Proliferation and differentiation potential of cryopreserved human skin-derived precursors

OBJECTIVES

Skin-derived precursors are recognized to be a potentially autologous and accessible source of neural precursor cells for drug screening or cell-based treatments, in many neurological disorders. Thus, it is necessary to investigate appropriate methods for cryopreservation of such human skin-derived precursors (hSKPs). The aim of this study was to evaluate different cryopreservation techniques for retention of hSKPs to discover an optimized protocol.

MATERIALS AND METHODS

We cryopreserved hSKPs treated with 0%, 10%, 20%, 30% and 40% foetal bovine serum (FBS) and three concentrations of dimethylsulphoxide (DMSO) 5%, 10% and 15%, with two different storage periods in liquid nitrogen (2 days: short-term storage; and 2 months: long-term storage). Then, we assessed survival and proliferation levels of the cells after freeze-thaw processes, by viability measurement and colony-forming assay. For detecting hSKPs, we used immunocytochemistry and RT-PCR assessments.

RESULTS

Our findings indicated that hSKPs cryopreserved in 5% DMSO without FBS, had better survival and proliferation potentials compared to other working formulations. With various concentrations of cryoprotectants over different time periods, hSKPs retained their differentiation potentiality and were able to differentiate into neurons (NFM and βΙΙΙ tubulin-positive), glial cells (GFAP-positive) and smooth muscle cells (SMA-positive).

CONCLUSIONS

  Results revealed that in only 5% DMSO, hSKPs could be cryopreserved for long-term storage with considerable survival and proliferation levels, without losing multipotency.

Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study

INTRODUCTION

Reliable and valid tools must be used to assess spasticity in clinical practise and research settings. There is a paucity of literature regarding the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS). No study, to date, has been performed to compare the validity of the MMAS and the MTS. This neurophysiological study protocol will compare the validity of the MMAS and the MTS in the assessment of poststroke wrist flexor spasticity.

METHODS AND ANALYSIS

Thirty-two patients with stroke from the University Rehabilitation clinics will be recruited to participate in this cross-sectional, non-interventional study. All measurements will be taken in the Physical Medicine and Rehabilitation Department of Shafa University Hospital in Tehran, Iran. First, wrist flexor spasticity will be assessed clinically using the MMAS and MTS. The tests will be applied randomly. For the MTS, the components of R1, R2, R2-R1 and quality of muscle reaction will be measured. Second, neurophysiological measures of H-reflex latency, H(max)/M(max) ratio, H(slp) and H(slp)/M(slp) ratio will be collected from the affected side. The results will be analysed using Spearman's ρ test or Pearson's correlation test to determine the validity of the MMAS and the MTS as well as to compare the validity between the MMAS and the MTS.

ETHICS AND DISSEMINATION

The Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences (TUMS) approved the study protocol.  The study results will be disseminated in peer-reviewed publications and presented at international congresses.

Assessment of rates of structural change in glaucoma using imaging technologies

PURPOSE

To review the ability of current imaging technologies to provide estimates of rates of structural change in glaucoma patients.

PATIENTS AND METHODS

Review of literature.

RESULTS

Imaging technologies, such as confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP), and optical coherence tomography (OCT), provide quantifiable and reproducible measurements of the optic disc and parapapillary retinal nerve fibre layer (RNFL). Rates of change as quantified by the rim area (RA) (for CSLO) and RNFL thickness (for SLP and OCT) are related to glaucoma progression as detected by conventional methods (eg, visual fields and optic disc photography). Evidence shows that rates of RNFL and RA loss are significantly faster in progressing compared with non-progressing glaucoma patients.

CONCLUSION

Measurements of rates of optic disc and RNFL change are becoming increasingly precise and individualized. Currently available imaging technologies have the ability to detect and quantify progression in glaucoma, and their measurements may be suitable end points in glaucoma clinical trials.

A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke

PRIMARY OBJECTIVE

To determine the extent to which the Brunnstrom recovery stages of upper limb in hemiparetic stroke patients are correlated to neurophysiological measures and the spasticity measure of Modified Modified Ashworth Scale (MMAS).

RESEARCH DESIGN

A concurrent criterion-related validity study.

INTERVENTIONS

Not applicable.

METHODS AND PROCEDURES

Thirty patients (15 men and 15 women; mean ± SD = 58.8 ± 11.5 years) with upper limb spasticity after stroke were recruited. Wrist flexor spasticity was rated using the MMAS. The neurophysiological measures were Hslp/Mslp ratio, H(max)/M(max) ratio and Hslp.

MAIN OUTCOMES AND RESULTS

There was a significant moderate correlation between the Brunnstrom recovery stages and the neurophysiological measures. The Brunnstrom recovery stages were highly correlated to the MMAS scores (r = -0.81, p < 0.0001).

CONCLUSIONS

The Brunnstrom recovery stages are moderately correlated with neurophysiological measures and highly correlated with the MMAS regarding the evaluation of motor recovery in stroke patients. The Brunnstrom recovery stages can be used as a valid test for the assessment of patients with post-stroke hemiplegia.

Prospective comparison of ultrasound biomicroscopy and anterior segment optical coherence tomography for evaluation of anterior chamber dimensions in European eyes with primary angle closure

PURPOSE

To compare the accuracy in measurement of the anterior chamber (AC) angle by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in European patients with suspected primary angle closure (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG).

DESIGN

Cross-sectional study.

METHODS

In all, 55 eyes of 33 consecutive patients presenting with PACS, PAC, or PACG were examined with AS-OCT, followed by UBM. The trabecular-iris angle (TIA) was measured in all four quadrants. The angle-opening distance (AOD) was measured at 500 microm from the scleral spur. The Bland-Altman method was used for assessing agreement between the two methods.

RESULTS

The mean (+/-SD) superior TIA was 19.3+/-15.8 degrees in AS-OCT and 15.7+/-15.0 degrees in UBM (P=0.50) and inferior TIA was 17.9+/-12.9 degrees (AS-OCT) and 16.7+/-14.1 degrees (UBM) (P=0.71). The superior AOD(500) was 0.17+/-0.16 mm in UBM and 0.21+/-0.16 mm in AS-OCT (P=0.06). Bland-Altman analysis showed a mean SD of+/-9.4 degrees for superior and inferior TIA and a mean SD of +/-0.10 mm for superior and inferior AOD(500).

CONCLUSIONS

This comparative study shows that AS-OCT measurements are significantly correlated with UBM measurements but show poor agreement with each other. We do not believe that AS-OCT can replace UBM for the quantitative assessment of the AC angle.

Mitochondrial DNA (mtDNA) A 3243G mutation associated with an annular perimacular retinal atrophy

BACKGROUND

A point mutation at the locus 3243 of the mitonchondrial DNA (mtDNA) is associated with either the MIDD syndrome (maternally inherited diabetes, deafness), the MELAS syndrome (myopathy, encephalitis, lactic acidosis, stroke) or cardiac, digestive, endocrine or exocrine dysfunctions. We report a peculiar maculopathy in two patients with an mtDNA 3243 mutation.

HISTORY AND SIGNS

Case 1: A visually asymptomatic 40-year-old woman was examined for screening of diabetic retinopathy. Visual acuity was 10 / 10 in both eyes. Case 2: A 54-year-old woman with deafness and diabetes complained of visual loss. Visual acuity was 6 / 10 for the right eye and 0.5 / 10 for the left eye. Both patients exhibited a chorioretinal areolar atrophy. Case 1 was followed over 15 years and exhibited a slow progression of the maculopathy with moderate loss of visual acuity to 6 / 10 in both eyes, but marked handicap from the annular scotoma.

THERAPY AND OUTCOME

None.

CONCLUSION

Both patients presented a perimacular annular retinal atrophy. Patients harbouring mtDNA 3243 mutation should be examined for the presence of a maculopathy, even if they are asymptomatic. Conversely, the finding of such a geographic maculopathy should suggest the possibility of a point mutation at the locus 3243 of the mitochondrial DNA, especially in the presences of diabetes mellitus and/or deafness.

The correlation between Modified Ashworth Scale scores and the new index of alpha motoneurones excitability in post-stroke patients

The Modified Ashworth Scale (MAS) is currently a widely used clinical scale to evaluate muscle spasticity. However, it lacks reliability and the validity, of the MAS as a clinical measure of muscle spasticity has been challenged. The aim of the present study was to examine the validity of the MAS in patients with wrist flexor spasticity after stroke by using the Hslope/Mslope (Hslp/Mslp) ratio as the new index of alpha motoneuron excitability. Twenty-seven adult patients (14 women and 13 men) with first ever stroke resulting in hemiplegia with a mean (SD, range) age of 57.9 (11.6, 37-75) were included in the study. The main outcome measures were the MAS for the clinical assessment of spasticity, and the Hslp/Mslp for the neurophysiological evaluation. There was not a significant correlation between the MAS scores and Hslp/Mslp ratio (r = 0.38, p > 0.05). The mean of the Hslp/Mslp did not show a hierarchical increase with the MAS scores. The findings indicate that the MAS is not a valid and ordinal level measure of muscle spasticity.

Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity after stroke

The Modified Modified Ashworth Scale (MMAS) is a clinical test for the measurement of spasticity. The aim of the present study was to examine the validity of the MMAS in patients with wrist flexor spasticity after stroke. 27 adult patients (14 women and 13 men) with first ever stroke resulting in hemiplegia with a mean (SD, range) age of 57.9 (11.6, 37-75) were included in the study. The outcome measures were the MMAS for the clinical assessment of spasticity, the Hslope/Mslope (Hslp/Mslp), and the H(max)/M(max) ratio for the neurophysiological evaluation. The mean of the Hslp/Mslp and the H(max)/M(max) were higher in patients with worse MMAS grades but the differences were not statistically significant. There was a significant positive correlation between the MMAS scores and Hslp/Mslp ratio as the new index of alpha motoneurone excitability or traditional index of H(max)/M(max) ratio (r = 0.39, p = 0.04). It is concluded that the MMAS to be a valid measure of spasticity after stroke.

Anti-plasminogen monoclonal antibody (MC2B8) inhibites angiogenesis

Angiogenesis is a complex process during which of new blood vessels are produced from the preexisting blood vessels. Formation and growth of new vessels play an important role in the physiologic process (embryonic growth, tissue repair) and pathologic process (tumor growth, inflammation) for surviving of the tissues. In fact, the development of tumors is depended upon new vessel formation through which the tumor is provided with nutrient and oxygen. In this research, the role ofplasminogen conformation with MC2B8 mAb (an antibody directed against C-terminal part of plasminogen) in clot lysis and angiogenesis is observed. In experimental model of angiogenesis, beads, covered with endothelial cells of bone marrow capillaries, are the source of endothelial cells. It coated in three-dimensional structure to be provided through fibrin gel. Different titers of monoclonal antibody (30-480 microg mL(-1)) MC2B8 were added in fibrin gel. 3-5 days after culturing of endothelial cells, growth and migration was seen as the result of capillary formation MC2B8 mAb delayed clot lysis and inhibited angiogenesis at the concentration of 240 microg mL(-1). Present findings suggest that these effects on capillary tube formation and clot lysis caused blockage or conformational changes in plasminogen epitopes involved in angiogenesis and fibrinolysis.

A preliminary study into the criterion validity of the Modified Modified Ashworth Scale using the new measure of the alpha motoneuron excitability in spastic hemiplegia

The Modified Ashworth Scale (MAS) is the most widely used clinical test for the measurement of muscle spasticity. This scale that suffers from limitations and lack of reliability and validity has recently been remodified. The aim of the present study is to investigate the criterion validity of the new Modified MAS(MMAS) in the upper limb in post-stroke hemiplegia, using the Hslope/Mslope (Hslp/Mslp) as a novel index of alpha motor neuron excitability. Prior to the validity study, the reliability of the MMAS was evaluated in 30 hemiplegic patients. The raters agreed on 23 patients (0. 76%). The MMAS had good inter-rater reliability (K= 0.63, SE = 0.11, p < 0.001) for the assessment of wrist flexors spasticity in hemiplegic patients. 12 adult patients (7 women and 5 men) with first ever stroke resulting in hemiplegia with a mean age of 58.9 +/- 11.9 years (range, 37-73) were included in the validity study. The outcome measures were the MMAS for the clinical assessment of spasticity, and the HslopelMslope and the Hmax/Mmax ratio for the electrophysiological evaluation. The results showed an increase in mean rank of Hslp / Mslp in patients with a score of 1, 2 or 3 on the MMAS. However, the difference among the groups was not significant (p > 0.05). There was also no relationship between the clinical scale of MMAS and either the traditional [Hmax / Mmax ratio (r = -0.06)] or the new index [Hslp / Mslp (r = 0.24)] of spinal excitability. This preliminary study recruited a small number of patients, and failed to confirm a linear correlation between these variables. A study with a large number of patients is suggested to clarify the outcome.

Gemcitabine combined with cisplatin as first-line treatment in patients 60 years or older with epithelial ovarian cancer: a phase II study

This phase II study evaluated the activity and toxicity of gemcitabine plus cisplatin as first-line treatment of patients with advanced ovarian cancer. Chemonaive patients >/=60-year-old with FIGO stage IIIC or IV epithelial ovarian carcinoma were enrolled. Patients received cisplatin 75 mg /m2 on day 1 and gemcitabine 1250 mg /m2 on day 1 (before cisplatin) and day 8 of a 21-day cycle. Of 44 female patients (median age, 70 years), 72.7% had stage IIIC disease and 67.4% had a Karnofsky performance status >/=80. Of the 37 response-evaluable patients (35 with measurable lesion[s] >/=2 cm), there were seven (18.9%) pathologic complete responses, two (5.4%) pathologic partial responses, two (5.4%) clinical complete responses, and 12 (32.4%) clinical partial responses, for an overall response rate of 62.2% (95% CI, 44.8%-77.5%), and a pathologic response rate of 24.3% (95% CI, 11.8%-41.2%). Median survival was 27.7 months (95% CI, 14.3-40.8 months). Grade 3/4 neutropenia and thrombocytopenia occurred in 59.5% and 30.2% of patients, respectively, with neutropenic fever in one patient. Grade 3 nausea /vomiting and alopecia occurred in 25.6% and 9.5% of patients, respectively. We conclude that gemcitabine plus cisplatin is active and feasible as first-line treatment of advanced epithelial ovarian cancer in patients >/=60 years. Further clinical trials adding gemcitabine to current standard, first-line treatment seem warranted in younger as well as older patients.

Gemcitabine combined with cisplatin as first-line treatment in patients 60 years or older with epithelial ovarian cancer: a phase II study

This phase II study evaluated the activity and toxicity of gemcitabine plus cisplatin as first-line treatment of patients with advanced ovarian cancer. Chemonaive patients ≥60-year-old with FIGO stage IIIC or IV epithelial ovarian carcinoma were enrolled. Patients received cisplatin 75 mg/m2 on day 1 and gemcitabine 1250 mg/m2 on day 1 (before cisplatin) and day 8 of a 21-day cycle. Of 44 female patients (median age, 70 years), 72.7% had stage IIIC disease and 67.4% had a Karnofsky performance status ≥80. Of the 37 response-evaluable patients (35 with measurable lesion[s] ≥2 cm), there were seven (18.9%) pathologic complete responses, two (5.4%) pathologic partial responses, two (5.4%) clinical complete responses, and 12 (32.4%) clinical partial responses, for an overall response rate of 62.2% (95% CI, 44.8%–77.5%), and a pathologic response rate of 24.3% (95% CI, 11.8%–41.2%). Median survival was 27.7 months (95% CI, 14.3–40.8 months). Grade 3/4 neutropenia and thrombocytopenia occurred in 59.5% and 30.2% of patients, respectively, with neutropenic fever in one patient. Grade 3 nausea /vomiting and alopecia occurred in 25.6% and 9.5% of patients, respectively. We conclude that gemcitabine plus cisplatin is active and feasible as first-line treatment of advanced epithelial ovarian cancer in patients ≥60 years. Further clinical trials adding gemcitabine to current standard, first-line treatment seem warranted in younger as well as older patients.

Gemcitabine plus etoposide in chemonaive extensive disease small-cell lung cancer: a multi-centre phase II study

BACKGROUND

Both gemcitabine and etoposide are active in the treatment of small-cell lung cancer (SCLC), and are characterised by mild toxicity profiles. The combination of both drugs was found to be feasible and active in a phase I dose-finding study in solid tumours. Therefore, a phase II trial was initiated to examine the activity and toxicity of this schedule in extensive disease SCLC.

PATIENTS AND METHODS

Forty-two chemo-naïve extensive disease SCLC patients were enrolled to receive gemcitabine 1000 mg/m2, days 1, 8 and 15, and etoposide 80 mg/m2, days 8, 9 and 10 of a 28-day cycle.

RESULTS

Thirty-seven patients were evaluable for efficacy (five received less than one cycle). No complete responses were observed, but partial responses were seen in 17 patients, yielding an overall response rate of 46%. The median duration of response was 5.8 months. Disease stabilisation was obtained in another 10 patients (27%). The median survival of the 37 protocol-qualified patients was 10.5 months (95% confidence interval (CI): 7.5-12.0). The levels of WHO grade 3 and 4 toxicities were low and clinically manageable.

CONCLUSION

In comparison with standard platinum-based regimens, this combination of gemcitabine and etoposide resulted in a somewhat lower response rate, but a similar median survival time. Haematological toxicity was more pronounced than expected from the toxicity data of each agent individually. However, because of its mild non-haematological toxicity, and its ability to be administered in an outpatient setting, this combination provides a reasonable palliative option for patients with extensive disease SCLC.