[Bakri balloon tamponade for severe post-partum haemorrhage: efficiency and fertility outcomes]. / Évaluation du ballon de Bakri dans les hémorragies graves du post-partum et fertilité ultérieure.

AIM: To evaluate efficiency of Bakri balloon tamponade (BB) to stop severe post-partum haemorrhage (PPH) and fertility outcomes. METHODS: Retrospective study including all patients who underwent Bakri balloon tamponade for severe PPH between January 2009 and December 2013. The objectives were to stop PPH by BB and to evaluate the fertility after Bakri balloon tamponade. RESULTS: Sixty-one women had a Bakri balloon inserted in utero for severe PPH. The PPH was stopped in 55 patients out of 61 (88%). The reasons of severe PPH were uterine atony in 44 cases (72%), placental retention in 10 cases, placenta praevia in 3 cases, and cervical or vaginal tears in 4 cases. In one third of cases, the pregnancy was complicated by diabetes, placenta praevia, hypertensive troubles. A cesarean section or an instrumental delivery was performed for one third of patients. The mean duration of the Bakri balloon insertion was of 7 hours [5-9] and the mean filling of the balloon was of 350 ml [205-450]. The mean blood loss was of 1600 [1200-2250]. Sixty-three percent of patients (n=38) received red blood cells transfusion. The BB was efficient after a vaginal delivery or after a caesarean section and in all cases of placenta praevia. In 6 cases, the BB was inefficient and uterine embolisation or a surgical procedure was performed to stop PPH. Nine women underwent a new pregnancy after the insertion of Bakri balloon for severe PPH and 3 delivered healthy newborns. CONCLUSION: Bakri balloon tamponade is a minimally invasive intrauterine device efficient to stop severe post-partum haemorrhage. New pregnancies and deliveries are possible after tamponade by Bakri balloon.

Intraparenchymal injection of bone marrow mesenchymal stem cells reduces kidney fibrosis after ischemia-reperfusion in cyclosporine-immunosuppressed rats.

Ischemia-reperfusion and immunosuppressive therapy are a major cause of progressive renal failure after kidney transplantation. Recent studies have shown that administration of bone marrow mesenchymal stem cells (MSCs) improves kidney functional recovery in the acute phase of post ischemia-reperfusion injury. In the present study, we used an original model of renal ischemia-reperfusion in immunosuppressed rats (NIRC) to investigate the effects of bone marrow MSCs on progression of chronic renal failure and the mechanisms potentially involved. Left renal ischemia-reperfusion (IR) was induced in unilateral nephrectomized Lewis rats. After IR, rats were treated daily with cyclosporine (10 mg/kg SC) for 28 days. MSCs were injected into the kidney at day 7 after IR. At day 28 after IR, kidneys were removed for histomorphological, biochemical, and gene expression analysis. The effect of conditioned media from MSCs on epithelial-mesenchymal transition was studied in vitro on HK2 cells. Our results show that, as compared to untreated NIRC rats, rats treated by intrarenal injection of MSCs 7 days after IR displayed improvement in renal function, reduction of interstitial fibrosis, and decrease in chronic tubule injury. These effects were associated with a decrease in interstitial α-SMA accumulation and MMP2 activity, markers of fibroblast/fibroblast-like cell activation, and renal remodeling, respectively. Finally, experiments in vitro showed that MSC-conditioned medium prevented epithelial-mesenchymal transition induced by TGF-ß in HK2 cells. In conclusion, our results show that, in immunosuppressed animals, a single intrarenal administration of MSCs reduced renal fibrosis and promoted the recovery of renal function.

Evaluation of alginate microspheres for mesenchymal stem cell engraftment on solid organ.

Mesenchymal stem cells (MSCs) may be used as a cell source for cell therapy of solid organs due to their differentiation potential and paracrine effect. Nevertheless, optimization of MSC-based therapy needs to develop alternative strategies to improve cell administration and efficiency. One option is the use of alginate microencapsulation, which presents an excellent biocompatibility and an in vivo stability. As MSCs are hypoimmunogenic, it was conceivable to produce microparticles with [alginate-poly-L-lysine-alginate (APA) microcapsules] or without (alginate microspheres) a surrounding protective membrane. Therefore, the aim of this study was to determine the most suitable microparticles to encapsulate MSCs for engraftment on solid organ. First, we compared the two types of microparticles with 4 × 10(6) MSCs/ml of alginate. Results showed that each microparticle has distinct morphology and mechanical resistance but both remained stable over time. However, as MSCs exhibited a better viability in microspheres than in microcapsules, the study was pursued with microspheres. We demonstrated that viable MSCs were still able to produce the paracrine factor bFGF and did not present any chondrogenic or osteogenic differentiation, processes sometimes reported with the use of polymers. We then proved that microspheres could be implanted under the renal capsule without degradation with time or inducing impairment of renal function. In conclusion, these microspheres behave as an implantable scaffold whose biological and functional properties could be adapted to fit with clinical applications.