退行性颈脊髓病的诊断和治疗进展

退行性颈脊髓病(DCM)是因颈椎退变造成颈脊髓受压、损伤的一类疾病, 随着我国老龄化人口的不断增加, DCM发病率也逐年增高。DCM发病机制可分为静态的退变和动态的不稳两方面因素。DCM临床表现主要为颈脊髓损害的症状和体征。磁共振成像(MRI), 特别是一些先进的定量微结构MRI, 对早期诊断DCM有着重要的作用。DCM患者保守治疗往往疗效不佳, 大部分患者需要进行手术解除神经压迫, 手术入路选择目前尚存争议。患者症状的持续时间长、术前的神经功能状态差和高龄是造成术后疗效不佳的主要因素。本文主要介绍关于DCM发病率、发病机制、诊断、评估和治疗的近年来的研究进展。     

角膜缘干细胞移植术治疗翼状胬肉的临床疗效

目的:探讨角膜缘干细胞移植术治疗翼状胬肉的临床疗效.方法:对135例(201眼)翼状胬肉患者作翼状胬肉切除联合角膜缘干细胞移植.结果:术后随访平均2-84个月,除9眼复发外其余全部一次性治愈,复发率为4.47%.蛄论:翼状胬肉切除联合角膜缘干细胞移植治疗翼状胬肉有独特疗效,治愈率高,复发率低,是目前较为理想的手术方法.     

干细胞移植治疗复杂性肛瘘的研究进展

目的了解干细胞移植在治疗复杂性肛瘘领域的研究进展情况。方法通过检索PubMed、Web of Science、CNKI、万方等数据库中有关干细胞移植在复杂性肛瘘领域应用的相关文献,对该疗法的临床疗效及优势或存在的问题进行分析总结。结果目前应用于复杂性肛瘘领域的干细胞主要是来源于脂肪组织的干细胞,它具有再生分化、免疫调节及修复肠黏膜屏障的生物学特性,其可作为种子细胞应用于复杂性肛瘘的治疗,其有效性值得肯定,但其临床治疗方案存在差异且缺乏统一的标准,其远期临床疗效有待观察;并且由于干细胞具有癌基因激活、抑癌基因失活的特性,其治疗复杂性肛瘘的安全性备受关注。结论干细胞移植作为一种新兴的疗法,特别是对于难以通过手术解决的复杂性肛瘘患者具有广泛的前景,但其远期疗效仍不尽如人意。由于目前研究的样本量较少、观察时间较短且缺乏随机对照等问题,使得目前临床数据缺乏信服力,同时成本高也限制了该技术的发展。     

自体骨髓干细胞移植治疗下肢缺血性疾病9例

目的 探讨自体骨髓干细胞移植术治疗下肢动脉缺血性疾病的临床效果.方法 回顾性分析9例行下肢血管造影检查确诊的下肢动脉缺血患者(9条患肢)采用自体骨髓干细胞移植术治疗的临床资料.结果 经治疗后,有6例患者(6条患肢)静息痛缓解或消失,溃疡愈合,间歇性跛行消失或距离延长,3例患者效果不佳.结论 自体骨髓干细胞移植术治疗下肢缺血性疾病具有一定的疗效,方法简单、安全.     

自体外周血造血干细胞移植治疗系统性红斑狼疮的临床观察

目的观察自体外周血造血干细胞移植治疗系统性红斑狼疮（SLE）的临床疗效。方法5例对其他治疗效果反应较差的复发SLE患者接受自体外周血造血干细胞移植术，造血干细胞动员方案采用环磷酰胺＋粒细胞集落刺激因子，应用CS-3000 Plus血细胞分离机采集外周血干细胞，预处理方案采用环磷酰胺＋抗胸腺球蛋白抗体方案，常规措施预防移植相关并发症。移植后3个月，复查各项免疫指标，评估疗效。结果5例患者造血干细胞动员均获成功，造血重建顺利回输后外周血中性粒细胞计数≥0．5×10^9／L的天数为8。16d；白细胞总数恢复正常的天数为10-20d：血小板计数〉20×10^9／L的天数为12～20d。无一例出现严重的移植后并发症。临床症状明显改善或消失。3个月后复查各项指标均较移植前有明显改善。结论自体外周血造血干细胞移植治疗SLE的临床疗效好，不良反应少，是治疗难治性SLE的一种较好的方法。     

自体脂肪颗粒加毛囊干细胞移植在脱发治疗中的应用

目的:观察自体脂肪颗粒加毛囊干细胞移植治疗脱发的疗效。方法:自体脂肪颗粒分离纯化后,加毛囊干细胞第一代培养细胞,对头顶脱发部位进行注射治疗。结果:36例患者,经过多次注射干细胞移植,均获得了明显改善,可见新生头发,效果满意,没有出现特殊并发症。结论:对于大面积脱发患者,应用自体脂肪颗粒加毛囊干细胞移植是一种安全、有效的方法,值得临床推广应用。     

应用自体外周血干细胞移植治疗IgE型多发性骨髓瘤1例

目的探讨自体外周血干细胞移植对IgE型多发性骨髓瘤的疗效。方法盐酸多柔比星脂质体+长春新碱+地塞米松联合沙立度胺方案化疗后采用自体外周血干细胞移植治疗1例IgE型多发性骨髓瘤患者。结果治疗结束后患者临床症状完全缓解,骨髓缓解,血清IgE水平恢复正常,从确诊至今已存活41个月,移植后存活24个月,情况良好。结论自体外周血干细胞移植可改善IgE型多发性骨髓瘤患者的预后。     

基因或干细胞移植治疗缺血性冠心病:新世纪的挑战

基因和骨髓干细胞移植是治疗缺血性冠心病的一种新方法。细胞移植的新概念、新的研究方法为未来心血管疾病的治疗和研究提供了令人兴奋的可能性。新近的细胞移植合并基因治疗可能是此领域的革命性进展。实验和初步临床资料证实，基因或者骨髓干细胞移植能产生巨大的生物学效应，使心脏生成新生血管或者心肌细胞，改善心肌血液供应，增加心脏功能或者代谢功能。尽管仍有许多问题需要解决，血管内皮生长因子或者骨髓干细胞移植是安全的，特别适合那些弥漫性血管病变不宜进行外科干预或者PTCA的患者，但仍有必要设计具有机械终点及临床终点的大规模随机、双盲、安慰剂对照试验，进行深入研究。     

干细胞治疗在肝胆胰疾病中的应用

近年来干细胞治疗逐渐应用于肝胆胰疾病临床,主用于治疗肝硬化、糖尿病和胰腺炎等疾病,其中研究最多、目前认为疗效最为确切的为肝硬化.目前临床应用于肝胆胰疾病的干细胞种类主要为脐血干细胞、自体骨髓干细胞和外周血干细胞,干细胞治疗肝胆胰疾病主要是通过介入DSA下经股动脉进入肝胆胰各脏器的供应动脉输注.干细胞可能通过自体分化和旁分泌等方式促进组织再生,改善器官功能.干细胞治疗肝胆胰疾病前景广阔,但还需要严格的伦理审查和临床随机对照研究来进一步证实.     

左心室辅助血泵及其临床应用研究进展

心力衰竭已严重威胁人们健康,由于供心缺乏,心室辅助作为治疗心力衰竭的重要方式,临床应用日益增多。心室辅助可用于心脏功能恢复前支持治疗,作为心脏移植前过渡支持治疗及对不适合心脏移植的患者进行永久辅助治疗。心室辅助血泵根据结构及工作机制不同,大体上分为三代。本文就心室辅助的血泵的种类及其临床应用研究进展做一综述。     

Cell transplantation in non-ischemic dilated cardiomyopathy

OBJECTIVE: With a rising incidence, dilated cardiomyopathy (DCM) is regarded as a major health care concern. Although both medical therapy and novel surgical treatments have been applied to treat DCM, the effects of preventing left ventricular (LV) dilatation are limited, and the mortality rate associated with the disease remains high. Thus novel management strategies for improved treatment of DCM are awaited. METHODS: Researchers have found that, in models of regional ventricular dysfunction, transplanted cells induced a profound biological phenomenon that restored contractile function and prevented ventricular dilatation. We have investigated muscle cell transplantation in hamsters with DCM, and have found that heart cells and smooth muscle cells survived in the host myocardium after transplantation, which suppressed LV dilatation and wall thinning, and preserved heart function. Our current studies are focusing on the clinical applicability of these encouraging early findings by evaluating the optimal cell types, the timing of transplantation, and cryopreservation as cell storage. Concurrently, we are investigating the influence of cell transplantation on myocardial remodeling in order to outline the mechanism of benefit afforded by donor cell engraftment. We believe that the timing of cell transplantation with respect to the progression of the underlying disease is critical in preventing ventricular thinning, dilation and preserving cardiac function. CONCLUSIONS: This novel approach can be a clinically applicable biological therapy for patients with progressive DCM. More studies to uncover the specific molecular and cellular effects of cell transplantation on the host myocardium are necessary for future clinical application.     

Tissue engineered myoblast sheets improved cardiac function sufficiently to discontinue LVAS in a patient with DCM: report of a case

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by progressive heart failure, and is a leading cause of mortality and morbidity. Recently, cellular therapy for end-stage heart failure has been emerging. We herein report a 56-year-old male who received a transplant of autologous myoblast sheets manufactured in temperature-responsive culture dishes. His clinical condition improved markedly, leaving him without any arrhythmia and able to discontinue using a left ventricular assist system and avoid cardiac transplantation. These findings suggest that cellular therapy using myoblast sheets is a promising new strategy for treating patients with end-stage DCM. This method might be an effective alternative to heart transplantation in the near future.     

Anaesthetic management of a parturient with dilated cardiomyopathy: A case report

Dilated cardiomyopathy (DCM) is a form of cardiomyopathy characterized by left ventricular or biventricular dilatation and impaired ventricular contractility. This results in systolic dysfunction of the heart with decreased left ventricular ejection fraction and progressive congestive cardiac failure. Pregnancy in patients with pre-existing dilated cardiomyopathy can flare up the disease and can be fatal. This case report describes the successful anaesthetic management of a parturient with dilated cardiomyopathy undergoing caesarean section under spinal anaesthesia.     

Non-transplant cardiac surgery for end-stage dilated cardiomyopathy in small children.

Between October 1997 and December 2000, a total of 7 pediatric patients with end-stage dilated cardiomyopathy (DCM) were referred to our service for heart transplantation; non-transplant cardiac surgery was offered as a biologic bridge. Two patients died before surgery and the in-hospital surgical mortality rate was 50%: 75% in 4 patients who received emergency surgery and 0% in 2 patients who received urgent surgery. Non-transplant cardiac surgery improved clinical outcome and acted as a biologic bridge, instead of a mechanical bridge, to heart transplantation in small children with DCM and severe heart failure.     

Partial left ventriculectomy in pediatric end-stage dilated cardiomyopathy

OBJECTIVE: Although a recent survey on pediatric cardiomyopathy in Japan showed that 48% of patients died despite the medical treatment, pediatric cardiac transplantation is not legal in Japan. We determined the feasibility of partial left ventriculectomy as an alternative to end-stage dilated cardiomyopathy. METHOD: We retrospective analyzed partial left ventriculectomy in 4 pediatric patients with end-stage dilated cardiomyopathy. RESULTS: In case 1, an 8-month-old girl underwent semiemergency partial left ventriculectomy. Her ejection fraction increased from 10% to 25%, and her condition improved initially, but she developed heart failure and underwent cardiac transplantation 6 months later in the US. In case 2, a 3-year-old boy developed severe heart failure 2 months after ventricular septal defect repair. Intensive medical therapy failed, so partial left ventriculectomy was done, which increased his ejection fraction from 15% to 35%. His condition is stable 35 months after surgery. In case 3, a 2-year-old girl with a chromosomal anomaly undergoing ventricular septal defect repair developed progressive heart failure 1 year later. Despite emergency partial left ventriculectomy, she died of hemoptysis 2 weeks postoperatively. In case 4, a 2-year-old girl developing progressive heart failure unresponsive to medical therapy after 10 months underwent elective partial left ventriculectomy and remains in stable condition 18 months postoperatively. CONCLUSION: Partial left ventriculectomy is appropriate for selected patients with end-stage dilated cardiomyopathy if medical therapy is not effective and heart transplantation is not possible.     

Advanced cardiac failure. New surgical approaches

THERAPEUTIC OPTIONS: Prognosis of advanced heart failure is ominous since survival rate is less than 65% one year after an acute and severe cardiac episode. Medical therapy has proven to be efficient in reducing fatal complications and in delaying critical evolution. Depending on the etiology and the myocardial status, new surgical approaches can also be proposed for repair or substitution. SURGICAL REPAIR: The beneficial effect of myocardial revascularization on severe ischemic cardiomyopathy, the relevance of mitral valve repair in dilated cardiomyopathy, and the advantage of ventricular remodeling in patients with major ventricular dyskinesia has been clearly demonstrated. All these surgical techniques improve ventricular function and enhance survival rate by about 70% after three years. SUBSTITUTION PROCEDURES: The best therapeutic option to recover heart function for normal life and reduced mortality remains, when possible, cardiac transplantation. Ventricular cardiac assist devices are planned as a temporary option to bridge the waiting period to transplantation or for myocardial recovery but can also be proposed as a chronic implantation in an outpatient care scheme. Cardiomyoplasty for therapeutic management of advanced cardiac failure is still a controversial surgical approach. Other clinical strategies such as transmyocardial laser revascularization, myocardial angiogenesis and myocardial cell therapy are being investigated or developed. ADAPTED TREATMENT: Optimal management of each patient with advanced heart failure requires an adequate treatment selected among a wide range of medical and/or surgical strategies.     

Left ventriculoplasty for nonischemic dilated cardiomyopathy

Surgical treatment of nonischemic dilated cardiomyopathy is a new field in cardiac surgery. Although current pharmacologic therapy has shown improved survival rates, many patients still need heart transplantation. To reduce the shortage of donors, there is a demanding need for effective nontransplant cardiac surgery. In the past 5 years, partial left ventriculectomy (PLV) has emerged with initial enthusiasm, but is not used because of high surgical mortality and late return of heart failure. There are several examples of improved clinical status and ventricular function with the procedure. By refining patient selection and surgical modification, ventriculoplasty will become a realistic option in the treatment of heart failure caused by nonischemic cardiomyopathy.     

Effect of biventricular pacing therapy in patients with dilated cardiomyopathy with severe congestive heart failure

Objectives: Biventricular pacing (BVP) therapy has recently emerged as an effective treatment for patients with moderate to severe congestive heart failure (CHF) and ventricular asynchrony all over the world. However, this therapy is not yet available in Japan. We evaluated the effects of BVP in patients with severe CHF due to dilated cardiomyopathy (DCM). Subjects: Four patients with medically refractory severe CHF due to DCM in New York Heart Association functional class III or IV heart failure underwent BVP therapy. We combined the implantation of the left ventricular (LV) epicardial lead via small thoracotomy following right atrial and ventricular intravenous leads under general anesthesia. We evaluated to determine whether improvements of ventricular function, ventricular size, mitral regurgitation, functional status, frequency of hospitalization, and quality of life were associated with BVP therapy. Results: BVP improved LV systolic function, decreased LV size and mitral regurgitation, and shortened prolonged QRS interval. The patients’ symptoms, exercise tolerance, frequency of hospitalization, and quality of life were also dramatically improved by BVP. Furthermore, combination of BVP and oral administration of amiodarone significantly prevented recurrence of ventricular tachycardia and paroxysmal atrial fibrillation, and maintained sinus rhythm for a long period. Conclusions: In view of these findings, BVP therapy may contribute to the development of new therapeutic method for patients with severe CHF due to DCM.     

Effective cardiac resynchronization therapy for an adolescent patient with dilated cardiomyopathy seven years after mitral valve replacement and septal anterior ventricular exclusion

Cardiac resynchronization therapy (CRT) is a new treatment for refractory heart failure. However, most heart failure patients treated with CRT are middle-aged or old patients with idiopathic or ischemic dilated cardiomyopathy. We treated a 17 year 11 month old girl with dilated cardiomyopathy after mitral valve replacement (MVR) and septal anterior ventricular exclusion (SAVE). Seven years after the SAVE procedure, she presented complaining of palpitations and general fatigue with normal activity. Her echocardiogram showed reduced left ventricular function. Despite of optimal medical therapy, her left ventricular function continued to decline and she experienced regular arrhythmias such as premature ventricular contractions. We thus elected to perform cardiac resynchronization therapy with defibrillator (CRT-D). After CRT-D, her clinical symptoms improved dramatically and left ventricular ejection fraction (LVEF) improved from 31.2% to 51.3% as assessed by echocardiogram. Serum BNP levels decreased from 448.2 to 213.6 pg/ml. On ECG, arrhythmias were remarkably reduced and QRS duration was shortened from 174 to 152 msec. In conclusion, CRT-D is an effective therapeutic option for adolescent patients with refractory heart failure after left ventricular volume reduction surgery.     

Restoration and regeneration of failing myocardium with cell transplantation and tissue engineering

Cell transplantation and the creation of bioengineered cardiovascular tissues are novel biologic approaches to restore and regenerate failing myocardium. These rapidly evolving therapies may complement and enhance other mechanical and surgical interventions for patients with congestive heart failure, providing cardiac surgeons with a wider range of treatments for patients at risk of congestive heart failure. Proof-of-concept studies have been performed in several experimental animal models of human cardiovascular disease, such as myocardial infarction and dilated cardiomyopathy. Although the exact mechanisms are unclear, cell transplantation restores cardiac function and limits ventricular dilatation. Clinical cell transplantation has been performed in a limited number of patients with encouraging preliminary results. In contrast, bioengineered muscle grafting is largely experimental but offers the promise of myocardial regeneration by replacing irreversibly damaged myocardium with healthy autologous tissue to facilitate more extensive ventricular remodeling surgery.