Predictors of Health-Related Quality of Life in Children with Cyanotic Heart Disease Who Underwent Palliative and Total Repair

Background: Studies on predictors of health-related quality of life (HRQOL) in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce. Therefore, we aimed to identify such predictors in children who received the modified Blalock–Taussig shunt (MBTS) and those who underwent total repair. Methods: In this historical cohort and concurrent follow-up study, data of children who underwent MBTS at the age of 0–3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained. Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation. Between January and December 2018, the “Pediatric Quality of Life Inventory 4.0 Generic Core Scales” with both child self-report and parent proxy-report scores were used to examine the HRQOL. Multivariate linear regression analysis was performed to identify independent predictors of HRQOL. Beta-coefficient (β) and 95% confidence intervals (95% CIs) were calculated and considered statistically significant at p < 0.05. Results: Among the 380 enrolled children, 148 died, 122 survived and waited for total repair, and 110 survived after total repair. In the multivariate analysis, chronic lung disease was a common predictor of lower physical and psychosocial HRQOL reported by the parents (β [95% CI]: −0.42 [−0.81, −0.03] and −0.49 [−0.89, −0.09], respectively). Total repair was a predictor of higher physical HRQOL according to both parents and children (β [95% CI]: 0.33 [0.09, 0.57] and 0.70 [0.36, 1.03], respectively). A predictor of higher psychosocial HRQOL reported by the parents was younger age during MBTS surgery compared with older age (β [95% CI]: 0.012 [0.001, 0.022]). In the total repair subgroup, undergoing the Fontan procedure (vs. Glenn procedure) was a predictor for lower physical HRQOL reported by the parents (β [95% CI]: −0.82 [−1.52, −0.13]). Higher socioeconomic status was a predictor of both physical and psychosocial HRQOL (β [95% CI]: 0.018 [0.001, 0.034] and 0.012 [0.0001, 0.04], respectively). Conclusions: Successful total repair was a predictor of higher physical HRQOL, and younger age during MBTS surgery was a predictor of higher psychological HRQOL in children with cyanotic heart disease. Higher socioeconomic status was a predictor of both physical and psychological HRQOL following total repair [Thai Clinical Trials Registry: TCTR20161221003].     

Interruptions of tenofovir/emtricitabine-based antiretroviral therapy in patients with HIV/hepatitis B virus co-infection

Thai patients enrolled in STACCATO with HIV/hepatitis B virus (HBV) co-infection and tenofovir/emtricitabine-based antiretroviral therapy (ART) were randomly assigned to continuous treatment or CD4 cell count-guided interruptions. HBV replication was suppressed below detection in 15/16 patients. Structured treatment interruption increased transaminases and HBV viraemia in five of six patients; one flare was severe. Conversion to anti-hepatitis Be occurred with continuous treatment only. Tenofovir/emtricitabine-containing ART is highly effective in controlling chronic HIV/HBV co-infection but treatment should not be interrupted.     

Repair of a large osteochondral defect in the knee joint using autologous and artificial bone graft combined with motion preserving distraction arthroplasty: a case report

The biological reconstruction of a large osteochondral defect in the weight-bearing area of the knee joint has long been a challenge to orthopedic surgeons. We present a case of a large posttraumatic defect in the weight-bearing area of knee joint treated with a novel distraction arthroplasty device after reconstruction of the joint surface using combined autologous and artificial bone graft.     

Determination of the safe penetration depth during all-inside meniscal repair of the posterior part of the lateral meniscus using the FasT-Fix suture repair system

Purpose  

The objective of this study was to determine the safe penetration depth of the FasT-Fix meniscal suture repair system during all-inside repair of the posterior part of the lateral meniscus.     

Mid-substance tear of the anterior and posterior cruciate ligaments in children: a report of three patients

We report one case of mid-substance injury of the posterior cruciate ligament and two cases of mid-substance injuries of the anterior cruciate ligament in children. Surgical repair with augmentation using the iliotibial band was performed on these patients without the use of transphyseal drill holes. A small strip of the iliotibial band was sutured onto the end of the cruciate ligament stump to augment the remnant. At the most recent follow-up examinations, conducted 5–11 years after surgery, no restriction or discomfort in daily and sport activities was reported, and acceptable levels of function in the injured knees were noted in all patients.     

In vivo bioluminescence imaging of transplanted bone marrow mesenchymal stromal cells using a magnetic delivery system in a rat fracture model

For the treatment of ununited fractures, we developed a system of delivering magnetic labelled mesenchymal stromal cells (MSCs) using an extracorporeal magnetic device. In this study, we transplanted ferucarbotran-labelled and luciferase-positive bone marrow-derived MSCs into a non-healing femoral fracture rat model in the presence of a magnetic field. The biological fate of the transplanted MSCs was observed using luciferase-based bioluminescence imaging and we found that the number of MSC derived photons increased from day one to day three and thereafter decreased over time. The magnetic cell delivery system induced the accumulation of photons at the fracture site, while also retaining higher photon intensity from day three to week four. Furthermore, radiological and histological findings suggested improved callus formation and endochondral ossification. We therefore believe that this delivery system may be a promising option for bone regeneration.     

The effect of microRNA-21 on proliferation and matrix synthesis of chondrocytes embedded in atelocollagen gel

The objective of this study was to investigate the effect of microRNA-21 (miR-21) on the proliferation and matrix synthesis of chondrocytes embedded in atelocollagen gel. Articular cartilage was harvested aseptically from the knee and hip joints of rats. In the experimental group, double-stranded miR-21 was transfected into the chondrocytes, and in the control group, scrambled siRNA was used. After that, chondrocytes were cultured in atelocollagen gel for 3 weeks. At 1, 2, and 3 weeks after transfection, the cell numbers were counted, and the expression levels of Col2a1 and aggrecan were measured by real-time PCR. Histological analysis by toluidine blue staining was performed at 3 weeks. The cell number in the experimental group rapidly increased compared to the control group. The expression levels of Col2a1 and aggrecan in the experimental group were higher than in the control. Histological analysis revealed that many more cells with a metachromatic stain were present in the experimental group than in the control. This study demonstrated that miR-21 promotes high proliferation and matrix synthesis of chondrocytes embedded in atelocollagen gel.