Combining regenerative medicine strategies to provide durable reconstructive options: auricular cartilage tissue engineering

Recent advances in regenerative medicine place us in a unique position to improve the quality of engineered tissue. We use auricular cartilage as an exemplar to illustrate how the use of tissue-specific adult stem cells, assembly through additive manufacturing and improved understanding of postnatal tissue maturation will allow us to more accurately replicate native tissue anisotropy. This review highlights the limitations of autologous auricular reconstruction, including donor site morbidity, technical considerations and long-term complications. Current tissue-engineered auricular constructs implanted into immune-competent animal models have been observed to undergo inflammation, fibrosis, foreign body reaction, calcification and degradation. Combining biomimetic regenerative medicine strategies will allow us to improve tissue-engineered auricular cartilage with respect to biochemical composition and functionality, as well as microstructural organization and overall shape. Creating functional and durable tissue has the potential to shift the paradigm in reconstructive surgery by obviating the need for donor sites

Efficacy of diagnostic tools for detecting cardiac arrhythmias: systematic literature search

Background/objectives Symptoms suggestive of cardiac arrhythmias are a challenge to the diag nosis Physical examination and a 12-lead ECG are of limited value, as rhythm disturbances are frequently of a paroxysmal nature New tech nologies facilitate a more accurate diagnosis The objective of this study was to review the medical literature in an effort to define a guide to rational diagnostic testing Methods Primary studies on the use of a diagnostic tool in the evaluation of palpitations were searched in MEDLINE, and EMBASE with an additional reference check Results Two types of studies were found descriptive and experimental studies, which compared the yield of two or more devices or diagnostic strategies Holter monitors seemed to have less diagnostic yield (33 to 35%) than event recorders Automatically triggered recorders detect more arrhythmias (72 to 80%) than patient-triggered devices (17 to 75%) Implantable devices are used for prolonged monitoring periods in patients with infrequent symptoms or unexplained syncope Conclusion The choice of the device depends on the characteristics of the symptoms and the patient Due to methodological shortcomings of the included studies no evidence-based diagnostic strategy can be proposed (Neth Heart J 2010,18 543-51