Stem Cell Therapy for Diabetic Foot Ulcers: Theory and Practice.

Diabetic foot ulcers are associated with increases in limb amputation, morbidity, and mortality. Recently, a stem cell application is emerging as promising adjuvant therapy. We presented available remedies by conducting a literature review on the application, safety, and efficacy of stem cell therapy. Relevant literature, including randomized control trials and article journals, was obtained from reputable search engines (PubMed, Scopus, and Web of Science). We analyzed five credible cohorts, with variable sources of stem cells, in a total of 216 participants, 151 males and 65 females, age (mean ± SD) of 64.5 ± 9.6 years. With an average success of 86.41% in all Wagner-II lesions, mesenchymal SCA (stem cell application) is safe and effective, hence can significantly prevent limb amputation.

Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis.

Oral anticoagulation (OAC) prevents thromboembolism yet greatly increases the risk of bleeding, inciting concern among clinicians. Current guidelines lack sufficient evidence supporting long-term OAC following successful atrial fibrillation catheter ablation (CA). A literature search was performed in PubMed, Google Scholar, Medline, and Scopus to seek out studies that compare continued and discontinued anticoagulation in post-ablation Atrial fibrillation (AF) patients. Funnel plots and Egger's test examined potential bias. Via the random-effects model, summary odds ratios (OR) with 95% confidence intervals (CI) were calculated using RevMan (5.4) and STATA (17.0). Twenty studies, including 22 429 patients (13 505 off-OAC) were analyzed. Stratified CHA2DS2-VASc score ≥2 examining thromboembolic events (TE) favored OAC continuation (OR 1.86; 95% CI: 1.02-3.40; P = .04). Sensitivity analysis demonstrated this association was attenuated. The on-OAC arm had greater incidence of major bleeding (MB) (OR 0.16; 95% CI: 0.08-0.95; P < .00001), particularly intracranial hemorrhage (ICH) and gastrointestinal bleeding (GI); (OR 0.17; 95% CI: 0.08-0.36; P < .00001) and (OR 0.12; 95% CI: 0.04-0.32; P < .0001), respectively. Our findings support sustained anticoagulation in patients with a CHA2DS2-VASc score of ≥2. Due to reduced outcome robustness, physician discretion is still advised.

Peratrial Balloon Pulmonary Valvotomy in Infants: Right Ventricular Wall None-Touch Technique.

Peratrial balloon pulmonary valvotomy, an alternative technique for severe pulmonary valve stenosis (PVS) in infants, performed exclusively under transesophageal echocardiographic guidance, is hereby described. The technique is performed using a hollow probe through a right minithoracotomy in the fourth intercostal space. The hollow probe introduces a guidewire through the PVS without touching the right ventricular wall, therefore avoiding eliciting ventricular arrhythmias, spasm of the right ventricular outflow tract, and subsequent hemodynamic instability. Unlike conventional approaches, the peratrial technique permits quicker orientation and dilatation and allows quick conversion to open heart surgery when needed.

Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results.

BACKGROUND/AIM: Both open heart surgery and percutaneous approaches retain several limitations in closing large apical muscular ventricular septal defects (AmVSD) in infants. We present probe-assisted percardiac device closure (PDC), an exclusively transoesophageal-echocardiography guided technique, as an alternative with midterm results. METHODS: Thirty-six infants with large AmVSDs (single or multiple-holed) underwent PDC in our department. Mean AmVSD for single and multiple-holed measured 7.2 ± 2.4 mm and 6.3 ± 3.4 mm, respectively. Subjects presented with a spectrum of cardiopulmonary sequelae and growth retardation, either alone or combined. Some were ventilator dependent and re-do cases. In addition, AmVSDs were categorized: cylindrical, tunnel and cave-like shaped as per color Doppler interrogation. Pursuant to cardiac access and deployment technique, subjects were apportioned: group A; inferior median sternotomy (perventricular), B; right mini-thoracotomy (peratrial) and C; complete median sternotomy (perventricular). Under exclusive echocardiography, the Z- or J probe-assisted delivery system was utilized to access AmVSDs and implant device(s) via aforementioned techniques. RESULTS: Forty-two muscular ventricular septal devices (8.4 ± 2.6 mm) were implanted in 36 subjects uneventfully. Seventeen "complex," and 10 cylindrical or straight tunnel-shapedAmVSDs (including 2 re-do patients) suited perventricular and peratrial techniques respectively. Comparatively, group B exhibited shorter procedural indices than A (p < .01). Five of 15 multiple-holed AmVSDs (four Swiss cheese) required two or three devices for a satisfactory occlusion. Nevertheless, post occlusion insignificant residual shunts( ≤ 2 mm) seldom achieved spontaneous closure, and at 36-month follow-up complete closure was 67%. Residual shunt persisted amongst multiple-holed. All patients improved during follow up. CONCLUSION: PDC is feasible, safe and effective alternative technique for AmVSD in infants.