scholarly journals Xenograft Bone-Derived Collagen Scaffold for Myelomeningocele Management

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sadid Khan ◽  
Natalie Campbell ◽  
Sam Fathizadeh ◽  
Sean Bucherl ◽  
Eric Nauman, Ph.D.
Keyword(s):  
Spina Bifida ◽  
Mechanical Strength ◽  
Treatment Options ◽  
Fetal Surgery ◽  
Collagen Scaffold ◽  
Lower Limbs ◽  
Neurological Injury ◽  
Maternal Complications ◽  
Bioactive Proteins ◽  
The Us

Background and Hypothesis: Spina bifida is a neural tube defect resulting from an incomplete closure of the caudal neuropore. The most debilitating form of spina bifida, myelomeningocele (MMC), can present with Chiari II malformation with concomitant hydrocephalus, bowel and bladder abnormalities, and impaired motor function of the lower limbs. The incidence rate of spina bifida is 3.4 per 10,000 live births reported within the US. On average, the US spends $1,176,000,000 annually on patient management and treatment. Advancements in existing treatment options, namely fetal surgery, can greatly decrease neurological injury and related costs, but at the risk of fetal and maternal complications. Various tissue engineering methods have been proposed including biodegradable and synthetic scaffolds, seeded with or without bioactive proteins and stem cells, sutured or glued to the defect, and administered fetoscopically or through open fetal surgery. However, no combination of these methods is fully biointegratable, watertight, provides complete coverage with adequate mechanical strength, and is able to be administered fetoscopically. Experimental Design: This study utilizes bovine and porcine bone to create an organic, flexible collagen scaffold that can be seeded with bioactive proteins and attached with adhesive for successful coverage of MMC defects. Conclusion and Potential Impact: The natural matrix may allow for quicker host cell integration and greater mechanical strength compared to existing models. This study will characterize the mechanical strength, permeability, and biointegration of the proposed management of spina bifida.

scholarly journals Comparison of an oncology clinical decision-support system’s recommendations with actual treatment decisions

2021 ◽  
Author(s):  
Suthida Suwanvecho ◽  
Harit Suwanrusme ◽  
Tanawat Jirakulaporn ◽  
Surasit Issarachai ◽  
Nimit Taechakraichana ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Treatment Options ◽  
Stage Iv ◽  
Clinical Decision ◽  
Treatment Decisions ◽  
Therapeutic Options ◽  
Cancer Type ◽  
The Us ◽  
Rectal Cancers

Abstract Objective IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. Methods This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH’s institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. Results Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. Conclusion This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.

scholarly journals ‘We did everything we could’– A qualitative study exploring the acceptability of maternal‐fetal surgery for spina bifida to parents

2021 ◽  
Author(s):  
Neeltje Crombag ◽  
Adalina Sacco ◽  
Bernadette Stocks ◽  
Philippe De Vloo ◽  
Johannes Van Der Merwe ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Qualitative Study ◽  
Fetal Surgery

Gene Therapy for Inherited Retinopathies: Update on Development Progress

2018 ◽  
Vol 2 (4) ◽  
pp. 219-226
Author(s):  
Susan Sun ◽  
Sandra R. Montezuma
Keyword(s):  
Gene Therapy ◽  
Genetic Disorders ◽  
Treatment Options ◽  
Genetic Material ◽  
Disease Process ◽  
Supportive Therapy ◽  
The Us ◽  
Retinal Disorders ◽  
The Status ◽  
Therapy Treatment

Inherited retinopathies are a group of genetic disorders that lead to blindness and/or vision impairment. Until now, treatment options for inherited retinopathies largely remained limited to supportive therapy. Gene therapy is an attractive therapeutic technique that allows repair of diseased genes, and it has shown success in vision improvement for patients affected by retinal disorders caused by genetic mutations. The US Food and Drug Administration approved the first gene therapy treatment for the eye, indicated for biallelic RPE65 mutation associated Leber congenital amaurosis (LCA), in December of 2017. Additionally, results from other ongoing clinical trials could further establish gene therapy as the milestone treatment that plays a role in disease process reversal for inherited retinopathies. This review article provides an update on the status of gene therapy for treatment of a variety of retinopathies, including LCA, choroideremia, achromatopsia, Stargardt disease, X-linked retinitis pigmentosa, and X-linked retinoschisis. Furthermore, this article explores transport methods of the genetic material, as well as therapy-delivery approaches used in the clinical setting.

Fetal Surgery Procedures and Associated Maternal Complications

2018 ◽  
pp. 997-1004
Author(s):  
Alireza A. Shamshirsaz ◽  
Venkata Bandi ◽  
David Muigai ◽  
R.H. Ball ◽  
Michael A. Belfort
Keyword(s):  
Fetal Surgery ◽  
Maternal Complications

Development and Mechanical Characterization of a Collagen/Hydroxyapatite Bilayered Scaffold for Ostechondral Defect Replacement

2011 ◽  
Vol 493-494 ◽  
pp. 890-895 ◽  
Author(s):  
Francesca Gervaso ◽  
Francesca Scalera ◽  
Sanosh Kunjalukkal Padmanabhan ◽  
Antonio Licciulli ◽  
Daniela Deponti ◽  
...  
Keyword(s):  
Mechanical Strength ◽  
Sol Gel ◽  
Three Dimensional ◽  
Collagen Scaffold ◽  
Mechanical Analysis ◽  
Design Parameters ◽  
Compression Tests ◽  
Templating Method ◽  
Organic Part ◽  
Hydroxyapatite Scaffold

In this work a novel three-dimensional ostechondral substitute is proposed that is made of an inorganic/organic hybrid material, namely collagen/hydroxyapatite. The two components of the substitute have been characterized separately. The inorganic part, a hydroxyapatite scaffold, was fabricated by a polymer sponge templating method using a reactive sub-micron powder synthesized in our laboratory by hydroxide precipitation sol-gel route. The organic part, a collagen scaffold, was fabricated by a freeze-dying technique varying design parameters. Both the parts were analysed by scanning electron microscopy and their mechanical properties assessed by compression tests. The hydroxyapatite scaffold showed a high and highly interconnected porosity and a mechanical strength equal to 0.55 MPa, higher than those reported in literature. The collagen scaffolds were seeded by chondrocytes, processed for histology analysis and tested in compression. The biological tests proved the ability of the scaffolds to be positively populated by chondrocytes and the mechanical analysis showed that the mechanical strength of the scaffolds significantly increased after 3 weeks of culture.

scholarly journals The Management of Older Adults with Pancreatic Adenocarcinoma

Geriatrics ◽  
2018 ◽  
Vol 3 (4) ◽  
pp. 85 ◽  
Author(s):  
John Ogden ◽  
Hao Xie ◽  
Wen Ma ◽  
Joleen Hubbard
Keyword(s):  
Older Adults ◽  
Pancreatic Cancer ◽  
Clinical Trial ◽  
Treatment Options ◽  
Karnofsky Performance Score ◽  
Nccn Guidelines ◽  
The Us ◽  
Localized Disease ◽  
Clinical Trial Enrollment ◽  
Current Guidelines

Pancreatic cancer is the eleventh most common cancer, yet it is the third leading cause of mortality. It is also largely a disease of older adults, with the median age of 71 at diagnosis in the US, with <1% of diagnoses occurring prior to age 50. Current NCCN guidelines recommend surgery for localized disease, followed by adjuvant therapy and/or consideration of enrollment in a clinical trial. For metastatic disease, current guidelines recommend clinical trial enrollment or systemic chemotherapy based on results from the landmark ACCORD-11 and MPACT trials. However, these trials focused heavily on younger, more fit patients, with the ACCORD-11 trial excluding patients over age 75 and the MPACT trial having 92% of its patients with a Karnofsky performance score >80. This article summarizes the available evidence in current literature in regards to the best treatment options for older adults, who represent the majority of pancreatic cancer diagnoses.

scholarly journals VP51.04: Options for intrauterine correction of spina bifida by open and fetoscopic fetal surgery: a systematic review

2021 ◽  
Vol 58 (S1) ◽  
pp. 306-306
Author(s):  
L. Lara‐Ávila ◽  
M. Martinez‐Rodriguez ◽  
R. Villalobos‐Gómez ◽  
H. López‐Briones ◽  
R. Cruz‐Martinez
Keyword(s):  
Systematic Review ◽  
Spina Bifida ◽  
Fetal Surgery

scholarly journals PUBIC SYMPHYSIS DIASTASIS IN PREGNANCY AND DELIVERY (REVIEW)

2018 ◽  
Vol 24 (3) ◽  
pp. 145-156
Author(s):  
A. L. Petrushin ◽  
A. V. Pryaluchina
Keyword(s):  
Internal Fixation ◽  
Treatment Options ◽  
Pubic Symphysis ◽  
Lower Limbs ◽  
Sacroiliac Joints ◽  
Pubic Symphysis Diastasis ◽  
Partial Load ◽  
Short Period ◽  
Pregnancy And Delivery ◽  
Symphysis Diastasis

Purpose of the study— to generalize and arrange the data published in scientific literature and to present currentviews on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery. Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences. Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.

scholarly journals Open Spina Bifida: Why Not Fetal Surgery?

2018 ◽  
Vol 45 (6) ◽  
pp. 430-434 ◽  
Author(s):  
Luca Mazzone ◽  
Ueli Moehrlen ◽  
Barbara Casanova ◽  
Samira Ryf ◽  
Nicole Ochsenbein-Kölble ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Fetal Surgery ◽  
Open Spina Bifida
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