Minimal modulation of the host immune response to SIS matrix implants by mesenchymal stem cells from the amniotic fluid.

PURPOSE: Surgical restoration of soft tissue defects often requires implantable devices. The clinical outcome of the surgery is determined by the properties inherent to the used matrix. Mesenchymal stem cells (MSC) modulate the immune processes after in vivo transplantation and their addition to matrices is associated with constructive remodeling. Herein we evaluate the potential of MSC derived from the amniotic fluid (AF-MSC), an interesting MSC source for cell therapeutic applications in the perinatal period, for immune modulation when added to a biomaterial. METHODS: We implant cell free small intestinal submucosa (SIS) or SIS seeded with AF-MSC at a density of 1 × 105/cm2 subcutaneously at the abdominal wall in immune competent rats. The host immune response is evaluated at 3, 7 and 14 days postoperatively. RESULTS: The matrix-specific or cellular characteristics are not altered after 24 h of in vitro co-culture of SIS with AF-MSC. The host immune response was not different between animals implanted with cell free or AF-MSC-seeded SIS in terms of cellular infiltration, vascularity, macrophage polarization or scaffold replacement. Profiling the mRNA expression level of inflammatory cytokines at the matrix interface shows a significant reduction in the expression of the pro-inflammatory marker Tnf-α and a trend towards lower iNos expression upon AF-MSC-seeding of the SIS matrix. Anti-inflammatory marker expression does not alter upon cell seeding of matrix implants. CONCLUSION: We conclude that SIS is a suitable substrate for in vitro culture of AF-MSC and fibroblasts. AF-MSC addition to SIS does not significantly modulate the host immune response after subcutaneous implantation in rats.

Frontomaxillary facial angle in chromosomally normal Thai foetuses at 11 to 13 weeks 6 days ' gestation.

Frontomaxillary facial (FMF) angle is the angle between upper part of the anterior end of the maxillary bone and the line along the frontal bone in the midfacial profile view. Based on several previous studies, FMF angle can be useful in screening Down syndrome foetuses, in which FMF angle is significantly larger than that in euploid foetuses. However, racial factors can influence the FMF angle as seen in the different normal ranges among ethnicities. Therefore, before the clinical application of the FMF angle, a reference range for its own population should firstly be developed. In this study, a Thai reference range of FMF angle has been established. The mean FMF angle in euploid foetuses with a 60-mm crown ­ rump length (CRL) was 81.07 °, with 0.23 ° increase for each mm increase in CRL, consistent with those observed in Caucasian and Chinese populations. The measurement of FMF angle has good reproducibility.

Midpregnancy cordocentesis training of maternal-fetal medicine fellows.

OBJECTIVE: To describe systematic cordocentesis training among maternal-fetal medicine (MFM) fellows. METHODS: During their 2-year training period, five MFM fellows, who had completed systematic model training, performed 1116 midpregnancy diagnostic cordocentesis procedures (mean, 223 (range, 185-259) procedures each) under expert supervision. The details of the procedures were recorded prospectively. Multiple pregnancies and those with fetal chromosomal or structural anomalies were excluded from analysis. The outcome measures included success rate, duration of the procedure, fetal loss and complications. RESULTS: Of the 1116 procedures performed, 184 were excluded because of fetal abnormalities; the remaining 932 were available for analysis. Cordocentesis was performed on free-floating umbilical cord (79.3%) and at the placental insertion site (20.7%). There was an immediate complication of transient fetal bradycardia in 10% of cases. Individual success rates ranged from 98.1 to 100% and the mean cumulative success rate had plateaued by approximately 60 procedures. The overall fetal loss rate was 1.3%. The overall mean +/- SD duration of successful procedures was 4.4 +/- 4.7 min, individual mean durations ranging from 3.7 to 5.9 min. CONCLUSIONS: MFM fellows with systematic training are able to perform cordocentesis with very high success rates, and with an acceptable procedure-related fetal loss rate. An intensive course of preclinical training with the model, and more than 60 procedures on patients under supervision is recommended.