Encapsulation of Human-Bone-Marrow-Derived Mesenchymal Stem Cells in Small Alginate Beads Using One-Step Emulsification by Internal Gelation: In Vitro, and In Vivo Evaluation in Degenerate Intervertebral Disc Model.

Cell microencapsulation in gel beads contributes to many biomedical processes and pharmaceutical applications. Small beads (<300 µm) offer distinct advantages, mainly due to improved mass transfer and mechanical strength. Here, we describe, for the first time, the encapsulation of human-bone-marrow-derived mesenchymal stem cells (hBM-MSCs) in small-sized microspheres, using one-step emulsification by internal gelation. Small (127−257 µm) high-mannuronic-alginate microspheres were prepared at high agitation rates (800−1000 rpm), enabling control over the bead size and shape. The average viability of encapsulated hBM-MSCs after 2 weeks was 81 ± 4.3% for the higher agitation rates. hBM-MSC-loaded microspheres seeded within a glycosaminoglycan (GAG) analogue, which was previously proposed as a mechanically equivalent implant for degenerate discs, kept their viability, sphericity, and integrity for at least 6 weeks. A preliminary in vivo study of hBM-MSC-loaded microspheres implanted (via a GAG-analogue hydrogel) in a rat injured intervertebral disc model demonstrated long-lasting viability and biocompatibility for at least 8 weeks post-implantation. The proposed method offers an effective and reproducible way to maintain long-lasting viability in vitro and in vivo. This approach not only utilizes the benefits of a simple, mild, and scalable method, but also allows for the easy control of the bead size and shape by the agitation rate, which, overall, makes it a very attractive platform for regenerative-medicine applications.

Mitral Valve Prolapse, Psychoemotional Status, and Quality of Life: Prospective Investigation in the Current Era.

OBJECTIVE: The purpose of this study is to investigate whether mitral valve prolapse is associated with the patient's psychoemotional status and health-related quality of life. METHODS: Mitral valve prolapse and mitral regurgitation were prospectively and comprehensively assessed in 281 patients (age 61 ± 13 years; 63% men); 216 patients with mitral valve prolapse were compared with 65 without mitral valve prolapse (of similar age and sex). Simultaneously, we assessed the patient's psychoemotional status (anxiety, depression, posttraumatic stress symptoms), health-related quality of life, and perceived severity of illness using validated questionnaires. RESULTS: Twenty-nine percent of the patients had either no or mild mitral regurgitation (area of effective regurgitant orifice ≤0.2), and 71% had clinically significant mitral regurgitation (moderate/severe). Stratifying patients into no/mild vs moderate/severe mitral regurgitation revealed no differences in psychoemotional status or mental health-related quality of life between patients with mitral valve prolapse vs those without mitral valve prolapse within each subgroup; no/mild mitral regurgitation and moderate/severe mitral regurgitation (all P ≥ .5). In multivariate analysis, mitral valve prolapse was not independently associated with psychoemotional status or health-related quality of life (all P ≥ .4). In addition, while objective severity of the illness was not related to psychoemotional status or health-related quality of life (all P ≥ .2), the patient's perceived severity of illness predicted in and of itself all psychoemotional (all P < .03) and quality-of-life outcomes (all P < .003). CONCLUSION: Mitral valve prolapse is not a determinant of the patient's psychoemotional status or quality of life. Psychoemotional status and health-related quality of life are determined by the patient's perception of the severity of the mitral valve disease, rather than by the presence of mitral valve prolapse.

Psychoemotional and quality of life response to mitral operations in patients with mitral regurgitation: a prospective study.

BACKGROUND: Severe mitral regurgitation (MR) is associated with frequent alteration of psychoemotional status (PES), with anxiety and stress symptoms related to health-related quality of life (HR-QOL). Yet, it is unknown whether surgical correction of MR leads to improvement or deterioration in PES and HR-QOL. METHODS: We prospectively performed comprehensive MR assessment and administered questionnaires assessing PES and HR-QOL in 131 patients (aged 60 years; 75% men) before and 6 months after operation for organic MR and compared them to 62 patients who did not undergo operation for mitral disease and 36 normal controls of similar age assessed with the same methods. RESULTS: Baseline PES was poorer preoperatively in patients undergoing mitral operation compared with patients who did not undergo mitral operation and normal controls (anxiety and posttraumatic stress [PTS]; both p < 0.01) with poorer physical HR-QOL (p < 0.01). Six months later, all these psychoemotional variables improved (all p ≤ 0.02) in the patients who underwent mitral operation, whereas no change was observed in the other 2 groups (all p > 0.1). Improvement after mitral repair resulted in postoperative normalization of emotional and physical well-being, with similar scores among all groups (all p ≥ 0.4). At 6-month follow-up, no difference in improvement in PES and HR-QOL was noted according to the surgical approach (robotic versus sternotomy, all p ≥ 0.2). CONCLUSIONS: Patients with severe organic MR present with frequent psychoemotional alterations and HR-QOL deterioration, in contrast to patients who do not undergo mitral operation and normal controls. After mitral operation, notable improvement results in normalization of emotional and physical well-being. Quantification of emotional and physical well-being provides important outcome measures in patients with organic MR and uncovers important benefits provided by surgical correction of MR.

Recovery bed planning in cardiovascular surgery: a simulation case study.

Recovery beds for cardiovascular surgical patients in the intensive care unit (ICU) and progressive care unit (PCU) are costly hospital resources that require effective management. This case study reports on the development and use of a discrete-event simulation model used to predict minimum bed needs to achieve the high patient service level demanded at Mayo Clinic. In addition to bed predictions that incorporate surgery growth and new recovery protocols, the model was used to explore the effects of smoothing surgery schedules and transferring long-stay patients from the ICU. The model projected bed needs that were 30 % lower than the traditional bed-planning approach and the options explored by the practice could substantially reduce the number of beds required.

Improving patient access in nuclear medicine: a case study of PET scanner scheduling.

We used the systems engineering technique of discrete event simulation modeling to assist in increasing patient access to positron emission tomographic examinations in the Department of Nuclear Medicine at Mayo Clinic, Rochester. The model was used to determine the best universal slot length to address the specific access challenges of a destination medical center such as Mayo Clinic. On the basis of the modeling, a new schedule was implemented in April 2012 and our before and after data analysis shows an increase of 2.4 scans per day. This was achieved without requiring additional resources or negatively affecting patient waiting, staff satisfaction (as evaluated by day length), or examination quality.