Temporomandibular Joint Discectomy Followed by Disc Replacement Using Viable Osteochondral and Umbilical Cord Allografts Results in Improved Patient Outcomes
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Abstract:
The ideal surgical solution to reconstruct the temporomandibular joint (TMJ) disc after it has been removed has remained elusive. The major obstacle has been identifying a durable biocompatible material that will provide for restoration of TMJ function. The present study evaluated the outcomes of the interpositional implantation of a cryopreserved viable osteochondral allograft (CVOCA) combined with a viable cryopreserved umbilical cord tissue (vCUT) allograft after TMJ discectomy in patients with internal derangement and/or degenerative joint disease (DJD).We implemented a retrospective case series study and enrolled patients with DJD or disc displacement diagnosed using the Diagnostic Criteria of Temporomandibular Disorders, who had undergone interpositional CVOCA and vCUT implantation after TMJ discectomy. The primary outcome variable was pain, measured using a visual analog scale (VAS). The secondary outcomes variables included maximal incisal opening (MIO) and Glasgow Benefit Inventory (GBI) general subscale scores. The primary analysis compared the preoperative measures with those at the last follow-up visit. Descriptive and analytic statistics were computed to summarize the sample's characteristics and assess the pre- and postoperative differences.The study sample included 9 patients with a mean age of 36 years, and 44% were men. The VAS scores had decreased significantly from 9.0 ± 2.0 to 3.0 ± 3.0 postoperatively (P = .001). The MIO had increased from 31 ± 5 to 36 ± 5 mm (P = .178). The average GBI general subscale score of 13 ± 46 for the 9 patients showed a trend toward improved quality of life and patient satisfaction with the surgery. The median postoperative follow-up at the time of our report was 15 months (interquartile range, 10; range, 2 to 27) without treatment-related complications.The reported outcomes suggest that the interpositional implantation of CVOCA and vCUT after TMJ discectomy could be a solution for reducing TMJ-related pain and restoring TMJ function. Longer follow-up and prospective multicenter studies are warranted.Keywords:
Discectomy
Discectomy
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Neonatal tetanus infection and umbilical cord infection (omphalitis) are the main causes of morbidity and mortality in infants throughout the country, especially in Southeast Asia due to improper umbilical cord care. Umbilical cord care is carried out after the neonate is born until the umbilical cord is released with great care, attention and care to prevent infection in the umbilical cord. The purpose of this study was to describe the results of implementing the implementation of umbilical cord care with the open method in neonates. This type of research method uses a case study by applying the open method of umbilical cord care to determine the timing of the release of the umbilical cord. The results of the condition of the neonate's umbilical cord Ny. A and Mrs. T has not been released, before the umbilical cord is treated with an open method. While the condition of the neonate's umbilical cord, Ny. A and Mrs. T has been released, after the open method of umbilical cord treatment with the release of the umbilical cord in the neonate Ny. A was released on the 4th day, quickly (umbilical cord detachment time <5 days) and the neonate Mrs. T loose on day 5, normal (time of umbilical cord detachment 5-7 days). Based on the results of the final evaluation, there are differences in the development of the umbilical cord release time before and after being given the open method of umbilical cord care.
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To investigate the influencing factors for the time of umbilical cord separation in full-term newborns.The time of umbilical cord separation was recorded in 337 full-term newborns. Single factor and multifactor unconditioned logistic regression were performed to investigate the influencing factors of umbilical cord separation. Fourteen possible factors associated with the time of umbilical cord separation, including sex, gestational age, body weight, position of umbilical cord ligature, length of umbilical cord stump, umbilical cord diameter, cleanness of umbilical cord paster, hand cleanness of medical staff and family members and umbilical infection, were involved.The single factor correlative analysis demonstrated that the position of umbilical cord ligature, length of umbilical cord stump, umbilical cord diameter, cleanness of umbilical cord paster, and umbilical infection were influencing factors for the time of umbilical cord separation (P<0.05). The multifactor unconditioned logistic regression analysis demonstrated four major influencing factors for umbilical cord separation: position of umbilical cord ligature, length of umbilical cord stump, cleanness of umbilical cord paster, and umbilical infection.The following factors contribute to early separation of umbilical cord: the proper position of umbilical cord ligature (<0.5 cm to umbilical ring), the umbilical cord stump of <0.5 cm, keeping the umbilical cord paster clean and the prevention of umbilical infection.
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Functional impairment
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A successful isolation of Mesenchymal Stem Cells (MSCs) for its clinical application is very important.Isolation of MSCs from neonatal sources like human Umbilical Cord Wharton's Jelly (hUCWJ) have been reported in many studies and are considered primitive but isolation of MSCs from human umbilical cord blood (hUCB) is open to discussion. MATERIALS AND METHODSThe MSCs from hUCWJ and hUCB were isolated by explant culture and Ficoll density gradient respectively.The media used for the two sources were Dulbecco's modified Eagles medium, GlutaMax and fetal bovine serum (FBS) for hUCWJ, and Iscove modified Dulbecco's medium and FBS for hUCB.Further, the isolated cells were studied as per criteria of International Society of Cellular Therapy to define the cells as MSCs.Finally, we compare the feasibility and ease of isolating the neonatal sources. RESULTSUnlike hUCWJ, defining hUCB cells to MSCs as per criteria is limited because the number of cells decreases once it reaches 50% confluence and after 2 weeks, they show differing morphology with an appearance of large dimension of multinucleated cells identifying them as osteoclast-like cells thus restricting further study.The cells derived from both the sources grew into long, spindle shaped cells with prominent nuclei but hUCB has limited proliferation and fulfilled only the first criterion to define as MSCs while the cells isolated from hUCWJ continue to grow for multiple passages and fulfil all the defining criteria. CONCLUSIONNeonatal derived hUCWJ is more ideal source for isolation of MSCs than hUCB with the potential to use it in regenerative medicine.
Wharton's jelly
Cord lining
Placenta cord banking
Cord blood
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1. Surgical Decision Making in Temporomandibular Joint Surgery 2. Diagnostic Imaging of the Temporomandibular Joint 3. Surgical Approaches to the Temporomandibular Joint 4. Surgery for Internal Derangement of the Temporomandibular Joint 5. Osseous Surgery of the Temporomandibular Joint 6. Traumatic Injuries of the Temporomandibular Joint 7. Autogenous and Alloplastic Reconstruction of the Temporomandibular Joint 8. Pathology of the Temporomandibular Joint
Temporomandibular Joint Disorder
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There are plenty of haematopoietic stem cells in umbilical cord blood, which are regarded as important resources for transplantation therapy. There are some arguments on whether or not mesenchymal stem cells(MSCs) exist in umbilical cord blood. Some researchers have such opinions that there exist a number of MSCs in umbilical cord blood as similar with one from bone marrow in many aspects. Others believe that the content of MSCs in umbilical cord blood is too low to expand in vitro. We summarized the data from last five years researches. On umbilical cord blood MSCs during last to help further research and application of this resource of MSCs.
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Objective To investigate the causes and reoperative effect of failed back surgery syndrome(FBSS). Methods 24 patients with failed back surgery syndrome were treated surgically. The primary surgeries were fenestration laminotomy and discectomy (10 cases); total or hemi-laminectomy and discectomy(14 cases), among whom 3 cases were undergone transpedicle screw fixation .The revision procedure included hemilaminectomy or total laminectomy, discectomy, enlarged decompression of nerve root canal, internal fixation, and posteriolateral or intervertebral fusion. Results The major causes of FBSS included recurrent disc herniation,secondary stenosis,wrong positioning of the operative level, failure of internal fixation. All patients with secondary operation were followed up from 2 months to 3 years and obtained satisfactory outcomes. The clinical improvement rate was 80.2%, and the results were excellent in 18 cases, and good in 6 cases. Conclusions Satisfactory outcome can be gained if the secondary operation is chose properly for FBSS.
Discectomy
Laminotomy
Failed back surgery
Spinal canal stenosis
Fenestration
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The development of the human umbilical cord blood transplants with hematopoietic repopulating cells has enabled some problems associated with bone marrow transplants to be solved. Frozen umbilical cord blood banks should facilitate the finding of suitable stem cell donors. However, further experience is necessary to develop the optimal method for collection, separation, storage and cryopreservation of umbilical cord blood. We report our experience in the organization of a Cord Blood Bank.
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Placenta cord banking
Hematopoietic stem cell
Blood units
Cord lining
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