Long-term clinical performance of flapless implant surgery compared to the conventional approach with flap elevation: A systematic review and meta-analysis

BACKGROUND The conventional implant approach involves flap elevation,which may result in increased soft tissue and bone loss and postoperative morbidity.The flapless surgical technique,aided by three-dimensional medical imaging equipment,is regarded as a possible alternative to the conventional approach to alleviate the above issues.Several studies have been performed regarding the role of flapless implant surgery.However,the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.AIM To compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.METHODS PubMed,EMBASE,Cochrane Central Register of Controlled Trials,and grey literature databases were searched from inception to 23 September 2019.Randomised controlled trials(RCTs)and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were included.Meta-analyses were conducted to estimate the odds ratios(ORs)or mean differences(MDs)and their 95%confidence intervals(CIs)between the long-term implant survival rate,marginal bone loss,and complication rate of the flapless and conventional groups.Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.RESULTS Ten articles,including four RCTs and six cohort studies,satisfied the eligibility criteria and nine of them were included in the meta-analysis.There was no significant difference between the long-term implant survival rate[OR=1.30,95%CI(0.37,4.54),P=0.68],marginal bone loss[MD=0.01,95%CI(-0.42,0.44),P=0.97],and complication rate[OR=1.44,95%CI(0.77,2.68),P=0.25]after flapless implant surgery and the conventional approach.Moreover,subgroup analyses revealed that there was no statistically significant difference between the implant survival rate[guided:OR=1.52,95%CI(0.19,12.35),P=0.70];free-hand:n=1,could not be estimated,marginal bone loss[guided:MD=0.22,95%CI(-0.14,0.59),P=0.23;free-hand:MD=-0.27,95%CI(-1.10,0.57),P=0.53],or complication rate[guided:OR=1.16,95%CI(0.52,2.63),P=0.71;free-hand:OR=1.75,95%CI(0.66,4.63),P=0.26]in the flapless and conventional groups either with use of the surgical guide or by the free-hand method.CONCLUSION The flapless surgery and conventional approach had comparable clinical performance over three years or more.The guided or free-hand technique does not significantly affect the long-term outcomes of flapless surgery.     

Sustained complete response to erlotinib in squamous cell carcinoma of the head and neck:A case report

BACKGROUND Squamous cell carcinoma of head and neck(SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes(levels 2 and 3). Imaging studies including(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx,oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment.He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.     

Clinical presentation and early predictors for poor outcomes in pediatric myocarditis:A retrospective study

BACKGROUND Myocarditis is an important cause of morbidity and mortality in children, leading to long-term sequelae including chronic congestive heart failure, dilated cardiomyopathy, heart transplantation, and death. The initial diagnosis of myocarditis is usually based on clinical presentation, but this widely ranges from the severe sudden onset of a cardiogenic shock to asymptomatic patients. Early recognition is essential in order to monitor and start supportive treatment prior to the development of severe adverse events. Of note, many cases of fulminant myocarditis are usually misdiagnosed as otherwise minor conditions during the weeks before the unexpected deterioration.AIM To provide diagnostic clues to make an early recognition of pediatric myocarditis.To investigate early predictors for poor outcomes.METHODS We conducted a retrospective cross-sectional single-center study from January 2008 to November 2017 at the Pediatric Department of our institution, including children < 18-years-old diagnosed with myocarditis. Poor outcome was defined as the occurrence of any of the following facts: death, heart transplant, persistent left ventricular systolic dysfunction or dilation at hospital discharge(early poor outcome), or after 1 year of follow-up(late poor outcome). We analyzed different clinical features and diagnostic test findings in order to provide diagnostic clues for myocarditis in children. Multivariable stepwise logistic regression analysis was performed using all variables that had been selected by univariate analysis to determine independent factors that predicted a poor early or late outcome in our study population.RESULTS A total of 42 patients [69% male; median age of 8(1.5-12) years] met study inclusion criteria. Chest pain(40%) was the most common specific cardiac symptom. Respiratory tract symptoms(cough, apnea, rhinorrhea)(38%),shortness of breath(35%), gastrointestinal tract symptoms(vomiting, abdominal pain, diarrhea)(33%), and fever(31%) were the most common non-cardiac initial complaints. Tachycardia(57%) and tachypnea(52%) were the most common signs on the initial physical exam followed by nonspecific signs of respiratory tract infection(44%) and respiratory distress(35%). Specific abnormal signs of heart failure such as heart murmur(26%), systolic hypotension(24%), gallop rhythm(20%), or hepatomegaly(20%) were less prevalent. Up to 43% of patients presented an early poor outcome, and 16% presented a late poor outcome. In multivariate analysis, an initial left ventricular ejection fraction(LVEF) < 30%remained the only significant predictor for early [odds ratio(OR)(95%CI) = 21(2-456), P = 0.027) and late [OR(95%CI) = 8(0.56-135), P = 0.047) poor outcome in children with myocarditis. LVEF correlated well with age(r = 0.51, P = 0.005),days from the initiation of symptoms(r =-0.31, P = 0.045), and N-terminal probrain natriuretic peptide levels(r = 0.66, P < 0.001), but not with troponin T(r =-0.05, P = 0.730) or C-reactive protein levels(r =-0.13, P = 0.391). N-terminal probrain natriuretic peptide presented a high diagnostic accuracy for LVEF < 30% on echocardiography with an area under curve of 0.931(95%CI: 0.858-0.995, P <0.001). The best cut-off point was 2000 pg/mL with a sensitivity of 90%,specificity of 81%, positive predictive value of 60%, and negative predictive value of 96%.CONCLUSION The diagnosis of myocarditis in children is challenging due to the heterogeneous and unspecific clinical presentation. The presence of LVEF < 30% on echocardiography on admission was the major predictor for poor outcomes.Younger ages, a prolonged course of the disease, and N-terminal pro-brain natriuretic peptide levels could help to identify these high-risk patients.     

Min-invasive surgical treatment for multiple axis fractures: A case report

BACKGROUND Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.CASE SUMMARY We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography(CT) scan revealed an axis injury consisting of an odontoid Type Ⅲ fracture associated with a Hangman fracture categorized as a Levine-Edwards Type Ⅰ fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.CONCLUSION Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.     

迟缓青霉素过敏反应高热休克1例

患者,女,38岁,教师。既往健康,因患上呼吸道感染1周,来院就诊,青霉素皮试(-),加入5%葡萄糖注射液500m l静脉滴注。上午11时静脉滴注结束,当日无不良反应及不适,下午正常生活。第2日上午继续静脉点滴青霉素800万U。批号、方法同前。11∶30静脉滴注结束,身体无不适。未用其他任何药物。13∶30在家中出现心悸、气短、胸闷、寒战、高热、脉搏细数。查体:体温40.3℃,心率124次/分,呼吸12次/分,血压测不清。急性痛苦病容,神志恍惚,烦躁不安,强迫体位,寒战,高热,张口呼吸,呼吸极度困难,带有喘鸣音,语音微弱,吐字不清,全身皮肤苍白,双眼球上翻,颈静…     

运用心理知识做好门诊医患纠纷协调工作

随着人们对医疗服务需求的日益增长以及法律意识和维权观念的不断增强,医患纠纷呈不断上升趋势.门诊是医院的一个"大窗口",人员流动性大,病人需经过挂号、看病、划价、取药、检查等许多过程,身心极易疲惫,情绪会变得烦躁、易怒,很容易与医务人员发生冲突,因此门诊是医患纠纷易发场所.所以运用心理知识做好门诊医患纠纷协调工作显得尤为重要.     

泌尿系结石患者的饮食管理

泌尿系结石的形成与食物的组成有关。根据文献报道，能影响泌尿系结石形成的食物成分有蛋白质、脂肪（胆固醇、鱼油、多不饱和脂肪酸）、糖类、嘌呤、草酸、矿物质（钙、镁、钠等）、维生素（A、B6、D、C、K）、蔬菜（菠菜）、磁化水、乳制品、液体、微量元素等。改变饮食习惯或进行饮食控制，有助于预防结石复发。     

全膝人工关节股骨假体屈曲对疗效的影响:1年随访结果

背景:对于全膝人工关节置换术的股骨假体屈曲问题,多数人认为不能或不太影响膝关节术后功能,仅仅是术后X射线片令人不甚满意,因此尚未引起人们足够的重视.目的:回顾分78例123膝全膝人工关节置换术股骨假体屈曲对随访疗效的影响.设计:分组对比观察.单位:中国中医科学院望京医院骨关节一科.对象:选择2001-10/2004-06在中国中医科学院望京医院关节一科行全膝人工关节置换者78例123膝,其中发生股骨假体不同程度屈曲15例17膝(13.8%),男5例,女10例,年龄47～81岁:未发生屈曲63例106膝(86.2%),男22例,女41例,年龄47～79岁.方法:回顾性分析方法比较股骨假体屈曲组和非屈曲组手术前后HSS(HSS knee rating score)评分、膝关节活动范围和屈曲挛缩畸形,并测量屈曲角和屈曲距离,股骨假体屈曲对置换效果的影响.主要观察指标:①股骨假体屈曲的测量结果.②患者膝关节HSS评分和活动度.③患者屈曲挛缩畸形例数及角度.④不良事件及副反应.结果:患者获随访1年以上.①17膝股骨假体屈曲角为7°～19°,平均为11.3°;股骨假体屈曲距离为2～4 mm,平均为2.6 mm.②术前屈曲组与非屈曲组患者HSS评分和膝关节活动范围差异均无显著性(P＞0.05),但术后屈曲组低于非屈曲组(P≤0.01);术后均高于术前(P=0.02或P＜0.01).③屈曲组术后屈曲挛缩例数和角度多于和大于非屈曲组(P＜0.01),两组术后屈曲挛缩均有改善(屈曲组P＜0.05,非屈曲组P＜0.01).④非屈曲组并发右股深静脉血栓1例,骨化性肌炎1例;屈曲组并发髌骨假体撞击征1膝.结论:本组资料证明,股骨假体屈曲对全膝人工关节置换效果的影响是增加术后膝关节屈曲挛缩的发生率,造成伸膝功能障碍.     

Laparoscopic repair of complete intrathoracic stomach with iron deficiency anemia:A case report

BACKGROUND Giant paraesophageal hiatal hernias(HH)are very infrequent,and their spectrum of clinical manifestations is large.Giant HH mainly occurs in elderly patients,and its relationship with anemia has been reported.For the surgical treatment of large HH,Nissen fundoplication is the most common antireflux procedure,and the reinforcement of HH repair with a patch(either synthetic or biologic)is still debatable.CASE SUMMARY We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia.After performing a series of tests and diagnostic approaches,results showed a complete intrathoracic stomach associated with severe iron deficiency anemia.The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication.Postoperatively,reflux symptoms were markedly relieved,and the imaging study showed complete reduction of the hernia sac.More importantly,anemia was resolved,and hemoglobin,serum iron and ferritin level were returned to the normal range.The patient kept regular follow-up appointments and remained in a satisfactory condition.CONCLUSION This case report highlights the relationship between large HH and iron deficiency anemia.For the surgical treatment of large HH,laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.     

Rare anaplastic sarcoma of the kidney:A case report

BACKGROUND Anaplastic sarcoma of the kidney(ASK)is a rare and newly recognized renal neoplasm.The tumor usually is extensive and cystic,characterized by pleomorphic spindle cells with marked atypia and associated with multinucleated cells.To date,only 27 cases have been reported in the literature.The authors present an additional case and summarize the relevant knowledge in the literature.CASE SUMMARY A 27-year-old previously healthy woman presented with a palpable mass over the abdomen and right flank soreness for one year.After the computed tomography study,the patient underwent right radical nephrectomy obtaining a 1680-g tumor with a size of 18.4 cm×14.5 cm×11 cm.The tumor is chiefly composed of anaplastic spindle cells with marked nuclear atypia admixed with multinucleated cells.Immunohistochemical evaluation of tumor cells exhibited diffuse positivity for CD56,p53,and vimentin,and focally positive for desmin.The diagnosis of ASK was established.Unfortunately,a local tumor recurrence followed by a distant metastasis developed within months.The patient died 26 months after the initial surgery.Comparing to the previously 27 cases of ASK,the current case had a relatively worse prognosis,which might be potentially associated with older patient age,larger tumor size,and the lack of en-bloc resection of adjacent organs during the initial radical nephrectomy.CONCLUSION This case points out the featured pathological findings for diagnosing ASK and suggests more aggressive management for patients with ASK.     

柳硼酊巧治灰指甲

灰指甲是由皮肤真菌侵犯甲板所致的一类疾病,多表现为甲板失去光泽、增厚变形,因变脆而破裂、缺失,病甲呈灰白、污黄色,临床多见,且顽固难治.笔者用柳硼酊(由本院药剂科配制)治疗该病5例,均治愈.现将此方法介绍如下.     

Hydrochloric acid enhanced radiofrequency ablation for treatment of large hepatocellular carcinoma in the caudate lobe:Report of three cases

BACKGROUND To report on the use of percutaneous hydrochloric acid(HCl) enhanced radiofrequency ablation(HRFA) for the treatment of large(maximum diameter ≥5 cm) hepatocellular carcinoma(HCC) in the caudate lobe.CASE SUMMARY Between August 2013 and June 2016, three patients with a large HCC(maximum diameter: 5.0, 5.7, and 8.1 cm) in the caudate lobe were treated by transarterial chemoembolization followed by computer tomography(CT) guided RFA using a monopolar perfusion RF electrode, which was enhanced by local infusion of 10%HCl at 0.2 mL/min(total volume, 3 to 12 mL). The output power of HRFA reached 100 W, and the average ablation time was 39 min(range, 15 to 60 min).Two patients each underwent one session of HRFA and one patient two sessions.After treatment, CT/magnetic resonance imaging showed that all the three lesions were completely ablated. There was no major complication. Two patients had asymptomatic bile duct dilatation. One patient died of tongue cancer 24 mo after ablation. The remaining two patients were alive and no area of enhancement is detected in the caudate lobe at 28 and 60 mo after ablation, respectively.CONCLUSION Percutaneous CT-guided HRFA is safe and efficacious in treating large HCC in the caudate lobe.     

纳米级阳离子聚合物优化转染siRNA的研究

背景:转染是基因研究最关键的始动环节,高效安全的基因转染试剂是基因研究的热点问题.纳米级材料表面活性强,易于表面修饰,膜通透性高,如何将物质纳米化应用于基因转染尚在探索之中.目的:观察不同分子质量、结脂度的纳米级阳离子聚合物的转染效率,筛选低毒、高效的优化转染试剂.设计:对照实验.单位:南方医科大学基因研究所.方法:实验于2006-03/2007-06在南方医科大学基因工程研究所实验室完成.以脂质体为阳性对照,将9种不同分子质量、结脂度的纳米级阳离子聚合物聚乳酸聚乙醇酸、壳聚糖-聚己内酯、聚乙烯亚胺-聚乙二醇,包裹FITC标记的以bcl-2基因为靶标的siRNA(0.2 nmol/L),转入无血清培养的白血病细胞株K562,于转染后6 h后补加20%胎牛血清培养基.MTT法测定24,48,72 h后细胞增殖状况,荧光显微镜检测转染48 h后各纳米材料转染效率,流式细胞仪检测白血病细胞株K562细胞Bcl-2蛋白的表达和凋亡率.结果:①荧光显微镜结果:不同材料的纳米级颗粒,其转染效率有统计学差异(P < 0.05),同种材料的纳米结构因其结脂度不同,其转染效率也有统计学差异(P < 0.05).②MTT结果:表明细胞增殖率与转染率正相关.③流式细胞仪结果表明:转染siRNA引起的靶基因表达抑制以及细胞凋亡率与转染效率正相关.结论:分子质量为1 800/2 000,脂结合力为29%的纳米级聚乙烯亚胺-聚乙二醇颗粒,为低毒、高效的转染试剂.     

基于MRI、CT不同层面和位像形态学依据回顾性分析双侧股骨头坏死塌陷的危险因素

背景:MRI、CT对骨组织形态学变化评估为客观金标准.目的:基于MRI、CT不同位像影像学客观依据分析双侧股骨头坏死塌陷的危险因素.设计、时间及地点:自身对照,分类汇总分析,试验于2003-04/2007-06在北京协和医学院研究生院完成.参试者:选择本科收治的双侧股骨头坏死并有完整塌陷前/未塌陷资料的患者48例,男21例,年龄21～48岁;女27例,年龄23～46岁.均为激素性股骨头坏死.股骨头坏死按照国际骨循环学会(ARCO)标准分期,ARCOA-C 4例,ARCOB-C 4例,ARCOB-B 12例,ARCOC-C 28例.方法:对有单/双侧塌陷的双侧股骨头坏死的患者影像资料进行回顾性分析.根据早期MRI T1中低信号带的形态分为开放型和包含型.根据坏死灶的CT变化类型分为:a:坏死灶形成硬化带,并且在软骨下骨下为连续的硬化带;b:在软骨下骨下为不连续的硬化带;c:软骨下骨下硬化带形成不明显:d:没有明显硬化带形成,坏死灶呈均匀中密度影.主要观察指标:坏死灶大小、位置、MRI形态、CT形态及塌陷.结果:单侧塌陷43例(ARCOA-C 4髋.ARCOB-C 4髋,ARCOB-B 12髋,ARCOC-C 23髋),双侧塌陷5例(ARCOC-C 10髋).负重面外侧型(64髋)塌陷49髋(ⅡB 12髋,ⅡC 37髋),负重面中央型(21髋)塌陷4髋(ⅡC 4髋)负重面内侧型(11髋)无塌陷;早期MRI T1中低信号带的形态开放型塌陷51髋,闭合型塌陷2髋.CT示坏死灶形成硬化带,并且在软骨下骨下为连续的硬化带O/23(type-a);有不连续硬化带形成但没有延伸到软骨下骨下者塌陷19/30髋(type-b);CT有硬化带形成,并不连续延伸到软骨下骨下者塌陷28/37髋(type-c);没有硬化带形成,病灶呈均匀中高密度影者塌陷6/6髋(type-d).结论:以MRI、CT评估,坏死灶上负重面外侧型更易早塌陷;对于双侧股骨头坏死的病例,MRI显示相似的面积,T1低信号带包含型者,预后相对较好;CT显示软骨下骨均匀增厚或明显的"焊接"现象是延迟塌陷的因素;但是软骨下骨没有或有不均匀不连续性硬化是危险因素.     

56例急性酒精中毒患者的急救与护理

急性酒精(乙醇)中毒是指一次饮酒过量超过人体代谢速度发生乙醇积蓄而造成的中毒.对中枢神经系统有抑制作用,表现为运动、呼吸、循环系统的功能紊乱.严重者可出现昏迷、甚至导致中枢麻痹或心脏抑制而死亡[1].     

Application of hybrid operating rooms for treating spinal dural arteriovenous fistula

BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas(SDAVFs).METHODS Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018.The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision,and the interoperative digital subtraction angiography(DSA)technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration.The patients were followed for an average of 2 years after the operation,and the preoperative American Spinal Cord Injury Association(ASIA)score and postoperative ASIA score at 6 mo after the operation were compared.RESULTS The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients,and there were no cases that required expansion of the range of the bone window in order to expose the lesions.Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique;therefore,the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients.With the assistance of the hybrid-OR,the feeding artery was correctly ligated in all cases,and the intraoperative error obliteration rate decreased from 18.2%(2/11)to 0%.All 11 patients were followed for an average of 2 years.The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score,and there were no patients with late recurrence during the follow-up.CONCLUSION Compared with intra-arterial embolization for the treatment of SDAVFs,hybrid-ORs can solve the problem of a higher incidence of initial failure and late recurrence.Compared with direct occlusion of SDAVFs in microsurgery,hybrid-ORs can take advantage of the intraoperative DSA system for locating the shunt and verifying the obliteration of fistulae in order to reduce the error obliteration rate.At this point,our experience suggests that the safety and ease of use make hybrid-ORs combined with microsurgery and intraoperative DSA systems an attractive modality for dealing with SDAVFs.     

确保中药不错抓、不漏抓的几点经验

随着社会的进步，人们对健康的认识也在逐步加深，已不是停留在表面上看是否病倒来衡量健康与否，而是深入到生理体征都还正常出于防患于未然在亚健康方面作保健。人们普遍知晓西药由于存在更多的副作用不适合用于保健和长时间大量服用，继而转向中药，中药由于副作用少，适合长期服用，能起到保健的作用而受到人们的青睐，尤其是一些慢性病更适合用中药来治疗。     

1例老年糖尿病足并发黑棘皮病患者的护理

黑棘皮病(AN)又名黑色角化病,系以色素增生、角化过度、乳突状、疣状增殖为特征的少见皮肤病,多见于腋下、腹股沟、颈部、乳晕、肛周和暴露部位.黑棘皮病的发病机制尚不清楚,可能与遗传、内分泌疾病、肿瘤、肥胖,药物以及交感神经功能失调有关.     

骨骼肌成肌细胞的移植

成肌细胞移植实验开展以来,无论是对遗传性肌病还是肌组织的严重损伤,其修复效率并不令人满意.成肌细胞培养、移植方法的改进、移植前受体和细胞准备、支架材料选取以及机体免疫情况等方面的改进都将影响到移植效率的提高,并进一步影响到受体功能的改善,所以从更深层次上来说,它关系到成肌细胞移植或细胞介导的基因治疗的前景.