Mesenchymal Stem Cells Isolated from Paediatric Paravertebral Adipose Tissue Show Strong Osteogenic Potential.

Mesenchymal stem cells (MSCs) represent the basis of novel clinical concepts in cellular therapy and tissue regeneration. Therefore, the isolation of MSCs from various tissues has become an important endeavour for stem cell biobanking and the development of regenerative therapies. Paravertebral adipose tissue is readily exposed during spinal procedures in children and could be a viable source of stem cells for therapeutic applications. Here, we describe the first case of MSCs isolated from paravertebral adipose tissue (PV-ADMSCs), obtained during a routine spinal surgery on a child. Using quantitative real-time PCR and flow cytometry, we show that PV-ADMSCs have different levels of stem marker expression compared to the MSCs from other sources while having the highest proliferation rate. Furthermore, we evaluate the multipotency of PV-ADMSCs by the three-lineage (adipogenic, osteogenic and chondrogenic) differentiation and compare it to the multipotency of MSCs from other sources. It was found that the PV-ADMSCs have a strong osteogenic potential in particular. Taken together, our data indicate that PV-ADMSCs meet the criteria for successful cell therapy, defined by the International Society for Cellular Therapy (ISCT), and thus, could provide a source of MSCs that is relatively easy to isolate and expand in culture. Due to their strong osteogenic potential, these cells provide a promising basis, especially for orthopaedic applications.

Rapidly Progressive Infection of Hand After a Cat Bite.

Cat bites represent the second most common mammalian bites after dog bites and are responsible for three-quarters of bites that result in infection. We report a case of a 60-year-old retired woman who was admitted to the surgery daily clinic due to fever and pain with three necrotic bite wounds on her hand and lymphangitis, which developed one day after she had been bitten by her cat. Prompt debridement, irrigation and drainage combined with empiric oral amoxicillin/clavulanic acid, resulted in clinical improvement and reduction of elevated inflammatory parameters specifically C-reactive protein. While wound cultures remained sterile, serology results were positive for Bartonella henselae.

Idarucizumab for dabigatran reversal in daily clinical practice: A case series.

BACKGROUND: Real-life experience with idarucizumab, which reverses the anticoagulant effect of dabigatran, is currently limited. OBJECTIVE: To evaluate efficacy and safety of the clinical use of idarucizumab after its availability in Slovenia. METHODS: We analysed consecutive cases treated with idarucizumab in Slovenia from January to October 2016. The decision to reverse dabigatran with idarucizumab was made by the treating clinicians, as was the assessment of clinical outcomes and blood sampling/monitoring (activated partial thromboplastin time, thrombin time and diluted thrombin time) before and after use. RESULTS: Idarucizumab was used in 17 cases. One patient was treated with the antidote twice with an interval of 2 months between treatments. The indications for idarucizumab use were: emergency surgery (4/17), severe bleeding (11/17; seven with intracranial bleeding) and ischaemic stroke (2/17). During surgery, no excessive bleeding was reported. Five patients died due to cardiogenic, haemorrhagic or septic shock, intracranial bleeding or multiple organ failure. Among cases with laboratory data available, baseline coagulation tests were prolonged in 12/13 cases with bleeding or emergency surgery. After idarucizumab administration, normal coagulation parameters were confirmed in 10/11. However, re-occurrence of dabigatran effect was noted later in four patients with creatinine clearance less than 30 ml min, and one patient with persistent bleeding required retreatment with idarucizumab. CONCLUSION: Our first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.

Delaying the superficial inferior epigastric artery flap: a solution to the problem of the small calibre of the donor artery.

BACKGROUND: Superficial inferior epigastric artery (SIEA) flap has a great advantage over other flaps of the area, that is, readily non-existent donor-site problems. The main reason why the SIEA flap has never been extensively used in breast reconstruction is the small diameter and variable anatomy of its donor artery. This study presents a possibility of enlarging the SIEA diameter using the delay-phenomenon mechanism. METHODS: A prospective clinical study of 26 patients was undertaken. Prior to surgery, ultrasound examinations were performed, measuring the diameter of SIEA and the velocity of blood flow in SIEA. The ipsilateral deep inferior epigastric artery (DIEA) was then ligated in all patients who had a measurable SIEA preoperatively. Two weeks later, measurements were repeated. The blood flow through SIEA was calculated and statistical analysis was applied. RESULTS: Twenty-one patients had an identifiable SIEA on preoperative measurements. On postoperative measurements, we confirmed ligation of DIEA in 19 patients, of these 17 patients had an augmentation in diameter (mean: 29%) and 18 in blood flow (mean: 127%). CONCLUSIONS: This study shows that ligating a single of the three main arteries (DIEA, SIEA and superficial circumflex iliac artery) irrigating skin/soft tissue of the lower abdomen, although the dominant one, results in widening of diameter and enlarging of blood flow of another artery (SIEA) supplying the same angiosome. The results of the present study might be used in future to increase the diameter and flow in SIEA when the vessel diameter found on preoperative imaging was too small for clinical microsurgical transfer. The drawback of the proposed delay procedure is the sacrifice of ipsilateral DIEA and an added operative procedure. STATEMENT: The clinical trial is registered with Clinical Trials (http://www.clinicaltrials.gov/). The clinical trial registration number is NCT01247129.