Use of collagen-hydroxyethylmethacrylate hydrogels for cell growth.

Collagen-hydroxyethylmethacrylate hydrogels were prepared by polymerizing monomeric hydroxyethylmethacrylate in the presence of various concentrations of soluble native collagen. The resulting transparent hydrogels were evaluated as substrata for growth of IMR-90 human embryonic lung fibroblasts. Without collagen no significant growth occurred, whereas a dose-response curve expressing maximal cell growth against collagen concentration could be constructed quite readily by the use of appropriate hydrogels. The method allows for quantification of the collagen contribution to cell growth and, in a more general sense, provides the foundation for a relatively easy procedure to probe mechanisms of cell adhesion and cell differentiation.     

Risk factors for delirium after on-pump cardiac surgery: a systematic review

IntroductionAs evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments need to be made for confounding variables. This review aims to systematically identify risk factors for delirium after cardiac surgery and to grade the evidence supporting these associations.MethodA prior registered systematic review was performed using EMBASE, CINAHL, MEDLINE and Cochrane from 1990 till January 2015 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007371). All studies evaluating patients for delirium after cardiac surgery with cardiopulmonary bypass (CPB) using either randomization or multivariable data analyses were included. Data was extracted and quality was scored in duplicate. Heterogeneity impaired pooling of the data; instead a semi-quantitative approach was used in which the strength of the evidence was graded based on the number of investigations, the quality of studies, and the consistency of the association reported across studies.ResultsIn total 1462 unique references were screened and 34 were included in this review, of which 16 (47 %) were graded as high quality. A strong level of evidence for an association with the occurrence of postoperative delirium was found for age, previous psychiatric conditions, cerebrovascular disease, pre-existent cognitive impairment, type of surgery, peri-operative blood product transfusion, administration of risperidone, postoperative atrial fibrillation and mechanical ventilation time. Postoperative oxygen saturation and renal insufficiency were supported by a moderate level of evidence, and there is no evidence that gender, education, CPB duration, pre-existent cardiac disease or heart failure are risk factors.ConclusionOf many potential risk factors for delirium after cardiac surgery, for only 11 there is a strong or moderate level of evidence. These risk factors should be taken in consideration when designing future delirium prevention strategies trials or when controlling for confounding in future etiological studies.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-1060-0) contains supplementary material, which is available to authorized users.     

Physical activity and cardiac function in the oldest old

The relationship of physical activity (PA) and cardiac function in the oldest old remains unclear. The objective of this study was to evaluate the relationship between PA and cardiac structure and function, in the oldest old. Subjects were recruited from the Jerusalem Longitudinal Cohort Study that was initiated in 1990 and has followed an age homogeneous cohort of Jerusalem residents born in 1920-1921. A total of 496 of the subjects from the most recent set of data collection in 2005-2006 underwent echocardiography at their place of residence in addition to structured interviews and physical examination. Standard echocardiographic assessment of cardiac structure and function including ejection fraction (EF) and diastolic function as assessed by E:E' measurements was performed. PA was defined as a dichotomous (≥4?hr of light exercise weekly) and as a categorical variable (<4?hr weekly/4 hours weekly/at least 1?hr daily/sport at least twice weekly). On bivariate analysis, mean EF was lower among sedentary versus active women (55.5%±8.5% vs. 58.4%±8.3, p=0.021). No other significant differences were observed between sedentary and active subjects, for either systolic or diastolic function. After adjusting for sex, education, diabetes, ischemic heart disease, hypertension, dependence in activities of daily living, and body mass index (BMI), no significant associations were found between systolic or diastolic function, or left ventricular structure and PA. Gender-specific analyses yielded similar findings. Our study of the oldest old did not demonstrate an association between PA and cardiac structure or function.     

自体游离骨膜移植修复儿童髋关节软骨大面积缺损：动物实验及临床应用

目的:通过自体游离骨膜移植修复儿童髋关节软骨大面积缺损的实验研究和临床应用,观察关节软骨缺损修复的组织形态学变化和临床应用疗效。方法:①动物实验:实验于2002-03/10在南京医科大学附属南京儿童医院儿科研究所完成。选用新西兰幼兔24只,将幼兔股骨头全层关节软骨用利刀切除其表面积的20%以上,制造髋关节软骨大面积缺损模型。按随机数字表法分为2组,每组12只,自体游离骨膜移植组取同侧股骨全层游离骨膜,将骨膜生发层朝向关节腔移植于软骨缺损区;对照组仅同法切除股骨头关节软骨。分别于术后第4,8,12,24周取其股骨头制成标本,对关节软骨缺损修复情况进行大体及组织形态学观察,并用Wston-blot法检测修复组织中Ⅱ型胶原蛋白的表达情况。②临床实验:选择2000-01/2005-06在南京医科大学附属南京儿童医院骨科手术治疗髋关节脱位时,采用自体游离骨膜移植修复髋关节软骨大面积缺损的患儿39例(48髋),监护人均知情同意。术后定期随访检查。髋关节脱位术后疗效根据临床功能及X射线检查结果进行评定:积分16-20分为优,11-15分为良,6-10分为可,<5分为差。结果:①动物实验:自体游离骨膜移植组术后第4周幼兔股骨头软骨缺损被光滑、不透明的类软骨组织替代;12周后软骨缺损由透明的软骨样组织修复;24周后则完全被近似正常的透明软骨修复。对照组术后24周股骨头软骨缺损仍由纤维样组织覆盖。自体游离骨膜移植组术后第4周起软骨缺损修复组织中Ⅱ型胶原蛋白呈持续高表达。②临床实验:39例患儿48髋均获随访,随访18-36个月18例22髋,37-54个月14例16髋,55-72个月7例10髋,平均32个月。髋关节脱位术后疗效优19例25髋(52.1%);良12例10髋(25.0%);可7例8髋(16.7%);差3例3髋(6.2%),优良率达77.1%。结论:动物实验结果显示幼兔自体游离骨膜移植3个月后基本完成了游离骨膜向关节软骨的分化,可为临床应用提供客观依据。临床实验证实,在手术治疗儿童髋关节脱位时,移植自体游离骨膜修复关节软骨大面积缺损,能够提高手术疗效。     

A TRANSIENT STAGE OF SUSPECTED DELAYED SENSITIVITY DURING THE EARLY INDUCTION PHASE OF IMMEDIATE CORNEAL SENSITIVITY

1. If quantities of bovine serum albumin or bovine gamma globulin in the range of 2 to 4 mg are inoculated intracorneally into rabbits, a biphasic reaction occurs in the cornea. 2. The primary reaction, which becomes manifest approximately 3 days after inoculation and lasts several days, is characterized by a diffuse clouding of the cornea. During this period, no antibody can be demonstrated either by serological or histological techniques. The animals react with a delayed type of skin reaction and the sensitivity can be passively transferred to normal guinea pigs with the cells of pooled lymph nodes or buffy coats. The corneal reaction is therefore considered a manifestation of delayed sensitivity. 3. The secondary reaction in the cornea, usually occurring about the 14th day after inoculation is the "Wessely phenomenon." This reaction is characterized by a precipitation of immune complexes in the cornea resulting in a visible annular corneal opacity. Circulating antibody can be readily demonstrated by both serological and histological techniques and the animals demonstrate typical Arthus skin sensitivity. 4. Generally intervening between these two phases of corneal activity is a stage in which the inoculated eye appears essentially normal. This stage is eliminated if both corneas are inoculated initially.     

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

Hepatitis D virus (HDV) infection is highly prevalent in patients with chronic hepatitis B (CHB). AASLD guidelines recommend a risk-based screening approach. Our aim was to ascertain if the risk-based approach leads to appropriate HDV screening, identify targets to improve screening rates, and study HDV clinical burden. CHB patients screened for HDV from 01/2016 to 12/2021 were identified. Level of training and specialty of providers ordering HDV screening tests were determined. HDV seropositive (HDV+) patient charts were reviewed for the presence of individual risk factors per the AASLD guidelines to determine if they met screening criteria. The severity of liver disease at the time of HDV screening was compared between the HDV+ group and a matched (based on age, hepatitis B e antigen status, BMI and sex) HDV seronegative (HDV−) group. During the study period, 1444/11,190 CHB patients were screened for HDV. Most screening tests were ordered by gastroenterology (90.2%) specialists and attending physicians (80.5%). HDV+ rate was 88/1444 (6%), and 72 HDV+ patients had complete information for analysis. 18% of HDV+ patients would be missed by a risk-based screening approach due to unreported or negative risk factors (see Table). A significantly higher number of HDV+ patients had developed significant fibrosis (p = 0.001) and cirrhosis (p < 0.01) by the time of screening than HDV− (n = 67) patients. In conclusion, targeted interventions are needed towards trainees and primary care clinics to improve screening rates. Current risk-based criteria do not appropriately screen for HDV. It is time for universal screening of HDV in CHB patients.