Intralesional autologous mesenchymal stem cells in management of osteonecrosis of femur: a preliminary study

BACKGROUND

Management of early stages of osteonecrosis aims to prevent the collapse of the femoral head by attempts at restoring the vascularity of femoral head. Bone marrow-derived mononuclear cells with their angiogenic and osteogenic properties appear to have the potential to halt the disease process when injected intralesionally following core decompression.

MATERIALS AND METHODS

Forty patients (60 hips) with stage I, II or III (ARCO system) osteonecrosis of femoral head were treated by either core decompression and isolated mononuclear cells (group A) or core decompression and unprocessed bone marrow injection (group B). The patients were followed up clinically and radiologically for a minimum of 2 years. The functional outcome was assessed in terms of Harris hip score, and disease progression was assessed radiologically by comparing the preoperative and follow-up MRI at the end of 2 years.

RESULTS

On 2-year follow-up, there was considerable improvement in the hip function as measured by the Harris hip score in both the groups (p = 0.031). On MRI, there was a decrease in the size of the lesion in group A (p = 0.03). Three of 30 hips (10.0 %) in group B required total hip replacement.

CONCLUSIONS

Implantation of autologous bone marrow stem cells in avascular necrosis of femoral head is a safe and effective procedure and has better outcome than bone marrow for early stage of avascular necrosis of femoral head.

Influence of periodontal disease on systemic disease: inversion of a paradigm: a review

Medicine and dentistry interface at many levels. For example, the focal infection theory, popular at the outset of the 1900s, suggested that systemic ailments could be traced to dental infections, which, in those days, were common, chronic, and often untreated. With the advent of modern dental and medical treatment, particularly antibiotics, this relationship was largely forgotten. Until recently, the discovery of relationships between periodontal disease and heart ailments, maternal oral health and prematurity of offspring, bidirectional interrelationships between diabetes and periodontal diseases, relationship of oral infections and chronic respiratory diseases and relationship between skeletal and oral bone mineral density, has brought a shift in the perspective. Research is now focused on the potential impact of periodontal diseases on systemic health. Thus, the impact of oral infection in systemic health defined a novel branch in Periodontology termed Periodontal medicine.

Stress Induced Crystallization in Elongational Flow

Stress-induced crystallization is studied in an extensional flow device (a cross-slot flow cell) for an isotactic Polypropylene (iPP) by measuring the micro-structure that develops after flow. Birefringence and Wide Angle X-ray experiments were performed. The birefringence experiments with flow below the melting temperature showed the occurrence of a fiber-like structure around the outflow centerline and, later in time, of ‘streamlines’. The latter are explained by the influence of shear gradients close to the optical windows. The WAXS experiments also showed the fiber-like structure around the outflow centerline, having orientations in the (110), (040) and (130) reflections, with a width of about 80 μm. This dominance of the elongational flow around the stagnation line could not be observed in experiments with flow above and subsequent crystallization below the melting temperature.

Structure development in this cell was numerically predicted using the Leonov and the extended Pompom (XPP) model. The oriented structures can be predicted. Moreover, process conditions are found with less influence of the (unwanted) shear gradients. Finally, it was concluded that the strain hardening behavior in the Leonov model over-estimates the first component of the Finger tensor, and thus the number of flow-induced nuclei. Therefore it is recommended to use the extended Pompom model as a more realistic basis for a quantitative flow-induced crystallization model.

Direct Route to Colloidal UHMWPE by Including LLDPE in Solution during Homogeneous Polymerization of Ethylene

The usual aggregation and precipitation driven by crystallization of nascent PE during homogeneous polymerization of ultra-high molecular weight polyethylene (UHMWPE) is inhibited by including linear low-density polyethylene (LLDPE) in the catalyst solution prior to addition of ethylene monomer. Co-crystallization of newly formed PE and dissolved LLDPE creates a polymer brush on the fold surfaces of the nascent crystallites. Consequently, aggregation is inhibited by steric stabilization. Scanning electron microscopy (SEM) images show that individual lamellae (approximately 10-20 nm thick) typically have lateral dimensions of 0.5 μm × 3.5 μm and form "bowtie" shaped stacks that are approximately 200-500 nm thick. This simple method for stabilizing nascent crystals against precipitation is enabling fundamental studies of their metastable "disentangled" state and may open scalable routes to compounding UHMWPE.

(99m)Tc-DMSA (V) in Evaluation of Osteosarcoma: Comparative Studies with (18)F-FDG PET/CT in Detection of Primary and Malignant Lesions

To evaluate the role of ^99mTc-DMSA (V) and [¹⁸F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both ^99mTc-DMSA (V) and whole-body [¹⁸F]FDG PET-CT scans within an interval of 1 week. 555–740 MBq of ^99mTc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [¹⁸F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUV_max = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMSA (V) scan had higher uptake in lung lesions as compared to FDG uptake on PET-CT. Three patients who did not show any DMSA uptake had subcentimeter lung nodule. Resuts of both ^99mTc-DMSA (V) (whole-body planar and SPECT imaging) and [¹⁸F]FDG PET-CT were comparable in evaluation of primary site lesions and metastatic lesions greater than 1 cm. Though ^99mTc-DMSA (V) had higher uptake in the lesions as compared to [¹⁸F]FDG PET-CT, the only advantage [¹⁸F]FDG PET-CT had was that it could also detect subcentimeter lesions.

Role of MRI in osteosarcoma for chemotherapy response evaluation and prediction: Correlation with histological necrosis

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Background:Histologic necrosis (HN), the current gold standard for response evaluation in osteosarcoma (OS), is accessible only after neoadjuvant chemotherapy (NACT) and may get affected by confounding factors. Thus, it would be useful to have surrogate markers of response evaluation and prognostication using magnetic resonance imaging (MRI) to individualize therapy. Method:Thirty-one treatment naïve OS patients received 3 cycles of NACT followed by surgery during 2006–2008. All patients underwent baseline and post-NACT conventional(C), diffusion-weighted (DW) and dynamic contrast enhanced (DCE) MRI. Taking ‘Huvos grading’ (good response >/= 90% HN) as reference standard, various parameters of MRI were compared with it. Tumor considered as ellipsoidal; volume (V), average tumor plane (ATP) and relative(r)-ATP (ATP/body surface area) were calculated using standard formula for ellipse. Receiver operating characteristic curves were generated to assess the best threshold and predictability. Sensitivity and specificity were calculated along with 95% confidence limits. After deriving thresholds for each parameter in univariable analysis, multivariable analysis was carried out. Results: Both pre-and post NACT, absolute and relative size parameters were well correlated with HN, though post NACT change in parameters did not. Apparent diffusion coefficient (ADC), either pre-and post NACT measurements or change following chemotherapy were not correlating well. However, on adjusting for volume, significant correlation was found. Thus, we could derive a new parameter diffusion per unit volume (DV= ADC /V). Change in shape of time intensity curve did not show significant correlation. Conclusions: In OS, NACT response can be assessed and predicted by conventional and DW- MRI early in the disease course which correlates well with HN. DV seems to be a sensitive substitute for response evaluation. For DCE-MRI, more sophisticated models in future studies might be useful. [Table: see text]

No significant financial relationships to disclose.

Nicotine induces cell proliferation, invasion and epithelial-mesenchymal transition in a variety of human cancer cell lines

Cigarette smoking is strongly correlated with the onset of nonsmall cell lung cancer (NSCLC). Nicotine, an active component of cigarettes, has been found to induce proliferation of lung cancer cell lines. In addition, nicotine can induce angiogenesis and confer resistance to apoptosis. All these events are mediated through the nicotinic acetylcholine receptors (nAChRs) on lung cancer cells. In this study, we demonstrate that nicotine can promote anchorage-independent growth in NSCLCs. In addition, nicotine also induces morphological changes characteristic of a migratory, invasive phenotype in NSCLCs on collagen gel. These morphological changes were similar to those induced by the promigratory growth factor VEGF. The proinvasive effects of nicotine were mediated by alpha7-nAChRs on NSCLCs. RT-PCR analysis showed that the alpha7-nAChRs were also expressed on human breast cancer and pancreatic cancer cell lines. Nicotine was found to promote proliferation and invasion in human breast cancer. The proinvasive effects of nicotine were mediated via a nAChR, Src and calcium-dependent signaling pathway in breast cancer cells. In a similar fashion, nicotine could also induce proliferation and invasion of Aspc1 pancreatic cancer cells. Most importantly, nicotine could induce changes in gene expression consistent with epithelial to mesenchymal transition (EMT), characterized by reduction of epithelial markers like E-cadherin expression, ZO-1 staining and concomitant increase in levels of mesenchymal proteins like vimentin and fibronectin in human breast and lung cancer cells. Therefore, it is probable that the ability of nicotine to induce invasion and EMT may contribute to the progression of breast and lung cancers.

Computed tomography-guided radiofrequency ablation of osteoid osteomas

PURPOSE

To report on 14 patients with osteoid osteomas treated by computed tomography-guided radiofrequency ablation.

METHODS

Nine males and 5 females aged 13 to 45 (mean, 25) years with osteoid osteomas were included. The proximal tibia was the commonest site involved. A bipolar 18-gauge radiofrequency probe with a 9- mm active tip was used. A 4.5-mm hollow drill was introduced into the nidus. Energy application was started at 2 W and increased to a maximum of 5 W. Heat was applied for 4 to 6 minutes at 90 degrees Celsius.

RESULTS

12 (86%) of the 14 patients had prompt pain relief; the remaining 2 underwent a repeat ablation. After a mean follow-up period of 19 (range, 9-25) months, no patient had pain recurrence.

CONCLUSION

Radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteomas.

Antifilarial activity of Caesalpinia bonducella against experimental filarial infections

BACKGROUND & OBJECTIVE

Lymphatic filariasis is a disabling disease that continues to cripple population in tropical countries. Currently available antifilarial drugs are not able to control the disease. Therefore, a better antifilarial is urgently required for proper management of the disease. We undertook this study to assess the antifilarial activity of Caesalpinia bonducella-seed kernel against rodent filarial parasite in experimental model.

METHODS

Microfilaraemic cotton rats and Mastomys coucha harbouring Litomosoides sigmodontis and Brugia malayi respectively, were treated with crude extract or fractions of the seed kernel C. bonducella through oral route for 5 consecutive days. Microfilaricidal, macrofilaricidal and female worm sterilizing efficacy was assessed.

RESULTS

Crude extract showed gradual fall in microfilariae (mf) count in L. sigmodontis-cotton rat model from day 8 post-treatment attaining more than 95 per cent fall by the end of observation period. It also exhibited 96 per cent macrofilaricidal and 100 per cent female sterilizing efficacy. The butanol fraction F018 caused 73.7 per cent reduction in mf count and 82.5 per cent mortality in adult worms with 100 per cent female sterilization. The aqueous fraction F019 exerted more than 90 per cent microfilaricidal activity and 100 per cent worm sterilization. Two chromatographic fractions, F024 and F025 of hexane soluble fraction exhibited 64 and 95 per cent macrofilaricidal activity, respectively. Both the fractions caused gradual fall in microfilaraemia and 100 per cent worm sterilization. In B. malayi-M. coucha model F025 showed gradual reduction in microfilaraemia and caused 80 per cent sterilization of female parasites

INTERPRETATION & CONCLUSION

In conclusion, C. bonducella- seed kernel extract and fractions showed microfilaricidal, macrofilaricidal and female-sterilizing efficacy against L. sigmodontis and microfilaricidal and female-sterilizing efficacy against B. malayi in animal models, indicating the potential of this plant in providing a lead for new antifilarial drug development.