鼻内镜下同种异体鼻中隔软骨移植术治疗鼻中隔穿孔

目的探讨鼻内镜下同种异体鼻中隔软骨移植术在鼻中隔穿孔修补中的疗效。方法收集2003～2011年采用夹层法治疗16例鼻中隔穿孔患者,在鼻内镜下行同种异体鼻中隔软骨移植术,术后定期鼻腔清洁和换药。结果 15例穿孔Ⅰ期愈合,1例Ⅱ期愈合,随访1～3年,无穿孔复发及不良反应,有效率100%。结论鼻内镜下同种异体鼻中隔软骨移植术在鼻中隔穿孔修补中疗效显著,具有较好的实用性。

环孢素A延长同种皮肤移植存活期的动物实验

以小鼠同种皮肤移植为模型，采取不同环孢素Ａ的给药方法及剂量，观察了环孢素Ａ对皮肤移植存活期的影响，结果表明：环孢素Ａ全身给药，可显著延长同种皮肤移植的存活期（Ｐ＜０．０１），作用强弱与剂量呈正相关；单独采用体外环孢素Ａ处理皮片，并不能延长移植皮片存活；但联合全身给药，则可明显延长移植皮片的存活时间（Ｐ＜０．０１）。

Massive allograft replacement in management of bone tumors

Objective： To evaluate the functional outcome and complications of allograft replacement in management of bone tumors. Methods： Between March 1992 and September 2002, 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5-35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts （n = 95）, hemi-condylar （n = 15）, massive （n = 23）, allograft-prosthesis composite （n = 12）, intercalary grafts （n = 15） or hemi-pelvic grafts （n = 4）. Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus. Results： At a median follow-up of 47 months （range, 12 to 168 months） after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one （12.8%） patients had local recurrence and 38 （23.2%） nonunion. Late complications included 11 （6.7%） fractures of the allograft and 18 （11.0%） infections of the graft, instability of the joint in the form of subluxation was noted in 13 （7.9%） patients. Ten extremities were amputated due to local recurrence or severe infection. Conclusion： AIIografts can be used for reconstruction of bony defects after tumor resection. AIIograft has nearly similar shape, strength, osteo-inductivity and osteo-conductivity with host bone. AIIograft implantation is a high complication reconstruction method, and the dsk of recurrence increases when less surgical margin achieves.

USING CRYOPRESERVED HOMOGRAFT PERICARDIAL PATCH IN STAGED COMPLETE REPAIR FOR TETRALOGY OF FALLOT

Objective To compare the difference of effect while using homograt pericardium patch and Gore-rex patch in staged complete repair for Tetralogy of Fallot （TOF） to enlarge the right ventricular outflow tract （RVOT）. Methods Twenty-eight patients with TOF underwent the staged complete repair. Gore-rex patches were used to enlarge the RVOT of 13 patients, and cryopreserved homograft pericardium patches were used to enlarge the RVOT of 15 patients. The patients were followed up with 2-dimensional echocardiography and chest x-ray. Results One operative death in Gore-rex patch group, the mortality was 7. 7% ; 1 early postoperative death in cryopreserved homograft pericardium patch group, the mortality was 6. 7%. Between 2 groups, hemostasia time in operation room with significant difference （ P 〈 0. 01 ）, pericardial cavity drainage volume with difference （ P 〈 0. 05 ）. Gore-rex patch group was followed up 2 to 4.5 years, homograft pericardium patch group was followed up 0. 8 to 2.1 years. Echocardiography showed that there was significant difference of the residual obstruction at RVOT level （ P 〈 0. 01 ）. No calcification shadow was discovered on the chest x-ray of both groups. Conclusion Homograft pericardium is tissue with high density and intensity, its elasticity and compliance are good. Using homograft pericardium patch maybe helpful to decrease the residual obstruction of RVOT after operation. It can be adapted as a repairing material in cardiac surgery.

The precursor frequency of alloreactive CTLs is proportional to the number of T cell epitope specificities

The aim of this study is to find the experimental evidence that the precursor frequency of alloreactive CTLs is proportional to the number of the T-cell epitope specificities. The number of T-cell epitope specificities was manipulated by pulsing different humor of HLA-A2 restricted peptide（s） onto the T2 cells, which acted as stimulating cells to elicit allo-reaction by co-culturing with peripheral blood lymphocytes （PBLs） of HLA-A2 negative individual. Ten HLA-A2 restricted peptides （all were normal cell components ） were synthesized, and cell peptide extract was prepared by frozen and thawed. T2 cells loaded with different number of peptide（s） were co-cultured with PBLs of an HLA-A2 negative individual; the latter were stained with PKH67 in advance. Then the proliferation was monitored with flow cytometry, and the precursor frequency of the effector cells was ＇analyzed by the ModFit Software. After 6 d of culture, no proliferation was observed in the bulk culture of PBL alone, and obvious proliferation took place when PBLs of the HLA-A2 negative were co-cultured with T2 cells loaded with or without loading peptide（ s）. The precursor frequency of the alloreactive CTLs was 0.052 819 for co-culture with T2 cells loaded without peptide; however it was 0. 030 429 for T2 cells with EBV/LMP2A and 0. 030 528 for T2 cells loaded with a single autogeneic peptide, and increased up to 0. 144 942 for T2 cells loaded with 10 autogeneic peptides; the precursor frequency was 0. 203 649 when co-cultured with T2 cells loaded with miscellaneous peptides extracted from the cytoplasm of T2 cells. This study reveals that the precursor frequency of alloreactive CTLs is proportional to the number of T-cell epitope specificities, and independent of the density of the allogeneic HLA Class Ⅰ molecule. Our findings support the hypothesis that the alloreactive T cell populations comprise miscellaneous T cell clones; each is specific to corresponding pMHC. The novel constellation of peptides presented by allogeneic MHC molecules makes thousands of different epitopes, which account for the exceptional high precursor frequency of alloreactive T cells.

Treatment of chronic osteomyelitis with one-stage allograft

Objective： To avoid disadvantages of two-stage cancellus bone autograft, we investigated the feasibility of one-stage allograft for reconstructing the bone defect resulting from debridement of chronic osteomyelitis in limbs. Methods： Between Feb. 1999 and Apr. 2004, 35 cases of chronic osteomyelitis （8 cases of nonunion ） underwent one-stage allograft after debridement in our hospital. Results： Thirty-five cases were followed up for an average period of 28 months （ range, 13 to 55 months）, in which 32 cases （91.43%） were found no infection, and 3 cases （8.57%） were confirmed recurrence of infection. Four out of 8 cases of bone nonunion healed in 9.5 months on average （ range, 3 to 12 months）, and another case also acquired union after redebridement and autograft of iliumdue to infection recurrence 35 days after surgery. Renonunion occurred in 3 cases, 2 out of whom healed after secondary operation with autograft. One case of renonunion and 2 cases of infection recurrence refused further treatment. Conclusions： A high rate of infection arrest can be attained when one-stage allograft is used to reconstruct the bone defect of chronic osteomyelitis after debridement in limbs. Therefore, chronic osteomyelitis should not be regarded as a contraindication to one-stage allogeneic bone grafting. Renonuion, however, achieves a relatively high rate, especially in cases of segmental bone defect.