Wednesday, December 13, 2017

Finally, a ‘Heart Patch’ to mend your broken heart

We are one step closer to the goal of repairing dead heart muscle in human beings, because of a research breakthrough by biomedical engineers at Duke University. The researchers have succeeded in creating a fully functioning artificial human heart muscle large enough to patch the area typically seen in patients who have suffered a heart attack.

The study was published on line in Nature Communications on November 28, 2017.

Ilia Shadrin, a biomedical engineering doctoral student at Duke University and first author on the study said in a newsletter, "Right now, virtually all existing therapies are aimed at reducing the symptoms from the damage that's already been done to the heart, but no approaches have been able to replace the muscle that's lost, because once it's dead, it does not grow back on its own. This is a way that we could replace lost muscle with tissue made outside the body."

It is estimated that around 12 million people worldwide suffer for myocardial infarction and continue living with the damaged tissue that could not contract or send electrical signals, both of which are necessary for proper heart function.

The heart patch is grown from human pluripotent stem cells and contains a myriad of different type of cells like cardiomyocytes, fibroblasts, and endothelial and smooth muscle cells, to create a tissue patch similar to functioning heart muscle. The patch can secrete enzymes and growth hormone that could help in recovering from the ischemic damage.

All these cells are put in specific combination in a jelly-like substance, where they reorganize and grow into functioning tissue. Each individual tissue patch has to be ‘custom made’ in separate container that needs a rocking and swaying motion, instead of being static.

Currently, these patches have been successfully into animal hearts. The researchers have to make many modifications to create the same tissue for human heart like increasing the thickness and vascularization.

Here is the video by Duke University showing the patch contracting on its own, a 3D visualization of the patch’s cells, and the rocking bath that proved critical to the heart patch’s record-breaking size.

Tuesday, December 12, 2017

ACOG updates its guidance on Neural Tube Defects

ACOG has recently released its updated guidance on Neural Tube Defects (NTDs) and includes guidelines about prevention, screening, antenatal management and delivery in pregnancies with  such defects. The practice bulletin No.187 is published in December issue of Journal Obstetrics and Gynecology.

NTDs is the second most common group of congenital malformation after cardiac anomalies. The prevalence differs according to race, region and environmental influences.

In contrast to other malformations, NTDs are preventable by supplementation of folic acid.  

The recommendations:

ACOG along with other professional organizations like CDC, AAFP, AAP, ACMG and AAN: Women in the reproductive age group, having the capacity to become pregnant should take at least 0.4 mg (400 µg) of folic acid daily.

USPSTF: all women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400-800 µg) of folic acid.

ACOG, CDC other organization suggests a higher dose of 4 mg (4000 μg) of folic acid for women who are at high risk of having a baby with NTD. These factors are:

Previous history of pregnancy with NTD
Having a partner with NTDs or a partner who previously has had a child with NTD
Patients with a second or third degree relative with NTD
Patient herself was born with NTD
History of taking anti-epileptic medication Valproic acid
Type 1 Diabetes Mellitus

ACOG has also made additional recommendations in the recent 2017 updates.

With Advancements in Ultrasound techniques, Maternal Serum Alpha Feto Protein (MSAFP) has become less important in diagnosing NTDs, when high quality, second trimester ultrasound is routinely used.

MSAFP is more important for screening for other anomalies and placental complications in such cases.

If MSAFP value is ≥ 2.5 MoMs, the detection rate for anencephaly is 95% and 65-80% for other open NTDs.

2D ultrasound has a detection rate of 96% and if structural abnormalities are seen on Ultrasound, they can be considered diagnostic.

3D ultrasound is not superior to 2D in diagnosing NTDs; however, it may be more helpful in delineating the upper limit of spinal defects.

The rates of diagnosing NTDs in first trimester are lower than that of 2nd trimester sonography.
MRI is not mandatory if NTD has already been identified in sonography.

Pregnancy and delivery management:

After a pregnancy with NTD is diagnosed options should be individualized according to each pregnancy:
Pregnancy termination
In Utero fetal surgery for repair
Expectant management with neonatal surgical repair.
Studies on In-Utero repairs have demonstrated that such neonates have functional level two or more times better than expected, and reduce the neonatal mortality and morbidity.


Regarding the timing of delivery, term delivery is preferred. Elective late preterm or early term cesarean is only considered if fetal repair has been done or other obstetric indication for surgery exists.
Retrospective studies with not very long-term follow-up have demonstrated no increased risk of vaginal delivery, but each case needs to be individualized.

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Monday, December 11, 2017

Preterm births more common after IVF/ICSI: a meta-analysis of cohort studies

Pregnancies conceived after IVF/ICSI face a greater risk of preterm delivery as compared to natural conceived cohorts reports the results of meta-analysis published recently in Journal Ultrasound in Obstetrics and Gynecology.

Earlier studies have also documented an increased risk of having a premature baby in couples who have conceived after IVF/ICSI, but whether this is a spontaneous (SPTB) phenomenon or iatrogenic has not been studied.

A research of literature identified 71 studies out of which 15 met the inclusion criteria, and resulted in total sample size of 61,677births.

Statistical analysis showed that SPTB occurred before 37 weeks in nearly 50% more pregnancies conceived by IVF/ICSI (10.1%) than natural conception (5.5%) (odds ratio 1.75; 95% CI 1.50-2.03). The corresponding rates before 34 weeks were 3.6% and 2.1% respectively.

Dr Paolo Cavoretto of IRCCS San Raffaele Hospital in Milan, Italy, is one of the study authors, and he opined that all pregnancies conceived with IVF/ICSI should undergo a mid-trimester transvaginal cervical length evaluation.

If a short cervix is diagnosed, intravaginal progesterone or cerclage should be considered as per individual patient obstetric history.

The researchers called for bigger studies in future, to explore in-depth the mechanism behind SPTB and also differentiate between iatrogenic or indicated PTB.

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