Proliferation of Human Osteoblastic Cells and Synthesis of Extracellular Bone Matrix on Biomaterials

Primary human osteoblasts were cultered on biomaterials to develop living bone substitutes by Tissue Engineering. Monolayer cultures were established from iliac crest biopsies. Single cell suspensions were then seeded onto tricalciumphosphate (TCP) BIOBASE®, hydroxyapatitecollagen(HAC), autoclaved cancellous bone (CB) and fibrin glue (FG) Tissucol® The constructs were analyzed by electronmicroscopy, Cell proliferation assay (XTT) and histology to assess adhesion, proliferation and extracellular matrix formation on the biomaterial.

The osteoblastic cells survived in the fibrin glue and established a mesenchymal phenotype. They adhered to the HAC-sponges, TCP and CB. Prolifertion was seen on TCP and CB. HAC had a suppressive effect on the cells. An inmature matrix was found on TCP and a bone neomatrix on CB after 4 weeks in vitro.

Previous extrauterine pregnancies and neonatal outcomes in primiparous women--an analysis of the German Perinatal Survey

AIM

The aim of this study was to compare neonatal outcomes in primiparous women with and without previous extrauterine pregnancies.

MATERIAL AND METHODS

We analysed data from 207 171 singleton pregnancies in primiparous women from the German Perinatal Survey of 1998-2000. To minimise confounding factors, we only included women without previous miscarriages or terminations of pregnancy and performed comparisons separately for 3 maternal age groups as well as for all cases together.

RESULTS

Women with and without previous extrauterine pregnancies were of comparable height and weight but women with previous extrauterine pregnancies were on average older (29.2 vs. 26.6 years). The preterm birth rate was higher in women with previous extrauterine pregnancies (9.4% vs. 6.8%, odds ratio 1.42 [95% confidence interval 1.18-1.69], p<0.001; analysing all cases together) as was the rate of neonates with a low birth weight ≤ 2 499 g (7.9% vs. 5.7%, odds ratio 1.43 [95% confidence interval 1.17-1.72], p>0.001; analysing all cases together). The proportions of neonates classified as small, appropriate, or large for gestational age were rather similar in women with and without previous extrauterine pregnancies; likewise Apgar scores differed only slightly, although for some comparisons statistical significance was reached in spite of the small magnitude of differences.

CONCLUSIONS

Previous extrauterine pregnancies are associated with higher rates of preterm birth and infants of low birth weight in subsequent pregnancies.

[Congenital malformations--a systematic cohort study from Mecklenburg-Western Pomerania (Germany)]

AIM

We aimed to set-up a passive malformations registry for 2002-2004 for the German Federal State of Mecklenburg-Western Pomerania in order to estimate the prevalence of congenital malformations among live births, stillbirths, miscarriages, and induced abortions. POPULATION AND STUDY DESIGN: Under the guidance of the working group "Neonatology Mecklenburg-Vorpommern" a standardised malformations record form modelled after the Mainz registry was developed and used to record malformations among live births, stillbirths, miscarriages, and induced abortions in all 21 obstetric departments in Mecklenburg-Western Pomerania between 2002 and 2004. We compared the population of neonates with malformations with a general population sample from the German Perinatal Survey of 1995-1997.

RESULTS

There were 768 neonates with at least one major malformation among a total of 37 634 neonates in Mecklenburg-Western Pomerania; this means that the prevalence of major malformations was 203.53 per 10 000 neonates. The prevalence of major malformations in liveborn infants was 178.61 per 10 000. The most common malformations in the total study population were ventricular septal defect (prevalence: 37.2 per 10 000), hydronephrosis (16.7 per 10 000), hypospadias (14.8 per 10 000), Down syndrome (10.1 per 10 000), and cleft lip and palate (9.0 per 10 000). Among the induced abortions the most common diagnoses were Down syndrome, anencephalus, Edwards syndrome, and congenital hydrocephalus. The preterm birth rate among the 637 liveborn and stillborn infants with malformations was 19.6%; 5.6% were born before 32 completed weeks of gestation. The small for gestational age rate for infants with malformations was 14.2% for girls and 14.5% for boys, thus increased compared with the general population sample (9.7%).

CONCLUSIONS

Congenital malformations are important determinants of childhood morbidity and mortality. Malformation prevalence and types of malformations, along with morbidity and mortality, are important parameters in perinatal medicine. The establishment of active malformation registries is therefore an important task.

Spontaneous growth in growth hormone deficiency from birth until 7 years of age: development of disease-specific growth curves

BACKGROUND

Little is known about spontaneous growth of growth hormone (GH)-deficient children during infancy and childhood.

METHODS

Retrospectively, we calculated disease-specific pretreatment percentiles for height, weight, BMI and growth velocity of 113 GH-deficient boys and 41 GH-deficient girls from birth until 7 years of age, by mean and standard deviation.

RESULTS

Infants with idiopathic GH deficiency (GHD) grow in disease-specific percentile channels. There is a significant difference in length and weight from birth onward compared to regional reference (p<0.001). Boys' birth length was 48.7+/-2.9 cm (p<0.001; -1.31+/-1.11 SDS), birth weight was 3.09+/-0.61 kg (p<0.01; -0.92+/-1.19 SDS), and BMI at birth was 12.9+/-1.7. Girls' birth length was 48.1+/-3.4 cm (p<0.05; -1.17+/-1.51 SDS), birth weight was 2.92+/-0.60 kg (p=0.05; -1.08+/-1.19 SDS), and BMI at birth was 12.6+/-2.2. There was a continuous loss of growth velocity, despite a wide variance in the first years, so height deficit became more evident with increasing age.

CONCLUSION

GHD is a congenital disease no matter when height deficit becomes clinically evident, because GH-deficient children grow in disease-specific percentile channels with a highly significantly reduced length and weight, which demonstrates that GH is essential for adequate growth in infancy and early childhood.

Epidermal growth factor (EGF) transfection of human bone marrow stromal cells in bone tissue engineering

A novel therapeutic approach for the treatment of bone defects is gene therapy assisted bone tissue engineering using bone marrow stromal cells (hBMSC). The aim of this study was to investigate the influence of human epidermal growth factor (hEGF) on proliferation and alkaline phosphatase (AP) activity of primary hBMSC in vitro. hBMSC cultures were achieved by explantation culture of bone chips. Following exposure to 0-10 ng recombinant hEGF (rhEGF)/ml cell numbers were determined by automated cell counting and cell bound AP activity was measured spectrophotometrically. hBMSC were transfected with hEGF plasmids and the proliferative effect was studied by cocultivation of transfected and untreated cells using porous cell culture inserts. The persistence of hEGF expression even after cell transfer was studied by the generation of possibly osteogenic constructs introducing transfected hBMSC in fibrin glue and bovine cancellous bone. The maximum increase in proliferation (156 +/- 7%) and AP activity (220 +/- 34%) was detected after exposition to 10 ng rhEGF/ml. In the separation chamber assay transfected cells produced hEGF concentrations up to 3.6 ng/ml, which induced a mean proliferation increase of 93% which could be significantly inhibited by a neutralizing hEGF antibody. Further, EGFsecretion of transfected hBMSC in 3D-culture was verified. Recombinant and transgenic hEGF stimulate proliferation of primary hBMSC in vitro. Lipotransfection of hBMSC with hEGF plasmids allows the transient and site directed delivery of biologically active transgenic hEGF. The introduction of mitogenic, angiogenic and chemoattractive factors in gene therapy assisted bone tissue engineering is discussed by the example of EGF.

Macrosomia: a new formula for optimized fetal weight estimation

OBJECTIVES

To develop and test a specific formula for estimating weight in the macrosomic fetus.

METHODS

Ultrasound estimations of fetal weight were carried out within 1 week of delivery in 424 singleton fetuses with a birth weight of > or = 4000 g. Exclusion criteria were multiple pregnancy, intrauterine death and major structural or chromosomal anomalies. Stepwise regression modeling was used to derive a prediction formula with birth weight as the dependent variable and maternal booking weight and fetal biometric measurements as independent parameters. After a new formula for estimated fetal weight (EFW) had been developed in a formula-finding group (n = 284), it was compared with commonly used weight equations (evaluation group, n = 140).

RESULTS

The new formula (log(e)EFW = 7.6377445039 + 0.0002951035 x maternal weight + 0.0003949464 x head circumference + 0.0005241529 x abdominal circumference + 0.0048698624 x femur length) proved to be superior to established equations, with the smallest mean error (mean +/- SD, -10 +/- 202 g), the smallest mean percentage error (mean +/- SD, -0.03 +/- 4.6%) and the lowest mean absolute percentage error (3.69 (range, 0.05-13.57)%) when studied in the evaluation group. With the new formula, 77.9% of estimates fell within +/- 5% of the actual weight at birth, 97.1% within +/- 10%, and 100% within +/- 15% and +/- 20%.

CONCLUSIONS

The new formula allows better weight estimation in the macrosomic fetus.

The influence of smoking during pregnancy on fetal growth. Considering daily cigarette consumption and the SGA rate according to length of gestation

BACKGROUND

Smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations and is associated with, amongst other adverse effects, a higher rate of small-for-gestational-age (SGA) neonates. The rate of SGA neonates born before 32 weeks and its association with smoking have so far not been the focus of attention.

MATERIAL AND METHODS

Using data of 643,288 primiparous women from the German perinatal statistics of 1995-2000, we aimed to investigate this relationship. We also analyzed our data according to daily cigarette consumption.

RESULTS

We found that smoking during pregnancy was strongly associated with lower birth weight and higher SGA rates. This effect was especially pronounced in women >or=31 years. There was clear dose dependence with regard to daily cigarette consumption. An increase in SGA rates in smokers versus non-smokers can already be seen for very early preterm deliveries (31 weeks of gestation or less).

CONCLUSIONS

Our results allow the definition of groups of women who are at higher risk of SGA births. We show that especially older primiparous women (aged >or=31 years) who smoke >10 cigarettes a day are at increased risk of experiencing fetal growth restriction.

The transverse forefoot arch demonstrated by a novel X-ray projection

OBJECTIVE

Metatarsalgia is often treated by metatarsal osteotomy. Exact knowledge of the normal anatomy of the forefoot is essential for pre-operative planning. The objective of this study was to investigate the forefoot arch during maximal loading in a randomly selected population sample.

METHODS

Two hundred subjects randomly selected from a municipality representative of Denmark were invited to interview and forefoot X-ray examination, including a novel horizontal X-ray projection by which the height of each metatarsal from the floor can be measured under maximal loading.

RESULTS

One hundred and thirty-four subjects (79%) presented themselves for interview and X-ray examination. The study group was representative of the randomly selected population sample in terms of age, sex and incidence of metatarsalgia. The study verified that the interrelated geometry of the metatarsal heads in the AP plane corresponds to a parabola as suggested previously (Le Lièvre's parabola). Also in the horizontal plane, the metatarsal heads generally form an arch, the transverse forefoot arch (TFA). Mean height was 3.91mm (S.E.=0.10). The individual height of the TFA varied from -1 to 10mm and was dependent on the width of the forefoot. The relative height of the arch (arch height divided by forefoot width) was independent of age and sex. A non-significant tendency towards a lower arch among subjects with metatarsalgia was observed.

CONCLUSION

This population study demonstrated that the metatarsal heads constitute arches in both planes (Le Lièvre's parabola in the AP plane and the transverse forefoot arch in the horizontal plane). This knowledge is essential for pre-operative planning in metatarsal osteotomy for metatarsalgia. Formulae for calculating the individual location of each metatarsal head were obtained.