7); group 2,administration of low-dose TXL alone from the 3rd day prior to AMI to the 4th day post transplantation (n=7); group 3,MSCs alone (n=7) and group 4, TXL + MSCs (n=7). AMI models were made by occlusion of the left anterior descending coronary artery for 90 minutes. Autologous bone marrow-MSCs (3├Ś107 cells/animal) were then injected into the post-infarct myocardium immediately after AMI and reperfusion. The survival and differentiation of implanted cells in vivo were detected by immunofluorescent analysis. The data of cardiac function were obtained at baseline (1 week after transplantation) and endpoint (6 weeks after transplantation) by single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Apoptosis was detected by TUNEL assay and the oxidative stress level was investigated in the post-infarct myocardium at endpoint.Results At endpoint, there was less fibrosis and inflammatory cell infiltration with more surviving myocardium in group 4 than in the control group. In group 4 the survival and differentiation of implanted MSCs were significantly improved more than that seen in group 3 alone (P'╝£0.0001); the capillary density was also significantly greater than in the control group,group 2 or 3 both in the infarcted zone (P'╝£0.0001) and the peri-infarct zone (P'╝£0.0001). MRI showed that parameters at baseline were not significantly different between the 4 groups. At endpoint, regional wall thickening and the
Relationship between alveolar cleft bone grafting and facial skeletal growth%ńēÖµ¦Įń¬üĶŻéµżŹķ¬©õĖÄķóīķ¬©ńö¤ķĢ┐ÕÅæĶé▓ńÜäÕģ│ń│╗
Institute of Scientific and Technical Information of China (English)
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Restriction specificity of virus-specific cytotoxic T cells from thymectomised irradiated bone marrow chimeras reconstituted with thymus grafts
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Adult-thymectomised lethally irradiated mice A that were reconstituted with T-cell-depleted bone marrow cells of (A X B)F1 origin plus fetal thymus grafts of (B X C)F1 origin generated virus-specific T cells restricted to B alone; adult-thymectomised and lethally irradiated (A X B)F1 mice that were reconstituted with T-cell depleted bone marrow cells of (A X B)F1 origin plus fetal thymus grafts of A and of B origin generated virus-specific T cells restricted to A or to B. These results do not reveal obvious suppressive influences of host or stem-cell origin that might have explained results obtained with various irradiated bone marrow or thymus chimeras, they indicate that the thymus' influence on maturing T cells is one of the limiting steps in the selection of T cells' restriction specificities. (Auth.)
Mesenchymal Stem Cells as a Potent Cell Source for Bone Regeneration
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Elham Zomorodian
Full Text Available While small bone defects heal spontaneously, large bone defects need surgical intervention for bone transplantation. Autologous bone grafts are the best and safest strategy for bone repair. An alternative method is to use allogenic bone graft. Both methods have limitations, particularly when bone defects are of a critical size. In these cases, bone constructs created by tissue engineering technologies are of utmost importance. Cells are one main component in the manufacture of bone construct. A few cell types, including embryonic stem cells (ESCs, adult osteoblast, and adult stem cells, can be used for this purpose. Mesenchymal stem cells (MSCs, as adult stem cells, possess characteristics that make them good candidate for bone repair. This paper discusses different aspects of MSCs that render them an appropriate cell type for clinical use to promote bone regeneration.
Combination of autologous bone marrow mesenchymal stem cells and cord blood mononuclear cells in the treatment of chronic thoracic spinal cord injury in 27 cases
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Lian-zhong WANG
Full Text Available Objective To investigate and evaluate therapeutic effects of transplantation of autologous bone marrow mesenchymal stem cells in conjunction with cord blood mononuclear cells for late thoracic spinal cord injury. Methods Data from 27 patients with late thoracic spinal cord injury who received transplantation of autologous bone marrow mesenchymal stem cells in conjunction with cord blood mononuclear cells in Neurosurgery Department of 463rd Hospital of PLA between July 2006 and July 2008 were collected and analyzed. The full treatment course consisted of 4 consecutive injections at one week apart. Indicators for evaluation followed that of the American Spiral Injury Association (ASIA Impairment Scale (AIS grade, ASIA motor and sensory scores, ASIA visual analog score, and the Ashworth score. The follow-up period was 6 months. Evaluations were made 6 weeks and 6 months after the treatment. Results Improvement from AIS A to AIS B was found in 4 patients. In one patient, improvement from AIS A to AIS C and in one patient from AIS B to AIS C was found 6 weeks after the treatment. The AIS improvement rate was 22.2%. In one patient improvement from AIS A to AIS B was found after 6 months. The overall AIS improvement rate was 25.9%. ASIA baseline motor scores of lower extremties were 0.5┬▒1.5, 1.7┬▒2.9, 3.1┬▒3.6 before the treatment, 6 weeks and 6 months after the treatment, respectively, and showed a statistically significant improvement (P < 0.05. ASIA sensory scores including light touch and pinprick were 66.6┬▒13.7 and 67.0┬▒13.6 respectively before treatment, and they became 68.8┬▒14.4, 68.4┬▒14.7 and 70.5┬▒14.4, 70.2┬▒14.4 six weeks and six months after the treatment. The changes were statistically significant (P < 0.05; Modified Ashworth Scale scores were 1.8┬▒1.5, 1.6┬▒1.2,1.1┬▒0.8 respectively at baseline, 6 weeks and 6months after the treatment, and showed a statistically significant descending trend (P < 0.05. Conclusion Transplantation of
A comparative study of outcome of ossiculoplasty using cartilage graft, bone and different alloplasts in chronic otitis media
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Sougata Mahanty
Full Text Available Objective: The objective was to determine which material, among autologous cartilage, autologous incus and partial ossicular replacement prosthesis (PORP, gives better postoperative hearing result in ossiculoplasty. Study Design: Nonrandomized prospective cohort (longitudinal study. Settings: Tertiary referral center. Materials and Methods: Patients were selected from outpatients department with the clinical diagnosis of chronic suppurative otitis media with cholesteatoma or granulation tissue. Patients underwent necessary preoperative investigations including pure tone audiometry (PTA. Total 67 patients were selected for this study, among them 12 patients did not fit the selection criteria and 5 patients lost during follow-up. Hence, total 50 patients were taken in the study group. Intervention: Ossiculoplasty with cartilage, incus and PORP after modified radical mastoidectomy. Main Outcome Measure: Hearing results were measured by PTA-air bone gap (PTA-ABG after 6 months of operation. Results: Selecting the criteria <20 dB ABG as success when stapes superstructure is present, cartilage has 60% success rate, incus has 73.68%, and PORP has 56.25% success. Extrusion rate of different prosthesis shows, PORP has 25%, cartilage has 20% extrusion. Incus has the lowest (5.26% extrusion rate. Conclusion: Among the ossiculoplasty materials, autologous incus gives best postoperative hearing gain and lowest extrusion rate.
Osteogenic protein-1 increases the fixation of implants grafted with morcellised bone allograft and ProOsteon bone substitute: an experimental study in dogs
DEFF Research Database (Denmark)
Baad-Hansen, Thomas Einer; Overgaard, S; Lind, M;
weeks osteogenic protein-1 increased bone formation and the energy absorption of implants grafted with allograft and ProOsteon. A composite of allograft, ProOsteon and osteogenic protein-1 was comparable, but not superior to, allograft used on its own. ProOsteon alone cannot be recommended as a......Impacted bone allograft is often used in revision joint replacement. Hydroxyapatite granules have been suggested as a substitute or to enhance morcellised bone allograft. We hypothesised that adding osteogenic protein-1 to a composite of bone allograft and non-resorbable hydroxyapatite granules...... surrounded by a concentric 3 mm gap. These gaps were randomly allocated to four different procedures in each dog: 1) bone allograft used on its own; 2) ProOsteon used on its own; 3) allograft and ProOsteon used together; or 4) allograft and ProOsteon with the addition of osteogenic protein-1. After three...
Six-month angiographic study of immediate autologous bone marrow mononuclear cell implantation on acute anterior wall myocardial infarction using a mini-pig model.
Sheu, Jiunn-Jye; Yuen, Chun-Man; Sun, Cheuk-Kwan; Chang, Li-Teh; Yen, Chia-Hung; Chiang, Chiang-Hua; Ko, Sheung-Fat; Pei, Sung-Nan; Chua, Sarah; Bhasin, Anuj; Wu, Chiung-Jen; Yip, Hon-Kan
This study investigated six-month angiographic results of autologous bone marrow mononuclear cell (BMMNC) transplantation immediately following acute myocardial infarction (AMI) in a mini-pig model.AMI was induced by left anterior descending artery ligation. Twenty-four mini-pigs were equally divided into group 1 [AMI plus saline injection in infarcted area (IA)], group 2 (AMI plus BMMNC transplantation into non-IA), group 3 (AMI plus BMMNC implantation into IA), and group 4 (sham control). One-week cultured BMMNCs (3.0 x 10(7)) were immediately transplanted following AMI induction. Angiographic studies over 6 months demonstrated that mitral regurgitation (MR) was lower in groups 3 and 4 than in groups 1 and 2 (all P < 0.01). Wall motion scores and left ventricular ejection fraction (LVEF) were higher in groups 3 and 4 than in groups 1 and 2 (all P < 0.05). Collateral circulation was higher in group 3 than in groups 1 and 2 ( P < 0.01). The wall thickness of the IA was higher, whereas the heart weight was lower in group 3 than in groups 1 and 2 (all P < 0.01).Immediate autologous BMMNC transplantation into IA is superior to saline-treated only or BMMNC transplantation into non-IA following AMI for reducing MR and improving LVEF. PMID:19367032
The Influence of Autologous Bone Marrow Stem Cell Transplantation on Matrix Metalloproteinases in Patients Treated for Acute ST-Elevation Myocardial Infarction
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Eline Bredal Furenes
Full Text Available Background. Matrix metalloproteinase-9 (MMP-9, regulated by tissue inhibitor of metalloproteinase-9 (TIMP-1 and the extracellular matrix metalloproteinase inducer (EMMPRIN, contributes to plaque instability. Autologous stem cells from bone marrow (mBMC treatment are suggested to reduce myocardial damage; however, limited data exists on the influence of mBMC on MMPs. Aim. We investigated the influence of mBMC on circulating levels of MMP-9, TIMP-1, and EMMPRIN at different time points in patients included in the randomized Autologous Stem-Cell Transplantation in Acute Myocardial Infarction (ASTAMI trial (n=100. Gene expression analyses were additionally performed. Results. After 2-3 weeks we observed a more pronounced increase in MMP-9 levels in the mBMC group, compared to controls (P=0.030, whereas EMMPRIN levels were reduced from baseline to 2-3 weeks and 3 months in both groups (P<0.0001. Gene expression of both MMP-9 and EMMPRIN was reduced from baseline to 3 months. MMP-9 and EMMPRIN were significantly correlated to myocardial injury (CK: P=0.005 and P<0.001, resp. and infarct size (SPECT: P=0.018 and P=0.008, resp.. Conclusion. The results indicate that the regulation of metalloproteinases is important during AMI, however, limited influenced by mBMC.
Improvement of myocardial perfusion reserve detected by cardiovascular magnetic resonance after direct endomyocardial implantation of autologous bone marrow cells in patients with severe coronary artery disease
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Lau Chu-Pak
Full Text Available Abstract Background Recent studies suggested that bone marrow (BM cell implantation in patients with severe chronic coronary artery disease (CAD resulted in modest improvement in symptoms and cardiac function. This study sought to investigate the functional changes that occur within the chronic human ischaemic myocardium after direct endomyocardial BM cells implantation by cardiovascular magnetic resonance (CMR. Methods and Results We compared the interval changes of left ventricular ejection fraction (LVEF, myocardial perfusion reserve and the extent of myocardial scar by using late gadolinium enhancement CMR in 12 patients with severe CAD. CMR was performed at baseline and at 6 months after catheter-based direct endomyocardial autologous BM cell (n = 12 injection to viable ischaemic myocardium as guided by electromechanical mapping. In patients randomized to receive BM cell injection, there was significant decrease in percentage area of peri-infarct regions (-23.6%, P = 0.04 and increase in global LVEF (+9.0%, P = 0.02, the percentage of regional wall thickening (+13.1%, P= 0.04 and MPR (+0.25%, P = 0.03 over the target area at 6-months compared with baseline. Conclusions Direct endomyocardial implantation of autologous BM cells significantly improved global LVEF, regional wall thickening and myocardial perfusion reserve, and reduced percentage area of peri-infarct regions in patients with severe CAD.
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fulfilling the predetermined inclusion and exclusion criteria were included in the study. STATISTICAL METHODS : Intergroup comparison was analysed by K - Independent sample t test. Intragroup comparison was analysed by Paired t - test. RESULTS : Patients were divided into two groups and treated with using Bone - patellar tendon - bone graft and Hamstring graft respectively. Mean age group of patients was 29.16 yrs. (range 16 - 51yrs and 30.88 yrs. (range 19 - 48yrs in group A and B respectively we found the incidence of ACL injury in 15 - 44 years age group to be greater than twice the general population. A mean delay in surgery of 4.66 months (range 2 - 12 months since the time of injury in group A and 4.46 months (range 2 - 7 months in group B was observed. Subjective IKDC evaluation was done at the end of 12 months. Ther e was no difference in both the groups in the terms of effusion, passive motion, knee compartment findings, ligament examination, X - ray findings. Functional test and IKDC grade of both the groups showed statistically very highly significant improvement. Ho wever, there was statistically very high Harvest site pathology in group A. CONCLUSION : We found that there is statistically no significant difference in the overall clinical outcome between hamstring autograft with transfix and bone - patellar tendon bone autograft with interference screw except that the patellar tendon group had a greater tendency of having donor site morbidity compared to the hamstring tendon group.
Acetabular defect reconstruction with impacted morsellized bone grafts or TCP/HA particles. A study on the mechanical stability of cemented cups in an artificial acetabulum model.
Bolder, S.B.T.; Verdonschot, N.J.J.; Schreurs, B.W.; Buma, P.
In revision surgery of the acetabulum bone defects can be filled with impacted human morsellized bone grafts. Because of a worldwide limited availability of human bone, alternatives are being considered. In this study we compared the initial stability of acetabular cups after reconstructing a cavita
Coracoid bone graft osteolysis after Latarjet procedure: A comparison study between two screws standard technique vs mini-plate fixation
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Giovanni Di Giacomo
Full Text Available Aims: One of the reason for Latarjet procedure failure may be coracoid graft osteolysis. In this study, we aimed to understand if a better compression between the coracoid process and the glenoid, using a mini-plate fixation during the Latarjet procedure, could reduce the amount of coracoid graft osteolysis. Materials and Methods: A computed tomography scan analysis of 26 prospectively followed-up patients was conducted after modified Latarjet procedure using mini-plate fixation technique to determine both the location and the amount of coracoid graft osteolysis in them. We then compared our current results with results from that of our previous study without using mini-plate fixation to determine if there is any statistical significant difference in terms of corcacoid bone graft osteolysis between the two surgical techniques. Results: The most relevant osteolysis was represented by the superficial part of the proximal coracoid, whereas the deep part of the proximal coracoid graft is least involved in osteolysis and has best bone healing. The current study showed a significant difference only for the deep part of the distal coracoid with our previous study (P < 0.01. Discussion: To our knowledge, there are no studies in literature that show the causes of coracoid bone graft osteolysis after Latarjet procedure. Conclusion: Our study suggests that there is a significant difference only for the deep part of the distal coracoid in terms of osteolysis. At clinical examination, this difference did not correspond with any clinical findings. Level of Evidence: Level 4. Clinical Relevance: Prospective case series, Treatment study.
Impaction grafting with morsellised allograft and tricalcium phosphate-hydroxyapatite: incorporation within ovine metaphyseal bone defects.
Pratt, J N J; Griffon, D J; Dunlop, D G; Smith, N; Howie, C R
An ovine model was used to investigate the in vivo properties of impacted tricalcium phosphate-hydroxyapatite (TCP-HA) aggregates, varying in chemical composition (ratio of TCP to HA) and particle size distribution (8 versus 3 particle size ranges). All pellets were impacted to a standard compactive effort. Eight sheep underwent implantation of pellets in 4 metaphyseal defects in both rear limbs. Treatment groups consisted of: (1) allograft (clinical control). (2) 50/50 allograft/80% HA/20% TCP in 8 particle size ranges, (3) 50/50 allograft/80% TCP/20% HA in 8 sizes and (4) 50/50 allograft/80% HA/20% TCP in only 3 sizes of particles. Healing of defects was evaluated at 14 weeks with computed tomography, histology and histomorphometry. The computer tomography (CT) density measured in all defects containing synthetic agents was higher than in defects filled with allograft alone (p<0.01). Defects containing 8 sizes of 80% HA/ 20% TCP granules (group 2) achieved lower histological scores and contained less bone than the clinical control (p<0.05), whereas groups 3 and 4 did not differ from the control. Although all synthetic agents were osteoconductive, our results suggest that increasing the ratio of TCP over HA and limiting the number of particle size ranges to 3 instead of 8 improve the performance of impacted aggregates as graft expanders. Evaluation under loading conditions of morsellised allograft expanded with 80% TCP/20% HA (BoneSave) in 3 particle size ranges is warranted.
Pure orbital blowout fractures reconstructed with autogenous bone grafts: functional and aesthetic outcomes.
Kronig, S A J; van der Mooren, R J G; Strabbing, E M; Stam, L H M; Tan, J A S L; de Jongh, E; van der Wal, K G H; Paridaens, D; Koudstaal, M J
The purpose of this study was to investigate the ophthalmic clinical findings following surgical reconstruction with autogenous bone grafts of pure blowout fractures. A retrospective review of 211 patients who underwent surgical repair of an orbital fracture between October 1996 and December 2013 was performed. Following data analysis, 60 patients who were followed up over a period of 1 year were included. A solitary floor fracture was present in 38 patients and a floor and a medial wall fracture in 22 patients. Comparing preoperative findings between these two groups, preoperative diplopia and enophthalmos were almost twice as frequent in the group with additional medial wall fractures: diplopia 8% and 14% and enophthalmos 18% and 55%, respectively. One year following surgery there was no diplopia present in either group. In the solitary floor fracture group, 3% still had enophthalmos. It can be concluded that at 1 year following the repair of pure orbital floor fractures using autogenous bone, good functional and aesthetic results can be obtained. In the group with both floor and medial wall fractures, no enophthalmos was found when both walls were reconstructed. When the medial wall was left unoperated, 29% of patients still suffered from enophthalmos after 1 year.
Tolerance to MHC class II disparate allografts through genetic modification of bone marrow
Jindra, Peter T.; TRIPATHI, SUDIPTA; Tian, Chaorui; Iacomini, John; Bagley, Jessamyn
Induction of molecular chimerism through genetic modification of bone marrow is a powerful tool for the induction of tolerance. Here we demonstrate for the first time that expression of an allogeneic MHC class II gene in autologous bone marrow cells, resulting in a state of molecular chimerism, induces tolerance to MHC class II mismatched skin grafts, a stringent test of transplant tolerance. Reconstitution of recipients with syngeneic bone marrow transduced with retrovirus encoding H-2I-Ab (...
Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion
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Kleiner JB
Full Text Available Jeffrey B Kleiner, Hannah M Kleiner, E John Grimberg Jr, Stefanie J Throlson The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA Study design: Disk material removed (DMR during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF surgery was compared to the corresponding bone graft (BG volumes inserted at the time of fusion. A novel BG delivery tool (BGDT was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD. This study was performed prospectively. Summary of background data: Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified. Methods: A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD. Results: DMR volumes averaged 3.6┬▒2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3┬▒3.2 mL, which is 2.6┬▒2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute. Conclusion: The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk
The beneficial effects of intracoronary autologous bone marrow stem cell transfer as an adjunct to percutaneous coronary intervention in patients with acute myocardial infarction.
Wang, Xiang; Xi, Wei-Chun; Wang, Fang
The efficacy of post-percutaneous coronary intervention (PCI) intracoronary injection with bone marrow mesenchymal stem cells (BMSCs) in patients with acute myocardial infarction (AMI) remains controversial. Here, 58 patients with AMI undergoing PCI were randomly divided into two groups: BMSC and control groups. Autologous BSMCs were then generated in vitro from the BMSC patients. After transplantation, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimensions (LVDd), and infarct size (IS) were evaluated in both groups. LVEF, LVDd, and IS improved after BMSC transplantation but the changes were not significantly different from those in the controls. The number of adverse events and rehospitalization rates after 1┬Āmonth were significantly higher in the control group than in the BMSC group. BMSC transplantation thus benefits patients by decreasing the number of adverse events and reducing the rehospitalization rate in the early stages following PCI. PMID:24975729
Polymorphisms in the genes ERCC2, XRCC3 and CD3EAP influence treatment outcome in multiple myeloma patients undergoing autologous bone marrow transplantation
DEFF Research Database (Denmark)
Vangsted, Annette; Gimsing, Peter; Klausen, Tobias W;
Individual variations in the ability to cope with DNA damage by DNA repair may be essential for the response to chemotherapy, since cancer cells from patients with an effective DNA repair may survive treatment. We have studied the effect on time to treatment failure (TTF) and overall survival (OS......) of polymorphism in the DNA repair genes ERCC1, ERCC2 and XRCC3, and in the apoptotic genes PPP1R13L and CD3EAP in 348 patients with multiple myeloma undergoing autologous bone marrow transplantation. Carriers of the variant C-allele of ERCC2 K751Q, the variant T-allele of XRCC3 T241M and the variant A...
Proximal Tibia Chondroblastoma Treated With Curettage and Bone Graft and Cement Use.
Cho, Hwan Seong; Park, Yeong Kyoon; Oh, Joo Han; Lee, Jung Hyun; Han, Ilkyu; Kim, Han-Soo
Chondroblastoma has a predilection for the epiphyses or apophyses of long tubular bones. Management of lesions in the proximal tibia is challenging because it is difficult to gain access to intraepiphyseal lesions for completion of curettage. From October 2007 to December 2011, 9 patients with de novo chondroblastoma of the proximal tibia underwent surgery at the authors' institution. All patients initially presented with pain, and 5 patients had limitation of range of motion of the ipsilateral knee. Four lesions abutted the tibial attachment sites of the cruciate ligaments. Surgical procedures included intralesional tumor curettage, additional burring, and packing of the defect with bone graft and/or bone cement. The extra-articular approach was used according to tumor location. The medial or lateral parapatellar approach was used when the tumor was located in the anterior two-thirds of the horizontal plane. When a lesion was located in the posterior third, the posteromedial or posterolateral approach was used as the lesion was cornered. Mean duration of follow-up was 47.2 months (range, 27-80 months). No local recurrence or pulmonary metastasis was noted at latest follow-up. Mean functional score was 29.3 points (range, 28-30 points). All patients fully recovered range of motion in the affected knee. No avulsion fracture or anteroposterior instability of the knee joint was detected. Results of the current study suggest that intralesion curettage followed by additional burring with an extra-articular approach is a successful treatment option for chondroblastoma of the proximal tibia.
Proximal Tibia Chondroblastoma Treated With Curettage and Bone Graft and Cement Use.
Cho, Hwan Seong; Park, Yeong Kyoon; Oh, Joo Han; Lee, Jung Hyun; Han, Ilkyu; Kim, Han-Soo
Chondroblastoma has a predilection for the epiphyses or apophyses of long tubular bones. Management of lesions in the proximal tibia is challenging because it is difficult to gain access to intraepiphyseal lesions for completion of curettage. From October 2007 to December 2011, 9 patients with de novo chondroblastoma of the proximal tibia underwent surgery at the authors' institution. All patients initially presented with pain, and 5 patients had limitation of range of motion of the ipsilateral knee. Four lesions abutted the tibial attachment sites of the cruciate ligaments. Surgical procedures included intralesional tumor curettage, additional burring, and packing of the defect with bone graft and/or bone cement. The extra-articular approach was used according to tumor location. The medial or lateral parapatellar approach was used when the tumor was located in the anterior two-thirds of the horizontal plane. When a lesion was located in the posterior third, the posteromedial or posterolateral approach was used as the lesion was cornered. Mean duration of follow-up was 47.2 months (range, 27-80 months). No local recurrence or pulmonary metastasis was noted at latest follow-up. Mean functional score was 29.3 points (range, 28-30 points). All patients fully recovered range of motion in the affected knee. No avulsion fracture or anteroposterior instability of the knee joint was detected. Results of the current study suggest that intralesion curettage followed by additional burring with an extra-articular approach is a successful treatment option for chondroblastoma of the proximal tibia. PMID:26726978
Regeneration of human bones in hip osteonecrosis and human cartilage in knee osteoarthritis with autologous adipose-tissue-derived stem cells: a case series
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Pak Jaewoo
Full Text Available Abstract Introduction This is a series of clinical case reports demonstrating that a combination of percutaneously injected autologous adipose-tissue-derived stem cells, hyaluronic acid, platelet rich plasma and calcium chloride may be able to regenerate bones in human osteonecrosis, and with addition of a very low dose of dexamethasone, cartilage in human knee osteoarthritis. Case reports Stem cells were obtained from adipose tissue of abdominal origin by digesting lipoaspirate tissue with collagenase. These stem cells, along with hyaluronic acid, platelet rich plasma and calcium chloride, were injected into the right hip of a 29-year-old Korean woman and a 47-year-old Korean man. They both had a history of right hip osteonecrosis of the femoral head. For cartilage regeneration, a 70-year-old Korean woman and a 79-year-old Korean woman, both with a long history of knee pain due to osteoarthritis, were injected with stem cells along with hyaluronic acid, platelet rich plasma, calcium chloride and a nanogram dose of dexamethasone. Pre-treatment and post-treatment MRI scans, physical therapy, and pain score data were then analyzed. Conclusions The MRI data for all the patients in this series showed significant positive changes. Probable bone formation was clear in the patients with osteonecrosis, and cartilage regeneration in the patients with osteoarthritis. Along with MRI evidence, the measured physical therapy outcomes, subjective pain, and functional status all improved. Autologous mesenchymal stem cell injection, in conjunction with hyaluronic acid, platelet rich plasma and calcium chloride, is a promising minimally invasive therapy for osteonecrosis of femoral head and, with low-dose dexamethasone, for osteoarthritis of human knees.
Late effects in survivors of Hodgkin and non-Hodgkin lymphoma treated with autologous hematopoietic cell transplantation: a report from the bone marrow transplant survivor study.
Majhail, Navneet S; Ness, Kirsten K; Burns, Linda J; Sun, Can-Lan; Carter, Andrea; Francisco, Liton; Forman, Stephen J; Bhatia, Smita; Baker, K Scott
We determined the prevalence of self-reported late-effects in survivors of autologous hematopoietic cell transplantation (HCT) for Hodgkin lymphoma (HL, n = 92) and non-Hodgkin lymphoma (NHL, n = 184) using a 255-item questionnaire and compared them to 319 sibling controls in the Bone Marrow Transplant Survivor Study. Median age at HCT was 39 years (range: 13-69) and median posttransplant follow-up was 6 years (range: 2-17). Median age at survey was 46 years (range: 21-73) for survivors and 44 years (range: 19-79) for siblings. Compared to siblings, HCT survivors reported a significantly higher frequency of cataracts, dry mouth, hypothyroidism, bone impairments (osteoporosis and avascular necrosis), congestive heart failure, exercise-induced shortness of breath, neurosensory impairments, inability to attend work or school, and poor overall health. Compared to those receiving no total-body irradiation (TBI), patients treated with TBI-based conditioning had higher risks of cataracts (odds-ratio [OR] 4.9, 95% confidence interval [CI] 1.5-15.5) and dry mouth (OR 3.4, 95% CI 1.1-10.4). Females had a greater likelihood of reporting osteoporosis (OR 8.7, 95% CI: 1.8-41.7), congestive heart failure (OR 4.3, 95% CI 1.1-17.2), and abnormal balance, tremor, or weakness (OR 2.4, 95% CI 1.0-5.5). HL and NHL survivors of autologous HCT have a high prevalence of long-term health-related complications and require continued monitoring for late effects of transplantation. PMID:17889351
Methodological approach for the evaluation of homologous bone graft use in post-extractive atrophic alveolar ridges
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B. Musante
Full Text Available The aim of this study is to investigate the in vivo efficacy of Puros® cancellous particulate allograft bone in the regeneration of post-extractive sites. Twelve molar or premolar sites were selected. Seven days after minimally invasive tooth extraction, Puros® cancellous particulate allografts were inserted into the elected sites. TC Cone-Beam investigation and at 4 months from surgery; bone height and width were evaluated. Five months after surgery, biopsy samples of the regenerated sites were taken and histologically analyzed to qualitatively evaluate bone regeneration. TC analysis showed, a mean bone gain of 4.1 mm in height and 2.02 mm in width. The histological analysis of the samples showed intense bone metabolic activity with active osteoblasts on the implant surface, at the level of the native bone-graft interface and in the grafted area. The radiographic and histological analyses demonstrate an optimal bonen regeneration, both in terms of quality and quantity using Puros®.
Expression of bone morphogenic protein 2/4, transforming growth factor-╬▓1, and bone matrix protein expression in healing area between vascular tibia grafts and irradiated bone-experimental model of osteonecrosis
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Purpose: For the surgical treatment of osteoradionecrosis after multimodal therapy of head-and-neck cancers, free vascular bone grafts are used to reconstruct osseous structures in the previously irradiated graft bed. Reduced, or even absent osseous healing in the transition area between the vascular graft and the irradiated graft bed represents a clinical problem. Inflammatory changes and fibrosis lead to delayed healing, triggered by bone morphogentic protein 2/4 (BMP2/4) and transforming growth factor (TGF)-╬▓1. Given the well-known fibrosis-inducing activity of TGF-╬▓1, an osteoinductive effect has been reported for BMP2/4. However, the influence of irradiation (RT) on this cytokine expression remains elusive. Therefore, the aim of the present in vivo study was to analyze the expression of BMP2/4, TGF-╬▓1, collagen I, and osteocalcin in the transition area between the bone graft and the graft bed after RT. Methods and materials: Twenty Wistar rats (male, weight 300-500 g) were used in this study. A free vascular tibia graft was removed in all rats and maintained pedicled in the groin region. Ten rats underwent RT with 5 x 10 Gy to the right tibia, the remainder served as controls. After 4 weeks, the previously removed tibia grafts were regrafted into the irradiated (Group 1) and nonirradiated (Group 2) graft beds. The interval between RT and grafting was 4 weeks. After a 4-week osseous healing period, the bone grafts were removed, and the transition area between the nonirradiated graft and the irradiated osseous graft bed was examined histomorphometrically (National Institutes of Health imaging program) and immunohistochemically (avidin-biotin-peroxidase complex) for the expression of BMP2/4, TGF-╬▓1, collagen I, and osteocalcin. Results: Absent or incomplete osseous healing of the graft was found in 9 of 10 rats after RT with 50 Gy and in 1 of 10 of the rats with nonirradiated osseous grafts. Histomorphometrically, the proportion of osseous healing in the
Graft-versus-leukemia effects from donor lymphocyte infusion after nonmyeloablative allogeneic bone marrow transplantation in mice
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DU Bing; LI De-peng; XU Kai-lin; PAN Xiu-ying
Background Nonmyeloablative allogeneic bone marrow transplantation has been used since the 1990s as a new hematological stem cell transplantation strategy for treating hematological diseases. The purpose of this study was to explore the graft-versus-leukemia (GVL) effects of donor lymphocyte infusions (DLIs) after nonmyeloablative allogeneic bone marrow transplantations, while assessing the declines in treatment-associated morbidity, mortality, and graft-versus-host disease (GVHD).Methods A total of 615 (H-2k) mice were injected with L615 tumor cells and received 500 cGy (60Co╬│-ray) irradiation three days later, followed by an allogeneic bone marrow transplantation (allo-BMT). The allo-grafts consisted of 3├Ś107 bone marrow cells and 1├Ś107 spleen cells from BALB/C (H-2d) donor mice. Two days after the allo-BMT, the recipient mice were given 200 mg/kg of cyclophosphamide. Subsequently, recipient mice were infused with either donor spleen cells (2├Ś107) on day 14 or 21, or donor spleen cells (5├Ś107) pretreated with hydrocortisone and cyclosporin A (CsA) in vitro on day 14 post-BMT.Results The median survival time of mice that received DLI on day 21 and pretreated DLI on day 14 post-BMT was longer than that of controls and the day 14 DLI group (P<0.01). No evidence of severe GVHD was observed in the day 21 DLI group nor in the day 14 treated DLI group. Mixed chimerism was confirmed in the day 14 DLI group, the day 14 treated DLI group, and the day 21 DLI group on the thirteenth day post-transplantation; full donor chimerism was observed two weeks after DLI.Conclusion Donor lymphocyte infusion after nonmyeloablative bone marrow transplantation may reduce transplantation-associated morbidity and mortality while strengthening graft-versus-leukemia effects.
Scaffold- and Cell System-Based Bone Grafts in Tissue Engineering (Review
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Kuznetsova D.S.
Full Text Available The review considers the current trends in tissue engineering including maxillofacial surgery based on the use of scaffolds, autologous stem cells and bioactive substances. The authors have shown the advantages and disadvantages of basic materials used for scaffold synthesis ŌĆö three-dimensional porous or fiber matrices serving as a mechanical frame for cells; among such materials there are natural polymers (collagen, cellulose, fibronectin, chitosan, alginate and agarose, fibroin, synthetic polymers (polylactide, polyglycolide, polycaprolactone, polyvinyl alcohol and bioceramics (hydroxyapatite, tricalcium phosphate and bioactive glasses. There have been demonstrated the matrix techniques, special attention being paid to innovative technologies of rapid prototyping ŌĆö the process of 3D-imaging according to a digital model. The most applicable of these techniques for biopolymers are laser stereolithography, selective laser sintering, fused deposition modeling, and 3D-printing. Great emphasis has been put on the use of bioactive substances in the process of obtaining scaffold-based bioengineered constructions ŌĆö setting of stem cells on matrices before their transplantation to the defect area. Special attention has been given to a current trend of cellular biology ŌĆö the application of multipotent mesenchymal stromal cells (most common marrow cells used in bone tissue regeneration, in particular, the available sources of their isolation and the variants of directed osteogenic differentiation have been presented. The review covers the characteristics and aims of bioactive substance inclusion in scaffold structure ŌĆö not only to induce osteogenic differentiation, but also to attract new stem cells of a carrier, as well as promote angiogenesis.
A Case Report of Multiple Aneurysmal Bone Cysts
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@@ Case Report A 30-year old male patient, admitted in our hospital for a fracture of the upper end of the left humerus in February, 2006, received treatment with curettage of the lesion in combination with an autologous bone graft from the right ilium plus internal fixation. A post-operative pathological examination indicated that there was a simple bone cyst in the area of the fracture, with a satisfactory postoperative recovery.
MRI follow-up examination of the knee after reconstruction of the anterior cruciate ligament with an autologous tendon graft; MRT des Knies in der Verlaufskontrolle der vorderen Kreuzbandplastik aus autologer Semitendinosussehne
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Bachmann, G. [Giessen Univ. (Germany). Roentgenabteilung Innere Medizin; Cassens, J. [Giessen Univ. (Germany). Orthopaedische Klinik; Heinrichs, C. [Giessen Univ. (Germany). Inst. fuer Pathologie; Saltenberger, H. [Giessen Univ. (Germany). Orthopaedische Klinik; Bauer, T. [Giessen Univ. (Germany). Roentgenabteilung Innere Medizin; Rauber, K. [Giessen Univ. (Germany). Roentgenabteilung Innere Medizin
In a prospective study, 153 MRI examinations were performed on 74 patients following reconstruction of a ruptured anterior cruciate ligament with a semitendinous graft. MRI examinations were performed at three defined intervals (3 months, 4 to 12 months, and 1 to 2 years postoperatively), and the findings were compared to simultaneous clinical tests to define stability criteria. This permitted reliable assessment of the integrity of the ligament graft; in three cases we correctly diagnosed a ruptured graft. A well defined tendon graft with recognizable fibrous structures correlated with a clinically stable ligament in 98% of the cases. Due to physiological transformation occurring from three months to one year postoperatively, that graft temporarily appears less distinct. Complete integration of the graft with full stability of the knee is visualized in the MRI scan as a tendon with low signal intensity. Postoperative complications and the desire to participate in sports activities are indications for MRI examination. (orig.) [Deutsch] In der prospektiven Studie wurden 153 MRT-Untersuchungen an 74 Patienten mit autologen Sehnentransplantaten (Semitendinosussehne) zum Ersatz des rupturierten vorderen Kreuzbandes durchgefuehrt. Die MRT-Kontrollen erfolgten in drei definierten Zeitintervallen (bis 3 Monate, 4 bis 12 Monate, 1 bis 2 Jahre) nach Anlage der Bandplastik. Die Befunde wurden mit den Ergebnissen gleichzeitig durchgefuehrter klinischer Funktionstests verglichen, um Kriterien fuer die Stabilitaet der Bandplastik zu definieren. Die Intaktheit der Bandplastik war zuverlaessig zu beurteilen und eine Ruptur in allen drei Faellen richtig erkannt worden. Physiologische Umbauvorgaenge in der Sehnenplastik vom 3. bis 12. postoperativen Monat fuehren zu einer voruebergehenden schlechteren Abgrenzbarkeit der Bandplastik in allen Sequenzen. Der Abschluss des Transplantatumbaus bei voller Stabilitaet des Knies wird durch eine signalarme Bandplastik im MRT dokumentiert
Peripheral blood stem cell graft compared to bone marrow after reduced intensity conditioning regimens for acute leukemia: a report from the ALWP of the EBMT
Savani, Bipin N.; Labopin, Myriam; Blaise, Didier; Niederwieser, Dietger; Ciceri, Fabio; Ganser, Arnold; Arnold, Renate; Afanasyev, Boris; Vigouroux, Stephane; Milpied, Noel; Hallek, Michael; Cornelissen, Jan J.; Schwerdtfeger, Rainer; Polge, Emmanuelle; Baron, Fr├®d├®ric; Esteve, Jordi; Gorin, Norbert C.; Schmid, Christoph; Giebel, Sebastian; Mohty, Mohamad; Nagler, Arnon
Increasing numbers of patients are receiving reduced intensity conditioning regimen allogeneic hematopoietic stem cell transplantation. We hypothesized that the use of bone marrow graft might decrease the risk of graft-versus-host disease compared to peripheral blood after reduced intensity conditioning regimens without compromising graft-versus-leukemia effects. Patients who underwent reduced intensity conditioning regimen allogeneic hematopoietic stem cell transplantation from 2000 to 2012 for acute leukemia, and who were reported to the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation were included in the study. Eight hundred and thirty-seven patients receiving bone marrow grafts were compared with 9011 peripheral blood transplant recipients after reduced intensity conditioning regimen. Median follow up of surviving patients was 27 months. Cumulative incidence of engraftment (neutrophil Ōēź0.5├Ś109/L at day 60) was lower in bone marrow recipients: 88% versus 95% (P<0.0001). Grade II to IV acute graft-versus-host disease was lower in bone marrow recipients: 19% versus 24% for peripheral blood (P=0.005). In multivariate analysis, after adjusting for differences between both groups, overall survival [Hazard Ratio (HR) 0.90; P=0.05] and leukemia-free survival (HR 0.88; P=0.01) were higher in patients transplanted with peripheral blood compared to bone marrow grafts. Furthermore, peripheral blood graft was also associated with decreased risk of relapse (HR 0.78; P=0.0001). There was no significant difference in non-relapse mortality between recipients of bone marrow and peripheral blood grafts, and chronic graft-versus-host disease was significantly higher after peripheral blood grafts (HR 1.38; P<0.0001). Despite the limitation of a retrospective registry-based study, we found that peripheral blood grafts after reduced intensity conditioning regimens had better overall and leukemia-free survival than bone marrow grafts. However
Õģ│ĶŖéķĢ£õĖŗĶć¬õĮōĶģśń╗│ĶéīÕÆīÕ╝éõĮōĶā½ÕēŹĶéīÕŹĢµØ¤ķćŹÕ╗║ÕēŹõ║żÕÅēķ¤¦ÕĖ"ńÜä1Õ╣┤ķÜÅĶ«┐µ»öĶŠā%Autologous hamstring grafts versus allogeneic anterior tibial muscle tendon grafts for arthroscopic reconstruction of single-bundle anterior cruciate ligament: A one-year follow-up
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ńÄŗµ┤¬; Dhakal Rabi Mohan; ÕŁ¤µśźÕ║å; µ«ĄÕŠĘÕ«ć; µØ©Ķ┐░ÕŹÄ; µØ£ķØ¢Ķ┐£; Õöɵ¼Ż; µØÄń½ŗńŠż; µ¢╣ķØÆ; µ▒żµśÄ
BACKGROUND: Due to artificial ligament has chronic fatigue, mere and mere people use a lie graft for the reconstruction of anterior and the posterior cruciate ligament injury.OBJECTP/E: To compare the curath/e effect aftei aithroscopic reconstruction of single-bundle ante lie t cruciate ligament using autclogous hamstring grafts and allogeneic anterior tibial muscle tendon grafts.METHODS: Cases of anterior cruciate ligament reconstruction which using single-bundle autologous hamstring grafts and allogeneic anterior tibia I muscle tend on grafts under arthrosco pic with 1 year follow up were collected. Totalry 23 cases were used autologous hamstring grafts for anterior cruciate ligament reconstruction, and 13 cases were used anterior tibial muscle tendon allograftfor anterior cruciate ligament reconstruction. The fixation of each reconstructed anterior cruciate Igamentwas done by femoral En do Button and tibial biodegradable interference screw. Using a brace to fix the troubled knee and having the physical training of the troubled knee lately and progress K/ely.RESULTS AND CONCLUSION; All the 43 cases were followed up for sk months after reconstruction. Lysholm score of the autologous tendon group was lower than that of the allogeneic tendon group 0.05). There was no significant difference between the two groups of Lysholm score after six months posto pe ratn/ery. Lysholmscore of the two groups after 6 months and a year construction postoperative showed significant difference as compared with preoperation (P < 005). There was significant difference of the Lysholm score after reconstruction in six months follow up and in one year follow up showing a statistic significance (f < 0.05). The curative effect of anterior cruciate ligament reconstruction using autologous hamstring grafts and allogeneic anterior tibial muscle tendon grafts is equally.%ĶāīµÖ»:ńö▒õ║Äõ║║ÕĘźķ¤¦ÕĖ"ÕŁśÕ£©µģóµĆ¦ń¢▓ÕŖ│,ĶČŖµØźĶČŖÕżÜńÜäõ║║ķććńö©Õ╝éõĮōĶéīĶģ▒ķćŹÕ╗║ÕēŹÕÉÄõ║żÕÅēķ¤¦ÕĖ"µŹ¤õ╝ż.ńø«ńÜä:µ»öĶŠāÕ
Transplantation of autologous bone marrow stem cells via hepatic artery for the treatment of acute hepatic injury: an experimental study in rabbits
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Objective: To evaluate the transplantation of autologous bone marrow stem cells via hepatic artery in treating acute hepatic injury in experimental rabbit models and to clarify the synergistic effect of hepatocyte growth-promoting factor (pHGF) in stem cell transplantation therapy for liver injury. Methods Acute hepatic injury models were established in 15 experimental rabbits by daily subcutaneous injection of CCl4 olive oil solution with the dose of 0.8 ml/kg for 4 days in succession. The experimental rabbits were randomly and equally divided into three groups: study group A (stem cell transplant, n = 5), study group B (stem cell transplant + pFHG, n = 5), and control group (n = 5). Bone marrow of 5 ml was drawn from the tibia in all rabbits of both study groups, from which bone marrow stem cells were isolated by using density gradient centrifugation, and 5 ml cellular suspension was prepared. Under fluoroscopic guidance, catheterization through the femoral artery was performed and the cellular suspension was infused into the liver via the hepatic artery. Only injection of saline was carried out in the rabbits of control group. For the rabbits in group B, pFHG (2.0 mg/kg) was administered intravenously every other day for 20 days. At 2, 4 and 8 weeks after stem cell transplantation, hepatic function was determined. Eight weeks after the transplantation all the rabbits were sacrificed and the liver specimens were collected and sent for pathological examination. Results After stem cell transplantation, the hepatic function was gradually improved.Eight weeks after the transplantation, the activity of AST, ALT and the content of ALB, TBIL were significantly lower than that before the procedure, while the content of GOLB was markedly increased in all rabbits. In addition, the difference in the above parameters between three groups was statistically significant (P < 0.05). Pathologically, the hepatocyte degeneration and the fiberous hyperplasia in the study groups were
Autologous bone grafting with platelet-rich plasma for alveolar cleft repair in patient with cleft and palate.
Giudice, Giuseppe; Cutrignelli, Daniela Anna; Leuzzi, Sara; Robusto, Fabio; Sportelli, Pasquale; Nacchiero, Eleonora
LŌĆÖinnesto osseo ├© essenziale nella terapia chirurgica della labiopalatoschisi (LPS), ma i tempi di osteogenesi ed integrazione ossea nella sede ricevente possono procrastinare i successivi interventi di ortodonzia. Nel nostro studio ├© stata valutata la capacit├Ā della PRP (platelet-rich plasma) associata al trapianto osseo nel diminuire il tempo dŌĆÖattesa e la durata del trattamento ortodontico in una coorte di 8 bambini, confrontandola con 8 controlli sottoposti a semplice innesto osseo. I risultati hanno mostrato come i soggetti sottoposti a trapianto osseo + PRP abbiano avuto la possibilit├Ā di essere sottoposti ad un trattamento ortodontico pi├╣ precoce (155 giorni vs 298) e pi├╣ breve (295 giorni vs 356) rispetto al gruppo di controllo. Inoltre nel gruppo di controllo si sono verificate con maggiore frequenza complicanze post-chirurgiche (quali fistole oro-nasali, disturbi periodontali, malattie dentali, perdita di spessore, massa o trabecolatura ossea) rispetto al gruppo sottoposto a PRP. Perci├▓ lŌĆÖassociazione della PRP (platelet-rich plasma) al trapianto osseo ├© una metodica che sembra associarsi ad una diminuzione statisticamente significativa dei tempi di integrazione ossea nei pazienti affetti da LPS, con conseguente anticipazione della ortodonzia e miglioramento degli outcome chirurgici.
[Bone tissue engineering. Reconstruction of critical sized segmental bone defects in the ovine tibia].
Reichert, J C; Epari, D R; Wullschleger, M E; Berner, A; Saifzadeh, S; N├Čth, U; Dickinson, I C; Schuetz, M A; Hutmacher, D W
Well-established therapies for bone defects are restricted to bone grafts which face significant disadvantages (limited availability, donor site morbidity, insufficient integration). Therefore, the objective was to develop an alternative approach investigating the regenerative potential of medical grade polycaprolactone-tricalcium phosphate (mPCL-TCP) and silk-hydroxyapatite (silk-HA) scaffolds.Critical sized ovine tibial defects were created and stabilized. Defects were left untreated, reconstructed with autologous bone grafts (ABG) and mPCL-TCP or silk-HA scaffolds. Animals were observed for 12 weeks. X-ray analysis, torsion testing and quantitative computed tomography (CT) analyses were performed. Radiological analysis confirmed the critical nature of the defects. Full defect bridging occurred in the autograft and partial bridging in the mPCL-TCP group. Only little bone formation was observed with silk-HA scaffolds. Biomechanical testing revealed a higher torsional moment/stiffness (pŌĆēCT analysis a significantly higher amount of bone formation for the ABG group when compared to the silk-HA group. No significant difference was determined between the ABG and mPCL-TCP groups. The results of this study suggest that mPCL-TCP scaffolds combined can serve as an alternative to autologous bone grafting in long bone defect regeneration. The combination of mPCL-TCP with osteogenic cells or growth factors represents an attractive means to further enhance bone formation.
[Bone tissue engineering. Reconstruction of critical sized segmental bone defects in the ovine tibia].
Reichert, J C; Epari, D R; Wullschleger, M E; Berner, A; Saifzadeh, S; N├Čth, U; Dickinson, I C; Schuetz, M A; Hutmacher, D W
Well-established therapies for bone defects are restricted to bone grafts which face significant disadvantages (limited availability, donor site morbidity, insufficient integration). Therefore, the objective was to develop an alternative approach investigating the regenerative potential of medical grade polycaprolactone-tricalcium phosphate (mPCL-TCP) and silk-hydroxyapatite (silk-HA) scaffolds.Critical sized ovine tibial defects were created and stabilized. Defects were left untreated, reconstructed with autologous bone grafts (ABG) and mPCL-TCP or silk-HA scaffolds. Animals were observed for 12 weeks. X-ray analysis, torsion testing and quantitative computed tomography (CT) analyses were performed. Radiological analysis confirmed the critical nature of the defects. Full defect bridging occurred in the autograft and partial bridging in the mPCL-TCP group. Only little bone formation was observed with silk-HA scaffolds. Biomechanical testing revealed a higher torsional moment/stiffness (pŌĆē<ŌĆē0.05) and CT analysis a significantly higher amount of bone formation for the ABG group when compared to the silk-HA group. No significant difference was determined between the ABG and mPCL-TCP groups. The results of this study suggest that mPCL-TCP scaffolds combined can serve as an alternative to autologous bone grafting in long bone defect regeneration. The combination of mPCL-TCP with osteogenic cells or growth factors represents an attractive means to further enhance bone formation. PMID:22476418
Investigating Oral Microbiome Profiles in Children with Cleft Lip and Palate for Prognosis of Alveolar Bone Grafting.
Liu, Luwei; Zhang, Qian; Lin, Jiuxiang; Ma, Lian; Zhou, Zhibo; He, Xuesong; Jia, Yilin; Chen, Feng
In this study, we sought to investigate the oral microbiota structure of children with cleft lip and palate (CLP) and explore the pre-operative oral bacterial composition related to the prognosis of alveolar bone grafting. In total, 28 patients (19 boys, 9 girls) with CLP who were scheduled to undergo alveolar bone grafting for the first time were recruited. According to the clinical examination of operative sites at the third month after the operation, the individuals were divided into a non-inflammation group (n = 15) and an inflammation group (n = 13). In all, 56 unstimulated saliva samples were collected before and after the operation. The v3-v4 hypervariable regions of the 16S rRNA gene were sequenced using an Illumina MiSeq sequencing platform. Based on the beta diversity of the operational taxonomic units (OTUs) in the inflammation and non-inflammation samples, the microbial variation in the oral cavity differed significantly between the two groups before and after the operation (P < 0.05). Analysis of the relative abundances of pre-operative OTUs revealed 26 OTUs with a relative abundance higher than 0.01%, reflecting a significant difference of the relative abundance between groups (P < 0.05). According to a principal component analysis of the pre-operative samples, the inflammation-related OTUs included Tannerella sp., Porphyromonas sp., Gemella sp., Moraxella sp., Prevotella nigrescens, and Prevotella intermedia, most of which were enriched in the inflammation group and showed a significant positive correlation. A cross-validated random forest model based on the 26 different OTUs before the operation was able to fit the post-operative status of grafted sites and yielded a good classification result. The sensitivity and specificity of this classified model were 76.9% and 86.7%, respectively. These findings show that the oral microbiota profile before alveolar bone grafting may be related to the risk of post-operative inflammation at grafted sites. PMID
Investigating Oral Microbiome Profiles in Children with Cleft Lip and Palate for Prognosis of Alveolar Bone Grafting
Liu, Luwei; Zhang, Qian; Lin, Jiuxiang; Ma, Lian; Zhou, Zhibo; He, Xuesong; Jia, Yilin; Chen, Feng
In this study, we sought to investigate the oral microbiota structure of children with cleft lip and palate (CLP) and explore the pre-operative oral bacterial composition related to the prognosis of alveolar bone grafting. In total, 28 patients (19 boys, 9 girls) with CLP who were scheduled to undergo alveolar bone grafting for the first time were recruited. According to the clinical examination of operative sites at the third month after the operation, the individuals were divided into a non-inflammation group (n = 15) and an inflammation group (n = 13). In all, 56 unstimulated saliva samples were collected before and after the operation. The v3-v4 hypervariable regions of the 16S rRNA gene were sequenced using an Illumina MiSeq sequencing platform. Based on the beta diversity of the operational taxonomic units (OTUs) in the inflammation and non-inflammation samples, the microbial variation in the oral cavity differed significantly between the two groups before and after the operation (P < 0.05). Analysis of the relative abundances of pre-operative OTUs revealed 26 OTUs with a relative abundance higher than 0.01%, reflecting a significant difference of the relative abundance between groups (P < 0.05). According to a principal component analysis of the pre-operative samples, the inflammation-related OTUs included Tannerella sp., Porphyromonas sp., Gemella sp., Moraxella sp., Prevotella nigrescens, and Prevotella intermedia, most of which were enriched in the inflammation group and showed a significant positive correlation. A cross-validated random forest model based on the 26 different OTUs before the operation was able to fit the post-operative status of grafted sites and yielded a good classification result. The sensitivity and specificity of this classified model were 76.9% and 86.7%, respectively. These findings show that the oral microbiota profile before alveolar bone grafting may be related to the risk of post-operative inflammation at grafted sites. PMID
Disseminated Fusarium infection in autologous stem cell transplant recipient
Vivian Iida Avelino-Silva; Jessica Fernandes Ramos; Fabio Eudes Leal; Leonardo Testagrossa; Yana Sarkis Novis
Disseminated infection by Fusariumis a rare, frequently lethal condition in severely immunocompromised patients, including bone marrow transplant recipients. However, autologous bone marrow transplant recipients are not expected to be at high risk to develop fusariosis. We report a rare case of lethal disseminated Fusariuminfection in an autologous bone marrow transplant recipient during pre-engraftment phase.
The effect of polystyrene sodium sulfonate grafting on polyethylene terephthalate artificial ligaments on in vitro mineralisation and in vivo bone tissue integration
Vaquette, C├®dryck; Viateau, V├®ronique; Gu├®rard, Sandra; Anagnostou, Fani; Manassero, Mathieu; Castner, David G.; Migonney, V├®ronique
This study investigates the impact of polystyrene sodium sulfonate (PolyNaSS) grafting onto the osseointegration of a polyethylene terephthalate artificial ligament (Ligament Advanced Reinforcement System, LARSŌäó) used for Anterior Cruciate Ligament (ACL). The performance of grafted and non-grafted ligaments was assessed in vitro by culturing human osteoblasts under osteogenic induction and this demonstrated that the surface modification was capable of up-regulating the secretion of ALP and induced higher level of mineralisation as measured 6 weeks post-seeding by Micro-Computed Tomography. Grafted and non-grafted LARSŌäó were subsequently implanted in an ovine model for ACL reconstruction and the ligament-to-bone interface was evaluated by histology and biomechanical testing 3 and 12 months post-implantation. The grafted ligaments exhibited more frequent direct ligament-to-bone contact and bone formation in the core of the ligament at the later time point than the nongrafted specimens, the grafting also significantly reduced the fibrous encapsulation of the ligament 12 months post-implantation. However, this improved osseo-integration was not translated into a significant increase in the biomechanical pull-out loads. These results provide evidences that PolyNaSS grafting improved the osseo-integration of the artificial ligament within the bone tunnels. This might positively influence the outcome of the surgical reconstructions, as higher ligament stability is believed to limit micro-movement and therefore permits earlier and enhanced healing. PMID:23790438
Optimization of dental status improves long-term outcome after alveolar bone grafting in unilateral cleft lip and palate.
Jabbari, Fatima; Skoog, Valdemar; Reiser, Eicka; Hakelius, Malin; Nowinski, Daniel
Objective : To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate. Design : Retrospective longitudinal study. Setting : Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. Patients : A total of 67 consecutive patients with unilateral complete cleft lip and palate. Interventions : Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years). Main Outcome Measures : Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery. Results : Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (Žü = 0.70195, P < .0001), followed by canine inclination