A pilot study of human mesenchymal stem cells from visceral and sub-cutaneous fat tissue and their differentiation to osteogenic phenotype

OBJECTIVE

To evaluate the different behavior of two different human adult adipocytes derived stem cells (hASCs) during proliferation and osteogenic differentiation.

PATIENTS AND METHODS

Human adult adipocytes stem cells (hAT-SCs) from visceral (hAV-SCs) and subcutaneous (hAS-SCs) sites were obtained after surgery procedures of seven patients. All samples were fully investigated and the different proliferation rates were evaluated. All MSCs clusters were cultured with an osteogenic and adipogenic differentiation medium. Homogeneous pools of Mesenchymal Stem Cells (MSCs) were confirmed by Flow-Cytometry Analysis (FACS) and Spectrophotometric Assay. The differentiated cells were eventually assessed for the expression of Alkaline Phosphatase (ALP), Alizarin Red (AR) and Oil Red-O (OR-O) detection, and analyzed by the Spectrophotometric Assay. After osteogenic differentiation, the cell clusters were incubated and analyzed with Real Time-Polymerase Chain Reaction (qRT-PCR) and fluorescence microscopy.

RESULTS

The FACS analysis performed on hAT-SCs confirmed the homogenous presence of MSCs in all samples. The ALP, AR stain confirmed the osteogenic differentiation capacity of MSCs towards osteoblast-like-cells. The colorimetric cell metabolic activity (MTS) assay showed an increase in the proliferation rate with different values in both sets hAS-SCs vs. hAV-SCs.

CONCLUSIONS

These in vitro findings of both hAS-SCs and hAV-SCs suggested an important role of these stem cells for future clinical use in bone regeneration. Indeed, the final outcomes suggested a better performance of cells coming from subcutaneous adipose tissue vs. those from visceral fat tissue.

Alcohol use and abuse: a cross-sectional study among Italian adolescents

INTRODUCTION

Alcohol is recognized as one of four major risk factors for non-communicable diseases. Exposure to alcoholic beverages during the adolescence has been linked to increased heavier drinking habits: obviously, the age of alcohol initiation resulted an important determinant of alcohol dependence. The aim of this study is to analyze knowledge, attitudes and practices in alcohol habit of adolescent population.

METHODS

943 students from 13 schools (middle and upper secondary schools) of the Bari district were enrolled in the study: in each school one class for each age was randomly selected. The research was carried out by an anonymous, self-administered questionnaire which investigated alcohol consumption, knowledge of alcohol consumption of parents and knowledge of the law regulating alcohol consumption.

RESULTS

34.8% (328) have never consumed alcoholic drinks while 65.2% (615) declare the use of alcohol; the average age of alcohol initiation was 12.2 years. 35.7% (329/921) of mothers and 36.6% (335/915) of fathers drink alcohol only on special occasions. 17.9% (168/939) considered that alcohol could be free sale at all while 16.4% (154/939) reported that sale is forbidden for children under 14.

CONCLUSIONS

The higher prevalence of alcohol habits and the poor knowledge on alcohol law seemed to indicated the need of improving public health efforts in the prevention of alcohol consumption among Italian adolescents.

Microbiological investigation of medication-related osteonecrosis of the jaw: preliminary results

Medication-related osteonecrosis of the jaw (MRONJ) is a well-recognized severe complication of bisphosphonate (BPs) treatment in patients with osteoporosis or metastatic cancer. Microbiological infection has been hypothesized as a contributing factor to bisphosphonate related osteonecrosis of the jaw (BRONJ). Despite infection being present in BRONJ patients, there is no clear data as to whether infection plays a role in the pathophysiology. Moreover, microbial cultures have not been helpful in directing therapy because specific pathogens have not been identified. The objective of this study was to determine the bacterial colonization of jawbone and identify the bacterial phylotypes associated with BRONJ. Twenty oncologic patients, aged 48-87 years (average age 70.65 ± 8.86 years) with BRONJ were enrolled in this study and underwent three different microbiological samplings. Overall, 60 samples were obtained from oral mucosa, necrotic bone fragments and fistula drainage. The same procedure was performed for the laboratory culture of all these specimens. No significant differences regarding either gram+ and gram– species (Chi-squared= 0.1642; p = 0.6854) or aerobes and anaerobes bacteria (Chi-squared= 3.084; p = 0.0791) were found. Compared to other sampling techniques, the oral swab allowed to obtain valuable microbial data in order to recognize pathogens responsible for the infection and to outline a focused antimicrobial therapy.

Management of oral pemphigus vulgaris: A case report and a clinical update

Pemphigus vulgaris (PV) is an uncommon autoimmune intraepithelial blistering disease. In most cases, the oral lesions were the first manifestation of the pathology. We report the case of a 42-year-old woman with a 4-month history of oral ulcerations. The patient reported that the lesions caused considerable discomfort and affected her normal oral function. On intraoral examination, ulcers were observed on the cheek and palatal mucosa and ventral surface of the tongue. No skin lesions were seen on extra oral examination. A diagnosis of PV was made after evaluating the biopsy samples. The main complication of PV is the reduced quality of life related to soreness or pain, particularly in ulcerative/erosive lesions. The presence of lesions among gingival tissues makes oral hygiene procedures very difficult, but plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease.

Periodontal disease and bone pathogenesis: the crosstalk between cytokines and porphyromonas gingivalis

Periodontal disease is the most frequent cause of tooth loss among adults. It is defined as a plaque-induced inflammation of the periodontal tissues that results in a loss of support of the affected teeth. This process is characterized by destruction of the periodontal attachment apparatus, increased bone resorption with loss of crestal alveolar bone, apical migration of the epithelial attachment, and formation of periodontal pockets. Although the presence of periodontal pathogens such as Porphyromonas gingivalis is a prerequisite, the progression of periodontal disease is dependent on the host response to pathogenic bacteria that colonize the tooth surface. Nowadays, a growing body of literature has accumulated to investigate the association between bone diseases, periodontal pathogens and periodontal diseases. The integration of pathogen-associated molecular patterns from microorganisms with their surface receptors in the immune cells, induces the production of several cytokines and chemokines that present either a pro- and/or anti-inflammatory role and the activation of mechanisms of controlling this and the related disease, such as osteoporosis and rheumatoid arthritis. This review focuses on the evidence and significance of bone host cell invasion by Porphyromonas gingivalis in the pathogenesis of bone disorders, as well as the different lines of evidence supporting the role of cytokines in bone diseases.

The effect of azidothymidine on germ tube formation in Candida albicans

Candida albicans have a marked propensity to cause infections in AIDS patients. A virulent trait of C. albicans is the yeast-hypha transition (Y-->H) which is influenced, in vitro and in vivo, by several factors. Since azidothymidine (AZT) is used in HIV-positive patients, the effect, in vitro, of different concentrations of AZT on C. albicans Y-->H transition was evaluated. C. albicans isolated from HIV-negative and HIV-positive patients were used and strains of C. tropicalis isolated from HIV-positive patients were also tested. AZT concentrations from 0.01 microg/ml to 10 microg/ml did not have any influence on the Y-->H transition, whereas 100 microg/ml AZT significantly inhibited the germ tube formation. AZT did not influence the formation of pseudohyphae in C. tropicalis. It is suggested that C. albicans infection observed in HIV-positive patients was not influenced by AZT therapy, because at currently used dosages, the Y-->H transition was not expected to increase.

Pediatric chance fracture associated with pedicle screw use: a case report

STUDY DESIGN

A previously undescribed clinic entity is presented, along with suggestions to prevent its reoccurrence.

OBJECTIVE

To identify a potential pitfall in the use of pedicle screw instrumentation in trauma cases. Also, to emphasize the need to identify and treat noncontiguous spinal fractures.

SUMMARY OF BACKGROUND DATA

No previous cases have yet been described with this particular complication, which would be remedied easily with established methods. Pedicle screw instrumentation previously has been associated primarily with complications due to aberrant screw insertion and injury to adjoining tissues, or due to fracture of the construct itself in the absence of fusion formation.

METHODS

A 15-year-old girl suffered a traumatic T12-L1 fracture dislocation and paraplegia. After pedicle screw instrumentation, her apparently benign L3 fracture progressed to a severely displaced Chance fracture. This was repaired with caudal laminar hook compression instrumentation.

RESULTS

Postoperatively, at a 1-year follow-up, the patient's spinal deformity was completely alleviated, though she remains paraplegic.

CONCLUSIONS

Unstable traumatic spinal injuries treated with pedicular instrumentation should have additional laminar hook compression configuration reinforcement at the ends of the constructs to prevent further stress-induced injury from the screws alone. Instrumentation constructs should not end at even minimally fractured levels.

Effect of anesthetic variables on dermatomal somatosensory-evoked potential monitoring in elective lumbar spinal surgery

We studied 108 adult cases of elective lumbar surgery using dermatomal somatosensory-evoked potential (DSEP) monitoring to evaluate its usefulness due to concern over potential neurologic injury during pedicle screw insertion. Both surgeons used all of the necessary precautions required during surgery so that DSEP monitoring was not the "primary," but rather a backup system for operative security. Quality tracings were obtained in 71% of cases; anesthetic difficulties being the major cause of poor monitoring. There were no neurological complications related to pedicle screw insertion. We found that DSEP monitoring was an excellent method to verify intraoperative neurological status, but required a high degree of cooperation between the anesthesiologists, monitoring technician, and surgeons. In today's cost-containment environment, its usefulness is subjected to the expertise of the spine surgeon and the hospital setting.

Calcified thoracic disc herniation with paraparesis. A case report

We present a case with partially calcified thoracic discs, one of which extruded into the spinal canal with paraparesis. The paste-like consistency complicated excision.

Infection of a Charcot spine. A case report

Charcot spine is an unusual neuropathic arthropathy that may be found in patients with complete neurologic lesions of the spinal cord. The case presented represents a progressive destructive lesion of a Charcot spine, which, on extensive investigation and subsequent surgical arthrodesis, demonstrated an infectious process. Infection must be considered as a possible etiology in a destructive lesion of a Charcot spine.

Thoracolumbar spinal fractures--concepts of treatment

The treatment of thoracolumbar spinal fractures has evolved significantly in the last 50 years. Clear classification systems now allow physicians to predict which fracture patterns will require surgery and which may be adequately treated non-operatively. These indications, as well as a brief overview of thoracolumbar spinal fracture care, are presented.

Spinal abnormalities in camptomelic dysplasia

Significant spinal abnormalities were found in eight patients (average age of 6 years, 5 months) with camptomelic dysplasia. The late ossification of the midthoracic pedicles served as a clear diagnostic criterion for the syndrome. Scoliosis averaging 63 degrees was found in all seven nonquadriplegic cases. Thoracic hyperkyphosis averaging 126 degrees was seen in six (75%) of the patients, while cervical kyphosis averaging 66 degrees was noted in three (38%). Vertebral body hypoplasia appeared to be a major cause of deformity. This study clarifies that patients with camptomelic dysplasia are surviving longer than previously expected and therefore should have their spinal deformities treated aggressively.

Total posterior vertebrectomy of the thoracic or lumbar spine

A total vertebrectomy in the thoracic or lumbar spine via a posterior approach can provide optimal neural decompression in certain severely compromised terminal patients affected with a malignant metastatic spinal lesion. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) internal fixator, accompanied by methyl methacrylate reconstruction of the anterior vertebral column, provides sufficient stabilization so that immediate ambulation with minimal external support is possible. This single operative procedure allows reduction of the iatrogenic trauma by avoiding an additional anterior exposure. Total posterior vertebrectomy has been performed successfully in a total of nine cases in this study. In three early cases the spine was stabilized with posterior transpedicular plate fixation. The six most recent cases in which the AO internal fixator was used have verified the effectiveness of this fixation system. A modification of this technique may be applied to certain primary benign or malignant spinal lesions by allowing appropriate tumor resection margins and anterior corticocancellous bone graft reconstruction.

Foreign body reaction to polymeric debris following total hip arthroplasty

Two cases of severe foreign body reaction to polymeric debris occurred following cemented total hip arthroplasty. The debris consisted of microfragments of both polyethylene and polymethylmethacrylate. Microfragments are believed to be primarily responsible for the extensive lytic reactions, which represent an extreme degree of the chronic inflammatory response that is commonly associated with loosening of cemented total hip arthroplasties. A schematic representation of the pathogenesis of component loosening, including the foreign body reaction, illustrates the relationship of this phenomenon to the general problem of aseptic loosening. Revision arthroplasty was successful in both cases, followed for a period of nine and 16 months, respectively.

Petriellidium boydii pachymeningitis treated with miconazole and ketoconazole

A very rare case of Petriellidium boydii pachymeningitis is described. Rarer still is the stabilization of this case for a prolonged period. Miconazole and ketaconazole both seemed useful in the treatment, and their role is discussed.