Pitavastatin-loaded bilosomes for oral treatment of hepatocellular carcinoma: a repurposing approach

Albeit its established efficacy as an anti-hyperlipidemic agent, pitavastatin (PIT) has been shown to have other various therapeutic effects. One of these effects is the anti-cancer activity against hepatocellular carcinoma (HCC). This effect has been evaluated in this study for the first time via its oral delivery loaded in bilosomes both in vitro in hepatocellular carcinoma (HCC) cell line; HepG2 and in vivo in an Ehrlich ascites carcinoma (EAC) model. Moreover, the impact of surface modification of bilosomes with lactoferrin (LF) as an active targeting ligand for HCC was investigated. Bilosomes were prepared by thin-film hydration and different molar phospholipid to bile salt ratios were used to optimize the bilosomal formulation. The molar phospholipid to bile salt ratio was adjusted to 4:1 at pH 7.4. LF-coated bilosomes possessed a particle size, PDI, entrapment efficiency, and zeta potential of 112.28 nm ± 6.35, 0.229 ± 0.06, 90.56% ± 3.22, and −7.86 mV ± 1.13, respectively. LF-coated bilosomes also increased permeation of PIT when tested on Caco-2 cells by 3.1-folds (compared to uncoated ones or free PIT solution). It also improved the cytotoxicity of HepG2 spheroids 44-folds more than PIT-free solution. RT-PCR analysis showed that LF-coated PIT-loaded bilosomes caused an improvement (2-fold increase) in the apoptotic potential of PIT mediated by caspase-3. In conclusion, the optimized LF-coated PIT-loaded bilosomes were cytotoxic to HCC with improved hepatocytes permeation and cellular uptake. Thus, the proposed formula could be a promising treatment for HCC.

Cytotoxic assessment of 3D printed photoinitiated prosthodontic resins versus heat polymerized acrylic resin (In-Vitro Study).. [DOI: 10.21203/rs.3.rs-1948364/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Although 3D printed photoinitiated resins are among the many materials utilized in prosthetic appliances today, biocompatibility for photocuring 3D printing materials for direct and long-term contacting with living body remain scarce. The purpose of this in vitro study was to evaluate the cell viability of human gingival fibroblasts after the exposure to two different 3D printed photoinitiated resins and compare it to the traditionally used heat polymerized acrylic resin for up to 7 days.Methods: This comparative in vitro study of sample size (n= 96), where the 3D printed resin disc samples (n= 64), were divided into two test groups, test group 1 (TG1) for NextDent Base resin (n= 32) and test group 2 (TG2) for Dental LT clear resin (n= 32), to be compared to Heat polymerized acrylic resin samples (Reference group (RG)) (n= 32). Human gingival fibroblasts were extracted from attached keratinized gingival tissues collected from healthy patient undergoing clinical crown lengthening procedure, cellular viability using MTT assay in response to TG1, TG2 and RG samples was assessed throughout four-time intervals (24, 48, 72 and 168 hours). The One-Way ANOVA test followed by Tukey’s post hoc test and Repeated Measures ANOVA test were used for statistical analyses, statistically significant different at P value ≤ 0.05Results: Throughout time intervals, there was a decrease in cell viability of all groups but with favorable cell viability which was more that 90% denoting non cytotoxicity. It was found to be significant among RG (P< 0.0001). The highest cell viability was found after 24 hours among all groups; however, the least viability was found after 48 hours among TG1 and RG, and among TG2 after 72 hours. After 168 hours, there was a non-statistical significant change in cell viability between groups (P= 0.526). there was significant increase in optical density for all groups throughout time intervals (P< 0.0001).Conclusion: Photoinitiated resins are comparable to traditionally used heat polymerized acrylic resin with equivalent cytotoxic effect for long term use. 3D printed photoinitiated resins are biocompatible and suggested for long term intraoral use.

Suture lateralization in congenital bilateral vocal cord immobility in neonates and infants: A hybrid approach

INTRODUCTION

Bilateral vocal cord immobility (BVCI) is a leading cause of stridor and airway obstruction in neonates which may arise idiopathically, as a result of birth trauma, or in the setting of Central nervous system lesions such as Arnold-Chiari malformation. Although many children with BVCI may be managed conservatively, surgical intervention may be necessary in those patients with ongoing upper airway obstruction. Many interventions have been described including, tracheostomy, cordotomy, cricoid splitting procedures, and arytenoidectomy. Vocal cord suture lateralization has the advantage of being both reversible and less morbid than other surgical interventions for BVCI. This study describes a novel variation of the suture lateralization procedure which aids in correct placement of the suture thus minimizing multiple needle passes and associated laryngeal edema.

METHODS

A retrospective chart review was undertaken of five patients undergoing suture lateralization of the vocal cord for BVCI at a single institution over a 10 year period. Post-operative voice and swallow outcomes were recorded.

RESULTS

Of five patients undergoing this procedure four returned to normal diet. One was diagnosed with a progressive neurological disorder and was persistently fed via gastrostomy tube. Three of the five patients spontaneously recovered vocal cord function and went on to have normal voice after suture removal.

CONCLUSION

Suture lateralization is a safe and effective means of alleviating upper airway obstruction in BVCI. It has the advantages of being reversable and minimally invasive; however, optimal suture placement is both vital and challenging. The novel technique described in this study allows identification of landmarks as and aid to suture placement thus reducing the need for multiple needle passes into the lumen of the larynx.

Role of Awareness Activities in Mega-Events

Background

Cardiovascular diseases remain to be one of the leading causes of death worldwide. There are some well-established risk factors such as a genetic disposition (hereditary), hypertension (high blood pressure), diabetes mellitus, obesity, high cholesterol level, poor dietary habits, inactive lifestyle, and smoking. The Egyptian direction is to invest in developing educational programs on cardiovascular diseases for the whole community and particularly for women. This initiative is echoed by experts who call for urgent action to improve care, prevent disease and increase awareness of cardiovascular diseases generally and within the women community. The Egyptian community is in great need to public awareness campaigns about cardiovascular diseases especially myocardial infarction and stroke. The CardioVascular Research, Education, Prevention foundation (CVREP) in collaboration with Stent Save a Life (SSL) initiative Egypt and the American Heart Association (AHA) and its initiative “Go Red For Women”, initiated a very successful awareness campaign for physicians and for public during the mega cardiovascular conference CardioAlex.21. ICOM Group (International Center for Organization and Marketing) in collaboration with Expand created a comprehensive public awareness program during CardioAlex.21 held in Alexandria, Egypt during the period 01 – 04 June, 2021.

Aim

Building awareness to the community to the signs and the “must take actions” in cardiovascular emergencies, as heart attacks.

Methods

A very creative campaign was held at the last day of CardioAlex.21 in Alexandria, Egypt, in which, ICOM and Expand teams organized a Marathon (Run) followed by an educational lecture for physicians and a session for public along with screening clinics stations for all attendees to have an onsite check up on their blood pressure and blood glucose level. “GO RED FOR WOMEN”, addressed the message for women to raise the awareness of cardiovascular risks and a very informative discussion was held. The audience questions were answered by SSL Board who moderated the session on a one-to-one story telling technique which made the sessions very interesting. Data was collected from persons who attended the session representing the Egyptian society.

Results

Eighty persons attended the awareness day, 54% of which were middle-aged participants with an age mean of 50 years old. 60% were women, 55% completed secondary education or more and 77% of them reported to have heard about heart attacks while, more than half stated they knew someone who had it. This campaign raised the public awareness regarding cardiovascular disease and how a minute is life changing, knowing how to react if someone experienced one or more of the heart attack symptoms as well as the proper management of MI patients. Also, the healthy lifestyle after undergoing a PPCI procedure was discussed.

Biomaterial-Based Nanocomposite for Osteogenic Repurposing of Doxycycline

Background

Besides its antimicrobial action, doxycycline (DX) has lately been repurposed as a small-molecule drug for osteogenic purposes. However, osteogenic DX application is impeded by its dose-dependent cytotoxicity. Further, high-dose DX impairs cell differentiation and mineralization.

Purpose

Integrating DX into a biomaterial-based delivery system that can control its release would not only ameliorate its cytotoxic actions but also augment its osteogenic activity. In this work, we managed to engineer novel composite DX–hydroxyapatite–polycaprolactone nanoparticles (DX/HAp/PCL) to modify DX osteogenic potential.

Methods

Employing a 2³-factorial design, we first optimized HApN for surface-area attributes to maximize DX loading. Composite DX/HAp/PCL were then realized using a simple emulsification technique, characterized using various in vitro methods, and evaluated for in vitro osteogenesis.

Results

The developed HApN exhibited a favorable crystalline structure, Ca:P elemental ratio (1.67), mesoporous nature, and large surface area. DX/HAp/PCL achieved the highest reported entrapment efficiency (94.77%±1.23%) of DX in PCL-based particles. The developed composite system achieved controlled release of the water-soluble DX over 24 days. Moreover, the novel composite nanosystem managed to significantly ameliorate DX cytotoxicity on bone-marrow stem cells, as well as enhance its overall proliferation potential. Alkaline phosphatase and mineralization assays revealed superior osteodifferentiation potential of the composite system. Quantification of gene expression demonstrated that while DX solution was able to drive bone-marrow stem cells down the osteogenic lineage into immature osteoblasts after 10-day culture, the innovative composite system allowed maturation of osteodifferentiated cells. To the best of our knowledge, this is the first work to elaborate the impact of DX on the expression of osteogenic genes: RUNX2, OSP, and BSP. Further, the osteogenicity of a DX-loaded particulate-delivery system has not been previously investigated.

Conclusion

Our findings indicate that repurposing low-dose DX in complementary biomaterial-based nanosystems can offer a prominent osteogenic candidate for bone-regeneration purposes.

Bone marrow-derived mesenchymal stem cells and extracellular vesicles enriched collagen chitosan scaffold in skin wound healing (a rat model)

BACKGROUND

Over the past ten years, regenerative medicine has focused on the regeneration and the reconstruction of damaged, diseased, or lost tissues and organs. Skin, being the largest organ in the human body, had attained a good attraction in this field. Delayed wound healing is one of the most challenging clinical medicine complications. This study aimed to evaluate the collagen chitosan scaffold's effect alone, or enriched with either bone marrow-derived mesenchymal stem cells (BM-MSCs) or their secreted extracellular vesicles (EVs) on the duration and quality of skin wound healing.

METHODS

A full-thickness skin wound was induced on the back of 32 adult male Sprague-Dawley rats. The wounds were either covered with collagen chitosan scaffolds alone, scaffolds enriched with stem cells, or extracellular vesicles. Unprotected wounds were used as control. Healing duration, collagen deposition and alignment, CD 68+ macrophage count, and functional tensile strength of healed skin were assessed (α = 0.05, n = 8).

RESULTS

The rate of skin healing was significantly accelerated in all treated groups compared to the control. Immuno-histochemical assessment of CD68+ macrophages showed enhanced macrophages count, in addition to higher collagen deposition and better collagen alignment in EVs and BM-MSCs treated groups compared to the control group. Higher tensile strength values reflected the better collagen deposition and alignment for these groups. EVs showed higher amounts of collagen deposition and better alignment compared to MSCs treated group.

CONCLUSION

The collagen chitosan scaffolds enriched with MSCs or their EVs improved wound healing and improved the quantity and remodeling of collagen with a better assignment to EVs.

Development of Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy for Patients with ST-Elevation Myocardial Infarction and Assessment of Its Use in Egypt

Objective: Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention (PCI) to restore blood flow in patients with the clinical presentation of an acute coronary syndrome and more specifically with ST-elevation myocardial infarction (STEMI) can save lives. This study aims to identify the mean time (door to balloon time and first contact to balloon time) to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods: A registry study of patients presenting to cardiac centers in Egypt was designed, where patients’ basic characteristics, the treatment strategy, and the door to balloon time and the first contact to balloon time were assessed.Results: One thousand six hundred fifty STEMI patients with a mean age of 57 years were included in the study. Immediate transfer for primary PCI was the most used treatment strategy, representing 74.6% of all treatment strategies used. The door to balloon time and the first contact to balloon time were 50 and 60 minutes, respectively, with a primary PCI success rate of 65.1%.Conclusion: The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for STEMI patients in Egypt.

Pediatric tracheostomy first tube change: When is it safe?

OBJECTIVES

The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective.

METHODS

We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Exclusion criteria were patients on whom the senior authors did not operate, operations done elsewhere, cases where maturation sutures were not used or a patient died prior to first tube change. We noted patient details, indication for tracheostomy, the need for long-term ventilation, timing of the first tube change, decannulation and need for surgical closure of persistent tracheocutaneous fistula.

RESULTS

93 patients were identified, of which 83 were included. The age range was 0-16 years, with the youngest day one of life and an overall mean age of 1.91 years. 59% of patients required long-term ventilation due to various co-morbidities. 26 patients (31%) underwent a first tube change on day 2 post-operatively. All these were uneventful and were irrespective of the patient's need for ventilation. Of the 42 patients who have subsequently been decannulated, 33 (79%) were noted to have a persistent tracheocutaneous fistula requiring surgical closure, four of whom needed revision closure.

CONCLUSIONS

This study shows that a first tube change on day 2 post-operatively is safe, facilitating earlier discharge from intensive care, allowing shorter length of sedation, earlier start to parent/carer training and wound assessment.

From normal gait to loss of ambulation in 6 months: a novel presentation of SCA17

Spinocerebellar ataxias are a group of rare and heterogeneous autosomal dominant disorders characterized by progressive ataxia and other features. Spinocerebellar ataxia 17 (SCA17) is one of the 32 subtypes described to date and is secondary to CAG/CAA repeat expansion in the gene coding for the TATA-box binding protein (TBP). SCA17 is clinically heterogeneous and typically presents with slowly evolving ataxia, dysarthria, dementia, depression, and other movement disorders such as chorea. More than 41 CAG/CAA repeats are considered diagnostic of SCA17, with more than 49 being associated with full penetrance. We report one patient presenting with isolated rapidly evolving ataxia who was found to have 44 CAG/CAA repeats in the TBP gene. This suggests that, while SCA17 typically slowly progresses over years, its repertoire of presentations should be expanded to include rapidly progressive isolated ataxia resembling paraneoplastic disorders or prion disease.

Endovascular treatment of sigmoid sinus aneurysm presenting as devastating pulsatile tinnitus. A case report and review of literature

Pulsatile tinnitus is a rare yet potentially disabling symptom that can have either vascular or nonvascular etiologies. A recently described vascular cause is an aneurysm of dural venous sinuses. To our knowledge, eight of such cases have been published, five of which were treated surgically and three by endovascular approach. We describe one additional case treated successfully by endovascular coiling and review the current data on this subject.