[Use of bone marrow mesenchymal stem cells for ex vivo cartilage regeneration]

Articular cartilage disorders and injuries often result in lifelong chronic pain and compromised quality of life. When it comes to local articular cartilage defects, modern medicine is limited to short-term pain relief and inflammation control. In extreme cases the affected tissue is surgically removed and replaced by a synthetic prosthesis of limited durability. Cell-based therapies to regenerate articular cartilage have been in use since 1994. Such therapies provide a healthy population of cells to the injured site and require differentiated chondrocytes from the uninjured site as base material. Their usage often leads to donor site morbidity and they generate rigid fibrous cartilage where more flexible hyaline cartilage is required. The major restrictive factors for such methods are inadequate number and limited proliferation capacity of chondrocytes in vitro. Tissue engineering of adult marrow stromal cells/mesenchymal stem cells (MSCs) with their almost unlimited proliferation potential and proven capability to differentiate into chondrocytes for ex vivo generation of cartilage tissue still remains a vision. For optimal harnessing of MSCs as chondroprogenitor cells, basic background information regarding commitment to the lineage, cartilage differentiation and the regulatory factors and molecules involved is essential.

A scoring system for mucosal disease severity with special reference to oral lichen planus

BACKGROUND

To date, there is only weak evidence for the superiority of any interventions over placebo for the palliation of symptomatic oral lichen planus (LP). Further research involving large placebo-controlled, randomized clinical trials is needed. These will require carefully selected and standardized outcome measures.

OBJECTIVES

To formulate a scoring system for intraoral LP.

METHODS

One hundred and fifty-six patients with biopsy-confirmed LP were scored at the first and subsequent visits according to (i) extent of site involvement, (ii) disease activity at each site and (iii) an overall pain score as reported by the patient. Overall differences between clinical variants of LP were analysed using the Kruskal-Wallis test and pairwise differences by the Mann-Whitney U-test. Clinical sensitivity (Wilcoxon signed-rank test) was assessed by scoring patients before and after treatment (n = 23).

RESULTS

Reticular LP (n = 48) was the commonest single type of clinical presentation, followed by ulcerative (n = 30), atrophic (n = 22), desquamative (n = 18) and plaque (n = 1). The median severity and activity scores were 13/6 (reticular), 39/20 (ulcerative), 20/9 (atrophic) and 23/11 (desquamative). Two or more clinical variants were seen in 37 cases. Statistical significance was observed for differences between clinical variants (P < 0.0001) and variation in scores (P < 0.01) when ulcerative LP was compared with all other types. Clinical sensitivity was statistically significant (P < 0.01), while reproducibility was high and allowed the response to therapy to be easily assessed.

CONCLUSIONS

It is suggested that this scoring system is easy to use, reproducible and sensitive enough to detect clinical responses to therapy.

Antagonist effect of DMSO on the cryoprotection ability of glycerol during cryopreservation of buffalo sperm

The objective of the present study was to investigate the synergistic effect of DMSO and glycerol added at various temperatures on the post-thaw quality of buffalo sperm. Pooled ejaculates from four Nili-Ravi buffalo bulls were divided into 18 aliquots and extended (1:10) in Tris-citric acid extender differing in glycerol:DMSO ratios (0:0, 0:1.5, 0:3; 3:0, 3:1.5, 3:3; and 6:0, 6:1.5, 6:3, respectively; %, v:v) either at 37 or 4 degrees C. Semen was packaged in 0.5 mL French straws and frozen in a programmable cell freezer. Thawing was performed at 37 degrees C for 50s. Post-thaw motion characteristics, plasma membrane integrity and acrosome morphology of buffalo sperm were determined using computer-assisted semen analyzer (CASA), hypoosmotic swelling (HOS) assay and phase-contrast microscopy, respectively. Glycerol (6%) in extender yielded better post-thaw sperm motility, velocities (straight-line and average path), plasma membrane integrity, and normal acrosomes (P<0.05). Post-thaw sperm motility and plasma membrane integrity declined in the presence of DMSO (P<0.01). The addition of glycerol (6%) at 37 degrees C yielded better post-thaw sperm motility, plasma membrane integrity and velocities than addition at 4 degrees C (P<0.05). In conclusion, glycerol is still an essential cryoprotectant for buffalo sperm. The addition of DMSO antagonized the cryoprotection ability of glycerol and reduced the post-thaw quality of buffalo sperm. Furthermore, 6% glycerol added at 37 degrees C, provided better cryoprotection to the motility apparatus and plasma membrane integrity of buffalo sperm.

Herpes zoster ophthalmicus in an otherwise healthy 7 years child

A 07 years otherwise healthy child, non vaccinated for chickenpox and with a history of chickenpox infection at 02 years of age presented with red colored lesions in right upper lid, right side of forehead, vertex and right side of nose and defective vision in right eye in Mymensingh Medical College Hospital, 20 days after the appearance of blister in the same region. On examination granulation tissue was present on the same area. There was no hair and skin over that area. Lesion was strictly limited to right side of midline. Eyelashes of right upper lid were absent and there was defective closure of eyelids. Best corrected visual acuity of right eye was 3/60 and of left eye was 6/6. There was ciliary congestion of right eye with haziness of cornea at interpalpebral region of right eye. Corneal sensitivity was reduced and there was uniform fluorescein staining at central part of cornea. Mild flare and cells were present in anterior chamber. Fundus examination revealed no abnormality. He was treated with systemic acyclovir, antibiotics, topical acyclovir, antibiotic and atropine. Corneal ulcer and skin lesions were healed, but the patient developed cicatricial ectropion of right upper lid and best corrected visual acuity of right eye was reduced to 6/60 due to corneal opacity. So early diagnosis and treatment of herpes zoster ophthalmicus is mandatory to prevent sight threatening complications.

Impact of household hygiene and water source on the prevalence and transmission of Helicobacter pylori: a South Indian perspective

INTRODUCTION

In developing countries, the Helicobacter pylori (H. pylori) infection rate is high, especially in lower socioeconomic groups. The populace in developing countries lives in conditions that are highly conducive to the acquisition of microorganisms. Poor hygiene, crowded household conditions and deficient sanitation mark their day-to-day life. We aimed to find out the roles of household hygiene and water source in the prevalence and transmission of H. pylori infection among the South Indian population using polymerase chain reaction (PCR) assay.

METHODS

The selected population consisted of 500 adults of varying ages ranging from 30 to 79 years, with upper gastrointestinal tract symptoms. Each participant in the study was given a questionnaire to complete. Samples to assess H. pylori infection included three gastric biopsies (two from the antrum and one from the corpus region). Infection was detected by PCR amplification of the 16S rRNA gene of H. pylori. The data was then examined statistically by univariate and multivariate analyses.

RESULTS

The overall prevalence of H. pylori was detected to be 80 percent. Prevalence increased with an increase in age and it was found to be 90 percent in the 70-79 year age group (p-value is less than 0.01). The prevalence of infection among people who drank water from wells was 92 percent compared with 74.8 percent of those who drank tap water (p-value is less than 0.001). H. pylori infection prevalence was found to be higher in people with low clean water index (CWI) (88.2 percent) than in those with higher CWI (33.3 percent) (p-value is less than 0.001). While the prevalence of H. pylori in the subjects with lower socioeconomic status was 86.1 percent, in higher groups, it was 70 percent (p-value is less than 0.001). The prevalence of H. pylori was also found to be higher in subjects who lived in overcrowded houses. It was 83.7 percent with high crowding index, 76.6 percent with medium crowding index, and 71.3 percent with low crowding index (p-value is less than 0.05).

CONCLUSION

The results of the present study suggest that the risk of acquisition and transmission of H. pylori can be prevented to a large extent by following improved household hygienic practices, proper waste disposal measures as well as the regular use of boiling water for drinking purposes.

Advanced glycation endproducts: what is their relevance to diabetic complications?

Glycation is a major cause of spontaneous damage to proteins in physiological systems. This is exacerbated in diabetes as a consequence of the increase in glucose and other saccharides derivatives in plasma and at the sites of vascular complications. Protein damage by the formation of early glycation adducts is limited to lysine side chain and N-terminal amino groups whereas later stage adducts, advanced glycation endproducts (AGEs), modify these and also arginine and cysteine residues. Metabolic dysfunction in vascular cells leads to the increased formation of methylglyoxal which adds disproportionately to the glycation damage in hyperglycaemia. AGE-modified proteins undergo cellular proteolysis leading to the formation and urinary excretion of glycation free adducts. AGEs may potentiate the development of diabetic complications by activation of cell responses by AGE-modified proteins interacting with specific cell surface receptors, activation of cell responses by AGE free adducts, impairment of protein-protein and enzyme-substrate interactions by AGE residue formation, and increasing resistance to proteolysis of extracellular matrix proteins. The formation of AGEs is suppressed by intensive glycaemic control, and may in future be suppressed by thiamine and pyridoxamine supplementation, and several other pharmacological agents. Increasing expression of enzymes of the enzymatic defence against glycation provides a novel and potentially effective future therapeutic strategy to suppress protein glycation.

Simultaneous occurrence of multiple types of cutaneous tuberculosis (TVC and PNT) with internal organ tuberculosis (PTB)

A 40 years old male patient of poor socioeconomic condition presented with a well circumscribed rough surfaced and fissured, verrucous plaque on left axilla and a similar lesion on right foot- which were clinically diagnosed as tuberculosis verrucosa cutis. He also had necrotic papular eruption with varioliform scarring in some lesions on upper back clinically diagnosed as papulonecrotic tuberculid. He had fever and cough and mild weight loss suspicious of pulmonary tuberculosis. On investigation ESR was raised, mild anaemia was present, MT was strongly positive, chest x-ray was suggestive of tuberculosis. So, he was diagnosed as a case of simultaneous occurrence of tuberculosis verrucosa cutis (TVC) with papulonecrotic tuberculid (PNT) with pulmonary tuberculosis (PTB). Standard anti tuberculosis chemotherapy already started to offer cure of all lesions.

Role of cardiac troponin I in staging and prognosis of congestive heart failure subjects

Congestive heart failure is the one of the major cardiovascular disorder that is increasing in incidence and cause of death globally. Mortality rate has increased 40%-50% in advanced cardiac failure and 15%-25% in mild to moderate cardiac failure within one year of diagnosis. There is no established biochemical marker for the diagnosis, prognosis and staging of heart failure. Cardiac Troponin I may be a novel useful tool in identifying patients with Heart failure who are at increased risk for progressive ventricular dysfunction and death. Thirty six congestive heart failure cases and thirty six healthy controls were included in this study and serum cardiac troponin I and Ejection fraction were measured. All the study subjects were grouped according to the NYHA class they belong. Cardiac troponin I was significantly higher in CHF cases than the controls. Troponin I also significantly differed among groups. EF of cases was significantly lower than the controls and also differed among groups. A significant negative correlation between cardiac troponin I and progressive decline of ejection fraction was evident in this study. Cardiac troponin I increased progressively with progression of heart failure. Thus, Cardiac troponin I could be used to stratify patients undergoing heart failure in to high and low risk groups for future cardiac events. Cardiac troponin I could also be used as a very important marker for the prognosis of the patients with congestive heart failure.

Endovascular aneurysm repair in a patient with a horseshoe kidney and impaired renal function

BACKGROUND

We present the case of an 80-year-old female with a three-week history of lower backache and a pulsatile mass in her epigastrium.

METHOD

Using CT angiogram, the presence of an infra-renal abdominal aortic aneurysm (AAA) and co-existent horseshoe kidney was confirmed.

RESULTS

Due to associated multiple co-morbidities of hypertension, moderate renal failure, COPD and morbid obesity, she underwent endovascular aneurysm repair (EVAR).

CONCLUSION

The presence of a horseshoe kidney (HSK) poses significant difficulty during open repair of an AAA, as satisfactory anatomical exposure of the aorta may prove potentially hazardous. This problem may be circumvented in suitable cases by endovascular repair, although treatment is not risk free. EVAR is usually only recommended if renal function is normal. We report a case of AAA coexistent with an HSK and moderate renal impairment, which was treated successfully using an EVAR technique, and with no subsequent renal complication.

A novel missense mutation of SLC7A9 frequent in Japanese cystinuria cases affecting the C-terminus of the transporter

Cystinuria is caused by the inherited defect of apical membrane transport systems for cystine and dibasic amino acids in renal proximal tubules. Mutations in either SLC7A9 or SLC3A1 gene result in cystinuria. The mutations of SLC7A9 gene have been identified mainly from Italian, Libyan Jewish, North American, and Spanish patients. In the present study, we have analyzed cystinuria cases from oriental population (mostly Japanese). Mutation analyses of SLC7A9 and SLC3A1 genes were performed on 41 cystinuria patients. The uptake of 14C-labeled cystine in COS-7 cells was measured to determine the functional properties of mutants. The protein expression and localization were examined by Western blot and confocal laser-scanning microscopy. Among 41 patients analyzed, 35 were found to possess mutations in SLC7A9. The most frequent one was a novel missense mutation P482L that affects a residue near the C-terminus end of the protein and causes severe loss of function. In MDCK II and HEK293 cells, we found that P482L protein was expressed and sorted to the plasma membrane as well as wild type. The alteration of Pro482 with amino acids with bulky side chains reduced the transport function of b(0,+)AT/BAT1. Interestingly, the mutations of SLC7A9 for Japanese cystinuria patients are different from those reported for European and American population. The results of the present study contribute toward understanding the distribution and frequency of cystinuria-related mutations of SLC7A9.

Spot morning urine protein creatinine ratio and 24 hour urinary total protein excretion rate

Proteinuria helps to establish the diagnosis of most renal diseases and also to predict the outcome of such diseases. Proteinuria is biochemically represented by measuring the protein concentration in timed collection of 24 hour urine. But, 24-hour timed urine collection is time consuming, cumbersome and often unreliable due to collection errors and also results in undue delay on diagnostic process. An alternate approach avoiding arduous and inaccurate timed urine collection can be the measurement of protein creatinine ratio in spot morning urine. This study was aimed to evaluate whether the spot morning urine protein creatinine ratio can be a reliable alternative to 24-hour urinary total protein (UTP) estimation. The study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka on 50 (fifty) non-diabetic Chronic Renal Disease (CRD) patients with an age ranging from 18 -70 years. The study subjects were grouped into mild, moderate and severe CRD on the basis of GFR. Urinary protein and creatinine concentrations were measured in spot morning urine samples and their ratios were calculated. Urinary protein measured in 24-hour timed collected urine samples gave the 24-hour UTP excretion rate. In our study, spot morning urine protein creatinine ratio significantly correlated with 24-hour UTP excretion rate in all CRD patients. Severe CRD patients gave significant positive correlation (p<0.05), whereas mild and moderate CRD patients gave very highly significant positive correlation (p<0.001). Therefore, it may be suggested that protein creatinine ratio in spot morning urine can be accepted as a reliable and alternative to 24-hour UTP excretion rate in non-diabetic chronic renal disease patients. This simple and inexpensive procedure will thus simplify the way of establishing the severity of renal disease along with its prognosis.

The role of BMP-6, IL-6, and BMP-4 in mesenchymal stem cell-dependent bone development: effects on osteoblastic differentiation induced by parathyroid hormone and vitamin D(3)

Human bone marrow-derived mesenchymal stem cells (MSCs) represent an ideal source for cell therapy for inherited and degenerative diseases, bone and cartilage repair, and as target for gene therapy. The role of the combination of human parathyroid hormone (PTH) and vitamin D(3) in bone formation and mineralization has been established in several osteoblast cell culture studies. The aim of the present study was to evaluate the role of this hormonal combination alone and in the presence of bone morphogenetic protein-4 (BMP-4) or-6 (BMP-6) in inducing osteogenic differentiation of human MSC. Human MSC derived from adult normal bone marrow that are positive for CD29, CD44, CD105, and CD166 and negative for CD14, CD34, and CD45, were treated with the PTH and 1,25-dihydroxyvitamin D(3) in the presence and absence of recombinant human BMP-4 or BMP6. PTH and vitamin D(3) induced high levels of expression of two key markers of bone formation: osteocalcin and alkaline phosphatase by MSCs. BMP-6 but not BMP-4 increased osteocalcin expression induced by PTH and vitamin D(3). Both BMPs enhanced calcium formation in MSC cultures and this response was potentiated by PTH and vitamin D(3). The present results revealed a novel potent effect of PTH and vitamin D(3) plus BMPs in inducing bone development by human MSCs. These results may facilitate therapeutic utility of MSCs for bone disease and help clarify mechanisms involved in stem cell-mediated bone development.

Spontaneously arising superficial temporal artery aneurysms: a report of two cases and review of the literature

The majority of superficial temporal artery (STA) aneurysms are due to trauma and are, in reality, false aneurysms. However, true STA aneurysms are extremely rare. Here, we present two cases of spontaneous superficial temporal artery aneurysms arising without any previous history of trauma.

Prevalence study to elucidate the transmission pathways of Helicobacter pylori at oral and gastroduodenal sites of a South Indian population

INTRODUCTION

Since the discovery of Helicobacter pylori (H. pylori), much progress has been made worldwide in the field of its epidemiology. In spite of these advancements, many aspects of epidemiology still remain unclear, particularly among populations with low socio-economic status. The present study was designed to elucidate the different routes of transmission of H. pylori in the Hyderabad (South India) population and to investigate the impact of certain factors, such as age, gender, and lifestyle.

METHODS

Samples used for the study included saliva and biopsy samples of 400 symptomatic subjects from Hyderabad, India. The patients were retrospectively grouped, based on histopathology of the biopsy and 16S rRNA amplification of both saliva and biopsy as H. pylori positive and negative.

RESULTS

This study showed that the prevalence of H. pylori in both saliva and biopsy samples increased with age. In addition, the H. pylori infection was found more commonly in the saliva and biopsy samples among males (64 percent and 60 percent, respectively) than females (53.3 percent and 64 percent, respectively). Similarly, 71.6 percent and 73.5 percent of those who consumed municipal water acquired H. pylori (which were respectively found in their saliva and biopsy samples) compared to a lesser proportion (12.6 percent and 12.6 percent, respectively) of those who consumed boiled or filtered water. The study also found that subjects who preferred home-cooked food (57.1 percent and 57.7 percent) showed a lower prevalence of H. pylori in saliva and biopsy samples, respectively, compared to those (80 percent and 88 percent) who frequently ate out.

CONCLUSION

The results of the present study suggest that besides the oral-oral route, the transmission of H. pylori also takes place through the consumption of food prepared under unhygienic conditions. Consumption of municipal tap water also has a high impact in the transmission of H. pylori.

Estimates of dietary exposure of children to artificial food colours in Kuwait

To assess the intake of artificial food colour additives by 5-14-year-old children in the State of Kuwait, a 24-h dietary recall was conducted twice on 3141 male and female Kuwaiti and non-Kuwaiti children from 58 schools. The determination of colour additives in 344 foods items consumed was performed using high-performance liquid chromatography with diode array detector. A comparison with the Food and Agriculture Organization and World Health Organization acceptable daily intakes (ADIs) was undertaken to evaluate the potential risk associated with the consumption of artificial colour additives by children in Kuwait. The results indicated that out of nine permitted colours, four exceeded their ADIs by factors of 2-8: tartrazine, sunset yellow, carmoisine and allura red. Further, follow-up studies to provide insight into potential adverse health effects associated with the high intakes of these artificial colour additives on the test population are warranted.

Diagnostic MR imaging features of craniocerebral Aspergillosis of sino-nasal origin in immunocompetent patients

BACKGROUND

Craniocerebral invasive Aspergillosis of sino-nasal origin has been reported with a very high mortality due to a peculiarly fulminant clinical course. Early diagnosis based on clinical radiological imaging may have an impact on final clinical outcome. This retrospective study focuses on characteristic MR imaging features of Aspergillosis (of sinonasal origin) in immunocompetent patients.

METHODS

Medical records of patients were reviewed retrospectively during the period from 1991 to 2003 in the two tertiary care hospitals. All the patients had radiological evidence of disease in the paranasal sinuses with or without intracranial extension. Immunocompetence of patients was assessed on clinical and radiological data. MRI scans (n=20) were reviewed by both clinical neurosurgeons and neuroradiologists separately. MRI was done on 1.5 tesla scanners and both T2-weighted and T1 weighted sequences were obtained followed gadolinium enhanced images. Patients were categorized into three types based on their anatomical location on MRI scans; type-1 being intracerebral, type-2 as intracranial extradural and type-3 invading orbit and/or skull base only. All these patient had the epicenter of disease in the nose and/or paranasal sinuses as evident on MR imaging. All patients underwent standard surgical intervention followed by antifungal therapy. Clinical outcome was assessed on Glasgow outcome scale with mean duration of clinical follow up of 13.9 months.

FINDINGS

Mean age of patents (n=20) was 31.1 years with male preponderance (3:1). MRI scans showed evidence of disease in paranasal sinuses including mucosal thickening (n=11) and complete filling of sinuses (n=9). T2-weighted images showed extremely hypo-intense fungal mass (n=19) while T1-weighted images had iso-intense signals (n=18). Gadolinium-enhanced images showed bright homogenous contrast enhancement (n=18) and peripheral ring enhancement pattern (n=2). All patients underwent appropriated surgical procedures depending upon anatomical location followed by standard antifungal therapy. Tissue diagnoses were established by histopathology (n=20) and culture growth (n=5). Overall mortality remained 15 percent.

INTERPRETATION

Craniocerebral Aspergillosis of sinonasal origin has typical MR imaging features. These features include a mass lesion producing hypo-to-iso-intense signals on T1-weighted, extremely low signals (hypo-intense) on T2-weighted images, with bright homogenous enhancement on post-gadolinium T1-weighted imaging. These features in the clinical background may be helpful in early diagnosis and management of Aspergillosis of sino-nasal origin in immunocompetent hosts. Prospective clinical study is required to make firm clinical therapeutic recommendations.

Translational proteomics: developing a predictive capacity -- a review

Over the past decade, proteomics has undergone a rapid development and radiation, diversifying across the biochemical landscape. While no single technique yet delivers complete proteomic coverage, application-specific adaptations afford significant opportunity for discovery and the development of predictive capacity (e.g. surrogate biomarker and clinical diagnostics). Targeted proteomic approaches, protein profiling strategies using affinity capture mass spectrometry and solution array represent realistic opportunities to deliver predictive capacity. The aim of this review is to provide an overview of proteomic technologies and how the outcomes delivered by such platforms may be translated into applications of predictive utility in clinical and basic science. In particular, recent applications in protein/peptide profiling (solid-phase affinity capture mass spectrometry and the targeted approach of antibody arrays) and the opportunities they afford researchers within the discipline of reproductive biology to develop new diagnostic and prognostic tests and surrogate biomarkers to improve the delivery of women's health care are considered.