This curriculum vitae document provides information about an individual's education, training, professional affiliations, research interests and publications. It details that the individual received an MD from Airlangga University in 1976 and became an internist, cardiologist and obtained a PhD from the same university. They have memberships in several national and international cardiovascular associations and have participated in research abroad. Their research interests involve basic science and clinical science topics related to atherosclerosis, stem cells and cardiovascular imaging. The CV lists the individual's formal training, additional courses/training, publications and presentations.
Okyanos Heart Institute Stem Cell Therapy Educational SeminarErika Rosenthal
Okyanos Heart Institute treats patients with coronary artery disease with their own stem cells. This presentation is part of a free educational seminar. More information can be found at http://www.okyanos.com
Dr. Kewal Krishan, Program Head, Heart Transplant & Ventricular Assist Devices Senior Consultant Cardiac Surgeon, Max Super Speciality Hospital, Saket He has done four years of advanced clinical fellowship at world’s top hospitals including Mayo Clinic, Rochester, USA and Mount Sinai Medical center New York, USA where he gained expertise in advanced therapies. Dr. Kewal is one of a handful surgeons in India who are formally trained in all aspects of heart transplantation. He was trained intensively in the entire spectrum of ventricular assist devices including bridge to transplant, short term and long term devices and destination therapy.
www.kewalkrishan.com
Okyanos Heart Institute Stem Cell Therapy Educational SeminarErika Rosenthal
Okyanos Heart Institute treats patients with coronary artery disease with their own stem cells. This presentation is part of a free educational seminar. More information can be found at http://www.okyanos.com
Dr. Kewal Krishan, Program Head, Heart Transplant & Ventricular Assist Devices Senior Consultant Cardiac Surgeon, Max Super Speciality Hospital, Saket He has done four years of advanced clinical fellowship at world’s top hospitals including Mayo Clinic, Rochester, USA and Mount Sinai Medical center New York, USA where he gained expertise in advanced therapies. Dr. Kewal is one of a handful surgeons in India who are formally trained in all aspects of heart transplantation. He was trained intensively in the entire spectrum of ventricular assist devices including bridge to transplant, short term and long term devices and destination therapy.
www.kewalkrishan.com
Myocardial viability testing all STICHed up, or about to be REVIVEDNicolas Ugarte
Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that
those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic
approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of
the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of
coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed
interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider
whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the futur
Absent Internal Carotid Artery in Circle of Willisiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Quantifying Cardiovascular and Behavioral Correlates of Fear in Mice: Implica...InsideScientific
To learn more and watch the webinar, go to:
https://insidescientific.com/webinar/quantifying-cardiovascular-and-behavioral-correlates-of-fear-in-mice-implications-for-ptsd-and-cardiovascular-disease-risk/
Post-traumatic stress disorder (PTSD) is a prevalent neuropsychological disorder that is in part characterized by exaggerated cardiovascular and autonomic arousal to trauma reminders, which over time may contribute to greater risk for cardiovascular disease (CVD) development (ie., stroke, hypertension). In both humans and rodents, cardiovascular and autonomic responses are strong measures of fear or threat assessment and therefore understanding how these systems go awry in anxiety disorders such as PTSD is critical for improving current PTSD therapies as well as reducing CVD risk in this population.
In this webinar, Dr. Paul Marvar and Benjamin Turley discuss research related to innovative methodology developed in rodent models for pairing real-time multi-modal assessment of behavioral (ie., freezing, startle) and cardiovascular (ie., blood pressure, heart rate) responses to cued fear learning and how these approaches may better inform underlying cardiovascular and autonomic impairments in fear-based disorders, such as PTSD.
Key Topics Include:
- To understand the physiological impact of PTSD on cardiovascular and autonomic homeostasis, CVD risk
- To understand how rodent models of conditioned fear learning can be used to assess real-time cardiovascular and autonomic fear or defensive emotional states in both home-cage and novel environments
- To further understand the benefits for using integrated behavioral and cardiovascular multi-modal methodologies and its translational implications for improved treatments for PTSD and CVD comorbidity
Myocardial viability testing all STICHed up, or about to be REVIVEDNicolas Ugarte
Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that
those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic
approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of
the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of
coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed
interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider
whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the futur
Absent Internal Carotid Artery in Circle of Willisiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Quantifying Cardiovascular and Behavioral Correlates of Fear in Mice: Implica...InsideScientific
To learn more and watch the webinar, go to:
https://insidescientific.com/webinar/quantifying-cardiovascular-and-behavioral-correlates-of-fear-in-mice-implications-for-ptsd-and-cardiovascular-disease-risk/
Post-traumatic stress disorder (PTSD) is a prevalent neuropsychological disorder that is in part characterized by exaggerated cardiovascular and autonomic arousal to trauma reminders, which over time may contribute to greater risk for cardiovascular disease (CVD) development (ie., stroke, hypertension). In both humans and rodents, cardiovascular and autonomic responses are strong measures of fear or threat assessment and therefore understanding how these systems go awry in anxiety disorders such as PTSD is critical for improving current PTSD therapies as well as reducing CVD risk in this population.
In this webinar, Dr. Paul Marvar and Benjamin Turley discuss research related to innovative methodology developed in rodent models for pairing real-time multi-modal assessment of behavioral (ie., freezing, startle) and cardiovascular (ie., blood pressure, heart rate) responses to cued fear learning and how these approaches may better inform underlying cardiovascular and autonomic impairments in fear-based disorders, such as PTSD.
Key Topics Include:
- To understand the physiological impact of PTSD on cardiovascular and autonomic homeostasis, CVD risk
- To understand how rodent models of conditioned fear learning can be used to assess real-time cardiovascular and autonomic fear or defensive emotional states in both home-cage and novel environments
- To further understand the benefits for using integrated behavioral and cardiovascular multi-modal methodologies and its translational implications for improved treatments for PTSD and CVD comorbidity
Nephrotic syndrome in Sickle Cell Disease of Western Odisha, India: A case re...inventionjournals
Sickle cell disease causes a distinct pattern of glomerular dysfunction. Subjects with sickle cell disease (SCD) are known to develop many potential functional and structural renal abnormalities. Glomerular hypertension and hyper filtration are thought to play a major role in the development of glomerular disease in subjects with SCD. We reported 5 unusual cases of sickle cell disease presenting as nephrotic syndrome. KEYWORDS- Nephrotic syndrome, sickle cell disease
Nephrotic syndrome in Sickle Cell Disease of Western Odisha, India: A case re...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
ABSTRACT- Coronary artery disease (CAD) is suspected as a leading cause of mortality in developed countries. Due
to cholesterol and fat deposit plaque is forming into the inner walls of the arteries of the heart, which leads to narrowing
of blood vessels of heart and reduce the blood flow rate into heart. Proprotein convertase subtilisin-like kexin type 9
(PCSK9) is one of the candidate gene that regulate lipoprotein retention pathway of CAD development. It is a newly
discovered serine protease that plays a key role in LDL-C homeostasis by mediating LDL receptor (LDLR). The LDL
receptor is breakdown through a post transcriptional mechanism and induces the production of very low-density
lipoprotein in the fasting state. The aim of this study was to investigate the frequency of single nucleotide
polymorphism (SNP) of PCSK9 gene of 155 CAD patients and 102 ages matched healthy controls. Serum lipids
including total cholesterol (TC), triglycerides (TG), HDL, LDL, and VLDL were analyzed. PCR-RFLP analysis was
carried out to genotype regions carrying Eam 1104I restriction site in the PCSK9. Gene considering significant
difference in serum TC, TG, HDL-C, LDL-C and VLDL-C levels (P<0.001, <0.0001) of patients and control samples.
In CAD patients, G allele frequency is less than A allele frequency. G allele is responsible for decreasing the
LDL: HDL ratio which shows evidence in having its protecting effect on the occurrence of CAD in West Bengal Population.
Key-words- CAD, PCSK9, SNP, Eam1104I, Polymorphism, West Bengal population
The Complete Guide to Know That RNA Sequencing of Cardiac Cells May Elucidate...Bennie George
A research report published in the international magazine Genes & Development, scientists from the Children's Hospital of Philadelphia used a powerful new technology to RNA sequence 20,000 single nuclei, opening up the biological events behind heart disease.
https://www.creative-bioarray.com/services/stem-cell-research.htm
EUTOX CME ERA-EDTA 2016 Vienna
A short overview on unhealthy endothelium during CKD and the role of selected uremic toxins mainly indoles, but with chocolate and zebrafish inside.
Dr. Steenblock treats patients suffering from Macular Degeneration using Stem Cell Treatments. Contact his office today at 1-800-300-1063. Websites:
www.stemcellmd.org
www.strokedoctor.com
www.stemcelltherapies.org
www.cerebralpalsycure.com
www.davidsteenblock.com
www.davidsteenblock.net
Similar to Future Inoroivement in Cardiac Regenerative Medicine (20)
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Future Inoroivement in Cardiac Regenerative Medicine
1. Curriculum Vitae
IDI (Indonesian Medical Association)
PAPDI (Indonesian Association of Internal Medicine)
PERKI (Indonesian Heart Association)
PUSKI (Indonesian Society of Medical
Ultrasonography)
PERKAVI (Indonesian Society of Heart Research)
ASE (American Society of Echocardiography)
ASNC (American Society of Nuclear Cardiology)
AHA (American Heart Association
SCCT (Society of Cardiac Computerized Tomography)
ASFC (ASEAN Society & Federation of Cardiology)
ISFC (International Society & Federation of
Cardiology)
WHL (World Hypertension League)
Membership :
National
International
2. Formal Training
1976
1981
1985
2004
MD
Faculty of Medicine /Airlangga University, Surabaya
Internist
Faculty of Medicine / Airlangga University,
Surabaya
Cardiologist
Faculty of Medicine / Airlangga University,
Surabaya
PhD
Faculty of Medicine / Airlangga University Surabaya
2R3esearch Interests
Basic Science
Clinical Science
1
2
3
4
1
2
3
Oxidant & Antioxidant in
Atherosclerosis
Atherosclerosic Regression
Stem Cell in Cardiovascular Diseases
Cardiovascular Imaging in
Atherosclerosis
Cardiovascular Imaging in Heart Failure
Stem Cell Treatment in Cardiovascular
Diseases
3. Curriculum Vitae
Sept-Oct 1992 Nuclear Cardiology. Royal Adelaide Hospital. University of Adelaide.
South Australia. Australia.
Nov 1992-February 1993 Nuclear Cardiology & Other Cardiac Imaging. Academische
Zijkenhuijs Leiden. Netherland.
Jan 1995 Stress Echocardiography. Hunter-Hill Clinic Cardiology. Sydney. New
South Wales. Australia.
April – June 2000 Research on Antioxidant Effect of Garlic Extract on Copper and
Lypoxygenase-catalyzed oxidation of LDL. Institute of Biochemistry.
University Clinic Charite. Humboldt University. Berlin. Germany.
Sept – Oct 2003 Research on the effect of Garlic Extract on Cholesterol Efflux from
Lipid-loaded J-774 Macrophages. Institute of Biochemistry.
University Clinic Charite. Humboldt University. Berlin. Germany.
Jan 2007 Advanced Course on Tissue Doppler Imaging. Chinese University.
Hong Kong.
May 2007 Advanced Course (Level 2 Certification) on Cardiovascular Computed
Tomography, Albany, New York, USA
May 2011 (Level 1 Certification) on Cardiovascular Magnetic Resonance
Imaging, Kualalumpur, Malaysia.
Additional Courses and Training
:
4. Curriculum Vitae
1. Effects of Onion on Diabetic patients. 15th International Congress of
Internal Medicine. Hamburg, (WEST GERMANY) : 18th - 22nd 1980.
2. Hypertension in the Critical Area of East Java. Singapore: 8th ASEAN
Congress of Cardiology. 7-11 December 1990.
3. Blood glucose and other coronary risk factors in critical areas of East
Java. Jakarta : 6th Congress of ASEAN Federation of Endocrinology, 2-4
July 1992.
4. The Effect of Garlic extracts (DDS, SAC) on Oxidized-LDL. Measurement
of HETE, HODE and its isomeres by HPLC. 1st National,Congress of
Indonesian Society of Heart Research. Jakarta : July 2002.
5. The Effect of Garlic extracts (DDS, SAC) on the Efflux of Cholesterol from
Acetylated-LDL-loaded J-774 Macrophages. Asian Pacific Congress of
Atherosclerosis. Nusadua, Bali 2004.
6. Effects of Garlic & its metabiolites on Atherosclerosis. Focus on
Atherosclerotic Regression. Keynote Speaker. International Organization
for Chemical Sciences in Development (IOCD). Working Group on Plant
Chemistry. Surabaya : April 09-11,2007.
7. Reversin increase plasticity of Bone Marrow-derived Mesenchymal Stem
Cell to generate Cardiomyocyte. Act Med Indon 2012;44:22-27
8. 3 Other International Publications
9. > 100 National Publications and Papers
Publications
:
5. CARDIOVASCULAR EMERGENCIES COURSE
Bumi Surabaya Hotel, November 7-8th, 2015
IMPROVEMENT IN
CARDIAC
REGENERATIVE
MEDICINE
Prof Budi Susetyo Pikir MD PhD
Department of Cardiology & Vascular Medicine /
Medical Faculty –
Dr.Soetomo Hospital /Airlangga University Hospital
Stem Cell Centre / Institute of Tropical Disease
Airlangga University
S U R A B A Y A
7. Primary Goals of Stem Cell Treatments
I. Biological Revascularization
II. Tissue Regeneration
III. In Vitro Organ / Apparatus development :
a) Vascular vessel
b) Vascularized Myocardial Patch
c) Valves
d) Bronchus
e) Epidermis / Dermis
f) Liver
g) etc
I. Paracrine Effect
Secondary Goals of Stem Cell Treatments
8. Good Retention
Favourable Growth of New Myocardial Tissue
Good Engraftment (Integration) with Native
Myocardium
STEM CELL for MYOCARDIAL
REGENERATION
Fully Functioning Myocardium
GOAL :
Electrophysiologic Function
Pump Function
9. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering
II. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascuklarization / Perfusion
3. Myocardial Viability
10. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascuklarization / Perfusion
3. Myocardial Viability
11. Choosing the right Source
of Stem Cells
The best source : Cardiac Resident
Stem Cells located at Subepicardiac
Fat of RV, etc.
Problems :
Difficult to obtain this cell
Limited in number in Cardiac
Diseases
16. Hierarchy of Cardiovascular Lineage SC
iPS
(pluripotent SC)
General Mesoderm
(polypotent SC)
Cardiohemangioblast
(multipotent SC)
Primitive Hemangioblast
(multipotent SC)
Cardiac SC
(oligopotent SC)
HPSC
(oligopotent SC)
Simple Hemangioblast
(oligopotent SC)
Cardiomyocyte Endocardial CellWBC
Megakaryoc
yteRBC Vascular Cells
Common Hard Tissue SC
(multipotent SC)
Common Ancestor SC
Myoskeletoblast
General Ectoderm
(polypotent SC)
General Endoderm
(polypotent SC)
17. Progress in In Stem Cell
Treatments
Embryonal
Stem Cell for
All Diseases
Bone-Marrow
Stem Cell for
All Diseases
Induced-
Pluripotent
Stem Cell for
All Diseases Spesific /
Resident Stem
Cell for Specific
DiseasesEarly Era New Era
Adipose-
derived MSCS
for All
Diseases
18. Unwanted Tissue in
Stem Cell Treatment :
ESC iPS MSC
(BM-MSC)
MSC
(Adipose-
derived
SC)
Resident
SC
Teratoma Teratoma
Other Tissue Other Tissue Bone
Fat
Fat
19. Unwanted Tissue in
Stem Cell Treatment :
Makino et al (1999) :
BM-MSC by 25 passaging spontaneous dedifferentiation
30 % Differentiation into beating Cardiomyocyte
KE Hatzistergos, A Blum, TA Ince, JM Grichnik, JM Hare. What Is the Oncologic Risk of Stem Cell
Treatment for Heart Disease? Circ Res. 2011;108:1300-1303
Hatzistergoset al (2011) :
Mouse MSC by 65 passaging Genetic Aberration ?
Differentiation into Multiple Organ FibroSarcoma
20. Progress in In Stem Cell
Treatments
Embryonal
Stem Cell for
All Diseases
Bone-Marrow
Stem Cell for
All Diseases
Induced-
Pluripotent
Stem Cell for
All Diseases
Resident
Stem Cell for
Specific
Diseases
Early Era
New Era
Adipose-
derived MSCS
for All
Diseases
21. Early vs New Era of SC Tx
Early Era of SC Tx
(not at the right track)
New Era of SC Tx
(at the right track)
Concept The best source –
• Embryonal SC or iPS
The best source –
Myocard Regeneration
• Flk-1 & Brachyuria SC or
• Cardiac Resident SC
• Combination of Cardiac Progenitor
Cell& EPC
• Myocardial Patch
Angiogenesis
• EPC for Biological
Revascularization
Animal Study • ESC, iPS
• Skeletal Myoblast
• BM-MSC
• Adipocyte-MSC
• Cardiac Resident SC
• Endoth Progenitor Cell
• Flk-1 SC
Clinical Aplication • BM-MNC
• BM-MSC
• Adipocyte-MSC
• Cardiac Resident SC
• EPC
• Extracardiac-derived ”Card SC”
22. Extracardiac Sources of
“Cardiac Stem/Progenitor Cells”
Adipose-MSC
1 % Spontaneous beating
cardiomyocytes (Planat-Benard V et al 2004)
10 % Spontaneous beating
cardiomyocytes (Jumabey et al, 2010)
Planat-Benard V, Menard C, Andre M, et al. Spontaneous Cardiomyocyte differentiation
from Adipose Tissue Stroma Cells. Circ Res. 2004;94:223-9.
23. Differentiation of PDL-SC
(Periodontic Ligament Stem Cells)
Neurogenic differentiation (Ectoderm)
Insulin-producing cell (Endoderm)
Hepatic cells differentiation (Endoderm)
Cardiomyogenic differentiaton (mesoderm) within 8
days
Osteogenic differentiation (mesoderm)
Chondrogenic differentiation (mesoderm)
23
Has many subpopulations of Stem Cells
24. After Stem Cell Treatment
using Dental Stem Cell
for Myocardial Regeneration
25. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineeri8ng
II. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascuklarization / Perfusion
3. Myocardial Viability
27. Can we use BM-MSC as source for
Myocardial Regeneration ?
Makino et al (1999)
Spontanenous dedifferentiation after subcultures for > 4 months
24 hours Azacytidine-induced cardiomyocyte differentiation 30 %
of Stem Cell became
– individual beating cardiomyocyte after 2 weeks of culture
– synchronized beating cardiomyocyte after 3 weeks of culture
Pikir et al (2010)
20 nM Reversin was given for 24 hours to induce dediferentiation, followed
by
9 μM 5-aza-2-deoxycytidine for 24 hours,
Cardiac Progenitor Cell (GATA +, CD34 and ckit +) formation after 21 days of
culture.
BM-MSC should be induced to Cardiac
Progenitor Cell (CPC) before can be used for
Myocardial Regeneration
28. Cardiomyocyte-inducing Agent :
5-aza-2-deoxycytidine
Budi S Pikir & Fedik Acta Med Indones. 2012 Jan;44(1):23-7
Genetic Expression of Cardiomyocyte-lineage
1 2 M 3
219 bp
RT-PCR : c-kit+
Lane 1-2 : Reversin plus 5-AZT
Lane M : Marker
Lane 3 : 5-AZT only
RT-PCR : CD34+
Lane M : Marker
Lane 1-2 : Reversin & 5-AZT
Lane 3 : Reversin only
Lane 4 : 5 AZT only
M 1 2 3 4
235 bp
29. Cardiomyocyte-inducing Agent :
5-aza-2-deoxycytidine
Budi S Pikir & Fedik Abdulrantam Acta Med Indones. 2012 Jan;44(1):23-7
Genetic Expression of Cardiomyocyte-lineage
1 2 3 4 5 6 M
1 2 3 4 5 6 M
286 bp
RT-PCR : MLC-2
Lane 1-6 : Reversin plus 5-AZT
Lane M : Marker
M 1 2 3
275 bp
RT-PCR : GATA-4
Lane M : Marker
Lane 1 : Reversin only
Lane 2 : 5 AZT only
Lane 3 : Reversin plus 5-AZT
30. Simple Epigenetic Reprogramming
Makino et al 1999
Budi S Pikir, Fedik A Rantam et al 2010
Spontaneous
Dedifferentiation
Differentiation
DifferentiationDedifferentiation
(24 hrs Reversin)
30 % Adult
Cardiomyocyte
BM-MSC
Cardiac
Progenitor
Cell
BM-MSC
4 months
passaging
3 weeks
31. Common Ancestor
Stem Cells :
CD-34 EPC for
Leukocyte or Vascular
Endothelial Cell
Regeneration
Flk-1 & Brachyuri SC for
Cardiovascular
Regeneration
Closest Family of
Stem Cells :
• BM-MSC for Dentin
Regeneration
• Dental SC for Bone
Regeneration
• Olfactory SC for
Paraplegia
• Ectodermal type of
Dental SC for Nerve
Regeneration
• Subpopulation of
Epidermal SC or Hair
Follicle SC for Nerve
Regeneration
Strategy to select
Correct Source of Stem Cells
32. Strategy to select
Correct Source of Stem Cells
Empirical Study:
• Subpopulation of
Adipose SC for Bone
or Dentasl
Regeneration
• Olfactory SC for
Paraplegia
• Ectodermal type of
Dental SC for Nerve
Regeneration
Empirical Study:
• Subpopulation of
Adipose SC for
Myocardial
Regeneration
• Subpopulation of
Dental SC for
Insuline-producing
cell (Beta-pancreas
cell)
• Subpopulation of
Adipose SC for Nerve
Regenefation
35. New Strategy using Stem Cell for
Myocardial Regenetration
1. Using Correct Sources of Stem Cell
a. Resident Cardiac Stem / Progenitor Cell or
b. Extracardiac Cardiac Stem / Progenitor
Cells
2. Using Purified Cardiac Stem / Progenitor
Cell
3. Using Scaffold for CPC attachment &
temporary nutrition
4. Adding Vascular Stem Cell (?) VSMPC
(?) & EPC
36. Different strategies for an improved
cell therapy of Myocardial Infarction.
Different strategies for an improved cell therapy of MI. After MI, albeit significantly preventing acute death and transiently
increasing contractile capacity, conventional medical treatment does not restore organ architecture. MSC transplantation is
able to induce a partial recovery of cardiac function and limit infarct expansion. However, low engraftment and differentiation
impair the therapy. Four systems aim at improving this situation and manage total tissue regeneration: tissue engineering,
genetic modification of cells, pretreatment with protective molecules and in vitro predifferentiation towards the desired
lineages.
Manuel Mazo, Miriam Araña, Beatriz Pelacho and Felipe Prosper. Chapter 1 Mesenchymal Stem Cells for Cardiac Repair:
Preclinical Models of Disease. In : Jürgen Hescheler · Erhard Hofer eds. Adult and Pluripotent Stem Cells. Potential for
Regenerative Medicine of the Cardiovascular System. Springer Dordrecht Heidelberg New York London. 2014.
37. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering :
1. iPS
2. Genetic Editing
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascuklarization / Perfusion
3. Myocardial Viability
40. Flk-1 Progenitor Stem Cell in mouse
model of Acute Myocardial Infarction
AMI by LAD ligation on Immunodeficient SCID beige mice
Flk-1 was purified by FACS (Fluorescence Activated cell Sorting)
Placebo (13) injection of PBS intramyocardially
Flk-1neg Progenitor SC injection of 5 x 105 cells
intramyocardially
Flk-1pos Progenitor SC injection of 5 x 105 cells
intramyocardially
Mauritz C, Martens A, Rojas SV, et al. Induced pluuripotent stem cell (iPSC)-derived
Flk-1 progenitor cell engraft, differentiate, and improve heart function in a mouse
model of Acyte Myocadial Infarction. Europ Hesrt J 2011;32 :2634-2641.
41. Flk-1 Progenitor Stem Cell in mouse
model of Acute Myocardial Infarction
Flk-1 was progenitor for Cardiomyocyte
and Vascular Cell Types
Engraft and Differentiate into New
Myocardium and Vascular Cell.
Improve LV Function
Mauritz C, Martens A, Rojas SV, et al. Induced pkuripotent stem cell (iPSC)-derived Flk-
1 progenitor cell engraft, differentiate, and improve heart function in a mouse model of
Acyte Myocadial Infarction. Europ Hesrt J 2011;32 :2634-2641.
42. Induced Pluripotent Cell (iPS) &
Dedifferentation from Somatic Cells.
42
Genetic
Reprogramming
Epigenetic
Reprogramming
Genetic Transfer :
Transfer Factors (TF)
Epigenetic Modification :
Enzymatic DNA/Histone /Ribosome
methylation/acetylation &
demethylation/deacetylation
1. Small Molecule :
• Reversin
2. Embryonal Cell Extract :
• Free cell extract Embryo, etc.
3. Small Protein :
• Oct4, Sox2, Klf4, c-Myc
• Oct3/4
• Sox2
• Klf4
• c-Myc
• Oct4
• Sox2
• Nanog
• Lin28
• Oct4
• Complicated procedures • Simple procedures
• More stable • Less stable
• Low Efficiency (< 1 %) • Very Low Efficiency (0.001-0.03 %)
• High-risk for side-effect • Low risk
44. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering :
1. iPS
2. Genetic Editing
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascuklarization / Perfusion
3. Myocardial Viability
45. Genetic Editing
45
Xiu-ling XU1, #, *, Fei YI 2, #, Hui-ze PAN 1, Shun-lei DUAN 1, Zhi-chao DING1, Guo-
hong YUAN 1, Jing QU1, Hai-chen ZHANG1, Guang-hui LIU1. Progress and prospects
in stem cell therapy. Acta Pharmacologica Sinica (2013) 34: 741–746.
46. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering :
1. iPS
2. Genetic Editing
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascuklarization / Perfusion
3. Myocardial Viability
47. Scaffold in Stem Cell Tx
I. Natural Scaffold
II. Synthetic Scaffold
1. Non Biodegradable
Scaffold
2. Biodegradable Scaffold
48. The major roles for supporting matrices
(scaffold)
1. It serves as a framework, which maintains the shape of
the defect. It provides physical support for the healing
area so that there is no collapse of the surrounding
tissue into the wound site.
2. It serves as a 3D substratum for cellular adhesion,
migration, proliferation and production of
extracellular matrix.
3. It serves as a barrier to restrict cellular migration in
a selective manner.
4. It potentially serves as a delivery vehicle for growth
factors.
5. Temporary Nutrition
48
49. Natural Scaffold :
Extracellular Matrix
Decellularized Bone
Decellularized Bronchial Tree from corpse
Decellularized Cardiac Valves from corpse
Etc. 49
Natural Scaffold for Bone tissue
engineering :
the extracellular matrix (ECM) of bone, the
unique microenvironmental niche for bone
morphogenesis
50. Scaffold for Myocardial Regeneration –
in the form of sheet
1. It serves as a framework, which maintains the shape of
the defect. It provides physical support for the healing
area so that there is no collapse of the surrounding
tissue into the wound site.
2. It serves as a 3D substratum for cellular adhesion,
migration, proliferation and production of
extracellular matrix.
3. It serves as a barrier to restrict cellular migration in
a selective manner.
4. It potentially serves as a delivery vehicle for growth
factors.
5. Temporary Nutrition
50
51. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascularization / Perfusion
3. Myocardial Viability
52. EVALUATION BY CARDIAC IMAGING
Stem Cell Transplantation
LV Function
LV Wall Motion
Myocardial Perfusion
Myocardial Viability
Due to stem cell ?
Due to paracrine effect ?
Cardiac
MRI
53. Cardiac
MRI
Stem Cell Transplantation
LV Function
LV Wall Motion
Myocardial Perfusion
Myocardial Viability
Due to stem cell ?
Due to paracrine effect ?
Stem Cell Tracking
Cardiac
MRI
EVALUATION BY CARDIAC MRI
54. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascularization / Perfusion
3. Myocardial Viability
55. Contrast Agent for Stem Cell Tracking
SPIO (Superparamagnetic Iron Oxide) Nano
Particle :
– Magnetitite Fe3O4 or Maghemite Fe2O3
Ferumoxide (Endorem in Europe) and Feridex in USA) 120-180 nm
Ferucarbotran (Resovist) diameter 62 nm
Ferumoxtrane-10 (Combidex in USA and Sinerem in Europe)
Ferumoxytol (Feraheme)
– Preparation of Stem Cell labelling
Surface labelling
Internalization of contrast into stem cell before transplantation :
– Cross-linked with a membrane-translocaqting signal peptide (e.g. HIV-1 Tat protein)
– Incubated in comnibination with transfection agentsa
56. EVALUATION BY CARDIAC MRI
• T1 Contrast Agent (bright positive signal ) :
• Gadolimnium (Gd-) containing NP (e.g. Gd-chelated NP and Gd-chelated
dextran NP) – GadoCellTrack
• Gadolinium oxide NP
• T2 Contrast Agent (negative signal or dark spot) :
• SPIO NP bimetallic ferrite NP (e.g. CoFe2O4, MnFe2O4 and NiFe2O4)
• Hybrid magnetic NP such Fe3O4, Au dumbbell
Contrast Agent can be detected ultil several month
after stem cell transplantation
57. Limitation of SPIO Contrast Agent
Extracellular deposition in tissue :
– Active exocytosis by viable stem cells
– Passive release due to death of transplanted cells
Immunocompetent animal:
– infiltrating leukocyte and microglia surrounding dead
stem cells and to internalize superparamagnetic iron-
oxide clusters
Immunodefficient animal :
– contrast clear at a faster rate – due to proliferation of
surviving transplanted cell and associated
labeldiffusion
58. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascularization / Perfusion
3. Myocardial Viability
60. Cardiac MRI
Perfusion Defect
Rest-stress MPI (a–f) in a patient with
severe proximal stenosis (90%
luminal narrowing) of the
osterolateral branch of the left
circumflex CA (arrow, g). First-pass
MPI during stress (a–c), and during
rest (d–f) showing 3 short-axis levels
(basal, mid, apical). While LV
myocardial nhancement is
homogeneous during rest, an
extensive perfusion defect (arrows, a–
c) is visible during adenosine stress
MPI involving the entire LV lateral
wall
61. Strategies for Improvement of
Stem Cell Treatment in
Myocardial Regeneration
I. Stem Cell Processing :
1. Cellular Engineering
2. Epigenetic Engineering
3. Genetic Engineering
II. Scaffold
III. Evaluation of Treatment :
1. Stem Cell Tracking
2. Myocardial Revascularization / Perfusion
3. Myocardial Viability
64. CONCLUSIONS :
with Current Practice of Stem Cell Tx
(BM-MNC , BM-MSC or Adipose-MSC) :
Short-term moderate improvement of LV
function (6%) – due to Paracrine Effet ?
Long-term ?
With Stem Cell Injection :
• I.V Injection - < 2 % reside in area of
target
• Intracoronary injection – 5 % reside in
area of target
• Intramyocardial injection – 25 % reside in
area of target.
65. FUTURE DIRECTION
Correct Source of Stem Cell :
Resident Cardiac Stem Cells
Extracardiac Source of Cardiac Mesoderm
(Brachyuri, Flk-1) or Cardiac Stem Cell
– Isolation directly from Adipose-MSC or Dental
Stem Cells
– “Transdifferentiation” from Closest Family of
Stem Cells (by epigenetic reprogramming before
differentiation)
Purified it before can be used for clinical application
66. Optimal preparation of STEM CELLS
– Correct source of STEM CELLS
– Optimal stage of development of STEM CELLS (Cardiac
Mesoderm, Cardiac Stem Cell, Cardiac Progenitor Cells)
– Purified it
– Add Vascular Smooth Muscle Progenitor Cells (?) and
Endothelial Progenitor Cell for Cardiac Progenitor Cells
Optimal Route of Injection (Intramyocardial –
subendocardial or subepicardial)
FUTURE DIRECTION
67. CONCLUSIONS :
to achieve the best result :
TISSUE ENGINEERING
(Patch or Injectable Scaffold)
(It is not possible to regenerate large
infarction with Cell Tx alone)