Cardiosphere-Derived Cells Improve Function in the Infarcted Rat Heart for at Least 16 Weeks – an MRI Study

Aims Endogenous cardiac progenitor cells, expanded from explants via cardiosphere formation, present a promising cell source to prevent heart failure following myocardial infarction. Here we used cine-magnetic resonance imaging (MRI) to track administered cardiosphere-derived cells (CDCs) and to measure changes in cardiac function over four months in the infarcted rat heart. Methods and Results CDCs, cultured from neonatal rat heart, comprised a heterogeneous population including cells expressing the mesenchymal markers CD90 and CD105, the stem cell marker c-kit and the pluripotency markers Sox2, Oct3/4 and Klf-4. CDCs (2×106) expressing green fluorescent protein (GFP+) were labelled with fluorescent micron-sized particles of iron oxide (MPIO). Labelled cells were administered to the infarcted rat hearts (n = 7) by intramyocardial injection immediately following reperfusion, then by systemic infusion (4×106) 2 days later. A control group (n = 7) was administered cell medium. MR hypointensities caused by the MPIOs were detected at all times and GFP+ cells containing MPIO particles were identified in tissue slices at 16 weeks. At two days after infarction, cardiac function was similar between groups. By 6 weeks, ejection fractions in control hearts had significantly decreased (47±2%), but this was not evident in CDC-treated hearts (56±3%). The significantly higher ejection fractions in the CDC-treated group were maintained for a further 10 weeks. In addition, CDC-treated rat hearts had significantly increased capillary density in the peri-infarct region and lower infarct sizes. MPIO-labelled cells also expressed cardiac troponin I, von Willebrand factor and smooth muscle actin, suggesting their differentiation along the cardiomyocyte lineage and the formation of new blood vessels. Conclusions CDCs were retained in the infarcted rat heart for 16 weeks and improved cardiac function

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Students' expectations of their applied research project supervisor.

The primary area of interest is to assess the expectations of students of their ARP supervisors. From this study, the researchers also hope to uncover issues such as students perception of ARP and plagiarism and problems faced by students in doing ARP as these issues would also affect students’ expectations of their ARP supervisors

Diagnosing phyllodes tumours of the breast: how successful are our current preoperative assessment modalities?

To assess the efficacy of the diagnostic modalities used in the preoperative assessment of phyllodes tumours.In this retrospective study of patients treated at Princess Alexandra Hospital, 51 phyllodes tumours in 49 patients diagnosed between 2005 and 2016 were reviewed with regard to their preoperative findings to assess which modalities, including clinical findings, mammography, ultrasound, fine needle aspiration and core biopsy, were most diagnostically discriminating. Data on demographics and management were also collected.While 90.2% of lesions were clinically palpable and an abnormality was seen in 86.1% of lesions subjected to mammography, the findings in relation to these two modalities were essentially those of non-discriminatory masses. Furthermore, although 100% of the phyllodes lesions were sonographically visible, suspicion of a phyllodes tumour was only noted in 21.6% of cases. Fine needle aspiration yielded results suspicious for phyllodes in 21.1% of cases while core biopsy resulted in confirmed or suspected phyllodes tumour diagnoses in 69.2% of instances. Serial measurements of phyllodes tumours yielded an average growth rate of 8.04 mm per 365 days.In the preoperative diagnosis of phyllodes tumours of the breast, ultrasound was a more discriminating imaging modality compared to mammography, and core biopsy demonstrated a superior accuracy of diagnosis over fine needle biopsy. A significant increase in lesion size over a short timeframe should also alert to the possibility of a phyllodes tumour

Genome-wide association study of B cell non-Hodgkin lymphoma identifies 3q27 as a susceptibility locus in the Chinese population

10.1038/ng.2666Nature Genetics457804-807NGEN