Long-term Feasibility Research Articles

AB1351-HPR A HAND EXERCISES MHEALTH APP FOR PATIENTS WITH RHEUMATOID ARTHRITIS: DEVELOPMENT, DESIGN AND USABILITY STUDY IN TURKEY

Background:The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme has been shown to provide long term improvement in hand function for patients with rheumatoid arthritis (RA) affecting their hands. In Turkey, limited number of physiotherapists work in rheumatology departments so there is an opportunity to use the digital technologies for exercise prescription and follow up to improve access to treatment.Growing research evidence supports the effectiveness of mHealth interventions for improving exercise adherence and motivation.To our knowledge,there is no hand exercises mHealth program for patients with rheumatoid arthritis designed by experts with the user-centered method.Objectives:The aim of our study is to develop and design a smartphone application for structured hand exercise program for patients with RA in Turkey and to test its usability.Methods:We used a qualitative user-centered design approach with 2 phases.PHASE 1:we conducted focus group meetings to discuss the content, feature and design of app to produce a prototype version of smartphone software for RA hand training program.The Focus Group consisted of two physiotherapists and three hand therapists working in the field in different rheumatology or hand rehabilitation clinics,two software-computer engineers, and three patients with RA who had previously participated in hand therapy. The focus group met 4 times during phase 1. PHASE 2:we investigated the usability of prototype version of the rheumatoid hand exercise smartphone app software. All focus group members (n=10) and 6 patients used the app for one week.All users filled the usability questionnaire and provided written feedback on the app. Revisions were made and the revised version was tested. We put the revised app in digital markets in Turkish and English.Results:The major themes identified from the Focus Group discussions during phase 1 were (a)Login techniques (b)self-monitoring (c)exercises types/frequency/diary, (d) patient education, (e)behavioral change and encouragement (f)exercise adherence. Patients and therapist all agreed the login needed to be easy. Patients wanted to be able to monitor their pain levels and hand function in the app. Patients thought the SARAH exercise were suitable for the app. A patient said:‘SARAH exercises is beneficial for my hand and tendon gliding exercise,I will be happy to see these exercises in app’. Patients wanted exercise reminders using push up notifications to encourage exercise were proposed and included.A patient commented ‘in themorning and after work, motivational push up messages could be beneficial for exercise habit.”During the phase 2,we identified a need for education on how to use digital app, ways to provide patient follow up to monitor adherence, the need to allow patients to select the amount of notifications. This feedback was incorporated into the final version.Conclusion:mHealth applications represent an easily accessible bridge between patients and health professionals for home-based programs. Using a user-centered approach ensured that we developed an application that met the needs of therapists and patients. Physiotherapists are using the app in rheumatology clinics in Turkey and long-term usability and feasibility studies are ongoing.

Long-term efficacy and feasibility of levonorgestrel-releasing intrauterine device use in patients with adenomyosis.

To evaluate the efficacy and feasibility of levonorgestrel-releasing intrauterine device (LNG-IUD) use longer than 5 years in women with adenomyosis.Data were retrospectively collected from patients who were treated with LNG-IUD longer than 5 years at the Chungnam National University hospital for adenomyosis diagnosed with ultrasonography from January 2006 to November 2013.A total of 131 patients who were diagnosed with adenomyosis had treated with LNG-IUD longer than 5 years. The mean duration of keeping 1 device without replacement was 58.35 ± 15.98 months, and total duration of LNG-IUD treatment was 83.86 ± 23.88 months. A total of 51 patients stopped using LNG-IUD after 5 years and the mean age at the time of LNG-IUD removal was 52.46 ± 6.9. LNG-IUD treatment had a significant effect on both menorrhagia and dysmenorrhea starting from the first month of insertion (P < .01), which persisted until 6 years when the effect started to plateau. The decrease in uterine volume was not consistent during the treatment period. The uterine volume decreased significantly only in the first and second year of LNG-IUD treatment and then from eighth to tenth year of LNG-IUD treatment (P < .05). Adverse events after insertion of LNG-IUD decreased significantly after 5 years.LNG-IUD treatment longer than 5 years is an effective and feasible method for patients diagnosed with adenomyosis.

Annual study of hydraulic characteristics in surface flow constructed wetlands using hydrogen and oxygen stable isotope technology

Complex flow patterns and hydraulic characteristics could reduce the utilization efficiency of constructed wetland (CW), and consequently, its pollutant removal performance. Thus, it is of great importance to explore the internal flow patterns of CWs. Isotopic molecules exist naturally in CWs and have special properties under liquid conditions; using hydrogen and oxygen isotope technology cannot only reduce secondary pollution but also reflect the hydraulic characteristics of CWs. In the present study, the annual variation of isotopic composition in field-scale CW was investigated to evaluate the long-term feasibility of stable isotopic technology characterizing hydraulic flow patterns. The relationship between nutrients concentration distribution and flow pattern variation in CW under different seasons was discussed as well. Results demonstrated that isotope 18O/16O distribution could be used to determine the internal flow pattern of CW throughout the year, except for preferential flow area of CWs in winter, since more hydraulic retention time is needed to ensure the change of water isotopes due to the small evaporation in winter. Lower ammonia nitrogen concentration was observed in the stagnant area, while the total phosphorus concentration of the stagnant area increased during winter. And more attention should be paid to aquatic plants during the CW design, since it has significant influence on the hydraulic flow patterns of CW.

Implementing Trauma-Informed Research-Supported Treatment: Fidelity, Feasibility, and Acceptability

Evidence indicates the importance of integrating treatment of co-occurring traumatic stress and substance use disorders in adolescent populations. However, the effectiveness of trauma-informed research-supported treatments (TI-RSTs) depends on program fidelity, feasibility, and acceptability. This study assessed perceived fidelity, feasibility, and acceptability of two TI-RSTs, The Sanctuary Model and Seeking Safety, at one residential adolescent substance misuse treatment agency. Perceived fidelity was examined two years into implementation while feasibility and acceptability were examined over time from early in the implementation process (n = 25), to 1 year later (n = 31), and to 2 years later (n = 23) through a series of staff interviews. Findings suggest that implementation of The Sanctuary Model and Seeking Safety at adolescent residential substance misuse treatment agencies can be conducted with fidelity and is feasible and acceptable. However, findings indicate that not all TI-RSTs are responded to in the same way. Furthermore, findings suggest that additional efforts might be necessary to ensure improved and long-term feasibility and acceptability, and consequently, the success of the implementation of TI-RSTs.

A prospective feasibility study of MammoSite accelerated partial breast irradiation for early breast Cancer.

Accelerated partial breast irradiation is a potential alternative to standard whole breast irradiation, following breast-conserving surgery, in the management of breast cancer. The MammoSite applicator-based technique allows for the delivery of a higher dose of radiation to the tumour bed and adjacent area, over a shorter treatment period. To investigate the long-term feasibility of the MammoSite technique in early stage breast cancer in an Irish cohort. Sixty-two patients with early stage breast cancer were enrolled in this prospective study between November 2005 and October 2012 at the University Hospital Galway. A single-entry MammoSite applicator was inserted post-operatively. A CT scan was performed to assess the balloon to skin distance, the conformance of target tissue to balloon surface and balloon symmetry. A total dose of 34Gy was delivered over 10 fractions twice daily. Median follow-up was 10years. 91.9% (57/62) completed the full course of MammoSite treatment. Technical issues with the MammoSite balloon precluded three patients from completing the full course of treatment. On last follow-up, 6.4% (4/62) of patients had developed an ipsilateral breast recurrence. Half of these recurrences occurred more than 10years after the initial breast cancer treatment. The most common toxicities observed were fibrosis (67.7%), pain (61.3%) and skin erythema (35.5%). The use of the MammoSite technique, as an alternative to standard whole breast irradiation, is feasible in a typical Irish clinical setting with integrated multidisciplinary team input.

Gene therapy for haemophilia.

Haemophilia is a genetic disorder characterized by spontaneous or provoked, often uncontrolled, bleeding into joints, muscles and other soft tissues. Current methods of treatment are expensive, challenging and involve regular administration of clotting factors. Gene therapy for haemophilia is a curative treatment modality currently under investigation. This is an update of a published Cochrane Review. To evaluate the safety and efficacy of gene therapy for treating people with haemophilia A or B. We searched the Cochrane Cystic Fibrosis & Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Date of last search: 17 April 2020. Eligible trials include randomised or quasi-randomised clinical trials, including controlled clinical trials comparing gene therapy (with or without standard treatment) with standard treatment (factor replacement) or other 'curative' treatment such as stem cell transplantation for individuals with haemophilia A or B of all ages who do not have inhibitors to factor VIII or IX. No trials of gene therapy for haemophilia matching the inclusion criteria were identified. No trials of gene therapy for haemophilia matching the inclusion criteria were identified. No randomised or quasi-randomised clinical trials of gene therapy for haemophilia were identified. Thus, we are unable to determine the safety and efficacy of gene therapy for haemophilia. Gene therapy for haemophilia is still in clinical investigation and there is a need for well-designed clinical trials to assess the long-term feasibility, success and risks of gene therapy for people with haemophilia.

Questionnaire-guided evaluation of the effectiveness of long-term intravesical 0.2% chondroitin sulfate therapy in interstitial cystitis.

To investigate the long-term feasibility, safety and effectiveness of intravesical chondroitin sulfate therapy in patients with one or more forms of chronic cystitis. The study included 62 female patients with interstitial cystitis/painful bladder syndrome (IC/PBS) who received intravesical chondroitin sulfate (40 ml/80 mg) therapy between 2014 and 2018. A total of 15 doses of intravesical treatment were applied, once weekly in the first month and once monthly from the second month onward. A 3-day voiding diary, a visual analog scale (VAS), the O'Leary Sant Indexes (ICSI/ICPI), the Pelvic Pain and Urgency/Frequency Symptom (PPUFS) Scale and PPUF Bother scores were recorded and evaluated through prospective comparison before treatment and at the first month and first year. Patients were also assessed using the Global Response Assessment (GRA) at the end of the first month and first year to assess the effectiveness of responses to treatment. In the first month of treatment, 0.2% chondroitin sulfate was ineffective in 22.5% of patients, with mild improvement observed in 40.0% and moderate-good improvement in 37.0%. Evaluation at the end of the first year revealed mild improvement in 21.0% of patients and moderate-good improvement in 79.0%. Statistically significant improvements were observed in all scoring systems at 1 and 12 months compared with pre-treatment values (p < 0.001). Long-term intravesical chondroitin sulfate therapy is a safe and highly successful therapeutic modality that produces significant improvement in patients' quality of life and symptoms in the treatment of IC/PBS.

Simulated photocatalytic aging of biochar in soil ecosystem: Insight into organic carbon release, surface physicochemical properties and cadmium sorption

Photochemical/photocatalytic reaction, one of the aging pathway of biochar in soil, not only changed the physicochemical properties of biochar, but also affected the migration and transformation of pollutants. Wheat straw biochar was photocatalytic aged in a Fenton-like system using organic acid as buffer solution under light sources, the organic carbon release and surface chemical changes of biochar were investigated to illustrate the adsorption behaviors. With Fe(III) or α-Fe2O3 added, the total organic carbon (TOC) of aged biochar solution was influenced more by buffer system than light sources, with the highest of 420.59mgL-1 in citric acid system. The production of the hydroxyl radical (OH·) at citric/Fe(III) system was higher than the oxalic/Fe(III) system under the Hg lamp and showed an increasing trend with time. With light exposure, the porous structure of the biochar altered and surface area increased from 7.613 to 29.74m2g-1. Meanwhile, the adsorption of cadmium ion by biochar aged in citric/Fe(III) system also showed an increased adsorption capacity with a maximum of 73.54mgg-1. So, a well understanding of biochar physicochemical properties changes under natural ecosystem was undoubtedly useful for scientific assessment the long-term feasibility of biochar as soil remediation.

Geoprocessing and climate simulation applied to transposition between watershed in São Paulo state, Brazil

The water crisis that hit the Southeast region of Brazil in the years 2014 and 2015 was generated by an atmospheric blocking associated with a high-pressure zone that persisted for more than 45 days, causing a drastic decrease in precipitation rates throughout the region. This fact had a major impact on the municipality of São Paulo, causing a crisis of lack of water availability. To face the problem of water shortages for the São Paulo Metropolitan Region, the water transposition from Paraíba do Sul River watershed to the Cantareira System was proposed to mitigate the referred crisis and other future ones. Therefore, to investigate the feasibility of the proposed solution becomes very important, given the changes in the rainfall profile generated by global climate changes that affect the climatic element precipitation. Geoprocessing techniques were associated with future rainfall data simulated by the HadCM3/Eta model using SRES (Special Report Scenarios Emission) A1B of IPCC (Intergovernmental Panel on Climate Change) to investigate the long-term feasibility of this proposal. The results point to the possibility of the project’s unsustainability until the year 2040, since only 35% of the year’s transposition may occur, reducing to 30% if only considering the 2030s.

Evaluation of Save-ideas intellectual property protection concept

In this paper, utilising the cost-benefit analysis we evaluate a unique supplementary concept to the traditional intellectual property protection and the long-term social-economic feasibility of Save-ideas company. Many creative innovators have ideas about solving problems, improving lives, increasing productivity, preventing damage, saving money, etc. But unfortunately, most of these people do not have the money, nor the time to go down the conventional IPR protection route. With changes brought about by the internet and crowd participation, new options to address this problem have emerged. Such a new solution is the save-ideas.com platform. The result of the analysis clearly justified used resources, while consequently straightening determination on continuation of the Save-Ideas (SIs) project with the current vision.

Evaluation of Save-ideas intellectual property protection concept

In this paper, utilising the cost-benefit analysis we evaluate a unique supplementary concept to the traditional intellectual property protection and the long-term social-economic feasibility of Save-ideas company. Many creative innovators have ideas about solving problems, improving lives, increasing productivity, preventing damage, saving money, etc. But unfortunately, most of these people do not have the money, nor the time to go down the conventional IPR protection route. With changes brought about by the internet and crowd participation, new options to address this problem have emerged. Such a new solution is the save-ideas.com platform. The result of the analysis clearly justified used resources, while consequently straightening determination on continuation of the Save-Ideas (SIs) project with the current vision.

Material Balance of Fuel Cycles for Plutonium Recycling in Pressurised Water Reactors

An inevitable effect of uranium fuel operation is the production of plutonium. Its increasing inventory requires adoption of plutonium management strategy. The option that can provide inventory minimization and utilization of plutonium’s energy content is its usage as nuclear fuel. Since the most common power reactors are the pressurized water reactors, the current paper examines the material balance of several fuel cycles for single and multiple plutonium recycle in a reference PWR. Once-through fuel cycle’s balance has been used as a benchmark. Plutonium production and consumption rates, uranium and separative work requirements have been evaluated for four fuel cycle variations. The results affirm the overall long-term feasibility of multiple plutonium recycle in PWRs in terms of increased plutonium consumption.

Left ventricular apical pacing in children: feasibility and long-term effect on ventricular function

Left ventricular apical pacing (LVAP) has been reported to preserve left ventricular (LV) function in chronically paced children with complete atrioventricular block (CAVB). We sought to evaluate long-term feasibility of LVAP and the effect on LV mechanics and exercise capacity as compared to normal controls. Thirty-six consecutive paediatric patients with CAVB and LVAP in the absence (N = 22) or presence of repaired structural heart disease (N = 14, systemic LV in all) and 25 age-matched normal controls were cross-sectionally studied after a median of 3.9 (interquartile range 2.1-6.8) years of pacing using echocardiography and exercise stress testing. Pacemaker implantation was uneventful and there was no death. Probability of the absence of pacemaker-related surgical revision (elective generator replacement excluded) was 89.0% at 5 years after implantation. Left ventricular apical pacing patients had lower maximum oxygen uptake (P = 0.009), no septal to lateral but significant apical to basal LV mechanical delay (P < 0.001) which correlated with decreased LV contraction efficiency (P = 0.001). Left ventricular ejection fraction and global longitudinal LV strain were, however, not different from controls. Results were similar in both the presence and absence of structural heart disease. Left ventricular apical pacing is technically feasible with a low reintervention rate. Mechanical synchrony between LV septum and free wall is maintained at the price of an apical to basal mechanical delay associated with LV contraction inefficiency as compared to healthy controls. Global LV systolic function is, however, not negatively affected by LVAP.

BENEFICENCE, COMPANIONSHIP AND FINANCES AS MOTIVATORS FOR PARTICIPATION IN INTERGENERATIONAL HOME SHARING

In January 2019, the UC Berkeley Retirement Center began piloting Berkeley Home Match (BHM), a program that matches graduate students who need affordable housing with retirees who live near campus and have an extra room. BHM seeks to address affordable housing challenges for retirees and students while creating meaningful relationships. While some data exists for home sharing programs, less is known about the motivators and outcomes of retirees and students participating in these programs. In addition to decreasing the financial burden of housing, Social Exchange Theory suggests the built-in reciprocity of intergenerational home sharing may facilitate meaningful relationships. The purpose of this program evaluation was to understand the motivating factors for participation in a University-based home sharing program. Applicants (N=35) rated factors that influenced their decision to participate using a 7-point scale (1=“Not Influential”, 7=“Very Influential”). On average, homeowners (N=6) rated “helping a student” 5.2, “income” 5.2, and “companionship” 3.6, while home seekers (N=29) rated “helping an older adult” 5.03, “rent price” 6.1, and “companionship” 4.76. Surprisingly, ratings for “helping a student” and “helping a senior” were the same or close to ratings for “income” and “rent prices,” suggesting beneficence could be a key motivator and interdependence a mechanism for relationship development. Additionally, students’ rating for “companionship” was higher than expected, indicating an openness to the relationship. These findings as well as other factors impacting home matching will be discussed, including participant demographics, reduced housing cost, housing characteristics, and long-term program feasibility.

Assess Long-term Feasibility of Reduced Dose Dasatinib in Chronic Phase Chronic Myeloid Leukemia Patients

Assess Long-term Feasibility of Reduced Dose Dasatinib in Chronic Phase Chronic Myeloid Leukemia Patients

Feasible Strategies for Sustaining Guideline Adherence: Cross-sectional Analysis of a National Collaborative.

Health care providers' adherence to guidelines declines over time, and feasible strategies for sustaining adherence have not yet been identified. We assessed the long-term feasibility of various strategies for sustaining guideline adherence and described factors influencing their use. We conducted a cross-sectional survey (N = 104) of physician leaders who participated in a national collaborative to improve care of infants with suspected sepsis. Data were collected on long-term use of strategies to promote guideline adherence (use, perceived effectiveness, and barriers to use). Sixty (58%) participants from diverse hospital settings responded. There were significant declines in use of quality improvement and educational strategies, largely driven by lack of time or staff resources and competing priorities. Electronic strategies (eg, order sets) and hospital policies or guidelines were feasible to continue long-term after the collaborative ended and were perceived as effective. Clinicians and healthcare leaders should consider prioritizing these strategies in their efforts to improve care and outcomes for children in hospital settings.

Fundamental and innovative approaches for filler design of thermal interface materials based on epoxy resin for high power density electronics application: a retrospective

The journey in the packaging of microelectronics with intense heat transfer rate and miniaturization are continuing. To satisfy the above criteria, the thermal interface materials (TIMs) classified into two categories. One should have high thermal conductivity, high dielectric constant or low electrical conductivity, and high mechanical strength inclusive of processability. Other is high thermal conductivity along with electrical conductivity properties. In this review, we have reported the idea and concept behind TIMs including varieties of TIMs and their significance. We also referred to a few progressive techniques of thermally conductive filler synthesis and preparation of epoxy-based thermal conductive TIMs. Some basic thermal conductivity models have been adopted to conceptualize the thermal conductivity mechanism along with various types of thermal conductivity measurement principle. We also explore how the morphological characteristics of different filler system affect the thermal conductivity of the epoxy matrix. In addition to thermal performance and efficiency, the reliability testing of TIM during package development stage is analyzed in which the design iteration has been considered for long-term packages and feasibility study. The specified utility of TIMs in different electronics application has been described according to properties of fabricated composite with the high-performance interface. The future perspectives of electronics packaging in advanced and miniaturized application for epoxy-based TIMs are briefly elaborated.

2417. Feasibility and Safety of Using a Probiotic Comprised of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 for C. difficile Infection Prevention Among Antibiotic Users: 15-Years of Prospective Results from a Single-Center

BackgroundHospitals use multiple concurrent prevention strategies to curb nosocomial C. difficile infection, but there are limited data on the long-term feasibility or safety of using a probiotic. Pierre-Le Gardeur Hospital, Québec, has been administering a probiotic comprised of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 since 2004 with documented results through March 31, 2014. Here we present an update for the past 5 years.MethodsSeveral nosocomial infection prevention practices were running concurrently at the hospital. Adult inpatients treated with antibiotics from April 1, 2014 to March 31, 2019 were eligible to receive the probiotic. The hospital pharmacy ensured that each patient took the probiotic capsules (Bio-K+® 50 Billion) daily from the initiation of antibiotic use. Confirmed nosocomial cases of C. difficile infection were recorded and reported to the provincial public health agency. The rate of nosocomial CDI for this hospital was compared with other non-University affiliated hospitals in the health region with more than 110 beds and fewer than 45% of patients age 65 and older, and, to all other hospitals in the health system.ResultsCumulatively over the past 15 years, more than sixty thousand antibiotic-treated adult inpatients took the probiotic daily during antibiotic use. Among 13 comparable hospitals, Pierre-Le Gardeur Hospital had the lowest rate of nosocomial CDI in 2014–2015, 2015–2016, 2016–2017, 2017–2018 and on average had the lowest rate for 2013–2018 (1.1 CDI cases per 10,000 patient-days). Compared with all hospitals in the Province of Quebec health system, N = 95, the hospital had the lowest nosocomial CDI rate on average for 2013–2018. No cases of Lactobacillus bacteremia were detected.ConclusionThe overall infection prevention strategy has been highly effective, resulting in a consistently low rate of nosocomial CDI. We found that it is feasible to administer this probiotic to antibiotic-treated inpatients with few restrictions. No Lactobacillus infections were observed from any of the three strains of bacteria for this probiotic when given to more than sixty thousand adult inpatients. Disclosures All authors: No reported disclosures.

Interventions to improve wellbeing among obstetricians and midwives at Cork University Maternity Hospital.

BackgroundThere is an increasing body of research demonstrating stress, burnout, and compassion fatigue among those working in obstetrics and gynaecology. The literature is lacking with respect to targeted interventions aimed at improving staff wellbeing.AimsTo investigate whether an intervention which increases support for staff is feasible to implement and effective at improving staff wellbeing.MethodsThis study was conducted in a tertiary university teaching maternity hospital. All doctors in training (DITs) (N = 28) and midwives (N = 69) working in the delivery suite were invited to participate. Wellbeing was assessed by measuring burnout, compassion fatigue, and perceived stress using validated questionnaires. These were distributed pre-intervention and 6 months after implementation of the interventions. The support interventions consisted of posters promoting self-care, team bonding sessions, and end of shift meetings.ResultsEighteen (64%) DITs and 22 (31%) midwives returned pre-intervention questionnaires. Thirteen (18%) midwives retuned post-intervention questionnaires, of which five midwives (7%) returned both the pre-intervention questionnaire and the post-intervention questionnaire. Eighty-seven percent of participants were experiencing emotional exhaustion pre-intervention. There was a statistically significant decrease in the Professional Quality of Life burnout score from pre-intervention (M = 25.8) to post-intervention (M = 21.4), p = 0.02. End of shift meetings were discontinued after 5 weeks due to low attendance. End of shift meetings provided an opportunity for support and debriefing; however, the timing of these sessions impaired their long-term feasibility.ConclusionDITs and midwives of this sample are experiencing high levels of burnout and compassion fatigue. End of shift meetings for midwives and team bonding sessions for DITs may positively impact on wellbeing, but in current format, they are not feasible for long-term implementation. The low level of participation highlights a challenge in implementing institution-wide support interventions.

Mesenchymal stem cells for the prevention of bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants who have been treated with supplemental oxygen and mechanical ventilation. Despite major advances in perinatal and neonatal medicine, limited progress has been made in reducing BPD rates. The use of mesenchymal stem cells (MSC) is a promising and innovative therapy for several diseases because they are easy to extract and they have low immunogenicity, anti-inflammatory properties, and regenerative ability. According to several pre-clinical studies that have used BPD animal models, one mechanism of action for MSC in BPD is mainly due to the paracrine effects of MSC-derived humoral factors, such as interleukin (IL)-6, IL-8, vascular endothelial growth factor, collagen, and elastin, rather than the multilineage and regenerative capacities of MSC. Cell-free preparations derived from MSC, including conditioned media and exosomes, remain a pre-clinical technology despite their great clinical potential. A first-in-human clinical trial of MSC treatment for BPD was performed as a phase I dose-escalation trial using umbilical cord blood-derived MSC. That trial demonstrated the short- and long-term safety and feasibility of MSC, given that significantly reduced inflammatory marker expression was observed in tracheal aspirates. As of recently, several clinical trials of MSC use for BPD are ongoing or are planned in some countries to investigate the efficacy of MSC in the prevention or treatment of BPD in premature infants. Many clinicians are currently awaiting the results from these trials so that MSC can be used clinically for human BPD.