Creation of Dystrophin Expressing Chimeric Cells of Myoblast Origin as a Novel Stem Cell Based Therapy for Duchenne Muscular Dystrophy

Over the past decade different stem cell (SC) based approaches were tested to treat Duchenne Muscular Dystrophy (DMD), a lethal X-linked disorder caused by mutations in dystrophin gene. Despite research efforts, there is no curative therapy for DMD. Allogeneic SC therapies aim to restore dystrophin in the affected muscles; however, they are challenged by rejection and limited engraftment. Thus, there is a need to develop new more efficacious SC therapies. Chimeric Cells (CC), created via ex vivo fusion of donor and recipient cells, represent a promising therapeutic option for tissue regeneration and Vascularized Composite Allotransplantation (VCA) due to tolerogenic properties that eliminate the need for lifelong immunosuppression. This proof of concept study tested feasibility of myoblast fusion for Dystrophin Expressing. Chimeric Cell (DEC) therapy through in vitro characterization and in vivo assessment of engraftment, survival, and efficacy in the mdx mouse model of DMD. Murine DEC were created via ex vivo fusion of normal (snj) and dystrophin–deficient (mdx) myoblasts using polyethylene glycol. Efficacy of myoblast fusion was confirmed by flow cytometry and dystrophin immunostaining, while proliferative and myogenic differentiation capacity of DEC were assessed in vitro. Therapeutic effect after DEC transplant (0.5 × 10⁶) into the gastrocnemius muscle (GM) of mdx mice was assessed by muscle functional tests. At 30 days post-transplant dystrophin expression in GM of injected mdx mice increased to 37.27 ± 12.1% and correlated with improvement of muscle strength and function. Our study confirmed feasibility and efficacy of DEC therapy and represents a novel SC based approach for treatment of muscular dystrophies.

Overcoming the obstacles of implementing infection prevention and control guidelines

Reasons for a successful or unsuccessful implementation of infection prevention and control (IPC) guidelines are often multiple and interconnected. This article reviews key elements from the national to the individual level that contribute to the success of the implementation of IPC measures and gives perspectives for improvement. Governance approaches, modes of communication and formats of guidelines are discussed with a view to improve collaboration and transparency among actors. The culture of IPC influences practices and varies according to countries, specialties and healthcare providers. We describe important contextual aspects, such as relationships between actors and resources and behavioural features including professional background or experience. Behaviour change techniques providing goal-setting, feedback and action planning have proved effective in mobilizing participants and may be key to trigger social movements of implementation. The leadership of international societies in coordinating actions at international, national and institutional levels using multidisciplinary approaches and fostering collaboration among clinical microbiology, infectious diseases and IPC will be essential for success.

Measurement of transient atomic displacements in thin films with picosecond and femtometer resolution

We report measurements of the transient structural response of weakly photo-excited thin films of BiFeO3, Pb(Zr,Ti)O3, and Bi and time-scales for interfacial thermal transport. Utilizing picosecond x-ray diffraction at a 1.28 MHz repetition rate with time resolution extending down to 15 ps, transient changes in the diffraction angle are recorded. These changes are associated with photo-induced lattice strains within nanolayer thin films, resolved at the part-per-million level, corresponding to a shift in the scattering angle three orders of magnitude smaller than the rocking curve width and changes in the interlayer lattice spacing of fractions of a femtometer. The combination of high brightness, repetition rate, and stability of the synchrotron, in conjunction with high time resolution, represents a novel means to probe atomic-scale, near-equilibrium dynamics.

Results of abdominoperineal resections for failures after combination chemotherapy and radiation therapy for anal canal cancers

Thirty patients treated with combination chemotherapy (CT) and radiation therapy (RT) for anal canal carcinoma were reviewed retrospectively to analyze the results of abdominoperineal resection (APR) for treatment failures. Mean follow-up was 34.9 months. Twenty-four patients had squamous carcinomas, and six had cloacogenic carcinomas. Twenty-five had negative inguinal lymph nodes, and five had positive inguinal lymph nodes. The group received 5-fluorouracil, mitomycin C, and 30 to 50 Gy of RT. Biopsy was obtained at six weeks posttherapy. Seventeen of 22 patients (77 percent) with primary tumors of less than 5 cm and negative nodes were disease free at 37 months post-CT-RT. None of the seven patients with primary tumors of greater than 5 cm or positive nodes were free of disease. APR was done for positive biopsy in eight patients and for local recurrence (disease detected after six months of treatment) in one patient. Eight of nine patients who had APR died of disease (mean, 20 months), and one of nine died of other causes. A review of published series, including our data, reveals 24 cases of APR post-CT-RT for positive biopsy, with 17 of 24 (71 percent) dead of disease within three years. APR for CT-RT failures has a poor prognosis. Future protocols may determine whether further CT-RT will improve survival. APR for palliation should always remain an option.

Submucosal arterial malformation of the colon with massive hemorrhage. Report of a case

The case of a 60-year-old man with massive lower intestinal bleeding, secondary to erosion of an abnormally large submucosal muscular artery in the ascending colon, is reported. The bleeding site was localized by angiography. The clinicopathologic presentation of this case is identical to Dieulafoy's disease, which occurs almost exclusively in the stomach. Three similar patients with lesions also located in the ascending colon have been reported in the English medical literature.

Arterial embolization: problems of source, multiplicity, recurrence, and delayed treatment

The clinical course of 225 patients who had experienced 309 arterial embolic episodes was reviewed with special reference to the problems of the identification of the source of embolization, multiplicity of involvement, significance of recurrence, and the effects of some therapeutic means, including anticoagulation, on the early and late results. The most common source of embolization was cardiac (in 85% of the cases). Persistent search, at times by complex diagnostic methods, uncovered the origin in all but 11% of the cases. Within a range of 8 hours to 7 days the effect of delayed treatment had a linear relationship to the severity of ischemic changes and the deterioration of favorable results. Angiography was helpful and often essential in the diagnosis of visceral embolism and in differentiating local thrombosis from embolism in the periphery. Recurrent embolization was common (in 28% of the cases), was often multiple, and had a grave prognosis. Permanent anticoagulant therapy, preferably with but even without the removal of the source of embolization, reduced the rate of recurrence and, in general, reduced early and late morbidity and mortality rates.

Aneurysms of the renal artery: problems of prognosis and surgical management

The clinical course of 29 patients bearing 36 renal artery aneurysms was reviewed. The majority of the lesions (30 of 36 or 83%) were detected incidentally in the course of angiographic examination, mostly in the study of peripheral atherosclerotic arterial disease. Twenty-five lesions 2.0 cm or less in diameter, treated conservatively and observed during a period of time of from 1 to 17 years, remained clinically silent. In 10 patients (with 11 lesions) surgical treatment was employed. For eight patients the surgical treatment consisted of reconstructive excision and repair, with excellent results in all cases but one for a period of observation of from 1 to 17 years. In one patient aneurysmal dilatation of a vein bypass graft resulted in nephrectomy 2 years following operation. In the remaining two patients nephrectomy was required. Unless hypertension or pregnancy complicates the clinical picture, renal arterial aneurysms 1.5 cm or less in diameter can be observed safely by periodic angiography. Surgical repair of an aneurysm is recommended regardless of size if pregnancy cannot be avoided and hypertension is uncontrolled, and in aneurysms 1.5 cm or less in diameter which show an increase in size. A number of reconstructive vascular procedures have proved successful. Ex vivo repair may be an organ-saving technical aid.