13 research outputs found

    Evaluation of human umbilical cord blood as a source of embryonic stem cells

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    Human umbilical cord blood (HUCB) has been poorly characterised as a source of embryonic stem cells (ESCs). The aim of this study, therefore, was to evaluate HUCB as source of mesenchymal stem cells (MSCs) with embryonic characteristics. HUCB was collected from consenting women undergoing elective caesarean sections. HUCB was meticulously explanted into MesenCult media and incubated. Qualitative and quantitative immunophenotyping of cells was achieved using fluorescein isothiocyanate (FITC) labelled antibodies (CD34, CD45, CD29, CD44, CD73 and CD105) phenotypic markers. Immunocytochemistry was carried out for the human ESC markers CD9, stage-specific embryonic antigen-1 and 4 (SSEA-1 and SSEA-4), E-cadherin, Podocalyxin (PODXL), sex-determining region Y-box 2 (SOX2), NANOG and Octamer (OCT3/4). MSCs were cultured to induce differentiation into adipogenic, osteogenic, chondrogenic and neurogenic cells. Immunocytochemistry was used to identify fatty acid binding protein-4 (FABP-4), osteocalcin, aggrecan, SOX2 and oligodendrocyte-4 (Olig-4) markers. The cells were strongly positive for the MSC markers CD29, CD44, CD73 and CD105; these cells also expressed the ESC markers CD9, SSEA-1 and SSEA-4, E-cadherin, PODXL, SOX2, NANOG and OCT3/4. Additionally, the MSCs expressed the adipogenic FABP-4, osteogenic osteocalcin, chondrogenic aggrecan and neural Olig-4 and SOX2 markers after differentiation. Therefore, HUCB is a rich source for MSCs with embryonic characteristics

    Global economic burden of unmet surgical need for appendicitis

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    Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US 92492millionusingapproach1and92 492 million using approach 1 and 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was 95004millionusingapproach1and95 004 million using approach 1 and 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

    Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

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    BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

    Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy