Tri Kurniawati

New Bone Formation in Tuberculous-Infected Vertebral Body Defect after Administration of Bone Marrow Stromal Cells in Rabbit Model

Study Design Preliminary experimental study using a rabbit spondylitis model. Purpose To observe the ossification in a micro-environment containing live Mycobacterium tuberculosis transplanted with bone marrow stromal cells (BMSCs) in rabbits. Overview of Literature BMSCs differentiate to osteoblasts and then osteocytes during ossification. Mycobacterium tuberculosis does not affect BMSC growth in vitro. Methods Six rabbits were divided into two groups of three rabbits. One group was positive for spondylitis tuberculosis by culture, polymerase chain reaction (PCR), and histopathologically. The other group was positive by PCR and histopathologically. Both groups were treated using BMSC transplantation and anti-tuberculosis drugs. After 6 weeks, ossification was evaluated by enumerating the number of osteoblasts, osteocytes, and lesion level of calcium. Results Mean number of osteoblasts was 207.00±31.00 in the first group and 220.33±73.46 in the second group. Mean number of intra-lesions osteocytes was in the first and second group was 18.33±30.04 and 31.00±26.87, respectively. Mean calcium level in the first group and second group was 2.94%±0.89% and 2.51%±0.13%, respectively. Total ossification score in the first and second group was 31.00 and 25.67, respectively. Conclusions Mycobacterium tuberculosis provides support for new bone formation by stimulating intra-lesion calcium metabolism. The microscopic environment containing live Mycobacterium tuberculosis enhances ossification.

Improvement of renal function after human umbilical cord mesenchymal stem cell treatment on chronic renal failure and thoracic spinal cord entrapment: a case report

BackgroundChronic renal failure is an important clinical problem with significant socioeconomic impact worldwide. Thoracic spinal cord entrapment induced by a metabolic yield deposit in patients with renal failure results in intrusion of nervous tissue and consequently loss of motor and sensory function. Human umbilical cord mesenchymal stem cells are immune naïve and they are able to differentiate into other phenotypes, including the neural lineage. Over the past decade, advances in the field of regenerative medicine allowed development of cell therapies suitable for kidney repair. Mesenchymal stem cell studies in animal models of chronic renal failure have uncovered a unique potential of these cells for improving function and regenerating the damaged kidney.Case presentationWe report a case of a 62-year-old ethnic Indonesian woman previously diagnosed as having thoracic spinal cord entrapment with paraplegic condition and chronic renal failure on hemodialysis. She had diabetes mellitus that affected her kidneys and had chronic renal failure for 2 years, with creatinine level of 11 mg/dl, and no urinating since then. She was treated with human umbilical cord mesenchymal stem cell implantation protocol. This protocol consists of implantation of 16 million human umbilical cord mesenchymal stem cells intrathecally and 16 million human umbilical cord mesenchymal stem cells intravenously. Three weeks after first intrathecal and intravenous implantation she could move her toes and her kidney improved. Her creatinine level decreased to 9 mg/dl. Now after 8 months she can raise her legs and her creatinine level is 2 mg/dl with normal urinating.ConclusionsHuman umbilical cord mesenchymal stem cell implantations led to significant improvement for spinal cord entrapment and kidney failure. The major histocompatibility in allogeneic implantation is an important issue to be addressed in the future.

Toxicity and biocompatibility profile of 3D bone scaffold developed by Universitas Indonesia: A preliminary study

Scaffold as a biomaterial must fulfill some requirements to be safely implanted to the human body. Toxicity and biocompatibility test are needed to evaluate scaffold material in mediating cell proliferation and differentiation, secreting extracelullar matrix and carrying biomolecular signals for cell communication. An in vitro study with mesenchymal stem cells consisted of direct contact test and indirect contact test using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) tetrazolium reduction assay was conducted on 4 scaffolds made of poly-L-lactic acid (PLA), polyvinyl alcohol (PVA), and hydroxyapatite-poly (vinyl alcohol) composite. There were cells-substrate adhesion impairment, morphological changes, cell death and reduction in cell proliferation seen at 2nd and 6th day in most tested scaffold. Cell count result at day-6 showed proliferation inhibition of more than 50% cell death (inhibition value >50) in all tested scaffold. In MTT assay, two scaffolds were proven non-toxic. In con...

The Needs of Current Implant Technology in Orthopaedic Prosthesis Biomaterials Application to Reduce Prosthesis Failure Rate

Today, orthopaedics is still in search for the most reliable biomaterial for prosthesis. The biomaterial needs to have good longevity and other supporting properties in order to maintain low implant failure. An ideal metallic biomaterial should be biocompatible, has similar elastic modulus to that of bone, has excellent resistance to fatigue, corrosion, aseptic loosening, and wear, and has good bone-bonding ability. The success of an implant depends on many factors. Good osseointegration is one of the factors required to reduce the rate of loosening of implants and in order to increase the chance of osseointegration, high stability of implants and early healing process encouragement are needed.

Optimization Correction Strength Using Contra Bending Technique without Anterior Release Procedure to Achieve Maximum Correction on Severe Adult Idiopathic Scoliosis

Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Posterior-only approach with rod and screw corrective manipulation to add strength of contra bending manipulation has correction achievement similar to that obtained by conventional combined anterior release and posterior approach. It also avoids the complications related to the thoracic approach. We reported a case of 25-year-old male adult idiopathic scoliosis with double curve. It consists of main thoracic curve of 150 degrees and lumbar curve of 89 degrees. His curve underwent direct contra bending posterior approach using rod and screw corrective manipulation technique to achieve optimal correction. After surgery the main thoracic Cobb angle becomes 83 degrees and lumbar Cobb angle becomes 40 degrees, with 5 days length of stay and less than 800 mL blood loss during surgery. There is no complaint at two months after surgery; he has already come back to normal activity with good functional activity.

Mycobacterium tuberculosis Contaminant Risk on Bone Marrow Aspiration Material from Iliac Bone Patients with Active Tuberculous Spondylitis

There was a concern on Mycobacterium tuberculosis spreading to the bone marrow, when it was applied on tuberculous spine infection. This research aimed to study the probability of using autologous bone marrow as a source of mesenchymal stem cell for patients with tuberculous spondylitis. As many as nine patients with tuberculous spondylitis were used as samples. During the procedure, the vertebral lesion material and iliac bone marrow aspirates were obtained for acid fast staining, bacteria culture, and PCR (polymerase chain reaction) tests for Mycobacterium tuberculosis at the Clinical Microbiology Laboratory of Faculty of Medicine Universitas Indonesia. This research showed that there was a relationship between diagnostic confirmation of tuberculous spondylitis based on the PCR test and bacterial culture on the solid vertebral lesion material with the PCR test and bacterial culture from the bone marrow aspirates. If the diagnostic confirmation concluded positive results, then there was a higher probability that there would be a positive result for the bone marrow aspirates, so that it was not recommended to use autologous bone marrow as a source of mesenchymal stem cell for patients with tuberculous spondylitis unless the PCR and culture examination of the bone marrow showed a negative result.

Bioreactor as a New Resource of Autologous Bone Graft to Overcome Bone Defect In Vivo

Bone defect will not undergo any process of healing when not treated. Tissue engineering is currently exploring alternatives for generating new bone tissue. The base triad for bone tissue engineering is manipulation of osteogenic cells, growth factors, and bio scaffolds. Diamond concept includes mechanical environment and this base triad. Provided constant stream of pluripotent stem cells and biomolecular signals that is necessary for bone formation are some advantages of this in vivo bioreactor. Thus, we conducted article searches by using computerized database of PUBMED and Google Scholar. After sorting and selecting, 14 articles were finally obtained. Several things are considered upon designing an in vivo bioreactor. Before conception, it is necessary to measure the size and geometry of the defect. Afterwards, the materials for bioreactor construction must be determined. These include the scaffold material, cell seeding, and growth factors. Method of prefabrications follows to be decided, including site for implantation and time until transfer. Lastly, additional strategies to improve angiogenesis and osseointegration can be considered and added, until the graft is clinically applied. Some issues still need to be covered on this new trending discovery. Study comparing prefabrication sites to find the most optimal site is needed, as well as the optimal time to harvest. Further development regarding technique to produce large volume of bone tissue must be considered. Moreover, further studies in human subjects with larger samples followed by evaluation after clinical implantation would be necessary to examine the applicability and feasibility in human population.

Realization and testing of multi-material 3D printer for bone scaffold fabrication

This research realized 3D constructs by integrating more than one material with multi fabrication system within a single session. A commercial rapid prototyping system, RepRap MendelTM, is modified so that it enables us to realize microenvironment composed of multi materials namely gelatin hydrogel and polylactic acid. Firstly, the session is preceded by realization of 3D scaffold using polylactic acid (PLA) with porosity and modulus elasticity as characterized. Later, the gelatin extrusion took place to seed the cellular in determined spatial arrangement. The results show that our apparatus able to realized scaffold that using PLA as matrix filled with gelatin that act as cell carrier in future application. The scaffolds have porous around 0.25 mm2 porosity with a modulus of elasticity around 160 MPa.

Pedicle screw position changing policy for nerve injury problems during screw insertion on thoracolumbar compression fractures

Introduction Intraoperative neurophysiologic monitoring (IONM) had important role related to the complications in spinal surgery. Somatosensory Evoked Potential (SSEP), Transcranial electric Muscle Evoked Potentials (tceMEPs), and free run EMG are parameters used to asses functional integrity of the nervous system during surgical procedures. Once warning signal was recognized, surgeon have to make a precise decision to overcome that problem. Presentation of case We present a 47-year old male with back pain due to compression fracture of thoracic vertebra T12 and lumbar vertebrae L1. While stabilizing through the posterior approach on the T11 and 12 as well as L2 and L3, the SSEP monitor showed 50% reduction in the waveform as the pedicle screw was inserted at the left side of T12. The instrumentation was changed into vertebra thoracal T10, T11, and vertebrae lumbar L2, L3. The SSEP normalized and post operatively pain decreased. After surgery there was no neurological deficit. Discussion Acute trauma as a result of spine instrumentation may provoke significant edema, with mass effect causing neurophysiological dysfunction. Administration of intravenous steroid would do at this stage, followed by constant infusion for following 24–48 h, may help ameliorating the mass effect and improving the neurologic outcome. Alternatively, immediate pedicle screw changing policy showed absolute recovery of nerve injury. Conclusion Insertion of pedicle screw in spinal surgery has a risk of complication that could be treated by pedicle screw changing policy.

Preservation and Tissue Handling Technique on Iatrogenic Dural Tear with Herniated Nerve Root at Cauda Equina Level

Iatrogenic or incidental dural tear is a relatively common complication in lumbar decompression surgery. Although mostly there are no changes that occurred in long-term result following an incidental durotomy, the sequelae are not always benign especially when the herniated nerve root is involved. Preservation and tissue handling is paramount in order to prevent further injury. Two cases of dural tear with herniated nerve root complicating the lumbar decompression surgery are presented. Direct watertight repair was performed using the preservation and tissue handling concept. Assessing the relative size between the dural tear and the root mass is the key in determining whether enlargement of tear is needed. Whenever feasible, the tear will not be enlarged. Opening the vent by using a suture anchor and manually repositioning the nerve root with a fine instrument is the key for an atraumatic handling of the herniated nerve root. Clinical and neurophysiology examination was performed postoperatively and no further neurologic deficit occurred despite the iatrogenic injury. Although some debate on a few intraoperative and postoperative details still persists, tissue handling and preservation concept should be applied in all cases.