Stem cells for babies and their surgeons: The future is now

Pediatric surgeons are ideal allies for the translation of basic science including stem cell therapies. In the spirit of Robert E. Gross, of applying creative solutions to pediatric problems with technical expertise, we describe the impending cellular therapies that may be derived from stem and progenitor cells. Understanding the types and capabilities of stem and progenitor cells is important for pediatric surgeons to join and facilitate progress for babies. We are developing an induced pluripotent stem cell therapy for enteric neuropathies such as Hirschsprung disease that might be helpful for children in the near future. Our goals, which we hope to share with other surgeons and scientists, include working to establish safe clinical trials and meeting regulatory standards in a thoughtful way that balances patients need and unknown risks.     

微信平台在门诊人工流产妇女延续护理中的应用效果

目的 调查基于微信公众平台在门诊人工流产妇女延续护理中的应用效果。 方法 选取234例门诊人工流产妇女,根据患者的入院顺序奇偶数进行编号分为微信组和普通组,每组117例,普通组采用传统门诊宣教,微信组在此基础上应用微信公众平台进行网络健康教育、多层次的医患沟通、门诊预约就诊等延续护理,比较2组避孕措施的掌握情况、避孕措施的运用情况。 结果 干预1个月后微信组避孕措施掌握情况明显好于普通组(t=3.923,P<0.001);干预4个月后,微信组未使用避孕措施的患者少于普通组(χ²=4.294,P=0.038)。 结论 微信延续护理可提高对人工流产妇女的关爱,降低重复流产率。     

瑞芬太尼对无痛人流患者的麻醉效果及IFN-γ、IL-10、NF-κB的变化研究

【目的】探讨瑞芬太尼对无痛人流患者的麻醉效果及干扰素-γ(IFN-γ)、白介素-10(IL-10)、核因子κB(NF-κB)变化的影响。【方法】于本院进行无痛人流患者140例,将其随机分为两组,观察组采用瑞芬太尼联合丙泊酚麻醉,对照组单纯采用丙泊酚麻醉。比较两组术中麻醉效果,术后苏醒时间以及对IFN-γ、IL-10、NF-κB水平的影响。【结果】观察组患者的优良率为98.6%(69/70),明显高于对照组的90.0%(63/70),且差异有显著性(P<0.05)。观察组患者术后苏醒时间及警觉/镇静(OAA/S)评分均优于对照组(P<0.05)。术后观察组患者IFN-γ水平明显低于对照组,IL-10、NF-κB水平明显高于对照组,且两组之间相比较差异均有显著性(P<0.05)。【结论】瑞芬太尼对无痛人流患者的麻醉效果好,可以有效降低患者血清内IFN-γ水平,提高IL-10、NF-κB水平,患者术后苏醒时间缩短,有利于患者术后恢复。     

血管内皮生长因子基因修饰诱导多能干细胞的生物学特性的研究

目的 探讨血管内皮生长因子(vascular endothelial growth factor,VEGF)基因修饰诱导多能干细胞(induced pluripotent stem cells,iPS)的生物学特性。方法 将培养好的iPS细胞分为3组,即N0(纯iPS培养)组、N1(空腺病毒载体转染iPS)组、N2(转染VEGF基因的iPS)组; 3组细胞分别进行传代培养,并采用MTT方法检测转染VEGF基因对细胞增殖的影响; 采用酶联免疫(ELISA)方法检测细胞培养上清液中VEGF的表达水平。结果 转染VEGF基因对iPS细胞增殖没有明显影响; N2组iPS细胞分泌的VEGF蛋白表达水平较N1组显著增加(P<0.05)。结论 经VEGF基因转染的iPS可正常存活生长,并可稳定表达该基因。     

Misoprostol as an adjunct to overnight osmotic dilators prior to second trimester dilation and evacuation: A systematic review and meta-analysis,

ObjectiveTo understand effect of adjunct misoprostol on cervical preparation with overnight osmotic dilators for dilation and evacuation after 16 weeks gestation.MethodsWe searched on-line reference databases using search terms for second trimester, abortion, misoprostol, and dilators. Randomized controlled trials of cervical preparation for second trimester D&E using overnight osmotic dilators comparing adjunct misoprostol to placebo were included. Weighted mean with standard deviation (SD) and pooled binary outcomes were compared.ResultsAmong 84 articles identified, three met inclusion criteria (n = 457 subjects) adjunct misoprostol did not significantly decrease mean procedure times (8.5 ± 4.6 vs 9.6 ± 5.8 min, p = 0.78) or manual dilation (18% vs 28%, p = 0.23) when compared to placebo. There was no difference in total complications (p = 0.61), major complications (p = 0.44), or cervical lacerations (p = 0.87).ConclusionCurrent limited evidence suggests adjunct misoprostol with osmotic dilators after 16 weeks does not affect procedure time or need for manual dilation.ImplicationsFurther research is needed to determine the effect of adjunct misoprostol on major complications and blood loss.     

Trends and targets of various types of stem cell derived transfusable RBC substitution therapy: Obstacles that need to be converted to opportunity

A shortage of blood during the pandemic outbreak of COVID-19 is a typical example in which the maintenance of a safe and adequate blood supply becomes difficult and highly demanding. So far, human RBCs have been produced in vitro using diverse sources: hematopoietic stem cells (SCs), embryonic SCs and induced pluripotent SCs. The existing, even safest core of conventional cellular bioproducts destined for transfusion have some shortcoming in respects to: donor –dependency variability in terms of hematological /immunological and process/ storage period issues. SCs–derived transfusable RBC bioproducts, as one blood group type for all, were highly complex to work out. Moreover, the strategies for their successful production are often dependent upon the right selection of starting source materials and the composition and the stability of the right expansion media and the strict compliance to GMP regulatory processes. In this mini-review we highlight some model studies, which showed that the efficiency and the functionality of RBCs that could be produced by the various types of SCs, in relation to the in-vitro culture procedures are such that they may, potentially, be used at an industrial level. However, all cultured products do not have an unlimited life due to the critical metabolic pathways or the metabolites produced. New bioreactors are needed to remove these shortcomings and the development of a new mouse model is required. Modern clinical trials based on the employment of regenerative medicine approaches in combination with novel large-scale bioengineering tools, could overcome the current obstacles in artificial RBC substitution, possibly allowing an efficient RBC industrial production.