Follow-up of newborns treated with extracorporeal membrane oxygenation: a nationwide evaluation at 5 years of age

Introduction  

Extracorporeal membrane oxygenation (ECMO) is a supportive cardiopulmonary bypass technique for babies with acute reversible cardiorespiratory failure. We assessed morbidity in ECMO survivors at the age of five years, when they start primary school and major decisions for their school careers must be made.     

可吸收性珊瑚羟基磷灰石与人骨髓间充质干细胞诱导成骨细胞复合培养及碱性成纤维细胞生长因子的作用

目的:观察人骨髓间充质干细胞诱导的成骨细胞与珊瑚羟基磷灰石的相容性及碱性成纤维细胞生长因子的作用。方法:实验于2003-02/2005-10在大连医科大学附属第一医院中心实验室及上海第二医科大学完成。实验材料:①可吸收性珊瑚羟基磷灰石。②人骨髓间充质干细胞:取自单纯性骨囊肿行自体骨髓注射治疗的患者(年龄10～16岁,平均14.5岁),患者均知情同意。实验分组:使用含地塞米松、β甘油磷酸钠和抗坏血酸的条件培养基诱导骨髓间充质干细胞分化为成骨细胞,与珊瑚羟基磷灰石复合培养,分为实验组(RPMI1640完全培养液 成骨细胞 可吸收性珊瑚羟基磷灰石),促增殖组(完全培养液 成骨细胞 可吸收性珊瑚羟基磷灰石 10μg/L碱性成纤维细胞生长因子),正常培养组(完全培养液 同等数量的成骨细胞)。实验评估:①采用扫描电镜观察成骨细胞与可吸收性珊瑚羟基磷灰石复合培养6h,1,3,7d时细胞形态。②成骨细胞附着于材料表面后生长增殖特性:于接种后24h,各组均取6孔细胞用胰蛋白酶消化贴壁细胞,包括材料上贴附的细胞,计数孔内细胞数及平均细胞数,绘制细胞生长曲线。③成骨细胞分泌碱性磷酸酶活性的测定:于接种后1,3,5,7d采用酶联免疫监测仪测410nm波长的吸光度值,计算每1000个细胞的吸光度值。结果:①成骨细胞与可吸收性珊瑚羟基磷灰石复合培养后细胞形态:复合培养6h,细胞多为单层结构,形态多样,有数个突起;复合培养1d,成骨细胞附着于可吸收性珊瑚羟基磷灰石表面并深入到材料的孔隙内,与材料牢固结合,并在材料表面伸展,细胞表面可见大量微绒毛;复合培养7d,细胞数量增多,可见少量胞体表面及细胞间有颗粒状钙盐结晶沉积,细胞形态无明显差异。②成骨细胞附着于材料表面后生长增殖特性:实验组细胞接种后,随时间延长数量逐渐增加,仍可保持正常的分裂增殖速度,与正常培养组相比差异无显著性意义(P>0.05)。复合培养4,5,6,7d后促增殖组细胞附着载体后数量增长明显高于实验组、正常培养组,差异均有显著性意义(P<0.05)。③成骨细胞分泌碱性磷酸酶活性的测定:随着培养时间的增加,3组细胞碱性磷酸酶含量(每1000个细胞的平均吸光度值)均逐渐增高(以实验组为例,复合培养1,3,5,7d分别为0.0121±0.0014,0.0154±0.0013,0.0172±0.0012,0.0183±0.0015),差异无显著性意义(P>0.05)。结论:①人骨髓间充质干细胞诱导的成骨细胞可以在一定的生物载体上正常生长、增殖,并保持生理功能。②10μg/L碱性成纤维细胞生长因子可促进此过程中细胞增殖。     

Deep white matter infarction: correlation of MR imaging and histopathologic findings

Focal and confluent areas of periventricular hyperintensity have been reported on magnetic resonance (MR) images in 30% of patients over 60 years of age. In order to better understand the pathologic basis of these lesions, the authors studied 14 formalin-fixed brains with MR imaging. Multiple focal areas of hyperintensity were identified in the periventricular white matter in three of the 14 brains studied (21%). Subsequent gross and microscopic pathologic examination of both hyperintense and normal-intensity areas was performed on 87 tissue sections. The larger lesions were characterized centrally by necrosis, axonal loss, and demyelination and therefore represent true infarcts. Reactive astrocytes oriented along the degenerated axons were identified at distances of up to several centimeters from the central infarct. This is called isomorphic gliosis and is associated with increased intensity on T2-weighted images that increases the apparent size of the central lesion.     

Wound healing in endoscopic sinus surgery: Phase 1 clinical trial evaluating the role of Chitogel with adjuvants

Objectives

This study aimed to determine the safety and efficacy of Chitogel, with and without Deferiprone (Def) and Gallium Protoporphyrin (GaPP), as a promoter of wound healing to improve surgical outcomes after endoscopic sinus susgery.

Design

A double-blinded, randomised control human clinical trial was conducted in patients undergoing ESS as a treatment for chronic rhinosinusitis. Participants underwent functional ESS or FESS with drill out as required and were randomised to receive test product Chitogel, Chitogel in combination with Def or Def-GaPP versus no packing (control).

Setting

Ostial stenosis and persistent inflammation are the main reasons for revision endoscopic sinus surgery (ESS). Post-operative (PO) dressings can improve PO wound healing and patient outcomes after ESS.

Participants

Eighty two patients were included in this study with 79 patients completing the study with 40 undergoing full house FESS and 39 FESS plus frontal drillout.

Main Outcome Measures

Patients were followed up at 2, 6 and 12 weeks PO, and outcome scores such as SNOT-22, VAS and LKS, pre and post-surgery (12 weeks) were compared.

Results

Seventy nine patients completed the study, there was a significant reduction in SNOT-22 score and improvement of VAS at 12 weeks in patients treated with Chitogel compared to control (p < .05). In those patients, the mean ostium area for the Chitogel and the Chitogel + Def + GaPP groups was higher across all three sinuses compared to the no-treatment control group, without statistical significance. Sphenoid sinus ostium was significantly more patent in patients treated with Chitogel compared to the control at the 12-week time point (p < .05).

Conclusion

Chitogel as a PO dressing after ESS results in the best patient-reported symptom scores and objective measurements. The combination of Def and GaPP to Chitogel though proving safe, had no effect on the ostium patency or mucosal healing.