Tag: Surgery (Orthopeadics)

New fiber optic guide-wire will enable surgeons to perform highly accurate hip fracture and spinal fusion surgery with minimal side effects. Common orthopedic procedures, such as hip and pelvic fracture surgery as well as spinal fusion, require the accurate positioning of a thin metallic wire to guide the positioning of a fixating screw. However, the surgical procedure is often hampered by deflection, bending and even breakage of the guide-wire, which then requires repair while complicating and prolonging the recovery of patients.

“This is a significant challenge,” said Prof. Meir Liebergall, head of the Department of Orthopedic Surgery at Hadassah Medical Center, “as complications in guide-wire positioning could lead to revision surgeries and increase hospitalization time and cost.”

To address this challenge, Prof. Liebergall partnered with a multidisciplinary team of medical doctors, along with engineering and business students, from The Hebrew University’s BioDesign: Medical Innovation program.

They identified a solution: by creating a system that provides real-time indication of deflection or bending of the guide-wire, the surgeon will be able to adjust the procedure before damage occurs.

The team developed BendGuide, an opto-electronic drilling system that monitors and detects minute changes in guide-wire trajectory during surgery. It allows surgeons to correct drilling trajectories during the procedure itself. The system eliminates guide-wire bending or breakage and significantly reduces operation time and enhances safety.

“This is an elegant technological solution to a complex problem,” said Prof. Yaakov Nahmias, director of The Hebrew University’s Alexander Grass Center for Bioengineering and the BioDesign program. “The group model and proof-of-concept experiments showed they could detect even miniscule changes in guide-wire trajectory.”

BendGuide uses a fiber bundle with a reflecting laser beam that enables detection of small deflections in wire trajectory. At a fully-aligned state, the beam power hits the center of the detector array. When deflected, mirror misalignment causes the power to spread differentially across the fiber bundle.

The market for computer-aided navigation systems for surgery is growing fast. The potential market is estimated at $500 million annually in the United States alone. BendGuide aims to become an integral part of this market, which is expected to grow further with the aging population.

https://www.sciencedaily.com/  Science Daily

https://www.sciencedaily.com/releases/2016/02/160223132717.htm  Original web page at Science Daily

The Karolinska Institute (KI) in Stockholm is ending its association with acclaimed but controversial surgeon Paolo Macchiarini, who pioneered transplants of artificial windpipes but has been accused of ethical breaches in his work.

Macchiarini’s contract will not be renewed when it runs out in November 2016, the Karolinska announced, and he has been asked to use his remaining time to phase out his research there. Macchiarini’s head of department is also responsible for ensuring that “the work of his research group is dismantled”, the institute says.

The 4 February decision comes after revelations in a Swedish documentary that Macchiarini conducted operations in Krasnodar, Russia, on at least one patient who was not life-threateningly ill, and that he misrepresented the success of his prosthetic grafts in scientific publications. The programme has created uproar in Sweden, and led the KI to announce earlier this week that it was looking into the case.

Now, the Karolinska has “lost confidence” in Macchiarini, explains Claes Keisu, a press officer for the institute. “He has overexploited Karolinska’s brand in his work in Krasnodar. His activities there has undermined KI’s reputation and damaged the public’s and the scientific community’s trust in KI,” Keisu says.

The institute is also looking into discrepancies in the surgeon’s CV, adds Keisu. Those allegations were first made in a Vanity Fair article.

The surgeon’s work was hailed as a game-changer in regenerative medicine when, in 2011, he implanted a plastic artificial trachea, using bioengineered stem cells, into a patient whose own windpipe had been damaged. Over the next three years, he carried out seven more synthetic trachea implantations — two more at the Karolinska, one in Illinois and four in Russia, where he heads a tissue engineering project. Six of the eight patients have died (from causes unrelated to the transplants, Macchiarini says), and one has been in intensive care since the procedure.

The documentary, made by SVT, Sweden’s national broadcaster, was aired in January. It suggested that in Russia, Macchiarini implanted a trachea into a woman who was not in a life-threatening condition. That was news to the Karolinska’s vice-chancellor Anders Hamsten, who said in a statement that the institute would never have approved Macchiarini’s activities in Russia if they were as the documentary describes.

Five months ago, Hamsten had cleared Macchiarini of allegations of misconduct in research papers — after an independent investigation had found the surgeon guilty. The institute has not yet decided whether to reopen that investigation. But on 4 February it said it would open an external investigation into its own handling of the Macchiarini case, to be led by a lawyer and medical researchers who have not yet been appointed. Swedish prosecutors are also investigating the three procedures carried out at Karolinska, but have not made any charges.

Macchiarini, a visiting professor at the KI since 2010, has not yet responded to Nature’s requests for comment after the latest Karolinska announcement. After the documentary, he said that he was “in the process of presenting all the multidisciplinary conference discussions that were had around each patient’s case — along with the ethical committee decisions that approved them — to the Karolinska Institute”.

Nature doi:10.1038/nature.2016.19315

http://www.nature.com/news/index.html  Nature

http://www.nature.com/news/karolinska-institute-to-cut-ties-with-controversial-surgeon-1.19315  Original web page at Nature

The researchers analyzed one-year follow-up data on 1,645 patients undergoing surgery for degenerative disease of the upper (cervical) and lower (lumbar) spine. Before and one year after surgery, the patients were evaluated using standard rating scales for disability and neck, back, arm and leg pain.

Based on a spinal surgery satisfaction scale, 83 percent of patient said they were satisfied with the outcomes of surgery one year later. The researchers wanted to see whether any of the factors evaluated before surgery could predict whether patients would be satisfied or dissatisfied with their outcomes.

After adjustment for a wide array of patient-specific factors, several specific predictors were identified. Patients who didn’t have at least a 15 percent improvement on a standard disability rating scale — considered to be the “minimal clinically important difference” — were four times more likely to be dissatisfied with their surgical outcomes.

Patients who didn’t achieve minimal clinically important differences in pain scores were about three times more likely to be dissatisfied with the results of surgery. Patients who were on Medicaid or uninsured also had lower satisfaction rates, as did those with higher initial pain and disability scores.

Patients with depression or anxiety before surgery were less likely to achieve clinically meaningful improvement, and had lower satisfaction rates. However, after adjustment for initial pain and disability scores, these mental health factors were not significant predictors.

Patient satisfaction scores are increasingly used as measures of the quality of medical care — and as a determinant of reimbursement for care provided. “Identifying modifiable factors that improve satisfaction is of utmost importance,” according to Dr. Devin and coauthors.

The new study shows that patient satisfaction ratings after surgery for spinal degenerative disease line up well with the level of improvement in pain and disability achieved. The researchers write, “Surgical ineffectiveness was a strong independent predictor of dissatisfaction.”

But the results also show a significant impact of initial pain and disability, suggesting that patients with more severe spinal degenerative disease are less likely to be satisfied with the results of surgery. Insurance status also seems to have an impact — Medicaid recipients or uninsured patients may have lower satisfaction rates even if they do improve clinically.

The study may provide tools to help identify individuals at risk of dissatisfaction and to improve the delivery of spine care, Dr. Devin and coauthors believe. They conclude, “Individualizing the patient preoperative counseling on the basis of these patient-specific factors can improve patient satisfaction with outcomes.

http://www.sciencedaily.com/  Science Daily

http://www.sciencedaily.com/releases/2015/07/150724084854.htm  Original web page at Science Daily

The standard limb-lengthening technique requires patients to be fitted with a device called a circular external fixator. The device consists of a rigid frame made of stainless steel and high-grade aluminum. Three rings surround the lower leg and are secured to the bone in order to manipulate bone fragments with stainless-steel pins.

The study examined an alternative technique that employed an internal titanium rod in addition to the external fixator. Researchers compared the standard technique with this alternative technique in trauma patients who underwent lengthening of the tibia (shinebone). The alternative technique significantly reduced the amount of time patients had to spend in the external fixator (from 11 months to seven months). Preventing amputation is known as limb salvage. A prerequisite for salvaging an arm or a leg is the ability to regenerate missing bone.

Limb lengthening is used to replace missing bone or to lengthen or straighten deformed bones. Patients include children born with birth defects and patients who have suffered severe fractures or bone cancer. In trauma patients, broken bones can become infected, requiring surgeons to remove the infected segment. In bone cancer patients, the surgeon takes out a segment of bone in order to remove the tumor. The limb-lengthening technique enables the patient to grow back the section of bone lost to infection or tumor.

Limb lengthening works on a principle known as distraction osteogenesis. Four times a day, the external fixator pulls apart two bone segments, and new bone tissue fills in the gap. As a result, the bone lengthens at a rate of about 1 mm. per day. Bones can be lengthened by between 15 percent and 25 percent of their original length at a time.

Once the new bone tissue is formed, it takes several more months until it fully regenerates. In the standard limb-lengthening technique, the patient wears the external fixator until the bone completely matures, in order to support the weight of the limb. In the alternative technique, the surgeon implants a titanium rod inside the bone, in order to reduce the amount of time the patient must spend in the external fixator.

The study was conducted at the Hospital for Special Surgery, where Dr. Bernstein completed a fellowship in limb lengthening and complex reconstruction. The study included 58 trauma patients who underwent limb lengthening. Thirty patients were treated with the standard technique. Twenty-eight patients were treated with the alternative technique, which combined the external fixator with the titanium rod implantation. In both groups, the average limb lengthening was 2.1 in.

There was no statistically significant difference in the severity or number of complications between both groups, and good-to-excellent results were found in all patients. Wearing an external fixator can irritate the skin and cause infections at the pin sites. Also, it’s difficult to wear clothes over the device, and sleeping can be uncomfortable.

“As soon as we get patients out of the external frame they feel better,” Dr. Bernstein said. “Limb deformity surgeons are trying their best to make it a bit easier for patients, without compromising the safety of the procedure.”

http://www.sciencedaily.com/  Science Daily

http://www.sciencedaily.com/releases/2015/07/150717120438.htm  Original web page at Science Daily

Healing times for skin ulcers and bedsores can be reduced by a third with the use of low-intensity ultrasound, scientists from the University of Sheffield and University of Bristol have found. Researchers from the University of Sheffield’s Department of Biomedical Science discovered the ultrasound transmits a vibration through the skin and wakes up cells in wounds helping to stimulate and accelerate the healing process

More than 200,000 patients in the UK suffer with chronic wounds every year at a cost of over £3.1 billion to the NHS. The ultrasound treatment, which also reduces the chance of wounds getting infected, is particularly effective when treating diabetics and the elderly. There are 11 million over-65s, three million diabetics, and 10 million smokers in the UK — all of whom are likely to suffer problems with healing wounds. A quarter of diabetics suffer from skin ulcers, particularly foot ulcers, due to the loss of sensation and circulation in the legs.

Lead author of the study Dr Mark Bass, from the University’s Centre for Membrane Interactions and Dynamics (CMIAD), said: “Skin ulcers are excruciatingly painful for patients and in many cases can only be resolved by amputation of the limb.

“Using ultrasound wakes up the cells and stimulates a normal healing process. Because it is just speeding up the normal processes, the treatment doesn’t carry the risk of side effects that are often associated with drug treatments.

The pioneering study, which is published in the Journal of Investigative Dermatology, was carried out in collaboration with the School of Biochemistry at the University of Bristol, the Wound Biology Group at the Cardiff Institute of Tissue Engineering and Repair, and the orthopaedic company, Bioventus LLC.

Dr Bass added: “Now that we have proven the effectiveness of ultrasound we need to explore the signal further. We have found that the ultrasound signal we currently use is effective, but it is possible that by refining the treatment we could improve the effects even further. “Because ultrasound is relatively risk free we could expect to see it in broad clinical use within three or four years.”

http://www.sciencedaily.com/  Science Daily

http://www.sciencedaily.com/releases/2015/07/150712203837.htm  Original web page at Science Daily

Statins have been shown to reduce complications from cardiovascular surgery. To determine whether statins might also help those undergoing major lung surgeries, a team of researchers conducted a well-designed study that randomized patients to receive either a statin or placebo before and after surgery. They found that patients undergoing major lung resection experienced fewer complications overall, however, the differences between groups for specific complications or changes in inflammatory markers failed to reach statistical significance

Statins have been shown to reduce complications from cardiovascular surgery. To determine whether statins might also help those undergoing major lung surgeries, a team at Memorial Sloan Kettering Cancer Center conducted a well-designed study that randomized patients to receive either a statin or placebo before and after surgery. They found that patients undergoing major lung resection experienced fewer complications overall, however, the differences between groups for specific complications or changes in inflammatory markers failed to reach statistical significance, according to a report in the Journal of Thoracic and Cardiovascular Surgery, the official publication of the American Association for Thoracic Surgery (AATS).

Because encouraging trends were observed, the authors have called for further evaluation in a larger multicenter, randomized, controlled trial. In an Editorial Commentary that accompanied the report, Betty C. Tong, M.D., of the Division of Cardiovascular and Thoracic Surgery of Duke University Medical Center (Durham, NC), concurred. ‘Imagine all the people who could potentially have benefited from the knowledge gained by this trial had it accrued as originally intended. With continued enthusiasm and surgeon commitment to multicenter clinical trials, we will be able to elucidate further the role of therapies such as this in preventing complications after lung resection,’ noted Tong.

The original study design called for 480 patients to be enrolled. In part because previously unpublished data on the efficacy of the statin (atorvastatin) to reduce postoperative atrial fibrillation were released soon after the trial began and it became challenging to find patients who were not taking the drug, only 164 patients were randomized into two groups.

Total postoperative complications occurred in 22 percent of patients receiving placebo and 12 percent patients receiving the statin. While the difference was not statistically significant, the composite of major pulmonary and cardiovascular complication rates in those who underwent more extensive surgeries (anatomic lung resections) were three-fold higher in placebo-treated patients than those who received the statin and the difference was statistically significant.

While other complications including pneumonia, acute respiratory failure, myocardial infarction, deep vein thrombosis, and mortality were more frequent in the placebo group compared to the statin group, the differences were not statistically significant. Postoperative rates of atrial fibrillation in the atorvastatin group were cut by almost half (from 27 to 14 percent), but the change, while perhaps clinically meaningful, was not statistically significant. In addition, no differences were found in plasma levels of markers of inflammation, such as C-reactive protein, tumor necrosis factor-α, or myeloperoxidase. ‘These promising results in patients undergoing anatomic pulmonary resection merit further evaluation in a larger multicenter, randomized, controlled trial before recommendation as standard clinical practice,’ explained lead author David Amar, M.D., of the Departments of Anesthesiology and Critical Care Medicine, and co-principal investigator Bernard Park, M.D., of the Department of Surgery at Memorial Sloan Kettering Cancer Center (New York).

In light of the increasing use of statins, including during the perioperative period for cardiac and thoracic surgery, and their low potential for adverse effects, Neel R. Sodha, M.D., and Frank W. Sellke, M.D., of the Division of Cardiothoracic Surgery of Alpert Medical School of Brown University (Rhode Island) prepared an Expert Review of the clinical evidence of perioperative statin use. ‘A review of the research shows that slightly more than half the studies [done for cardiac surgery] support the anti-inflammatory effect of statins. Clinical studies are confounded because most patients proceeding to cardiac or thoracic surgery are receiving statins to reduce the progression of coronary artery disease. Therefore, it is difficult to know whether statins also reduce postoperative complications. Conclusions regarding the relationship of statins to clinical outcomes cannot be drawn based on current data,’ stated Sodha and Sellke.

They point to wide variation among reports concerning the magnitude of the reduction in inflammatory parameters. Noting that the two trials (including that of Amar and colleagues) investigating the effect of statins in thoracic surgery produced discordant results, they concluded that ‘this inconsistency lends more weight to the need for caution in using statins for the sole purpose of minimizing perioperative inflammation.’

http://www.sciencedaily.com/  Science Daily

http://www.sciencedaily.com/releases/2015/06/150622182503.htm  Original web page at Science Daily

Hand injuries are frequently caused by human and animal bites, prompting as many as 330,000 emergency department visits in the United States each year. A literature review appearing in the January issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) outlines the potential complications of human and animal bites to the hand, the importance of early injury assessment, and the use of antibiotic and other treatment methods to avoid infection, permanent disability, and amputation.

“Although many people may be reluctant to immediately go to a doctor, all bites to the hand should receive medical care,” said orthopaedic surgeon and lead study author Stephen A. Kennedy, MD. “And while routine antibiotics are not necessarily recommended for other bite wounds, they are recommended for a bite to the hand to reduce the risk of infection and disability.” Human bites to the hand–while accounting for only two to three percent of all hand bite injuries–can occur during altercations and include wounds caused by punching type contact with the mouth or teeth, domestic abuse, or accidentally during sports, play, or other activities. Human bites to the fingers and hand that penetrate through the skin can transmit infection through oral flora, or saliva, which contains more than 600 bacterial species.

Animals also have saliva containing a broad range of bacteria. Adult dog jaws, especially among larger breeds, are capable of exerting a bite force of more than 300 pounds, and when combined with the variety and sharpness of their teeth–designed to clamp, hold, tear, and crush food–can cause significant injuries to hand and finger ligaments, tendons, and bones. Cats do not have the jaw strength of dogs; however, their sharp, narrow teeth also can cause serious injury. An estimated 30 percent to 50 percent of cat bites are complicated by infections, which can occur as early as three hours after injury in approximately 50 percent of the infection cases. Infections due to dog bites typically occur at less than half the rate of cat bites.

If a hand-to-mouth injury or bite occurs: Inspect the hand carefully for any puncture wounds. Even a small wound can inject virulent bacteria under the skin. If there is a puncture wound of any size, wash as soon as possible with soap and water then seek medical advice.

If you see redness, feel increasing pain over time or see red streaking up the hand or arm (or along a tendon), these are signs of a significant infection and immediate medical attention is needed. Prompt treatment, ideally within 24 hours of an animal or human bite, can prevent serious injury or infection: Symptoms of infection include erythema (redness), edema (swelling), progressive pain, and fever. The patient’s medical, immunization, and recent antibiotic history, as well as the timing and location of injury, should be considered when determining treatment. Patients who have prosthetic joints are at risk of an infection “seeding,” or anchoring, at the site of the metal, ceramic, or plastic device.

The size and depth of the wound and the amount of devitalized (dead) tissue should be assessed along with potential damage to neurovascular structures and tendons, underlying fractures, the presence of exposed bone and/or infection, and the integrity of the joint. All patients with hand bites should receive antibiotic treatment, which can lower the infection rate from an average of 28 percent to 2 percent. Open wounds may need to be surgically irrigated and débrided (cleaned, including removal of unhealthy or dead tissue).

http://www.sciencedaily.com/  Science Daily

http://www.sciencedaily.com/releases/2015/01/150105125838.htm

Original web page at Science Daily

Autologous rib cartilage is the preferred source of graft material for rhinoplasty because of its strength and ample volume. However, using rib cartilage for dorsal augmentation to build up the bridge of the nose has been criticized for its tendency to warp and issues at the cartilage donor site, such as pneumothorax (a collapsed lung) and postoperative scarring. Jee Hye Wee, M.D., of the National Medical Center, Seoul, South Korea, and co-authors reviewed the available medical literature to evaluate complications associated with autologous rib cartilage and rhinoplasty. Authors identified 10 studies involving 491 patients with an average follow-up across all studies of 33.3 moths. Results indicate that combined complication rates from the studies were 3.08 percent for warping, 0.22 percent for resorption, 0.56 percent for infection, 0.39 percent for displacement, 5.45 percent for hypertrophic chest scarring (keloids), 0 percent for pneumothorax and 14.07 percent for revision surgery. “The overall long-term complications associated with autologous rib cartilage use in rhinoplasty were low. Because warping and hypertrophic chest scarring had relatively high rates, surgeons should pay more attention to reduce these complications. … Future analysis should include studies with larger pools of patients, clearer definitions of complications and longer-term follow-up to obtain more reliable results,” the study concludes.

http://www.sciencedaily.com/ Science Daily

http://www.sciencedaily.com/releases/2014/11/141127212325.htm Original web page at Science Daily

The St Vincent’s Hospital Heart Lung Transplant Unit has carried out the world’s first distant procurement of hearts donated after circulatory death (DCD). These hearts were subsequently resuscitated and then successfully transplanted into patients with end-stage heart failure.

Transplant Units until now have relied solely on donor hearts from brain-dead patients whose hearts are still beating. The use of DCD hearts, where the heart is no longer beating, represents a paradigm shift in organ donation and will herald a major increase in the pool of available hearts for transplantation. St Vincent’s has recently transplanted two patients using DCD hearts both of whom have recovered extremely well. The DCD transplants were carried out following pioneering basic and translational research undertaken by the Victor Chang Cardiac Research Institute and St Vincent’s Hospital, who have jointly developed a special preservation solution that together with the use of a novel portable console to house, resuscitate and transport donor hearts; has made this milestone achievable. The ex vivo Organ Care System (OCS — TransmedicsTM) involves the Transplant retrieval team connecting the donor heart to a sterile circuit where it is kept beating and warm thereby limiting the detrimental effects of cold ischaemia (a period where the heart is dormant without oxygen and nutrients) that occurs with the standard organ preservation mode of packing the heart on ice in an Esky. Once housed inside the portable device, the heart is reanimated, preserved and able to be functionally assessed until it is ready to be placed inside the recipient. Coined the “Heart in a box,” for the past several months the OCS has provided the transplant surgeons greater versatility with regard to both organ preservation and resuscitation. This has enabled the St Vincent’s Transplant Unit to conduct several regular heart transplants this year through more long distance organ retrievals and most importantly, retrieval of “marginal hearts,” that is, brain death hearts previously regarded as being unsuitable for transplantation. This portable OCS technology will help significantly in mitigating the significant disparity that remains between the increasing number of patients with end-stage heart failure on the transplant waiting list and the number of suitable donor-hearts that are available. Whilst the use of DCD organs has already made an enormous positive impact on liver, kidney and lung transplantation, it has to date not been possible to use DCD hearts. This is the first time internationally that human heart transplantation has been achieved with hearts donated following circulatory death and procured at a distance with portable organ preservation technology. In acknowledging the significance of this milestone for his Unit, Professor Peter MacDonald, Medical Director of the St Vincent’s Heart Transplant Unit, Head of the Transplantation Research Laboratory at the Victor Chang Institute and Professor of Medicine at UNSW said, “In many respects this breakthrough represents a major inroad to reducing the shortage of donor organs. As we mark the 30th anniversary of the St Vincent’s Heart Lung Transplant Unit and the 20th anniversary of the Victor Chang Institute this year, this is a timely breakthrough. In all our years, our biggest hindrance has been the limited availability of donor organs.”

http://www.sciencedaily.com/  Science Daily

http://www.sciencedaily.com/releases/2014/10/141024144822.htm  Original web page at a Science Daily

In a ground-breaking research project at the University of Gothenburg, seven Swedish women have had embryos reintroduced after receiving wombs from living donors. Now the first transplanted woman has delivered a baby — a healthy and normally developed boy. The world-unique birth was acknowledged in The Lancet on 5 October. The uterus transplantation research project at the University of Gothenburg started in 1999 and has been evaluated in over 40 scientific articles. The goal of the Gothenburg project is to enable women who were born without a womb or who have lost their wombs in cancer surgery to give birth to their own children. Nine women in the project have received a womb from live donors — in most cases the recipient’s mother but also other family members and close friends. The transplanted uterus was removed in two cases, in one case due to a serious infection and in the other due to blood clots in the transplanted blood vessels. The seven remaining women have in 2014 tried to become pregnant through a process where their own embryos, produced through IVF, are reintroduced to the transplanted uterus. The first early pregnancy was confirmed in the spring after a successful first pregnancy attempt in a woman in her mid-30s, a little over a year after her transplantation. In early September, the woman successfully delivered a baby by caesarean section, making her the first woman in the world to deliver a child from a transplanted uterus. Her uterus was donated by a 61-year-old unrelated woman. The caesarean section had to be performed earlier than planned: the woman developed preeclampsia in week 32 of her pregnancy and the CTG indicated that the baby was under stress. A caesarean section was performed in accordance with normal clinical routines so as not to risk the health of the mother and child. According to Professor Mats Brännström, who performed the caesarean section, the perfectly healthy newborn boy is developing normally. The baby weighed 1,775 grams (3 lbs14.6 oz) at birth, which is normal size considering the gestational age at delivery. The baby screamed right away and has not required any other care than normal clinical observation at the neonatal unit. The mother and child are both doing well and have returned home. The new parents are of course very happy and thankful,’ says Professor Mats Brännström, who is leading the research project. The reason for the woman’s preeclampsia is unknown, but it may be due to her immunosuppressive treatment combined with the fact that she is missing one kidney. The age of the donated womb may also be a factor. Also, preeclampsia is generally more common among women who have become pregnant through IVF treatment.’

The woman has had three mild rejection episodes since the transplant, one of which occurred during the pregnancy. The rejection episodes, which are often seen also in other types of transplants, could be stopped with immunosuppressive treatment. The research team followed the pregnancy closely, carefully monitoring the growth and development of the foetus with a special focus on the blood supply to the uterus and umbilical cord. ‘There were concerns that the blood supply may be compromised since we had reattached the blood vessels to the womb. But we did not notice anything unusual concerning the function of the uterus and the foetus, and the pregnancy followed all normal curves,’ says Brännström. ‘It gives us scientific evidence that the concept of uterus transplantation can be used to treat uterine factor infertility, which up to now has remained the last untreatable form of female infertility. It also shows that transplants with a live donor are possible, including if the donor is past menopause,’ says Brännström. Several research teams around the world have been awaiting the results of the Gothenburg study in order to launch similar observational studies. The pregnancy attempts are ongoing with the other six women in the project.

http://www.sciencedaily.com/  Science Dail

http://www.sciencedaily.com/releases/2014/10/141007092110.htm Original web page at Science Daily

Damaged leg muscles grew stronger and showed signs of regeneration in three out of five men whose old injuries were surgically implanted with extracellular matrix (ECM) derived from pig bladder, according to a new study conducted by researchers at the University of Pittsburgh School of Medicine and the McGowan Institute for Regenerative Medicine. Early findings from a human trial of the process and from animal studies were published today in Science Translational Medicine. When a large volume of muscle is lost, typically due to trauma, the body cannot sufficiently respond to replace it, explained senior investigator Stephen F. Badylak, D.V.M., Ph.D., M.D., professor of surgery at Pitt and deputy director of the McGowan Institute, a joint effort of Pitt and UPMC. Instead, scar tissue can form that significantly impairs strength and function. Pig bladder ECM has been used for many years as the basis for medical products for hernia repair and treatment of skin ulcers. It is the biologic scaffold that remains left behind after cells have been removed. Previous research conducted by Dr. Badylak’s team suggested that ECM also could be used to regenerate lost muscle by placing the material in the injury site where it signals the body to recruit stem and other progenitor cells to rebuild healthy tissue. “This new study is the first to show replacement of new functional muscle tissue in humans, and we’re very excited by its potential,” Dr. Badylak said. “These are patients who can’t walk anymore, can’t get out of a car, can’t get up and down from a chair, can’t take steps without falling. Now we might have a way of helping them get better.” For the Muscle Tendon Tissue Unit Repair and Reinforcement Reconstructive Surgery Research Study, which is sponsored by the U.S. Department of Defense and is continuing to enroll new participants, five men who had at least six months earlier lost at least 25 percent of leg muscle volume and function compared to the uninjured limb underwent a customized regimen of physical therapy for 12 to 26 weeks until their function and strength plateaued for a minimum of two weeks.

Then, study lead surgeon J. Peter Rubin, M.D., UPMC Professor and chair of plastic surgery, Pitt School of Medicine, surgically implanted a “quilt” of compressed ECM sheets designed to fill into their injury sites. Within 48 hours of the operation, the participants resumed physical therapy for up to 26 additional weeks. The researchers found that three of the participants, two of whom had thigh injuries and one a calf injury, were stronger by 20 percent or more six months after the surgery. One thigh-injured patient improved on the “single hop test” by 1,820 percent, and the other had a 352 percent improvement in a chair lift test and a 417 percent improvement in the single-leg squat test. Biopsies and scans all indicated that muscle growth had occurred. Two other participants with calf injuries did not have such dramatic results, but both improved on at least one functional measure and said they felt better. “This work represents an important step forward in our ability to repair tissues and improve function with materials derived from natural proteins. There will be more options to help our patients,” Dr. Rubin said. The study also showed six months after an injury, mice treated with ECM showed signs of new muscle growth while untreated mice appeared to form typical scars.

http://www.sciencedaily.com/   Science Daily

May 27, 2014

http://www.sciencedaily.com/releases/2014/04/140430143016.htm  Original web page at Science Daily

Researchers at Columbia Engineering announced today that they have successfully grown fully functional human cartilage in vitro from human stem cells derived from bone marrow tissue. Their study, which demonstrates new ways to better mimic the enormous complexity of tissue development, regeneration, and disease, is published in the April 28 Early Online edition of Proceedings of the National Academy of Sciences (PNAS). “We’ve been able — for the first time — to generate fully functional human cartilage from mesenchymal stem cells by mimicking in vitro the developmental process of mesenchymal condensation,” says Gordana Vunjak-Novakovic, who led the study and is the Mikati Foundation Professor of Biomedical Engineering at Columbia Engineering and professor of medical sciences. “This could have clinical impact, as this cartilage can be used to repair a cartilage defect, or in combination with bone in a composite graft grown in lab for more complex tissue reconstruction.” For more than 20 years, researchers have unofficially called cartilage the “official tissue of tissue engineering,” Vunjak-Novakovic observes. Many groups studied cartilage as an apparently simple tissue: one single cell type, no blood vessels or nerves, a tissue built for bearing loads while protecting bone ends in the joints. While there has been great success in engineering pieces of cartilage using young animal cells, no one has, until now, been able to reproduce these results using adult human stem cells from bone marrow or fat, the most practical stem cell source. Vunjak-Novakovic’s team succeeded in growing cartilage with physiologic architecture and strength by radically changing the tissue-engineering approach. The general approach to cartilage tissue engineering has been to place cells into a hydrogel and culture them in the presence of nutrients and growth factors and sometimes also mechanical loading. But using this technique with adult human stem cells has invariably produced mechanically weak cartilage. So Vunjak-Novakovic and her team, who have had a longstanding interest in skeletal tissue engineering, wondered if a method resembling the normal development of the skeleton could lead to a higher quality of cartilage.

Sarindr Bhumiratana, postdoctoral fellow in Vunjak-Novakovic’s Laboratory for Stem Cells and Tissue Engineering, came up with a new approach: inducing the mesenchymal stem cells to undergo a condensation stage as they do in the body before starting to make cartilage. He discovered that this simple but major departure from how things were usually? being done resulted in a quality of human cartilage not seen before. Gerard Ateshian, Andrew Walz Professor of Mechanical Engineering, professor of biomedical engineering, and chair of the Department of Mechanical Engineering, and his PhD student, Sevan Oungoulian, helped perform measurements showing that the lubricative property and compressive strength — the two important functional properties — of the tissue-engineered cartilage approached those of native cartilage. The researchers then used their method to regenerate large pieces of anatomically shaped and mechanically strong cartilage over the bone, and to repair defects in cartilage. “Our whole approach to tissue engineering is biomimetic in nature, which means that our engineering designs are defined by biological principles,” Vunjak-Novakovic notes. “This approach has been effective in improving the quality of many engineered tissues — from bone to heart. Still, we were really surprised to see that our cartilage, grown by mimicking some aspects of biological development, was as strong as ‘normal’ human cartilage.” The team plans next to test whether the engineered cartilage tissue maintains its structure and long-term function when implanted into a defect. “This is a very exciting time for tissue engineers,” says Vunjak-Novakovic. “Stem cells are transforming the future of medicine, offering ways to overcome some of the human body’s fundamental limitations. We bioengineers are now working with stem cell scientists and clinicians to develop technologies that will make this dream possible. This project is a wonderful example that we need to ‘think as a cell’ to find out how exactly to coax the cells into making a functional human tissue of a specific kind. It’s emblematic of the progress being driven by the exceptional young talent we have among our postdocs and students at Columbia Engineering.”

http://www.sciencedaily.com/  Nature

May 27, 2014

http://www.sciencedaily.com/releases/2014/04/140430142820.htm  Original web page at Nature

Kidney cancers are the eighth most common cancer affecting adults, accounting for around 3% of all cancers in Europe; In 2012 it was estimated that there would be approximately 84.400 new cases of Kidney cancer with 34,700 deaths. It is usually treated surgically, but the operations can be stressful, and speed and accuracy are essential. The ability to produce exact 3-dimensional models of objects means that 3D printing is set to revolutionize many fields. Now a group of surgeons from Kobe University in Japan has combined the 3D imaging capabilities of Computer Tomography, with 3D printing, to produce exact scale model of kidneys prior to surgery. This allows surgeons to practice surgery in difficult kidney cancer cases. So far they have produced ten 3D kidney models to assist in kidney cancer operations. The group used computer tomography to produce a 3D scan of a diseased kidney. They then fed this information into a commercially-available 3D printer to produce a 3D model of the diseased kidney. As the scan is personalized for each patient, this meant that the surgeons were able to construct a 3D scale model of each individual’s kidney cancer. The model — which was printed using two different materials- allowed the surgeons to accurately determine the margins of the kidney tumors. The 3D printed organ model was made of transparent material so that the blood vessels could be seen from the outside, meaning that surgeons could see the exact position of the blood vessels prior to surgery. This allowed the surgeons to simulate surgery on the kidney tumor prior to real surgery. The surgery itself was then performed robotically. Presenting the work at the European Association of Urology congress in Stockholm, lead researcher Dr Yoshiyuki Shiga said: “The use of this “hands-on” model system gave us a 3D anatomical understanding of the kidney and the tumor. This enabled the surgeon to work on a smaller area. This is important, as it means that the area where the blood supply is interrupted during surgery can be reduced, in fact we found that the shortest interruption time was only 8 minutes, compared to a normal average of 22 minutes. We also found that where we had to remove part of the kidney, the fact that we knew the exact location of the blood vessels helped us greatly. At the moment this is still an expensive technique, adding between $500 and $1500 to the cost of surgery, but we hope that if it is more widely used then costs will fall.”

http://www.sciencedaily.com/  Science Daily

May 13, 2014

http://www.sciencedaily.com/releases/2014/04/140414100801.htm  Original web page at Science Daily

For the first time, scientists have succeeded in coaxing laboratory cultures of human stem cells to develop into the specialized, unique cells needed to repair a patient’s defective or diseased bladder. The breakthrough, developed at the UC Davis Institute for Regenerative Cures and published today in the scientific journal Stem Cells Translational Medicine, is significant because it provides a pathway to regenerate replacement bladder tissue for patients whose bladders are too small or do not function properly, such as children with spina bifida and adults with spinal cord injuries or bladder cancer. “Our goal is to use human stem cells to regenerate tissue in the lab that can be transplanted into patients to augment or replace their malfunctioning bladders,” said Eric Kurzrock, professor and chief of the division of pediatric urologic surgery at UC Davis Children’s Hospital and lead scientist of the study, which is titled “Induction of Human Embryonic and Induced Pluripotent Stem Cells into Urothelium.” To develop the bladder cells, Kurzrock and his UC Davis colleagues investigated two categories of human stem cells. In their key experiments, they used induced pluripotent stem cells (iPS cells), which were derived from lab cultures of human skin cells and umbilical blood cells that had been genetically reprogrammed to convert to an embryonic stem cell-like state. If additional research demonstrates that grafts of bladder tissue grown from human stem cells will be safe and effective for patient care, Kurzrock said that the source of the grafts would be iPS cells derived from a patient’s own skin or umbilical cord blood cells. This type of tissue would be optimal, he said, because it lowers the risk of immunological rejection that typifies most transplants.

In their investigation, Kurzrock and his colleagues developed a protocol to prod the pluripotent cells into becoming bladder cells. Their procedure was efficient and, most importantly, the cells proliferated over a long period of time — a critical element in any tissue engineering application. “What’s exciting about this discovery is that it also opens up an array of opportunities using pluripotent cells,” said Jan Nolta, professor and director of the UC Davis Stem Cell program and a co-author on the new study. “When we can reliably direct and differentiate pluripotent stem cells, we have more options to develop new and effective regenerative medicine therapies. The protocols we used to create bladder tissue also provide insight into other types of tissue regeneration.” UC Davis researchers first used human embryonic stem cells obtained from the National Institutes of Health’s repository of human stem cells. Embryonic stem cells can become any cell type in the body (i.e., they are pluripotent), and the team successfully coaxed these embryonic stem cells into bladder cells. They then used the same protocol to coax iPS cells made from skin and umbilical cord blood into bladder cells, called urothelium, that line the inside of the bladder. The cells expressed a very unique protein and marker of bladder cells called uroplakin, which makes the bladder impermeable to toxins in the urine. The UC Davis researchers adjusted the culture system in which the stem cells were developing to encourage the cells to proliferate, differentiate and express the bladder protein without depending upon signals from other human cells, said Kurzrock. In future research, Kurzrock and his colleagues plan to modify the laboratory cultures so that they will not need animal and human products, which will allow use of the cells in patients.

Kurzrock’s primary focus as a physician is with children suffering from spina bifida and other pediatric congenital disorders. Currently, when he surgically reconstructs a child’s defective bladder, he must use a segment of their own intestine. Because the function of intestine, which absorbs food, is almost the opposite of bladder, bladder reconstruction with intestinal tissue may lead to serious complications, including urinary stone formation, electrolyte abnormalities and cancer. Developing a stem cell alternative not only will be less invasive, but should prove to be more effective, too, he said. Another benefit of the UC Davis study is the insight it may provide about the pathways of bladder cancer, which is diagnosed in more than 70,000 Americans each year, according to the National Cancer Institute. “Our study may provide important data for basic research in determining the deviations from normal biological processes that trigger malignancies in developing bladder cells,” said Nolta. More than 90 percent of patients who need replacement bladder tissue are adults with bladder cancer. Kurzrock said “cells from these patients’ bladders cannot be used to generate tissue grafts because the implanted tissue could carry a high risk of becoming cancerous. On the other hand, using bladder cells derived from patients’ skin may alleviate that risk. Our next experiments will seek to prove that these cells are safer.”

http://www.sciencedaily.com/  Science Daily

April 15, 2014

http://www.sciencedaily.com/releases/2014/03/140321164856.htm  Original web page at Science Daily

Stem cell transplant was viable and effective in halting or reversing degenerative disc disease of the spine, a meta-analysis of animal studies showed, in a development expected to open up research in humans. Recent developments in stem cell research have made it possible to assess its effect on intervertebral disc (IVD) height, Mayo Clinic researchers reported in a scientific poster today at the 30th Annual Meeting of the AmericanAcademy of Pain Medicine. “This landmark study draws the conclusion in pre-clinical animal studies that stem cell therapy for disc degenerative disease might be a potentially effective treatment for the very common condition that affects people’s quality of life and productivity,” said the senior author, Wenchun Qu, MD, PhD, of the Mayo Clinic in Rochester, Minn. Dr. Qu said not only did disc height increase, but stem cell transplant also increased disc water content and improved appropriate gene expression. “These exciting developments place us in a position to prepare for translation of stem cell therapy for degenerative disc disease into clinical trials,” he said. The increase in disc height was due to restoration in the transplant group of the nucleus pulposus structure, which refers to the jelly-like substance in the disc, and an increased amount of water content, which is critical for the appropriate function of the disc as a cushion for the spinal column, the researchers concluded.

The researchers performed a literature search of MEDLINE, EMBASE and PsycINFO databases and also manually searched reference lists for original, randomized, controlled trials on animals that examined the association between IVD stem cell transplant and the change of disc height. Six studies met inclusion criteria. Differences between the studies necessitated the use of random-effects models to pool estimates of effect. What they found was an over 23.6% increase in the disc height index in the transplant group compared with the placebo group (95% confidence interval [CI], 19.7-23.5; p < 0.001). None of the 6 studies showed a decrease of the disc height index in the transplant group. Increases in the disc height index were statistically significant in all individual studies. The authors commented that it is time to turn attention to the much-needed work of determining the safety, feasibility, efficacy of IVD stem cell transplant for humans. “A hallmark of IVD degenerative disease is its poor self-repair capacity secondary to the loss of IVD cells. However, current available treatments fail to address the loss of cells and cellular functions. In fact, many invasive treatments further damage the disc, causing further degeneration in the diseased level or adjacent levels,” said the lead study author Jason Dauffenbach, DO. “The goal of tissue engineering using stem cells is to restore the normal function and motion of the diseased human spine.”

http://www.sciencedaily.com/  Science Daily

April 1, 2014

http://www.sciencedaily.com/releases/2014/03/140308094811.htm  Original web page at Science Daily

Researchers have developed a new way to study bone disorders and bone growth, using stem cells from patients afflicted with a rare, genetic bone disease. The approach, based on Nobel-Prize winning techniques, could illuminate the illness, in which muscles and tendons progressively turn into bone, and addresses the similar destructive process that afflicts a growing number of veterans who have suffered blast injuries — including traumatic amputations or injuries to the brain and nervous system. This insidious hardening of tissues also grips some patients following joint replacement or severe bone injuries. The disease model, described in a new study by a UC San Francisco-led team, involves taking skin cells from patients with the bone disease, reprogramming them in a lab dish to their embryonic state, and deriving stem cells from them. Once the team derived the stem cells, they identified a cellular mechanism that drives abnormal bone growth in the thus-far untreatable bone disease, called fibrodysplasiaossificans progressiva (FOP). Furthermore, they found that certain chemicals could slow abnormal bone growth in the stem cells, a discovery that might help guide future drug development.

Clinically, the genetic and trauma-caused conditions are very similar, with bone formation in muscle leading to pain and restricted movement, according to the leader of the new study, Edward Hsiao, MD, PhD, an endocrinologist who cares for patients with rare and unusual bone diseases at the UCSF Metabolic Bone Clinic in the Division of Endocrinology and Metabolism. The human cell-based disease model is expected to lead to a better understanding of these disorders and other illnesses, Hsiao said. “The new FOP model already has shed light on the disease process in FOP by showing that the mutated gene can affect different steps of bone formation,” Hsiao said. “These different stages represent potential targets for limiting or stopping the progression of the disease, and may also be useful for blocking abnormal bone formation in other conditions besides FOP. The human stem-cell lines we developed will be useful for identifying drugs that target the bone-formation process in humans.” The team’s development of, and experimentation with, the human stem-cell disease model for FOP, published in the December issue of the Orphanet Journal of Rare Diseases, is a realization of the promise of research using stem cells of the type known as induced pluripotent stem (iPS) cells, immortal cells of nearly limitless potential, derived not from embryos, but from adult tissues.

Shinya Yamanaka, MD, PhD, a UCSF professor of anatomy and a senior investigator with the UCSF-affiliated Gladstone Institutes, as well as the director of the Center for iPSCell Research and Application (CiRA) and a principal investigator at Kyoto University, shared the Nobel Prize in 2012 for discovering how to make iPS cells from skin cells using a handful of protein “factors.” These factors guide a reprogramming process that reverts the cells to an embryonic state, in which they have the potential to become virtually any type of cell. Because injuries and surgeries can trigger rapid bone formation in FOP patients, obtaining tissue samples for extensive lab study is extremely difficult. Human iPS cells provide a unique solution by allowing the creation of the needed tissues in the lab. Hsiao and colleagues carefully gathered skin samples from donors, and then grew the skin cells in culture before converting them into iPS cells using the methods created by Yamanaka. In addition to providing an alternative to embryonic stem cells for potential use in regenerating diseased tissues, iPS cells are being used to learn more about diseases, especially diseases driven by mutated genes. Unlike the skin cells from which they originated, the human iPS cells created from FOP patients show increased cartilage formation and increased bone mineralization, two critical steps that are necessary to form mature bone. Bone morphogenetic proteins (BMPs) play a central role in the bone formation within muscle. FOP results from a gene mutation that causes a defect in the receptor protein to which BMPs bind, thereby increasing bone formation. “These cells will be a key tool for finding ways to stimulate and control human bone growth for regenerative medicine or bone repair,” Hsiao said. “The iPS cells may also help us identify treatments for more common diseases, such as atherosclerosis and vascular calcification, because the same bone morphogenetic protein pathways are involved in these medical conditions.”

http://www.sciencedaily.com/  Science Daily February 4, 2014

http://www.sciencedaily.com/releases/2014/01/140108093250.htm  Original web page at Science Daily