Harnessing the Anti-Inflammatory Effects of Perinatal Tissue Derived Therapies for the Treatment of Inflammatory Skin Diseases: A Comprehensive Review

Dealing with chronic inflammatory skin conditions like atopic dermatitis and psoriasis can be extremely difficult. Current treatments, such as topical corticosteroids, often have limitations and side effects. However, researchers have discovered that the placenta's remarkable properties may provide a breakthrough in effectively addressing these skin conditions. The placenta comprises three essential tissues: decidua, placental membrane, and umbilical cord. Placental derivatives have shown significant potential in treating psoriasis by reducing inflammatory cytokines and inhibiting keratinocyte proliferation. In the case of atopic dermatitis, umbilical cord stem cells have demonstrated anti-inflammatory effects by targeting critical factors and promoting anti-inflammatory cytokines. The scope of benefits associated with placental derivatives transcends these specific applications. They also potentially address other inflammatory skin diseases, such as vitiligo, by stimulating melanin production. Moreover, these derivatives have been leveraged in the treatment of pemphigus and epidermolysis bullosa (EB), showcasing potential as a wound dressing that could eliminate the necessity for painful dressing changes in EB patients. In summary, the integration of placental derivatives stands to revolutionize our approach to inflammatory skin conditions owing to their distinct properties and the prospective benefits they offer. This comprehensive review delves into the current applications of placental derivatives in addressing inflammatory skin diseases, presenting a novel treatment approach.

Female versus viral: Understanding the UK gender health inequalities during the Covid-19 pandemic using e-archives

Despite the development of digital health infrastructure, female health inequalities have worsened during the pandemic. This transdisciplinary study, through health, feminist, and infrastructural geographical lens, examines how gender health inequalities may have emerged or worsened during Covid-19 in the UK. This study leverages a novel web archive collection, Python coding-powered data-handling text analysis (of over 0.2 billion words), and thematic analysis to examine three themes: vaccines, social minority groups, and women's self-care. The findings suggest that the pandemic has impacted health inequalities among British women and girls and more, in a 'more-than-gender' way in terms of health (care) outcomes and access. In addition to reflecting on the use of e-archives in this study including suggesting the potential of combining e-archiving, coding, natural language processing (NLP) and generative AI/Large Language Models (LLMs) in producing and analysing trans-temporal (big) datasets, I argue that a geographical crisis perspective that balances the needs of everyday life and possible crises can be considered when preparing for public health emergencies. I adopt the e-archiving of this study to rethink 'digital health infrastructure' as 'actors', 'facilitators', and 'voicers', revealing how human-computer interaction and people in the virtual realm can be infrastructure.

Perspectives on the use of decellularized/devitalized and lyophilized human perinatal tissues for bone repair: Advantages and remaining challenges

Human amniotic membrane (hAM) has been extensively used for several decades as a bioactive scaffold for regenerative medicine. In its cryopreserved form-one of the main storage formats-the presence of viable cells has often been questioned. Furthermore, there is little published evidence of the role of endogenous amniotic cells from cryopreserved hAM in tissue repair. Some technologies, often patented and combined, have facilitated the use of hAM. Decellularization and devitalization processes have been developed to ensure its safety and prevent immune rejection. Lyophilization and dehydration methods have had a significant impact on clinical practices by enabling storage at room temperature in the operating room and making handling and cutting easier. Consequently, the commercialization of hAM has expanded, initially in the USA, and now in Europe. In the last decade, there has been growing interest in new perinatal tissues in clinical medicine. Similar processes have been adapted for these tissues to prevent immune or inflammatory reactions, and to improve storage and make them easier to use. For example, in the USA, many products marketed for wound healing undergo lyophilization, sometimes in combination with decellularization. Given our expertise, we wanted to highlight the potential of decellularized/devitalized and lyophilized perinatal tissues in regenerative medicine, particularly for bone repair. In this opinion paper, we discuss why these tissues represent the future of regenerative medicine, their potential drawbacks and strategies to overcome these challenges.

Efficacy of Platelet-Rich Plasma in Treatment of Achilles Tendinopathy: Systematic Review and Meta-Analysis

Chronic Achilles tendinopathy is a debilitating condition that significantly affects mobility and quality of life. Platelet-rich plasma (PRP) therapy has been proposed as a treatment option, leveraging growth factors to promote tendon healing, but its effectiveness remains unclear. This review aimed to evaluate the effectiveness of PRP in reducing pain, improving function, and facilitating recovery in chronic Achilles tendinopathy. A total of 13 studies involving 697 patients were analyzed. Key outcomes included pain reduction (measured by visual analog scale {VAS}), functional improvement (Victorian Institute of Sports Assessment-Achilles {VISA-A}), return to activity, and patient satisfaction. Study variability was analyzed using heterogeneity measures. PRP demonstrated significant pain reduction (pooled mean VAS: 71.24, 95% CI: 53.06-89.42). Functional improvement was observed (VISA-A scores: 35.10-86.80). On average, 85% of patients returned to activity (95% CI: 65-98%) and 72% reported satisfaction (95% CI: 51-88%). High heterogeneity (I²=97%) was noted, likely due to variability in PRP preparation and treatment protocols. PRP offers promise as a treatment for chronic Achilles tendinopathy, with evidence of pain relief and functional improvement. However, variability in outcomes emphasizes the need for standardized approaches to its use and further research to better define its role in clinical practice.

A critical overview of systematic reviews and meta-analyses of intra-articular injection of platelet rich plasma versus hyaluronic acid for knee osteoarthritis

This study is to summarize and evaluate the available evidence for the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) for knee osteoarthritis (KOA). Eight databases were searched from inception to September 15, 2024. All systematic reviews (SRs)/meta-analyses (MAs) treated with PRP versus HA for KOA were collected. Literature screening and data extraction were independently performed by two reviewers. The methodological quality, reporting quality, risk of bias, evidence quality, and evidence overlap rate of the included studies were evaluated by using AMSTAR 2, PRISMA 2020, ROBIS, GRADE, and GROOVE systems. Seventeen SRs were included. The results showed that the effectiveness and safety of PRP in the treatment of KOA may be superior to HA. The methodological quality of all 17 documents was extremely low quality. Sixteen of them had poor reporting quality, and there were relatively serious information deficiencies. All SRs were determined to be at high risk. Among the 221 outcome indicators, there were two medium-quality evidences, 30 low-quality evidences, and 189 extremely low-quality evidences. It was found that there was a very high overlap among the included articles. Currently, the quality of SRs on the treatment of KOA with PRP versus HA is relatively low. Future authors of SRs should adhere to quality assessment tool criteria, expand sample sizes to reduce overlap, and evaluate the quality of evidence for merged study results, in order to provide more reliable and rigorous evidence-based support for clinical practice.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Shoulder Disorders: A Review of Current Clinical Evidence

INTRODUCTION

A multidisciplinary approach is recommended to manage shoulder pain, the third most common musculoskeletal disorder, but traditional modalities have limitations, providing only temporary symptomatic pain relief instead of targeting the underlying pathophysiology. Recently, autologous peripheral blood-derived orthobiologics (APBOs) have become popular for the management of shoulder disorders. Platelet-rich plasma (PRP) is the most frequently used APBO, but its efficacy remains disputable. Thus, the possibility of using other APBOs, such as platelet lysate (PL), autologous conditioned serum (ACS), gold-induced cytokine (GOLDIC), plasma rich in growth factors (PRGF), growth factor concentrate (GFC), autologous protein solution (APS), and hyperacute serum (HS), for the management of shoulder disorders have been considered. This review summarizes the outcomes of clinical studies involving APBOs to manage shoulder disorders.

METHODS

Multiple databases (PubMed, Web of Science, Embase, and Scopus) were searched employing terms for APBOs and various shoulder disorders for articles published in the English language to September 11, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Only six clinical studies fulfilled our pre-defined search and inclusion criteria. Specifically, one, two, two, and one studies involving the use of PL, ACS, PRGF, and APS, respectively, were included in this review. No clinical studies were identified involving the use of GOLDIC, GFC, and HS.

CONCLUSIONS

Administration of PL, ACS, PRGF, and APS is safe and can reduce pain and improve function in patients with shoulder disorders, including rotator cuff tendinopathy, subacromial impingement syndrome, glenohumeral osteoarthritis and delayed union fracture of the clavicle. Given the dearth of relevant literature and limitations of the available studies, more prospective clinical studies, and ideally, randomized controlled trials, with extended follow-up are necessary to establish the efficacy of APBOs and to select the ideal APBO for the management of shoulder disorders.

Unveiling new therapeutic horizons in rheumatoid arthritis: an In-depth exploration of circular RNAs derived from plasma exosomes

Rheumatoid arthritis (RA), a chronic inflammatory joint disease causing permanent disability, involves exosomes, nanosized mammalian extracellular particles. Circular RNA (circRNA) serves as a biomarker in RA blood samples. This research screened differentially expressed circRNAs in RA patient plasma exosomes for novel diagnostic biomarkers. In this study, samples of RA patients with insufficient response to methotrexate (MTX-IR), combined use of tumor necrosis factor inhibitors (TNFi) were followed up for half a year, and 56 circRNA samples of self-test data were stratified into training, testing, and external validation cohorts according to whether American College of Rheumatology 20% improvement criteria (ACR20) was achieved. A diagnostic xgboost model was developed using common hub genes identified by random forest and least absolute shrinkage and selection operator (LASSO), with intersection genes derived from overlapping machine learning-selected genes. Diagnostic performance evaluated via receiver operating characteristic (ROC) curves using pROC for area under the curve (AUC). Optimal LASSO model with 4 circRNAs determined, with AUC > 0.6 for key genes. The model validation performed well on the test set, but not significantly on the validation set. Then, circRNA screening was performed in combination with clinical data, and cross-validation identified hsa-circ0002715, hsa-circ0001946, hsa-circ0000836, and rheumatoid factor (RF) as key genes, among which hsa-circ0002715 and hsa-circ0001946 were emphasized as key markers on the training set. In addition, the morphology and size of exosomes and the expression of CD9 and CD81 verified the successful extraction of exosomes. The qPCR analysis of plasma exosomes in TNFi patients found that the expression of hsa-circ0002715 was higher than that in patients who didn't reach ACR20, and the expression of hsa-circ0001946 was lower than that in patients who didn't reach ACR20. The above studies suggested that hsa-circ0002715 and hsa-circ0001946 may become markers for predicting MTX-IR RA patients and TNFi precision treatment.

EEG-Spectra-Guided Personalized rTMS in PTSD with Co-occurring Psychiatric Disorders: A Case Series

Personalized repetitive Transcranial Magnetic Stimulation (PrTMS®) offers an individualized approach to neuromodulation through customized treatment protocols. This case series aims to explore therapeutic outcomes of PrTMS® in two patients with post-traumatic stress disorder (PTSD), based on standardized rating scale scores and spectral EEG-guided alpha brainwave activity optimization. Participants diagnosed with PTSD received PrTMS® treatments informed by quantitative rating scales and weekly spectral EEG measurements. Weekly psychometric assessments showed an improvement in symptoms, as quantified by PCL-5 (Posttraumatic Stress Disorder Checklist for DSM-5), GAD-7 (Generalized Anxiety Disorder 7-item scale), PHQ-9 (Patient Health Questionnaire-9), and SCI (Sleep Condition Indicator) questionnaires. Specifically, PCL-5 scores demonstrated an average reduction of 20.5 points by the midpoint of treatment (4 weeks), while GAD-7 and PHQ-9 scores decreased by 7 and 8.5 points, respectively, at the end of 7 weeks. Mean SCI scores increased by 6 points by the end of the 7 week-treatment period. While previous studies have also highlighted the role of spectral EEG-directed personalized PrTMS in the treatment of PTSD, ongoing research is needed in order to understand the long-term efficacy of PrTMS®.

Establishing an Electrophysiological Recording Platform for Epidural Spinal Cord Stimulation in Neuropathic Pain Rats

Purpose

Spinal cord stimulation (SCS) is pivotal in treating chronic intractable pain. To elucidate the mechanism of action among conventional and current novel types of SCSs, a stable and reliable electrophysiology model in the consensus animals to mimic human SCS treatment is essential. We have recently developed a new in vivo implantable pulsed-ultrahigh-frequency (pUHF) SCS platform for conducting behavioral and electrophysiological studies in rats. However, some technical details were not fully understood. This study comprehensively analyzed methodology and technical challenges and pitfalls encountered during the development and implementation of this model.

Materials and Methods

Employing a newly developed pUHF-SCS (±3 V, 2 Hz pulses with 500-kHz biphasic radiofrequency sinewaves), we assessed analgesic effect and changes of evoked local field potentials (eLFPs) in the bilateral primary somatosensory and anterior cingulate cortices in the rats with or without spared nerve injury (SNI) using the platform. The placement of stimulating needle electrodes in the hind paw was examined and optimized for functionality.

Results

SNI enhanced the C component of eLFPs in bilateral cortexes elicited by stimulating the contralateral but not the ipsilateral lateral aspect of the hind paw. Repeated pUHF-SCS significantly reversed SNI-induced paw hypersensitivity and reduced C-component enhancement. An impedance test can determine an optimal SCS electrode function: an SCS discharge threshold of 100-400 μA for cortical activation or a motor threshold of 150-600 μA for the hind limbs. Impedance increased due to growth of fibrotic tissue but stabilized after post-implantation day 12.

Conclusion

We presented a reliable electrophysiological platform for SCS application in rat neuropathic pain model and demonstrated potent analgesic effects of pUHF-SCS. All device implantations or pUHF-SCS per se did not cause evident spinal cord damage. This safe and stable platform provides an in vivo rat model for SCS investigation of mechanisms of action and device innovation.

Sociodemographic, Clinical and Genetic Correlates of Aggressive and Auto-Aggressive Behaviour in Alcohol-Dependent Individuals - Preliminary Study

Purpose

Reducing the risk of aggressive behaviour requires preventive measures that depend on our knowledge of predisposing factors. The study's aim was to compare sociodemographic variables, clinical variables and the frequency of gene polymorphisms predisposing to destructive behaviour between subpopulations of individuals with a history of suicidality and/or of aggression, both being treated for alcohol dependence.

Patients and Methods

Sixty-nine patients hospitalised for alcohol dependence participated in the study. The sociodemographic, clinical (SADD, BPAQ) and genetic variables were compared between subpopulations of alcohol-dependent patients selected according to type of aggressive behaviour, including a history of suicidal behaviour and control nonalcohol-dependent group. Polymorphisms of MAOA, COMT, DRD2 and DAT1 loci that are known as risk factors of mental dysfunctions were investigated.

Results

The subpopulation of patients with suicide attempts had a longer time in education than patients with aggressive and suicidal behaviour (11.9 vs 9.7 years). Patients with suicide attempts and patients with aggression had lower levels of alcohol dependence than patients with comorbid suicide attempts and concomitant aggression. For the MAOA gene lower frequency of the G/G genotype with tendency to statistical significance was observed among patients burdened by suicidal behaviour in comparison to patients with aggression and a significantly higher A/G genotype compared to cases with aggression and controls. In the case of COMT polymorphism, the G/G genotype was reported significantly less often among patients with suicide attempts and comorbid aggression than among patients with control group).

Conclusion

Compared to patients with either only suicidal tendencies or aggression, those with comorbid aggression and suicide attempts are characterised by poorer social performance. Genetic variation in MAOA loci may be a risk factor for impulsive behaviour like suicidal behaviour, and especially aggression.

Current status of nanofat in the management of knee osteoarthritis: A systematic review

BACKGROUND

Osteoarthritis (OA) is a prevalent joint disorder requiring innovative treatment approaches.

AIM

To evaluate the use of nanofat, a specialized form of adipose tissue-derived cells, in the treatment of OA, by examining its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes.

METHODS

A comprehensive review of preclinical studies, clinical trials, and in vitro investigations was conducted. The included studies provided insights into the potential role of nanofat in OA treatment, addressing its efficacy, safety profile, mechanisms of action, comparative effectiveness, and long-term outcomes.

RESULTS

Clinical studies consistently reported the efficacy of nanofat in providing pain relief and functional improvement in patients with OA. Local adverse events were limited to the injection site, such as localized pain and inflammation, and resolved within a few days to weeks. Systemic adverse events were rare, and no significant long-term complications were observed. Mechanistically, nanofat was found to enhance chondrocyte proliferation, reduce inflammation, and promote angiogenesis, thereby contributing to its therapeutic effects.

CONCLUSION

Nanofat therapy holds promise as a therapeutic option for managing OA, providing pain relief, functional improvement, and potential tissue regeneration. The safety profile of nanofat treatment appears favorable, but long-term data are still limited. Standardized protocols, larger randomized controlled trials, longer follow-up periods, and cost-effectiveness evaluations are warranted to establish optimal protocols, comparative effectiveness, and long-term outcomes. Despite current limitations, nanofat therapy demonstrates translational potential and should be considered in clinical practice for OA treatment, with careful patient selection and monitoring.

A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA)

INTRODUCTION

KOA, a chronic degenerative joint disease, is commonly treated with intra-articular HA and PRP, used alone or in combination. However, the efficacy and safety of combination therapy (PRP + HA) remain unclear.

AIM

The aim of this systematic review and meta-analysis is to assess the clinical effectiveness and safety profile of PRP + HA versus PRP monotherapy for KOA.

MATERIAL AND METHODS

A systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals. The mean difference (MD) and risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I2statistics and the appropriate p-value. The analysis used RevMan 5.4. GRADE system was used for evidence assessment for each outcome parameter.

RESULTS

This meta-analysis of 11 RCTs (n = 1023 KOA patients) revealed that PRP + HA has substantial effectiveness than PRP alone in reducing OMAC total scores [MD -1.77 (95% CI -2.20 to - 1.34); I2 = 10%, and p < 0.001], VAS scores [MD -4.27 (95% CI -4.96 to - 3.58); I2 = 13%, and p < 0.001], and Lequesne index score [MD -5.48 (95% CI -6.56 to - 4.40); I2 = 16%, and p < 0.001], while increasing IKDC scores [MD -2.10 (95% CI -3.70 to - 0.50); I2 = 9%, and p = 0.01], with low risk of adverse events [RR 0.41 (95% CI 0.35 to 0.48); I2 = 12%, and p < 0.001].

CONCLUSION

This meta-analysis reveals that, for patients with KOA, PRP + HA therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy.

Management of knee osteoarthritis using bone marrow aspirate concentrate: a systematic review

INTRODUCTION

Knee osteoarthritis (OA) is a common degenerative joint condition and a major cause of disability in the general population.

SOURCE OF DATA

Recent published literature identified from PubMed, EMBASE, Google Scholar, and Scopus.

AREAS OF AGREEMENT

Orthobiological therapies try to regenerate articular cartilage and stop the progression of the degenerative lesion. Intra-articular injections of biological derivates have been increasingly used in the last decade.

AREAS OF CONTROVERSY

The indications for the use of bone marrow aspirate concentrate (BMAC) are still unclear.

GROWING POINTS

We systematically reviewed the current literature on BMAC in the management of knee OA, giving an update on the current indications for the selection of the ideal patient and the preparations and efficacy of BMAC compared to other biological alternatives.

AREAS TIMELY FOR DEVELOPING RESEARCH

BMAC is a valuable source of mesenchymal stem cells, offering potential benefits in attenuating the inflammatory pathway associated with knee OA. Intra-articular injection of BMAC has shown effectiveness in clinical trials improving functional outcomes of knee OA patients. The superiority of BMAC over other orthobiological treatments cannot be assessed because of conflicting results.

Safety and performance of a novel synthetic biomimetic scaffold for iliac crest defect reconstruction during surgical treatment of pelvic girdle pain: a first-in-human trial

INTRODUCTION

Surgical treatment of pelvic girdle pain (PGP) involves arthrodesis of sacroiliac (SI) and pubic symphysis joints. Fusion of pubic symphysis involves the implantation of an autologous iliac crest tricortical graft harvested from the iliac crest. The objective was to assess the safety of a novel synthetic graft substitute (b.Bone) for iliac crest reconstruction and to evaluate the results of PGP surgical treatment.

SOURCES OF DATA

Consecutive participants undergoing pelvic fusion and requiring iliac crest reconstruction were enrolled and followed-up for 12 months in a prospective first-in-human clinical investigation. Adverse events were documented, and health-related quality of life was evaluated using EuroQol-5D-5L questionnaire. Iliac crest defect healing was evaluated by the Modified Lane and Sandhu radiological scoring system. In addition, relevant published peer-reviewed scientific articles identified from PubMed.

AREAS OF AGREEMENT

The EQ-5D-5L scores improved steadily reaching the highest point at 365 days. By 365 days complete healing of the bone defect was observed.

AREAS OF CONTROVERSY

The management of PGP remains challenging with mixed results reported in the literature.

GROWING POINTS

While there is lack of consensus on how to manage PGP, the present study shows improved outcomes at one year following surgery. The synthetic b.Bone scaffold is a safe option with good healing outcomes for iliac crest defect reconstruction.

AREAS TIMELY FOR DEVELOPING RESEARCH

Although b.Bone synthetic scaffold found to be safe, further studies reporting on surgical treatment of PGP are required to confirm the findings in comparative trials.

Monkeypox: a re-emergent virus with global health implications - a comprehensive review

Monkeypox virus (MPXV) is an enclosed, double-stranded DNA virus from the Orthopoxvirus genus, which also contains variola, vaccinia, and cowpox. MPXV, which was once confined to West and Central Africa, has recently had a rebound, spreading beyond its original range since 2017. The virus is distinguished by its unique morphology, which includes an oval or brick-shaped structure and a complex lipid and protein makeup. The current multi-country outbreak designated a public health emergency in 2022, has highlighted MPXV's shifting epidemiology and ability to spread rapidly over the globe. 'No one is safe until everyone is safe' is a slogan we often heard during the COVID-19 pandemic, which is now also required for the growing global and regional mpox outbreaks. The epidemic is divided into two clades: Clade I and Clade II, which have distinct pathogenic characteristics. Diagnostic approaches have developed with advances in molecular techniques, yet problems persist in resource-constrained situations. This overview summarizes the virus's history, epidemiology, morphology, and clinical characteristics, offering insights into its recent comeback and current global response efforts.

Detection of Acromion Types in Shoulder Magnetic Resonance Image Examination with Developed Convolutional Neural Network and Textural-Based Content-Based Image Retrieval System

Background: The morphological type of the acromion may play a role in the etiopathogenesis of various pathologies, such as shoulder impingement syndrome and rotator cuff disorders. Therefore, it is important to determine the acromion's morphological types accurately and quickly. In this study, it was aimed to detect the acromion shape, which is one of the etiological causes of chronic shoulder disorders that may cause a decrease in work capacity and quality of life, on shoulder MR images by developing a new model for image retrieval in Content-Based Image Retrieval (CBIR) systems. Methods: Image retrieval was performed in CBIR systems using Convolutional Neural Network (CNN) architectures and textural-based methods as the basis. Feature maps of the images were extracted to measure image similarities in the developed CBIR system. For feature map extraction, feature extraction was performed with Histogram of Gradient (HOG), Local Binary Pattern (LBP), Darknet53, and Densenet201 architectures, and the Minimum Redundancy Maximum Relevance (mRMR) feature selection method was used for feature selection. The feature maps obtained after the dimensionality reduction process were combined. The Euclidean distance and Peak Signal-to-Noise Ratio (PSNR) were used as similarity measurement methods. Image retrieval was performed using features obtained from CNN architectures and textural-based models to compare the performance of the proposed method. Results: The highest Average Precision (AP) value was reached in the PSNR similarity measurement method with 0.76 in the proposed model. Conclusions: The proposed model is promising for accurately and rapidly determining morphological types of the acromion, thus aiding in the diagnosis and understanding of chronic shoulder disorders.

Amniotic fluid stem cell extracellular vesicles promote lung development via TGF-beta modulation in a fetal rat model of oligohydramnios

Oligohydramnios (decreased amniotic fluid volume for gestational age) is a severe condition associated with high morbidity and mortality mainly due to fetal pulmonary hypoplasia. Currently, there are limited treatment options to promote fetal lung development. Administration of stem cells and their derivates have shown promising regenerative properties for several fetal and neonatal diseases related to arrested lung development. Herein, we first characterized pulmonary hypoplasia secondary to oligohydramnios in a surgical rat model. Experimental induction of oligohydramnios led to impaired lung growth, branching morphogenesis (fewer airspaces with decreased Fgf10, Nrp1, Ctnnb1 expression), proximal/distal progenitor cell patterning (decreased Sox2 and Sox9 expression), and TGF-β signaling. We then tested antenatal administration of extracellular vesicles derived from amniotic fluid stem cells (AFSC-EVs). In oligohydramnios lungs, AFSC-EV administration improved lung branching morphogenesis and airway progenitor cell patterning at least in part through the release of miR-93-5p. Our experiments suggest that AFSC-EV miR-93-5p blocked SMAD 7, resulting in upregulation of pSMAD2/3 and restoration of TGF-β signaling. Conversely, oligohydramnios lungs treated with antagomir 93-5p transfected AFSC-EVs had decreased branching morphogenesis and TGF-β signaling. This is the first study reporting that antenatal administration of stem cell derivatives could be a potential therapy to rescue lung development in fetuses with oligohydramnios.

Analysis of the therapeutic efficacy of arthroscopic repair of the subscapularis tendon combined with coracoplasty

The aim of this study was to analyze the outcomes of arthroscopic subscapularis tendon repair combined with coracoplasty in the treatment. The study involved 80 patients (46 males, 34 females; aged 33 to 73 years), who underwent arthroscopic repair for subscapularis tears (type I, II, and III) presenting symptoms of anterior shoulder pain and tenderness. Subcoracoid impingement was defined as a coracohumeral distance of less than 6 mm on preoperative magnetic resonance imaging, with a follow-up of was at least two years. The patients were divided into two groups: Group A underwent coracoplasty, while Group B did not. The postoperative functional outcomes of the two groups were compared and analyzed using an independent sample t-test. The patients' prognosis was assessed pre- and postoperatively using the University of California Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) shoulder score, and Visual Analog Scale (VAS)pain score. Postoperatively, primary wound healing was successful in all patients, with no systemic or localized shoulder joint infections or brachial plexus nerve injuries. Both groups showed improvements in overall functional outcomes after surgical intervention. At the 24-month follow-up, all evaluated parameters in both groups demonstrated improvements compared to preoperative values (P < 0.05). The functional scores significantly increased in both groups post-surgery compared to preoperative values (p < 0.01). When comparing the two groups using an independent sample t-test, the p-values for all indicators, except forward flexion range of motion, were below 0.01. The statistical analysis indicated that patients in Group A had better recovery outcomes than those in Group B, except for forward flexion. The results suggested that subcoracoid impingement syndrome could potentially be a significant precursor to subscapularis tendon injuries. It is noteworthy noting that the combined approach of subscapularis tendon repair and coracoplasty showed superior therapeutic efficacy compared to isolated subscapularis tendon repair when subscapularis tendon injuries were associated with subcoracoid impingement.

Context-Aware Dual-Task Deep Network for Concurrent Bone Segmentation and Clinical Assessment to Enhance Shoulder Arthroplasty Preoperative planning

Goal: Effective preoperative planning for shoulder joint replacement requires accurate glenohumeral joint (GH) digital surfaces and reliable clinical staging. Methods: xCEL-UNet was designed as a dual-task deep network for humerus and scapula bone reconstruction in CT scans, and assessment of three GH joint clinical conditions, namely osteophyte size (OS), joint space reduction (JS), and humeroscapular alignment (HSA). Results: Trained on a dataset of 571 patients, the model optimized segmentation and classification through transfer learning. It achieved median root mean squared errors of 0.31 and 0.24 mm, and Hausdorff distances of 2.35 and 3.28 mm for the humerus and scapula, respectively. Classification accuracy was 91 for OS, 93 for JS, and 85% for HSA. GradCAM-based activation maps validated the network's interpretability. Conclusions: this framework delivers accurate 3D bone surface reconstructions and dependable clinical assessments of the GH joint, offering robust support for therapeutic decision-making in shoulder arthroplasty.

Therapeutic effect of mesenchymal stem cell-derived exosome therapy for periodontal regeneration: a systematic review and meta-analysis of preclinical trials

BACKGROUND

To assess the therapeutic effects of mesenchymal stem cell (MSC)-derived exosome therapy on periodontal regeneration and identify treatment factors associated with enhanced periodontal regeneration in recent preclinical studies.

METHODS

Searches were conducted in PubMed, Cochrane Library, EMBASE, and Web of Science databases until October 10, 2024. A risk of bias (ROB) assessment was performed using the SYRCLE tool. Osteogenic-related parameters were used as the primary outcome measures.

RESULTS

In total, 1360 articles were identified, of which 17 preclinical studies were based on MSC-derived exosome therapy, and they demonstrated a beneficial effect on BV/TV (SMD = 13.99; 95% Cl = 10.50, 17.48; p < 0.00001), CEJ-ABC (SMD = -0.22; 95% Cl = -0.31, -0.13; p < 0.00001), BMD (SMD = 0.29; 95% Cl = 0.14, 0.45; p = 0.0002), and Tp.Sp (SMD = -0.08; 95% Cl= -0.15, -0.02; p = 0.02) compared with the control group. However, no significant differences were observed in Tp.Th (SMD = 0.03; 95% CI = 0.00, 0.07; p = 0.09) between the exosome-treated group and control group. Additionally, subgroup analysis indicated that preconditioned exosomes (p = 0.03) significantly improved BV/TV. In contrast, there were no significant differences in the enhancement of BV/TV with respect to the application method (p = 0.29), application frequency (p = 0.10), treatment duration (p = 0.15), or source of MSCs (p = 0.31).

CONCLUSIONS

MSC-derived exosomes show great promise for enhancing the quality of periodontal regeneration. However, more standardized and robust trials are needed to reduce heterogeneity and bias across studies and to confirm the therapeutic parameters associated with the enhancement of periodontal regeneration by MSC-derived exosomes.

REGISTRATION

CRD42024546236.

Integrative Korean medicine for recurrent lumbar disc herniation after coronavirus disease vaccination: A case report and literature review

RATIONALE

Many side effects have been associated with the coronavirus disease (COVID-19) vaccine. While most adverse events (AEs) are mild, serious adverse events are occasionally observed in the neurological and musculoskeletal systems. Nevertheless, articles reporting such serious adverse events after COVID-19 vaccination are limited, and only few case reports with detailed descriptions are available in the literature.

PATIENT CONCERNS

Herein, we report the case of a 41-year-old male office worker who developed symptoms of recurrent disc herniation 2 days after COVID-19 vaccination; the patient had no other factors that may have caused the recurrence of disc herniation, such as excessively vigorous activities, following vaccination.

DIAGNOSES

Consequently, the patient was suspected of having cauda equina syndrome owing to recurrent lumbar disc herniation, and he underwent surgery.

INTERVENTIONS

The patient underwent integrative Korean medicine treatment, including acupuncture, pharmacopuncture, and Chuna manual therapy, for 8 months postoperatively.

OUTCOMES

After treatment, the patient's postoperative complications improved; the Numerical Rating Scale score changed from 5 to 1, and the Oswestry Disability Index score changed from 30 to 3. A literature review showed various cases of adverse events related to musculoskeletal inflammation or immune-mediated pathogenesis.

LESSONS

This paper confirmed the possibility that COVID vaccination is related to lumbar disc herniation recurrence and the possibility of integrative Korean medicine as an effective treatment option after lumbar disc herniation surgery.

Analyzing exosomal miRNA profiles in tetralogy of fallot fetuses' amniotic fluid

Amniotic fluid (AF)-derived exosomal miRNA have been explored as potential contributors to the pathogenesis of Tetralogy of Fallot (TOF). This study aimed to investigate the expression profiles of AF-derived exosomal miRNAs and their potential contribution to TOF development. Exosomes were isolated from AF samples obtained from pregnant women carrying fetuses diagnosed with TOF. AF-derived exosomal miRNAs expression profiles were generated using the Agilent human miRNA Array V21.0, comparing 5 TOF samples with 5 healthy controls. Differential expression analysis identified 257 significantly dysregulated miRNAs in the TOF group. KEGG pathway enrichment analysis revealed that the predicted targets of these differentially expressed miRNAs were enriched in pathways associated with congenital disorders. Notably, 25 of these miRNAs were previously reported to be regulated by both Notch and Wnt signaling pathways, which are critical to heart development. Further investigation using mouse embryonal carcinoma P19 cells revealed that miR-10a-5p overexpression inhibited cardiomyogenic differentiation, as evidenced by the suppression of cardiomyocyte marker genes like TBX5. A dual-luciferase reporter assay confirmed TBX5 as a direct target of miR-10a-5p, suggesting a regulatory mechanism involving their interaction. In summary, our study demonstrates that miR-10a-5p may contribute to the pathogenesis of TOF by impairing cardiomyocyte differentiation through direct targeting of TBX5. These findings enhance our understanding of TOF and its molecular underpinnings.

Adipose-derived mesenchymal stem cells combined with platelet-rich plasma are superior options for the treatment of osteoarthritis

BACKGROUND

There is currently no definitive treatment for osteoarthritis. We examined the therapeutic effects and underlying mechanisms of platelet-rich plasma (PRP) and adipose-derived mesenchymal stem cells (ADSCs), individually or in combination, in a rat model of anterior cruciate ligament-induced degenerative osteoarthritis (OA) of the knee. This study seeks to advance clinical approaches to OA treatment.

METHODS

Eight- to nine-week-old male Sprague-Dawley (SD) rats were randomly assigned to two groups: (1) a normal control group (Group A) and (2) a model group. The control group received no treatment. The model group underwent treatment and was further subdivided into six groups: Group B (an injury control group), Group C (high-dose ADSCs), Group D (PRP combined with high-dose ADSCs), Group E (low-dose ADSCs), Group F (PRP combined with low-dose ADSCs), and Group G (PRP alone). PRP and/or ADSCs were administered via intra-articular injection on Days 7, 37, and 67 post-surgery. Daily observations recorded activity levels and behavior, while weight changes were monitored weekly. Digital radiography (DR) was conducted on Days 30, 60, and 90 post-surgery to assess joint surface and contour alterations. Histopathological examination and inflammatory factor analysis were performed on cartilage and synovial tissue.

RESULTS

No abnormal reactions were observed in any rats, and body weights increased as expected (P > 0.05). Significant differences in knee swelling rates and Wakitani scores were observed between Groups A and B (P < 0.01). Knee swelling rates also differed significantly between Group B and Groups C-G (P < 0.01). Wakitani scores decreased on Days 60 and 90 in Groups C-G. TNF-α and IL-1β expression levels were significantly higher in Group B compared to Group A (P < 0.05). Expression levels of these genes were significantly lower in Groups C-G than in Group B (P < 0.05).

CONCLUSIONS

Repeated intra-articular injections of PRP and ADSCs alleviated inflammation and pain, promoted tissue repair, and modulated immune responses in rats with surgically induced OA. The combination of PRP and ADSCs demonstrated enhanced therapeutic efficacy, suggesting its potential as a treatment option for OA.

Low-energy differential target multiplexed SCS derivative reduces pain and improves quality of life through 12 months in patients with chronic back and/or leg pain

INTRODUCTION

Energy-reducing spinal cord stimulation (SCS) approaches have the potential to impact patient experience with rechargeable and non-rechargeable SCS devices through reducing device recharge time or enhancing device longevity. This prospective, multi-center study evaluated the safety, effectiveness, and actual energy usage of differential target multiplexed (DTM) endurance therapy, a reduced energy DTM SCS derivative.

METHODS

Subjects who reported an overall pain visual analog score (VAS) of ≥6/10 cm and an Oswestry Disability Index score of 21-80 out of 100 at baseline with moderate to severe chronic, intractable back and/or leg pain were eligible. Evaluation visits occurred at 1, 3, 6, and 12 months post-device activation. The primary objective was to characterize change in overall pain intensity, as measured by VAS, from baseline to 3-month visit.

RESULTS

Fifty-seven subjects enrolled at 12 US sites from November 2020 through June 2021, 35 were implanted with a rechargeable SCS device, and 27 completed the 12-month visit. Subjects experienced a 50.4% mean reduction in overall pain from baseline at the 3-month follow-up that was sustained through 12 months. Additional outcomes including changes in overall, back, and leg pain intensity, quality of life, disability, therapy satisfaction, safety, and current battery usage are shown through 12-month follow-up.

CONCLUSION

The use of DTM endurance SCS therapy in this study resulted in reductions in pain relief through 12 months, demonstrating that energy-reducing stimulation patterns can provide clinical benefit. Clinically effective, reduced energy SCS derivatives have the potential to impact patient experience through either reduced recharge requirements or increased device longevity.

Is there an Increase in Total Hip Arthroplasty Due to Osteonecrosis of Femoral Head After Covid-19 Pandemic?: A Retrospective Study Among Patients in Central Karnataka, India

Introduction

Coronavirus disease 2019 (COVID-19) infection or corticosteroid usage during the COVID-19 pandemic as risk factors for avascular necrosis (AVN) of the femoral head (osteonecrosis of the femoral head/femoral head AVN [FHAVN]), as well as its link to clinical and radiological outcomes, are poorly understood. Osteonecrosis, which results from a disruption in vascular supply to the femoral head, is a prevalent cause of hip joint deterioration and one of the most common reasons for total hip arthroplasty (THA)/total hip replacement in India and other Asian countries. This study will aid in understanding the condition's epidemiology and statistically determining the risk of disease related with pandemic exposure.

Materials and Methods

This is a retrospective study of 100 hips diagnosed with osteonecrosis/osteoarthritis of the femoral head that underwent THA at a tertiary care center before and after the COVID-19 pandemic between February 2014 and February 2024.

Results

Late stages of FHAVN, when the diagnosis requiring THA, following the pandemic have increased exponentially. It has also switched from affecting the middle-aged to the younger age groups. Furthermore, the bilaterality necessitating THA has increased considerably. There is a clear shift in the presentation of this disabling illness, as well as the need for THA, which otherwise is rarely carried out on younger people. Furthermore, data on how much corticosteroids were used in the treatment is disturbingly scant, and how it may have contributed to this ailment in India is still questionable.

Conclusion

The COVID-19 pandemic could be the most serious threat, causing late-stages FHAVN (stages 3 and 4 of the Ficat and Arlet classification), in an accelerated manner, necessitating THA and overburdening existing medical care.

Managing Co-Occurring Disorders on Adolescent Inpatient Psychiatric Units

The contemporary management of the adolescent patient on the psychiatric inpatient adolescent unit in the twenty-first century entails a new type of comprehensive and wide ranging familiarity with several types of clinically challenging co-occurring disorders including cannabis use disorder and eating disorders. In this article, there is a delineation of current understanding of the prevalence of these diagnoses in addition to a review of prevailing expert opinion as to principles of evaluation and management of these conditions in patients stabilized on the adolescent inpatient psychiatric unit.

Wharton's Jelly Mesenchymal Stem Cells: Shaping the Future of Osteoarthritis Therapy with Advancements in Chitosan-Hyaluronic Acid Scaffolds

This review explores the potential of Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) in cartilage regeneration and osteoarthritis treatment. It covers key factors influencing chondrogenesis, including growth factors, cytokines, and hypoxia, focusing on precise timing. The effectiveness of three-dimensional cultures and scaffold-based strategies in chondrogenic differentiation is discussed. Specific biomaterials such as chitosan and hyaluronic acid are highlighted for tissue engineering. The document reviews clinical applications, incorporating evidence from animal research and early trials and molecular and histological assessments of chondrogenic differentiation processes. It addresses challenges and strategies for optimizing MSC-derived chondrocyte therapy, emphasizing the immunomodulatory properties of these cells. The review concludes as a comprehensive road map for future research and clinical applications in regenerative medicine.

Hereditary Patterns and Genetic Associations in Obsessive-Compulsive Disorder (OCD): Neuropsychiatric Insights, Genetic Influences, and Treatment Perspectives

Obsessive-Compulsive Disorder (OCD), a prevalent neuropsychiatric condition, affects approximately 2%-3% of the global population. This paper provides an extensive overview of OCD, detailing its clinical manifestations, neurobiological underpinnings, and therapeutic approaches. It examines OCD's classification shift in the DSM-5, the role of the cortico-striatothalamo- cortical pathway in its development, and the various factors contributing to its etiology, such as genes, environmental factors, and genetic predispositions. The challenges in diagnosing OCD and the effectiveness of both psychological and pharmacotherapeutic treatments are discussed. The paper also highlights the significant overlap between OCD and other mental health disorders, emphasizing its impact on global disability. Moreover, the role of genetic factors in OCD, including twin studies and gene association studies, is elaborated, underscoring the complex interplay of hereditary and environmental influences in its manifestation. The review further delves into the polygenic nature of OCD, illustrating how multiple genes contribute to its development, and explores the implications of genetic studies in understanding the disorder's complexity. Additionally, this research study delves into the concept of polygenic inheritance in complex diseases, highlighting the role of multiple genes in increasing OCD risk. A Genome-wide Association Study (GWAS) is employed to assess Single Nucleotide Polymorphisms (SNPs) to unearth genetic associations with OCD. This comprehensive analysis provides valuable insights into OCD's genetic landscape, paving the way for enhanced diagnostic approaches and treatment modalities.

Geometric Reconstruction of Cartilage Tissue With Mesenchymal Stem Cell-Assisted Electromechanical Reshaping: An Experimental Study

ABSTRACT

Shaping the ear cartilage and preserving the shape are important and quite difficult. The aim of this study was to demonstrate the effectiveness of the Wharton's jelly-derived stem cell-assisted electromechanical reshaping method in a rabbit ear cartilage defect model and to compare it with surgical reshaping.For the purpose of 25 × 4-mm cartilage defect reconstruction, 48 rabbit ears were divided into 2 main groups according to the shaping method, and these main groups were divided into 3 subgroups according to stem cell injection: control, sham, and stem cell.A rabbit ear cartilage defect was created, and rib cartilage was collected for reconstruction. Although electromechanical reshaping was performed in accordance with the rabbit ear geometry angle, surgical scoring and suturing were performed in the classical method. Stem cells were applied in the first week, and the grafts were removed in the first month. Analyses included angular change, weight change, and histopathology.In this study, electromechanical reshaping was histopathologically similar to surgical reshaping and is more effective in preserving the shape. Cartilage thickness and weight were higher in stem cell groups.Electromechanical reshaping is emerging as an effective and standardized method to maintain cartilage stability and geometry and offers a viable alternative to classic surgical techniques. In addition, stem cell application gave physical strength to cartilage. It is a method that allows us to obtain more stable and more durable cartilages that maintain given shape with the combination of Wharton jelly-assisted electromechanical reshaping method.

Obese Patients Do Not Benefit from Bone Marrow Aspiration Concentrate Injection for Knee Osteoarthritis: A Prospective Cohort Study of 68 Patients

BACKGROUND

Bone marrow aspirate concentrate (BMAC) is considered one of the biological treatments for knee osteoarthritis (KOA). Patient selection remains a key factor to ensure that optimal treatment benefit and body mass index (BMI) are one of the key factors to be considered. This study aims to evaluate the influence of obesity on the duration of treatment benefit of BMAC for KOA.

METHODS

This prospective cohort study enrolled 68 patients who underwent a single BMAC injection for early stage KOA. The patients were categorized based on their BMI into normal, overweight, and obese groups. Visual Analog Scale (VAS) for pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) were the outcomes analysed. The duration of treatment benefit is estimated by Kaplan-Meier survival analysis.

RESULTS

Sixty-eight patients (normal BMI = 43, overweight BMI = 15, obese BMI = 10) were enrolled in the study for analysis. While significant improvement in the outcome scores was noted compared to the baseline throughout the study period in the normal BMI and overweight group, the obese group returned to baseline parameters at 3 months follow-up. Patients in the normal BMI group demonstrated significant improvement in VAS (p < 0.001) and KOOS (p < 0.001) outcomes compared to the overweight and obese group. Survival analysis demonstrated a significant decline in the mean treatment benefit of 9.8 (95%CI [6.151-13.431], p = 0.027) months in normal BMI group to 6.6 (95%CI [3.473-9.727]) months and 4.1 (95%CI [2.760-5.440]) months in overweight and obese groups, respectively.

CONCLUSION

BMI is a significant factor that influences the benefit of BMAC injection for early knee OA. Hence, BMAC injection must be used with caution in individuals with high BMI.

Efficacy of Fetal Wharton's Jelly Mesenchymal Stem Cells-Derived Small Extracellular Vesicles in Metabolic Syndrome

BACKGROUND/OBJECTIVE

Metabolic syndrome (MetS) is characterized by abdominal obesity, increased blood pressure (BP), fasting blood glucose (FBG) and triglyceride levels, and reduced high-density lipoprotein (HDL) levels. This study aims to investigate the efficacy of the Wharton's jelly mesenchymal stem cells (WJMSCs)-derived small extracellular vesicles' (sEVs) preparations in managing MetS.

METHOD

Twenty-four rats were fed with a high-fat and high-fructose diet to induce MetS for 16 weeks and randomized into three groups (n = 8/group): a MetS Control group treated with normal saline, MetS Low Dose (LD) group treated with a LD of sEVs preparations (3 × 109 particle/rat), and MetS High Dose (HD) group treated with a HD of sEVs preparations (9 × 109 particles/rat). The Control Non-Disease (ND) group was given a standard rat diet and autoclaved tap water with normal saline as treatment. Treatments were given via intravenous injection every three weeks for twelve weeks. Rats were assessed every six weeks for physical measurements, FBG, lipid profiles, CRP, leptin, adiponectin, and BP. Necropsy evaluation was performed on the lungs, liver, spleen, and kidney.

RESULTS

Significant reductions in FBG, triglycerides, BP, and increased HDL levels were observed in the treated groups compared to the control group. However, significant abdominal circumference (AC) improvement was not observed in the treated groups. Non-significant associations were found between fasting CRP, leptin, and adiponectin levels with MetS rats after treatment. In addition, sEVs preparations improved inflammation and hemorrhage in the lung and mineralisation in the renal of the treated group.

CONCLUSIONS

Human fetal WJMSCs-derived sEVs preparations improve all the clusters of MetS in rats except AC and could be further explored as a treatment for MetS.

Comparing the Rate of Dissolution of Two Commercially Available Synthetic Bone Graft Substitutes

This study characterized the dissolution properties of two commercially available bone substitutes: (1) A calcium sulfate (CaS)/brushite/β-tricalcium phosphate (TCP) graft containing 75% CaS and 25% calcium phosphate; and (2) a CaS/hydroxyapatite (HA) bone graft substitute composed of 60% CaS and 40% HA. Graft material was cast into pellets (4.8 mm outer diameter × 3.2 mm). Each pellet was placed into a fritted thimble and weighed before being placed into 200 mL of deionized water. The pellets were removed from the water on days 1, 2, 3, 4, 6, 8, 14, 18, or until no longer visible. The mass and volume of each pellet were calculated at each timepoint to determine the rate of dissolution. Analysis of variance was performed on all data. Statistical significance was defined as p < 0.05. The CaS/HA pellets were completely dissolved after day 8, while the CaS/brushite/β-TCP pellets remained until day 18. The CaS/brushite/β-TCP pellets had significantly more mass and volume at days 1, 2, 3, 4, 6, and 8 timepoints. The CaS/brushite/β-TCP pellets lost 46% less mass and 53% less volume over the first 4 days as compared to CaS/HA pellets. The CaS/brushite/β-TCP pellets had a rough, porous texture, while the CaS/HA pellets had a smooth outer surface. Overall the CaS/brushite/β-TCP pellets dissolved approximately twice as slowly as the CaS/HA pellets in vitro. As these in vitro findings might have in vivo implications, further clinical data are required to further confirm and establish the optimal synthetic bone substitute strategy or antibiotic delivery carrier.

Ceramic substitutes, failure to achieve solid fusion in posterolateral instrumented fusion: a surgical and histological evaluation

PURPOSE

As the number of instrumented fusions increases, so does the utilization of bone substitutes. However, controversies persist regarding the effectiveness of ceramics in promoting solid fusion. Few histological studies have been conducted on patients to address this issue. To contribute insights into this topic, we assessed bony fusion both intraoperatively and histologically in patients who underwent posterolateral instrumented fusions enhanced with a biphasic ceramic compound.

METHODS

We analyzed a series of 13 patients who underwent revision surgery due to adjacent segment disease following the initial use of ceramics as bone extenders in the index surgery. In each case, patients exhibited apparent radiological fusion in the instrumented posterolateral fusions. Follow-up exceeded 18 months. Bone fusion was assessed intraoperatively, and biopsies of the bone mass at the intertransverse area were examined under an optical microscope.

RESULTS

Surgical exploration of the fusion block at the intertransverse space did not indicate solid fusion. Moreover, histological analysis of the 13 biopsies revealed a lack of proper integration of the bone substitutes, incomplete resorption of hydroxyapatite granules, and substitution of ceramic particles by immature fibrous tissue lacking the structural competence to bear loads or add stability to spinal fusion.

CONCLUSION

The utilization of biphasic ceramics proved ineffective in attaining a proper fusion mass between the intertransverse space. Both surgical inspection and histological studies confirmed the absence of integration. Prudence should be exercised regarding the use of ceramics. While no clear instability was observed, neither was there any integration.

Comprehensive Review and Meta-Analysis of Psychological and Pharmacological Treatment for Intermittent Explosive Disorder: Insights From Both Case Studies and Randomized Controlled Trials

Intermittent explosive disorder (IED) is characterized by sudden, disproportionate outbursts of anger that can severely impact individuals' quality of life, causing difficulties in maintaining relationships, issues at work or school and potential legal troubles. This study aimed to systematically review and meta-analyse the effectiveness of psychological and pharmacological treatments for IED, drawing insights from both case studies and randomized controlled trials (RCTs). A total of 12 RCTs and 14 case studies were included in this comprehensive analysis. The meta-analysis revealed that psychological treatments, particularly cognitive behavioural therapy (CBT), showed significant effectiveness in reducing aggression and achieving full remission compared to pharmacological treatments. However, the latter, notably fluoxetine, demonstrated notable efficacy in managing irritability and achieving treatment response. Subgroup analysis identified follow-up time and intervention type as significant moderators of treatment outcomes. The systematic review of case studies highlighted the successful application of deep brain stimulation (DBS) and various off-label medications, including SSRIs and mood stabilizers, in managing IED symptoms. Despite these insights, the study emphasizes the need for more robust evidence-based treatment protocols and further research into the underlying mechanisms of IED to develop targeted treatments.

The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

Bone aging and extracellular vesicles

Bone aging, a major global health concern, is the natural decline in bone mass and strength. Concurrently, extracellular vesicles (EVs), tiny membrane-bound particles produced by cells, have gained recognition for their roles in various physiological processes and age-related diseases. The interaction between EVs and bone aging is of growing interest, particularly their effects on bone metabolism, which become increasingly critical with advancing age. In this review, we explored the biology, types, and functions of EVs and emphasized their regulatory roles in bone aging. We examined the effects of EVs on bone metabolism and highlighted their potential as biomarkers for monitoring bone aging progression. Furthermore, we discussed the therapeutic applications of EVs, including targeted drug delivery and bone regeneration, and addressed the challenges associated with EV-based therapies, including the technical complexities and regulatory issues. We summarized the current research and clinical trials investigating the role of EVs in bone aging and suggested future research directions. These include the potential for personalized medicine using EVs and the integration of EV research with advanced technologies to enhance the management of age-related bone health. This analysis emphasized the transformative potential of EVs in understanding and managing bone aging, thereby marking a significant advancement in skeletal health research.

Amniotic membrane, a novel bioscaffold in cardiac diseases: from mechanism to applications

Cardiovascular diseases represent one of the leading causes of death worldwide. Despite significant advances in the diagnosis and treatment of these diseases, numerous challenges remain in managing them. One of these challenges is the need for replacements for damaged cardiac tissues that can restore the normal function of the heart. Amniotic membrane, as a biological scaffold with unique properties, has attracted the attention of many researchers in recent years. This membrane, extracted from the human placenta, contains growth factors, cytokines, and other biomolecules that play a crucial role in tissue repair. Its anti-inflammatory, antibacterial, and wound-healing properties have made amniotic membrane a promising option for the treatment of heart diseases. This review article examines the applications of amniotic membrane in cardiovascular diseases. By focusing on the mechanisms of action of this biological scaffold and the results of clinical studies, an attempt will be made to evaluate the potential of using amniotic membrane in the treatment of heart diseases. Additionally, the existing challenges and future prospects in this field will be discussed.

Impact of the COVID-19 vaccination on confusion around vaccination in general: A longitudinal study on a university population over 18 months

Even before the COVID-19 pandemic, vaccine hesitancy was one of the main global public health threats. Unfortunately, the COVID-19 crisis and its associated risks only reinforced this hesitancy. This study aimed to identify to what extent the COVID-19 vaccination affected confusion around vaccination in general, its change and any associated factors. A questionnaire was distributed to the university population of Liège between April-June 2021 (Time 1) and July-September 2022 (Time 2). The impact of the COVID-19 vaccination on confusion around vaccination in general (score 0 to 100) was divided into three groups based on the tertiles of the study sample at different times and whether or not any change had been observed. Ordinal and multinomial regression analyses were performed to assess the relationship between the confusion and various determinants. The sample consisted of 491 participants. Time 1 vs Time 2, 41.3% vs 35.4% seemed to be less confused, 24.2% vs 28.7% were moderately confused and 34.4% vs 35.8% more confused, respectively. In terms of change, 19.4% of participants were less confused, 55.2% had not changed their opinion and 25.5% were more confused. The determinants causing confusion at both times and regarding change were self-perception, health literacy, past vaccination experiences and COVID-19 related factors (COVID-19 vaccination intention and trust in source of information at Time 1; preferred source of information, trust in vaccine producers and conspiratorial beliefs at Time 2; trust in vaccine producers for change). The results demonstrated that the COVID-19 vaccination impacted confusion around vaccination in general. Both unrelated and related COVID-19 factors, particularly regarding the progression of the pandemic, seem to have contributed to this confusion. Contributing factors require a personalised approach, evidence-based information being communicated with messages adapted to the situation and its evolution designed to allay individuals' fears about vaccination.

Extracellular vesicles from platelet-poor plasma possess anti-inflammatory and anti-catabolic effects in chondrocytes stimulated with IL-1β or synovial membrane-conditioned media

BACKGROUND

Although osteoarthritis (OA) is the most prevalent form of arthritis, there is still no effective treatment capable of combining immunomodulatory effects with cartilage repair. Extracellular vesicles (EVs) represent a promising new generation of cell-free therapies for OA. Blood-derived products, including plasma, are an easily available and abundant source of EVs with anti-inflammatory and regenerative properties. In this study, our objective was to analyze the effect of platelet poor plasma-derived extracellular vesicles (PPP-EVs) on stimulated OA chondrocytes in vitro. We hypothesize that PPP from healthy donors could be a suitable source of EVs that can modulate the inflammatory environment of OA chondrocytes.

METHODS

Cartilage and synovial membrane (SM) were obtained from patients with OA and whole blood from healthy donors. Synovial membrane-conditioned media (CM / SM) was analyzed using multiplex immunoassays. EVs were isolated from PPP using size exclusion chromatography (SEC) and characterized by nanoparticle tracking analysis (NTA), Western blot, and flow cytometry (FC). The phenotype of the chondrocytes was analyzed using fluorescence microscopy and RT-qPCR. Chondrocytes were stimulated with IL-1β or CM/SM for 24 h. The impact of PPP-EVs on stimulated chondrocyte gene expression was evaluated using RT-qPCR.

RESULTS

The PPP-EVs isolated by SEC were positive for the tetraspanins CD9, CD63, and CD81. The chondrocyte phenotype was confirmed by positive expression of Collagen II and Aggrecane. CM/SM and IL-1β caused inflammatory changes in chondrocytes, which was observed by increased expression of the genes MMP-1, MMP-3 and MMP-13, RANTES, TSG-6, and YKL-40 compared to the control. PPP-EVs added to stimulated chondrocytes for 24 h significantly decreased the expression of the chondrocyte gene YKL-40, TSG-6 and MMP-1.

CONCLUSIONS

In this study, we confirmed that PPP is a suitable source of EVs, which can be efficiently isolated by SEC. We found that PPP-EVs were capable of decreasing the expression of inflammatory genes in OA chondrocytes stimulated with IL-1β or CM/SM. This study provides preliminary results on PPP-EVs as an affordable and promising option to modulate the catabolic microenvironment of OA chondrocytes in vitro.

Intra-articular injection of exosomes derived from different stem cells in animal models of osteoarthritis: a systematic review and meta- analysis

BACKGROUND

In recent years, the increasing incidence of osteoarthritis (OA) has attracted widespread public attention; however, the available effective treatments are limited. As a result, new therapeutic approaches, including stem cell and exosome therapies, have been proposed and are gradually gaining popularity. Because exosomes are immunocompatible, there is thought to be more potential for their use in clinical settings. This study summarizes the efficacy of exosomes in the treatment of OA.

METHODS

In total, we conducted a comprehensive search of the PubMed, Web of Science, and Embase databases using medical subject headings terms to identify studies published from their inception until November 2023 that investigated the use of stem cell-derived exosomes in treating OA. We focused on specific outcomes including osteophyte score, chondrocyte count, pain level, qPCR and histological assessments such as the OARSI (Osteoarthritis research society international) score to measure cartilage degeneration. For data extraction, we used GetData Graph Digitizer to retrieve values from graphs, and the meta-analysis was conducted using RevMan 5.3 software. We chose mean difference (MD) as the primary effect measure since all included studies reported the same outcomes. Ultimately, 20 articles met the inclusion criteria and were included in the meta-analysis.

RESULTS

We evaluated 20 studies comprising a total of 400 subjects. Compared with control groups, the exosome-treated groups showed significantly improved histological outcomes, as measured by the OARSI score (n = 400; MD = -3.54; 95% CI = [-4.30, -2.79]; P < 0.00001; I2 = 98%). This indicates a marked reduction in cartilage degeneration and OA severity in the exosome-treated groups. Notably, exosome therapy was more effective when administered during the early stages of OA. Additionally, a once-weekly dosing schedule yielded better results compared to more frequent administrations. Of the three exosome isolation methods assessed, kit-based extraction demonstrated a trend toward superior therapeutic efficacy.

CONCLUSIONS

Exosome treatment improved OA compared to placebo treatment.

Similar efficacy of intra-articular hyaluronic acid injections and other biologically active injections in patients with early stages knee osteoarthritis: a level I meta-analysis

INTRODUCTION

The present meta-analysis compared the efficacy of intra-articular hyaluronic acid (HA) injections in patients with early to mild knee osteoarthritis (OA) (Kellgren Lawrence I-II) versus other commonly injected biologically active compounds using patient-reported outcome measures (PROMs). The outcomes of interest were the visual analogue scale (VAS) and the Western Ontario McMaster Osteo-Arthritis Index (WOMAC) scores.

METHODS

This study was conducted according to the 2020 PRISMA statement. In April 2024, PubMed, Web of Science, Google Scholar, and Embase were accessed without time constraints. All the randomised controlled trials (RCTs) investigating the efficacy of intra-articular HA injections in the early stages of knee OA were accessed. Data concerning the VAS, WOMAC, and related subscales were collected at baseline and the last follow-up. Only studies clearly stated the degrees of advancement of OA using the Kellgren-Lawrence scoring system were used.

RESULTS

The literature search resulted in four RCTs (390 patients). The mean length of the last follow-up was 7.5 ± 3.0 months. 72.3% (282 of 390) of the patients were women. The mean age of the patients was 58.1 ± 3.2 years, and the mean BMI was 27.3 ± 3.2 kg/m2. At the last follow-up, no difference was found between HA and the control group in VAS, WOMAC, and related subscales.

CONCLUSION

In patients with early to mild knee osteoarthritis, the current level of evidence suggests that intra-articular injections using HA performed similarly to other biologically active compounds commonly injected in the knee joint for a minimum of three months.

LEVEL OF EVIDENCE

Level I, meta-analysis.

Monkeypox and drug repurposing: seven potential antivirals to combat the viral disease

The growing concern about the monkeypox (Mpox) virus infection has garnered a lot of public attention. However, the treatment options available to combat the same is limited to tecovirimat. Additionally, in a possible incidence of resistance, hypersensitivity, or adverse drug reaction, it is imperative to devise and reinforce the second-line therapy. Thus, in this editorial, the authors suggest seven antiviral drugs that could potentially be repurposed to combat the viral illness.

Innovative Approaches in Knee Osteoarthritis Treatment: A Comprehensive Review of Bone Marrow-Derived Products

Knee osteoarthritis (OA) is a chronic articular disease characterized by the progressive degeneration of cartilage and bone tissue, leading to the appearance of subchondral cysts, osteophyte formation, and synovial inflammation. Conventional treatments consist of non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, and glucocorticoids. However, the prolonged use of these drugs causes adverse effects. NSAIDs, for instance, are known to be nephrotoxic, increasing the damage to articular cartilage. New therapies capable of accelerating the process of tissue regeneration and repair are being discussed, such as the use of orthobiologics that are naturally found in the body and obtained through minimally invasive collection and/or laboratory manipulations. Bone marrow aspirate (BMA) and bone marrow aspirate concentrate (BMAC) are both rich in hematopoietic stem cells, mesenchymal stem cells (MSCs), and growth factors (GFs) that can be used in the healing process due to their anabolic and anti-inflammatory effects. The aim of this literature review is to assess the efficacy of BMA and BMAC in the treatment of knee OA based on the favorable results that researchers have obtained with the use of both orthobiologics envisaging an accelerated healing process and the prevention of OA progression.

Beyond the Pain Management Clinic: The Role of AI-Integrated Remote Patient Monitoring in Chronic Disease Management - A Narrative Review

Remote Patient Monitoring (RPM) stands as a pivotal advancement in patient-centered care, offering substantial improvements in the diagnosis, management, and outcomes of chronic conditions. Through the utilization of advanced digital technologies, RPM facilitates the real-time collection and transmission of critical health data, enabling clinicians to make prompt, informed decisions that enhance patient safety and care, particularly within home environments. This narrative review synthesizes evidence from peer-reviewed studies to evaluate the transformative role of RPM, particularly its integration with Artificial Intelligence (AI), in managing chronic conditions such as heart failure, diabetes, and chronic pain. By highlighting advancements in disease-specific RPM applications, the review underscores RPM's versatility and its ability to empower patients through education, shared decision-making, and adherence to therapeutic regimens. The COVID-19 pandemic further emphasized the importance of RPM in ensuring healthcare continuity during systemic disruptions. The integration of AI with RPM has refined these capabilities, enabling personalized, real-time data collection and analysis. While chronic pain management serves as a focal area, the review also examines AI-enhanced RPM applications in cardiology and diabetes. AI-driven systems, such as the NXTSTIM EcoAI™, are highlighted for their potential to revolutionize treatment approaches through continuous monitoring, timely interventions, and improved patient outcomes. This progression from basic wearable devices to sophisticated, AI-driven systems underscores RPM's ability to redefine healthcare delivery, reduce system burdens, and enhance quality of life across multiple chronic conditions. Looking forward, AI-integrated RPM is expected to further refine disease management strategies by offering more personalized and effective treatments. The broader implications, including its applicability to cardiology, diabetes, and pain management, showcase RPM's capacity to deliver automated, data-driven care, thereby reducing healthcare burdens while enhancing patient outcomes and quality of life.

Amniotic fluid-derived stem cells: potential factories of natural and mimetic strategies for congenital malformations

BACKGROUND

Mesenchymal stem cells (MSCs) derived from gestational tissues offer a promising avenue for prenatal intervention in congenital malformations although their application is hampered by concerns related to cellular plasticity and the need for invasive, high-risk surgical procedures. Here, we present naturally occurring exosomes (EXOs) isolated from amniotic fluid-derived MSCs (AF-MSCs) and their mimetic analogs (MIMs) as viable, reproducible, and stable alternatives. These nanovesicles present a minimally invasive therapeutic option, addressing the limitations of MSC-based treatments while retaining therapeutic efficacy.

METHODS

MIMs were generated from AF-MSCs by combining sequential filtration steps through filter membranes with different porosity and size exclusion chromatography columns. A physicochemical, structural, and molecular comparison was conducted with exosomes (EXOs) released from the same batch of cells. Additionally, their distribution patterns in female mice were evaluated following in vivo administration, along with an assessment of their safety profile throughout gestation in a mouse strain predisposed to neural tube defects (NTDs). The possibility to exploit both formulations as mRNA-therapeutics was explored by evaluating cell uptake in two different cell types(fibroblasts, and macrophages) and mRNA functionality overtime in an in vitro experimental setting as well as in an ex vivo, whole embryo culture using pregnant C57BL6 dams.

RESULTS

Molecular and physiochemical characterization showed no differences between EXOs and MIMs, with MIMs determining a threefold greater yield. Biodistribution patterns following intraperitoneal administration were comparable between the two particle types, with the uterus being among targeted organs. No toxic effects were observed in the dams during gestation, nor were there any malformations or significant differences in the number of viable versus dead fetuses detected. MIMs delivered a more intense and prolonged expression of mRNA encoding for green fluorescent protein in macrophages and fibroblasts. An ex-vivo whole embryo culture demonstrated that MIMs mainly accumulate at the level of the yolk sac, while EXOs reach the embryo.

CONCLUSIONS

The present data confirms the potential application of EXOs and MIMs as suitable tools for prevention and treatment of NTDs and proposes MIMs as prospective vehicles to prevent congenital malformations caused by in utero exposure to drugs.

Diagnostic accuracy of polymerase chain reaction for detection of mpox in humans

Objective

To evaluate diagnostic accuracy of polymerase chain reaction (PCR) in detecting mpox infection in humans by pooling the estimates of sensitivity and specificity across different study settings.

Methods

A systematic search was conducted in PubMed, Cochrane database, Scopus, and Google Scholar. Studies that evaluated the diagnostic accuracy of PCR test for the detection of monkeypox virus providing the sensitivity and specificity values and the total number of samples were included. The sensitivity and specificity values of PCR test were pooled for all the included studies. The meta-analysis was conducted in accordance with PRISMA guidelines using the metadta package in STATA software. A summary receiver operating characteristic (SROC) curve and forest plot were generated. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024590183.

Results

Twelve studies were included for meta-analysis. The pooled sensitivity and specificity estimate across all the studies using a random effects model was 0.99 (95% CI [0.95, 1.00]) and 1 (95% CI [0.96, 1.00]), respectively. The SROC curve confirmed high diagnostic accuracy of PCR. The quality assessment of diagnostic accuracy studies (QUADAS) tool depicted low risk of bias.

Conclusions

This systematic review and meta-analysis is the first study in the scientific literature to provide a pooling for diagnostic accuracy for PCR test for mpox and confirms it as an accurate tool in detecting the infection in humans.

Antibody Avidity Maturation Following Booster Vaccination with an Intranasal Adenovirus Salnavac Vaccine

BACKGROUND

The COVID-19 pandemic has led to the rapid development of new vaccines and methods of testing vaccine-induced immunity. Despite the extensive research that has been conducted on the level of specific antibodies, less attention has been paid to studying the avidity of these antibodies. The avidity of serum antibodies is associated with a vaccine showing high effectiveness and reflects the process of affinity maturation. In the context of vaccines against SARS-CoV-2, only a limited number of studies have investigated the avidity of antibodies, often solely focusing on the wild-type virus following vaccination. This study provides new insights into the avidity of serum antibodies following adenovirus-based boosters. We focused on the effects of an intranasal Salnavac booster, which is compared, using a single analytical platform, to an intramuscular Sputnik V.

METHODS

The avidity of RBD-specific IgGs and IgAs was investigated through ELISA using urea and biolayer interferometry.

RESULTS

The results demonstrated the similar avidities of serum antibodies, which were induced by both vaccines for six months post-booster. However, an increase in antibody avidity was observed for the wild-type and Delta variants, but not for the BA.4/5 variant.

CONCLUSIONS

Collectively, our data provide the insights into antibody avidity maturation after the adenovirus-based vaccines against SARS-CoV-2.