Objectives: to determine whether initial contact with emergency services via a mobile phone (MP) in life threatening situations is associated with increased survival or reduced length of stay when compared to contact via a landline.

A retrospective cohort – data from all emergency dispatches from a UK county ambulance service was linked to the Patient Admission System at local hospitals. All emergency dispatches for immediately life-threatening events (designated as Code Red) between 01/01/1995 and 31/06/2006 were tracked to death or discharge.

Main Outcome Measures:

Mortality (at scene, at emergency department, and during hospitalisation), admissions (to the emergency department (ED), inpatients care, and the intensive care unit (ICU)) and mean lengths of stay were analysed by initial exposure (MP versus landline) using multi-variant analysis with logistic regression controlling for potential confounding variables.

354,199 ambulances were dispatched in the 11.5 years. Mobile phone use rose to 25% by study end. 66% of ambulances subsequently transferred patients to hospital. MP compared to landline reporting of emergencies resulted in significant reductions in the risk of death at scene for medical events (OR 0.74; 95% CI 0.65 to 0.85), but not for trauma (OR 1.04). ED medical deaths were higher (OR 1.33; 95% CI 1.33 to 1.72) as were in-patient (OR 1.19). There was no effect on ED or hospital trauma deaths (ORs 0.81, 0.84). The probability of being admitted to hospital and ICU was higher with MP call for trauma (ORs 1.22, 1.44). There was no difference in mortality between mobile or landline calls from either urban or rural areas.

There is little evidence to suggest a lower threshold to make an emergency call from a MP. The potential advantages of MP use of ease of access, supplying bystander/patient advice and shortening the ‘golden hour’ appear confined to non-trauma emergencies.

Introduction: Osteonecrosis of the femoral head, which involves the death of cells in trabecular bone and marrow, leads to fracture of subchondral bone and loss of the femur articulating surface in the hip and ultimately leads to total hip replacement (THR). Retrospective clinical studies show that osteonecrosis in 80–90% of affected patients inevitably progresses to destroy the femur head, usually within 2–3 years of diagnosis. None of the current treatment options are effective at terminating or reversing the disease process. Two reports (Hernigou and Beaujean, 2002 and Gangji, et al 2004) using fresh autologous bone marrow tissue injected directly into the necrotic femoral head, reported a high rate of success, especially in early stage osteonecrosis, in patients at most risk for disease progression. As a more standardized alternative to fresh bone marrow, Aastrom Biosciences has developed a proprietary automated process to expand autologous bone marrow cells. The ex vivo expanded cells referred to as Bone Repair Cells (BRC) are based on Aastrom Tissue Repair Cell (TRC) technology. BRC are a mixture of stem and early progenitor cells including cells of hematopoietic, mesenchymal, and endothelial lineages derived from a small sample of the patient’s own bone marrow.

Materials and Methods: Fresh bone marrow mononuclear cells from normal donors were purchased from Poietics Inc. (Gaithersburg, Maryland) for BRC culture. After ex vivo expansion, BRC viability and cell phenotype characterization was performed by flow cytometry. The frequency of mesenchymal and hematopoietic stem cells within BRC was determined using CFU-F and CFU-GM assays. The osteogenic and vascular in vitro potential of BRC was measured using standard osteogenic differentiation assays and tube formation assays. The bone formation potential of BRC was determined using an ectopic bone formation model involving subcutaneous implantation. Based on the in vitro and in vivo potential of BRC, a mixing procedure was developed to implant BRC and bone matrix into osteonecrotic sites during standard core decompression surgery. The viability of BRC within the bone matrix was measured using standard cell metabolic assays.

Results: BRC possess a diverse range of cell phenotypes with the potential to differentiate down the osteogenic and angiogenic lineage under the right conditions. BRC also has the potential for in vivo bone formation. In addition, examination of several cell-surface markers revealed a strong correlation between the frequency of cell surface markers CD105+, CD166+, CD90+ and in vivo bone formation scores when implanted with a ceramic matrix material. This BRC product can be mixed with a bone matrix for the implantation into long-bone defects or osteonecrotic sites without loss in cell viability.

Discussion: Aastrom BRCs have both in vivo and in vitro bone and vascular potential; thus, it is our intent to demonstrate clinical safety and efficacy in treating osteonecrosis patients with BRC. Aastrom’s ON-CORE trial is a 120 patient Phase III clinical trial for the treatment of University of Pennsylvania radiographic classification stage IIb and IIc osteonecrosis patients. The primary efficacy endpoint of this trial is to delay disease progression of osteonecrosis to fracture for at least 24 months post-treatment, and potentially prevent collapse of the femur head, which will be measured by a blinded third-party reviewer through magnetic resonance imaging. Patients will be followed for a total of 5 years, post-treatment.