Long-Term Results of a Phase I/II Clinical Trial of Autologous Mesenchymal Stem Cell Therapy for Femoral Head Osteonecrosis

(1) Background: Osteonecrosis of the femoral head (ONFH) is characterized by impaired vascularization with ischemia resulting in bone cell death, leading to the deterioration of the hip joint. Mesenchymal stem/stromal cells (MSCs) are an attractive potential therapeutic approach in this setting. The aim of this study is to evaluate the clinical improvement in terms of pain and quality of life, as well as the safety of the procedure during the follow-up of patients. (2) Methods: A Phase I-II Open-Label Non-Randomized Prospective clinical trial was conducted. Eight patients with idiopathic ONFH and stage < IIC in the ARCO classification were included. Four weeks before therapy, 40 mL of autologous bone marrow was obtained, and MSCs were expanded under Good-Manufacturing-Practice (GMP) standards. Study medication consisted of a suspension of autologous BM-derived MSCs (suspended in a solution of 5-10 mL of saline and 5% human albumin) in a single dose of 0.5-1 × 10⁶ cells/kg of the patient, administered intraosseously with a trocar and under radioscopic control. Per-protocol monitoring of patients included a postoperative period of 12 months, with a clinical and radiological assessment that included the visual analog scale (VAS), the Harris scale, the SF-36, and the radiological evolution of both hips. In addition, all patients were further followed up for eight years to assess the need for long-term total hip replacement (THR) surgery. (3) Results: Median age of patients included was 48.38 ± 7.38 years, and all patients were men. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell administration. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 12.5% of patients improved at the end of follow-up, whereas 50% improved clinically. No adverse effects related to the procedure were recorded, and none of the patients needed THR surgery within the first year after MSC therapy. (4) Conclusions: The use of autologous MSCs for patients with ONFH disease is feasible, safe in the long term, and potentially effective.

Pulmonary function is associated with frailty, hospitalization and mortality in older people: 5-year follow-up

BACKGROUND

The relationship between pulmonary impairment and frailty has rarely been studied in community-dwelling older adults.

OBJECTIVE

This study aimed to analyze the association between pulmonary function and frailty (prevalent and incident), identifying the best cut-off points to detect frailty and its association with hospitalization and mortality.

METHODS

A longitudinal observational cohort study with 1188 community-dwelling older adults was taken from the Toledo Study for Healthy Aging. The forced expiratory volume in the first second (FEV₁) and the forced vital capacity (FVC) were measured with spirometry. Frailty was evaluated using the Frailty Phenotype and Frailty Trait Scale 5. Associations between pulmonary function and frailty, hospitalization and mortality in a 5-year follow-up and the best cut-off points for FEV₁ and FVC were analyzed.

RESULTS

FEV₁ and FVC were associated with frailty prevalence (OR from 0.25 to 0.60), incidence (OR from 0.26 to 0.53), and hospitalization and mortality (HR from 0.35 to 0.85). The cut-off points of pulmonary function identified in this study: FEV1 (≤1.805 L for male and ≤1.165 L for female) and FVC (≤2.385 L for male and ≤1.585 L for female) were associated with incident frailty (OR: 1.71-4.06), hospitalization (HR: 1.03-1.57) and mortality (HR: 2.64-5.17) in individuals with and without respiratory diseases (P < 0.05 for all).

CONCLUSION

Pulmonary function was inversely associated with the risk of frailty, hospitalization and mortality in community-dwelling older adults. The cut-off points for FEV₁ and FVC to detect frailty were highly associated with hospitalization and mortality in the 5-year follow-up, regardless of the existence of pulmonary diseases.

Healthcare cost expenditures associated to frailty and sarcopenia

Objectives

Frailty and sarcopenia have been related with adverse events, including hospitalization. However, its combined effect with hospitalization-related outcomes, including costs, has not been previously investigated. Our purpose was to explore how frailty, sarcopenia and its interaction could impact on healthcare expenditures.

Methods

1358 community-dwelling older adults from the Toledo Study of Healthy Ageing (TSHA) were included. Sarcopenia was measured using the Foundation for the National Institutes of Health criteria fitted to our cohort. Frailty was defined according to Frailty Trait Scale 5 (FTS5) and the Frailty Index fitted to the cut-off points of TSHA population. Hospitalization costs were taken from hospital records and costs were attributed according to Diagnostic-Related Groups, using as the cost base year 2015. Two-part regression models were used to analyze the relationship between frailty and sarcopenia and hospital admission, number of hospitalizations, length of stay and hospitalization costs.

Results

Sarcopenia was associated only with the probability of being admitted to hospital. Frailty was also associated with higher hospital use, regardless of the frailty tool used, but in addition increased hospital admission costs at follow-up by 23.72% per year and by 19.73% in the full model compared with non-frail individuals. The presence of sarcopenia did not increase the costs of frailty but, by opposite, frailty significantly increased the costs in people with sarcopenia, reaching by 46–56%/patient/year at follow-up. Older adults with frailty and sarcopenia had a higher risk of hospitalization, disregarding the tool used to assess frailty, and higher hospitalization costs (FTS5) in the full model, at the cross-sectional and at the follow-up level.

Conclusions

Frailty is associated with increased hospitalization costs and accounts for the potential effects of sarcopenia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03439-z.

A Novel, Simple and Highly Efficient Route to Obtain PrBaMn2O5+δ Double Perovskite: Mechanochemical Synthesis

In this work, a mechanochemical route was proposed for the synthesis of the PrBaMn₂O_5+δ (PMBO) double layered perovskite phase. The mechanochemical reaction between Pr₆O₁₁, BaO₂, and MnO powders with cationic stoichiometric ratios of 1/1/2 for Pr/Ba/Mn was performed using high-energy milling conditions in air. After 150 min of milling, a new phase with perovskite structure and cubic symmetry consistent with the A-site disordered Pr_0.5Ba_0.5MnO₃ phase was formed. When this new phase was subsequently annealed at a high temperature in an inert Ar atmosphere, the layered PrBaMn₂O_5+δ phase was obtained without needing to use a reducing atmosphere. At 1100 °C, the fully reduced layered PrBaMn₂O₅ phase was achieved. A weight gain was observed in the 200–300 °C temperature range when this fully reduced phase was annealed in air, which was consistent with the transformation into the fully oxidized PrBaMn₂O₆ phase. The microstructural characterization by SEM, TEM, and HRTEM ascertained the formation of the intended PrBaMn₂O_5+δ phase. Electrical characterization shows very high electrical conductivity of layered PBMO in a reducing atmosphere and suitable in an oxidizing atmosphere, becoming, therefore, excellent candidates as solid oxide fuel cell (SOFC electrodes).

Development by Mechanochemistry of La0.8Sr0.2Ga0.8Mg0.2O2.8 Electrolyte for SOFCs

In this work, a mechanochemical process using high-energy milling conditions was employed to synthesize La_0.8Sr_0.2Ga_0.8Mg_0.2O_3-δ (LSGM) powders from the corresponding stoichiometric amounts of La₂O₃, SrO, Ga₂O₃, and MgO in a short time. After 60 min of milling, the desired final product was obtained without the need for any subsequent annealing treatment. A half solid oxide fuel cell (SOFC) was then developed using LSGM as an electrolyte and La_0.8Sr_0.2MnO₃ (LSM) as an electrode, both obtained by mechanochemistry. The characterization by X-ray diffraction of as-prepared powders showed that LSGM and LSM present a perovskite structure and pseudo-cubic symmetry. The thermal and chemical stability between the electrolyte (LSGM) and the electrode (LSM) were analyzed by dynamic X-ray diffraction as a function of temperature. The electrolyte (LSGM) is thermally stable up to 800 and from 900 °C, where the secondary phases of LaSrGa₃O₇ and LaSrGaO₄ appear. The best sintering temperature for the electrolyte is 1400 °C, since at this temperature, LaSrGaO₄ disappears and the percentage of LaSrGa₃O₇ is minimized_. The electrolyte is chemically compatible with the electrode up to 800 °C. The powder sample of the electrolyte (LSGM) at 1400 °C observed by HRTEM indicates that the cubic symmetry Pm-3m is preserved. The SOFC was constructed using the brush-painting technique; the electrode–electrolyte interface characterized by SEM presented good adhesion at 800 °C. The electrical properties of the electrolyte and the half-cell were analyzed by complex impedance spectroscopy. It was found that LSGM is a good candidate to be used as an electrolyte in SOFC, with an Ea value of 0.9 eV, and the LSM sample is a good candidate to be used as cathode.

Gait Velocity and Chair Sit-Stand-Sit Performance Improves Current Frailty-Status Identification

Frailty is characterized by a loss of functionality and is expected to affect 9.9% of people aged 65 and over. Here, current frailty classification is compared with a collection of selected kinematic parameters. A total of 718 elderly subjects (319 males and 399 females; age: 75.4 ± 6.1 years), volunteered to participate in this study and were classified according to Fried's criteria. Both the 30-s chair stand test (CST) and the 3-m walking test were performed and a set of kinematic parameters were obtained from a single inertial unit. A decision tree analysis was used to: 1) identify the most relevant frailty-related parameters and 2) compare validity of this classification. We found that a selected set of parameters from the 30-s CST (i.e., range of movement, acceleration, and power) were better at identifying frailty status than both the actual outcome of the test (i.e., cycles' number) and the normally used criteria (i.e., gait speed). For the pre-frail status, AUC improves from 0.531 using the actual test outcome and 0.516 with gait speed to 0.938 with the kinematic parameters criteria. In practice, this could improve the presyndrome identification and perform the appropriate actions to postpone the progression into the frail status.

Life-long spontaneous exercise does not prolong lifespan but improves health span in mice

Background

Life expectancy at birth in the first world has increased from 35 years at the beginning of the 20th century to more than 80 years now. The increase in life expectancy has resulted in an increase in age-related diseases and larger numbers of frail and dependent people. The aim of our study was to determine whether life-long spontaneous aerobic exercise affects lifespan and healthspan in mice.

Results

Male C57Bl/6J mice, individually caged, were randomly assigned to one of two groups: sedentary (n = 72) or spontaneous wheel-runners (n = 72). We evaluated longevity and several health parameters including grip strength, motor coordination, exercise capacity (VO_2max) and skeletal muscle mitochondrial biogenesis. We also measured the cortical levels of the brain-derived neurotrophic factor (BDNF), a neurotrophin associated with brain plasticity. In addition, we measured systemic oxidative stress (malondialdehyde and protein carbonyl plasma levels) and the expression and activity of two genes involved in antioxidant defense in the liver (that is, glutathione peroxidase (GPx) and manganese superoxide dismutase (Mn-SOD)). Genes that encode antioxidant enzymes are considered longevity genes because their over-expression may modulate lifespan. Aging was associated with an increase in oxidative stress biomarkers and in the activity of the antioxidant enzymes, GPx and Mn-SOD, in the liver in mice. Life-long spontaneous exercise did not prolong longevity but prevented several signs of frailty (that is, decrease in strength, endurance and motor coordination). This improvement was accompanied by a significant increase in the mitochondrial biogenesis in skeletal muscle and in the cortical BDNF levels.

Conclusion

Life-long spontaneous exercise does not prolong lifespan but improves healthspan in mice. Exercise is an intervention that delays age-associated frailty, enhances function and can be translated into the clinic.

The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging

OBJECTIVE

To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo (Spain).

METHODS

Data were taken from the Toledo Study for Healthy Aging, a population-based study conducted on 2,488 individuals aged 65 years and older. Study participants were selected by a two-stage random sampling from the municipal census of Toledo, covering both institutionalized and community dwelling persons from rural and urban settings. Data were collected from 2006 to 2009, and included information on social support, activities of daily living, comorbidity, physical activity, quality of life, depressive symptoms, and cognitive function. In addition, a nurse collected anthropometric data, conducted tests of physical performance (walk speed, upper and lower extremities strength, and the stand-and-sit from a chair test) and obtained a blood sample. The diagnosis of the frailty syndrome was based on the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss).

RESULTS

In total, 41.8% (95% confidence interval [CI] 39.4-44.2%) of the study participants were prefrail, and 8.4% (95% CI 7.1-9.8%) were frail. There were no differences in the prevalence of frailty by sex, level of education, occupation, marital status, or place of residence. The frequency of the frailty syndrome increased with age, and was higher in those with disability, depression, hip fracture and other comorbidity, such as cardiovascular disease and disorders of the central nervous system.

CONCLUSIONS

The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other populations in the Mediterranean basin.

Cyanide removal from cassava mill wastewater using Azotobactor vinelandii TISTR 1094 with mixed microorganisms in activated sludge treatment system

Cassava mill wastewater has a high organic and cyanide content and is an important economic product of traditional and rural low technology agro-industry in many parts of the world. However, the wastewater is toxic and can pose serious threat to the environment and aquatic life in the receiving waters. The ability of Azotobactor vinelandii TISTR 1094, a N2-fixing bacterium, to grow and remove cyanide in cassava wastewater was evaluated. Results revealed that the cells in the exponential phase reduce the level of cyanide more rapidly than when the cells are at their stationary growth phase. The rate of cyanide removal by A. vinelandii depends on the initial cyanide concentration. As the initial cyanide concentration increased, removal rate increased and cyanide removal of up to 65.3% was achieved. In the subsequent pilot scale trial involving an activated sludge system, the introduction of A. vinelandii into the system resulted in cyanide removals of up to 90%. This represented an improvement of 20% when compared to the activated sludge system which did not incorporate the strain.

Structural and dynamic properties of BaInGeH: a rare solid-state indium hydride

BaInGeH was synthesized by hydrogenating the intermetallic compound BaInGe. The crystal structure determination from the powder neutron diffraction data of BaInGeD [P3m1, Z = 1, a = 4.5354(3) A, c = 5.2795(6) A] reveals the presence of hydrogen in tetrahedral voids defined by three Ba atoms and one In atom.