Treatment of hypoplastic left heart syndrome: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

This meta-analysis aimed to consolidate existing data from randomised controlled trials on hypoplastic left heart syndrome.

METHODS

Hypoplastic left heart syndrome specific randomised controlled trials published between January 2005 and September 2021 in MEDLINE, EMBASE, and Cochrane databases were included. Regardless of clinical outcomes, we included all randomised controlled trials about hypoplastic left heart syndrome and categorised them according to their results. Two reviewers independently assessed for eligibility, relevance, and data extraction. The primary outcome was mortality after Norwood surgery. Study quality and heterogeneity were assessed. A random-effects model was used for analysis.

RESULTS

Of the 33 included randomised controlled trials, 21 compared right ventricle-to-pulmonary artery shunt and modified Blalock-Taussig-Thomas shunt during the Norwood procedure, and 12 regarded medication, surgical strategy, cardiopulmonary bypass tactics, and ICU management. Survival rates up to 1 year were superior in the right ventricle-to-pulmonary artery shunt group; this difference began to disappear at 3 years and remained unchanged until 6 years. The right ventricle-to-pulmonary artery shunt group had a significantly higher reintervention rate from the interstage to the 6-year follow-up period. Right ventricular function was better in the modified Blalock-Taussig-Thomas shunt group 1-3 years after the Norwood procedure, but its superiority diminished in the 6-year follow-up. Randomised controlled trials regarding medical treatment, surgical strategy during cardiopulmonary bypass, and ICU management yielded insignificant results.

CONCLUSIONS

Although right ventricle-to-pulmonary artery shunt appeared to be superior in the early period, the two shunts applied during the Norwood procedure demonstrated comparable long-term prognosis despite high reintervention rates in right ventricle-to-pulmonary artery shunt due to pulmonary artery stenosis. For medical/perioperative management of hypoplastic left heart syndrome, further randomised controlled trials are needed to deliver specific evidence-based recommendations.

200 TELOMERASE ACTIVITY MODIFICATION WITH RESVERATROL IN CANINE ADIPOSE-DERIVED MESENCHYMAL STEM CELLS

It has been established that the telomerase activity of donor cells is causally linked to the reprogramming efficiency, which includes somatic cell nuclear transfer (SCNT). Among the many cell source as donor cells of SCNT, canine adipose-derived stem cells (Ad-MSCs), a form of adult stem cells, are donor cells that have been recently used. Resveratrol (trans-3,5,4′-trihydroxystilbene), a polyphenolphytoalexin, possesses diverse biochemical and physiological action, including antiplatelet and reducing cellular senescence via telomerase activity modification. However, appropriate dose and time of resveratrol for telomerase activity modification in Ad-MSCs have not been investigated. In addition, unlike most normal somatic cells which have negative telomerase activities; low to moderate levels of the enzyme in mesenchymal stem cells have been described. In the present study, we compared the cellular telomerase activity of Ad-MSCs according to the dose of resveratrol and passages of Ad-MSCs. Cells were isolated from collected adipose derived tissues of beagle at age 7 and cultured in RCME-P provided from RNL Bio incorporation. For identification of telomerase activity in ad-MSCs, adult fibroblasts derived from same dog were used as negative control. After 2 days of cultivation, Ad-MSCs were treated with 2 μM, 10 μM, or 25 μM resveratrol or without resveratrol at 39°C for 24 h in a humidified atmosphere of 5% CO2 in air. Ad-MSCs with passage at 1, 4, and 7 were used for analysis. Telomerase activity was measured by the telomeric repeat amplification protocol assay. Statistical analysis was performed by the two-way ANOVA. P < 0.05 was considered as showing a statistically significant difference between means. It revealed that Ad-MSCs have telomerase activity significantly higher than those shown in fibroblasts (negative control). Resveratrol increased telomerase activity, with maximal increase at 10, 25 μM at passage of 1, 4 (P < 0.05). However, increase of telomerase activity in Ad-MSCs treated with 10, 25 μM at passage 7 was not shown and the telomerase activities of Ad-MSCs at passage 7 were lower than those of Ad-MSCs at passage 1 and 4 (P < 0.05). In conclusion, the telomerase activity was detectable in canine Ad-MSCs, which may suggest that canine Ad-MSCs have similar telomere biology compared to that of other adult stem cells. Furthermore, resveratrol can enhance activation of telomerase activity with dose dependent increase. Further studies are warranted on efficiency of establishing a stable donor cells for SCNT using Ad-MSCs treated with resveratrol. This study was supported by R&E (#550–20130027), IPET (#311062–04–2-SB010), RNL Bio (#550–20130013), RDA (PJ008975022013), the Research Institute for Veterinary Science, and TS Corporation.

Spontaneous remission of aplastic anemia: a retrospective analysis

BACKGROUND AND OBJECTIVES

Although acquired aplastic anemia is usually a chronic disorder, a small proportion of patients with aplastic anemia was reported to recover spontaneously without specific therapy such as allogeneic bone marrow transplantation or immunosuppressive treatment. We attempted to determine the rate of spontaneous remission in the patients with AA.

DESIGN AND METHODS

We reviewed the medical records of adult patients (n=136) who were diagnosed as aplastic anemia at the Asan Medical Center from 1990 to 2000. The hematologic criteria of spontaneous remission were defined according to the proposed remission criteria of the SAA Working Party of the EBMT.

RESULTS

Eighteen (13%) of 136 patients satisfied the criteria for spontaneous remission at median 14 days (range, 4-332) from the diagnosis of aplastic anemia. In fifteen (83%) of 18 patients, spontaneous remission occurred within 50 days. Spontaneous remission was complete in fourteen patients (78%). Only two patients relapsed at 208 and 1,857 days after spontaneous remission, respectively. Multivariate logistic regression analysis showed that presence of infection at diagnosis (p = 0.017), drug as an etiology of aplastic anemia (p = 0.028), and serum albumin level less than 3.4 g/dL (p = 0.005) were independent predictive factors for spontaneous remission.

INTERPRETATION AND CONCLUSIONS

Our study confirmed that a minority of patients with AA recovered spontaneously. Spontaneous remission was rapid and complete in most patients, and relapses were rarely observed. In most cases with spontaneous remission, aplastic anemia might be associated with external factors such as drug or infection.

Blunt traumatic rupture of the diaphragm: sonographic diagnosis

Ultrasonographic features of seven patients with diaphragmatic rupture due to blunt trauma were analyzed. The ruptures occurred at the left hemidiaphragm in four patients and at the right in three. Direct ultrasonographic findings were as follows: disrupted diaphragm in four patients; nonvisualized diaphragm in three patients; floating diaphragm in two patients; and herniation of the liver or bowel loops through the diaphragmatic defect in three patients. Indirect sonographic findings included pleural effusion or subphrenic fluid collection in five patients and splenic laceration in one. Although the number of patients was limited, ultrasonography was very useful for the diagnosis of diaphragmatic rupture.