Tissue-engineered tracheal replacement in a child: a 4-year follow-up study

In 2010, a tissue-engineered trachea was transplanted into a 10-year-old child using a decellularized deceased donor trachea repopulated with the recipient's respiratory epithelium and mesenchymal stromal cells. We report the child's clinical progress, tracheal epithelialization and costs over the 4 years. A chronology of events was derived from clinical notes and costs determined using reference costs per procedure. Serial tracheoscopy images, lung function tests and anti-HLA blood samples were compared. Epithelial morphology and T cell, Ki67 and cleaved caspase 3 activity were examined. Computational fluid dynamic simulations determined flow, velocity and airway pressure drops. After the first year following transplantation, the number of interventions fell and the child is currently clinically well and continues in education. Endoscopy demonstrated a complete mucosal lining at 15 months, despite retention of a stent. Histocytology indicates a differentiated respiratory layer and no abnormal immune activity. Computational fluid dynamic analysis demonstrated increased velocity and pressure drops around a distal tracheal narrowing. Cross-sectional area analysis showed restriction of growth within an area of in-stent stenosis. This report demonstrates the long-term viability of a decellularized tissue-engineered trachea within a child. Further research is needed to develop bioengineered pediatric tracheal replacements with lower morbidity, better biomechanics and lower costs

Estabilização segmentar da coluna lombar nas lombalgias: uma revisão bibliográfica e um programa de exercícios

No tratamento de lombalgias, exercícios tradicionais de fortalecimento dos músculos abdominais e extensores do tronco têm sido alvo de críticas por submeter a coluna vertebral a altas cargas de trabalho, aumentando o risco de nova lesão. Estudos recentes comprovam a eficácia da estabilização segmentar como tratamento para a lombalgia, sendo menos lesiva por ser realizada em posição neutra. Pesquisas sugerem que, sem a ativação correta dos estabilizadores profundos do tronco, as recidivas do quadro álgico são notadas com muita freqüência. Este estudo procedeu à revisão da literatura sobre o tratamento das lombalgias mediante estabilização da coluna e propõe exercícios para seu tratamento baseados na estabilização segmentar lombar. Na base PubMed, por meio dos descritores estabilização lombar, multífido lombar, transverso do abdome e os equivalentes em inglês, foram selecionados 47 artigos e livros publicados entre 1984 e 2006. A literatura estabelece um elo entre lombalgia e escasso controle dos músculos profundos do tronco, em especial o multífido lombar e o transverso do abdome; estudos também indicam os músculos quadrado lombar e diafragma como estabilizadores lombares. Propõem-se assim exercícios de contrações isométricas sincronizadas, sutis e específicas, que atuam diretamente no alívio da dor por meio do aumento da estabilidade do segmento vertebral.When treating low-back pain, traditional exercises for strengthening abdomen and trunk erector muscles have been criticised for their submitting spinal structures to high loads, thereby increasing the risk of new injury. Recent studies have pointed to the effectiveness of segmental stabilisation in treating low-back pain, less damaging since it is done in neutral position. Current research suggests that, unless the trunk deep stabilizers are correctly activated, recurrence of pain is more often noticed. This is a review of 47 articles and books published between 1984 and 2006, resulting from a search in PubMed database by means of key words lumbar stabilization, lumbar multifidus and transversus abdominis muscles. Literature has established a link between low-back pain and poor control of deep trunk muscles, particularly the lumbar multifidus and transversus abdominis muscles; some studies also point out the quadratus lumborum and diaphragm muscles as lumbar stabilizers. By drawing on the reviewed material, we suggest exercises of subtle and specific synchronized isometric contractions for these lumbar stabilisers, which act directly upon pain relief by increasing lumbar spine stability