Why I use Poetry in My Medical Teaching.

Opinion piece - no abstract required

Human Muscle Progenitor Cells Overexpressing Neurotrophic Factors Improve Neuronal Regeneration in a Sciatic Nerve Injury Mouse Model

The peripheral nervous system has an intrinsic ability to regenerate after injury. However, this process is slow, incomplete, and often accompanied by disturbing motor and sensory consequences. Sciatic nerve injury (SNI), which is the most common model for studying peripheral nerve injury, is characterized by damage to both motor and sensory fibers. The main goal of this study is to examine the feasibility of administration of human muscle progenitor cells (hMPCs) overexpressing neurotrophic factor (NTF) genes, known to protect peripheral neurons and enhance axon regeneration and functional recovery, to ameliorate motoric and sensory deficits in SNI mouse model. To this end, hMPCs were isolated from a human muscle biopsy, and manipulated to ectopically express brain-derived neurotrophic factor (BDNF), glial-cell-line-derived neurotrophic factor (GDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor (IGF-1). These hMPC-NTF were transplanted into the gastrocnemius muscle of mice after SNI, and motor and sensory functions of the mice were assessed using the CatWalk XT system and the hot plate test. ELISA analysis showed that genetically manipulated hMPC-NTF express significant amounts of BDNF, GDNF, VEGF, or IGF-1. Transplantation of 3 × 106 hMPC-NTF was shown to improve motor function and gait pattern in mice following SNI surgery, as indicated by the CatWalk XT system 7 days post-surgery. Moreover, using the hot-plate test, performed 6 days after surgery, the treated mice showed less sensory deficits, indicating a palliative effect of the treatment. ELISA analysis following transplantation demonstrated increased NTF expression levels in the gastrocnemius muscle of the treated mice, reinforcing the hypothesis that the observed positive effect was due to the transplantation of the genetically manipulated hMPC-NTF. These results show that genetically modified hMPC can alleviate both motoric and sensory deficits of SNI. The use of hMPC-NTF demonstrates the feasibility of a treatment paradigm, which may lead to rapid, high-quality healing of damaged peripheral nerves due to administration of hMPC. Our approach suggests a possible clinical application for the treatment of peripheral nerve injury

Placental Villous Hypermaturation is Associated with Improved Neonatal Outcomes

Introduction: Accelerated placental maturation is considered a sign of maternal vascular malperfusion, and is often interpreted as an adaptive, compensatory response by the placenta. We tested this interpretation by comparing outcomes in pregnancies with and without accelerated maturation. Methods: Using data from the National Collaborative Perinatal Project, we categorized preterm placentas (24 - 34 weeks, inclusive; 2525 births) by whether they showed placental villous hypermaturation (PVH), i.e., had the appearance of a placenta of 37 weeks or over upon microscopic examination. We assessed whether PVH was associated with maternal race, maternal BMI, fetal sex, type of preterm birth, preeclampsia, signs of infection or inflammation or placental abruption. We also assessed whether placentas showing PVH were associated with improved outcomes in terms of survival, Apgar score, or oxygen use. Results: PVH was more common in preeclamptic pregnancies and less common in pregnancies complicated by placental abruption or showing signs of placental infection or inflammation. Adjusting for potentially confounding factors, PVH was associated with reduced odds of fetal death, death between birth and 120 days of age, low Apgar scores and oxygen use. PVH was also associated with higher birthweights for gestational age. When correcting for the effect of birthweight, the association between PVH and reduced fetal and neonatal death remained significant. Discussion: Accelerated placental maturation, as manifested by PVH, is associated with improved outcomes. Our work therefore supports the hypothesis that accelerated maturation is a compensatory response by the placenta to improve its transport capacity in specific pregnancy complications

Opioid Replacement for Pregnant Mothers With Opioid Use Disorder and Fetal Neurodevelopment: A Review

This paper reviews the published literature regarding neurodevelopmental outcomes in neonates following in utero exposure to opioids. We have summarized available clinical and experimental data. Overall, clinical data is limited and equivocal with most studies showing no significant neurodevelopmental impairments in infants and children exposed to opioids in utero. Various outcome measures assessed language, communication, cognitive, psychomotor, and behavioural outcomes. The equivocality of the data may be a result of the complexity of the cohort and the inability to disentangle the effect of the opioids from the multiple comorbidities. Results from experimental data show that all opioids cross the placental barrier. Mouse studies show biochemical and neurophysiological changes, leading to long-term effects on learning and memory. Some data also suggests that epigenetic and imprinting changes in the central nervous system of mice may lead to multigenerational effects of opioid exposure. Ultimately, the benefits of opioid replacement therapy outweigh its risks, but it should be done in the context of a broader biopsychosocial risk reduction approach. Promoting mother-child bonding and care through skin-to-skin contact, rooming-in, and breastfeeding can reduce severity of neonatal abstinence syndrome and improve outcomes. This cohort of women and children requires advocacy for comprehensive multidisciplinary care.  Résumé Cet article passe en revue la littérature publiée concernant les résultats neurodéveloppementaux chez les nouveau-nés après exposition in utero aux opioïdes. Nous avons résumé les données cliniques et expérimentales disponibles. Dans l’ensemble, les don- nées cliniques sont limitées et équivoques, avec la plupart des études ne montrant aucune déficience neurodéveloppementale significative chez les nourrissons et les enfants exposés aux opioïdes in utero. Diverses mesures de résultats ont évalué les résultats linguistiques, de communication, cognitifs, psychomoteurs et comportementaux. L’équivocité des données peut être le résultat de la complexité de la cohorte et de l’incapacité à démêler l’effet des opioïdes des multiples comorbidités. Les résultats des données expérimentales montrent que tous les opioïdes traversent la barrière placentaire. Les études sur la souris montrent des changements biochimiques et neurophysiologiques, conduisant à des effets à long terme sur l’apprentissage et la mémoire. Certaines données suggèrent également que les changements épigénétiques et d’empreinte dans le système nerveux central des souris peuvent conduire à des effets multigénérationnels de l’exposition aux opioïdes. En fin de compte, les avantages de la thérapie de substitution aux opioïdes l’emportent sur ses risques, mais cela devrait être fait dans le contexte d’une approche plus large de réduction des risques biopsychosociaux. La promotion des liens et des soins entre la mère et l’enfant par le contact peau à peau, l’accoutumance et l’allaitement peut réduire la gravité du syndrome d’abstinence néonatale et améliorer les résultats. Cette cohorte de femmes et d’enfants a besoin de plaidoyer pour des soins multidisciplinaires complets.